bluuebunny/crossref_metadata_2025 huggingface dataset:
S146. ASSOCIATION OF IMPAIRED MODEL-FREE DECISION-MAKING WITH ABERRANT STRIATAL DOPAMINE, BRAIN ACTIVATION, AND COGNITIVE DIFFICULTIES IN PATIENTS WITH SCHIZOPHRENIA DURING PSYCHOTIC REMISSION
Authors: Brandl Felix , Avram Mihai , Cabello Jorge , Mustafa Mona , Leucht Claudia , Leucht Stefan , Ziegler Sibylle , Wunderlich Klaus , Sorg Christian
Published: May 2020

Background

Human decision-making ranges between the extremes of automatic and fast model-free behavior (i.e., relying only on previous outcomes) and more flexible, but computationally demanding model-based behavior (i.e., implementing cognitive models). Model-based/model-free decision-making can be investigated using sequential decision tasks and has been shown to be associated with presynaptic striatal dopamine synthesis. During phases of psychotic remission in schizophrenia, dopamine synthesis in the dorsal striatum is reduced. We hypothesized that particularly model-free decision-making is impaired in schizophrenia during psychotic remission and is associated with (i) abnormal dopamine synthesis in dorsal striatum, (ii) aberrant task-activation in dorsal striatum, and (iii) cognitive difficulties in patients (e.g., reduced speed).

Methods

26 patients with chronic schizophrenia, currently in psychotic remission, and 22 healthy controls (matched by age and gender) were enrolled in the study. Model-based/model-free decision-making was evaluated with a two-stage Markov decision task, followed by computational modeling of subjects’ learning behavior. Presynaptic dopamine synthesis was assessed by 18F-DOPA positron emission tomography and subsequent graphical Patlak analysis. Task-activation was measured by functional magnetic resonance imaging. Cognitive impairments were quantified by Trail-Making-Test A (among others). Associations between decision-making parameters, dopamine synthesis, task-activation, and cognitive impairments were tested by correlation analyses.

Results

Patients with schizophrenia showed selectively impaired model-free decision-making. 18F-DOPA uptake (i.e., presynaptic dopamine synthesis capacity) in the dorsal striatum was decreased in patients. Impaired model-free decision-making in patients correlated with (i) decreased dopamine synthesis in dorsal striatum, (ii) abnormal task-activation in dorsal striatum, and (iii) lower speed in Trail-Making-Test A.

Discussion

Results demonstrate an association of reduced dorsal striatal dopamine synthesis and brain activity with impaired model-free decision-making in schizophrenia, which potentially contributes to cognitive difficulties.
S153. IMPAIRED THETA PHASE-COUPLING BETWEEN HIPPOCAMPUS AND MEDIAL PREFRONTAL CORTEX IN SCHIZOPHRENIA
Authors: Adams Rick , Bush Daniel , Zheng Fanfan , Meyer Sofie , Kaplan Raphael , Orfanos Stelios , Reis Marques Tiago , Howes Oliver , Burgess Neil
Published: May 2020

Background

A genetic schizophrenia (Scz) mouse model has impaired hippocampal-prefrontal synchrony during spatial working memory (Sigurdsson et al., 2000, Nature). These Df(16)A(+/-) mice (models of the human 22q11.2 microdeletion) have impaired mPFC phase coupling to hippocampal theta (1–8 Hz) oscillations, which predicts performance. This deficit has never been demonstrated in human Scz subjects, however, and its mechanistic basis is unclear.

Methods

18 Scz (8 unmedicated) and 26 age, gender and IQ-matched controls performed a spatial memory task whilst undergoing magnetoencephalography (MEG), and a ‘memory integration’ task dependent on hippocampal function (without MEG). A partly overlapping group of 33 Scz and 29 controls underwent positron emission tomography (PET) to measure the availability of GABAARs expressing the α5 subunit (concentrated on hippocampal somatostatin interneurons).

Results

We demonstrate – in the spatial memory task, during memory recall – that theta power increases in left medial temporal lobe (mTL) are impaired in Scz, as is theta phase coupling between mPFC and mTL. Importantly, the latter cannot be explained by theta power changes, head movement, antipsychotics, cannabis use, or IQ, and is not found in other frequency bands. Moreover, mPFC-mTL theta coupling correlated strongly with performance in controls, but not in Scz, who were mildly impaired at the spatial memory task and no better than chance on the memory integration task. Use of antipsychotic medication may ameliorate this mPFC-HC theta coupling deficit. Finally, mTL regions showing reduced theta phase coupling in Scz MEG participants overlapped substantially with areas of diminished α5-GABAAR availability in the wider Scz PET sample.

Discussion

These results indicate that impaired theta phase coupling between hippocampus and mPFC could underlie hippocampal-prefrontal dysconnectivity in schizophrenia, and impairments in the cognitive domains that depend on communication between these areas. They also imply α5-GABAARs (and the cells that express them) have a role in the phase coupling process.
S159. SUBCORTICAL GRAY MATTER VOLUME IS ASSOCIATED WITH SCHIZOPHRENIA AND WITH BOTH ITS FAMILIAL AND CLINICAL RISK
Authors: Passiatore Roberta , Antonucci Linda A , Fazio Leonardo , Gelao Barbara , Falsetti Andrea , Caforio Grazia , Popolizio Teresa , Bertolino Alessandro , Blasi Giuseppe , Pergola Giulio , Antonucci Linda
Published: May 2020

Background

Patients with schizophrenia (SCZ) show lower volumetric estimates of gray matter (GM) than healthy controls (HC). Similar results have been reported in healthy siblings of patients (SIB). However, it is unclear whether this phenotype is also present in individuals at clinical high-risk (CHR), characterized by sub-threshold symptoms and loss of functioning. We hypothesized that GM volumetric differences are associated with both familial and clinical risk for schizophrenia

Methods

We processed the T1-weighted MRI scans acquired at 3 Tesla of 544 HC, 63 SIB, 20 CHR and 120 SCZ using CAT12. We used ANCOVA to assess group differences (HC vs. CHR vs. SIB vs. SCZ), with linear and quadratic age, gender and total intracranial volume as nuisance covariates. We assessed the reproducibility of our case/control findings in an independent sample of 127 HC and 36 SCZ. Group differences were tested post hoc through Fisher’s test.

