bluuebunny/crossref_metadata_2025 huggingface dataset:
The apparent ileal digestibility and the apparent total tract digestibility of carbohydrates and energy in hybrid rye are different from some other cereal grains when fed to growing pigs
Authors: McGhee Molly L , Stein Hans H
Published: July 2020

An experiment was conducted to determine the apparent ileal digestibility (AID) and the apparent total tract digestibility (ATTD) of energy, starch, and total dietary fiber (TDF) in two varieties of hybrid rye and compare these values with values obtained for barley, wheat, corn, and sorghum. It was hypothesized that there are no differences in AID and ATTD of energy and nutrients among hybrid rye, barley, wheat, and sorghum. Twenty-four ileal cannulated barrows (initial body weight = 28.1 ± 3.0 kg) were randomly allotted to a two-period experimental design with six diets and four replicate pigs in each period for a total of eight replicate pigs per diet. Diets consisted of 97% of each grain, and each pig received a different diet in each period. The initial 5 d of each period were considered the adaptation period, whereas urine and fecal materials were collected from the feed provided from day 6 to 10, and ileal digesta were collected on days 12 and 13 of each period. Results indicated that the metabolizable energy (ME) on a dry matter (DM) basis was greatest (P < 0.05) in corn and wheat (3,732 and 3,641 kcal/kg DM), and least (P < 0.05) in barley (3,342 kcal/kg DM), whereas the two hybrid ryes contained 3,499 and 3,459 kcal/kg DM, respectively. The ME values in hybrid rye were not different from values determined for barley and sorghum (3,573 kcal/kg DM). In all grains, the AID of starch was greater than 90%, and the ATTD of starch was nearly 100%. Barley contained more TDF than the other cereal grains, and the two hybrid ryes had concentrations of soluble dietary fiber that were close to the concentration in barley but greater than in wheat, corn, and sorghum. The AID of TDF was less than 35% for all cereal grains, but the ATTD of TDF was greater (P < 0.05) in the two hybrid ryes (68% and 70%) than in the other ingredients (56% to 58%). In conclusion, feeding hybrid rye to pigs resulted in reduced pre-cecal absorption of energy compared with wheat, corn, and sorghum, but because hindgut fermentation of fiber was greater in hybrid rye than in other cereal grains, the content of ME in hybrid rye was not different from barley and sorghum but less than in corn and wheat.
Method for Postmortem Tissue Quantification of Δ9-Tetrahydrocannabinol and Metabolites Using LC–MS-MS
Authors: Al-Asmari Ahmed I
Published: July 2020

A method for analyzing Δ9-tetrahydrocannabinol (THC), 11-hydroxy-Δ9-THC (THC-OH) and 11-nor-Δ9-THC-9-carboxylic acid (THC-COOH) in postmortem solid specimens using liquid chromatography–tandem mass spectrometry was developed and validated. A Stomacher instrument was used to prepare these tissues before extraction. Prior to solid phase extraction, liver, kidney, stomach, lung, brain, muscle, bladder and intestine tissues were pretreated with alkaline hydrolysis. All calibration curves were found to be linear with coefficients of determination greater than 0.99. The limit of quantification was 1.0 ng/g. Using three controls, within-run precision ranged between 1.0 and 12.0%, between-run precision ranged between 1.0 and 6.0%, and accuracy ranged between −7.0 and 8.0%. Matrix effects ranged from −21 to 24%. After matrix effects were excluded, analytical recoveries ranged from 79 to 97%. The distributions of THC, THC-OH and THC-COOH were investigated in 32 postmortem cases that tested positive for cannabinoids. This revealed new information regarding the distribution of THC metabolites in stomach, intestine and bladder. Alkaline hydrolysis was sufficient for the deglucuronidation of THC-COOH-glucuronide to its free form, THC-COOH, in all tissues of interest. In conclusion, measuring THC and its metabolites (THC-OH and THC-COOH) in tissues is crucial for any forensic toxicology detection method, especially when bodies are heavily decomposed, as solid tissues may be the only specimens available for testing.
The Impact of a Comprehensive Risk Prediction Model for Colorectal Cancer on a Population Screening Program
Authors: Saya Sibel , Emery Jon D , Dowty James G , McIntosh Jennifer G , Winship Ingrid M , Jenkins Mark A
Published: July 2020

