bluuebunny/crossref_metadata_2025 huggingface dataset:
Validation of the current and pressure coupling schemes with nonlinear simulations of TAE and analysis on the linear stability of tearing mode in the presence of energetic particles
Authors: ZHANG Haowei , MA Zhiwei
Published: November 2022

Both current and pressure coupling schemes have been adopted in the hybrid kinetic–magnetohydrodynamic code CLT-K recently. Numerical equivalences between these two coupling schemes are strictly verified under different approximations. First, when considering only the perturbed distribution function of energetic particles (EPs), the equivalence can be proved analytically. Second, when both the variations of the magnetic field and the EP distribution function are included, the current and pressure coupling schemes numerically produce the same result in the nonlinear simulations. On this basis, the influences of co-/counter-passing and trapped EPs on the linear stabilities of the m/n = 2/1 tearing mode (TM) have been investigated (where m and n represent the poloidal and toroidal mode numbers, respectively). The results of scanning

β

h

of EPs show that the co-passing and trapped EPs are found to stabilize the TM, while the counter-passing EPs tend to destabilize the TM. The behind (de)stabilization mechanisms of the TM by EPs are carefully analyzed. Furthermore, after exceeding critical EP betas, the same branch of the high-frequency mode is excited by co-/counter-passing and trapped EPs, which is identified as the m/n = 2/1 energetic particle mode.
An experience based artificial neural network in the design optimization of steel frames
Authors: Jahjouh Mahmoud
Published: November 2022

The design of steel frames is an iterative process relying on the experience and decisions of the designer to achieve economical and safe designs. With recent advances in artificial intelligence, particularly, artificial neural networks, it became possible to train such networks to simulate an experienced designer. Thus, the aim of this contribution is to investigate the possibility of artificial neural networks gaining design experience and using such experience in predicting adequate and economical designs. To achieve this aim, an adaptive harmony search algorithm is used to obtain the optimum structural design of two-dimensional steel frames. Those designs are, in a sense, considered an experience, which are then used in training artificial neural networks. The trained networks are finally used in predicting the optimum solution of new problem variants. In total, 18684 samples based on 3114 two-dimensional frames were used to train multiple feed forward artificial neural networks, with a training, validation and testing ratios of 70%, 15% and 15%, respectively. The trained networks’ performance was verified, and used in design predictions on interpolated and extrapolated cases. Considering the designs suggested by the artificial neural networks, 99% were adequate in the case of network verification. Furthermore, 97% and 93% of designs were adequate in the case of interpolation and extrapolation. Thus, artificial neural networks are able to learn from the design experience and provide good approximations for designs of variants even outside the training set. Such findings encourage the development of artificial intelligence assisted design systems that are capable of suggesting optimum or near-optimum designs for two-dimensional frames. Also, it could encourage further research for three-dimensional steel frames and more complex steel structure systems.
EIT for tactile sensing:considerations regarding the injection-measurement pattern
Authors: Smela Elisabeth
Published: November 2022

Bipolar current injection and voltage measurement (I–M) patterns are frequently used in electrical impedance tomography (EIT) for tactile sensing. In this work, the total set of 36 unique combinations for 16-electrode systems is investigated using simulations. Performance is evaluated on a circular sensor as a function of hyperparameter and target position with respect to critical performance measures for tactile sensing; these include not only peak amplitude and resolution, but also susceptibility to noise and, importantly, the uniformity of performance over the sensor area. The determination of which pattern to employ can therefore be based on the needs of the particular application. The relative performance of the I–M patterns is determined at small hyperparameters by electrode placement symmetry, but at large hyperparameters by sensitivity at the center of the sensor. Patterns with high spatial symmetry should be avoided; these include electrode pairs on opposite sides of the sensor. Patterns with electrodes in adjacent positions, which have been the norm for tactile sensing, should also not generally be used. If performance on all metrics across a wide range of hyperparameters is needed, then placing both the injection and measurement electrodes 3 spaces apart (the 3–3 pattern) can be a good strategy for the Gauss-Newton 1-step algorithm with the Laplacian prior. The use of 13 electrodes instead of 16 is also examined. The absence of symmetry provides greater flexibility in the choice of I–M pattern, and the loss in performance may be small; furthermore, the reduction in data collection time may be advantageous. Beyond avoiding the worst I–M patterns, the most important measure to take is decreasing noise on the signal to permit the use of a smaller hyperparameter; this is of greater importance than selecting from among the remaining I–M patterns.
Blood Pressure Variability and Cognitive Decline: A Post Hoc Analysis of the SPRINT MIND Trial
Authors: Sible Isabel J , Nation Daniel A
Published: November 2022

Background

Blood pressure (BP) variability (BPV) is an emerging risk factor for cognitive impairment and dementia, but relationships with cognition in the context of antihypertensive strategies remain unclear. We examined whether visit-to-visit BPV relates to cognitive change based on antihypertensive treatment type.

Methods

In this post hoc analysis of the SPRINT MIND trial, 2,348 participants underwent 4 BP measurements over a 9-month period after treatment randomization (standard vs. intensive BP lowering) and ≥ 1 neuropsychological evaluation thereafter. BPV was calculated as tertiles of BP SD. Participants underwent cognitive testing at baseline and every 2 years during the planned 4-year follow-up. Cognitive composite scores were calculated for global cognition, memory, language, executive function, and processing speed. Linear mixed models investigated relationships between BPV, antihypertensive treatment group, and time on cognitive composite scores.