Results

We found significant group effects in the bilateral thalamus, bilateral hippocampus and anterior cingulate (FWE<0.05). Specifically, SCZ presented the lowest GM volume in these regions compared to the other three groups, with SIB and CHR’s GM estimates intermediate between HC and SCZ (p<0.05). The associations with schizophrenia were replicated in the independent validation sample.

Discussion

Individuals with familial or clinical risk for schizophrenia have lower GM estimates in the same brain regions. These findings, suggest that these structural features are not only associated with familial risk for schizophrenia but that they are also associated with its sub-threshold symptoms.
S171. EFFECT OF DAOA GENETIC VARIATION ON WHITE MATTER ALTERATION IN CORPUS CALLOSUM IN PATIENTS WITH FIRST-EPISODE SCHIZOPHRENIA
Authors: Su Wenjun , Zhu Tianyuan , Xu Lihua , Wei Yanyan , Zeng Botao , Zhang Tianhong , Cui Huiru , Wang Junjie , Jia Yuping , Wang Jinhong , Goff Donald C , Tang Yingying , Wang Jijun
Published: May 2020

Background

D-amino acid oxidase activator (DAOA) gene, which plays a key role in glutamatergic transmission and mitochondrial function, is frequently linked with the liability for schizophrenia. In this study, we aimed to investigate whether the variation of DAOA rs2391191 could be associated with alterations in white matter integrity in first episode schizophrenia patients, and whether it influences the association between white matter integrity, cognitive function and clinical symptoms of schizophrenia.

Methods

Forty-six patients with first-episode schizophrenia and forty-nine sex, age and education-matched healthy controls underwent diffusion tensor imaging (DTI) and were genotyped for SNP DAOA rs2391191. Tract-based spatial statistics (TBSS) was used to delineate the major fiber tracts that showed significant group difference. Patients underwent pathophysiological assessments using Brief Psychiatric Rating Scale (BPRS) and Scale for Assessment of Negative Symptoms (SANS). Cognitive function assessments were performed by Chinese version of the MATRICS Consensus Cognitive Battery (MCCB).

Results

Schizophrenia patients presented lower fractional anisotropy (FA) and higher radial diffusivity (RD) mainly spreading over corpus callosum and corona radiata compared with healthy controls (FWE-corrected p<0.05). Compared with patients carrying G allele, patients with AA genotype showed lower FA in body of corpus callosum, and higher RD in genu of corpus callosum, right superior and anterior corona radiata, and left posterior corona radiata. But there were no significant FA or RD differences between two genotype groups in healthy controls. In patients carrying G allele, mean FA values in body of corpus callosum were positively correlated with working memory, mean RD values in genu of corpus callosum were negatively associated with speed of processing, working memory and composite score of MATRICS Consensus Cognitive Battery (MCCB), whilst there were no significant correlations found in AA homozygotes.

Discussion

Abnormal white matter integrity in corpus callosum and corona radiata were replicated among our sample of first episode schizophrenia. Genetic variation of DAOA rs2391191 was associated with this abnormality, with AA homozygotes showing less white matter integrity in corpus callosum. Our findings also suggested that rs2391191influenced the association between white matter integrity and cognitive function of schizophrenia patients. Such results might be due to the process of glutamatergic neurotransmission and mitochondrial function DAOA involves in as pinpointed by previous in vitro studies.
S198. SELF-DISTURBANCES AND THEIR NEURAL SIGNATURES IN SCHIZOPHRENIA
Authors: Zaytseva Yulia , Kozakova Eva , Mohr Pavel , Spaniel Filip , Mishara Aaron
Published: May 2020

Background

The self-disturbances (SDs) concept is considered to be part of the Schneider’s first rank symptoms, i.e., thought-withdrawal, thought-insertion, thought-broadcasting, somatic-passivity experiences, mental/motor automatisms, disrupted unitary self-experience (Mishara et al., 2014). SDs were originally described by W. Mayer-Gross (1920), who observed them in psychotic patients.

Methods

We classified Mayer-Gross’ findings on SDs into the following categories: experience is new/compelling (aberrant salience), reduced access/importance of autobiographical past, cognitions/emotions occur independently from self’s volition, foreign agents have power over self and developed an SDs scale based on these categories and cognitive domains (perception, motor, speech, thinking etc.). Scale is applied as a measure of the frequency of the experiences. In our current study on phenomenology and neurobiology of psychotic symptoms, we administered the scale to a study group of patients with schizophrenia (N=84) and healthy volunteers (N=170). Further, the resting state fMRI was performed and the group was divided into two subgroups with (N=13) and without self-disturbances (N=10) and in healthy individuals (N=39).

Results

We found substantial differences in the frequency of self-disturbances in patients with schizophrenia compared to healthy controls (total score differences, Z=-5.83, p< 0.001). On a neural level, patients with self-disturbances experienced a decreased functional brain connectivity of the default mode and salience networks as compared to the patients without self-disturbances and healthy controls. The differences were mainly explained by the factor ‘’foreign agents’’ and the novelty of the experience.

