bluuebunny/crossref_metadata_2025 huggingface dataset:
Population pharmacokinetics of cyclophosphamide and 4-hydroxycyclophosphamide metabolite in patients with autoimmune glomerulonephritis
Authors: Iliopoulou Veatriki N , Charkoftaki Georgia , Cooper Jennifer C , Dokoumetzidis Aristides , Joy Melanie S
Published: August 2021

Objectives

To develop a simultaneous population pharmacokinetic model of cyclophosphamide (CY) and 4-hydroxycyclophosphamide (4-OH) in patients with glomerulonephritis.

Methods

In total, 23 patients participated in a pharmacokinetic evaluation using dense plasma sampling. A population pharmacokinetic model was developed in Monolix Suite 2020R1 that simultaneously describes the kinetics of CY and 4-OH. Several structural and residual error models were evaluated and patient variables were tested as potential covariates. The final model was selected based on visual predictive check and bootstrap. Simulations of plasma concentrations for various doses were conducted.

Key findings

A model including two compartments for CY and one for 4-OH was found to best describe the data. A proportional error model for both compounds was chosen. The following estimates were found for the main CY pharmacokinetic parameters: total clearance, 13.3 l/h with inter-individual variability (IIV) 32%, and central volume of distribution, 59.8 l with IIV 12%. The metabolite elimination rate constant was 4.3 h−1 with IIV 36% and the proportion of metabolism 64%. Sex was a significant covariate on the central volume of CY, with females exhibiting 25% lower value than males.

Conclusions

A population pharmacokinetic model was developed for CY and 4-OH in patients with autoimmune glomerulonephritis. Simulations using various dose regimens allow for informed dosing before the initiation of therapy.
Safe laparoscopic resection of a giant schwannoma in the retroperitoneum using a fluorescent ureteral stent: a case report
Authors: Nishimuta Masato , Sumida Yorihisa , Araki Masato , Wakata Kouki , Hamada Kiyoaki , Kugiyama Tota , Shibuya Ayako , Hashimoto Shintaro , Ozeki Keisuke , Morino Shigeyuki , Kiya Soichiro , Baba Masayuki , Nakamura Akihiro
Published: August 2021

Schwannomas that occur in the retroperitoneal cavity are rare. We herein report a patient who underwent safe laparoscopic resection by using a preoperative 3D computed tomography (CT) image and a fluorescent ureteral stent during the surgery.

A 47-year-old man presented with left lower abdominal pain. CT showed a 10-cm continuous retroperitoneal tumor originating at the third lumbar nerve in the lower left abdomen. Schwannoma was suspected. We underwent laparoscopic resection of the tumor guided by 3D images obtained preoperatively. A fluorescent ureteral stent was implanted during the surgery to improve visibility and protect the left ureter. The resection was completed without injury of other organs and vessels. The patient was discharged on postoperative Day 5.

By performing a preoperative simulation using 3D CT images, we could anticipate the anatomical findings and easily identify them intraoperatively. In addition, the fluorescent ureteral stent provided visual support, thereby contributing to safe surgery.
Immunotherapy against esophageal primary amelanotic malignant melanoma relapse
Authors: Tsukamoto Ryoichi , Ihara Hiroaki , Takase Masaru , Shimazu Ai , Takei Masahiko , Miura Hiroyoshi , Sakamoto Kazuhiro , Namekata Koji
Published: August 2021

Melanoma is a malignant tumor derived from melanocytes. Esophageal melanomas occur infrequently, especially primary amelanotic malignant melanoma of the esophagus (PAMME), which is extremely rare. Here, we report the case of a 74-year-old man with an esophageal amelanotic melanoma on the esophagogastric junction (EGJ) found on esophagogastroduodenoscopy. Radical surgery for the tumor at the EGJ was performed with total gastrectomy and D2 lymph node dissection. Diagnosis of PAMME was confirmed postoperatively by immunohistochemical staining. Four months after the surgery, abdominal computed tomography revealed multiple liver metastases. The patient received seven cycles of nivolumab monotherapy and two subsequent cycles of nivolumab and ipilimumab, and these metastases diminished. Recently, new therapeutic agents including immunotherapy have been developed for malignant melanoma and these agents have the potential of improving the prognosis of PAMME. Here, we present new insights into the diagnosis and therapeutic methods that can be used against primary esophageal melanoma.
Quantitative Detection of Anti-SARS-CoV-2 Antibodies Using Indirect ELISA
Authors: Luo Shuhong , Xu Jianhua , Cho Chih Yun , Zhu Siwei , Whittaker Kelly C , Wang Xingqi , Feng Jie , Wang Meng , Xie Shehuo , Fang Jianmin , Huang Andy S , Song Xuedong , Huang Ruo-Pan
Published: August 2021

Objective

Real-time reverse transcription-polymerase chain reaction is the gold standard for the diagnosis of COVID-19, but it is necessary to utilize other tests to determine the burden of the disease and the spread of the outbreak such as IgG-, IgM-, and IgA-based antibody detection using enzyme-linked immunosorbent assay (ELISA).

Materials and Methods

We developed an indirect ELISA assay to quantitatively measure the amount of COVID-19 IgG, IgM, and IgA antibodies present in patient serum, dried blood, and plasma.