Background

In many countries, population colorectal cancer (CRC) screening is based on age and family history, though more precise risk prediction could better target screening. We examined the impact of a CRC risk prediction model (incorporating age, sex, lifestyle, genomic, and family history factors) to target screening under several feasible screening scenarios.

Methods

We estimated the model’s predicted CRC risk distribution in the Australian population. Predicted CRC risks were categorized into screening recommendations under 3 proposed scenarios to compare with current recommendations: 1) highly tailored, 2) 3 risk categories, and 3) 4 sex-specific risk categories. Under each scenario, for 35- to 74-year-olds, we calculated the number of CRC screens by immunochemical fecal occult blood testing (iFOBT) and colonoscopy and the proportion of predicted CRCs over 10 years in each screening group.

Results

Currently, 1.1% of 35- to 74-year-olds are recommended screening colonoscopy and 56.2% iFOBT, and 5.7% and 83.2% of CRCs over 10 years were predicted to occur in these groups, respectively. For the scenarios, 1) colonoscopy was recommended to 8.1% and iFOBT to 37.5%, with 36.1% and 50.1% of CRCs in each group; 2) colonoscopy was recommended to 2.4% and iFOBT to 56.0%, with 13.2% and 76.9% of cancers in each group; and 3) colonoscopy was recommended to 5.0% and iFOBT to 54.2%, with 24.5% and 66.5% of cancers in each group.

Conclusions

A highly tailored CRC screening scenario results in many fewer screens but more cancers in those unscreened. Category-based scenarios may provide a good balance between number of screens and cancers detected and are simpler to implement.
Raltegravir-associated Drug-Reaction With Eosinophilia and Systemic Symptoms Syndrome in a Pediatric Patient Without Characteristic Human Leukocyte Antigen B*57:01 or B*53:01 alleles
Authors: Thomas Sanya J , Kilgore Jacob T , Becken Bradford A , Cunningham Coleen K , Thompson Amelia B
Published: July 2020

We present the first published case of raltegravir-associated drug-reaction with eosinophilia and systemic symptoms (DRESS) syndrome in a child without characteristic human leukocyte antigen haplotypes HLA-B*57:01 or HLA-B*53:01. A 4-year-old African American female with perinatally acquired human immunodeficiency virus infection was hospitalized for DRESS after starting a raltegravir-based antiretroviral regimen.
Laparoscopic assisted submucosal excision of an intussuscepting colonic lipoma
Authors: Ejtehadi Farshid , Mohammed Elsamoual , Vijay Vardhini
Published: July 2020

Colonic lipomas are the most widespread non-epithelial tumours of the large bowel. They often present with absent, non-specific or intermittent symptoms. Intussusception is the most common complication that may occur as a result of such a lesion. We present the case of a young female patient with a history of intermittent abdominal pain associated with nausea. She presented to the emergency department with subacute large bowel obstruction. A diagnosis of colo-colic intussusception due to a large descending colonic lipoma was confirmed on CT scan. The patient underwent a laparoscopic assisted submucosal excision of the lipoma. We discuss this unique operative technique as well as preoperative investigations and histopathology findings. Although successful endoscopic excision of lipomas has been reported, segmental resection of the colon is most commonly practiced. To the best of our knowledge, this is the first report of laparoscopic assisted submucosal excision of an intussuscepting colonic lipoma.
‘The Being that is in a Manner Equal with God’ (Phil. 2:6C): A Self-Transforming, Incarnational, Divine Ontology
Authors: Fletcher-Louis Crispin
Published: July 2020

