bluuebunny/crossref_metadata_2025 huggingface dataset:
Unveiling the potential of phase portrait-based recurrence network: a revelation through lung sound analysis
Authors: Sankararaman S
Published: November 2021

The work reported in this article introduces the novel concept of phase portrait-based recurrence network (RN) analysis in the digital auscultation of expiratory wheeze (ES) and vesicular (VS), with its potential revealed through machine learning techniques (MLTs). The time-series lung sound signals of ES and VS, subjected to power spectral density analysis, revealed information regarding the morphology of the respiratory tract responsible for the generation of signature frequency components. Having constructed the complex network using Pearson’s linear correlation coefficient ($P_{a,b}$) and employing the graph features for classification by principal component analysis (PCA), it is understood that the graph features thus obtained are incapable of classifying the two signals. Hence, a novel method, recurrence network, of constructing a network from the phase portrait of the time series is employed to deduce the network features. The MLTs, K-nearest neighbour (KNN) and PCA, are found to give better classification when RN topological features are used. When PCA separates the two signals with 84.7% total variance between the principal components, KNN yields 100% prediction accuracy. Thus, the study unveils the potential of RN over $P_{a,b}$-based complex network in classifying the lung sound signals ES and VS and thereby opening the possibility of employing the technique in digital auscultation, a best-suited one for the time of the widespread pandemic coronavirus disease-2019.
Interannual measures of nutritional stress during a marine heatwave (the Blob) differ between two North Pacific seabird species
Authors: Tate Heidi M , Studholme Katharine R , Domalik Alice D , Drever Mark C , Romero L Michael , Gormally Brenna M G , Hobson Keith A , Hipfner J Mark , Crossin Glenn T
Published: November 2021

‘The Blob’, a mass of anomalously warm water in the Northeast Pacific Ocean peaking from 2014 to 2016, caused a decrease in primary productivity with cascading effects on the marine ecosystem. Among the more obvious manifestations of the event were seabird breeding failures and mass mortality events. Here, we used corticosterone in breast feathers (fCort), grown in the winter period during migration, as an indicator of nutritional stress to investigate the impact of the Blob on two sentinel Pacific auk species (family Alcidae). Feathers were collected from breeding females over 8 years from 2010 to 2017, encompassing the Blob period. Since Pacific auks replace body feathers at sea during the migratory period, measures of fCort provide an accumulated measure of nutritional stress or allostatic load during this time. Changes in diet were also measured using δ15N and δ13C values from feathers. Relative to years prior to the Blob, the primarily zooplanktivorous Cassin’s auklets (Ptychoramphus aleuticus) had elevated fCort in 2014–2017, which correlated with the occurrence of the Blob and a recovery period afterwards, with relatively stable feather isotope values. In contrast, generalist rhinoceros auklets (Cerorhinca monocerata) displayed stable fCort values across years and increased δ15N values during the Blob. As marine heatwaves increase in intensity and frequency due to climate change, this study provides insight into the variable response of Pacific auks to such phenomena and suggests a means for monitoring population-level responses to climatological variation.
Left atrial myxoma resection through right mini-thoracotomy in a patient with retrosternal gastric tube
Authors: Kan-o Meikun , Kimura Satoshi , Shiose Akira
Published: November 2021

We report a case with a retrosternal gastric tube after oesophagectomy, who required left atrial myxoma resection, pulmonary vein isolation and left atrial appendage closure. A right mini-thoracotomy approach was adopted to avoid neo-oesophagus injury, and nitric oxide inhalation was useful to facilitate one-lung ventilation while dissecting the pleural adhesion.
Quorum-sensing molecules increase ethanol yield from Saccharomyces cerevisiae
Authors: Huang Xing-Feng , Reardon Kenneth F
Published: November 2021

One strategy to increase the yield of desired fermentation products is to redirect substrate carbon from biomass synthesis. Nongenetic approaches to alter metabolism may have advantages of general applicability and simple control. The goal of this study was to identify and evaluate chemicals for their ability to inhibit the growth of Saccharomyces cerevisiae while allowing ethanol production with higher yields. Eight potential growth-inhibitory chemicals were screened for their ability to reduce cell growth in 24-well plates. Effective chemicals were then evaluated in cultivations to identify those that simultaneously reduced biomass yield and increased ethanol yield. The yeast quorum-sensing molecules 2-phenylethanol, tryptophol and tyrosol were found to increase the ethanol yield of S. cerevisiae JAY 270. These molecules were tested with seven other yeast strains and ethanol yields of up to 15% higher were observed. The effects of 2-phenylethanol and tryptophol were also studied in bioreactor fermentations. These findings demonstrate for the first time that the ethanol yield can be improved by adding yeast quorum-sensing molecules to reduce the cell growth of S. cerevisiae, suggesting a strategy to improve the yield of ethanol and other yeast fermentation products by manipulating native biological control systems.
Translating the concept of “cultural identity” in public policies: Between the international and the national, and the tangible and intangible dimension
Authors: Pirri Valentini Anna
Published: November 2021

A concept such as that of “cultural identity” seems primarily belonging to the historic-artistic domain, but understanding its meaning is also fundamental for legal scholars dealing with cultural heritage policies and administration. This article examines how that notion has been shaped by legislators at different levels, revealing specific meanings depending on whether we are dealing with international conventions or national norms, and with tangible or intangible cultural heritage. The comparison of international conventions and national legislation highlights the clash between different orientations in the cultural heritage sector, namely between nationalists and internationalists. From a regulatory perspective, this clash of interests is reflected in the opposing concepts of “common heritage of mankind” and “national cultural identity,” whose legal implications need to be addressed. These two definitions are examined and challenged in an effort to understand whether they still have a legal meaning or if they have been replaced by a “global” notion of cultural identity. From a more general perspective, through an analysis of three case studies, the article reveals the role played by legal traditions when the same matter is regulated both by national and international legislative interventions enacted in different time periods.