Results

The population cutoff values for positivity were determined by receiver operating characteristic curves to be 1.23 U/mL, 23.09 U/mL, and 6.36 U/mL for IgG, IgM, and IgA, respectively. After albumin subtraction, the specificity remained >98% and the sensitivity was 95.72%, 83.47%, and 82.60%, respectively, for IgG, IgM, and IgA antibodies to the combined spike subunit 1 receptor binding domain and N proteins in serum. Plasma and dried blood spot specimens were also validated on this assay.

Conclusion

This assay may be used for determining the seroprevalence of SARS-CoV-2 in a population exposed to the virus or in vaccinated individuals.
Indicative Conditionals and Epistemic Luminosity
Authors: Hewson Matthew , Kirkpatrick James Ravi
Published: August 2021

Kevin Dorst has recently pointed out an apparently puzzling consequence of denying epistemic luminosity: given some natural-sounding bridging principles between knowledge, credence, and indicative conditionals, the denial of epistemic luminosity licenses the knowledge and assertability of abominable-sounding conditionals of the form ⌜If I don’t know that ϕ, then ϕ⌝. We provide a general and systematic examination of this datum by testing Dorst’s claim against various semantics for the indicative conditional in the setting of epistemic logic. Our conclusion is that, regardless of whether knowledge is luminous, the knowability of these conditionals is highly sensitive to the correct semantic analysis of the indicative conditional. Moreover, standard pragmatic resources can explain away the infelicity of such assertions. As it stands, the datum does not tell against epistemic non-luminosity.
The qualitative accuracy of clinical dermatophytes via matrix-assisted laser desorption ionization-time of flight mass spectrometry: A meta-analysis
Authors: Chen Jin , Zheng Feng , Sun Xihuan , Gao Hongzhi , Lin Shu , Zeng Yiming
Published: August 2021

Dermatophytes are an important part of superficial fungal infections, and accurate diagnosis is paramount for successful treatment. Recently, matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) has emerged as a powerful tool to identify clinical pathogens; its advantages are cost-effectiveness, rapid detection, and high accuracy. However, as the accurate identification of clinical dermatophytes via MALDI-TOF MS has still not been fully evaluated, we performed a meta-analysis for its systematic evaluation. Fifteen eligible studies were involved and showed high accuracy with an identification ratio of 0.96 (95% CI = 0.92─1.01) and 0.91 (95% CI = 0.86─0.96) at the genus and species levels, respectively. The results showed higher accuracy ratio of Vitek MS (91%) than MALDI Biotyper (85%). Dermatophytes such as Trichophyton interdigitale (0.99, 95% CI = 0.97─1.02), T. mentagrophytes var interdigitale (1.00, 95% CI = 0.98─1.02), and Microsporum canis (0.97, 95% CI = 0.89─1.04) showed high accuracy in detected clinical dermatophytes. Moreover, a library with self-built database set up by laboratories showed higher accuracy than commercial database, and 15-day cultivation for dermatophytes showed highest accuracy considering culture time. High heterogeneity was observed and decreased only with the subgroup analysis of species. The subgroup analysis of mass spectrometry, library database, and culture time also exhibited high heterogeneity. In summary, our results showed that MALDI-TOF MS could be used for highly accurate detection of clinically pathogenic dermatophytes, which could be an alternative diagnostic method in addition to morphological and molecular methods.
TERA-Seq: true end-to-end sequencing of native RNA molecules for transcriptome characterization
Authors: Ibrahim Fadia , Oppelt Jan , Maragkakis Manolis , Mourelatos Zissimos
Published: August 2021

Direct sequencing of single, native RNA molecules through nanopores has a strong potential to transform research in all aspects of RNA biology and clinical diagnostics. The existing platform from Oxford Nanopore Technologies is unable to sequence the very 5′ ends of RNAs and is limited to polyadenylated molecules. Here, we develop True End-to-end RNA Sequencing (TERA-Seq), a platform that addresses these limitations, permitting more thorough transcriptome characterization. TERA-Seq describes both poly- and non-polyadenylated RNA molecules and accurately identifies their native 5′ and 3′ ends by ligating uniquely designed adapters that are sequenced along with the transcript. We find that capped, full-length mRNAs in human cells show marked variation of poly(A) tail lengths at the single molecule level. We report prevalent capping downstream of canonical transcriptional start sites in otherwise fully spliced and polyadenylated molecules. We reveal RNA processing and decay at single molecule level and find that mRNAs decay cotranslationally, often from their 5′ ends, while frequently retaining poly(A) tails. TERA-Seq will prove useful in many applications where true end-to-end direct sequencing of single, native RNA molecules and their isoforms is desirable.
Structural and chemical evolution in layered oxide cathodes of lithium-ion batteries revealed by synchrotron techniques
Authors: Qian Guannan , Wang Junyang , Li Hong , Ma Zi-Feng , Pianetta Piero , Li Linsen , Yu Xiqian , Liu Yijin
Published: August 2021

