bluuebunny/crossref_metadata_2025 huggingface dataset:
Astragalus polysaccharide mitigates transport stress-induced hepatic metabolic stress via improving hepatic glucolipid metabolism in chicks
Authors: Zhao Bi-Chen , Tang Yi-Xi , Qiu Bai-Hao , Xu Hao-Liang , Wang Tian-Hao , Elsherbeni Ahmed Ibrahim Ahmed , Gharib Hassan Bayoumi Ali , Li Jin-Long
Published: July 2022

In the modern poultry industry, newly hatched chicks are unavoidably transported from the hatching to the rearing foster. Stress caused by multiple physical and psychological stressors during transportation is particularly harmful to the liver. Astragalus polysaccharide (APS) possesses multiple benefits against hepatic metabolic disorders. Given that transport stress could disturb hepatic glucolipid metabolism and the role of APS in metabolic regulation, we speculated that APS could antagonize transport stress-induced disorder of hepatic glucolipid metabolism. Firstly, newly hatched chicks were transported for 0, 2, 4, and 8 h, respectively. Subsequently, to further investigate the effects of APS on transport stress-induced hepatic glucolipid metabolism disturbance, chicks were pretreated with water or APS and then subjected to transport treatment. Our study suggested that APS could relieve transport stress-induced lipid deposition in liver. Meanwhile, transport stress also induced disturbances in glucose metabolism, reflected by augmented mRNA expression of key molecules in gluconeogenesis and glycogenolysis. Surprisingly, APS could simultaneously alleviate these alterations via peroxisome proliferator-activated receptor gamma coactivator 1 alpha (PGC-1α)/Sirtuin 1 (SIRT1)/AMP-activated protein kinase (AMPK) pathway. Moreover, APS treatment regulated the level of peroxisome proliferator-activated receptor alpha (PPARα) and peroxisome proliferator-activated receptor gamma (PPARγ), thereby alleviating transport stress-induced alterations of VLDL synthesis, cholesterol metabolism, lipid oxidation, synthesis, and transport-related molecules. These findings indicated that APS could prevent the potential against transport stress-induced hepatic glucolipid metabolism disorders via PGC-1α/SIRT1/AMPK/PPARα/PPARγ signaling system.
Design of three-dimensional Voronoi strut midsoles driven by plantar pressure distribution
Authors: Cheng Huaqin , Liu Bin , Liu Meiying , Cao Wei
Published: July 2022

The customized production pattern has brought significant innovation to the design and manufacturing of footwear. To improve the matching degree between the consumer’s feet and deepen the customization of the sole’s personalized function, a three-dimensional (3D) Voronoi strut midsole structural design method driven by plantar pressure distribution is proposed in this paper, which not only realizes the functional requirements but also takes into account the aesthetic of midsoles. In this method, the foot characteristics and pressure information obtained by the foot measuring system are employed as the data-driven basic of the midsole structural design, and a weighted random sampling strategy is introduced for constructing the Voronoi sites. Moreover, a Voronoi clipping algorithm is proposed to make the 3D Voronoi diagram adaptive to the midsole boundary. And then, taking the clipped 3D Voronoi edges as skeleton lines, the smooth and continuous 3D Voronoi strut midsoles are generated by the implicit surface modelling technology and implicit function fusion. All the algorithms are integrated into a digital framework by independent programming. And both the static and dynamic tests show that the 3D Voronoi strut midsole can make the plantar pressure distribution more homogenous and can effectively reduce the load on the metatarsal and heel region. What is more, it can provide superior energy absorption and cushioning properties, offer better resilience, bring consumers a more comfortable wearing experience and reduce the probability of joint injury caused by the abnormal plantar pressure concentration.
Youths as targets: factors of online hate speech victimization among adolescents and young adults
Authors: Obermaier Magdalena , Schmuck Desirée
Published: July 2022

A significant number of adolescents and young adults are targeted by online hate speech. The effect of such hateful utterances can involve severe psychological harm, especially for youths who have to master developmental tasks. Therefore, drawing on criminology’s routine activity theory, this study investigates the factors that help explain why youths become victimized through online hate speech. We conducted a national quota-based quantitative online survey that was representative of adolescent and young adult online users (N = 1,180). In the results, we identified six latent profiles of young targets with overall high or low online hate speech victimization, victimization due to gender, migration background, religion, or political engagement on behalf of the queer community. While relative subjective deprivation, political participation, and lower digital media literacy positively predicted overall victimization through online hate speech, being targeted was more likely for members of the aforementioned social groups and those showing political engagement.
The early Universe was dust-rich and extremely hot
Authors: Viero Marco P , Sun Guochao , Chung Dongwoo T , Moncelsi Lorenzo , Condon Sam S
Published: July 2022

We investigate the dust properties and star-formation signature of galaxies in the early Universe by stacking 111 227 objects in the recently released COSMOS catalogue on maps at wavelengths bracketing the peak of warmed dust emission. We find an elevated far-infrared luminosity density to redshift 8, indicating abundant dust in the early Universe. We further find an increase of dust temperature with redshift, reaching $100\pm 12\,\mathrm{ K}$ at $\mathit{z}$ ∼ 7, suggesting either the presence of silicate rich dust originating from Population ii stars, or sources of heating beyond simply young hot stars. Lastly, we try to understand how these objects have been missed in previous surveys, and how to design observations to target them. All code, links to the data, and instructions to reproduce this research in full are located at https://github.com/marcoviero/simstack3/.
Ionizing protoplanetary discs in pebble collisions
Authors: Wurm Gerhard , Jungmann Felix , Teiser Jens
Published: July 2022

