bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of the efficacy of small-incision clamp-assisted reduction and open reduction for the treatment of femoral shaft fractures with an anterograde intramedullary nail: a retrospective study
Authors: Lin Shufeng , Zhang Zefeng , Yan Yipeng , Li Yizhong , Lin Jinkuang , Ye Hui
Published: March 2022

Background

To compare the efficacy of small-incision clamp-assisted reduction with open reduction for the treatment of femoral shaft fractures by anterograde intramedullary nailing.

Methods

The data of 63 patients with femoral shaft fractures, treated between January 2016 and June 2021, were retrospectively analyzed. All patients received anterograde intramedullary nail fixation, and the OA/OTA classification of fractures was 32-C. The average follow-up period was 13 months (range: 11–14 months). According to the method of fracture reduction, patients were divided into a small-incision clamp-reduction group (referred to as the clamp-reduction group) and an open-reduction group. The reduction time, operative time, the number of fluoroscopy, intraoperative blood loss, postoperative VAS score, postoperative time to discharge, and the rates of intraoperative and postoperative complications were compared between the two groups.

Results

There were statistically significant differences in reduction time, operative time, the number of fluoroscopy, intraoperative blood loss, postoperative VAS score, postoperative time to discharge (t = 6.718, − 11.679, 18.963, − 11.609, − 22.432, − 7.187; P < 0.05). In the clamp-reduction group, there was no intraoperative blood transfusion. However, there were one case of wound infection and one case of deep vein thrombosis after operation. In the open-reduction group, ten patients received intraoperative blood transfusion, one patient developed hemorrhagic shock, two patients developed wound infection, and two patients developed bone nonunion during follow-up.

Conclusions

Both groups had good functional recovery after operation. However, compared with open reduction, clamp reduction is a safer reduction method with shorter operation time, less intraoperative blood loss, less postoperative pain, shorter hospital stay and fewer postoperative complications.
Effects of different positive end-expiratory pressure titration strategies during prone positioning in patients with acute respiratory distress syndrome: a prospective interventional study
Authors: Boesing Christoph , Graf Peter T. , Schmitt Fabian , Thiel Manfred , Pelosi Paolo , Rocco Patricia R. M. , Luecke Thomas , Krebs Joerg
Published: March 2022

Background

Prone positioning in combination with the application of low tidal volume and adequate positive end-expiratory pressure (PEEP) improves survival in patients with moderate to severe acute respiratory distress syndrome (ARDS). However, the effects of PEEP on end-expiratory transpulmonary pressure (Ptpexp) during prone positioning require clarification. For this purpose, the effects of three different PEEP titration strategies on Ptpexp, respiratory mechanics, mechanical power, gas exchange, and hemodynamics were evaluated comparing supine and prone positioning.

Methods

In forty consecutive patients with moderate to severe ARDS protective ventilation with PEEP titrated according to three different titration strategies was evaluated during supine and prone positioning: (A) ARDS Network recommendations (PEEPARDSNetwork), (B) the lowest static elastance of the respiratory system (PEEPEstat,RS), and (C) targeting a positive Ptpexp (PEEPPtpexp). The primary endpoint was to analyze whether Ptpexp differed significantly according to PEEP titration strategy during supine and prone positioning.

Results

Ptpexp increased progressively with prone positioning compared with supine positioning as well as with PEEPEstat,RS and PEEPPtpexp compared with PEEPARDSNetwork (positioning effect p < 0.001, PEEP strategy effect p < 0.001). PEEP was lower during prone positioning with PEEPEstat,RS and PEEPPtpexp (positioning effect p < 0.001, PEEP strategy effect p < 0.001). During supine positioning, mechanical power increased progressively with PEEPEstat,RS and PEEPPtpexp compared with PEEPARDSNetwork, and prone positioning attenuated this effect (positioning effect p < 0.001, PEEP strategy effect p < 0.001). Prone compared with supine positioning significantly improved oxygenation (positioning effect p < 0.001, PEEP strategy effect p < 0.001) while hemodynamics remained stable in both positions.

Conclusions

Prone positioning increased transpulmonary pressures while improving oxygenation and hemodynamics in patients with moderate to severe ARDS when PEEP was titrated according to the ARDS Network lower PEEP table. This PEEP titration strategy minimized parameters associated with ventilator-induced lung injury induction, such as transpulmonary driving pressure and mechanical power. We propose that a lower PEEP strategy (PEEPARDSNetwork) in combination with prone positioning may be part of a lung protective ventilation strategy in patients with moderate to severe ARDS.

Trial registration

German Clinical Trials Register (DRKS00017449). Registered June 27, 2019. https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00017449
Observed efficacy and clinically important improvements in participants with osteoarthritis treated with subcutaneous tanezumab: results from a 56-week randomized NSAID-controlled study
Authors: Neogi Tuhina , Hunter David J. , Churchill Melvin , Shirinsky Ivan , White Alexander , Guermazi Ali , Omata Masanari , Fountaine Robert J. , Pixton Glenn , Viktrup Lars , Brown Mark T. , West Christine R. , Verburg Kenneth M.
Published: March 2022

Background

A recent phase 3 study demonstrated that treatment with tanezumab, a nerve growth factor inhibitor, or nonsteroidal anti-inflammatory drugs (NSAIDs) improves pain and physical function in participants with moderate-to-severe osteoarthritis (OA) of the hip or knee. Here, we evaluated the time course and clinical importance of these initial efficacy findings using a mixture of primary, secondary, and post hoc endpoints.