Results

Elevated BPV was associated with the fastest decline in processing speed (ß = −.07 [95% CI −.12, −.01]; P = 0.02) and executive function (ß = −.08 [95% CI −.16, −.006]; P = 0.03) in the standard treatment group only. BPV was not related to cognitive change in the intensive treatment group. Mean/minimum/maximum BP was not associated with cognitive composite scores over time in either antihypertensive treatment group.

Conclusions

Elevated BPV remains a risk for cognitive decline despite strictly controlled BP levels, in the standard treatment group. Specific declines were observed in processing speed and executive function, domains often impacted by cerebrovascular disease and may underpin risk for dementia and cerebrovascular disease associated with BPV. Clinical trial information: ClinicalTrials.gov; NCT01206062.
SPRDA: a link prediction approach based on the structural perturbation to infer disease-associated Piwi-interacting RNAs
Authors: Zheng Kai , Zhang Xin-Lu , Wang Lei , You Zhu-Hong , Ji Bo-Ya , Liang Xiao , Li Zheng-Wei
Published: November 2022

piRNA and PIWI proteins have been confirmed for disease diagnosis and treatment as novel biomarkers due to its abnormal expression in various cancers. However, the current research is not strong enough to further clarify the functions of piRNA in cancer and its underlying mechanism. Therefore, how to provide large-scale and serious piRNA candidates for biological research has grown up to be a pressing issue. In this study, a novel computational model based on the structural perturbation method is proposed to predict potential disease-associated piRNAs, called SPRDA. Notably, SPRDA belongs to positive-unlabeled learning, which is unaffected by negative examples in contrast to previous approaches. In the 5-fold cross-validation, SPRDA shows high performance on the benchmark dataset piRDisease, with an AUC of 0.9529. Furthermore, the predictive performance of SPRDA for 10 diseases shows the robustness of the proposed method. Overall, the proposed approach can provide unique insights into the pathogenesis of the disease and will advance the field of oncology diagnosis and treatment.
The Perceived Public Image of Palestinian Female Social Workers in Israel: Effects on Professional Experiences
Authors: Hardal-Zreik Hozam
Published: November 2022

The public image of social workers has recently received considerable attention. However, relatively few have examined how social workers interpret that image and how it affects their practice. As social workers from oppressed groups have been excluded from this discussion, the current study critically examines how Palestinian female social workers (PFSWs) in social services perceive their public image and how it affects them, using intersectionality theory. The study employs a qualitative method based on thirty semi-structured interviews with PFSWs who work in social services within the Palestinian community. The findings indicate that PFSWs perceive their public image in terms of subordination to family–community ties, intersected otherness and negligence. They are marginalised by this image, which has led to a loss of public legitimacy and safety. The study enriches the literature and deepens the debate regarding the public image of social workers in general, and among women from oppressed groups in particular. Additionally, it emphasises the need to improve the working conditions of Palestinian social workers in order to improve their public image and quality of service.
ddRADseq reveals the relationships of harakeke and wharariki (Phormium species, Asphodelaceae) and selected weaving cultivars in Aotearoa New Zealand
Authors: Shepherd Lara D , Scheele Sue M , Te Awa Isaac , Smissen Rob D
Published: November 2022

Phormium tenax (harakeke) and P. cookianum (wharariki) are important plants for Māori, particularly as weaving materials. At least 60 different cultivars were selected for specific purposes; most are harakeke, but some are suspected hybrids between the two species. We used next-generation sequencing to examine the relationships of wild and cultivated Phormium. We found that the two species could be distinguished genetically, despite evidence of hybridization and introgression. We observed genetic structuring within harakeke and most of the cultivars clustered with wild North Island samples. Our results indicate that it is possible that the populations of harakeke on offshore islands (Norfolk Island, the Kermadec Archipelago, Rēkohu and the subantarctic islands) are all introduced, either by Māori or early European settlers.
Sulfur-fumigated ginger identification via brightness information and voting mechanism
Authors: Wang Tianshu , Yan Hui , Wang Ziyi , Yang Rui , Zhang Jin , Hu Kongfa , Yang Xichen , Wei Minghui , Duan Jinao
Published: November 2022

As a food consumed worldwide, ginger is often sulfur-fumigated. Sulfur-fumigated ginger is harmful to health. However, traditional methods to detect sulfur-fumigated ginger are expensive and unpractical for the general public. In this paper, we present an efficient and convenient identification method based on image processing. First, rapid detection kits were employed to mark three levels of sulfur-fumigated gingers, and the RGB images of the gingers of each sulfur-fumigated level are collected. Second, the brightness and texture features were extracted from the images. Three machine learning methods, Support Vector Machine, Back Propagation Neural Network and Random Forest, were applied to establish prediction models. Third, the accuracy of each model was calculated and different weights were assigned for different models. Finally, models with different weights determined whether the ginger was sulfur-fumigated or non-sulfur-fumigated, and then the results were summarized to establish the final identification model. The experimental results show that the proposed method is robust. When the training set occupies 90%, the prediction accuracy is up to 100%. When the training set only occupies 10%, the accuracy remains high at 80%. Meanwhile, the proposed method is more competitive than other methods in terms of accuracy.
Continuous vagal intraoperative neuromonitoring during video-assisted thoracoscopic surgery for left lung cancer: its efficacy in preventing permanent vocal cord paralysis
Authors: Seong Yong Won , Chai Young Jun , Lee Jung-Man , Ok You Jung , Oh Se Jin , Choi Jae-Sung , Moon Hyeon Jong
Published: November 2022

OBJECTIVES

We investigated the safety and efficacy of continuous intraoperative neuromonitoring (CIONM) during video-assisted thoracoscopic lobectomy for left lung cancer in preventing recurrent laryngeal nerve injury.