Think globally, act locally.
Judicial amendment and our constitutional lives: A reply to Emmett Macfarlane
Authors: Berger Kate Glover
Published: November 2021

This short article responds to Emmett Macfarlane’s important piece, “Judicial Amendment of the Constitution,” with questions about how well his theory of judicial amendment maps, and thereby offers guidance about, the realities of constitutional life. I focus on the application of Macfarlane’s theory to one of the Supreme Court of Canada’s most internationally known opinions, the Quebec Secession Reference. I take this approach not merely to stake out an interpretation of the Court’s decision in the Secession Reference that differs from Macfarlane’s, but rather to better see what Macfarlane’s approach exposes and occludes about lived constitutionalism. To this end, this essay first questions whether the Secession Reference is an instance of judicial amendment, as Macfarlane argues it is. It then considers the implications of this questioning beyond the Reference. I argue that Macfarlane’s theory would benefit from a more robust account of structural interpretation and that a future normative account should grapple with how the concept of judicial amendment helps us understand our constitutional lives.
Lifts of Twisted K3 Surfaces to Characteristic 0
Authors: Bragg Daniel
Published: November 2021

Deligne [9] showed that every K3 surface over an algebraically closed field of positive characteristic admits a lift to characteristic 0. We show the same is true for a twisted K3 surface. To do this, we study the versal deformation spaces of twisted K3 surfaces, which are particularly interesting when the characteristic divides the order of the Brauer class. We also give an algebraic construction of certain moduli spaces of twisted K3 surfaces over ${\operatorname {Spec}}\ \textbf {Z}$ and apply our deformation theory to study their geometry. As an application of our results, we show that every derived equivalence between twisted K3 surfaces in positive characteristic is orientation preserving.
After the Medium: Rereading Stories on a String and the War at Canudos
Authors: Lebner Ashley
Published: November 2021

Moving from contemporary ethnography to Brazilian poetry from the turn of the twentieth century, this paper extends recent calls to attend more to relationships in religious studies. Scholars have argued that focusing on intimate relations allows us to stay critical while overcoming the impasses produced by opposed approaches, especially those that either privilege materiality or interiority. This paper explores how a focus on relations inspired by the work of Marilyn Strathern, which acknowledges the broad reach of relations—from the interpersonal to the conceptual, nonhuman, and evil—offers more than just a way to unite approaches. I read relations through cordel poetry from northeast Brazil, including verses found in the rubble of Brazil’s most notorious war, Canudos (1897). Engaging critically with studies of popular media that naturalize mediation, materiality, and politics as analytical starting points, I show how focusing on relations can help transform both the terms of our analyses and the politics of our descriptions.
Cefiderocol treatment for carbapenem-resistant Acinetobacter baumannii infection in the ICU during the COVID-19 pandemic: a multicentre cohort study
Authors: Pascale Renato , Pasquini Zeno , Bartoletti Michele , Caiazzo Luca , Fornaro Giacomo , Bussini Linda , Volpato Francesca , Marchionni Elisa , Rinaldi Matteo , Trapani Filippo , Temperoni Chiara , Gaibani Paolo , Ambretti Simone , Barchiesi Francesco , Viale Pierluigi , Giannella Maddalena
Published: November 2021

Objectives

To analyse the impact of cefiderocol use on outcome in patients admitted to the ICU for severe COVID-19 and further diagnosed with carbapenem-resistant Acinetobacter baumannii (CR-Ab) infection.

Methods

Retrospective multicentre observational study was performed at four Italian hospitals, from January 2020 to April 2021. Adult patients admitted to ICU for severe COVID-19 and further diagnosed with CR-Ab infections were enrolled. Patients treated with cefiderocol, as compassionate use, for at least 72 h were compared with those receiving alternative regimens. Primary endpoint was all-cause 28 day mortality. The impact of cefiderocol on mortality was evaluated by multivariable Cox regression model.

Results

In total, 107 patients were enrolled (76% male, median age 65 years). The median time from ICU admission to CR-Ab infection diagnosis was 14 (IQR 8–20) days, and the main types of CR-Ab infections were bloodstream infection (58%) and lower respiratory tract infection (41%). Cefiderocol was administered to 42 patients within a median of 2 (IQR 1–4) days after CR-Ab infection diagnosis and as monotherapy in all cases. The remaining patients received colistin, mostly (82%) administered as combination therapy. All-cause 28 day mortality rate was 57%, without differences between groups (cefiderocol 55% versus colistin 58% P = 0.70). In multivariable analysis, the independent risk factor for mortality was SOFA score (HR 1.24, 95% CI 1.15–1.38, P < 0.001). Cefiderocol was associated with a non-significant lower mortality risk (HR 0.64, 95% CI 0.38–1.08, P = 0.10).