We introduce collisions of solids as a new and efficient ionization mechanism for gas in protoplanetary discs, which especially operates in the dense midplane of protoplanetary discs. This idea is sparked by laboratory experiments where we found that charge, which is exchanged by grains in mutual collision (tribocharging), is not tied to their surfaces alone. As kind of collateral effect, charges also become entrained into the gas phase, i.e. collisions ionize the protoplanetary disc. Therefore, solids are not only sinks of charges in discs but also sources. A first estimate shows that ionization rates in the midplane at 1 AU in the range of $10^{-19}\!-\!10^{-15}\,{\rm s}^{-1}$ seem feasible depending on the assumption of rather calm or highly turbulent conditions with radial particle pile up.
The direct effect of fibroblast growth factor 23 on vascular smooth muscle cell phenotype and function
Authors: Vergara Noemi , de Mier M Victoria Pendón-Ruiz , Rodelo-Haad Cristian , Revilla-González Gonzalo , Membrives Cristina , Díaz-Tocados Juan M , Martínez-Moreno Julio M , Torralbo Ana I , Herencia Carmen , Rodríguez-Ortiz María Encarnación , López-Baltanás Rodrigo , Richards Williams G , Felsenfeld Arnold , Almadén Yolanda , Martin-Malo Alejandro , Ureña Juan , Santamaría Rafael , Soriano Sagrario , Rodríguez Mariano , Muñoz-Castañeda Juan R
Published: July 2022

Background

In chronic kidney disease (CKD) patients, increased levels of fibroblast growth factor 23 (FGF23) are associated with cardiovascular mortality. The relationship between FGF23 and heart hypertrophy has been documented, however, it is not known whether FGF23 has an effect on vasculature. Vascular smooth muscle cells VSMCs may exhibit different phenotypes; our hypothesis is that FGF23 favours a switch from a contractile to synthetic phenotype that may cause vascular dysfunction. Our objective was to determine whether FGF23 may directly control a change in VSMC phenotype.

Methods

This study includes in vitro, in vivo and ex vivo experiments and evaluation of patients with CKD stages 2–3 studying a relationship between FGF23 and vascular dysfunction.

Results

In vitro studies show that high levels of FGF23, by acting on its specific receptor FGFR1 and Erk1/2, causes a change in the phenotype of VSMCs from contractile to synthetic. This change is mediated by a downregulation of miR-221/222, which augments the expression of MAP3K2 and PAK1. miR-221/222 transfections recovered the contractile phenotype of VSMCs. Infusion of recombinant FGF23 to rats increased vascular wall thickness, with VSMCs showing a synthetic phenotype with a reduction of miR-221 expression. Ex-vivo studies on aortic rings demonstrate also that high FGF23 increases arterial stiffening. In CKD 2–3 patients, elevation of FGF23 was associated with increased pulse wave velocity and reduced plasma levels of miR-221/222.

Conclusion

In VSMCs, high levels of FGF23, through the downregulation of miR-221/222, causes a change to a synthetic phenotype. This change in VSMCs increases arterial stiffening and impairs vascular function, which might ultimately worsen cardiovascular disease.
The transcriptional repressors VAL1 and VAL2 mediate genome-wide recruitment of the CHD3 chromatin remodeler PICKLE in Arabidopsis
Authors: Liang Zhenwei , Yuan Liangbing , Xiong Xiangyu , Hao Yuanhao , Song Xin , Zhu Tao , Yu Yaoguang , Fu Wei , Lei Yawen , Xu Jianqu , Liu Jun , Li Jian-Feng , Li Chenlong
Published: July 2022

PICKLE (PKL) is a chromodomain helicase DNA-binding domain 3 (CHD3) chromatin remodeler that plays essential roles in controlling the gene expression patterns that determine developmental identity in plants, but the molecular mechanisms through which PKL is recruited to its target genes remain elusive. Here, we define a cis-motif and trans-acting factors mechanism that governs the genomic occupancy profile of PKL in Arabidopsis thaliana. We show that two homologous trans-factors VIVIPAROUS1/ABI3-LIKE1 (VAL1) and VAL2 physically interact with PKL in vivo, localize extensively to PKL-occupied regions in the genome, and promote efficient PKL recruitment at thousands of target genes, including those involved in seed maturation. Transcriptome analysis and genetic interaction studies reveal a close cooperation of VAL1/VAL2 and PKL in regulating gene expression and developmental fate. We demonstrate that this recruitment operates at two master regulatory genes, ABSCISIC ACID INSENSITIVE3 and AGAMOUS-LIKE 15, to repress the seed maturation program and ensure the seed-to-seedling transition. Together, our work unveils a general rule through which the CHD3 chromatin remodeler PKL binds to its target chromatin in plants.
Class I TCP transcription factor AtTCP8 modulates key brassinosteroid-responsive genes
Authors: Spears Benjamin J , McInturf Samuel A , Collins Carina , Chlebowski Meghann , Cseke Leland J , Su Jianbin , Mendoza-Cózatl David G , Gassmann Walter
Published: July 2022