Methods

Participants on stable NSAID therapy and with a history of inadequate response to other standard OA analgesics were enrolled in an 80-week (56-week treatment/24-week safety follow-up), randomized, NSAID-controlled, phase 3 study primarily designed to assess the safety of tanezumab for moderate-to-severe OA of the knee or hip. Participants received oral NSAID (twice daily naproxen, celecoxib, or diclofenac) or subcutaneous tanezumab (2.5mg or 5mg every 8 weeks). Non-responders were discontinued at week 16. Changes from baseline in WOMAC Pain and Physical Function, Patient’s Global Assessment of Osteoarthritis (PGA-OA), and average pain in the index joint were compared between tanezumab and NSAID groups over the 56-week treatment period. Clinically meaningful response (e.g., ≥30% and ≥50% improvement in WOMAC Pain and Physical Function), rescue medication use, and safety were also assessed.

Results

All groups improved WOMAC Pain, WOMAC Physical Function, PGA-OA, and average pain in the index joint over the 56-week treatment period relative to baseline. Across all groups, improvements generally occurred from the time of first assessment (week 1 or 2) to week 16 and then slightly decreased from week 16 to 24 before stabilizing from weeks 24 to 56. The magnitude of improvement and the proportion of participants achieving ≥30% and ≥50% improvement in these measures was greater (unadjusted p≤0.05) with tanezumab than with NSAID at some timepoints on or before week 16. Adverse events of abnormal peripheral sensation, prespecified joint safety events, and total joint replacement surgery occurred more frequently with tanezumab than with NSAID.

Conclusions

Tanezumab and NSAID both provided early and sustained (up to 56 weeks) efficacy relative to baseline. Improvements in pain and function were clinically meaningful in a substantial proportion of participants. Adverse events of abnormal peripheral sensation and joint safety events occurred more frequently with tanezumab than with NSAID.

Trial registration

ClinicalTrials.govNCT02528188. Registered on 19 July 2015.
Acute effects of beetroot juice and caffeine co-ingestion during a team-sport-specific intermittent exercise test in semi-professional soccer players: a randomized, double-blind, placebo-controlled study
Authors: Berjisian Erfan , McGawley Kerry , Saunders Bryan , Domínguez Raúl , Koozehchian Majid S. , de Oliveira Caio Victor Coutinho , Rafiei Ramin , Miraftabi Hossein , Sarshin Amir , Naderi Alireza
Published: March 2022

Background

Beetroot juice (BJ) and caffeine (CAF) are considered as ergogenic aids among athletes to enhance performance, however, the ergogenic effects of BJ and CAF co-ingestion are unclear during team-sport-specific performance. This study aimed to investigate the acute effects of BJ and CAF co-ingestion on team-sport-specific performance, compared with placebo (PL), BJ, and CAF alone.

Method

Sixteen semi-professional male soccer players (age: 19.8 ± 2.2 years, body mass: 69.2 ± 6.1 kg, height: 177.3 ± 6.0 cm) completed four experimental trials using a randomized, double-blind study design: BJ + CAF, CAF + PL, BJ + PL, and PL + PL. Countermovement jump with arm swing (CMJAS) performance and cognitive function by Stroop Word-Color test were evaluated before and after the Yo–Yo Intermittent Recovery Test level 1 (YYIR1). Also, rate of perceived exertion (RPE), heart rate, and gastrointestinal (GI) discomfort were measured during each session.

Results

No significant differences were shown between test conditions for total distance covered in YYIR1 (BJ + CAF: 1858 ± 455 m, CAF + PL: 1798 ± 422 m, BJ + PL: 1845 ± 408 m, PL + PL 1740 ± 362 m; p = 0.55). Moreover, CMJAS performance, cognitive function, and RPE during the YYIR1 were not significantly different among conditions (p > 0.05). However, the average heart rate during the YYIR1 was higher in CAF + PL compared to PL + PL (by 6 ± 9 beats/min; p < 0.05), and GI distress was greater in BJ + CAF compared to PL + PL (by 2.4 ± 3.6 a.u.; p < 0.05).

Conclusion

These results suggest, neither acute co-ingestion of BJ + CAF nor BJ or CAF supplementation alone significantly affected team-sport-specific performance compared to the PL treatment.
Optical scan and 3D printing guided radiation therapy – an application and provincial experience in cutaneous nasal carcinoma
Authors: Cheng Jui Chih , Dubey Arbind , Beck James , Sasaki David , Leylek Ahmet , Rathod Shrinivas
Published: March 2022

Background

Single field Orthovoltage radiation is an acceptable modality used for the treatment of nasal cutaneous cancer. However, this technique has dosimetric pitfalls and unnecessary excessive exposure of radiation to organs at risk (OAR). We present the clinical outcome of a case series of cutaneous nasal tumours using a novel technique incorporating an optical scanner and a 3-dimensional (3D) printer to deliver treatments using parallel opposed (POP) fields.