Conclusions

Our study confirms the potential role of cefiderocol in the treatment of CR-Ab infection, but larger clinical studies are needed.
The Impact of Hemolysis-Index Thresholds on Plasma and Serum Potassium Measurements
Authors: Yin Tiffany , Herskovits Adrianna Z
Published: November 2021

Background

Modern clinical laboratory analyzers measure a hemolysis index (H-index) because test results can be inaccurate when intracellular contents from erythrocytes leak into serum or plasma. In 2020, Roche Diagnostics decreased the H-index from 90/100 to 20 for potassium, recommending that laboratories avoid using specimens with an H-index >20; however, there are a limited number of studies investigating the impact of this recommendation on patient testing.

Methods

Out of 113 916 serum or plasma potassium tests performed within a 6-month interval, 72 patients with potentially hemolyzed potassium specimens (H-index >20) and a second non-hemolyzed specimen (H-index ≤20) within 2 h were identified. The clinical impact of decreasing the H-index and the utility of applying a corrective formula for adjusting potassium results were evaluated.

Results

The majority of initial test results either had small differences between original and corrected results that would not have affected clinical management or H-indices above the threshold previously recommended by Roche. We estimated the second sample was reported an average of 3 h 23 min after the initial sample was collected, with 95% CI [2 h 37 min to 4 h 8 min], and the median time delay was 2 h 44 min.

Conclusions

Our analysis does not show a clear benefit from avoiding the use of potassium specimens above an H-index threshold of 20. Our findings suggest these practices may be detrimental in terms of patient safety due to increased turnaround time for a critical analyte.
Glycated Albumin in Pristine and Non-Pristine Stored Samples in the National Health and Nutrition Examination Survey (NHANES) 1999–2004
Authors: Daya Natalie R , Rooney Mary R , Tang Olive , Coresh Josef , Christenson Robert H , Selvin Elizabeth
Published: November 2021

Background

Glycated albumin is cleared by the Food and Drug Administration (FDA) for clinical use in diabetes care. To understand its performance in the general US population, we conducted measurements in >19 000 samples from the National Health and Nutrition Examination Survey (NHANES). Of these samples, 5.7% had previously undergone at least 2 freeze–thaw cycles and were considered “non-pristine.”

Methods

We measured glycated albumin and albumin using the Lucica GA-L (Asahi Kasei) assay in stored serum samples from NHANES 1999–2004. Serum albumin (Roche/Beckman) was previously measured. We examined the correlations of percent glycated albumin with hemoglobin A1C (HbA1c)and fasting glucose in the pristine and non-pristine samples. We also measured cystatin C (Siemens) and compared these to cystatin C (Dade Behring) previously obtained in a subsample.

Results

Glycated albumin (%) was significantly lower in pristine vs non-pristine samples (13.8% vs 23.4%, P < 0.0001). The results from the Asahi Kasei albumin assay (g/dL) were highly correlated with albumin originally measured in NHANES (Pearson’s correlation coefficient, r = 0.76) but values were systematically higher (+0.25 g/dL, P < 0.0001). Cystatin C (Siemens) was similar to previous cystatin C measurements (r = 0.98) and did not differ by pristine status (P = 0.119). Glycated albumin (%) was highly correlated with HbA1c and fasting glucose in pristine samples (r = 0.78 and r = 0.71, respectively) but not in non-pristine samples (r = 0.11 and r = 0.12, respectively).

Conclusions

The performance of the glycated albumin assay in the pristine samples was excellent. Performance in non-pristine samples was highly problematic. Analyses of glycated albumin in NHANES 1999–2004 should be limited to pristine samples only. These results have major implications for the use of these public data.
Rethinking Drug Analysis in Health Care: High-Throughput Analysis of 71 Drugs of Abuse in Oral Fluid Using Ion Mobility--High-Resolution Mass Spectrometry
Authors: Bergström Moa Andresen , Lövgren Hanna , Abrahamsson Anna , Eriksson Emma K , Andersson Maria Lindbjer , Komorowska Marta , Axelsson Magnus A B
Published: November 2021