Rechargeable battery technologies have revolutionized electronics, transportation and grid energy storage. Many materials are being researched for battery applications, with layered transition metal oxides (LTMO) the dominating cathode candidate with remarkable electrochemical performance. Yet, daunting challenges persist in the quest for further battery developments targeting lower cost, longer lifespan, improved energy density and enhanced safety. This is, in part, because of the intrinsic complexity of real-world batteries, featuring sophisticated interplay among microstructural, compositional and chemical heterogeneities, which has motivated tremendous research efforts using state-of-the-art analytical techniques. In this research field, synchrotron techniques have been identified as a suite of effective methods for advanced battery characterization in a non-destructive manner with sensitivities to the lattice, electronic and morphological structures. This article provides a holistic overview of cutting-edge developments in synchrotron-based research on LTMO battery cathode materials. We discuss the complexity and evolution of LTMO’s material properties upon battery operation and review recent synchrotron-based research works that address the frontier challenges and provide novel insights in this field. Finally, we formulate a perspective on future directions of synchrotron-based battery research, involving next-generation X-ray facilities and advanced computational developments.
Supinator to Posterior Interosseous Nerve Transfer for Restoration of Finger Extension
Authors: Bazarek Stanley , Sten Margaret , Nin Darren , Brown Justin M
Published: August 2021

BACKGROUND

Cervical spinal cord injuries result in a severe loss of function and independence. The primary goal for these patients is the restoration of hand function. Nerve transfers have recently become a powerful intervention to restore the ability to grasp and release objects. The supinator muscle, although a suboptimal tendon transfer donor, serves as an ideal distal nerve donor for reconstructive strategies of the hand. This transfer is also applicable to lower brachial plexus injuries.

OBJECTIVE

To describe the supinator to posterior interosseous nerve transfer with the goal of restoring finger extension following spinal cord or lower brachial plexus injury.

METHODS

Nerve branches to the supinator muscle are transferred to the posterior interosseous nerve supplying the finger extensor muscles in the forearm.

RESULTS

The supinator to posterior interosseous nerve transfer is effective in restoring finger extension following spinal cord or lower brachial plexus injury.

CONCLUSION

This procedure represents an optimal nerve transfer as the donor nerve is adjacent to the target nerve and its associated muscles. The supinator muscle is innervated by the C5-6 nerve roots and is often available in cases of cervical SCI and injuries of the lower brachial plexus. Additionally, supination function is retained by supination action of the biceps muscle.
Traumatic and Spontaneous Vertebral Artery Dissections: An Analysis of Tertiary-Center 310 Patient Cohort
Authors: Prasad Nikil , Mitra Akash , Shlobin Nathan A , Azad Hooman A , Cloney Michael B , Hopkins Benjamin S , Jahromi Babak S , Potts Matthew B , Dahdaleh Nader S
Published: August 2021

BACKGROUND

Vertebral artery dissections (VADs) are rare yet potentially devastating events. While the etiology of these events is either traumatic or spontaneous, there is a paucity of quantitative literature comparing the two.

OBJECTIVE

To identify differences in predisposing factors, event characteristics, and clinical outcomes between traumatic VADs (tVADs) and spontaneous VADs (sVADs).

METHODS

We retrospectively identified patients with VADs presenting to our institution at VAD onset with at least a 3-mo follow-up. Demographics, event characteristics, treatment details, and neurological outcomes as modified Rankin scale (mRS) scores were collected.

RESULTS

Of the 310 patients sustaining 366 VADs total, 187 (60.3%) patients experienced a total of 221 (60.4%) sVADs and 123 (39.7%) patients experienced a total of 145 (39.6%) tVADs. sVADs were more likely to occur in the intracranial course of the artery (P = .042) and have a lower mRS at discharge, 3-month, and last clinical follow-up (P = 003, .002, and .001, respectively). tVADs were more likely associated with concomitant fractures (P < .001).

CONCLUSION

Despite similar patient populations, tVADs are associated with higher mRS scores at all time points. Although further study is needed, this may suggest other concomitant trauma rather than the VAD itself is contributing to worse neurological status in patients with tVADs.
Endoscopic Endonasal Resection of Cranio-Cervical Junction Chordoma and Ventral Chiari Decompression: A Case Report
Authors: Muthiah Nallammai , McDowell Michael M , Zenonos Georgios , Agarwal Nitin , Snyderman Carl H , Friedlander Robert M , Gardner Paul A
Published: August 2021

BACKGROUND

Chiari I malformations secondary to other causes represent a small subset of presenting symptomatic cases. Typically, the primary cause of the malformation is addressed first and results in resolution of the malformation and symptoms. However, in some cases, a patient may present with both a primary Chiari I malformation and another unrelated neurosurgical lesions.

OBJECTIVE

To present a unique case in which resection of a ventral tumor allowed for spontaneous resolution of a simultaneously noted dorsal Chiari I malformation.

METHODS

Pertinent data, including presenting symptoms, hospital course, surgical notes, preoperative images, and postoperative images, were collected using the electronic medical record.

RESULTS

We present a case of a 46-yr-old man with a Chiari I malformation in conjunction with a ventral cranio-cervical junction chordoma. Endoscopic endonasal resection of the chordoma and ventral foramen magnum decompression resulted in radiographic resolution of the Chiari malformation and resolution of his symptoms. Our report represents a rare case of ventral foramen magnum decompression as a treatment for Chiari I malformation.