The plant-specific TEOSINTE BRANCHED1/CYCLOIDEA/PROLIFERATING CELL FACTOR (TCP) transcription factor family is most closely associated with regulating plant developmental programs. Recently, TCPs were also shown to mediate host immune signaling, both as targets of pathogen virulence factors and as regulators of plant defense genes. However, comprehensive characterization of TCP gene targets is still lacking. Loss of function of the class I TCP gene AtTCP8 attenuates early immune signaling and, when combined with mutations in AtTCP14 and AtTCP15, additional layers of defense signaling in Arabidopsis (Arabidopsis thaliana). Here, we focus on TCP8, the most poorly characterized of the three to date. We used chromatin immunoprecipitation and RNA sequencing to identify TCP8-bound gene promoters and differentially regulated genes in the tcp8 mutant; these datasets were heavily enriched in signaling components for multiple phytohormone pathways, including brassinosteroids (BRs), auxin, and jasmonic acid. Using BR signaling as a representative example, we showed that TCP8 directly binds and activates the promoters of the key BR transcriptional regulatory genes BRASSINAZOLE-RESISTANT1 (BZR1) and BRASSINAZOLE-RESISTANT2 (BZR2/BES1). Furthermore, tcp8 mutant seedlings exhibited altered BR-responsive growth patterns and complementary reductions in BZR2 transcript levels, while TCP8 protein demonstrated BR-responsive changes in subnuclear localization and transcriptional activity. We conclude that one explanation for the substantial targeting of TCP8 alongside other TCP family members by pathogen effectors may lie in its role as a modulator of BR and other plant hormone signaling pathways.
Rice co-expression network analysis identifies gene modules associated with agronomic traits
Authors: Zhang Yu , Han Ershang , Peng Yuming , Wang Yuzhou , Wang Yifan , Geng Zhenxing , Xu Yupu , Geng Haiying , Qian Yangwen , Ma Shisong
Published: July 2022

Identifying trait-associated genes is critical for rice (Oryza sativa) improvement, which usually relies on map-based cloning, quantitative trait locus analysis, or genome-wide association studies. Here we show that trait-associated genes tend to form modules within rice gene co-expression networks, a feature that can be exploited to discover additional trait-associated genes using reverse genetics. We constructed a rice gene co-expression network based on the graphical Gaussian model using 8,456 RNA-seq transcriptomes, which assembled into 1,286 gene co-expression modules functioning in diverse pathways. A number of the modules were enriched with genes associated with agronomic traits, such as grain size, grain number, tiller number, grain quality, leaf angle, stem strength, and anthocyanin content, and these modules are considered to be trait-associated gene modules. These trait-associated gene modules can be used to dissect the genetic basis of rice agronomic traits and to facilitate the identification of trait genes. As an example, we identified a candidate gene, OCTOPUS-LIKE 1 (OsOPL1), a homolog of the Arabidopsis (Arabidopsis thaliana) OCTOPUS gene, from a grain size module and verified it as a regulator of grain size via functional studies. Thus, our network represents a valuable resource for studying trait-associated genes in rice.
The different effect of tongue motor task training (TTT) and strength training (ST) on the modulation of genioglossus corticomotor excitability and upper airway stability in rats
Authors: Li Wen-Yang , Jin Hongyu , Zou Ying , Huang Hong , Wei Zhijing , Kang Jian , Xue Yixue , Wang Wei
Published: July 2022

Study Objectives

The mechanical efficiency of upper airway (UA) muscles are pivotal in maintaining UA stability. We aimed to investigate if different tongue training approaches could differently induce signs of neuroplastic in the corticomotor pathways and upper airway stability changes.

Methods

36 Sprague–Dawley rats were trained daily for eight weeks to lick an isotonic force-sensing disc at targeting forces using 30%–50% of maximal achieved lick force (MALF) for tongue task training (TTT) or targeting force set above 50%, 60%, and 70% of MALF progressively for tongue strength training (TST). Corticomotor excitability was dynamically assessed by GG response to transcortical magnetic stimulation (TMS) at different sessions. GG EMG activity, GG ultrastructure and myosin heavy chain (MHC), UA dynamics were assessed after eight weeks.

Results

After 4 weeks, GG TMS latencies decreased in both tongue training groups when compared with the control group (p < .05) and this excitability was more stable in TTT group. After 8 weeks, both GG TMS response and EMG activity revealed increased excitability in TTT and TST groups. The apoptotic pathological morphology changes of GG ultrastructure were observed in TST group, but not TTT. Percentage of GG MHC type I fibers in TST group was higher than the control and TTT groups (p < .05). The UA Pcrit decreased significantly in TTT group (p < .05) and tend to decrease in TST group (p = .09).

Conclusion

TTT could improve the UA stability and induce the neuroplastic changes more efficiently without training-induced muscle injury, while TST revealed a fatigue-resistance change in GG.
ARPIP: Ancestral Sequence Reconstruction with Insertions and Deletions under the Poisson Indel Process
Authors: Jowkar Gholamhossein , Pečerska Jūlija , Maiolo Massimo , Gil Manuel , Anisimova Maria
Published: July 2022

Modern phylogenetic methods allow inference of ancestral molecular sequences given an alignment and phylogeny relating present-day sequences. This provides insight into the evolutionary history of molecules, helping to understand gene function and to study biological processes such as adaptation and convergent evolution across a variety of applications. Here, we propose a dynamic programming algorithm for fast joint likelihood-based reconstruction of ancestral sequences under the Poisson Indel Process (PIP). Unlike previous approaches, our method, named ARPIP, enables the reconstruction with insertions and deletions based on an explicit indel model. Consequently, inferred indel events have an explicit biological interpretation. Likelihood computation is achieved in linear time with respect to the number of sequences. Our method consists of two steps, namely finding the most probable indel points and reconstructing ancestral sequences. First, we find the most likely indel points and prune the phylogeny to reflect the insertion and deletion events per site. Second, we infer the ancestral states on the pruned subtree in a manner similar to FastML. We applied ARPIP (Ancestral Reconstruction under PIP) on simulated data sets and on real data from the Betacoronavirus genus. ARPIP reconstructs both the indel events and substitutions with a high degree of accuracy. Our method fares well when compared to established state-of-the-art methods such as FastML and PAML. Moreover, the method can be extended to explore both optimal and suboptimal reconstructions, include rate heterogeneity through time and more. We believe it will expand the range of novel applications of ancestral sequence reconstruction. [Ancestral sequences; dynamic programming; evolutionary stochastic process; indel; joint ancestral sequence reconstruction; maximum likelihood; Poisson Indel Process; phylogeny; SARS-CoV.]
Joint attention in infants at high familial risk for autism spectrum disorder and the association with thalamic and hippocampal macrostructure
Authors: Montenegro Julia T P , Seguin Diane , Duerden Emma G
Published: July 2022