Discussion

The scale identifies self-disturbances in schizophrenia and confirms self-related processing in patients with schizophrenia to be associated with altered activation in the cortical midline structures.

Supported by the grant projects MH CR AZV 17-32957A and MEYS NPU4NUDZ: LO1611.
S203. EFFECT OF LONG-ACTING INJECTIONS OF PALIPERIDONE PALMITATE ON CLINICAL AND FUNCTIONAL OUTCOMES IN PATIENTS WITH SCHIZOPHRENIA BASED ON ILLNESS DURATION
Authors: Kim Seoyoung , Youn Kim Su , Jung Koh Min , Jee Choi Gum , Kim Euitae
Published: May 2020

Background

While early intervention shows a better outcome in patients with schizophrenia, the benefit of early administration of long-acting injectable antipsychotics (LAI) in schizophrenia is not well-studied. Paliperidone Palmitate is one of the most frequently used LAI, and it is usually administered in the later stage of the illness than oral medication. In this study, the difference in clinical and functional improvement by illness duration after the administration of Paliperidone LAI was evaluated.

Methods

Patients with schizophrenia who planned to switch their antipsychotic treatment from oral ones to once-monthly Paliperidone LAI were recruited from hospitals in South Korea from 26 July 2010 to 25 July 2017. The clinical and functional change was measured every 4 weeks with Clinical Global Impression Severity (CGI-S) scale and Personal and Social Performance (PSP) scale for 6 months after initiation of Paliperidone LAI. Compared to baseline, improvements after switching to Paliperidone LAI were analyzed based on the duration of illness (DI) (less than 3 years, 3 to 10 years, over 10 years).

Results

1166 participants (DI≤3 years, N=240; 310 years, N=484) were enrolled. The change in CGI-S score was significantly different according to the DI and those with DI less than 3 years showed the most improvement in the aspect of clinical symptoms (DI, p<0.001; week, p<0.001; DI*week, p=0.013). All three groups showed significant improvements in PSP scores after the treatment with Paliperidone LAI and patients with DI less than 3 years demonstrated the highest PSP scores (DI, p<0.001; DI*week, p=0.436; week, p<0.001).

Discussion

Switching to Paliperidone LAI showed significantly better outcomes in schizophrenia patients especially with those with shorter DI. This result suggests that earlier administration of LAI in schizophrenia might lead to better clinical and functional outcomes.
S206. ARIPIPRAZOLE LONG-ACTING INJECTABLE IN SCHIZOPHRENIA DURING PREGNANCY: A CASE REPORT
Authors: Sole Eva , Ignacio Duran Juan , Lera Sara , Torres Anna , Andres Susana , Garriga Marina , Garcia-Esteve Lluïsa , Roca Alba
Published: May 2020

Background

Long-acting injectable (LAI) antipsychotics provide some advantages in treatment compliance of psychotic disorders. However, information about their effects during pregnancy is still very limited. We expose a clinical case of aripiprazole LAI use in a pregnant woman diagnosed of schizophrenia.

Methods

A non-systematic review using Pubmed was conducted using the following terms: schizophrenia, pregnancy, aripiprazole and aripiprazole LAI. A clinical record review was performed for the clinical case report.

Results

We report the case of a 30-year-old woman diagnosed of schizophrenia. She required several hospital admissions in the past because of the mental disorder and the lack of treatment adherence, what was the consequence of having no insight of illness and her pregnancy desires.

She was initially treated with risperidone, suffering from some adverse effects like prolactine elevation and amenorrhea. In the last hospital admission, she started treatment with aripiprazol 20mg, having a good tolerability and being finally changed into aripiprazole LAI 400mg/28days. No incidences were reported and stability was achieved.

After five months, she became pregnant and started being followed up in the Perinatal Mental Health Unit that belongs to the same hospital. The severity of the mental disorder and her stability at that moment made psychiatrists; obstetricians and patient decide to keep the antipsychotic treatment with subsequent appointments. The goal was to supervise psychopathology and blood tests during pregnancy.

Prolactine was in physiologic levels and there were no obstetric complications. She finally delivered at 41 gestational weeks to a 3465g baby girl (Apgar 1’: 9 Apgar 5’: 10). No neonatal complications were reported. The Stafford interview was also administered in order to explore her social, obstetric and psychological background as well as possible psychiatric complications due to pregnancy and puerperium. No psychiatric complications were reported. Postpartum Bounding Questionnaire was also administered. No bounding disorder was detected.

Discussion

Pregnancy and postpartum are periods that carry a high risk of illness onset or recurrence in women with severe mental disorders, such as schizophrenia. Having a good control of the symptoms may prevent from risks to both patient and child, due to the important influence that exists on the development of the baby and the mother-infant relationship.
S207. CHRONIC TREATMENT WITH 1METIQ INDUCES PRO-COGNITIVE EFFECT ON RECOGNITION MEMORY IN KETAMINE MODEL OF SCHIZOPHRENIA IN RATS
Authors: Białoń Magdalena , Wąsik Agnieszka , Żarnowska Marcelina
Published: May 2020

Background

Schizophrenia is severe mental disorder that affects 1% of world population and cause long-term disability (Mueser and McGurk, 2004). Manifestation of the illness can be distinguished into three groups – positive, negative and cognitive symptoms (van Os, 2009). However, cognitive ones (e.g. memory deficits) seem to remain resistant to pharmacotherapy (Cerveri et al., 2019). Memory deficits, as a symptoms of schizophrenia, may be modeled in animals by using a specified dose of ketamine and measured in novel object recognition (NOR) test (Lafionatis et al., 2019). 1-methyl-1,2,3,4-tetrahydroisoquinoline (1MeTIQ) is an endogenous amine present and synthesized in the mammalian brain with neuroprotective properties (Antkiewicz-Michaluk et al., 2014) and our last study have shown anxiolytic action of 1MeTIQ in rat model of schizophrenia (Wąsik et al., 2019) therefore we decided to define a potential of 1MeTIQ to exhibit pro-cognitive effect on memory in ketamine-treated rats.