Materials and methods

The POP delivery method was validated using ion chamber and phantom measurements before implementation. A retrospective chart review of 26 patients treated with this technique between 2015 and 2019 was conducted. Patients’ demographics and treatment outcomes were gathered and tabulated. These patients first underwent an optical scan of their faces to collect topographical data. The data were then transcribed into 3D printing algorithms, and positive impressions of the faces were printed. Custom nose block bolus was made with wax encased in an acrylic shell; 4 cm thick using the printed face models. Custom lead shielding was also generated. Treatments were delivered using 250 KeV photons POP arrangement with 4 cm diameter circle applicator cone and prescribed to the midplane. Dose and fractionation were as per physician discretion.

Results

Phantom measurements at mid-plane were found to match the prescribed dose within ±0.5%. For the 26 cases in this review, the median age was 78.5 years, with 15 females and 11 males. 85% of cases had Basal cell carcinoma (BCC); 1 had squamous cell carcinoma (SCC), one had synchronous BCC + SCC, and 1 had Merkel cell carcinoma. Twenty-one cases had T1N0 disease, 4 had T2N0, and 1 had T3N0. Dose and fractionation delivered were 40Gy in 10 fractions for the majority of cases. The complete response rate at a median follow-up of 6 months was 88%; 1 patient had a refractory tumour, and one patient had a recurrence. Toxicities were minor with 81% with no reported side effects. Three patients experienced grade 3 skin toxicity.

Conclusions

Utilization of optic scanner and 3D printing technology, with the innovative approach of using POP orthovoltage beams, allows an effective and efficient way of treatment carcinomas of the nose with a high control rate and low toxicity profiles.
Effectiveness of cognitive–behavioural therapies of varying complexity in reducing depression in adults: systematic review and network meta-analysis
Authors: Angelakis Ioannis , Huggett Charlotte , Gooding Patricia , Panagioti Maria , Hodkinson Alexander
Published: March 2022

Background

Cognitive–behavioural therapy (CBT) is frequently used as an umbrella term to include a variety of psychological interventions. It remains unclear whether more complex CBT contributes to greater depression reduction.

Aims

To (a) compare the effectiveness of core, complex and ultra-complex CBT against other psychological intervention, medication, treatment-as-usual and no treatment in reducing depression at post-treatment and in the long term and (b) explore important factors that could moderate the effectiveness of these interventions.

Method

MEDLINE, PsycInfo, Embase, Web of Science and the Cochrane Register of Controlled Trials were searched to November 2021. Only randomised controlled trials were eligible for the subsequent network meta-analysis.

Results

We included 107 studies based on 15 248 participants. Core (s.m.d. = −1.14, 95% credible interval (CrI) −1.72 to −0.55 [m.d. = −8.44]), complex (s.m.d. = −1.24, 95% CrI −1.85 to −0.64 [m.d. = −9.18]) and ultra-complex CBT (s.m.d. = −1.45, 95% CrI −1.88 to −1.02 [m.d. = −10.73]) were all significant in reducing depression up to 6 months from treatment onset. The significant benefits of the ultra-complex (s.m.d. = −1.09, 95% CrI −1.61 to −0.56 [m.d. = −8.07]) and complex CBT (s.m.d. = −0.73, 95% CrI −1.36 to −0.11 [m.d. = −5.40]) extended beyond 6 months. Ultra-complex CBT was most effective in individuals presenting comorbid mental health problems and when delivered by non-mental health specialists. Ultra-complex and complex CBT were more effective for people younger than 59 years.

Conclusions

For people without comorbid conditions healthcare and policy organisations should invest in core CBT. For people <59 years of age with comorbid conditions investments should focus on ultra-complex and complex CBT delivered without the help of mental health professionals.
Enhancing the Interpretation of the "Greater Southwest"
Authors: Saffell Cameron L.
Published: March 2022

In an introduction to papers from the 2003 Agricultural History Society (AHS) symposium, the author discusses the need for international exchange and contributions to the scholarship of a cross-border region that some scholars call the "Greater Southwest." Monographs from several disciplines dealing with this geographic area--the portion of southwestern North America that straddles the Southwestern United States and Northern Mexico--have often been specialized examinations that do not overlap in geography or time. Increased understanding of the region is becoming more imperative, and it recently has gained more attention from academia. This symposium offered a chance to add to the body of knowledge, plus have a venue where academics from the United States and Mexico could meet to exchange scholarship. The meeting also marked the return of an Agricultural History Society symposium to an agricultural museum and an invitation for public school teachers to hear current interpretations directly from scholars and museum professionals.
The Country Life Commission: Reconsidering a Milestone in American Agricultural History
Authors: Peters Scott J. , Morgan Paul A.
Published: March 2022

Theodore Roosevelt charged his 1908 Country Life Commission with looking into the deficiencies of agriculture and country life and the means by which they might be remedied. Though some scholars have judged it a positive milestone in American agricultural history, prevailing assessments are critical, negative, and often conflicting. Critics view it as an example of patronizing, technocratic social engineering aimed at urbanizing and industrializing the countryside to benefit national and industrial economic interests. Yet this interpretation is inconsistent with the commission’s report. Rather than offering a technocratic program to engineer agriculture and country life, the report is one of the first high-profile, comprehensive attempts to outline a broad-gauge vision of sustainability in American agriculture. It reflects an ecological sensitivity and a variant of Progressive Era reform devoted to key civic and economic ideals. Though flawed, the commission’s vision of agriculture and country life deserves to be seen as a milestone in the story for the struggle for sustainability.
A Nineteenth–Century Resource for Agricultural History Research in the Twenty–First Century
Authors: Atack Jeremy
Published: March 2022