We have identified a clinical need for a sensitive, specific, flexible, comprehensive and affordable analytical technology to efficiently detect polydrug use. In addition, the current standard practice of surveilled urine sampling is uncomfortable for the patient; hence, more patient-friendly sample collection methods are requested. To fill these needs, we have developed and validated a high-throughput liquid chromatography–high-resolution mass spectrometry (LC--HRMS) method for the analysis of drugs of abuse (DoA) in oral fluid (OF). The method covers a panel of 71 substances including traditional DoA, prescription narcotics and new psychoactive substances (NPS), with a guaranteed limit of identification of <3 µg/L for 87% of the analytes. Method validation showed high accuracy (>99.7%), sensitivity (>99.7%) and specificity (100%). Most analytes had a high process efficiency during the salting-out liquid–liquid extraction sample preparation and no or only a minor matrix effect during the analysis. We have implemented this method in clinical routine and present data from 18,579 OF samples collected during routine patient treatment in mainly psychiatric and addiction clinics in West Sweden between September 2020 and June 2021. Seventy-one percent of the samples were positive and a total of 41,472 DoA findings were detected. Amphetamine (27%), buprenorphine (25%), nordiazepam (18%) and alprazolam (16%) were most prevalent. New psychoactive substances were detected in 189 samples (1.0%). The occurrence of polydrug use was common; 34% of the positive samples contained three analytes or more and 12% six or more. To the best of our knowledge, this is the first method for comprehensive analysis of DoA in OF using LC--HRMS and the largest dataset published on the detection of DoA in OF. With the current complex and variable drug use pattern, this broad, cost-effective and reliable method has largely replaced immunoassay screening in urine in our laboratory.
A Nonlethal Full-Thickness Flame Burn Produces a Seroma Beneath the Forming Eschar, Thereby Promoting Pseudomonas aeruginosa Sepsis in Mice
Authors: Brammer Jerod , Wolf Gideon , Baliban Scott M , Allen Jessica C , Choi Myeongjin , Kambouris Adrienne R , Simon Raphael , Fiskum Gary , Chao Wei , Lopez Kerri , Miller Catriona , Singh Nevil J , Cross Alan S
Published: November 2021

The World Health Organization estimates ~180,000 deaths occur annually from burn-related injuries. Many victims who survive the initial burn trauma succumb to bacterial infections that lead to sepsis during treatment. Although advancements in burn care continue to improve in high-income countries due to their burn centers and advanced research, low and middle-income countries continue to see high frequencies of burn injuries and burn-related deaths due to secondary infections. Bacterial-derived sepsis is the most life-threatening danger for people that survive burn injuries. Here we provide evidence for the first time that a subeschar seroma forms postburn even in the absence of infection in mice. The seroma fills with a volume estimated at 500 µL of fluid, 25% of the blood supply, free of red blood cells. The seroma fluid supports robust Pseudomonas aeruginosa (PA) growth and contains inflammatory cytokines and chemokines, which recruit immature neutrophils and monocytes to the seroma in the absence of endothelial breakdown. These immune cells fail to contain PA expansion and dissemination. This recruitment of monocytes and immature neutrophils may result in sequestering these critical immune cells away from other tissues during a pivotal time during bacterial dissemination, promoting PA-mediated sepsis.
Learning in Lockdown: Teaching Human Rights Practice During the COVID-19 pandemic
Authors: Roda Claudia , Perry Susan
Published: November 2021

This article explores the authors’ university course on ‘Human Rights and Digital Technology’, designed to engage students in a holistic assessment of the application of international human rights law to the digital universe. In addition to the intellectual premises of our course, this article examines the notable shift in teaching practice during the start of the Covid-19 pandemic, as the authors moved from classroom to online instruction. We argue that during the pandemic many students experienced the loss of equal access to higher education based on merit or capacity, a human right guaranteed by the Universal Declaration and the International Covenant on Economic, Social and Cultural Rights. In fact, students recognized how online education, at least in this specific context, may have exacerbated social and economic differences. This article provides the analysis of a small survey of our students’ perceptions of online learning in the middle of a global pandemic. Based on the authors’ observations and survey results, our article points to three salient factors that affected the quality and fairness of online education during the lockdown period: the absence of in-person, experienced human feedback to hone critical thinking; access (or lack thereof) to functioning technology; and compromised student attention. We highlight several lessons learned from this experience, and how a human rights framework may help both professors and students identify the conditions under which online learning is more likely to be successful and to guarantee equal access to higher education.
No Functional Immunity for Crimes under International Law before Foreign Domestic Courts
Authors: Epik Aziz
Published: November 2021

For some time now, there seemed to be consensus that functional immunity does not protect (former) state officials from criminal prosecution by foreign domestic courts in cases where they are suspected of having committed or participated in crimes under international law. Recently, however, this has been called into question not only by scholars but also by members of the International Law Commission as well as a considerable number of state representatives. It is against this backdrop that the German Federal Court of Justice has issued a landmark judgment confirming the exclusion of functional immunity in cases of crimes under international law. This article provides a summary as well as a legal analysis of the Court’s main arguments. It focuses on the main question of immunity while also touching upon the Court’s application of the substantive law concerning war crimes under the German Code of Crimes Against International Law.
Farmers’ Preferences and Willingness to Pay for Attributes of Integrated Pest Management Methods Against Spodoptera frugiperda (Lepidoptera: Noctuidae) in Benin
Authors: Houngbo Sidol , Zannou Afio , Zossou Espérance , Zanmènou Calmette S G , Aoudji Augustin , Sinzogan Antonio A , Sikirou Rachidatou , Ahanchédé Adam
Published: November 2021

In response to the invasion of Spodoptera frugiperda (J.E. Smith) in Africa, farmers rely mainly on synthetic pesticides which are harmful to human health and environment. This study investigated farmers’ preferences and willingness to pay (WTP) for attributes of integrated pest management (IPM) methods against S. frugiperda. A survey was conducted among 400 randomly selected maize farmers in eight districts of Benin using a questionnaire. Results showed that the majority of farmers (66.5%) who were interested in the IPM approach preferred a combined use of intercropping and ecological control products in managing S. frugiperda. Farmers who were more likely to pay for IPM strategies against S. frugiperda had less access to extension services, very small farms, and relatively low income. They represented 38.82% of the sample and were willing to pay additional protection costs of 4.53 US$/ha for the combination of several management methods, 86.09 US$/ha for the reduction of human health risks, 22.20 US$/ha for the preservation of environment, and 4.90 US$/ha for a reduction in yield losses. The policy implications of these findings for the extension of IPM technologies were discussed.
Symptoms’ resolution, adverse events profile and 1-year survival rate associated with different cervical cancer therapies among patients receiving care in two Nigerian tertiary hospitals
Authors: Samaila Aliyu , Adibe Maxwell O
Published: November 2021

Objectives

To evaluate the symptoms’ resolution, adverse events (AEs) profile and 1-year survival rate associated with different cervical cancer (CC) therapies among patients receiving care in two Nigerian tertiary hospitals.