Methods

NOR test consisted of adaptation (24h before testing) and two phases (T1 and T2, with 1-hour interval). Exploration times of each objects, preference (PI) and discrimination (DI) indexes were measured. Microdialysis was performed to asses glutamate release in frontal cortex. Male Sprague Dawley rats were divided into 4 groups. The control group received saline injections. Animals received acute ketamine (20mg/kg, i.p.) or chronic (7x) administration of1MeTIQ (50mg/kg, i.p.). The combined group received single dose of ketamine 30 minutes after last dose of 1MeTIQ.

Results

In T1 phase of NOR, there were no changes between exploration times of two identical objects. In T2 phase with two different objects, we observed no significant changes in group treated with ketamine. 1MeTIQ given alone increased the difference between time of objects exploration. In combined group, 1MeTIQ completely reversed the effect of ketamine. Ketamine tended, however, without statistical significance, to decrease PI and DI. Treatment with 1MeTIQ did not change mentioned indexes. In microdialysis study, we observed no significant changes in glutamate release in any group.

Discussion

We demonstrated that chronic administration of 1MeTIQ may improve recognition memory function. However, we didn’t observe changes in glutamate release. We suggest that pro-cognitive effect of 1MeTIQ is associated with its impact on monoamine metabolism.
A moderate physiological dose of benzyl butyl phthalate exacerbates the high fat diet-induced diabesity in male mice
Authors: Zhang Jian , Powell Catherine A , Kay Matthew K , Park Min Hi , Meruvu Sunitha , Sonkar Ravi , Choudhury Mahua
Published: May 2020

Exposure to endocrine disrupting chemicals (EDCs) used in plastic manufacturing processes may be contributing to the current increase in metabolic disorders. Here, we determined that benzyl butyl phthalate (BBP), a common EDC and food packaging plasticizer, mixed into chow diet (CD) and high fat diets (HFD) at varying concentrations (4 μg/kg body weight (bw)/day, 169 μg/kg bw/day, 3 mg/kg bw/day, 50 mg/kg bw/day) produced a number of detrimental and sex-specific metabolic effects in C57BL/6 male and female mice after 16 weeks. Male mice exposed to moderate (3 mg/kg bw/day) concentrations of BBP in an HFD were especially affected, with significant increases in body weight due to significant increases in weight of liver and adipose tissue. Other doses did not show any significant changes when compared to only CD or HFD alone. HFD in the presence of 3 mg/kg bw/day BBP showed significant increases in fasting blood glucose, glucose intolerance, and insulin intolerance when compared to HFD alone. Furthermore, this group significantly alters transcriptional regulators involved in hepatic lipid synthesis and its downstream pathway. Interestingly, most of the BBP doses had no phenotypic effect when mixed with CD and compared to CD alone. The female mice did not show a similar response as the male population even though they consumed a similar amount of food. Overall, these data establish a dose which can be used for a BBP-induced metabolic research model and suggest that a moderate dosage level of EDC exposure can contribute to widely ranging metabolic effects.
Characterisation of actions of p-menthane-3,8-diol repellent formulations against Aedes aegypti mosquitoes
Authors: Goodyer Larry , Grootveld Martin , Deobhankar Kedar , Debboun Mustapha , Philip Manju
Published: May 2020

Background

Characterisation of mosquito repellents using arm-in-cage tests are performed by assessing the 95% effective dose (ED95), half-life and complete protection time (CPT). This study fully characterizes these properties for p-menthane-3,8-diol (PMD), which has not been widely studied, and a long-acting formulation containing a PMD-vanillin composite.

Methods

A series of arm-in-cage tests against Aedes aegypti (Diptera: Culicidae) mosquitoes were devised using 6 volunteers to estimate CPT or 10 to estimate the ED95 and half-lives for three repellents: 20% N,N-diethyl-3-methylbenzamide (DEET), 30% PMD and a novel 30% PMD-vanillin formulation. Non-linear regression analysis was used to characterize the relationship between applied dose and CPT.

Results

PMD and DEET showed a very similar log dose relationship to CPT; however, the PMD-vanillin formulation exhibited a sigmoidal ‘S-shaped’ relationship. This resulted in a 1.5-fold higher CPT for PMD-vanillin compared with that of 20% DEET when applied at a dose of 1.6 mg/cm2, but little difference was observed at lower doses of 0.8–1 mg/cm2. The ED95 value for the 30% PMD and PMD-vanillin formulations were 0.25 and 0.24 mg/cm2, respectively, these being higher than that for 20% DEET (0.09 mg/cm2). The half-lives for 30% PMD and 20% DEET were similar (2.23 vs. 2.74 h), but longer for the PMD-vanillin formulations (3.8 h).

Conclusions

A full characterisation for other repellent formulations, particularly those claiming extended longevity, should be conducted in order to identify differences at various applied doses.
Wound Healing and Wound Care in Neonates: Current Therapies and Novel Options
Authors: Steen Emily H. , Wang Xinyi , Boochoon Kieran S. , Ewing Donald C. , Strang Harrison E. , Kaul Aditya , Masri Leighanne , Balaji Swathi , Hollier Larry H. , Keswani Sundeep
Published: May 2020

GENERAL PURPOSE

To provide wound care information that considers the specific physiology of neonates.