CONCLUSION

It is felt that the chordoma mass effect was not the source of the Chiari I malformation. Thus, both ventral and dorsal decompressions of the posterior fossa may be considered for Chiari I decompression in select circumstances.
Seasonal hydromedusan feeding patterns in an Eastern Boundary Current show consistent predation on primary consumers
Authors: Corrales-Ugalde Marco , Sponaugle Su , Cowen Robert K , Sutherland Kelly R
Published: August 2021

Cnidarian jellyfish can be dominant players in the food webs of highly productive Eastern Boundary Currents (EBC). However, the trophic role of inconspicuous hydromedusae in EBCs has traditionally been overlooked. We collected mesozooplankton from five stations along two cross-shelf transects in the Northern California Current (NCC) during winter and summer of 2018–2019. We analyzed gut contents of 11 hydromedusan species and the prey community to (i) determine prey resource use by hydromedusae and (ii) determine temporal shifts in the trophic niche of hydromedusae, focusing on the two most collected species (Clytia gregaria and Eutonina indicans). Hydromedusae in the NCC fed mostly on copepods, appendicularians and invertebrate larvae. Nonmetric multidimensional scaling of hydromedusan diets showed seasonal shifts in prey resource driven by the abundant C. gregaria, which fed mostly on copepod eggs during winter and fed mostly on appendicularians and copepods during summer. Prey selectivity for copepod eggs increased during winter for C. gregaria and E. indicans. Intriguingly, theoretical ingestion rates show that both species acquire similar amounts of carbon during upwelling and nonupwelling conditions. Hydromedusae’s consistent presence and predation impact across seasons may lead to significant effects in carbon and energy transfer through the NCC food web.
Rank, Experience, and Attitudes towards Domestic Violence Intervention: A Moderated Mediation Analysis of Chinese Police Officers
Authors: Lin Kai , Wu Yuning , Sun Ivan Y , Wang Xiying
Published: August 2021

By analyzing survey data collected from over 400 police officers in Jiangsu Province, China, this study assessed the direct and indirect effects of officer rank and experience on police support for law enforcement domestic violence (DV) intervention. The results from the path analysis revealed that officer experience of handling DV reduced support for DV intervention, and this reductive effect was stronger among frontline officers as compared with their supervisors. Supervisory support was directly linked to officer support for handling DV, mediating the influences of demographic and experiential factors. These findings suggest that when it comes to DV intervention, the experience of handling DV, moderated by officer rank, plays a strong role in shaping DV enforcement in China along with supervisory support. Implications for policymaking and future research were also discussed.
Impact of animation-supported consent on complaints and serious incidents due to failure to inform
Authors: Wald D S , Arrol L
Published: August 2021

Background

Introduction of digital animations to explain medical procedures before consent to treatment (animation-supported consent) has been shown to improve patient-reported understanding of a procedure’s benefits, risks and alternatives.

Aim

We examined whether introduction of animation-supported consent is associated with a change in the incidence of complaints and serious incidents due to failure to inform.

Methods

Multi-language animations explaining 10 cardiac procedures, in coronary intervention, electrophysiology and cardiac surgery, (www.explainmyprocedure.com) were introduced at a London cardiac centre from April 2019. Complaints and serious incidents due to failure to inform were identified from the hospital Datix database for the two years before introducing animation-supported consent (no animation group) and the two years afterwards (animation group), together with the total number of procedures and major complications recorded during these periods. We compared the incidence of complaints and serious incidents, expressed as a proportion of the number of major complications, recorded during each period.

Results

There were 580 complications among 21 855 procedures performed in the no animation group and 411 complications among 18 254 procedures in the animation group. There were 14 complaints or serious incidents due to failure to inform in the no animation group and 3 in the animation group; rates of 2.41% (14/580) and 0.73% (3/411), respectively (P < 0.001 for difference).

Conclusion

In this observational comparison, introduction of animation-supported consent was associated with a 70% reduction in complaints or serious incidents due to failure to inform before consent. This has significant quality and cost implications for improving consent pathways in clinical practice.
A Dynamic Framework for Earnings Inequality between Black and White Men
Authors: Ren Chunhui
Published: August 2021

The present study conceptualizes earnings inequality between black and white men as a three-stage dynamic process: the pre-market human capital acquisition, the labor-market entry, and the longitudinal career progression. Based on the Panel Study of Income Dynamics (PSID), this framework is put to an empirical test that leads to two major conclusions. First, overall patterns of black-white earnings inequality are shaped primarily at labor-market entry as opposed to developing within the labor market. Second, the longitudinal progression of earnings inequality exhibits distinctive trajectories across different pre-market groups. Less-educated black men face a wider earnings gap at labor-market entry, but the gap stays relatively stable over time. Highly educated black men face a narrower earnings gap at labor-market entry, but the gap widens over time. I attribute these patterns to the temporal-specific interplays between race and a series of labor-market mechanisms.
Multimodal learning of pheromone locations
Authors: Pardasani Meenakshi , Marathe Shruti D. , Purnapatre Maitreyee Mandar , Dalvi Urvashi , Abraham Nixon M.
Published: August 2021