METHODS

From August 2015 to March 2020, 22 patients with left lung cancer without CIONM (unmonitored) and 20 patients with left lung cancer with CIONM underwent thoracoscopic lobectomy with complete mediastinal lymph node dissection including 4L dissection. Clinical outcomes from these 2 groups were compared.

RESULTS

The incidence of 4L metastasis was 7.14% (3 patients). There was no significant difference in the total number of dissected 4L lymph nodes between the 2 groups (3.23 ± 2.2 in the unmonitored group, 3.95 ± 2.0 in the CIONM group). CIONM was successful in all of the cases. There was no significant difference in the incidence of postoperative vocal cord palsy (22.7% in the unmonitored group, 20% in the CIONM group, P = 1.000). All of the 5 patients (100%) had permanent vocal cord palsy in the unmonitored group. Although statistically insignificant, 75% (3 patients) had total recovery of the vocal cord function, with only 1 patient remaining in permanent vocal cord palsy in the CIONM group.

CONCLUSIONS

CIONM was safe and efficient. CIONM might be helpful to avoid permanent vocal cord palsy by immediately warning the surgeon about impending nerve injury, so the surgeon can stop delivering further injury to the recurrent laryngeal nerve.
Medicinal cannabis for patients with chronic non-cancer pain: analysis of safety and concomitant medications
Authors: Schubert Elise A , Alffenaar Johannes C , Johnstone Masego T , Barlow John W , Wheate Nial J
Published: November 2022

Objectives

This study aimed to explore the incidence of adverse events (AEs) reported by patients when initiating medicinal cannabis treatment for chronic pain, and the association of cannabis constituents, dose and concomitant medicines with AE incidence.

Methods

Patient demographics, cannabis products and AE data were collected as part of the Cannabis Access Clinics Observational Study, and concomitant medicines were obtained from patient health summaries provided by referring doctors. Cannabis products were grouped by their constituents as either cannabidiol-only or containing both cannabidiol and Δ-9-tetrahydrocannabinol.

Key findings

From a total of 275 patients, each had a median of six concomitant medicines, with opioids (n = 179; 65%) the most common. A total of 35.6% patients took 10 or more other medicines, and they were associated with a 3.6 times higher likelihood to report the AE of fatigue (P = 0.048). Patients who received concomitant gabapentinoids were 2.4 times more likely to report dizziness (P = 0.036), patients on tricyclic antidepressants were 1.8 times more likely to report somnolence (P = 0.034) and 3.4 times more likely to report anxiety (P = 0.04), when compared with patients who were not prescribed those classes of medications. Those patients who were prescribed products containing both cannabidiol and Δ-9-tetrahydrocannabinol were 1.5 times more likely (P = 0.004) to have experienced an AE when compared with those prescribed only cannabidiol.

Conclusions

These findings show that certain concomitant medications and cannabis constituents may be associated with AE incidence when initiating medicinal cannabis. These potential pharmacokinetic and pharmacodynamic interactions require further study to develop guidance for prescribers and pharmacists.
Application of electrical resistivity tomography (ERT) in uranium mining earth dam
Authors: Moreira César Augusto , Guireli Netto Leonides , Camarero Pedro Lemos , Bertuluci Fernanda Barbosa , Hartwig Marcos Eduardo , Domingos Reinaldo
Published: November 2022

Dams are built to contain water or mining tailings and provide several benefits to society. The safety and stability of these structures are essential since eventual accidents can generate catastrophic damage. The main cause of ruptures is associated with abnormal seepage, which can progress to an internal erosion process. To assess the stability and safety of dams, periodic inspections are carried out, which typically include visual inspections and geotechnical instrumentation. Some geophysical methods have the potential to assist conventional geotechnical instrumentation using non-destructive and rapid acquisition investigations. The present study applied a finite element forward modeling to evaluate the percolation conditions and water stability in an earth dam of a decommissioned uranium mine in Brazil. The dam is the final structure of the contention system of mine water treatment. The electrical resistivity data were acquired using electrical resistivity tomography (ERT) and Schlumberger array. The results were presented from the inversion of data in 3D models. The data were processed by open-source software (modeling and inversion of geophysical data). The results indicate the presence of water in the vertical filter located in the crest area. The different levels of investigation indicated water infiltration in the rock mass of the dam foundation. These results are supported by structural surveys carried out in the area that indicate a fracturing pattern in the rock mass of the mine area. The results of the study were satisfactory for the desired purposes and demonstrate that geophysical methods constitute an important complementary tool for the geotechnical monitoring dams.
Seismic inversion and fracture prediction in tilted transversely isotropic media
Authors: Li Qin , Wang Hanlin , Yang Xiaoying , Ma Suibo , Liu Xingye , Li Jiang
Published: November 2022