TARGET AUDIENCE

This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES

After participating in this educational activity, the participant will:

1. Differentiate the use of hydrocolloids, hydrogels, foam dressings, and barrier creams in the neonatal population.

2. Identify issues related to the use of solvents, alginates, collagen dressings, and negative-pressure wound therapy in neonates.

OBJECTIVE

To discuss what is known about the wound milieu in premature and full-term neonates, including the unique challenges pediatric clinicians face, the therapies that have proven effective, and the therapies contraindicated for use in neonatal wound healing to guide treatment that accounts for the specific physiological characteristics of this often overlooked population.

DATA SOURCES

Data were collected on neonatal wound healing from a wide variety of sources, including PubMed, Google Scholar, journals, and textbooks.

STUDY SELECTION

Selection criteria included publications focused on the differences and nuances of wound healing in neonates in comparison with all other age groups.

DATA EXTRACTION

Data were extracted based on articles covering wound healing therapies with proven effectiveness in neonates. Terms for neonatal wound care were compiled, and then a comprehensive literature search was performed by the authors.

DATA SYNTHESIS

Although many therapies are safe for treatment of older children and adolescents, most have not been explicitly tested for neonatal use. This article reviews therapies with proven effectiveness and/or specific concerns in the neonatal population.

CONCLUSION

This review sheds light on the advantages and disadvantages of current standards of care regarding wound healing for neonates to direct researchers and clinicians toward developing treatments specifically for this delicate population.
The New USMLE Step 1 Paradigm: An Opportunity to Cultivate Diversity of Excellence
Authors: Pershing Suzann , Co John Patrick T. , Katznelson Laurence
Published: May 2020

The February 2020 announcement that United States Medical Licensing Examination (USMLE) Step 1 results will be reported as pass/fail instead of numerical scores has been controversial. Step 1 scores have played a key role in residency selection, including screening for interviews. Although Step 1 scores are viewed as an objective criterion, they have been shown to disadvantage female and underrepresented minority applicants, cause student anxiety and financial burden, and affect student well-being. Furthermore, Step 1 scores incompletely predict applicants’ overall residency performance. With this paradigm shift in Step 1 score reporting, residency programs will have fewer objective, standardized metrics for selection decisions, which may lead to greater emphasis on USMLE Step 2 Clinical Knowledge scores or yield unintended consequences, including shifting weight to metrics such as medical school reputation.

Yet, greater breadth in residency selection metrics will better serve both applicants and programs. Some students excel in coursework, others in research or leadership. All factors should be recognized, and broader metrics should be implemented to promote and recognize diversity of excellence. Given the need for metrics for residency selection as well as for a more holistic approach to evaluating residency applicants, assessment during medical school should be revisited and made more meaningful. Another opportunity may involve use of situational judgment tests to predict professionalism and performance on other competencies. It will be important to evaluate the impact of the new Step 1 paradigm and related initiatives going forward. Residency application overload must also be addressed.
Preoperative Fluid Fasting Times and Postinduction Low Blood Pressure in Children
Authors: Simpao Allan F. , Wu Lezhou , Nelson Olivia , Gálvez Jorge A. , Tan Jonathan M. , Wasey Jack O. , Muhly Wallis T. , Tsui Fu-Chiang , Masino Aaron J. , Stricker Paul A.
Published: May 2020

Background

Children are required to fast before elective general anesthesia. This study hypothesized that prolonged fasting causes volume depletion that manifests as low blood pressure. This study aimed to assess the association between fluid fasting duration and postinduction low blood pressure.

Methods

A retrospective cohort study was performed of 15,543 anesthetized children without preinduction venous access who underwent elective surgery from 2016 to 2017 at Children’s Hospital of Philadelphia. Low blood pressure was defined as systolic blood pressure lower than 2 standard deviations below the mean (approximately the 2.5th percentile) for sex- and age-specific reference values. Two epochs were assessed: epoch 1 was from induction to completion of anesthesia preparation, and epoch 2 was during surgical preparation.

Results

In epoch 1, the incidence of low systolic blood pressure was 5.2% (697 of 13,497), and no association was observed with the fluid fasting time groups: less than 4 h (4.6%, 141 of 3,081), 4 to 8 h (6.0%, 219 of 3,652), 8 to 12 h (4.9%, 124 of 2,526), and more than 12 h (5.0%, 213 of 4,238). In epoch 2, the incidence of low systolic blood pressure was 6.9% (889 of 12,917) and varied across the fasting groups: less than 4 h (5.6%, 162 of 2,918), 4 to 8 h (8.1%, 285 of 3,531), 8 to 12 h (5.9%, 143 of 2,423), and more than 12 h (7.4%, 299 of 4,045); after adjusting for confounders, fasting 4 to 8 h (adjusted odds ratio, 1.33; 95% CI, 1.07 to 1.64; P = 0.009) and greater than 12 h (adjusted odds ratio, 1.28; 95% CI, 1.04 to 1.57; P = 0.018) were associated with significantly higher odds of low systolic blood pressure compared with the group who fasted less than 4 h, whereas the increased odds of low systolic blood pressure associated with fasting 8 to 12 h (adjusted odds ratio, 1.11; 95% CI, 0.87 to 1.42; P = 0.391) was nonsignificant.