The paper announces the imminent availability of a major extension of the well-known Bateman-Foust sample. This new resource will contain linked agricultural and population census data between 1850 and 1880 for thousands of individuals in an expanded group of townships including some from the Pacific Coast states and Massachusetts and has in excess of 220,000 person-observations. The paper discusses a number of problems and complications associated with the creation of this retrospective panel database. It also shows how these data may be linked to other computer-searchable data-bases and resources (such as land records) and discusses the impact of personal and family characteristics on persistence and the likelihood of record linkage within the sample townships using a panel from a completed subsection of the project.
"Fifty–Four Days Work of Two Negroes": Enslaved Labor in Colonial Somerset County, Maryland
Authors: Russo J. Elliott
Published: March 2022

The uses of enslaved labor outside the context of staple crop production become evident through an examination of colonial Somerset County, the southernmost Maryland county on the Chesapeake Bay’s Eastern Shore. By the early eighteenth century, conditions in Somerset amounted to something of a paradox. The county’s planters were thoroughly embedded in the larger Chesapeake plantation society and replicated, insofar as they were able, the features of that society, including the use of slave labor and cultivation of tobacco. Yet poor soil conditions pushed residents to the edges of the tobacco economy. Unable to grow tobacco profitably, Somerset’s men and women identified alternative export commodities that were more suited to the resources at hand, including lumber, meat, and ships. In addition, many Somerset residents were active in an expanding coastwide trade that linked economic activity in the county to markets elsewhere in the colonies. Russo examines the allocation of enslaved labor in Somerset’s diversified economy using information drawn from judicial, tax, probate, and land records. Consideration of the evidence for Somerset County indicates that scholars need to devote more attention to the characteristics of slavery in anomalous areas that exist within broad staple-producing regions.
The Old World in the New South: Entrepreneurial Ventures and the Agricultural History of Cullman County, Alabama
Authors: Davis Robert S.
Published: March 2022

The story of the creation of Cullman County in the post Civil War South has been the subject of propaganda and myth that has gone far beyond Alabama. German immigrants from Cincinnati, Ohio, founded an agricultural community that traditional accounts credit with bringing about an agricultural revolution in what had been a frontier area, in the best traditions of innovation in the New South. The reality of Cullman County’s history proves more valuable to understanding southern farming than the rosy legends. Hard geographical and social realties clashed with the often impractical vision of colonizer John G. Cullmann. His Germans, with their traditional work ethic and willingness to experiment with such new products as wine and strawberries, did try, sometimes unsuccessfully, to make practical changes in southern farming. Far more families from neighboring Georgia answered Cullmann’s call, and they implemented the traditional southern cotton culture. Living among both groups were local white and black farm families from before the arrival of the Germans who also struggled in their own ways to survive. How these groups failed, succeeded, and remained outlines just how limited could be the success of even the best laid plans in what remained all too much a part of the traditional South.
Clearing Swamps, Harvesting Forests: Trees and the Making of a Plantation Landscape in the Colonial South Carolina Lowcountry
Authors: Edelson S. Max
Published: March 2022

English colonists and African slaves began occupying the South Carolina Lowcountry in the late seventeenth century. During the eighteenth century thousands of slaves cleared thousands of acres of swamplands to create the colony’s signature rice fields and secure its place within the Atlantic economy. This essay examines the changing perceptions and uses of trees as the key to understanding how planters transformed a perceived wilderness into one of British America’s wealthiest and most repressive plantation societies. Colonists used trees to assess and understand the land’s capacity for market agriculture. Slaves cleared land of its wood to prepare the terrain for planting, provide Britain’s empire with vital commodities, and build the infrastructure of daily material life in the region. As colonists and slaves came into sustained engagement with this landscape they learned to exploit its distinctive natural resources more intensively. This transformation is better understood as a process of agricultural adaptation than as an episode in environmental degradation.
"Be Receptive to the Good Earth": Health, Nature, and Labor in Countercultural Back–to–the–Land Settlements
Authors: Edgington Ryan H.
Published: March 2022

Modern environmental activists unified behind calls for a change in how humans understood their relationships with nature. Yet they approached their concerns through a variety of historical lenses. Countering arguments that suggest environmentalism had its deepest roots in outdoor leisure, the countercultural back-to-the-land movement turned to a markedly American practice of pastoral mythmaking that held rural life and labor as counter to the urban-industrial condition. Counterculturalists relied specifically on notions of simple work in rural collective endeavors as the means to producing a healthy body and environment. Yet the individuals who went back-to-the-land often failed to remedy conflicts that arose as they attempted to abandon American consumer practices and take up a "primitive" and down-to-earth pastoral existence. Contact with rural nature time and again translated to physical maladies, impoverishment, and community clashes in many rural countercultural communes. As the back-to-the-land encounter faded, the greater movement’s ethos did not disappear. Counterculturalists used the consumption of nature through rural labor as a fundamental idea in a growing cooperative food movement. The back-to-the-land belief in the connection between healthy bodies, environments, a collective identity helped to expand a new form of consumer environmentalism.
Ranching Modernization in Tropical Brazil: Foreign Investment and Environment in Mato Grosso, 1900–1950
Authors: Wilcox Robert W.
Published: March 2022