Memorizing pheromonal locations is critical for many mammalian species as it involves finding mates and avoiding competitors. In rodents, pheromonal information is perceived by the main and accessory olfactory systems. However, the role of somatosensation in context‐dependent learning and memorizing of pheromone locations remains unexplored. We addressed this problem by training female mice on a multimodal task to locate pheromones by sampling volatiles emanating from male urine through the orifices of varying dimensions or shapes that are sensed by their vibrissae. In this novel pheromone location assay, female mice’ preference toward male urine scent decayed over time when they were permitted to explore pheromones vs neutral stimuli, water. On training them for the associations involving olfactory and whisker systems, it was established that they were able to memorize the location of opposite sex pheromones, when tested 15 days later. This memory was not formed either when the somatosensory inputs through whisker pad were blocked or when the pheromonal cues were replaced with that of same sex. The association between olfactory and somatosensory systems was further confirmed by the enhanced expression of the activity‐regulated cytoskeleton protein. Furthermore, the activation of main olfactory bulb circuitry by pheromone volatiles did not cause any modulation in learning and memorizing non‐pheromonal volatiles. Our study thus provides the evidence for associations formed between different sensory modalities facilitating the long‐term memory formation relevant to social and reproductive behaviors.
Communicating to Engage: An Improvisational Theater-Based Communication Training Designed to Support Community–Academic Partnership Development
Authors: Battaglia Tracy A. , Megrath Kyle , Spencer Nikki , Pamphile Jennifer , Crossno Chase , Maschke Ariel , Bak Sharon , O’Connor George T. , Clark Cheryl R. , Sarfaty Suzanne
Published: August 2021

Problem

The potential for community-engaged research to address health inequity requires deliberate effort to create trusting and equitable community–academic partnerships. A lack of evidence-based opportunities for cultivating such partnerships remains a barrier.

Approach

In 2017 and 2018, the authors designed, facilitated, and evaluated a mixed stakeholder training, Communicating to Engage, at 2 urban academic medical centers involved in the All of Us research program, Boston Medical Center and Mass General Brigham. The goal was to bring together researchers and community members to develop communication skills through improvisational theater-based co-learning. The curriculum was inspired by several evidence-based learning frameworks including community-based participatory research principles and improvisational theater techniques. A self-administered survey completed before and after the training session measured participants’ communication skills using the Self-Perceived Communication Competence Scale (SPCCS) and comfort with specific communication styles as outlined in the program’s training objectives. Paired t tests were used to measure changes in scaled responses among combined participants and separately among self-identified community members and researchers.

Outcomes

Sixty-nine total participants across 6 workshops completed training evaluations. Overall, pre–post survey analysis demonstrated significant mean score improvement for both the SPCCS and comfort with specific communication styles. In stratified analysis, both community members (n = 26) and researchers (n = 38) reported significant improvement in scores related to comfort with specific communication styles. Only researchers, but not community members, had significant improvement in SPCCS scores.

Next Steps

The Communicating to Engage program brought community and researcher stakeholders together and demonstrated improvement in self-perceived communication styles, yet researcher participants benefited more than community participants. Future innovation is necessary to further target community stakeholder communication training needs. Mixed stakeholder improvisational theater-based learning provides deliberate opportunities to build new community–academic partnerships that may enhance health equity initiatives.
Influence of seasonal variability on orthopedic surgical outcomes in pediatric patients: a review of surgical site infections
Authors: Lin James S. , Singh Satbir , Sumski Alan , Balch Samora Julie
Published: August 2021

Surgical site infections (SSIs) are challenging, with highly variable reported rates for children undergoing orthopedic surgery. It has been shown in adults that there is seasonal variability in SSI rates, with peak incidences in the summer months. We reviewed 8766 pediatric orthopedic procedures completed at a quaternary children’s hospital over a 43-month period. Data collected included: age, sex, BMI, season of procedure, cultures, and other variables related to risks and treatment of SSIs. Of 4875 male and 3891 female pediatric patients undergoing orthopedic procedures, 47 patients (0.54%) with an average age of 11.3 years (range: 2.0–18.6) developed an SSI. Average time between surgery and diagnosis was 27.7 ± 19.8 days. Sixty percent of SSI patients had a BMI in the 85th percentile or above, and 49% of SSI patients had a BMI above the 95th percentile. Thirty-eight patients had positive cultures, with most common infections being due to methicillin-sensitive Staphylococcus aureus in 11 (29%) cases, polymicrobial in 9 (24%), pseudomonas in 5 (13%), and coagulase-negative Staphylococcus in 5 (13%). SSI rate in winter (0.18%) was significantly lower than in autumn (0.77%, P = 0.006) and summer (0.69%, P = 0.02). The difference did not reach statistical significance from the infection rate in spring (0.53%, P = 0.06). Twenty-nine (62%) SSI cases were considered elective in nature, and the other 18 (38%) cases were for acute traumatic injuries. There is a significantly higher SSI rate in summer and autumn than winter for pediatric patients undergoing orthopedic surgeries. Most patients with SSIs were overweight or obese.
The Influence of Surgeon Experience and Subspeciality on the Reliability of the AO Spine Sacral Classification System
Authors: Karamian Brian A. , Schroeder Gregory D. , Levy Hanna A. , Canseco Jose A. , Benneker Lorin M. , Kandziora Frank , Rajasekaran Shanmuganathan , Öner F. Cumhur , Schnake Klaus J. , Kepler Christopher K. , Vaccaro Alexander R.
Published: August 2021

Study Design.

Cross-sectional survey.

Objective.

To determine the influence of surgeons’ level of experience and subspeciality training on the reliability, reproducibility, and accuracy of sacral fracture classification using the Arbeitsgemeinschaft für Osteosynthesefragen Spine Sacral Classification System.

Summary of Background Data.

A surgeons’ level of experience or subspecialty may have a significant effect on the reliability and accuracy of sacral classification given various levels of comfort with imaging assessment required for accurate diagnosis and classification.