Conclusions

Longer durations of clear fluid fasting in anesthetized children were associated with increased risk of postinduction low blood pressure during surgical preparation, although this association appeared nonlinear.

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What This Article Tells Us That Is New
The View From Anne's Shoulders
Authors: Gorman Geraldine , Lusk Brigid , Clay Rebecca
Published: May 2020

In 2016, students and faculty at the University of Illinois at Chicago recreated and celebrated the life of nursing leader, Anne Larson Zimmerman (1914-2003). Students conducted archival research and oral histories. Faculty transformed their findings into a script recreating Zimmerman's life. Following months of rehearsals, 22 nursing students, directed by 2 theater students, offered 3 performances of While I am Here: The Life and Legacy of Anne Zimmerman. Audiences included Zimmerman's family, the general public, students, and nurses. Through their engagement in the project, students discovered in Zimmerman a role model for social justice leadership and deepened appreciation of nursing history's relevancy.
Biomechanical Testing of a Transmetatarsal Base Screw in Lisfranc Injuries
Authors: Fitzpatrick Sean M. , Bologna Matthew , Reynolds Alan W. , Schimoler Patrick J. , Smolinski Anne , Kharlamov Alexander , Westrick Edward , Miller Mark Carl
Published: May 2020

Objectives:

To compare displacement between the cuneiforms and metatarsals for a typical Lisfranc screw and a transmetatarsal base screw under biomechanical loading.

Methods:

Eight pairs of cadaveric feet (16 total) were evaluated. The Lisfranc ligamentous structures were transected in all specimens. All feet were repaired with screws traversing the first and second tarsometatarsal joints. A Lisfranc screw was placed from the first cuneiform to the second metatarsal in 8 specimens. A transmetatarsal base screw from the first metatarsal to the second metatarsal was placed in the remaining 8 corresponding feet. The repairs were randomized by side. Markers were placed on the dorsum of the midfoot for optical tracking. The feet were mounted into a load frame and loaded on the plantar forefoot to 100, 400, 800, and 1100 N. Displacement was measured and recorded using 3D camera tracking.

Results:

Displacement between the first cuneiform and second metatarsal base was found to be significantly less (P = 0.02) with the transmetatarsal screw than the Lisfranc screw. There were no significant differences between displacements at any other articulations.

Conclusions:

This study demonstrates biomechanical superiority using a modified transmetatarsal base screw compared with the highly used Lisfranc screw for fixation of ligamentous Lisfranc injuries.
Reliability of the Walter Reed Classification for Heterotopic Ossification Severity in Amputees
Authors: Hoyt Benjamin W. , Roach William B. , Lundy Alexander E. , D'Alleyrand Jean-Claude , Forsberg Jonathan A. , Potter Benjamin K.
Published: May 2020

Objective:

At this time, there is no validated tool for describing heterotopic ossification (HO) severity or measuring efficacy of therapies after amputation. This study aims to validate the Walter Reed classification system for reliable characterization of HO burden in residual limbs.

Design:

Descriptive, Level IV.

Setting:

US Military Trauma Referral Center.

Study Population:

Five orthopaedic surgeon raters with varying experience levels assessed orthogonal radiographs of 100 randomly selected residual upper and lower limbs after combat-related amputation.

Intervention:

A standardized education session on the Walter Reed HO classification system followed by 2 grading sessions, separated by a 2-week waiting period.

Main Outcome Measures:

Scores were analyzed for interobserver and intraobserver reliability using weighted Cohen's kappa, intraclass correlation coefficient, and Krippendorff's alpha for ordinal variables.

Results:

After the waiting period, 89% of HO was rated the same by observers with an intraobserver kappa = 0.83 (95% confidence interval [CI] 0.75–0.92). Interobserver reliability was evaluated using group-wise comparison among observers, resulting in an overall Krippendorff's alpha = 0.78 (95% CI 0.76–0.80). Using intraclass correlation coefficient, interrater consistency was 0.94 (95% CI 0.91–0.96).

Conclusions:

The Walter Reed HO classification system is substantially reliable for use by raters with any level of orthopaedic training. In addition, it is reliable for evaluation of both through bone and disarticulation type amputations in the upper and lower extremities. However, in 11% of cases, a secondary read may vary, suggesting that this system is useful for understanding HO and developing interventions but may benefit from further refinement, including advanced imaging and clinical correlation.
The Fibular Intramedullary Nail Versus Locking Plate and Lag Screw Fixation in the Management of Unstable Elderly Ankle Fractures: A Cadaveric Biomechanical Comparison
Authors: Carter Thomas H. , Wallace Robert , Mackenzie Samuel A. , Oliver William M. , Duckworth Andrew D. , White Timothy O.
Published: May 2020

Objectives:

To compare the biomechanical failure properties of the fibular intramedullary nail with locking plate and lag screw fixation in the management of unstable elderly distal fibular fractures.

Methods:

Twelve fresh-frozen cadaveric lower limbs (6 matched-pairs) were studied. A simulated OTA/AO 44-B fracture was created, then randomly allocated within each pair to intramedullary nail or locking plate fixation supplemented with an interfragmentary lag screw. The limbs were secured with the foot rigidly held in 20 degrees of supination, loaded to 700N and subjected to progressive external rotation until failure.

Results:

The mean specimen age was 86.5 years (61–97). Mean torque to failure was greater in the intramedullary nail group, but did not reach statistical significance (23.5 N·m vs. 21.6 N·m; P = 0.463). The nail failed at a significantly greater angle of rotation compared with plate fixation (66.5 degrees vs. 53.3 degrees; P = 0.046). There was no significant difference between the groups with respect to construct stiffness (P = 0.673) or energy absorbed (P = 0.075). The locking plate specimens failed through plate and screw construct pull off at the implant-bone interface. In contrast, the intramedullary nail specimens failed at the lateral ligament complex, whereas the fracture-implant construct remained intact.