Accompanying the expansion of modern beef production in the nineteenth and twentieth centuries were technologies and methods that proponents assumed were applicable to all ecosystems. Successes in Europe, the United States, and Argentina convinced ranchers, investors, and animal scientists that these could be applied in the tropical Americas with ease. This assumption contributed to a wave of foreign ranching investment in semi-tropical Mato Grosso, Brazil, beginning in the early twentieth century. However, such a view failed to consider the specific characteristics of such environments and led to difficulties for several ventures and a re-evaluation of the relationship between ecosystems and the type of ranching appropriate to them. Ultimately, local Brazilian practice and experimentation proved more successful in tropical and semi-tropical Brazil, forcing foreign ranching concerns to adapt their techniques. Following the logic of earlier decades, more recently cattle-raising practices developed in Mato Grosso and similar regions have been applied in the tropical Amazon, resulting in widespread ecological devastation. The uneven experiences of foreign entrepreneurs in Mato Grosso offer valuable lessons for understanding the application of modernization technologies to diverse ecosystems; such knowledge can lead to a more sustainable approach to meat production.
Landlords and Tenants in the Wake of Abolition and Ecological Devastation in Brazil’s Middle Paraíba Valley
Authors: CROCITTI JOHN J.
Published: March 2022

This article uses Barra do Piraí as a case study of rural land tenure, production, consumption, and labor in Brazil’s Middle Paraíba Valley during the half century following abolition of slavery in 1888. Dairy farming and railroad development distinguished Barra do Piraífrom other coffee-producing areas that suffered from ecological devastation. By 1900 the land’s loss of fertility precluded further plantation agriculture in Barra do Pir aí, leading to the transition from lucrative coffee cultivation to dairy farming based on meager capital inputs. Compared to the earlier coffee culture, dairy farms produced only modest wealth for landlords and required fewer laborers, compelling impoverished tenants to migrate in search of employment. Since Barra do Piraí was an important railroad junction, many rural laborers ended up in the locale after using the railroad as a migratory path. At the same time, the railroad and proto-industries that it stimulated provided alternative employment for rural laborers, thereby partially mitigating the leverage landlords had over the abundant labor force. The availability of industrial and proto-industrial employment created occupational diversity among rural tenants and introduced them to work routines that would become commonplace when the region more fully industrialized after 1940.
This Land Ain’t My Land: The Eviction of Sharecroppers by the Farm Security Administration
Authors: ADAMS JANE , GORTON D.
Published: March 2022

The New Deal resettlement communities appear in the literature as efforts to ameliorate the wretched condition of southern sharecroppers and tenants.However, those evicted to make way for the new settlers are virtually invisible in the historic record. The resettlement projects were part of larger efforts to modernize rural America. "Modernization" is a complex process whereby a relatively specific set of assumptions and behaviors make other assumptions and behaviors "wrong, "both morally and pragmatically. The removal of former tenants and their replacement by FSA clients in the lower Mississippi alluvial plain — the Delta — reveals core elements of New Deal modernizing policies, exposing key concepts that guided the FSA’s tenant removals: the definition of rural poverty as rooted in the problem of tenancy; the belief that economic success entailed particular cultural practices and social forms; and the commitment by those with political power to gain local support. These assumptions undergirded acceptance of racial segregation and the criteria used to select new settlers. Alternatives could only become visible through political or legal action — capacities sharecroppers seldom had. However, in succeeding decades, these modernizing assumptions created conditions for Delta African Americans on resettlement projects to challenge white supremacy.
An Unremembered Diversity: Mixed Husbandry and the American Grasslands
Authors: SYLVESTER KENNETH , CUNFER GEOFF
Published: March 2022

The Green Revolution of the 1960s brought about a dramatic rise in global crop yields. But, as most observers acknowledge, this has come at a considerable cost to biodiversity. Plant breeding, synthetic fertilizers, and mechanization steadily narrowed the number of crop varieties commercially available to farmers and promoted fencerow-to-fencerow monocultures. Many historians trace the origins of this style of industrialized agriculture to the last great plow-up of the Great Plains in the 1920s. In the literature, farms in the plains are often described metaphorically as wheat factories, degrading successive landscapes. While in many ways these farms were a departure from earlier forms of husbandry in the American experience, monocultures were quite rare during the early transformation of the plains. Analysis of a large representative sample, based on manuscript agricultural censuses and involving twenty-five townships across the state of Kansas, demonstrates that diverse production reached even the most challenging of plains landscapes.
"Hop to the Top with the Iowa Chop": The Iowa Porkettes and Cultivating Agrarian Feminisms in the Midwest, 1964–1992
Authors: DEVINE JENNY BARKER
Published: March 2022

Over the course of twenty-eight years, between 1964 and 1991, members of the Iowa Porkettes, the women’s auxiliary to the Iowa Pork Producer’s Association (IPPA), promoted pork products in order to assert their roles as agricultural producers. For the members of the Porkettes, technological change and the growth of agribusiness provided new opportunities to challenge patriarchal hierarchies in agricultural organizations. Over time, as the overall number of ho g farmers declined and the agricultural marketplace increasingly demanded professional expertise, the Porkettes transformed a women’s auxiliary into a female-led commodity organization. Initially, members participated in appropriately ’’ feminine" activities including Pork Queen contests, lard-baking contests, consultations with high school home economics instructors, and the distribution of promotional materials. By the late 1970s, however, members began to employ a new rhetoric shaped by their labor on the farm to claim an important stake in the production and marketing of commodities. They took responsibility for large-scale advertising campaigns, managed a growing budget, and became leaders within the IPPA. Their experiences offer insight into broader developments of second wave agrarian feminisms that enabled farm women’s organizations to renegotiate
Suppositionality, Virtuality, and Chinese Cinema
Authors: McGrath Jason
Published: March 2022