Methods.

High-resolution computerized tomography (CT) images from 26 cases were assessed on two separate occasions by 172 investigators representing a diverse array of surgical subspecialities (general orthopedics, neurosurgery, orthopedic spine, orthopedic trauma) and experience (<5, 5–10, 11–20, >20 yrs). Reliability and reproducibility were calculated with Cohen kappa coefficient (k) and gold standard classification agreement was determined for each fracture morphology and subtype and stratified by experience and subspeciality.

Results.

Respondents achieved an overall k = 0.87 for morphology and k = 0.77 for subtype classification, representing excellent and substantial intraobserver reproducibility, respectively. Respondents from all four practice experience groups demonstrated excellent interobserver reliability when classifying overall morphology (k = 0.842/0.850, Assessment 1/Assessment 2) and substantial interobserver reliability in overall subtype (k = 0.719/0.751) in both assessments. General orthopedists, neurosurgeons, and orthopedic spine surgeons exhibited excellent interobserver reliability in overall morphology classification and substantial interobserver reliability in overall subtype classification. Surgeons in each experience category and subspecialty correctly classified fracture morphology in over 90% of cases and fracture subtype in over 80% of cases according to the gold standard. Correct overall classification of fracture morphology (Assessment 1: P = 0.024, Assessment 2: P = 0.006) and subtype (P
2 < 0.001) differed significantly by years of experience but not by subspecialty.

Conclusion.

Overall, the Arbeitsgemeinschaft für Osteosynthesefragen spine sacral classification system appears to be universally applicable among surgeons of various subspecialties and levels of experience with acceptable reliability, reproducibility, and accuracy.

Level of Evidence: 4
Age as a Risk Factor for Complications Following Anterior Cervical Discectomy and Fusion
Authors: Lawless Michael H. , Tong Doris , Claus Chad F. , Hanson Connor , Li Chenxi , Houseman Clifford M. , Bono Peter , Richards Boyd F. , Kelkar Prashant S. , Abdulhak Muwaffak M. , Chang Victor , Carr Daniel A. , Park Paul , Soo Teck M.
Published: August 2021

Study Design.

Retrospective analysis of prospectively collected registry data using multivariable analyses of imputed data

Objective.

We sought to demonstrate that age would not be associated with complications in patients undergoing anterior cervical discectomy and fusion (ACDF).

Summary of Background Data.

Elderly patients (≥70 yrs) undergoing ACDF are considered a higher risk for complications. However, conclusive evidence is lacking. The Michigan Spine Surgery Improvement Collaborative (MSSIC) is a quality improvement collaborative with 30 hospitals across Michigan.

Methods.

The study included all patients who had 1 to 4 level ACDF (September 2015–August 2019) for 90-day complications. Major and minor complications were defined using a validated classification. Multiple imputations were used to generate complete covariate datasets. Generalized estimating equation model was used to identify associations with complications using the whole cohort and elderly subgroup analyses. Bonferroni correction was used.

Results.

Nine thousand one hundred thirty five patients (11.1% ≥ 70 yrs and 88.9% <70 yrs) with 2266 complications were analyzed. Comparing elderly versus non-elderly, the elderly had a significantly higher rate of any complications (31.5% vs. 24.0%, P < 0.001) and major complications (14.1% vs. 7.0%, P < 0.001). On multivariable analysis, age was not independently associated with any complication. POD#0 ambulation and preop independent ambulation were independently associated with significantly decreased odds of any complication. In the elderly, independent preoperative ambulation was protective for any complication (odds ratio [OR] 0.53, 0.39–0.73 95% confidence interval [CI]), especially major complications (OR 0.41, 0.27–0.61 95% CI).

Conclusion.

Age was not an independent risk factor for complications in patients that underwent ACDF. In the elderly, independent preoperative ambulation was especially protective for major complications.

Level of Evidence: 3
Increasing Cost Efficiency in Adult Spinal Deformity Surgery
Authors: Passias Peter G. , Brown Avery E. , Bortz Cole , Alas Haddy , Pierce Katherine , Ahmad Waleed , Naessig Sara , Lafage Renaud , Lafage Virginie , Hassanzadeh Hamid , Labaran Lawal A. , Ames Christopher , Burton Douglas C. , Gum Jeffrey , Hart Robert , Hostin Richard , Kebaish Khaled M. , Neuman Brian J. , Bess Shay , Line Breton , Shaffrey Christopher , Smith Justin , Schwab Frank , Klineberg Eric
Published: August 2021

Study Design.

Retrospective study of a prospective multicenter database.

Objective.

The purpose of this study was to identify predictors of lower total surgery costs at 3 years for adult spinal deformity (ASD) patients.

Summary of Background Data.

ASD surgery involves complex deformity correction.

Methods.

Inclusion criteria: surgical ASD (scoliosis ≥20°, sagittal vertical axis [SVA] ≥5 cm, pelvic tilt ≥25°, or thoracic kyphosis ≥60°) patients >18 years. Total costs for surgery were calculated using the PearlDiver database. Cost per quality-adjusted life year was assessed. A Conditional Variable Importance Table used nonreplacement sampling set of 20,000 Conditional Inference trees to identify top factors associated with lower cost surgery for low (LSVA), moderate (MSVA), and high (HSVA) SRS Schwab SVA grades.

Results.