The conventional Amplitude variation with offset (AVO) inversion has been mainly developed for the isotropic media and therefore it is generally inapplicable to the anisotropic fractured formations. A set of tilted fractures in isotropic medium can be regarded as a transversely isotropic (TTI) medium. The reflection coefficient equation in TTI media contains many parameters such as anisotropic parameters, velocities, azimuth and dip angles. The selection of objective functions can significantly affect its performance in searching for the optimal solution. The seismic inversion of the TTI medium remains challenging because of its many parameters, and is very complicated after conversion into solving function problems. The genetic algorithm (GA) provides a universal framework to solve the optimization problem in complex systems, and it is independent of the types and disciplines of problems. In this study, the GA-based seismic prestack inversion of the TTI medium is implemented by constructing the objective functions of anisotropic parameters based on the TTI medium reflection coefficient approximation. The inversion performance is shown to be satisfactory on the one-dimensional well logging model, modified Hess model and the field datum. Furthermore, fracture filling materials are well predicted according to the theories of the equivalent medium for fractured materials and fracture weakness. The inversion results demonstrate the proposed method to be feasible and robust. The findings of this research are expected to provide theoretical guidance for the inversion of elastic parameters of anisotropic media and fracture type identification in hydrocarbon reservoirs.
Atrial septal defect in a pediatric patient with Williams Syndrome: a rare presentation
Authors: Grajeda Javier , Mubarak Amir N , Ardebol Javier , Grajeda Guillermo
Published: November 2022

Characterized by congenital heart defects (CHD) and elfin-like facies, Williams-Beuren syndrome (WS) is a multisystemic disorder that occurs approximately in 1 in 10 000 newborns [1]. WS is caused by a contiguous gene microdeletion of the Williams Beuren syndrome critical region (WBSCR) on chromosome 7q11.23, resulting in an abnormal elastin gene (ELN). There is a wide range of CHD in patients with WS, with supravalvular aortic stenosis (SAS) being the most common, and atypically the atrial septal defect (ASD) [2]. Few reports and reviews have linked the appearance of ASD to WS. Thus, data on the management of ASD secondary to WS is not well-documented. The following case report consists of the diagnosis and management of an ASD in a pediatric patient with WS.
Cultural information bubbles: A new approach for automatic ethical evaluation of digital artwork collections based on Wikidata
Authors: Zhitomirsky-Geffet Maayan , Minster Sara
Published: November 2022

Large digital repositories created and maintained by art museums provide open access to millions of works of art and make them available to new audiences with diverse backgrounds, views, and needs. Digitization of cultural collections by art museums has opened an opportunity to correct the historical injustices and imbalances in information representation. The first step toward this goal is a systematic critical evaluation of digital cultural collections from an ethical perspective. In this study, we propose and apply a new automated methodology for evaluation of digital cultural collections, based on a recently proposed ethical framework for evaluation of knowledge organization systems. The developed approach utilizes Wikidata for automatic creation of a unified ontological scheme comprised of ethically marked properties of cultural heritage items. These properties are used to automatically measure and compare the compliance of a database with a set of ethical criteria, on a large scale, in a database-agnostic manner. The findings, based on two prominent art museums—the Metropolitan Museum of Art and the Rijksmuseum—as well as the Wikidata artwork collection, indicate the presence of biases and a Western cultural information bubble. The Met artwork database’s scores are relatively close to Wikidata and more inclusive and balanced than those of the Rijksmuseum.
The extreme super-eddington NLS1 RX J0134.2-4258 – II. A weak-line Seyfert linking to the weak-line quasar
Authors: Jin Chichuan , Done Chris , Ward Martin , Panessa Francesca , Liu Bo , Liu He-Yang
Published: November 2022

RX J0134.2-4258 is one of the most super-Eddington narrow-line Seyfert 1 (NLS1) galaxies, on which we conducted a monitoring campaign from radio to X-rays. In this paper, we present a detailed analysis of its optical/UV spectra and broad-band spectral energy distribution. Our study shows that the preferred black hole mass of RX J0134.2-4258 is MBH ∼ 2 × 107 M⊙, giving a mass accretion rate through the outer disc of $\dot{m}_{\rm out} \sim 20$ (assuming zero spin), compared to the observed luminosity ratio Lbol/LEdd ∼ 6. This reduction in radiative efficiency is expected for super-Eddington flows, as power can be lost via advection and/or disc winds. We find that the optical/UV lines of RX J0134.2-4258 resemble those from weak-like quasars (WLQs), as it has notably weak C iv and N v emission lines. It also has drastic X-ray variability, again similar to that recently observed in some other WLQs. However, WLQs have systematically higher masses (≳108 M⊙), and lower Eddington ratios ($\dot{m}_{\rm out} \sim 1$) than RX J0134.2-4258. We compare instead to the most extreme NLS1s, with similarly large $\dot{m}_{\rm out}$ but smaller masses. These show similarly large reductions in radiative efficiency but their UV lines are not similarly wind dominated. We suggest a new category of weak-line Seyfert galaxies to describe sources like RX J0134.2-4258, and interpret its (so far unique) properties in a model, where the lower disc temperature in the higher mass black holes leads to the UV-line-driving mechanism, which enhances the super-Eddington radiation-pressure-driven wind.
TOPAS, a network-based approach to detect disease modules in a top-down fashion
Authors: Buzzao Davide , Castresana-Aguirre Miguel , Guala Dimitri , Sonnhammer Erik L L
Published: November 2022