In Chinese performance arts, one thing that was largely abandoned in the shift from traditional drama to motion pictures was the suppositionality of Chinese operatic performance, and the transition to digital cinema, particularly in the case of big-budget blockbusters that compete for mass audiences in greater China as well as abroad, raises the question of if and how an aesthetic of suppositionality is related to the emerging virtual realism enabled by computer-generated imagery (CGI). The concept of suppositionality not only helps us to evaluate how contemporary Chinese animation and CGI blockbusters remediate premodern cultural narratives but also provides an analytical measure for approaching the growing phenomenon of motion capture and composited performances. The “virtual realism” of CGI frees Chinese filmmakers to reject the ontological realism of photography and instead favor an aggressively animated style of visual effects while returning actors to a reprise of the suppositional performance style of traditional opera.
185 Safety of Venous Thromboembolism Chemoprophylaxis Following Traumatic Intracranial Hemorrhage
Authors: Boulter Jason H. , Szuflita Nicholas S. , Porambo Michael , Dewar Callum D. , Woodle Samuel , Scanlon Michaela , Shields Margaret , Meister Melissa , Brennan Alexandra , Bailey Zachary , Scultetus Anke , Shear Deborah , Ahlers Stephen , Tigno Teodoro A. , Reed Aaron , Dengler Bradley , Bell Randy S.
Published: March 2022

INTRODUCTION:

Post-traumatic brain injury (TBI) venous thromboembolic (VTE) disease represents a serious complication which occurs not infrequently given the hypercoagulable state of trauma. Unfortunately, VTE chemoprophylaxis has historically been limited by concerns for intracranial hemorrhagic expansion.

METHODS:

The Joint Trauma System was queried for United States service members with blast or penetrating TBIs. Data regarding demographics, injury characteristics, and VTE chemoprophylaxis administration were collected and the imaging database was searched for pre- and post-chemoprophylaxis head CTs. All identified hemorrhages were volumetrically analyzed and pre- and post-chemoprophylactic hemorrhage volumes were compared.

RESULTS:

383 patients were identified from the Joint Trauma System. Of those, 136 patients were found to have 393 hemorrhages with a majority being intraparenchymal (55.0%). The mean hemorrhage volume was 3.2cc (SD = 8.1cc) with a mean time from injury to first chemoprophylaxis dose of 71.5 hours (SD = 36.2 hours). There was a significant reduction in volume between the pre- and post-chemoprophylaxis head CTs (3.2cc [SD = 8.1cc] vs 3.0cc [SD = 7.8cc], p = 0.024). When analyzed by time from injury to chemoprophylaxis, there was no difference for patients who received prophylaxis within 48 hours of injury (N = 95, pre: 2.2cc [SD = 4.2cc], post: 2.2cc [SD = 4.9cc], p = 0.964) or within 24 hours of injury (N = 27, pre: 1.8cc [SD = 3.9cc], post: 1.4cc [SD = 2.4cc], p = 0.304). Similarly, when patients were stratified by type of injury, there was no significant difference in hemorrhage volume after chemoprophylaxis administration in patients with closed (N = 137, pre: 1.8cc [SD = 4.2cc], post: 1.5cc [SD = 3.2cc], p = 0.180) or penetrating injuries (N = 233, pre: 4.1cc [SD = 9.5cc], post: 3.8cc [SD = 9.4cc], p = 0.068). Finally, an analysis of larger injuries (defined as hemorrhages greater than 5cc) demonstrated a significant reduction in hemorrhage volume following chemoprophylaxis administration (N = 64, pre: 14.8cc [SD = 14.4cc], post: 12.9cc [SD = 14.9cc], p = 0.003).

CONCLUSION:

These data suggest that administration of chemoprophylaxis within as little as 24 hours from hemorrhagic TBI does not result in hemorrhage expansion in closed or penetrating injuries irrespective of the volume of damaged tissue.
187 Ketamine and Spinal Fusion Surgery: Does It Increase or Reduce Postoperative Opioid Consumption? A Systematic Review and Meta-Analysis of Randomized Controlled Trial
Authors: Wijaya Jeremiah Hilkiah , Wong Edbert
Published: March 2022

INTRODUCTION:

Ketamine is a commonly used anesthetic that can also be used for analgesia and sedation. However, none has examined its role in spinal fusion surgery.

METHODS:

Using the keywords ketamine, spinal fusion surgery, postoperative, and opioid, each reviewer individually carried out a literature search from PubMed, EuroPMC, and Cochrane CENTRAL until May 15, 2021. We only included studies with the adult population, a randomized controlled trial design, English language publications, and reported the key exposure. Additionally, only fully reviewed literature was included. We also excluded non-human literature. The primary endpoint was morphine consumption after 24 and 48 hours of undertaking surgery, whereas secondary endpoints were pain and complications. The pain was analyzed using the visual analogue scale (VAS). We performed a standardized mean difference meta-analysis for postoperative morphine consumption and pain. For complications, we reported the odds ratio as the pooled effect estimate. Each studies quality included was assessed using the Newcastle-Ottawa Scale.