Three hundred sixtee of 322 ASD patients met inclusion criteria. At 3-year follow up, the potential cost of ASD surgery ranged from $57,606.88 to $116,312.54. The average costs of surgery at 3 years was found to be $72,947.87, with no significant difference in costs between deformity groups (P > 0.05). There were 152 LSVA patients, 53 MSVA patients, and 111 HSVA patients. For all patients, the top predictors of lower costs were frailty scores <0.19, baseline (BL) SRS Activity >1.5, BL Oswestry Disability Index <50 (all P < 0.05). For LSVA patients, no history of osteoporosis, SRS Activity scores >1.5, age <64, were the top predictors of lower costs (all P < 0.05). Among MSVA patients, ASD invasiveness scores <94.16, no past history of cancer, and frailty scores <0.3 trended toward lower total costs (P = 0.071, P = 0.210). For HSVA, no history of smoking and body mass index <27.8 trended toward lower costs (both P = 0.060).

Conclusion.

ASD surgery has the potential for improved cost efficiency, as costs ranged from $57,606.88 to $116,312.54. Predictors of lower costs included higher BL SRS activity, decreased frailty, and not having depression. Additionally, predictors of lower costs were identified for different BL deformity profiles, allowing for the optimization of cost efficiency for all patients.

Level of Evidence: 3
A Randomized Controlled Trial to Evaluate the Clinical Effectiveness of 3D-Printed Orthosis in the Management of Adolescent Idiopathic Scoliosis
Authors: Lin Yangmin , Cheung Jason Pui Yin , Chan Chi Kwan , Wong Sidney Wing Fai , Cheung Kenneth Man Chee , Wong Martin , Wong Wun Ching , Cheung Prudence Wing Hang , Wong Man Sang
Published: August 2021

Study Design.

Prospective randomized controlled trial.

Objective.

To compare clinical effectiveness and quality of life (QoL) of the 3D-printed orthosis (3O) and conventional orthosis (CO) for adolescent idiopathic scoliosis (AIS).

Summary of Background Data.

Using 3D printing technology to design and fabricate orthoses to manage AIS aiming to improve in-orthosis correction and patients’ compliance that are considered essential factors of effective treatment. Clinical evaluation was conducted to study the effectiveness of this innovative method.

Methods.

Thirty females with AIS who met the criteria (age 10–14, Cobb 20–40°, Risser sign 0–2, ≤12 months after menarche) were recruited. Subjects were randomly allocated to the 3O group (n = 15, age 12.4, Cobb 31.8°) and CO group (n = 15, age 12.0, Cobb 29.3°). All patients were prescribed for full-time wearing (23 hours/d) and follow-up every 4 to 6 months until bone maturity. Compliance was monitored by thermosensors, while QoL was assessed using three validated questionnaires.

Results.

Comparable immediate in-orthosis correction was observed between 3O (−11.6°, P < 0.001) and CO groups (−12.9°, P < 0.001). In the QoL study via SRS-22r, the 3O group got worse results after 3 months in aspects of function, self-image, and mental health (−0.5, −0.6, −0.7, P < 0.05) while the CO group had worse results in aspects of self-image and mental health (−0.3, −0.3, P < 0.05). No significant difference was found in QoL assessments between groups. After 2 years of follow-up, 22 patients were analyzed with 4 dropouts in each group. Comparable angle reduction was observed in both groups (3O: −2.2°, P = 0.364; CO: −3.5°, P = 0.193). There was one subject (9.1%) in the 3O group while two subjects (18.2%) in the CO group had curve progression >5°. Daily wearing hours were 1.9 hours longer in the 3O group than the CO group (17.1 vs. 15.2 hours, P = 0.934).

Conclusion.

The 3O group could provide comparable clinical effects as compared with the CO group while patients with 3O showed similar compliance and QoL compared to those with CO.

Level of Evidence: 1
Peripheral Oxygen Saturation Facilitates Assessment of Respiratory Dysfunction in the Sequential Organ Failure Assessment Score With Implications for the Sepsis-3 Criteria
Authors: Valik John Karlsson , Mellhammar Lisa , Sundén-Cullberg Jonas , Ward Logan , Unge Christian , Dalianis Hercules , Henriksson Aron , Strålin Kristoffer , Linder Adam , Nauclér Pontus
Published: August 2021

OBJECTIVES:

Sequential Organ Failure Assessment score is the basis of the Sepsis-3 criteria and requires arterial blood gas analysis to assess respiratory function. Peripheral oxygen saturation is a noninvasive alternative but is not included in neither Sequential Organ Failure Assessment score nor Sepsis-3. We aimed to assess the association between worst peripheral oxygen saturation during onset of suspected infection and mortality.

DESIGN:

Cohort study of hospital admissions from a main cohort and emergency department visits from four external validation cohorts between year 2011 and 2018. Data were collected from electronic health records and prospectively by study investigators.

SETTING:

Eight academic and community hospitals in Sweden and Canada.