Methods

This study employed a prospective longitudinal design with a 12-month patient follow-up. It was conducted at Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto in Sokoto state and Ahmadu Bello University Teaching Hospital (ABUTH), Zaria in Kaduna state, North-Western Nigeria. Data of all the 157 eligible CC patients who came to the Radiotherapy and Clinical Oncology clinics of the hospitals were collected at baseline and after the first, third and last treatment courses/radiation fractions. Data analysis was done with appropriate descriptive and inferential statistics using SPSS V. 20 for windows. P < 0.05 was considered statistically significant.

Key findings

Patients who received chemoradiation therapy (CRT), 29 (100.0%), adjuvant chemoradiation therapy (CRTS), 9 (100.0%), adjuvant chemotherapy (CTS), 6 (100.0%) and chemotherapy (CT), 27 (28.1%) (P < 0.001) reported per vaginal bleeding (PVB) to have been completely stopped after therapy. Patients who received CT 4 (9.8%) experienced grade 3 anaemia, leucopaenia was experienced by patients who received CT 27 (54.0%) and CRT 20 (52.6%), P = 0.004. Grade 2 creatinine increase was observed in patients who received CRT 3 (8.1%) and CT 2 (3.1%), P = 0.013. There was no significant association between the therapy option received and 1-year survival rate of the patients within the clinical stage at P < 0.05. However, age (OR = 0.257, P = 0.042), number of comorbidities (OR = 0.123, P = 0.039) and number of complications (OR = 0.013, P < 0.001) were found to be the independent predictors of survival.

Conclusions

Chemoradiation and adjuvant therapies were found to be associated with the best resolution of symptoms. CT and CRT had high frequencies and severities of AEs. Therapy options received by the patients were not associated with their 1-year survival rates within clinical stages.
The soleus muscle flap for coverage of mid-third leg defects: a Jamaican experience
Authors: Williams Geoffrey , Diaz Gabriella
Published: November 2021

Motor vehicle accidents are a major public health problem in Jamaica, representing the leading cause of death in adolescents and young adults and consuming a large part of the health care budget, as surviving victims usually require surgical intervention and prolonged hospital stays.

Patients with mid-third compound tibial fractures present a particularly difficult surgical challenge due to the difficulty in achieving soft-tissue coverage of the bone in this area, hence the need for extended hospitalization in order to prevent infection.

We have used a Hemi-Soleus Muscle Flap to achieve coverage of these difficult wounds, thereby eliminating the risk of osteomyelitis, reducing hospital stays and returning patients to productive lives in a much shorter period.
A pedunculated small bowel gastrointestinal stromal tumour (GIST) masquerading as an ovarian tumour
Authors: Turner Lauren M , Jeans Phillip , Robson Stephen
Published: November 2021

While gastro-intestinal stromal tumours (GIST) are the most common non-epithelial neoplasms of the gastrointestinal tract, 10% occur externally. Symptomatology is therefore broad, dependent on location. A 42-year-old female presented to the Emergency Department after 12 hours of severe right lower abdominal, preceded by vague pain over two weeks. Imaging revealed a right-sided 7.5 × 5.8 × 5.6 cm ovarian cystic lesion, suspicious for torsion. Laparoscopically, the lesion was densely adherent to small and large bowel, and she was proceeded to resection of an assumed primary ovarian neoplasm. Histopathology revealed an infarcted epithelioid GIST, high-grade with clear margins (stage pT3). There are only 24 cases of GISTs pre-operatively mistaken for gynaecological neoplasms. Additionally, there are reports of GISTs metastasizing to ovaries. Both computed tomography and ultrasound are non-specific, including hypo- and hyperechoic features. In all published cases, imaging was not able to identify presumed gynaecological neoplasms as GISTS. Differential diagnoses for pelvic masses should include non-gynaecological tumours.
Laparoscopic and robotic-assisted mesh pelvic closure for locally advanced and recurrent colorectal cancer
Authors: Rusli Siti Mayuha , Choo Jeong Min , Piozzi Guglielmo Niccolò , Kim Seon Hahn
Published: November 2021