RESULTS:

We included four notable studies in this study (n = 515). 34.5% male and 65.5% female with the mean age of 45.4 years old. We found that intraoperative ketamine administration were associated with lower postoperative opioid consumption -38.35 mg (95% CI -53.18, -23.52), decreased VAS score -0.83 (95% CI -1.26, -0.39), and lower postoperative complications (OR 0.80, 95% CI 0.60, 1.06).

CONCLUSION:

Ketamine administration intraoperatively resulted in a considerable reduction in morphine intake, decreased pain, and fewer adverse reactions in spinal fusion surgery patients.
189 Arterial Hypertension Independently Predicts Recurrence After Microvascular Decompression for Trigeminal Neuralgia—A Modifiable Risk Factor as a Key Component
Authors: Pinto Vasco S. , Sousa Sérgio , Silva Carla , Calheiros Alfredo
Published: March 2022

INTRODUCTION:

Microvascular decompression is highly effective for the management of classical refractory trigeminal neuralgia. Nonetheless, predictors of post-operative prognosis are incompletely understood.

METHODS:

We performed a retrospective analysis of the classical trigeminal neuralgia cases submitted to microvascular decompression in our center between 2003 and 2019. 57 patients were identified and pre-op clinical and imagiological characteristics, surgical findings, complications and pain control – both immediate and long-term – were described. Outcome was measured using the Barrow Neurological Institute Pain Intensity Score (BNIPIS).

RESULTS:

Mean age at procedure was 63.9 years, with a female predominance (66.7%). Most symptoms were in the V2 and V3 territory and the most common trigger identified was mastication. History of arterial hypertension was identified in 49.1%. Vascular contact at surgery was identified in almost all patients (97.6%). Regarding pain outcome results, at 6 months post-op, 80.7% of patients had a good recovery (BNIPIS = 3). This result was maintained at 12 months, with 78.9% of patients having a good outcome. At long follow-up (median 77 months), 82.5% of patients had a BNIPIS = 3, with 50% achieving a BNIPIS 1. Recurrence was identified in 37.3% of patients, with a median of 44 months. On multivariate analysis, hypertension was independently associated with recurrence (OR = 4.9; 95% CI 1.2-19.3; p = 0.023).

CONCLUSION:

Microvascular decompression is a valuable resource for managing refractory trigeminal neuralgia. Factors associated with recurrence are poorly understood. Arterial hypertension, a potentially modifiable risk factor, might be a recurrence predictor, possibly by modulating local vascular phenomena. Better understanding of the pathophysiology involved can provide physicians means to overcome this incapacitating disease.
195 3D Genome Structure and Epigenetic Transcription Regulation in Pediatric High-Grade Glioma
Authors: Saratsis Amanda M. , Huang Tina , Wang Juan , Hu Ye , Piunti Andrea , Bartom Elizabeth , Shilatifard Ali , Yue Feng
Published: March 2022

INTRODUCTION:

Pediatric high-grade gliomas (pHGGs), including glioblastoma multiforme (GBM) and diffuse intrinsic pontine glioma (DIPG), are highly morbid brain tumors. Up to 80% of DIPGs harbor a somatic missense mutation in genes encoding Histone H3. To investigate whether the H3K27M mutant protein is associated with distinct chromatin structure affecting transcription regulation, we generated the first high-resolution Hi-C and ATAC-Seq maps of pHGG cell lines, and integrated these with tissue and cell genomic data.

METHODS:

We sequenced patient-derived cell lines (DIPG n = 6, GBM n = 3, normal n = 2) and frozen tissue specimens (DIPG n = 1, normal brainstem n = 1). Analyses included cell line RNA-Seq, ChIP-Seq (H3K27ac, H3K27me3, H3K27M) and genome-wide chromatin conformation capture (Hi-C), as well as tissue ATAC-Seq. Publicly available pediatric glioma tissue ChIP-Seq data was integrated with cell data.

RESULTS:

We identified tumor-specific enhancers and regulatory networks for known oncogenes in DIPG and GBM. In DIPG, FOX, SOX, and STAT families were among top H3K27Ac enriched motifs. Significant differences in Topologically Associating Domains (TADs) and DNA looping were observed at OLIG2 and MYCN in H3K27M mutant DIPG, relative to wild-type GBM and normal cells. Pharmacologic treatment targeting H3K27Ac (BET and Bromodomain inhibition) altered these 3D structures. Functional analysis of differentially enriched enhancers in DIPG implicated SOX2, SUZ12, and TRIM24 as top activated upstream regulators. Distinct genomic structural variations leading to enhancer hijacking and gene co-amplification were identified at A2M, JAG2, and FLRT1.

CONCLUSION:

We show genome structural variations enhancer-promoter interactions that impact gene expression in pHGG in the presence and absence of the H3K27M mutation. Our results imply that tridimensional genome alterations may play a critical role in the pHGG epigenetic landscape and thereby contribute to pediatric gliomagenesis. Further studies examining the impact of the alterations are therefore underway.
301 1000 Cases of Surgically Treated Aneurysmal Subarachnoid Haemorrhage: Changes in Practice and Clinical Outcomes
Authors: Budohoski Karol P. , Tajsic Tamara , Bal Jarnail , Levrini Virginia , Guilfoyle Mathew , Helmy Adel , Kirkpatrick Peter , Kirollos Ramez , Trivedi Rikin
Published: March 2022

INTRODUCTION:

Aneurysmal subarachnoid haemorrhage (aSAH) remains a complex and multidisciplinary pathology. With endovascular methods expanding fewer patients are treated surgically.

