bluuebunny/crossref_metadata_2025 huggingface dataset:
COVID-19: On the Disparity in Outcomes Between Military and Civilian Populations
Authors: Riley Pete , Ben-Nun Michal , Turtle James , Bacon David , Owens Akeisha N , Riley Steven
Published: October 2021

Introduction

The CoronaVirus Disease 2019 (COVID-19) pandemic remains a formidable threat to populations around the world. The U.S. Military, in particular, represents a unique and distinguishable subset of the population, primarily due to the age and gender of active duty personnel. Current investigations have focused on health outcome forecasts for civilian populations, making them of limited value for military planning.

Materials and Methods

We have developed and applied an age-structured susceptible, exposed, infectious, recovered, or dead compartmental model for both civilian and military populations, driven by estimates of the time-dependent reproduction number, R(t), which can be both fit to available data and also forecast future cases, intensive care unit (ICU) patients, and deaths.

Results

We show that the expected health outcomes for active duty military populations are substantially different than for civilian populations of the same size. Specifically, while the number of cases is not expected to differ dramatically, severity, both in terms of ICU burdens and deaths, is substantially lower.

Conclusions

Our results confirm that the burden placed on military health centers will be substantially lower than that for equivalent-sized civilian populations. More practically, the tool we have developed to investigate this (https://q.predsci.com/covid19/) can be used by military health planners to estimate the resources needed in particular locations based on current estimates of the transmission profiles of COVID-19 within the surrounding civilian population in which the military installation is embedded. As this tool continues to be developed, it can be used to assess the likely impact of different intervention strategies, as well as vaccine policies; both for the current pandemic as well as future ones.
Association of Military Employment With Late-Life Cognitive Decline and Dementia: A Population-Based Prospective Cohort Study
Authors: Power Melinda C , Murphy Alia E , Gianattasio Kan Z , Zhang Y i , Walker Rod L , Crane Paul K , Larson Eric B , Gibbons Laura E , Kumar Raj G , Dams-O’Connor Kristen
Published: October 2021

Introduction

As the number of U.S. veterans over age 65 has increased, interest in whether military service affects late-life health outcomes has grown. Whether military employment is associated with increased risk of cognitive decline and dementia remains unclear.

Materials and Methods

We used data from 4,370 participants of the longitudinal Adult Changes in Thought (ACT) cohort study, enrolled at age 65 or older, to examine whether military employment was associated with greater cognitive decline or higher risk of incident dementia in late life. We classified persons as having military employment if their first or second-longest occupation was with the military. Cognitive status was assessed at each biennial Adult Changes in Thought study visit using the Cognitive Abilities Screening Instrument, scored using item response theory (CASI-IRT). Participants meeting screening criteria were referred for dementia ascertainment involving clinical examination and additional cognitive testing. Primary analyses were adjusted for sociodemographic characteristics and APOE genotype. Secondary analyses additionally adjusted for indicators of early-life socioeconomic status and considered effect modification by age, gender, and prior traumatic brain injury with loss of consciousness TBI with LOC.

Results

Overall, 6% of participants had military employment; of these, 76% were males. Military employment was not significantly associated with cognitive change (difference in modeled 10-year cognitive change in CASI-IRT scores in SD units (95% confidence interval [CI]): −0.042 (−0.19, 0.11), risk of dementia (hazard ratio [HR] [95% CI]: 0.92 [0.71, 1.18]), or risk of Alzheimer’s disease dementia (HR [95% CI]: 0.93 [0.70, 1.23]). These results were robust to additional adjustment and sensitivity analyses. There was no evidence of effect modification by age, gender, or traumatic brain injury with loss of consciousness.

Conclusions

Among members of the Adult Changes in Thought cohort, military employment was not associated with increased risk of cognitive decline or dementia. Nevertheless, military veterans face the same high risks for cognitive decline and dementia as other aging adults.
Dermatofibrosarcoma Protuberans in Active Duty Military Personnel: A Case Report
Authors: Nam Soyun , Park Jae Berm , Kim Hyun-Chul
Published: October 2021

Dermatofibrosarcoma protuberans (DFSP) is an uncommon, soft tissue sarcoma with a high rate of local recurrence, low rate of distant metastasis, and infiltrative growth. We report two cases of DFSP in young active duty military personnel. Both cases underwent primary excision at the Armed Forces Capital Hospital with positive surgical margins and underwent re-excision at Samsung Medical Center. Dermatofibrosarcoma protuberans is a rare finding, and wide local excision with or without skin flap remains the procedure of choice. Awareness of DFSP in young patients is important for proper diagnosis and treatment and to achieve local control. Complete excision of the tumor with a clear surgical margin and thorough surveillance after surgery are recommended for service members to maintain their active duty status and to prevent ineffective combat conditions.
Susceptibility testing of Prototheca bovis isolates from cases of bovine mastitis using the CLSI reference broth microdilution method and the Sensititre YeastOne colorimetric panel
Authors: Álvarez-Pérez Sergio , Anega Blanca , Díaz-de-Tuesta Juan A , González-Martín Juan V , Riesgo-Martínez Mercedes , García Marta E , Blanco José L
Published: October 2021