Autism spectrum disorder (ASD) is a heritable neurodevelopmental disorder. Infants diagnosed with ASD can show impairments in spontaneous gaze-following and will seldom engage in joint attention (JA). The ability to initiate JA (IJA) can be more significantly impaired than the ability to respond to JA (RJA). In a longitudinal study, 101 infants who had a familial risk for ASD were enrolled (62% males). Participants completed magnetic resonance imaging scans at 4 or 6 months of age. Subcortical volumes (thalamus, hippocampus, amygdala, basal ganglia, ventral diencephalon, and cerebellum) were automatically extracted. Early gaze and JA behaviors were assessed with standardized measures. The majority of infants were IJA nonresponders (n = 93, 92%), and over half were RJA nonresponders (n = 50, 52%). In the nonresponder groups, models testing the association of subcortical volumes with later ASD diagnosis accounted for age, sex, and cerebral volumes. In the nonresponder IJA group, using regression method, the left hippocampus (B = −0.009, aOR = 0.991, P = 0.025), the right thalamus (B = −0.016, aOR = 0.984, P = 0.026), as well as the left thalamus (B = 0.015, aOR = 1.015, P = 0.019), predicted later ASD diagnosis. Alterations in thalamic and hippocampal macrostructure in at-risk infants who do not engage in IJA may reflect an enhanced vulnerability and may be the key predictors of later ASD development.
Lyme Neuroborreliosis with Intracranial Hypertension and Erythema Multiforme: A Rare Presentation
Authors: Chhajed Monika , Jain Amit , Gunasekaran Pradeep Kumar , Dhaliwal Navdeep , Saini Lokesh
Published: July 2022

A 9-year-old previously healthy boy presented with high-grade intermittent fever, severe headache associated with neck stiffness for 5 days, rash over trunk and extremities for 4 days, vomiting for 3 days and diplopia for 2 days. There was no history of seizures, abnormal body movements, altered sensorium or focal deficits. On examination, he had maculopapular erythematous rashes over the trunk and extremities and erythema multiforme. He had bilateral abducens nerve palsy and the rest of the cranial nerve, sensory and motor examination was normal. He had neck stiffness and positive Kernig’s sign. Fundus examination showed grade 4 papilledema. Cerebrospinal fluid workup revealed elevated opening pressure, lymphocytic pleocytosis, normal protein and glucose levels. Neuroimaging showed features suggestive of intracranial hypertension. Borrelia IgM and IgG antibodies came positive. The uniqueness of our case lies with two rare presenting manifestations of Lyme neuroborreliosis in the same child.
Phylogeography ofKisauraRoss (Trichoptera: Philopotamidae) of the Japanese Archipelago and the character displacement evolution observed in a secondary contact area between genetically differentiated intra-specific lineages
Authors: Suzuki Tomoya , Kuhara Naotoshi , Tojo Koji
Published: July 2022

In this study we present evidence of an ongoing speciation event in the Japanese Archipelago. The Kisaura nozakii species complex (Philopotamidae) is a group of a small trichopteran insects, and it has been reported that this species has large differences between populations in the copulatory organs (genitalia) of males. Therefore, we conducted molecular phylogenetic analyses based on the mtDNA COI region (658 bp) and genome-wide nDNA single nucleotide polymorphisms (SNPs) (16 254 loci) using the K. nozakii species complex and a sister-species, K. borealis. We also conducted principal component analyses (PCA) based on the forewing length and seven morphological characteristics of the male genitalia. It was revealed that the K. nozakii species complex is composed of multiple allopatrically differentiated genetic lineages. However, two genetic lineages were distributed sympatrically/parapatrically in the western area of the Japanese Archipelago, and the occurrence of ‘character displacement’ in the male genitalia was detected in this area. We consider that the evolutionary event in this species complex has high potential to become a model case for elucidating the processes of speciation and species diversification.
Caring for behaviorally challenging patients in nonpsychiatric settings
Authors: Shields Lisa B.E. , Flanders Kimberly , Mangan Brian , Gentry Candice
Published: July 2022

This article discusses a pilot study on the use of a behavior support plan to safely address patients who exhibit disruptive behaviors in the ED and nonpsychiatric medical settings while respecting their autonomy.
The Analgesic Efficacy of Ultrasound-guided Quadratus Lumborum Block Transmuscular or Posterior Approach After Hip Surgery
Authors: Gong Feipeng , Li Yuxu , Wen Jiabin , Cheng Jinhui , Min Huan
Published: July 2022

Background:

No review or meta-analysis exists to elucidate the efficacy and safety of quadratus lumborum block (QLB) on the pain intensity, opioid requirement, and mobilization in patients undergoing hip surgery. This systematic review and meta-analysis of randomized controlled trials were designed to compare QLB with no block or placebo (without other nerve/plexus blocks) for patients undergoing hip surgery.

Methods:

Two individual researchers conducted the platform searches on the PubMed, Cochrane Library, and Embase databases from inception to June 12, 2021. Only English publications were included. The pain at rest score at 12 postoperative hours was designated as the primary outcome. Secondary outcomes included rest pain at rest scores at 6 and 24 postoperative hours, dynamic pain score at 6, 12, and 24 postoperative hours, total opioid consumption, postoperative nausea and vomiting, and patient satisfaction.