Conclusion:

Intramedullary nailing and locking plate fixation have similar biomechanical characteristics when tested to failure. The benefits of the minimally invasive surgery offered by the intramedullary nail make it an attractive implant in the management of these patients.
Malunions and Nonunions of the Acromion and Coracoid Proceses: A Comparison of Functional Outcomes Before and After Reconstruction
Authors: Ogunleye Temi D. , Schirmers Joseph , Gilbertson Jeffrey A. , Schroder Lisa K. , Cole Peter A.
Published: May 2020

Objectives:

To assess surgical and functional outcomes in a cohort of patients having operatively reconstructed scapula process malunions and/or nonunions.

Design:

Retrospective case series.

Setting:

Level I trauma center.

Patients/Participants:

Between 2003 and 2018, we identified 16 patients who presented to our institution with symptoms associated with a nonunion or malunion of closed, displaced fractures of the scapula processes after acute injury mechanisms.

Intervention:

Surgical osteotomy of the malunion or debridement of the nonunion and subsequent reconstruction.

Main Outcome Measurements:

The primary outcome measured included range of motion, strength, and DASH. Return to work was a secondary outcome.

Results:

Among 13 of the 16 (81%) patients with ≥12 months follow-up, the mean follow-up was 34 months (range, 12–112 months). Three patients were lost to follow-up. The mean DASH score improved from 56.4 ± 22.4 preoperatively to 23.4 ± 22.2 postoperatively (P < 0.001). Among the patients with ≥1-year follow-up, range of motion improved from preoperative to final follow-up in abduction (P = 0.020). Among the 15 of 16 patients for whom occupation data are available, 73% either returned to their original occupation (n = 7) or did not due to reasons other than their reconstructive surgery (n = 4). Two postoperative complications occurred including failure of acromion nonunion fixation at 4 months and went on to heal after revision surgery. All reconstructions united without malunion.

Conclusions:

Reconstruction of the scapula process malunion and nonunion is possible, providing restoration of function and symptom relief, with a low complication rate.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Thoracoscopic Vertebral Body Tethering for Adolescent Idiopathic Scoliosis: A Minimum of 2 Years’ Results of 21 Patients
Authors: Pehlivanoglu Tuna , Oltulu Ismail , Ofluoglu Ender , Sarioglu Ender , Altun Guray , Korkmaz Murat , Yildirim Kerem , Aydogan Mehmet
Published: May 2020

Background:

Anterior vertebral body tethering (VBT) is a growth modulating and fusionless treatment option that is considered as a new promising method for the management of adolescent idiopathic scoliosis (AIS). This prospective cohort study aimed to present the minimum 2-year results of anterior VBT applied to 21 skeletally immature patients with AIS.

Methods:

Twenty-one skeletally immature patients with a diagnosis of AIS were included. A decision to proceed with surgery was established after the detection of curve progression despite the brace (>40 degrees) with a minimum curve flexibility of 30%.

Results:

Patients had an average age of 11.1 and an average follow-up period of 27.4 months. All patients underwent thoracoscopic placement of thoracic screws, from the convex side of curves. An average of 7.1 levels of tethering was undertaken. Average preoperative major thoracic curve magnitudes improved from 48.2 to 16 degrees on the first erect postoperative x-ray, and to 10 degrees at the last follow-up (P<0.001). Immediate postoperatively, 1 case with chylothorax was detected and treated conservatively, and another case with tether breakage was detected at the third postoperative year and replaced thoracoscopically. No other major complication was acquired.

Conclusions:

Anterior VBT as a growth modulating treatment option by allowing the correction of the scoliotic deformity and preserving coronal balance was detected to be a safe and effective option for the surgical treatment of AIS in skeletally immature patients, if applied under strict inclusion criteria. VBT by allowing preservation of spinal segmental motion is yielding promising radiographic results without causing any major complications.

Level of Evidence:

Level IV.
Intramuscular Liposomal Bupivacaine Decreases Length of Stay and Opioid Usage Following Lumbar Spinal Fusion
Authors: Roh Michael S. , Kucher Oksana A. , Shick Kyle M. , Knolhoff Daniel R. , McGarvey Jeremy S. , Peterson Susan C.
Published: May 2020

Study Design:

A retrospective cohort review.

Objectives:

The objective of this study was to investigate the efficacy of liposomal bupivacaine (LB) in patients undergoing lumbar spinal fusion.

Summary of Background Data:

Historically, posterior spinal fusion has been recognized as a particularly painful surgery. Postoperative pain limits early patient mobilization and discharge, and negatively impacts patient satisfaction. Local infiltration of anesthetic agents combined with postoperative multimodal pain management is common. On the basis of existing data, the liposomal formulation of bupivacaine might play a role in promoting faster recovery during the immediate postoperative period. The purpose of this study was to investigate the potential impact of LB on postoperative opioid requirements, ambulation, and duration of hospital stay, as well as potential health care cost savings.

Materials and Methods:

A historical cohort of adult lumbar spinal fusion patients was retrospectively evaluated, in which 105 patients received nonliposomal anesthetic and 105 received LB. Both groups were managed with a standardized postoperative analgesia regimen. Demographic information, opioid consumption, length of stay, distance ambulated, and total cost of inpatient stay were collected.