A total of 62 Prototheca bovis isolates from cases of bovine mastitis were tested for susceptibility to different antifungal compounds by the Clinical and Laboratory Standards Institute (CLSI) reference microdilution method and a commercial colorimetric microdilution panel (Sensititre YeastOne). All isolates displayed low susceptibility to echinocandins (MICs > 8 μg/ml for anidulafungin, caspofungin, and micafungin), flucytosine (MIC > 64 μg/ml), and the azoles enilconazole and fluconazole (MICs > 4 and > 64 μg/ml, respectively). Moreover, 45.2, 32.3, and 1.6% of isolates had MICs > 4 μg/ml for ketoconazole, terbinafine, and voriconazole, respectively, when tested by the CLSI method. In contrast, all isolates were more susceptible to the polyene compounds amphotericin B and nystatin, and itraconazole, posaconazole, and ravuconazole (MICs ≤ 2 μg/ml, in all cases). Comparison of the results obtained in the CLSI and Sensititre methods showed excellent essential agreement (EA) for azoles (98.4% for itraconazole and posaconazole, and 100% for voriconazole) and moderate EA for amphotericin B (72.6%), when MICs were read after 48 and 24 h of incubation, respectively. In contrast, much lower EA values were obtained in some cases when the MICs for both techniques were determined after 48 h of incubation (e.g., 9.7% for amphotericin B and 69.4% for posaconazole). Therefore, the CLSI broth microdilution method and the Sensititre YeastOne panel can be used indistinctly for susceptibility testing of P. bovis isolates against azoles but not against amphotericin B until further optimization of the test conditions.

Lay summary

The antifungal susceptibility of Prototheca bovis isolates was analyzed. All tested isolates displayed low susceptibility to echinocandins, flucytosine, and some azoles. Excellent agreement of the results of two different test methods was obtained for azoles, but not for the polyene amphotericin B.
The BAyesian STellar algorithm (BASTA): a fitting tool for stellar studies, asteroseismology, exoplanets, and Galactic archaeology
Authors: Aguirre Børsen-Koch V , Rørsted J L , Justesen A B , Stokholm A , Verma K , Winther M L , Knudstrup E , Nielsen K B , Sahlholdt C , Larsen J R , Cassisi S , Serenelli A M , Casagrande L , Christensen-Dalsgaard J , Davies G R , Ferguson J W , Lund M N , Weiss A , White T R
Published: October 2021

We introduce the public version of the BAyesian STellar Algorithm (BASTA), an open-source code written in Python to determine stellar properties based on a set of astrophysical observables. BASTA has been specifically designed to robustly combine large data sets that include asteroseismology, spectroscopy, photometry, and astrometry. We describe the large number of asteroseismic observations that can be fit by the code and how these can be combined with atmospheric properties (as well as parallaxes and apparent magnitudes), making it the most complete analysis pipeline available for oscillating main-sequence, subgiant, and red giant stars. BASTA relies on a set of pre-built stellar isochrones or a custom-designed library of stellar tracks, which can be further refined using our interpolation method (both along and across stellar tracks or isochrones). We perform recovery tests with simulated data that reveal levels of accuracy at the few percent level for radii, masses, and ages when individual oscillation frequencies are considered, and show that asteroseismic ages with statistical uncertainties below 10 per cent are within reach if our stellar models are reliable representations of stars. BASTAis extensively documented and includes a suite of examples to support easy adoption and further development by new users.
Polarization properties of FRB 20201124A from detections with the Effelsberg 100-m radio telescope
Authors: Hilmarsson G H , Spitler L G , Main R A , Li D Z
Published: October 2021

The repeating fast radio burst (FRB) source, FRB 20201124A, was found to be highly active in 2021 March and April. We observed the source with the Effelsberg 100-m radio telescope at 1.36 GHz on 2021 April 9 and detected 20 bursts. A downward drift in frequency over time is clearly seen from the majority of bursts in our sample. A structure-maximizing dispersion measure (DM) search on the multicomponent bursts in our sample yields a DM of 411.6 ± 0.6 pc cm−3. We find that the rotation measure (RM) of the bursts varies around their weighted mean value of −601 rad m−2 with a standard deviation of 11.1 rad m−2. This RM magnitude is 10 times larger than the expected Galactic contribution along this line of sight (LoS). We estimate an LoS magnetic field strength of 4–6 µG, assuming that the entire host galaxy DM contributes to the RM. Further polarization measurements will help determine FRB 20201124A’s RM stability. The bursts are highly linearly polarized, with some showing signs of circular polarization, the first for a repeating FRB. Their polarization position angles (PAs) are flat across the burst envelopes and vary between bursts. We argue that the varying polarization fractions and PAs of FRB 20201124A are similar to known magnetospheric emission from pulsars, while the observed circular polarization, combined with the RM variability, is hard to explain with Faraday conversion. The high linear polarization fractions, flat PAs, and downward drift from FRB 20201124A bursts are similar to previous repeating sources, while the observed circular polarization is a newly seen behaviour among repeaters.
Nanobase.org: a repository for DNA and RNA nanostructures
Authors: Poppleton Erik , Mallya Aatmik , Dey Swarup , Joseph Joel , Šulc Petr
Published: October 2021

We introduce a new online database of nucleic acid nanostructures for the field of DNA and RNA nanotechnology. The database implements an upload interface, searching and database browsing. Each deposited nanostructures includes an image of the nanostructure, design file, an optional 3D view, and additional metadata such as experimental data, protocol or literature reference. The database accepts nanostructures in any preferred format used by the uploader for the nanostructure design. We further provide a set of conversion tools that encourage design file conversion into common formats (oxDNA and PDB) that can be used for setting up simulations, interactive editing or 3D visualization. The aim of the repository is to provide to the DNA/RNA nanotechnology community a resource for sharing their designs for further reuse in other systems and also to function as an archive of the designs that have been achieved in the field so far. Nanobase.org is available at https://nanobase.org/.
Effectiveness of Neural Mobilization Techniques in the Management of Musculoskeletal Neck Disorders with Nerve-Related Symptoms: A Systematic Review and Meta-Analysis with a Mapping Report
Authors: Varangot-Reille Clovis , Cuenca-Martínez Ferran , Arribas-Romano Alberto , Bertoletti-Rodríguez Rodrigo , Gutiérrez-Martín Álvaro , Mateo-Perrino Fernando , Suso-Martí Luis , Blanco-Díaz María , Calatayud Joaquín , Casaña José
Published: October 2021

Objective

The objective was to assess the effectiveness of neural mobilization (NM) techniques in the management of musculoskeletal neck disorders with nerve-related symptoms (MND-NRS).