Results:

Seven trials including 514 patients were included. When compared with controls, the QLB technique significantly reduced pain at rest scores at 12 hours after surgery (mean difference −1.15, −1.52 to −0.77, P<0.0001). The secondary outcomes were limited by heterogeneity: secondary pain outcomes and opioid consumption were consistently improved with QLB (P<0.05); patient satisfaction and postoperative nausea and vomiting were similar between the groups based on the Inverse Variance Heterogeneity model (P>0.05). The overall quality of evidence was moderate.

Conclusions:

There is moderate evidence that QLB employment in hip surgery produces significant reduction in pain scores and opioid consumption within 24 hours. QLB appears to be an appropriate option for postoperative analgesia after hip surgery.
Respiratory Effects of the Atypical Tricyclic Antidepressant Tianeptine in Human Models of Opioid-induced Respiratory Depression
Authors: Algera Hyke , van der Schrier Rutger , Cavalla David , van Velzen Monique , Roozekrans Margot , McMorn Alison , Snape Michael , Horrigan Joseph P. , Evans Stuart , Kiernan Bernard , Sarton Elise , Olofsen Erik , Niesters Marieke , Dahan Albert
Published: July 2022

Background

Animal data suggest that the antidepressant and α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor modulator tianeptine is able to prevent opioid-induced respiratory depression. The hypothesis was that oral or intravenous tianeptine can effectively prevent or counteract opioid-induced respiratory depression in humans.

Methods

Healthy male and female volunteers participated in two studies that had a randomized, double blind, placebo-controlled, crossover design. First, oral tianeptine (37.5-, 50-, and 100-mg doses with 8 subjects) pretreatment followed by induction of alfentanil-induced respiratory depression (alfentanil target concentration, 100 ng/ml) was tested. Primary endpoint was ventilation at an extrapolated end-tidal carbon dioxide concentration of 55 mmHg (V̇E55). Next, the ability of four subsequent and increasing infusions of intravenous tianeptine (target tianeptine plasma concentrations 400, 1,000, 1,500, and 2,000 ng/ml, each given over 15 min) to counteract remifentanil-induced respiratory depression was determined in 15 volunteers. Ventilation was measured at isohypercpania (baseline ventilation 20 ± 2 l/min). The primary endpoint was minute ventilation during the 60 min of tianeptine versus placebo infusion.

Results

Alfentanil reduced V̇E55 to 13.7 (95% CI, 8.6 to 18.8) l/min after placebo pretreatment and to 17.9 (10.2 to 25.7) l/min after 50-mg tianeptine pretreatment (mean difference between treatments 4.2 (–11.5 to 3.0) l/min, P = 0.070). Intravenous tianeptine in the measured concentration range of 500 to 2,000 ng/ml did not stimulate ventilation but instead worsened remifentanil-induced respiratory depression: tianeptine, 9.6 ± 0.8 l/min versus placebo 15.0 ± 0.9 l/min; mean difference, 5.3 l/min; 95% CI, 2.5 to 8.2 l/min; P = 0.001, after 1 h of treatment.

Conclusions

Neither oral nor intravenous tianeptine were respiratory stimulants. Intravenous tianeptine over the concentration range of 500 to 2000 ng/ml worsened respiratory depression induced by remifentanil.

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What We Already Know about This Topic

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Preoperative MRI Reliably Predicts Pedicle Dimensions on Intraoperative CT Images in Structural Main Thoracic Curves in Patients With Adolescent Idiopathic Scoliosis
Authors: Mitchell Stuart L. , Heyer Jessica H. , Baldwin Keith D. , Greenhill Dustin A. , Flynn John M. , Anari Jason B.
Published: July 2022

Study Design.

A retrospective comparative study.

Objective.

The aim of this study was to compare the length and diameter of thoracic pedicles in patients with adolescent idiopathic scoliosis (AIS) as measured on preoperative magnetic resonance imaging (pMRI) to intraoperative computed tomography (iCT) scan.

Summary of Background Data.

Optimally sized pedicle screw placement during instrumented posterior spinal fusion for AIS can maximize correction and minimize screw pullout. While iCT-guided navigation can quickly estimate screw position and size, this technology is not universally available. Many surgeons utilize pMRI, when obtained, to estimate screw sizes. Data comparing these measurements on pMRI and iCT is limited. We hypothesized that in patients with surgical magnitude AIS, pedicle length, and diameter measured on pMRI would have at least moderate reliability compared to those made on iCT images.

Materials and Methods.

The pMRI and iCT for 60 patients with structural thoracic curves who underwent posterior spinal fusion for AIS at a single center between 2009 and 2017 were analyzed. Bilateral T5–T12 vertebral levels were evaluated for pedicle chord length and pedicle isthmic diameter on both pMRI and iCT. Between-study reliability and interrater reliability was evaluated for each level of the thoracic spine.

Results.

There is good reliability for pedicle length [intraclass correlation coefficient (ICC)=0.8, 95% confidence interval (CI): 0.78–0.83] and diameter (ICC=0.86, 95% CI: 0.84–0.88) between pMRI and iCT. When assessed by level, T6 has the lowest reliability for length (ICC=0.52, 95% CI: 0.33–0.67) and diameter (ICC=0.55, 95% CI: 0.35–0.69). Interrater reliability ranged from moderate-to-good reliability for all pedicle measurements for both length and diameter on pMRI and iCT.

Conclusion.