This article challenges the consensus that τὸ εἶναι ἴσα θεῷ (Phil. 2:6c) means ‘equality with God’ and denotes a status. Linguistic analysis, contextual considerations, and a thorough investigation of an inventory of 149 extant Greek references to divine equality (ἴσος /ἴσα + θεός) show that Phil. 2:6c means ‘being (that is) in a manner equal with God’. Although it evokes well-known language for the status of rulers who received ‘honours equal to the gods’, it has a distinct, rarely attested, but Homeric syntax (cf. Iliad 5:441–2; 21:315), for which the closest parallel is Homeric Hymns 5, line 214. As such, it denotes a dynamic ontology, a mode of being expressed, or actualized, in Christ’s incarnational self-transformation (vv. 7–8). The words also serve a creative affirmation and subversion of the middle Platonic distinction between ‘being’ and ‘becoming’ (as that was expressed in Plutarch and Philo): Christ exists and acts from ‘being’ (ὑπάρχων … τὸ εἶναι v. 6) and is misperceived in the realm of ‘becoming’ (γενόμενος … γενόμενος vv. 7–8). But, against the Platonists, he has a divine ‘being’ that ‘becomes’.
Reorganisation of rhizosphere soil pore structure by wild plant species in compacted soils
Authors: Burr-Hersey Jasmine E , Ritz Karl , Bengough Glyn A , Mooney Sacha J
Published: July 2020

Soil compaction represents a major impediment to plant growth, yet wild plants are often observed thriving in soil of high bulk density in non-agricultural settings. We analysed the root growth of three non-cultivated species often found growing in compacted soils in the natural environment. Plants of ribwort plantain (Plantago lanceolata), dandelion (Taraxacum officinale), and spear thistle (Cirsium vulgare) were grown for 28 d in a sandy loam soil compacted to 1.8 g cm–3 with a penetration resistance of 1.55 MPa. X-Ray computed tomography was used to observe root architecture in situ and to visualise changes in rhizosphere porosity (at a resolution of 35 μm) at 14 d and 28 d after sowing. Porosity of the soil was analysed within four incremental zones up to 420 μm from the root surface. In all species, the porosity of the rhizosphere was greatest closest to the root and decreased with distance from the root surface. There were significant differences in rhizosphere porosity between the three species, with Cirsium plants exhibiting the greatest structural genesis across all rhizosphere zones. This creation of pore space indicates that plants can self-remediate compacted soil via localised structural reorganisation in the rhizosphere, which has potential functional implications for both plant and soil.
The Manufacturing of 3D Printed models for the Neurotraumatological Education of Military Surgeons
Authors: Duda Sven , Meyer Lisa , Musienko Eugen , Hartig Sascha , Meyer Tobias , Fette Marc , Wessling Heinrich
Published: July 2020

Introduction

When deployed abroad, military surgeons frequently have to deal with casualties involving head trauma. The emergency treatments, as well as craniotomies, are often performed by non-neurosurgeons qualified with basic neurotraumatological skills. Previous neurotrauma courses for education of non-neurosurgeons in Germany teach surgical emergency skills but do not include the training of skills needed to successfully utilize imaging in surgical planning, which is of importance for the safety and success of the treatment. To overcome these limitations, 3D printed models of neurotrauma cases were fabricated for application in the training of non-neurosurgeons.

Materials and Methods

Five models of actual neurotrauma cases from our neurosurgical department were segmented from CT scans and 3D printed using multi-part fused deposition modeling. Model quality was assessed with respect to the representation of pre-defined anatomical landmarks. The models were then fixed to a wooden mount with a central light source and covered by a latex mask for skin simulation. Surgical planning by means of craniometric measurements on the basis of available CT scans of the corresponding patients was then applied to the model.