METHODS:

All patients following surgery for aSAH between 2007 - 2019 were included. Baseline characteristics outcomes were analysed. We compared outcomes between experienced (=50 independent cases) and non-experienced surgeons (<50 independent cases), and high-volume (=20 cases/year) and low-volume surgeons (<20 cases/year).

RESULTS:

970 patients with 1003 aneurysms were identified with median age 56. 73.8% were WFNS grade 1 or 2. The majority of aneurysm were on the middle cerebral artery (41.4%), anterior communicating artery (27.6%) and posterior communicating artery (17.5%). 37.4% of aneurysm were <7 mm in size. Technical error rate was 6%, resulting in a post-operative infarct in 4.9% of patients. 19 patients (2%) died within 30 days of admission. There were no significant changes in technical error rates or post-operative infarcts or death (p = 0.79 and p = 0.77 respectively) over the study period. There was no difference in post-operative infarctions between experienced and non-experienced surgeons (p = 0.28), but there was a difference when comparing high-volume vs. low-volume surgeons (p = 028).

CONCLUSION:

We present real world data on surgical indications and outcomes after aSAH. We believe that this constitutes important data demonstrating good retention of skills and good clinical outcomes in a very dynamic field of cerebrovascular surgery. We also demonstrate a relationship between surgical case volume and outcomes.
305 Characterizing and Comparing Brain Injury Associated With Traditional Self-Retracting Brain Retractors With Novel Tubular Retractors
Authors: Naeem Abdul , Dryden Georgia , Hammond Robert , Speechley Mark , Wade Kevin A. , Boulton Melfort R.
Published: March 2022

INTRODUCTION:

Tubular retractors are FDA approved and in the Neurosurgical marketplace, but adaptation has been hampered by lack of evidence showing superiority over traditional retractors when performing subcortical surgery.

METHODS:

Nine porcine models underwent a simulated neurosurgical operation. Retractors were inserted for four hours after which the porcine model was euthanized. The en-bloc extracted porcine brain was fixed in 10% formalin, paraffin embedded, sectioned at 4 um and stained with hematoxylin and eosin (H&E) using standard laboratory protocols. Computer algorithms were generated to calculate areas of cerebral edema and hemorrhage adjacent to retractor surfaces.

RESULTS:

Using a two-tailed t-test with a significance level of 0.05, traditional brain retractors were associated with statistically significantly greater cerebral edema when compared to tubular retractors (17.36 um2 vs. 12.42 um2; p = 0.0038). There was no statistically significant difference in mean areas of hemorrhage between traditional brain retractors and tubular retractors noted (3.43 um2 vs 3.60 um2; p = 0.8297).

CONCLUSION:

Tubular retractors are associated with significantly less edema in surrounding brain than traditional retractors. On histopathological merits, this study supports the application of tubular retractors over traditional retractors.
314 Spinal Versus General Anesthesia for Lumbar Spine Surgery: Prospective Analysis of Quality of Life, Postoperative Fatigue and Cognitive Dysfunction
Authors: De Biase Gaetano , Gruenbaum Shaun , Quinones-Hinojosa Alfredo , Abode-Iyamah Kingsley
Published: March 2022

INTRODUCTION:

Low back pain is the leading cause of years lost to disability worldwide, and this burden is increasing as our population ages. Postoperative fatigue and postoperative cognitive dysfunction (POCD) commonly affect patients during their recovery period and diminish their quality of life. There has recently been increasing interest in the use of spinal anesthesia (SA) for lumbar spine surgery. To date the literature that has compared spine surgery under SA versus general anesthesia (GA) has been focused exclusively on safety, perioperative outcomes and costs.

METHODS:

We conducted a prospective non-randomized study in patients undergoing elective lumbar spine surgery under SA or GA by a single surgeon. Fatigue was assessed with a fatigue VAS scale (0-10) and with Chalder Fatigue Scale (CFQ); quality of life with the Medical Outcomes Study 12-item Short Form (SF-12); differences in cognition with the Mini-Mental State Exam(MMSE). Patients were assessed before the surgery to acquire their baseline and again 1 month after surgery.

RESULTS:

Fifty patients completed the study, 25 underwent surgery under spinal and 25 under general anesthesia. The groups were homogeneous for baseline clinical characteristics; with no differences in preoperative baseline fatigue, quality of life and cognition, and physical and mental components of the SF-12 between the SA and GA groups. At 1-month after surgery spinal anesthesia when compared to general anesthesia had better fatigue scores: i) fatigue VAS (2.9 ± 1.5 versus 5.6 ± 2.3, (p < 0.0001)); ii) fatigue CFQ (11.2 ± 3.1 versus 16.5 ± 3.9 (p < 0.0001)). At 1-month after surgery we observed a significant difference in the physical component of SF-12, spinal anesthesia having 38.8 ± 8.9 versus 29.4 ± 10.3 (p = 0.002). We did not observe significant postoperative differences in mental component of SF-12. There was no significant difference in MMSE at 1-month follow-up.

CONCLUSION:

At 1 month postop patients that underwent surgery under spinal anesthesia had less postoperative fatigue and better quality of life.