Results:

Although there was no difference in the pain scores between the 2 groups, the LB group was associated with significantly lower opioid usage throughout the postoperative period. More patients in the LB group were discharged within 2 days of surgery compared with the control group (88.6% vs. 38.1%, P<0.05). The control group was able to walk for a longer median distances (175 vs. 150 ft, P=0.02) on the first attempt, however, a significantly larger proportion of the LB group walked within the first 12 hours after surgery (61% vs. 3%, P<0.001). Also, LB usage was associated with $218 higher pharmacological cost compared with the control group but an overall $3035 lower cost for the entire hospitalization (P<0.001).

Conclusion:

Adjunctive usage of LB with lumbar fusion surgeries promotes earlier mobility, lower opioid consumption, and shorter length of stay resulting in overall lower health care cost.

Level of Evidence:

Level III.
Arthroscopic “S”-shaped Ligamentoplasty for Floating Lunate
Authors: Corella Fernando , Ocampos Montserrat , Laredo Rafael , Tabuenca Jose , Corella Miguel Angel , Larrainzar-Garijo Ricardo
Published: May 2020

The concurrence of tears of the scapholunate (SL) and lunotriquetral (LT) ligaments is not unusual and can also occur without an apparent perilunate dislocation. Badia and Khanchandani called this combined lesion a “floating lunate” because the ligamentous attachments on both sides of the lunate are absent and the lunate floats in a neutral position. There have been few published papers referring to the treatment of this kind of instability. In recent years, we have developed an arthroscopic ligamentoplasty for SL instability. However, this procedure is not indicated whether the LT ligament is also damaged. With this current modification, both the strongest portions of the SL and LT ligaments can be reconstructed without opening the joint, thereby avoiding an open approach. We have described this as an “S”-shaped ligamentoplasty, as the graft resembles an “S” as it travels inside the scaphoid, lunate, and triquetrum. The same postoperative early mobilization protocol can be applied to this kind of reconstruction.
Corrective Metacarpal Osteotomy With Intramedullary Screw Fixation: Technique and Case Report
Authors: Koh Aaron Eu Wen , Tong Pei Yein , Vaikunthan Rajaratnam
Published: May 2020

Metacarpal malunion with significant angulation leading to symptoms from bony prominence in the palm or dorsum and decreased grip strength occur rarely, but may lead to patients requiring surgical correction. Corrective osteotomy procedures with plate fixation are commonly performed for these patients. Localizing the correct site of osteotomy and the required amount of bone removal for precise correction is difficult even with adequate preoperative planning. After osteotomy, plate osteosynthesis is the most common fixation method to allow for early mobilization; however, plate osteosynthesis can lead to soft tissue irritation, which may necessitate secondary surgeries for tenolysis and implant removal. This case study highlights our use of an intramedullary wire as an additional guide to the ideal site of osteotomy and then the use of an intramedullary screw for stabilization of the osteotomy site.
Extracorporeal Membrane Oxygenation for Coronavirus Disease 2019-Induced Acute Respiratory Distress Syndrome: A Multicenter Descriptive Study*
Authors: Yang Xiao , Cai Shuhan , Luo Yun , Zhu Fangfang , Hu Ming , Zhao Yan , Zheng Ruiqiang , Li Xuyan , Hu Bo , Peng Zhiyong
Published: May 2020

Objectives:

Severe acute respiratory distress syndrome is complicated with coronavirus disease 2019 and extracorporeal membrane oxygenation support may be necessary in severe cases. This study is to summarize the clinical features, extracorporeal membrane oxygenation characteristics, and outcomes of patients with severe acute respiratory syndrome coronavirus 2 pneumonia received extracorporeal membrane oxygenation.

Design:

Descriptive study from two hospitals.

Setting:

The ICUs from university hospitals.

Patients:

Patients with severe acute respiratory syndrome coronavirus 2 pneumonia received mechanical ventilation, including those underwent extracorporeal membrane oxygenation from Zhongnan Hospital of Wuhan University and Wuhan Pulmonary Hospital from January 8, 2020, to March 31, 2020.

Interventions:

None.

Measurements and Main Results:

Clinical records, laboratory results, ventilator parameters, and extracorporeal membrane oxygenation-related data were abstracted from the medical records. One-hundred twenty-nine critically ill patients with severe acute respiratory syndrome coronavirus 2 pneumonia were admitted to ICU of the two referral hospitals. Fifty-nine patients received mechanical ventilation and 21 of them received extracorporeal membrane oxygenation support (fourteen from Zhongnan hospital and seven from Wuhan pulmonary hospital). Compared to mechanical ventilation patients without extracorporeal membrane oxygenation support, there was a tendency of decline in mortality but with no significant difference (no-extracorporeal membrane oxygenation group 24/38 [63.2%] vs extracorporeal membrane oxygenation group 12/21 [57.1%]; p = 0.782). For those patients with extracorporeal membrane oxygenation, 12 patients died and nine survived by April 7, 2020. Among extracorporeal membrane oxygenation patients, the Paco
2 prior to extracorporeal membrane oxygenation was lower (54.40 mm Hg [29.20–57.50 mm Hg] vs 63.20 mm Hg [55.40–72.12 mm Hg]; p = 0.006), and pH prior to extracorporeal membrane oxygenation was higher (7.38 [7.28–7.48] vs 7.23 [7.16–7.33]; p = 0.023) in survivors than nonsurvivors.

Conclusions:

Extracorporeal membrane oxygenation might be an effective salvage treatment for patients with severe acute respiratory syndrome coronavirus 2 pneumonia associated with severe acute respiratory distress syndrome. Severe Co
2 retention and acidosis prior to extracorporeal membrane oxygenation indicated a poor prognosis.