A vast scenario of potential disease mechanisms and remedies is yet to be discovered. The field of Network Medicine has grown thanks to the massive amount of high-throughput data and the emerging evidence that disease-related proteins form ‘disease modules’. Relying on prior disease knowledge, network-based disease module detection algorithms aim at connecting the list of known disease associated genes by exploiting interaction networks. Most existing methods extend disease modules by iteratively adding connector genes in a bottom-up fashion, while top-down approaches remain largely unexplored. We have created TOPAS, an iterative approach that aims at connecting the largest number of seed nodes in a top-down fashion through connectors that guarantee the highest flow of a Random Walk with Restart in a network of functional associations. We used a corpus of 382 manually selected functional gene sets to benchmark our algorithm against SCA, DIAMOnD, MaxLink and ROBUST across four interactomes. We demonstrate that TOPAS outperforms competing methods in terms of Seed Recovery Rate, Seed to Connector Ratio and consistency during module detection. We also show that TOPAS achieves competitive performance in terms of biological relevance of detected modules and scalability.
Disseminated Tuberculosis With an Atypical Cutaneous Manifestation in a Hematopoietic Cell Transplant Patient in the Early Posttransplant Period: Case Report and Review of the Literature
Authors: Czech Mary M , Dioverti Maria Veronica , Karaba Andrew H , Jain Tania , Talluru Sai M , Sunshine Joel C , Kang Jun , Parrish Nikki , Kates Olivia S
Published: November 2022

We describe an unusual case of posttransplant tuberculosis reactivation in a man who underwent allogeneic hematopoietic cell transplant. Concomitant with disseminated adenovirus infection, reactivation of tuberculosis manifested as disseminated, nonfollicular pustules on day +49. Skin biopsy was obtained on day +50. Initial histopathologic evaluation did not suggest mycobacterial infection, but tissue stain showed acid-fast organisms, which were subsequently identified as Mycobacterium tuberculosis. Shortly after the cutaneous presentation of tuberculosis, the patient died on day +52. Our case is among a paucity of reports describing tuberculosis reactivation in hematopoietic cell transplant patients in the early posttransplant period. It highlights the difficulty of diagnosing contemporaneous systemic infections, and it presents a rare and atypical cutaneous manifestation of tuberculosis in a hematopoietic cell transplant patient. Our case and review of the literature emphasize the need for further research to elucidate risk factors associated with early posttransplant reactivation of tuberculosis, and the importance of remaining vigilant for active tuberculosis in hematopoietic cell transplant patients with epidemiologic risk factors.
Rituximab-treated rheumatic patients: B cells predict seroconversion after COVID-19 boost or revaccination in initial vaccine non-responders
Authors: Ammitzbøll Christian , Kragh Thomsen Marianne , Bøgh Andersen Jakob , Jensen Jens Magnus Berth , From Hermansen Marie-Louise , Dahl Johannsen Anders , Larsen Mads Lamm , Mistegaard Clara Elbæk , Mikkelsen Susan , Szabados Fruzsina , Vils Signe Risbøl , Erikstrup Christian , Hauge Ellen-Margrethe , Troldborg Anne
Published: November 2022

Objectives

To investigate the effect of either a booster vaccine (one dose) or revaccination (two doses 3 weeks apart) on the antibody response to the COVID-19 mRNA vaccines in patients with rheumatic disease (RD) treated with rituximab (RTX) who had not produced vaccine-reactive antibodies after the initial two vaccine doses. Further, to examine if B cell levels in peripheral blood predicted seroconversion.

Methods

We included 91 RTX-treated RD patients previously vaccinated against COVID-19. Patients were offered revaccination or a single booster vaccination with an mRNA vaccine. Serum total antibodies against SARS-CoV-2 spike protein were measured before and 6 weeks after the last vaccine dose. B cells (CD19+CD45+) were measured by flow cytometry at inclusion.

Results

Of RD patients with undetectable SARS-CoV-2 antibody levels before inclusion, seroconversion was seen in 38% 6 weeks after the booster dose and 32% after revaccination. Patients receiving revaccination had significantly higher antibody levels than patients receiving a booster dose (P < 0.001). In both univariate and multivariate logistic regression analysis, only B cells higher than 10/µl before boost or revaccination were associated with seroconversion (P = 0.009 and P = 0.01, respectively). Seroconversion was independent of age, gender, diagnosis, cumulative RTX dose, RTX treatment time and time since last RTX treatment.