Methods

We conducted a systematic review with meta-analysis, using pain intensity, disability, perceived function, cervical range of motion, and mechanosensitivity as the main outcome measures.

Results

The systematic review included 22 studies (n = 978). More favorable outcomes were observed for NM on pain intensity compared with control interventions (standardized mean differences (SMDs) −0.92; 95% CI −1.66−0.18), but not compared with other treatments (OTs) (SMD 1.06; 95% CI −0.02 to 2.15). Regarding neck pain intensity, no significant differences were found in favor of NM compared with OTs (SMD 0.37; 95% CI −0.35 to 1.1). However, between-treatment differences were found in favor of OT on arm-pain intensity (SMD 0.57; 95% CI 0.08–1.05). In addition, the grouped MA did not show statistically significant differences between NM and OT outcomes on the cervical range of motion (SMD 0.16; 95% CI −0.06 to 0.38). However, compared with no intervention, NM was associated with significantly improved outcomes in cervical rotation (SMD 0.91; 95% CI 0.61–1.22). Similar results were found regarding disability (SMD −0.08; 95% CI −0.36−0.20, and SMD −1.44; 95% CI −2.28−0.6, respectively). Finally, NM was associated with more favorable outcomes on mechanosensitivity compared with OT (SMD 0.79; 95% CI 0.15–1.42) and greater improvements in function compared with no intervention (SMD 0.89; 95% CI 0.16–1.62).

Conclusions

NM appeared to be effective to improve overall pain intensity when embedded in a physiotherapy treatment in the management of MND-NRS. When compared with no intervention, it was effective to improve neck rotation, disability, and function. However, it was not superior to other types of treatments in improving overall pain intensity, neck pain intensity, arm pain intensity, cervical range of motion and disability, except for mechanosensitivity.
CXCL13 predicts long-term radiographic status in early rheumatoid arthritis
Authors: Greisen Stinne R , Mikkelsen Clara , Hetland Merete L , Østergaard Mikkel , Hørslev-Petersen Kim , Junker Peter , Stengaard-Petersen Kristian , Deleuran Bent
Published: October 2021

Objectives

Identification of RA patients at a high risk of joint destruction remains challenging. The C-X-C motif chemokine 13 (CXCL13) has previously been suggested as a marker of disease activity in RA. Here, we investigate the potential of plasma CXCL13 as a marker of long-term radiographic status and progression.

Methods

CXCL13 was measured in plasma from treatment-naïve RA patients (n = 158) with an 11-year follow-up. At baseline, clinical and biochemical DASs were obtained; among these CRP, ESR, DAS in 28 joints with CRP (DAS28CRP), number of swollen joints (SJC28) and radiographic status, evaluated by total Sharp score (TSS). Age- and gender-matched healthy controls (HCs) were included.

Results

CXCL13 was significantly increased at baseline and decreased during treatment; however, it was not reduced to the level in HCs. At baseline, CXCL13 was associated with both CRP and ESR, but not with other markers of disease activity. Baseline CXCL13 was correlated with both TSS and radiographic progression (ΔTSS) at 11 years. With an 89% probability, levels of CXCL13 above 85 pg/ml predicted the risk of a TSS of 5 or above, after 11 years of treatment. Compared with CRP, DAS28CRP, SJC28 and ACPA status, CXCL13 was superior in predicting 11-year joint destruction.

Conclusion

In early RA, one single measurement of plasma CXCL13 at baseline is superior to currently used clinical and serological disease markers in the prediction of long-term radiographic status and progression.
Pressure Support versus Spontaneous Ventilation during Anesthetic Emergence—Effect on Postoperative Atelectasis: A Randomized Controlled Trial
Authors: Jeong Heejoon , Tanatporn Pisitpitayasaree , Ahn Hyun Joo , Yang Mikyung , Kim Jie Ae , Yeo Hyean , Kim Woojin
Published: October 2021

Background

Despite previous reports suggesting that pressure support ventilation facilitates weaning from mechanical ventilation in the intensive care unit, few studies have assessed its effects on recovery from anesthesia. The authors hypothesized that pressure support ventilation during emergence from anesthesia reduces postoperative atelectasis in patients undergoing laparoscopic surgery using the Trendelenburg position.

Methods

In this randomized controlled double-blinded trial, adult patients undergoing laparoscopic colectomy or robot-assisted prostatectomy were assigned to either the pressure support (n = 50) or the control group (n = 50). During emergence (from the end of surgery to extubation), pressure support ventilation was used in the pressure support group versus intermittent manual assistance in the control group. The primary outcome was the incidence of atelectasis diagnosed by lung ultrasonography at the postanesthesia care unit (PACU). The secondary outcomes were Pao
2 at PACU and oxygen saturation measured by pulse oximetry less than 92% during 48 h postoperatively.