Extensive resection that may be required in locally advanced and recurrent colorectal cancer result in formation of empty pelvic cavity that has the potential to cause small bowel descent into the pelvis. In patients with prior history of radiotherapy and multiple abdominal surgery, the risk of adhesion and subsequent small bowel obstruction can lead to increasing need for surgery and its resulting morbidity and mortality. We present five cases of locally advanced and recurrent colorectal cancer requiring laparoscopic and robotic-assisted pelvic closure with Gore-Tex Dual Mesh as prevention of small bowel descent into the pelvis. One out of the five cases had a history of small bowel obstruction after the surgery and wound-related infection occurred in one patient. There was no mesh-related complication or mortality. Pelvic closure using Gore-Tex Dual Mesh is feasible to prevent small bowel descent after surgery for locally advanced and recurrent colorectal cancer.
Detection of a Cryptic KMT2A/AFDN Gene Fusion [ins(6;11)(q27;q23q23)] in a Pediatric Patient with Newly Diagnosed Acute Myeloid Leukemia
Authors: Berg Holly E , Greipp Patricia T , Baughn Linda B , Falcon Corey P , Jackson Courtney C , Peterson Jess F
Published: November 2021

KMT2A gene rearrangements are a major oncogenic driver in multiple hematologic neoplasms. Apart from t(9;11)(p21;q23) (KMT2A/MLLT3) in acute myeloid leukemia (AML), KMT2A gene rearrangements are considered to convey high risk and poor overall survival. Herein, we report a case of a 7 year old boy with newly diagnosed AML and a cryptic KMT2A/AFDN gene fusion resulting from a 5′KMT2A insertional event. The results of conventional chromosome studies revealed trisomy 8 in all 20 metaphases, with normal-appearing chromosomes 6 and 11. A KMT2A break-apart FISH probe identified 2 intact copies of the KMT2A gene region and an extra 5′KMT2A signal in 85% of interphase nuclei.

Subsequent FISH studies using a KMT2A/AFDN dual-color dual-fusion FISH probe revealed positive results for a single fusion in 82% of interphase nuclei, indicating a KMT2A/AFDN gene fusion. Subsequently, metaphase FISH confirmed the location of the KMT2A/AFDN fusion at 6q27. To our knowledge, this represents only the second time in the literature that a cryptic KMT2A/AFDN gene fusion resulting from a 5′KMT2A insertional event was reported.
The world's future: A question of art and health
Authors: Rivas Virgilio A
Published: November 2021

Art has shown its resilient nature throughout prehistoric and modern human history, from extreme climate challenges to worsening microbial threats against species’ health. From the cave paintings scattered across three continents, Europe, Latin America and Asia, to the digitization of culture that characterizes the modern creative industry, art has continued to remind us that existential risks are better addressed through co-habitational thinking/caring. This short essay makes a case for art resilience amid the pandemic that has shown no sign of surrendering to human intervention as planetary multispecies life braces for a more precarious climate emergency in years to come.
Factors associated with patient activation in inflammatory arthritis: a multisite cross-sectional study
Authors: Jones Bethan , Ndosi Mwidimi , Hunt Andrew , Harcourt Diana , Dures Emma
Published: November 2021

Objectives

Patient activation covers the skills, abilities and behaviour that impact how able and willing someone is to take an active role in self-managing their health. This study explored clinical and psychosocial factors associated with patient activation in rheumatology patients.

Methods

This was a cross-sectional study using postal survey methods. Participants with inflammatory rheumatic conditions were from six rheumatology centres in England. Patient activation was captured using the Patient Activation Measure (PAM). Twenty-nine explanatory factors were tested for potential association with patient activation in univariable and multivariable analyses. In preliminary multivariable analyses, factors found to have an association with patient activation at a P < 0.1 level were entered into the final multivariable model. Those that remained significant at a P < 0.05 level were considered associated with patient activation.

Results

The sample comprised 251 participants (74% female) with a mean age of 59.31 years (s.d. 12.69), disease duration of 14.48 years (s.d. 12.52) and a PAM score of 58.3 (s.d. 11.46). Of the 29 candidate factors, 25 were entered into a preliminary multivariable analysis. In the final multivariable analysis, four factors (self-efficacy, the illness belief that treatment will control participants’ condition and two dimensions of health literacy) were significantly associated with patient activation. This final model accounted for 40.4% of the variance in PAM scores [F(4, 246) = 41.66, P < 0.001].

Conclusions

Patient activation is important in managing rheumatic conditions. Our data confirm that self-efficacy and health literacy are particular targets for patient activation interventions.
Ultrasound features of Achilles enthesitis in psoriatic arthritis: a systematic review
Authors: Patience Aimie , Steultjens Martijn P , Hendry Gordon J
Published: November 2021

Objectives

The objectives were to evaluate the methodological and reporting quality of ultrasound (US) studies of Achilles enthesitis in people with psoriatic arthritis (PsA), to identify the definitions and scoring systems adopted and to estimate the prevalence of ultrasound features of Achilles enthesitis in this population.

Methods

A systematic literature review was conducted using the AMED, CINAHL, MEDLINE, ProQuest and Web of Science databases. Eligible studies had to measure US features of Achilles enthesitis in people with PsA. Methodological quality was assessed using a modified Downs and Black Quality Index tool. US protocol reporting was assessed using a checklist informed by the European League Against Rheumatism (EULAR) recommendations for the reporting of US studies in rheumatic and musculoskeletal diseases.