Conclusion

Continuously impaired humoral response to mRNA vaccines was found in most RTX-treated patients after a booster dose or revaccination. Seroconversion was observed in approximately one-third of the patients. Measurable B cells before boosting or revaccination was the strongest predictor of antibody response after boost or revaccination.
Evaluation of a technique of patellar tendon shortening to correct patella alta associated with severe crouch gait in cerebral palsy
Authors: Mohan Vipin , Ganjwala Dhiren , Singh Kumar , Shah Hitesh
Published: November 2022

This study was undertaken to evaluate the results of patella tendon shortening to correct patella alta in the context of surgery for the management of severe crouch gait. Our aim was to ascertain whether the corrected position of the patella and improvement of the power of the quadriceps were maintained for 4 years or more. Twenty older children (mean age: 14.2 years) with long-standing crouch gait secondary to cerebral diplegia underwent surgery to correct crouch gait that included the patellar tendon shortening. The technique for plicating the tendon differed for skeletally mature and immature patients. The length of the patellar tendon was measured by the Koshino Index. The strength of the quadriceps muscle was assessed by manual muscle testing and with a dynamometer and extensor lag, if present, was measured with a goniometer. In all 40 knees, the patella was brought to a more distal position and the position was maintained for a mean duration of 84 months (Koshino Index: preoperative 1.3 ± 0.10; 3-month postoperative 0.95 ± 0.05; final follow-up 0.95 ± 0.04). The results were the same for the techniques used for skeletally mature and immature patients. The power of the quadriceps improved [Medical Research Council (MRC) grade 3 to MRC grade 4] and the improvement was maintained. The technique of patella tendon shortening was effective in correcting patella alta and improving quadriceps power. The shortened patellar tendon did not stretch over the period of follow-up. Level of evidence: III
Is prematurity a risk factor for developmental dysplasia of the hip? A systematic review and meta-analysis
Authors: Burkhart Robert J. , McNassor Ryan , Acuña Alexander J. , Kamath Atul F.
Published: November 2022

Developmental dysplasia of the hip (DDH) is the most common orthopedic disorder in newborns. Early recognition and diagnosis are critical to prevent long-term complications. While several risk factors have been established, the association between prematurity and DDH remains unclear. Our analysis sought to analyze the literature exploring the relationship between prematurity and DDH. Articles evaluating the relationship between prematurity and DDH published between 1 January 2000 and 1 February 2022 were queried, with 11 studies included for analysis. Overall, a total of 8720 patients were included. The gestational age ranged from 23 to 36 weeks for preterm and ≥37 weeks for term births. Seven studies agreed that gestational age did not have a significant impact on DDH. Pooled analysis of available data demonstrated no significant difference in DDH among preterm and term infants (OR, 1.11; 95% CI, 0.82–1.51; P = 0.49). Sub-group analysis of two studies reporting data on very preterm (≤32 weeks) and term infants revealed no significant difference in the occurrence of DDH (OR, 4.58; 95% CI, 0.09–244.78; P = 0.45). Four studies found early gestational age is associated with a significantly higher incidence of mature hips compared to late preterm or term babies. Similarly, pooled analysis demonstrated significantly lower Graf classification among preterm infants (OR, 0.13; 95% CI, 0.03–0.61; P = 0.009). Based on the current literature, our analysis found that prematurity is not strongly associated with DDH. Furthermore, early gestational age was associated with a significantly higher incidence of mature hips measured by Graf classification.
Apophyseal ilium avulsion fractures in young athletes: a systematic review and return to sport analysis
Authors: Vadhera Amar S. , Lee Jonathan S. , Sivasundaram Lakshmanan , Ogle Miranda , Westrick Jennifer C. , Kunze Kyle N. , Gursoy Safa , Chahla Jorge
Published: November 2022

The purpose of the current investigation was to synthesize the epidemiology, cause, management, and return to sport (RTS) outcomes of ilium avulsion fractures sustained during sporting activities in young athletes. Studies reporting on athletes <18 years old sustaining an avulsion fracture along the ilium [injury to the anterior superior or inferior iliac spine (ASIS or AIIS), or the iliac crest (IC)], and the athlete’s RTS status were included. RTS was analyzed by injury acuity, location, mechanism of injury, and management, whereas complications were recorded. Seventy studies comprising 286 avulsions (169 ASIS, 87 AIIS, and 30 IC) were included. The mean age of athletes was 14.5 + 1.3 years (range, 8–18 years). Sprinting (n = 103/286; 36.0%) and soccer (n = 97/286; 33.9%) were the most common sports during which injuries occurred. A total of 96.5% (n = 276/286) of athletes reported successful RTS at an average of 16.2 + 19.3 weeks. The RTS rate for patients sustaining ASIS, AIIS, and IC avulsions was 95.3, 97.7, and 100%, respectively. Acute trauma was responsible for 89.8% (n = 158/176) of injuries, which demonstrated a significantly faster (13.3 + 9.3 weeks) and higher RTS rate (99.4%) compared with those with chronic avulsions (74.4 + 40.9 weeks and 83.3%, respectively). Those with complications (18.2%) had a significantly lower RTS rate (90.4%) and longer recovery (23.7 weeks) compared with athletes without complications (97.9% and 14.5 weeks, respectively). Outcomes were not significantly different based on sex or management. However, chronic avulsions and postoperative complications sustained worse RTS results. An accurate and timely diagnosis is crucial when presented with these rare injuries to avoid increasing the chronicity of injury.
Is subclassification of Gartland extension-type pediatric supracondylar fracture into types IIA and IIB necessary for treatment decision? A result of pediatric orthopedist’s survey and review of literature
Authors: Tangadulrat Pasin , Adulkasem Nath , Suganjanasate Kuntalee , Wongcharoenwatana Jidapa , Ariyawatkul Thanase , Kaewpornsawan Kamolporn , Chotigavanichaya Chatupon , Eamsobhana Perajit
Published: November 2022