Results

The 3D printed models precisely represented the cranium, the lesion, and anatomical landmarks, which are taken into consideration during surgical planning. Surface covering with washable latex masks ensured sufficient masking of the now non-noticeable lesion within the semi-translucent skull. Surgical planning was performed using washable marker drawings. When lighted, the otherwise non-visible lesion within the semi-translucent 3D printed craniums became visible and facilitated immediate success control for the course participants.

Conclusion

The presented method provided a way to fabricate precise 3D models of neurotrauma cases, which are suitable to teach the application of medical imaging in surgical planning. For further benefit analysis, the application of the presented education tool needs to be investigated within a neurotrauma course.
Metabolism-based isolation of invasive glioblastoma cells with specific gene signatures and tumorigenic potential
Authors: Smith Stuart James , Rowlinson Jonathan , Estevez-Cebrero Maria , Onion David , Ritchie Alison , Clarke Phil , Wood Katie , Diksin Mohammed , Lourdusamy Anbarasu , Grundy Richard Guy , Rahman Ruman
Published: July 2020

Background

Glioblastoma (GBM) is a highly aggressive brain tumor with rapid subclonal diversification, harboring molecular abnormalities that vary temporospatially, a contributor to therapy resistance. Fluorescence-guided neurosurgical resection utilizes the administration of 5-aminolevulinic acid (5-ALA) generating individually fluorescent tumor cells within a background population of non-neoplastic cells in the invasive tumor region. The aim of the study was to specifically isolate and interrogate the invasive GBM cell population using a novel 5-ALA-based method.

Methods

We have isolated the critical invasive GBM cell population by developing 5-ALA-based metabolic fluorescence-activated cell sorting. This allows purification and study of invasive cells from GBM without an overwhelming background “normal brain” signal to confound data. The population was studied using RNAseq, real-time PCR, and immunohistochemistry, with gene targets functionally interrogated on proliferation and migration assays using siRNA knockdown and known drug inhibitors.

Results

RNAseq analysis identifies specific genes such as SERPINE1 which is highly expressed in invasive GBM cells but at low levels in the surrounding normal brain parenchyma. siRNA knockdown and pharmacological inhibition with specific inhibitors of SERPINE1 reduced the capacity of GBM cells to invade in an in vitro assay. Rodent xenografts of 5-ALA-positive cells were established and serially transplanted, confirming tumorigenicity of the fluorescent patient-derived cells but not the 5-ALA-negative cells.

Conclusions

Identification of unique molecular features in the invasive GBM population offers hope for developing more efficacious targeted therapies compared to targeting the tumor core and for isolating tumor subpopulations based upon intrinsic metabolic properties.
Nonquinolone Options for the Treatment of Mycoplasma genitalium in the Era of Increased Resistance
Authors: Doyle Michelle , Vodstrcil Lenka A , Plummer Erica L , Aguirre Ivette , Fairley Christopher K , Bradshaw Catriona S
Published: July 2020

In the era of increasing macrolide- and quinolone-resistant Mycoplasma genitalium (MG), we report the efficacy of 2 nonquinolone antimicrobials in patients with limited treatment options. Pristinamycin + doxycycline cured 75% (95% CI, 64%–85%), and minocycline cured 71% (95% CI, 54%–85%) of cases. These data provide useful estimates to inform clinical practice.
Use of a Standardized Dalbavancin Approach to Facilitate Earlier Hospital Discharge for Vulnerable Patients Receiving Prolonged Inpatient Antibiotic Therapy
Authors: Vazquez Deida Axel A , Shihadeh Katherine C , Preslaski Candice R , Young Heather L , Wyles David L , Jenkins Timothy C
Published: July 2020

Twenty-seven patients receiving prolonged inpatient antibiotic therapy for a serious bacterial infection received a single dose of dalbavancin 7–10 days before the planned end date to facilitate earlier hospital discharge. Eighty-one percent met criteria for clinical success, 7% experienced a potential adverse event, and 182 hospital days were averted.
Platonic Relations and Mathematical Explanations
Authors: Knowles Robert
Published: July 2020