Results

Fifteen studies were included. One study was scored as high methodological quality, 9 as moderate and 5 as low. Significant heterogeneity was observed in the prevalence, descriptions, scoring of features and quality of US protocol reporting. Prevalence estimates (% of entheses) reported included hypoechogenicity [mean 5.9% (s.d. 0.9)], increased thickness [mean 22.1% (s.d. 12.2)], erosions [mean 3.3% (s.d. 2.5)], calcifications [mean 42.6% (s.d. 15.6)], enthesophytes [mean 41.3% (s.d. 15.6)] and Doppler signal [mean 11.8% (s.d. 10.1)].

Conclusions

The review highlighted significant variations in prevalence figures that could potentially be explained by the range of definitions and scoring criteria available, but also due to the inconsistent reporting of US protocols. Uptake of the EULAR recommendations and using the latest definitions and validated scoring criteria would allow for a better understanding of the frequency and severity of individual features of pathology.
Housing Consumption and Investment: Evidence from Shared Equity Mortgages
Authors: Benetton Matteo , Bracke Philippe , Cocco João F , Garbarino Nicola
Published: November 2021

We exploit a U.K. government-sponsored product and provide evidence on shared equity mortgages. The analysis shows how the interaction of house price growth and leverage regulation promotes product adoption. Following an increase in the equity limit, households use the additional financing to buy more expensive properties rather than reduce leverage. Equity used as a complement to debt is likely less beneficial for financial stability than when used as a substitute. Equity borrowers are less likely to change lenders when refinancing their senior debt. Finally, we measure the equity provider returns, which are affected by selection and undervaluation at repayment.

Authors have furnished an Internet Appendix, which is available on the Oxford University Press Web site next to the link to the final published paper online.
Treatment of Early-onset Scoliosis: Similar Outcomes Despite Different Etiologic Subtypes in Traditional Growing Rod Graduates
Authors: Akbarnia Behrooz A. , Pawelek Jeff B. , Hosseini Pooria , Salari Pooria , Kabirian Nima , Marks David , Shah Suken A. , Skaggs David L. , Emans John B. , Elsebaie Hazem , Thompson George H. , Sponseller Paul D.
Published: November 2021

Background:

It is unclear whether traditional growing rod (TGR) treatment outcomes vary by early-onset scoliosis (EOS) subtype. The goal of this study was to compare radiographic outcomes and complications of TGR treatment by EOS subtype.

Methods:

We queried an international database of EOS patients from 20 centers to identify “graduates” who had (1) undergone primary TGR treatment from 1993 to 2014; (2) completed TGR treatment; and (3) had an uneventful clinical examination within 6 months after completion of TGR treatment with no anticipated further intervention. We included 202 patients in 4 etiologic subgroups: neuromuscular (n=65), syndromic (n=57), idiopathic (n=52), and congenital (n=28). Mean age at surgery was 7.1 years (range, 1.6 to 14.9 y); mean duration of follow-up was 8 years (range, 2 to 18.6 y). The groups did not differ by mean age, body mass index, sex, number of lengthenings, or duration of follow-up. The following preoperative differences were significant: (1) greater mean major curve in the neuromuscular versus idiopathic subgroup; (2) shorter spinal height (T1-S1) in the congenital versus idiopathic subgroup; and (3) smaller proportion of ambulatory patients in the neuromuscular subgroup versus all other subgroups.

Results:

We found no significant differences among subgroups in mean major curve correction or changes in thoracic height (T1-T12), spinal height, or global kyphosis at any point. Rates of deep surgical site infection, implant-related complications, and neurological complications were not different among subgroups. The medical complication rate was significantly lower in the idiopathic group compared with the other groups.

Conclusions:

Major curve correction and spinal and thoracic height increases did not differ significantly at any point by EOS subtype. Rates of deep surgical site infection, implant-related complications, and neurological complications did not differ by subtype. Except for the lower rate of medical complications in the idiopathic group, our findings suggest that, after TGR treatment, patients can expect similar outcomes regardless of their EOS subtype.

Level of Evidence:

Level III, therapeutic.
The Utility of Routine Radiographic Monitoring in Pediatric Osteoarticular Infections
Authors: Gajewski Christopher R. , Gajewski Nicholas D. , Upfill-Brown Alexander , Thompson Rachel M. , Silva Mauricio
Published: November 2021

Background:

Pediatric musculoskeletal (MSK) infections broadly include isolated osteomyelitis (OM), septic arthritis (SA), and combined infections (OM+SA). These diagnoses are often monitored with serum inflammatory markers and serial radiographs to monitor treatment response and development of negative sequelae, despite limited data supporting these practices. The purpose of this study is to evaluate the utility of obtaining serial radiographic follow-up for pediatric osteoarticular infections.

Methods:

An institutional review board–approved retrospective review was completed. Children 18 years and below admitted to a single institution with a culture/biopsy-proven diagnosis of OM, SA, or OM+SA. All postdischarge radiographs were reviewed and retrospectively categorized as either routine (scheduled) or reactive. Routine radiographs were obtained regardless of clinical presentation. Reactive radiographs were obtained in patients presenting with the sign of an altered clinical course. Negative sequelae, defined as growth arrest/disturbance, pathologic fracture, recurrent MSK infection, and underlying neoplastic process, were recorded and tracked. Descriptive statistics were used to summarize demographic and outcome variables. Number needed to screen (NNS) was defined as the inverse of the incidence of negative sequelae detected.