Pedicle measurements made on pMRI may be used with reasonable reliability to predict pedicle dimensions visualized on iCT, allowing surgeons to preoperatively plan pedicle screw sizes based off magnetic resonance imaging.
Postoperative Pain Management Following Orthopedic Spine Procedures and Consequent Acute Opioid Poisoning: An Analysis of New York State From 2009 to 2018
Authors: Kim Kang Woo , Brodeur Peter G. , Mullen Marguerite A. , Gil Joseph A. , Cruz Aristides I.
Published: July 2022

Objective.

Considering the high rates of opioid usage following orthopedic surgeries, it is important to explore this in the setting of the current opioid epidemic. This study examined acute opioid poisonings in postoperative spine surgery patients in New York and the rates of poisonings among these patients in the context of New York’s 2016 State legislation limiting opioid prescriptions.

Methods.

Claims for adult patients who received specific orthopedic spine procedures in the outpatient setting were identified from 2009 to 2018 in the New York Statewide Planning and Research Cooperative System (SPARCS) database. Patients were followed to determine if they presented to the emergency department for acute opioid poisoning postoperatively. Multivariable logistic regression was performed to evaluate the effect of patient demographic factors on the likelihood of poisoning. The impact of the 2016 New York State Public Health Law Section 3331, 5. (b), (c) limiting opioid analgesic prescriptions was also evaluated by comparing rates of poisoning prelegislation and postlegislation enactment.

Results.

A total of 107,456 spine patients were identified and 321 (0.3%) presented postoperatively to the emergency department with acute opioid poisoning. Increased age [odds ratio (OR)=0.954, P<0.0001] had a decreased likelihood of poisoning. Other race (OR=1.322, P=0.0167), Medicaid (OR=2.079, P<0.0001), Medicare (OR=2.9, P<0.0001), comorbidities (OR=3.271, P<0.0001), and undergoing multiple spine procedures during a single operative setting (OR=1.993, P<0.0001) had an increased likelihood of poisoning. There was also a significant reduction in rates of postoperative acute opioid poisoning in patients receiving procedures postlegislation with reduced overall likelihood (OR=0.28, P<0.0001).

Conclusion.

There is a higher than national average rate of acute opioid poisonings following spine procedures and increased risk among those with certain socioeconomic factors. Rates of poisonings decreased following a 2016 legislation limiting opioid prescriptions. It is important to define factors that may increase the risk of postoperative opioid poisoning to promote appropriate management of postsurgical pain.
Simultaneous Hypercorrection of Lowest Instrumented Vertebral Tilt and Main Thoracic Curve is Associated With Progression of Residual Lumbar Curve in Adolescent Idiopathic Scoliosis
Authors: Chen I-Hsin , Chen Chih-Wei , Hu Ming-Hsiao , Wang Po-Yao , Yeh Yu-Cheng , Lee Yuan-Fuu , Lai Po-Liang , Yang Shu-Hua
Published: July 2022

Study Design.

A retrospective cohort study.

Objective.

To determine radiographic parameters, including the lowest instrumented vertebral (LIV) tilt, related to the postoperative magnitude and progression of residual lumbar curves (LCs) in adolescent idiopathic scoliosis patients who underwent posterior spinal fusion with LIV at or above L1.

Summary of Background Data.

Although several guidelines have been proposed for thoracic curve fusion, factors related to the postoperative magnitude and potential progression of unfused LCs remained undetermined. The effect of the LIV tilt on residual LCs is also unclear.

Materials and Methods.

Patients with Lenke type 1 to 4 curves who underwent posterior spinal fusion with LIV at or above L1 with a minimum follow-up period of 2 years were evaluated. Prediction models for residual LCs were developed using multivariate linear regressions with selected radiographic parameters. Subgroup analyses, followed by sensitivity tests, were then performed for variables best predicting the progression of residual LCs.

Results.

A total of 130 patients were included. Multivariate linear regression analysis showed that the immediate postoperative LIV-tilt angle was associated with the immediate postoperative LCs and the prediction model for residual LCs, with high accuracy (R=0.93 and 0.77, respectively). Sensitivity tests revealed immediate postoperative LIV-tilt angle <10° and correction rate of main thoracic curve Cobb angle >53% as predictors for progression of residual LCs, and they reached moderate discrimination when combined together as one criterion (odds ratio=16.3, 95% confidence interval=5.3–50.1; sensitivity=89%, specificity=67%, positive predicted value=51%, negative predicted value=94%).

Conclusion.

The current study revealed that LIV tilt, as an operable factor during surgery, is not only a determinant in prediction models showing high correlation with the magnitude of postoperative LCs but a predictor for progression of residual LCs. “Immediate postoperative LIV-tilt angle <10° and correction rate of main thoracic curve Cobb angle >53%,” as a united criterion, could serve as a predictor for progression of residual LCs.
The T4-L1-Hip Axis
Authors: Hills Jeffrey , Lenke Lawrence G. , Sardar Zeeshan M. , Le Huec Jean-Charles , Bourret Stephane , Hasegawa Kazuhiro , Wong Hee-Kit , Hey Hwee Weng Dennis , Liu Gabriel , Riahi Hend , Chelli-Bouaziz Mouna , Kelly Michael P.
Published: July 2022

Study Design.

This is a cross-sectional cohort.

Objective.

The aim was to describe sagittal plane alignment and balance in a multinational cohort of nondegenerated, asymptomatic adults.

Summary of Background Data.

Current sagittal alignment targets were developed using correlations between radiographic and quality-of-life measures in spinal deformity patients, rather than disease-free samples leading to relatively poor accounting for variance within a population.

Materials and Methods.