Results

Ninety-seven patients were included in the analysis. The duration of emergence was 9 min and 8 min in the pressure support and control groups, respectively. The incidence of atelectasis at PACU was lower in the pressure support group compared to that in the control group (pressure support vs. control, 16 of 48 [33%] vs. 28 of 49 [57%]; risk ratio, 0.58; 95% CI, 0.35 to 0.91; P = 0.024). In the PACU, Pao
2 in the pressure support group was higher than that in the control group (92 ± 26 mmHg vs. 83 ± 13 mmHg; P = 0.034). The incidence of oxygen saturation measured by pulse oximetry less than 92% during 48 h postoperatively was not different between the groups (9 of 48 [19%] vs. 11 of 49 [22%]; P = 0.653). There were no adverse events related to the study protocol.

Conclusions

The incidence of postoperative atelectasis was lower in patients undergoing either laparoscopic colectomy or robot-assisted prostatectomy who received pressure support ventilation during emergence from general anesthesia compared to those receiving intermittent manual assistance.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Multiple Cases of Auditory Neuropathy Illuminate the Importance of Subcortical Neural Synchrony for Speech-in-noise Recognition and the Frequency-following Response
Authors: White-Schwoch Travis , Anderson Samira , Krizman Jennifer , Bonacina Silvia , Nicol Trent , Bradlow Ann R. , Kraus Nina
Published: October 2021

Objectives:

The role of subcortical synchrony in speech-in-noise (SIN) recognition and the frequency-following response (FFR) was examined in multiple listeners with auditory neuropathy. Although an absent FFR has been documented in one listener with idiopathic neuropathy who has severe difficulty recognizing SIN, several etiologies cause the neuropathy phenotype. Consequently, it is necessary to replicate absent FFRs and concomitant SIN difficulties in patients with multiple sources and clinical presentations of neuropathy to elucidate fully the importance of subcortical neural synchrony for the FFR and SIN recognition.

Design:

Case series. Three children with auditory neuropathy (two males with neuropathy attributed to hyperbilirubinemia, one female with a rare missense mutation in the OPA1 gene) were compared to age-matched controls with normal hearing (52 for electrophysiology and 48 for speech recognition testing). Tests included standard audiological evaluations, FFRs, and sentence recognition in noise. The three children with neuropathy had a range of clinical presentations, including moderate sensorineural hearing loss, use of a cochlear implant, and a rapid progressive hearing loss.

Results:

Children with neuropathy generally had good speech recognition in quiet but substantial difficulties in noise. These SIN difficulties were somewhat mitigated by a clear speaking style and presenting words in a high semantic context. In the children with neuropathy, FFRs were absent from all tested stimuli. In contrast, age-matched controls had reliable FFRs.

Conclusion:

Subcortical synchrony is subject to multiple forms of disruption but results in a consistent phenotype of an absent FFR and substantial difficulties recognizing SIN. These results support the hypothesis that subcortical synchrony is necessary for the FFR. Thus, in healthy listeners, the FFR may reflect subcortical neural processes important for SIN recognition.
Clamp Assisted Reduction of the Transverse Acetabular Fracture With Anterior Column Screw Fixation and Posterior Plating: A Technical Trick and Case Series
Authors: Mitchell Phillip M. , Shaath M. Kareem , Routt Milton “Chip”
Published: October 2021

Displaced transverse acetabular fractures are unstable injuries that frequently require repair. Although multiple approaches, techniques, and fixation constructs have been described to treat this pattern, achieving an anatomical reduction and applying fixation to maintain this until union remains the goal of treatment. We present a surgical technique for transverse or transverse/posterior wall acetabular fractures repaired using a clamp-assisted reduction through the sciatic notch, followed by anterior column screw fixation and subsequent posterior column plating through a Kocher–Langenbeck exposure. We review a case series of 55 patients treated with this technique and evaluate reduction quality using postoperative computed tomogram scans to assess for any residual step-off.
Anterior Intrapelvic Plating of the Sacroiliac Joint—A Cadaveric Quantification of Visualized Area with Case Series
Authors: Shofoluwe Ademola , Bruggers Jennifer , Becher Stephen
Published: October 2021

The objective of this study was to quantitatively describe the area available on the sacrum for reduction and plating using the Anterior Intrapelvic approach and describe its use clinically in a case series. The area available for plate and screw placement on 5 cadavers was on average 1007 ± 231 mm3. The cranial/caudal dimension at greatest length was 39.78 ± 6.91 mm, and the greatest length medial to the sacroiliac joint was 30.91 ± 3.43 mm. The major anatomic restraints to visualization were the S1 nerve root and the external and internal iliac vessels. Large fragment plates had an area overlying the sacrum of 360 mm3, and all sacrum had an area for at least two plates. The exposure was succesfully used for reduction, fixation and direct inspection of neural elements in 4 patients, demonstrating the anterior intrapelvic approach can be expanded to the lateral sacrum.
No Difference in the Rates of Unplanned Return to the Operating Room Between Magnetically Controlled Growing Rods and Traditional Growth Friendly Surgery for Children With Cerebral Palsy
Authors: Sun Margaret Man-Ger , Buckler Nicholas J. , Al Nouri Mason , Howard Jason J. , Vaughan Majella , St. Hilaire Tricia , Sponseller Paul D. , Smith John T. , Thompson George H. , El-Hawary Ron
Published: October 2021

Background:

Early-onset scoliosis (EOS) is common in children with cerebral palsy (CP). The effectiveness of magnetically controlled growing rods (MCGR) and the risk for unplanned return to the operating room (UPROR) remain to be studied in this patient population. The primary outcome of this study was to examine the frequency of UPROR between MCGRs as compared with traditional growth friendly (TGF) surgeries for children with EOS secondary to CP.