Results:

A total of 131 patients were included for analysis, with a mean age of 11.9 years (SD: 4.96 y). Ninety (69%) patients were diagnosed and treated for OM, 25 (19%) for SA, and 16 (12%) for combined infections. A total of 329 radiographs were obtained following discharge. Of those obtained, 287 (88%) were routine, resulting in the detection of 2 (0.7%) negative sequelae and a resultant NNS of 143 radiographs (95% confidence interval: 36-573). The remaining 39 were reactive radiographs, resulting in the detection of 2 (5.1%) negative sequelae with an NNS of 20 radiographs (95% confidence interval: 5-78).

Conclusions:

While radiographs remain a widely utilized tool to screen for the development of negative sequelae in pediatric osteoarticular infections, they rarely alter management in the absence of other concerning clinical signs or symptoms such as recurrent fevers, swelling of the extremity, or limb deformity. Moreover, routine radiographic surveillance should be replaced with a reactive radiographic protocol.

Level of Evidence:

Level III—retrospective comparative study.
Outpatient Operative Management of Pediatric Supracondylar Humerus Fractures: An Analysis of Frequency, Complications, and Cost From 2009 to 2018
Authors: Modest Jacob M. , Brodeur Peter G. , Lemme Nicholas J. , Testa Edward J. , Gil Joseph A. , Cruz Aristides I.
Published: November 2021

Background:

In an effort to increase the value of health care in the United States, there has been increased focus on shifting certain procedures to an outpatient setting. While pediatric supracondylar humerus fractures (SCHFs) have traditionally been treated in an inpatient setting, recent studies have investigated the safety and efficiency of outpatient surgery for these injuries. This retrospective study aims to examine ongoing trends of outpatient surgical care for SCHFs, examine the safety and complication rates of these procedures, and investigate the potential cost-savings from this shift in care.

Methods:

Pediatric patients less than 13 years old who underwent surgery for closed SCHF from 2009 to 2018 were identified using International Classification of Diseases-9/10 Clinical Modification and Procedural Classification System codes in the New York Statewide Planning and Research Cooperative System (SPARCS) database. Linear regression was used to assess the shift in proportion of outpatient surgical management of these injuries over time. Multivariable Cox proportional hazards regression was used to compare return to emergency department (ED) visit, readmission, reoperation, and other adverse events. A 2-sample t test was performed on the average charge amount per claim for inpatient versus outpatient surgery.

Results:

A total of 8488 patients were included in the analysis showing there was a statistically significant shift towards outpatient management between 2009 (23% outpatient) and 2018 (59% outpatient) (P<0.0001). Relative to inpatient surgical management, outpatient surgical management had lower rates of return ED visits at 1 month (hazard ratio: 0.744, P=0.048). All other adverse events compared across inpatient and outpatient surgical management were not significantly different. The median amount billed per claim for inpatient surgeries was significantly higher than for outpatient surgeries ($16,097 vs. $9,752, P<0.0001). White race, female sex, and weekday ED visit were associated with increased rate of outpatient management.

Conclusions:

This study demonstrates the trend of increasing outpatient surgical management of pediatric SCHF from 2009 to 2018. The increased rate of outpatient management has not been associated with elevated complication rates but is associated with significantly reduced health care charges.

Level of Evidence:

Level III—retrospective cohort.
Reliability of 3 Radiologic Classifications for the Severity of the Developmental Dysplasia of the Hip in Children Older Than 4 Years
Authors: Singh Kumar A. , Ganjwala Dhiren , Gupta Parmanand , Vazhayil Kottamttavida Imthias , Varma Mahendra , Shah Hitesh
Published: November 2021

Background:

Tonnis, International Hip Dysplasia Institute (IHDI), and lateral metaphyseal height (LMH) are commonly used classifications for grading the severity of the developmental dysplasia of the hip. The reliability of these classifications is not widely studied in older children. The aim of the study was to evaluate the reliability of these 3 radiologic classifications in children older than 4 years and compared with children younger than 4 years and evaluate the cases with varied inter-rater reliability.

Methods:

A purposeful sample of 40 children with untreated developmental dysplasia of the hip with ages between 6 months to 8 years was studied for the assessment of the severity grading according to all 3 classifications. Six pediatric orthopaedic surgeons classified all hips for all 3 categorical classifications as per the original description. Inter-rater and intrarater reliability was calculated according to the intraclass correlation coefficient. The cases with different ratings were assessed in detail to evaluate the reasons for the varied rating.

Results:

The interobserver and intraobserver reliability of all 3 classifications were excellent [intraclass correlation coefficient (ICC): 0.935, 0.820, and 0.935 for IHDI, Tonnis, and LMH classification, respectively]. The excellent reliability was also observed in younger and older children. Interobserver reliability of only dysplastic hips (52 hips) was good for Tonnis (ICC: 0.741) and excellent for IHDI (ICC: 0.911) and LMH classification (ICC-0.9). The main reason for the varied rating was because of the varied perception of the superolateral margin of the acetabulum in few hips.

Conclusion:

The inter-rater and intrarater reliability of all 3 classifications (IHDI, Tonnis, and LMH) is excellent. All classifications can be used till the age of 8 years. The difficulty in selecting the superolateral margin of the acetabulum is a major cause of inter-rater variability.

Level of Study:

Level III.