Some scientific explanations appear to turn on pure mathematical claims. The enhanced indispensability argument appeals to these ‘mathematical explanations’ in support of mathematical platonism. I argue that the success of this argument rests on the claim that mathematical explanations locate pure mathematical facts on which their physical explananda depend, and that any account of mathematical explanation that supports this claim fails to provide an adequate understanding of mathematical explanation.
How Commercially Available Virtual Reality–Based Interventions Are Delivered and Reported in Gait, Posture, and Balance Rehabilitation: A Systematic Review
Authors: Weber Heather , Barr Christopher , Gough Claire , van den Berg Maayken
Published: July 2020

Objective

Virtual reality (VR) technologies are increasingly used in physical rehabilitation; however, it is unclear how VR interventions are being delivered, and, in particular, the role of the therapist remains unknown. The purpose of this study was to systematically evaluate how commercially available VR technologies are being implemented in gait, posture, and balance rehabilitation, including justification, content, procedures, and dosage of the intervention and details of the therapist role.

Methods

Five databases were searched between 2008 and 2018. Supervised interventional trials with >10 adult participants using commercially available VR technologies to address mobility limitations were independently selected by 2 authors. One author extracted reported intervention characteristics into a predesigned table and assessed methodological quality, which was independently verified by a second author. A total of 29 studies were included.

Results

Generally, minimal clinical reasoning was provided to justify technology or activity selection, with recreational systems and games used most commonly (n = 25). All but 1 study used a single interventional technology. When explicitly described, the intervention was delivered by a physical therapist (n = 14), a therapist assistant (n = 2), both (n = 1), or an occupational therapist (n = 1). Most studies reported supervision (n = 12) and safeguarding (n = 8) as key therapist roles, with detail of therapist feedback less frequently reported (n = 4). Therapist involvement in program selection, tailoring, and progression was poorly described.

Conclusion

Intervention protocols of VR rehabilitation studies are incompletely described and generally lack detail on clinical rationale for technology and activity selection and on the therapist role in intervention design and delivery, hindering replication and translation of research into clinical practice. Future studies utilizing commercially available VR technologies should report all aspects of intervention design and delivery and consider protocols that allow therapists to exercise clinical autonomy in intervention delivery.

Impact Statement

The findings of this systematic review have highlighted that VR rehabilitation interventions targeting gait, posture, and balance are primarily delivered by physical therapists, whose most reported role was supervision and safeguarding. There was an absence of detail regarding complex clinical skills, such as tailoring of the intervention and reasoning for the choice of technology and activity. This uncertainty around the role of the therapist as an active ingredient in VR-based rehabilitation hinders the development of implementation guidelines. To inform the optimal involvement of therapists in VR rehabilitation, it is essential that future studies report on all aspects of VR intervention design and delivery.
The Unprecedented Stock Market Reaction to COVID-19
Authors: Baker Scott R , Bloom Nicholas , Davis Steven J , Kost Kyle , Sammon Marco , Viratyosin Tasaneeya
Published: July 2020

No previous infectious disease outbreak, including the Spanish Flu, has affected the stock market as forcefully as the COVID-19 pandemic. In fact, previous pandemics left only mild traces on the U.S. stock market. We use text-based methods to develop these points with respect to large daily stock market moves back to 1900 and with respect to overall stock market volatility back to 1985. We also evaluate potential explanations for the unprecedented stock market reaction to the COVID-19 pandemic. The evidence we amass suggests that government restrictions on commercial activity and voluntary social distancing, operating with powerful effects in a service-oriented economy, are the main reasons the U.S. stock market reacted so much more forcefully to COVID-19 than to previous pandemics in 1918–1919, 1957–1958, and 1968.
Telemedicine versus face-to-face delivery of cognitive behavioral therapy for insomnia: a randomized controlled noninferiority trial
Authors: Arnedt J Todd , Conroy Deirdre A , Mooney Ann , Furgal Allison , Sen Ananda , Eisenberg Daniel
Published: July 2020

Study Objectives

In a randomized controlled noninferiority trial, we compared face-to-face and telemedicine delivery (via the AASM SleepTM platform) of cognitive-behavioral therapy (CBT) for insomnia for improving insomnia/sleep and daytime functioning at posttreatment and 3-month follow-up. A secondary objective compared the modalities on treatment credibility, satisfaction, and therapeutic alliance.