Methods:

Patients with EOS secondary to CP were prospectively identified from an international database, with data retrospectively analyzed. Scoliosis, kyphosis, T1-S1, and T1-T12 height were measured preoperation, immediate postoperation, and at minimum 2-year follow-up. The risk and etiology of UPRORs were compared between MCGR and TGF.

Results:

Of the 120 patients that met inclusion criteria, 86 received TGF (age 7.5±0. 1.8 y; mean follow-up 7.0±2.9 y) and 34 received MCGR (age 7.1±2.2 y, mean follow-up 2.8±0.0.5 y). Compared with TGF, MCGR resulted in significant improvements in maintenance of scoliosis (P=0.007). At final follow-up, UPRORs were 8 of 34 patients (24%) for MCGR and 37 of 86 patients (43%) for TGF (P=0.05). To minimize the influence of follow-up period, UPRORs within the first 2 years postoperation were evaluated: MCGR (7 of 34 patients, 21%) versus TGF (20 of 86 patients, 23%; P=0.75). Within the first 2 years, etiology of UPROR as a percentage of all patients per group were deep infection (13% TGF, 6% MCGR), implant failure/migration (12% TGF, 9% MCGR), dehiscence (4% TGF, 3% MCGR), and superficial infection (4% TGF, 3% MCGR). The most common etiology of UPROR for TGF was deep infection and for MCGR was implant failure/migration.

Conclusion:

For patients with EOS secondary to CP, there was no difference in the risk of UPROR within the first 2 years postoperatively whether treated with TGF surgery or with MCGRs (23% TGF, 21% MCGR).

Level of Evidence:

Level III—retrospective cohort, therapeutic study.
Does the Choice of Spinal Interbody Fusion Approach Significantly Affect Adjacent Segment Mobility?
Authors: Wangsawatwong Piyanat , Sawa Anna G.U. , Pereira Bernardo de Andrada , Lehrman Jennifer N. , Turner Jay D. , Uribe Juan S. , Kelly Brian P.
Published: October 2021

Study Design.

Biomechanical study of range of motion (ROM) at the vertebral levels adjacent to the construct of posterior pedicle screw-rod fixation with different types of lumbar interbody fusion techniques (LIF).

Objective.

To investigate the differences in adjacent segment mobility among three types of LIF: lateral lumbar interbody fusion (LLIF), transforaminal lumbar interbody fusion (TLIF), and posterior lumbar interbody fusion (PLIF).

Summary of Background Data.

Previous studies have concluded that LLIF, TLIF, and PLIF with posterior pedicle screw-rod fixation (PSR) provide equivalent stability in cadaveric specimens and are comparable in fusion rate and functional outcome. However, long-term complications, such as adjacent segment degeneration associated with each type of interbody device, are currently unclear. Little is known about the biomechanical effects of interbody fusion technique on the mobility of adjacent segments.

Methods.

Normalized ROM data at the levels adjacent to L3–L4 PSR fixation with three different types of lumbar interbody fusion approaches (LLIF, TLIF, and PLIF) were analyzed. Intact (n = 21) and instrumented (n = 7 per group) L2–L5 cadaveric specimens were tested multidirectionally under pure moment loading (7.5 Nm). Analysis of variance of adjacent segment ROM among the groups was performed. Statistical significance was set at P < 0.05.

Results.

Normalized ROM was significantly greater with PLIF than with LLIF in all directions at both proximal and distal adjacent segments (P ≤ 0.02) except for axial rotation at the distal adjacent segment (P = 0.07). TLIF also had greater normalized ROM than LLIF during lateral bending at the proximal adjacent segment (P = 0.008) and during flexion, extension, and lateral bending at the distal adjacent segment (P ≤ 0.03). Normalized ROM was not significantly different between PLIF and TLIF.

Conclusion.

The choice of lumbar interbody fusion approach influences adjacent segment motion in a cadaveric model. LLIF had the least adjacent segment motion.

Level of Evidence: 3
Effect of metformin use on the risk and prognosis of colorectal cancer in diabetes mellitus: a meta-analysis
Authors: Wang Qi , Shi Min
Published: October 2021

Whether metformin is a protective factor of colorectal cancer (CRC) among CRC patients is still not entirely clear. Thus, we conducted this systemic review and meta-analysis to provide a comprehensive review of associations between metformin therapy and CRC risk or survival outcomes for clinical decisions. Articles published before July 2021 were searched in databases (PubMed and Web of Science). Odds ratio (OR)/risk ratio (RR) or hazard ratio (HR) and their confidence intervals (CIs) were computed using STATA 12.0 software. Q test and I
2 were conducted to explore heterogeneities between studies. The present meta-analysis showed that metformin use was associated with decreased risk and lower all-cause mortality of CRC in diabetes mellitus (DM) with random-effects models (risk: OR/RR = 0.71, 95% CI, 0.64–0.80, I
2 = 89.3%, P < 0.001; all-cause mortality: HR = 0.72, 95% CI, 0.62–0.83, I
2 = 60.1%, P = 0.014). In addition, the study showed that metformin use was associated with a lower CRC-specific mortality in DM in cohort studies with a fixed-effects model (HR = 0.80, 95% CI, 0.70–0.92, I
2 = 34.7%, P = 0.190). Overall, in this meta-analysis, we found that metformin may be a protective factor for CRC risk and prognosis in patients with DM. Further well-designed, large-scale clinical studies are needed to evaluate the accuracy of our findings and more preclinical experiments are needed to reveal the underlying mechanism of metformin.
Versatility of Hard Occlusal Splints in Optimizing Outcomes in Patients with Old Pan-facial Fractures
Authors: Hussein Mohammed Ahmed , Besher Abdelaziz , Saad Mohammed Aly , Wilson Adel Michel
Published: October 2021

Background:

Pan-facial fracture repair is considered one of the most challenging complex reconstructive procedures to perform. It is always better to treat facial fractures as soon as possible. A delay of several days or weeks makes an ideal anatomic reduction difficult, if not impossible.