Extension-type pediatric supracondylar humeral fractures are very common. The Gartland classification is typically used to guide treatment. However, there is still no consensus on what factors should be used to subclassify the type II fractures and whether subclassification is needed to guide treatment. Therefore, we aim to explore the opinions of pediatric orthopedists on the treatment method of the Gartland type II supracondylar fracture. Specifically, we ask what factors are considered for their treatment decisions and whether subclassification is needed to guide treatment. An online questionnaire was developed and sent to the Thai Paediatric Orthopedics Society and Asia-Pacific Paediatric Orthopaedic Society members. The results were analyzed to explore the relationship between respondents’ demographic factors and treatment decisions. Out of 113 participants reached, 57 (50.4%) responded to the questionnaire. Factors chosen by respondents are stability testing intraoperatively (73.7%), the relationship of the anterior humeral line and capitellum (66.7%), the presence of rotation (50.9%), the presence of translation (47.4%), the presence of medial comminution 42.1%), soft tissue condition(38.6%), the shaft – condylar angle (31.6%), and the Bauman angle (21.1%). Thirty-three of 57 respondents (57.9%) deemed subclassification for Gartland type II necessary for guiding treatment. About half of respondents in our study deemed the current Gartland type II subclassification necessary to guide treatment, which may indicate that the subclassification might not be sufficiently comprehensive and reliable. Therefore, better criteria for a subclassification and a prospective evaluating study might be needed.
Rate of concomitant cellulitis and osteoarticular infections in a pediatric population
Authors: Ryan Claire Berdelle , Romere Chase Matthew , Shah Romil , Souder Christopher D. , Ellington Matthew
Published: November 2022

Concern for infection is a common presentation in pediatric emergency departments. Clinical signs of cellulitis in pediatric patients often lead to a workup for osteoarticular infection despite a lack of evidence to suggest that the two entities commonly co-exist. With this in mind, we asked: (1) What is the rate of concomitant cellulitis and osteoarticular infections in the pediatric population? (2) What factors are associated with concomitant cellulitis and osteoarticular infections? This is a retrospective study of 482 pediatric patients who underwent MRI to evaluate for either cellulitis or an osteoarticular infection at a single tertiary care children’s hospital. Data were analyzed to assess the prevalence of osteomyelitis concomitant with cellulitis in our sample population. Concomitant cellulitis and osteoarticular infection were present in 11% of all cases (53/482). Of the concomitant infections, 92% percent (49/53) were present in distal locations (Group 1) and 8% (4/53) were present in proximal locations (Group 2). Bivariate analysis showed that concomitant infections on the distal extremities were significantly more common than concomitant infections on the proximal extremities (P < 0.001). We found that concomitant cellulitis and osteoarticular infection were (1) uncommon and (2) significantly less common when clinical signs of cellulitis were present in the proximal extremities (proximal to ankle or wrist). This suggests that advanced imaging is most appropriate for patients who present with cellulitis on the distal extremities and can be used more judiciously in patients presenting with cellulitis on the proximal extremities. Level of Evidence – Level III.
Black Families' Experiences of Developmental Screening: Review of Well-Child Visits to Inform Enhanced Autism Spectrum Disorder Risk Assessment
Authors: Weitlauf Amy S. , Vehorn Alison , Miceli Alexandra , Pinnock Theodora , Dada Yewande , Hine Jeffrey , Warren Zachary
Published: November 2022

Objective:

Black families face barriers to early diagnosis of autism spectrum disorder (ASD). Most work emphasizes systemic delays to diagnosis rather than how existing screening procedures may affect identification. Our goal was to examine pediatric care visits in which screening was most likely to occur to document behaviors of parents and providers.

Methods:

We examined 18- to 36-month primary care visits in our electronic health record system (n = 99) of thirty-nine 4- and 8-year-old Black children later diagnosed with ASD. We extracted qualitative and quantitative data and engaged in consensus coding. We captured whether formal screening occurred, the content of concerns of parents and providers, and referral patterns for follow-up care or evaluation.

Results:

Consistent with existing work, we found differences in parent and provider concerns and discrepancies in referral rates. Parents often endorsed concerns about language, sleeping or eating habits, behavior, or motor skills rather than ASD, but specific mention of ASD as a concern increased over time. Referrals for follow-up care were more likely when providers, not parents alone, expressed concerns about patient development.

Conclusion:

Pediatric providers cannot place the burden on families to raise autism concerns. Although some level of developmental risk was noted at most visits for children later diagnosed with ASD, referrals were only made when providers were also concerned, and most of these were for speech-language evaluation. Ongoing work is necessary to better understand how existing care systems interact with diverse families to inform the creation of inclusive screening practices that mitigate diagnostic delays.
Implementing the Get SET Early Model in a Community Setting to Lower the Age of ASD Diagnosis
Authors: Smith Christopher J. , James Stephen , Skepnek Erica , Leuthe Eileen , Outhier Lisa Elder , Avelar Delia , Barnes Cynthia Carter , Bacon Elizabeth , Pierce Karen
Published: November 2022

Objective:

The objective of this study was to implement a validated, university-based early detection program, the Get SET Early model, in a community-based setting. Get SET was developed to improve
S

creening,
E

valuation, and
T

reatment referral practices. Specifically, its purpose was to lower the age of diagnosis and enable toddlers with autism spectrum disorder (ASD) to begin treatment by 36 months.