Sagittal balance was defined using vertebral body tilt and spinopelvic alignment was defined as the vertebral pelvic angles from C2 to L5 (vertebral pelvic angle=vertebral tilt+pelvic tilt). Associations with pelvic incidence (PI) were assessed using linear regression. Multivariable linear regression was used to estimate a normal L1-S1 lordosis, adjusting for PI and the L1 pelvic angle (L1PA). Correlation between the L1 and T4 pelvic angles was assessed to define a normal thoracic alignment conditioned on lumbar alignment.

Results.

Among 320 volunteers from 4 continents, median age was 37% and 60% were female. C2 tilt was independent of PI with minimal variation. PI was inadequate for estimating a normal lumbar lordosis (L1-S1, r
2=0.3), but was strongly associated with the lumbar pelvic angles (L1PA, r
2=0.58). Defining lumbar lordosis as a function of PI and L1PA resulted in high explained variance (R
2=0.74) and the T4 pelvic angle had near perfect correlation with the L1PA (r=0.9).

Conclusions.

We defined normal sagittal balance and spinopelvic alignment in a disease-free international volunteer cohort. Four parameters are either fixed or directly modifiable in surgery and can define a normal thoracic and lumbar alignment: the L1-S1 lordosis defined as a function of PI and the L1PA; and the T4 pelvic angle is nearly equivalent to the L1PA, aligning the T4-L1-hip axis.
Treatment Failure in Vertebral Osteomyelitis
Authors: Yagdiran Ayla , Jochimsen Dorothee , Kernich Nikolaus , Herden Jan , Eysel Peer , Eberhardt Kirsten A. , Jung Norma
Published: July 2022

Study Design.

Retrospective cohort study.

Objective.

The aim was to compare the influence of 2 common vertebral osteomyelitis (VO) causing pathogens on treatment failure within the first year of diagnosis.

Summary of Background Data.

VO is mainly caused by Staphylococcus aureus (SA), while enterococci and streptococci (ENST) are also responsible for a significant proportion of VO, particularly in elderly patients. Data on VO caused by SA show a tendency for worse outcome, whereas data on VO caused by ENST are scarce. For this purpose, our study compares characteristics of patients with VO caused by SA or ENST in order to analyze risk factors for treatment failure.

Methods.

We conducted a retrospective monocentric study including VO patients from 2008 to 2020. Primary outcome was treatment failure defined as death or relapse within 1 year (T1). We compared patients diagnosed with VO caused by Staphylococcus aureus including MRSA to patients diagnosed with VO caused by Enterococcus and Streptococcus species, which were combined into one group. Polymicrobial infections were excluded. We employed multiple logistic regression analysis to adjust for confounding. To account for moderation, the model was repeated with an included interaction term.

Results.

Data of 130 VO patients (SA=95; ENST=35) were available at T1. Treatment failure occurred in 37% of SA patients and 23% of ENST patients. On multivariate analysis SA [odds ratio (OR): 3.12; 95% confidence interval (CI): 1.09–10.53; P=0.046], Charlson comorbidity index (OR: 1.31; 95% CI: 1.11–1.58; P=0.002) and infectious endocarditis (IE; OR: 4.29; 95% CI: 1.23–15.96; P=0.024) were identified as independent risk factors for treatment failure.

Conclusion.

In our cohort every third patient with VO caused by SA or ENST dies within 1 year. Our findings indicate that patients with VO caused by SA, concomitant IE and/or a high Charlson comorbidity index score may be at elevated risk for treatment failure. These findings can be used to individualize patient care and to direct clinical surveillance. This could include echocardiography evaluating for the presence of IE in patients with VO caused by gram-positive pathogens.
Marijuana Use and its Effect on Clinical Outcomes and Revision Rates in Patients Undergoing Anterior Cervical Discectomy and Fusion
Authors: Lambrechts Mark J. , D’Antonio Nicholas D. , Toci Gregory R. , Karamian Brian A. , Farronato Dominic , Pezzulo Joshua , Breyer Garrett , Canseco Jose A. , Woods Barrett , Hilibrand Alan S. , Kepler Christopher K. , Vaccaro Alexander R. , Schroeder Gregory R.
Published: July 2022

Study Design.

A retrospective cohort study.

Objective.

To determine if (1) preoperative marijuana use increased complications, readmission, or reoperation rates following anterior cervical discectomy and fusion (ACDF), (2) identify if preoperative marijuana use resulted in worse patient-reported outcome measures (PROMs), and (3) investigate if preoperative marijuana use affects the quantity of opioid prescriptions in the perioperative period.

Summary of Background Data.

A growing number of states have legalized recreational and/or medical marijuana, thus increasing the number of patients who report preoperative marijuana use. The effects of marijuana on clinical outcomes and PROMs in the postoperative period are unknown.

Methods.

All patients 18 years of age and older who underwent primary one- to four-level ACDF with preoperative marijuana use at our academic institution were retrospectively identified. A 3:1 propensity match was conducted to compare patients who used marijuana versus those who did not. Patient demographics, surgical characteristics, clinical outcomes, and PROMs were compared between groups. Multivariate regression models measured the effect of marijuana use on the likelihood of requiring a reoperation and whether marijuana use predicted inferior PROM improvements at the one-year postoperative period.

Results.

Of the 240 patients included, 60 (25.0%) used marijuana preoperatively. Multivariate logistic regression analysis identified marijuana use (odds ratio=5.62, P<0.001) as a predictor of a cervical spine reoperation after ACDF. Patients who used marijuana preoperatively had worse one-year postoperative Physical Component Scores of the Short-Form 12 (PCS-12) (P=0.001), Neck Disability Index (P=0.003), Visual Analogue Scale (VAS) Arm (P=0.044) and VAS Neck (P=0.012). Multivariate linear regression found preoperative marijuana use did not independently predict improvement in PCS-12 (β=−4.62, P=0.096), Neck Disability Index (β=9.51, P=0.062), Mental Component Scores of the Short-Form 12 (MCS-12) (β=−1.16, P=0.694), VAS Arm (β=0.06, P=0.944), or VAS Neck (β=−0.44, P=0.617).