Methods:

Patients presenting late with noncompound pan-facial fractures and interrupting maxillary and mandibular arches who were candidates for ORIF were included. Patients had been divided randomly into two groups: group A was managed by the ordinary sequence of repair, and group B was managed with the aid of occlusal dental splint.

Results:

In total, 20 patients presented late (3–9 weeks post insult) due to serious injuries that required previous intervention. The time until obtaining optimal occlusion ranged between 80 and 120 minutes in the study group, whereas in the control group, the time ranged between 120 and 180 minutes (P < 0.0001). Postoperative malocclusion was noticed to be less frequent in the splint group than in the control group: only one patient with residual malocclusion in the study group versus two patients in the control group.

Conclusions:

Occlusal splints could be a good modality for restoring the pre-morbid occlusion in patients with delayed pan-facial fractures. It is a simple, reliable technique that could be easily integrated into our daily practice, and could help decrease the intraoperative time needed for restoration of optimal occlusion and decrease the postoperative malocclusions.
Evaluation of Efficacy, Efficiency, and Cell Viability of a Novel Descemet Membrane Endothelial Keratoplasty Graft Preparation Device, DescePrep, in Nondiabetic and Diabetic Human Donor Corneas
Authors: Solley Katherine D. , Berges Alexandra , Diaz Christine , Ostrander Benjamin T. , Ding Andy S. , Larson Sara A. , Frank Kendall , Lee Darrell , Guerrero Juan , deCarvalho Tagide , Ruppel Edward , Haileyesus Ailon , Dou Yueheng , Schweitzer Shannon , Pramanik Sudeep , Yazdi Youseph , Parikh Kunal S.
Published: October 2021

Purpose:

The purpose of this study was to evaluate the safety, efficacy, and efficiency of a Descemet membrane endothelial keratoplasty (DMEK) graft preparation device, DescePrep, through measurement of graft viability, yield, and preparation time in both healthy and diabetic (high-risk) donor eyes.

Methods:

Twenty nondiabetic and 10 diabetic donor corneas were processed using DescePrep, which standardizes the liquid bubble technique. Corneas were stained with trypan blue and then processed. Cell counts through specular microscopy, optical coherence tomography imaging, and slit-lamp analysis were used for the evaluation of graft separation and viability in 5 nondiabetic corneas. The remaining 25 corneas (15 nondiabetic and 10 diabetic) were evaluated for preparation success rate and processing time. Ten corneas (5 nondiabetic and 5 diabetic) were randomly selected for further evaluation of global cell loss through staining.

Results:

Ninety-seven percent of corneas (29 of 30) were prepared successfully with DescePrep. The average preparation time was 2.83 ± 1.8 minutes. There was no significant difference in the time of preparation between the nondiabetic and diabetic groups (P = 0.077). The overall average cell death after processing was 7.9% ± 3.7% for all corneas. There was no significant difference in cell viability between diabetic and nondiabetic tissues after DescePrep processing (P = 0.769).

Conclusions:

DescePrep is a new DMEK preparation technique that can process both nondiabetic and diabetic donor corneas at high yields in minutes. High-yield preparation of diabetic corneas may offer eye banks access to a larger donor pool, which is important because the demand for DMEK grafts continues to rise worldwide.
The Effect of COVID-19 Infection During Pregnancy; Evaluating Neonatal Outcomes and the Impact of the B.1.1.7. Variant
Authors: Murphy Claire A. , O’Reilly Daniel P. , Edebiri Osasere , Donnelly Jennifer C. , McCallion Naomi , Drew Richard J. , Ferguson Wendy
Published: October 2021

Background:

Coronavirus disease 2019 (COVID-19) infection during pregnancy has been associated with adverse perinatal outcomes. We aim to evaluate the neonatal outcomes including the incidence of preterm birth, admission to the neonatal unit and incidence of congenital anomalies in this cohort. We will also describe these outcomes in the context of the B.1.1.7. variant outbreak, the dominant variant in Ireland since January 2021, which has had a greater impact on pregnant patients.

Methods:

This was a retrospective study of liveborn infants, delivered between 1st March 2020 and 1st March 2021, to women with a severe acute respiratory syndrome coronavirus 2 diagnosis during pregnancy, in a tertiary maternity hospital (8,500 deliveries/year). Clinical data were collected, and analyses were performed to evaluate the impact of maternal symptom status, time from diagnosis to delivery and the B.1.1.7. variant on neonatal outcome.

Results:

In total 133 infants (1.6%) were born to women with severe acute respiratory syndrome coronavirus 2 identified during pregnancy. The median birth weight was 3.45 kg and gestational age at birth was 39.3 weeks. 14 infants (10.5%) were preterm. 22 infants (16.5%) required admission to the neonatal unit and 7 (5.3%) were small for gestational age. There was no difference in growth, preterm birth or neonatal unit admission based on maternal symptom status or infection after the outbreak of B.1.1.7. as the dominant strain.