Methods:

One hundred nine pediatric health care providers were recruited to administer the Communication and Symbolic Behavior Scales Developmental Profile Infant-Toddler Checklist at 12-month, 18-month, and 24-month well-baby visits and referred toddlers whose scores indicated the need for a developmental evaluation. Licensed psychologists were trained to provide diagnostic evaluations to toddlers as young as 12 months. Mean age of diagnosis was compared with current population rates.

Results:

In 4 years, 45,504 screens were administered at well-baby visits, and 648 children were evaluated at least 1 time. The overall median age for ASD diagnosis was 22 months, which is significantly lower than the median age reported by the CDC (57 months). For children screened at 12 months, the age of first diagnosis was significantly lower at 15 months. Of the 350 children who completed at least 1 follow-up evaluation, 323 were diagnosed with ASD or another delay, and 239 (74%) were enrolled in a treatment program.

Conclusion:

Toddlers with ASD were diagnosed nearly 3 years earlier than the most recent CDC report, which allowed children to start a treatment program by 36 months. Overall, Get SET Early was an effective strategy for improving the current approach to screening, evaluation, and treatment. Efforts to demonstrate sustainability are underway.
Modern indications for referral for kidney and pancreas transplantation
Authors: Fridell Jonathan A. , Stratta Robert J.
Published: November 2022

Purpose of review

Pancreas transplantation (PTx) is currently the only therapy that can predictably achieve sustained euglycemia independent of exogenous insulin administration in patients with insulin-dependent diabetes mellitus. This procedure involves a complex abdominal operation and lifetime dependence on immunosuppressive medications. Therefore, PTx is most frequently performed in combination with other organs, usually a kidney transplant for end stage diabetic nephropathy. Less frequently, solitary PTx may be indicated in patients with potentially life-threatening complications of diabetes mellitus. There remains confusion and misperceptions regarding indications and timing of patient referral for PTx.

Recent findings

In this review, the referral, evaluation, and listing process for PTx is described, including a detailed discussion of candidate assessment, indications, contraindications, and outcomes.

Because the progression of diabetic kidney disease may be less predictable than other forms of kidney failure, early referral for planning of renal and/or pancreas transplantation is paramount to optimize patient care and allow for possible preemptive transplantation.
Paradigm shift in lifestyle modification for solitary kidney after donor nephrectomy
Authors: Tantisattamo Ekamol , Kalantar-Zadeh Kamyar
Published: November 2022

Purpose of review

Living donor kidney transplantation potentially leads to long-term complications including chronic kidney disease, end-stage kidney disease, elevated blood pressure, and pregnancy-associated hypertension. Given living donors generally do not have underlying medical conditions, lifestyle modifications, particularly dietary interventions may prevent those complications and improve their health outcomes.

Recent findings

Glomerular hyperfiltration occurs as physiologic adaptation during an initial postdonor nephrectomy period. In the long-term, these adaptations may become pathologic consequences resulting from hyperfiltration-mediated kidney injury and ultimately secondary focal segmental glomerulosclerosis in the solitary kidney. Dietary interventions to slow a decline in kidney function include low protein intake of <0.8 g/kg/day and low sodium consumption of 2–4 g/day as well as certain health dietary patterns. There is no evidence regarding the quantity and quality of protein that can be recommended for living kidney donors and the same for sodium. Plant Dominant (PLADO) diets, Dietary Approaches to Stop Hypertension (DASH), Mediterranean, and vegetarian diets may be favorable for living kidney donors with solitary kidney but the evidence is still lacking.

Although dietary interventions may provide benefits and kidney health for living kidney donors, further studies including clinical trials are required to incorporate them into clinical practice guidelines.
Postburn Reconstruction of the Face and Neck
Authors: Sabapathy S. Raja , Shanmugakrishnan R. Raja , Ramkumar Sanjai , Muthukumar Vamseedharan , Senthilkumaran M. , Bharathi R. Ravindra
Published: November 2022

Learning Objectives:

After studying this article, the participant should be able to: 1. Understand the cardinal principles in the management of postburn deformities in the face and neck. 2. Understand reconstruction of specific subsites in the face and neck affected by burn contracture. 3. Acquire knowledge about the various techniques of burn reconstruction of the face and neck. 4. Grasp technical nuances and select appropriate surgical options for individual cases.

Postburn contractures in the face and neck region are multifactorial in origin and difficult to prevent in extensive burns. Facial burns lead to distortion of anatomical landmarks, causing aesthetic, functional, and psychological problems. Each subunit of the face is unique in structure; thus, the surgeon needs to adjust the timing of surgery and the technique according to region and the severity of contracture. Contracture of one unit, especially that of the neck and forehead, can exaggerate the contracture in neighboring subunits. The role of these extrinsic influences must be considered while sequencing surgical procedures. The burn surgeon must be adept in all reconstructive surgery techniques from skin grafting to tissue expanders to microsurgery to obtain the best outcomes. Surgery must be followed up with long-term physical therapy and psychological rehabilitation to help burn survivors with head and neck contractures to integrate back into society.