PATIENTS:

Adult patients with suspected infection episodes.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

The main cohort included 19,396 episodes (median age, 67.0 [53.0–77.0]; 9,007 [46.4%] women; 1,044 [5.4%] died). The validation cohorts included 10,586 episodes (range of median age, 61.0–76.0; women 42.1–50.2%; mortality 2.3–13.3%). Peripheral oxygen saturation levels 96–95% were not significantly associated with increased mortality in the main or pooled validation cohorts. At peripheral oxygen saturation 94%, the adjusted odds ratio of death was 1.56 (95% CI, 1.10–2.23) in the main cohort and 1.36 (95% CI, 1.00–1.85) in the pooled validation cohorts and increased gradually below this level. Respiratory assessment using peripheral oxygen saturation 94–91% and less than 91% to generate 1 and 2 Sequential Organ Failure Assessment points, respectively, improved the discrimination of the Sequential Organ Failure Assessment score from area under the receiver operating characteristics 0.75 (95% CI, 0.74–0.77) to 0.78 (95% CI, 0.77–0.80; p < 0.001). Peripheral oxygen saturation/Fio
2 ratio had slightly better predictive performance compared with peripheral oxygen saturation alone, but the clinical impact was minor.

CONCLUSIONS:

These findings provide evidence for assessing respiratory function with peripheral oxygen saturation in the Sequential Organ Failure Assessment score and the Sepsis-3 criteria. Our data support using peripheral oxygen saturation thresholds 94% and 90% to get 1 and 2 Sequential Organ Failure Assessment respiratory points, respectively. This has important implications primarily for emergency practice, rapid response teams, surveillance, research, and resource-limited settings.
Diabetes risk reduction diet and the risk of breast cancer
Authors: Turati Federica , Bravi Francesca , Rossi Marta , Serraino Diego , Mattioli Veronica , Augustin Livia , Crispo Anna , Giacosa Attilio , Negri Eva , La Vecchia Carlo
Published: August 2021

Objective

Diabetes and insulin levels may increase the risk of postmenopausal breast cancer. In the present investigation, we aimed at evaluating whether adherence to a diabetes risk reduction diet (DRRD) lowers the risk of breast cancer.

Methods

We used data from an Italian, multicentric case-control study (1991–1994) including 2569 incident histologically-confirmed breast cancer cases and 2588 hospital controls. A food frequency questionnaire collected subjects’ usual diet. We derived a DRRD score on the basis of eight items: intake of cereal fiber, total fruit, coffee, polyunsaturated to saturated fats ratio and nuts (higher scores for higher intakes), and dietary glycemic index, red/processed meat and sugar-sweetened beverages/fruit juices (higher scores for lower intakes). The score theoretically ranged 8–37, with higher values indicating greater DRRD adherence. Odds ratios (ORs) of breast cancer according to the DRRD score were estimated using multiple logistic regression models.

Results

The DRRD score was inversely related to the risk of breast cancer. The ORs were 0.93 [95% confidence interval (CI), 0.89–0.98] for a three-point score increment and 0.76 (95% CI, 0.64–0.89) for the highest versus the lowest quartile (P for trend 0.001). Inverse associations were observed in subgroups of covariates.

Conclusions

Higher DRRD adherence may decrease the risk of breast cancer.
Prospective Longitudinal Assessment of Health-related Quality of Life in Patients With Brain Metastases Undergoing Radiation Therapy
Authors: Salans Mia , Yip Anthony , Burkeen Jeffrey , Liu Kevin X. , Lee Euyhyun , Pan-Weisz Tonya , Marshall Deborah , McDuff Susan G.R. , Sharifzadeh Yasamin , Dalia Yoseph , Sanghvi Parag , Simpson Daniel , Xu Ronghui , McDonald Carrie , Hattangadi-Gluth Jona A.
Published: August 2021

Objective:

We conducted a prospective clinical trial of patients receiving radiation (RT) for brain metastases to identify clinical predictors of pre-RT and post-RT health-related quality of life (hrQoL).

Materials and Methods:

Patients with brain metastases completed overall (European Organisation for Research and Treatment of Cancer QLQ C15-PAL) and brain tumor-specific (QLQ-BN20) hrQoL assessments pre-RT (n=127) and 1 (n=56) and 3 (n=45) months post-RT. Linear and proportional-odds models analyzed patient, disease, and treatment predictors of baseline, 1-, and 3-month hrQoL scores. Generalized estimating equations and repeated measures proportional-odds models assessed predictors of longitudinal hrQoL scores.

Results:

Most patients underwent stereotactic radiosurgery (SRS) (69.3%) and had non−small-cell lung (36.0%) metastases. Compared with SRS, receipt of whole brain RT was associated with a higher odds of appetite loss (baseline P=0.04, 1 mo P=0.02) and greater motor dysfunction (baseline P=0.01, 1 mo P=0.003, 3 mo P=0.02). Receipt of systemic therapy was associated with better emotional functioning after RT (1 mo P=0.03, 3 mo P=0.01). Compared with patients with breast cancer, patients with melanoma had higher odds of better global hrQoL (P=0.01) and less pain (P=0.048), while patients with lung cancer reported lower physical function (P=0.048) 3 months post-RT. Nonmarried patients had greater odds of higher global hrQoL (1 mo P=0.01), while male patients had lower odds of reporting more hair loss (baseline P=0.03, 3 mo P=0.045). Patients 60 years and above had lower odds of more drowsiness (P=0.04) and pain (P=0.049) over time.

Conclusions:

Patients receiving SRS versus whole brain RT and systemic therapy reported better posttreatment hrQoL. In addition, melanoma metastases, nonmarried, male, and older patients with reported better hrQoL in various as well as domains after intracranial RT.