Conclusions:

Following a COVID-19 infection in pregnancy, there was no increase in the incidence of preterm birth or neonatal intensive care unit admission compared with 5-year hospital data. Maternal symptom status did not influence neonatal outcomes. Further studies to evaluate the impact of COVID-19 in early pregnancy, the variants of concern, particularly the emerging Delta variant and COVID-19 placentitis are required.
Audiologic Outcomes of Footplate Drillout for Obliterative Otosclerosis
Authors: Conway Robert M. , Sioshansi Pedrom C. , Babu Seilesh C. , Tu Nathan C. , Schettino Amy E. , Bojrab Dennis I. , Schutt Christopher A.
Published: October 2021

Objective:

To evaluate the audiologic outcomes of microdrill fenestration for obliterative otosclerosis compared to traditional stapedotomy technique.

Study Design:

Retrospective chart review.

Setting:

Tertiary referral center.

Patients:

Adult patients undergoing stapedotomy for otosclerosis.

Main Outcome Measure(s):

Patients were separated into groups that underwent either microdrill or laser fenestration based on intraoperative severity of disease. Audiologic outcomes and complications were compared between the two groups.

Results:

There were 588 ears in 519 patients that were evaluated. There was a significant postoperative improvement in pure tone average, air-bone gap, and mean bone conduction thresholds for both the obliterative and nonobliterative group (p < 0.001). There was no significant difference in the pre- or postoperative hearing status between the two groups. There was no significant difference in complications between the two groups, including no cases of postoperative profound hearing loss in the drill fenestration group.

Conclusions:

Audiologic outcomes are similar between microdrill fenestration and laser fenestration for otosclerosis. Pure tone average, air-bone gap, and mean bone conduction thresholds all improved postoperatively and were similar between groups.
Clinical and microbiological characteristics of men with nonobstructive acute pyelonephritis
Authors: Park Min Gu , Cho Sung Yong , Kwon Se Yun , Choi Hoon , Lee Jeong Woo
Published: October 2021

To investigate the differences in clinical and microbiological features in men hospitalized with community-acquired (CA) and healthcare-associated (HA) nonobstructive acute pyelonephritis (APN), as well as the predictive factors associated with bacteremia.

Men discharged from urological centers with nonobstructive APN were identified using an electronic medical records system. We compared the clinical and microbiological data between subjects with CA-APN and HA-APN.

Of the 245 men with nonobstructive APN, 175 had CA-APN, and 70 had HA-APN. The HA group was significantly older, had a longer hospital stay, and had more underlying diseases, bacteremia, and intensive care unit admissions than the CA group. The most commonly cultured microorganism was Escherichia coli. The susceptibility of the cultured bacteria to fluoroquinolone was 68.7% in the CA group and 45.3% in the HA group (P = .005). The proportion of extended-spectrum beta-lactamase-producing bacteria was 22.7% for CA and 53.5% for HA (P < .001). The sensitivity to piperacillin/tazobactam was 94.9% for CA and 90.0% for HA, and the sensitivity to amikacin was more than 95% for both groups. The multivariate analysis revealed that an age ≥65 years and chronic liver disease were independent predictive factors for bacteremia.

The incidence of antibiotic resistance and bacteremia was higher in the HA group than in the CA group. However, resistance to fluoroquinolone and the presence of extended-spectrum beta-lactamase-producing bacteria were high in both groups. Piperacillin/tazobactam and amikacin may be suitable treatment options in men with nonobstructive APN.
Total lesion glycolysis as a predictor of clinical T3–4a laryngeal cancer with laryngectomy or nonlaryngectomy
Authors: Suzuki Hidenori , Tamaki Tsuneo , Terada Hoshino , Nishio Masami , Nishikawa Daisuke , Beppu Shintaro , Sawabe Michi , Hanai Nobuhiro
Published: October 2021

The purpose of the present study is to investigate whether the 18F-fluorodeoxyglucose (18F-FDG) uptake parameter is related to survival outcomes for patients with clinical T3–T4a laryngeal cancer with various definitive treatments including total laryngectomy (TL). Parameters of 18F-FDG uptake in the primary tumors of 46 cases which were assessed by positron emission tomography with computed tomography were enrolled in the present observation study. Monovariate or multivariate survival analyses were performed with log-rank test or Cox regression model, with the hazard ratio (HR) and 95% confidence interval (CI), respectively. Cutoff values of the 18F-FDG uptake parameters were determined by the lowest P-value for monovariate overall survival. In the monovariate analysis, both metabolic tumor volume ≥13.1 and total lesion glycolysis (TLG) ≥46.5 were significantly associated with shorter overall survival, and TLG ≥46.5 was also related to a reduction in distant metastasis-free survival. In the multivariate analysis adjusting for clinical T classification (cT4/cT3) and treatment group (TL/non-TL), TLG (≥46.5/<46.5) was associated with both poorer overall (HR: 3.16, 95% CI: 1.10–9.49) and distant metastasis-free (HR: 8.91, 95% CI: 1.93–62.6) survival. In conclusion, TLG is a predictor for survival in laryngeal cancer.
Comparison of long-term outcome according to involved aganglionic segments of total colonic aganglionosis
Authors: Youn Joong Kee , Yang Hee-Beom , Ko Dayoung , Park Kwi-Won , Jung Sung-Eun , Kim Hyun-Young
Published: October 2021

Total colonic aganglionosis (TCA) is a rare form of Hirschsprung disease, with more severe symptoms than rectosigmoid Hirschsprung disease. We aimed to evaluate the surgical outcomes according to the involved segments of TCA.