Methods

A total of 65 adults with chronic insomnia (46 women, 47.2 ± 16.3 years of age) were randomized to 6 sessions of CBT for insomnia delivered individually via AASM SleepTM (n = 33, CBT-TM) or face-to-face (n = 32, CBT-F2F). Participants completed sleep diaries, the Insomnia Severity Index (ISI), and daytime functioning measures at pretreatment, posttreatment, and 3-month follow-up. Treatment credibility, satisfaction, and therapeutic alliance were compared between treatment modalities. The ISI was the primary noninferiority outcome.

Results

Based on a noninferiority margin of four points on the ISI and, after adjusting for confounders, CBT-TM was noninferior to CBT-F2F at posttreatment (β = 0.54, SE = 1.10, 95% CI = 1.64 to 2.72) and follow-up (β = 0.34, SE = 1.10, 95% CI = 1.83 to 2.53). Daytime functioning measures, except the physical composite scale of the SF-12, were significantly improved at posttreatment and follow-up, with no difference between treatment formats. CBT-TM sessions were, on average, nearly 10 min shorter, yet participant ratings of therapeutic alliance were similar to CBT-F2F.

Conclusions

Telemedicine delivery of CBT for insomnia is not inferior to face-to-face for insomnia severity and yields similar improvements on other sleep and daytime functioning outcomes. Further, telemedicine allows for more efficient treatment delivery while not compromising therapeutic alliance.

Clinical Trial Registration Number

NCT03293745
Congruence and Conflict in the Higher-Level Phylogenetics of Squamate Reptiles: An Expanded Phylogenomic Perspective
Authors: Singhal Sonal , Colston Timothy J , Grundler Maggie R , Smith Stephen A , Costa Gabriel C , Colli Guarino R , Moritz Craig , Pyron R Alexander , Rabosky Daniel L
Published: July 2020

Genome-scale data have the potential to clarify phylogenetic relationships across the tree of life but have also revealed extensive gene tree conflict. This seeming paradox, whereby larger data sets both increase statistical confidence and uncover significant discordance, suggests that understanding sources of conflict is important for accurate reconstruction of evolutionary history. We explore this paradox in squamate reptiles, the vertebrate clade comprising lizards, snakes, and amphisbaenians. We collected an average of 5103 loci for 91 species of squamates that span higher-level diversity within the clade, which we augmented with publicly available sequences for an additional 17 taxa. Using a locus-by-locus approach, we evaluated support for alternative topologies at 17 contentious nodes in the phylogeny. We identified shared properties of conflicting loci, finding that rate and compositional heterogeneity drives discordance between gene trees and species tree and that conflicting loci rarely overlap across contentious nodes. Finally, by comparing our tests of nodal conflict to previous phylogenomic studies, we confidently resolve 9 of the 17 problematic nodes. We suggest this locus-by-locus and node-by-node approach can build consensus on which topological resolutions remain uncertain in phylogenomic studies of other contentious groups. [Anchored hybrid enrichment (AHE); gene tree conflict; molecular evolution; phylogenomic concordance; target capture; ultraconserved elements (UCE).]
Gone fishing: legal professional privilege and data subject access requests in trust law Dawson-Damer v Taylor Wessing LLP [2020] EWCA Civ 352
Authors: Towl Charles
Published: July 2020