Conclusion.

Preoperative marijuana use increased the risk of a cervical spine reoperation after ACDF, but it did not significantly change the amount of postoperative opioids used or the magnitude of improvement in PROMs.

Level of Evidence.

Levwl III
Diagnostic and Management Considerations for the IPAA With Crohn’s Disease-Like Features
Authors: Akiyama Shintaro , Dyer Emma C. , Rubin David T.
Published: July 2022

BACKGROUND:

Patients with ulcerative colitis often develop medically refractory colonic inflammation or colorectal neoplasia, and approximately 10% to 15% of patients require surgery. The most common surgical procedure is a restorative proctocolectomy with IPAA. Even if the preoperative diagnosis is ulcerative colitis, approximately 10% of patients can develop inflammatory pouch conditions resembling a Crohn’s disease phenotype.

OBJECTIVE:

This study aimed to review the diagnostic approach, prognosis, and management of IPAA with Crohn's disease–like features.

DATA SOURCES:

The data sources include search in electronic databases.

STUDY SELECTION:

This narrative review included studies focusing on pouches with Crohn's disease–like features.

MAIN OUTCOME MEASURES:

The main topics in this review included the pathogenesis, risk factors, diagnosis, phenotypes, prognosis, and medications of pouches with Crohn's disease–like features.

RESULTS:

A diagnostic approach for the pouch conditions resembling a Crohn's disease phenotype should be based on history–taking to evaluate its risk factors and endoscopic assessment of the pouch. Prior disease history and pathology, location of pouch complications, and timing of complications offer clues for the differential diagnosis of this phenotype. We advocate for the more descriptive term “pouch with Crohn's disease–like features” and reserve the term “Crohn's disease of the pouch” for patients who undergo IPAA and have a precolectomy diagnosis of Crohn's disease or whose colectomy pathology revealed Crohn's disease. Medications, which are often used for traditional Crohn's disease, show efficacy in pouches with Crohn's disease–like features as well. The poor prognosis associated with pouches with Crohn's disease–like features, particularly the fistulizing phenotype, underscores the importance of proactive monitoring and therapeutic intervention.

LIMITATIONS:

The limitations include no explicit criteria for article selection.

CONCLUSIONS:

This review suggests future research should seek to understand the natural history and meaningful shorter and longer term therapeutic targets for these types of pouch phenotypes. Long-term follow-up and prospective preoperative and postoperative interventional trials of treatments and prevention strategies are needed.
Establishing Chinese Fetal Growth Standards: Why and How
Authors: Zeng Xiaojing , Zhu Jing , Zhang Jun
Published: July 2022

Choosing a fetal growth standard or reference is crucial when defining normal and abnormal fetal growth. We reviewed the recently published standards and compared them with a customized fetal growth chart based on a nationwide population in China. There were substantial discrepancies in the fetal growth pattern, suggesting that these standards may not be applicable to Chinese fetuses. Developing a Chinese-specific standard may better meet our clinical requirements. We also discuss the steps to establish a Chinese fetal growth standard and the potential challenges, including regional disparities and accuracy of sonographic estimated fetal weight. Standardized ultrasound measurement protocol and the introduction of new ultrasonography technology may be helpful in developing a more precise standard than existing ones for the Chinese population.
Genetics Etiologies Associated with Fetal Growth Restriction
Authors: Shi Dayuan , Cai Luyao , Sun Luming
Published: July 2022

Fetal growth restriction (FGR) is associated with multiple adverse perinatal outcomes, such as increased risk of intrauterine death, neonatal morbidity and mortality, and long-term adverse outcomes. Genetic etiological factors are critical in fetuses with intrauterine growth restriction, including chromosomal abnormalities, copy number variants, single gene disorders, uniparental disomy, epigenetic changes, and confined placental mosaicism. This paper aims to provide an overview of genetic defects related to FGR and to highlight the importance of prenatal genetic counseling and testing for precise diagnosis and management of FGR.
Preventing Stillbirth: A Review of Screening and Prevention Strategies
Authors: Noël Laure , Coutinho Conrado Milani , Thilaganathan Basky
Published: July 2022

Stillbirth is a devastating pregnancy complication that still affects many women, particularly from low and middle-income countries. It is often labeled as “unexplained” and therefore unpreventable, despite the knowledge that placental dysfunction has been identified as a leading cause of antepartum stillbirth. Currently, screening for pregnancies at high-risk for placental dysfunction relies on checklists of maternal risk factors and serial measurement of symphyseal-fundal height to identify small for gestational age fetuses. More recently, the first-trimester combined screening algorithm developed by the Fetal Medicine Foundation has emerged as a better tool to predict and prevent early-onset placental dysfunction and its main outcomes of preterm preeclampsia, fetal growth restriction and stillbirth by the appropriate use of Aspirin therapy, serial growth scans and induction of labour from 40 weeks for women identified at high-risk by such screening. There is currently no equivalent to predict and prevent late-onset placental dysfunction, although algorithms combining an ultrasound-based estimation of fetal weight, assessment of maternal and fetal Doppler indices, and maternal serum biomarkers show promise as emerging new screening tools to optimize pregnancy monitoring and timing of delivery to prevent stillbirth. In this review we discuss the strategies to predict and prevent stillbirths based on first-trimester screening as well as fetal growth and wellbeing assessment in the second and third trimesters.