Patients with aganglionosis extending from the anus to at least the ileocecal valve were included. The medical records of 33 TCA patients from 1981 to 2014 were reviewed. Three groups were analyzed based on the involved segment (jejunum, jejunoileal junction, and distal ileum).

The median age at the pull-through operation was 6.2 (3.3–114) months. The median follow-up duration was 216 (21–411) months. Transition zone in the jejunum, jejunoileal junction, and distal ileum was identified in 3, 5, and 25 patients, respectively. The most common method of operation was Duhamel pull-through. Perianal excoriation and enterocolitis were the most common postoperative complications. The complication rates were 45% to 51% and not different among the groups. The defecation frequency normalized 3 years postoperatively, and body weight started to recover after 2 years irrespective of the involved segment.

Therefore, close monitoring with proper management of defecation and body weight for at least 2 to 3 years postoperatively is required.
The efficacy and safety of glucokinase activators for the treatment of type-2 diabetes mellitus
Authors: Gao Qian , Zhang Wenjun , Li Tingting , Yang Guojun , Zhu Wei , Chen Naijun , Jin Huawei
Published: October 2021

Background:

Glucokinase activators (GKAs) are a novel family of glucose-lowering agents used for the treatment of type-2 diabetes mellitus. Treatment with different GKAs has been shown to reduce blood glucose levels in these patients. We compared the efficacy/safety of GKAs in patients with type-2 diabetes mellitus through a meta-analysis.

Methods:

We searched the PubMed, Excerpt Medica Database, and Cochrane Central Register of Controlled Trials databases for articles published before December 30, 2020. We computed the weighted mean difference (WMD) and 95% confidence interval (CI) for the change from baseline to the study endpoint for GKA versus placebo treatments.

Results:

A total of 4 articles (5 studies) were included in the meta-analysis. GKAs were associated with reductions in glycated hemoglobin levels from baseline (WMD, −0.3%; 95% CI, −0.466% to −0.134%). No significant difference between GKA and placebo treatment was observed in the results of fasting plasma glucose levels from baseline (WMD 0.013 mmol/L; 95% CI, −0.304–0.33 mmol/L). A significantly higher change in 2-hour postprandial plasma glucose (2-h PPG) levels (WMD −2.434 mmol/L; 95% CI, −3.304 to −1.564 mmol/L) was observed following GKA than placebo treatment. GKAs were associated with a higher prevalence of causing hypoglycemic events than placebo treatment (risk difference [RD], 0.06; 95% CI 0.013–0.106). GKAs had no association with the risk of developing adverse effects (RD, 0.038; 95% CI, −0.03–0.106) and serious adverse events (RD, 0.01; 95% CI, −0.004–0.023).

Conclusions:

GKAs were more effective for postprandial blood glucose control. However, these agents showed a significantly high risk of causing hypoglycemia.

PROSPERO registration number:

CRD42021220364.
Updates in the understanding and management of diverticular disease
Authors: Eckmann Jason D. , Shaukat Aasma
Published: October 2021

Purpose of review

Diverticulosis leads to significant morbidity and mortality and is increasing in prevalence worldwide. In this paper, we review the clinical features, diagnosis, and management of diverticular disorders, followed by a discussion of recent updates and changes in the clinical approach to diverticular disease.

Recent findings

Recent literature suggests that antibiotics are likely not necessary for low-risk patients with acute uncomplicated diverticulitis, and not all patients with recurrent diverticulitis require colectomy. Dietary restrictions do not prevent recurrent diverticulitis. Visceral hypersensitivity is increasingly being recognized as a cause of persistent abdominal pain after acute diverticulitis and should be considered along with chronic smoldering diverticulitis, segmental colitis associated with diverticula, and symptomatic uncomplicated diverticular disease.

Clinicians should be aware that traditionally held assumptions regarding the prevention and management of diverticular disorders have recently been called into question and should adjust their clinical practice accordingly.
Reviewing the Outcomes of Different Treatment Approaches in Elderly Pancreatic Cancer Patients
Authors: Doyle James , Amundsen Tyson , Hall James A. , Raiyani Chandni , Wong Lucas
Published: October 2021

Objectives

The incidence of pancreatic cancer is age dependent. Ninety percent of new diagnoses occur in patients older than 55 years. Despite the association with age and cancer, elderly patients are historically underrepresented in clinical trials. Thus, optimal management of elderly patients has a lack of data. The purpose of this retrospective study was to investigate the outcomes of palliative chemotherapy in elderly patients with pancreatic cancer compared with supportive care alone.

Methods

Unicentric data were reviewed on all elderly patients (defined as age >65 years) with a diagnosis of pancreatic cancer from 2008 through 2019 to compare outcomes in those who received chemotherapy versus supportive care alone.

Results

The study reviewed 665 patients with a median age of 75 years (mean, 75.7 years) and average Charlson Comorbidity Score of 5.74. Of them, 291 received chemotherapy and 363 received supportive care only. Chemotherapy was associated with a median overall survival of 250 versus 93 days with supportive care (P < 0.0001). Analysis showed improved survival for all age ranges, cancer stages, and Charlson Comorbidity Scores.

Conclusions

Elderly pancreatic cancer patients can benefit from palliative chemotherapy, and it should be considered, especially in patients with fewer medical comorbidities and better functional status.