Following a data subject access request made in 2014, the Court of Appeal has recently taken the opportunity to consider the nature of joint privilege. By affirming that joint privilege is a procedural issue, rather than a substantive element of trust law, the court removed it from the remit of offshore restrictions upon trustee disclosure duties. However, the Data Protection Act 2018 may yet frustrate future attempts by beneficiaries to use subject access requests to pursue fishing expeditions.
Trust-owned companies and the irreducible core of the trust
Authors: Fee Jason
Published: July 2020

The recent Hong Kong Court of Final Appeal case of Zhang Hong Li v DBS Bank (Hong Kong) Ltd upheld the effectiveness of anti-Bartlett clauses. This gives rise to the question of whether a trust-corporate structure, coupled with a well-drafted anti-Bartlett clause, leaves any room for trust obligations. Through the lens of the law on trust-owned companies, this article thus seeks to reconceptualise the ‘irreducible core of trust obligations’. It argues that the irreducible core means the minimum duties which are necessary to preserve the integrity of the trust concept. It draws a distinction between core and mandatory duties, in that the ‘bells and whistles’ one adds in specific contexts may be mandatory duties reflecting appropriate policies, instead of core duties necessary for a trust to exist. It accordingly considers the proper content of the irreducible core, as distinguished from other mandatory duties.
Long-term Functional Outcome in Young Adult Survivors of Childhood Brain Tumor
Authors: Demers Catherine , Gélinas Isabelle , Carret Anne-Sophie
Published: July 2020

Background and Objective:

The late effects of childhood brain tumors (BTs) are extensively described in the literature. However, their effect on independent living skills of survivors is not. Therefore, the aim of this study is to assess the impact of late effects of childhood BT and related treatment on the performance in daily living activities of survivors. Furthermore, we wanted to determine which factors are likely to be associated with performance limitation.

Methods:

A cross-sectional study was conducted.

Setting:

Follow-up clinic in a tertiary care university hospital.

Patients:

Young adult survivors of childhood BT.

Intervention and Measurements:

No intervention was delivered. Performance in activities of daily living (ADL) was measured by the Assessment of Motor and Process Skills 5 years or more after diagnosis. Sociodemographic and medical information was also collected.

Results:

Thirty-six young adults, mean age 21.0 years (range, 16-29 years) and mean time since completion of treatment 10.1 years (range, 4.0-18.0 years), participated in this study. Results showed that 55% of the participants had results under the motor cutoff and 36% under both the motor and process cutoffs representing the lower limit of competent ADL task performance. Lower level of functioning was associated with younger age at diagnosis for process skills and tumor location (odds ratio [OR] = 9.0; 95% confidence interval [CI], 1.97-41.08), female gender (OR = 5.14; 95% CI, 1.18-22.48), longer time since treatment (OR = 0.2; 95% CI, 0.05-0.08), and multiple chronic health conditions (OR = 0.06; 95%CI, 0.01-0.51) for motor skills.

Limitations:

The study design does not allow to make causal inference.

Conclusions:

Five years or more after diagnosis, survivors of pediatric BT show decreased motor and process skills affecting their performance in ADL. Recommendations from this study include the development of effective rehabilitation and prevention programs to optimize their functional outcome and to target patients at heightened risk for follow-up.
Evaluation of NICU Healthcare Providers' Experience of Patient Ethics and Communication Excellence (PEACE) Rounds
Authors: McManus Kim , Robinson Patricia
Published: July 2020

Background:

Neonatal intensive care (NICU) providers may experience distress due to controversial orders or the close relationships they form with neonates' families. A “Patient Ethics and Communications Excellence [PEACE] Rounds” intervention developed at Indiana University proved to significantly relieve distress by facilitating interdisciplinary discussions of clinically and ethically challenging issues associated with pediatric intensive care (PICU) patient care. NICU healthcare providers face similar challenges and will benefit from understanding the potential efficacy of PEACE Rounds in this setting.

Purpose:

This study describes the experiences of NICU healthcare providers who participate in PEACE Rounds and evaluates their perceptions of how it affects their distress levels, contributes to interdisciplinary collaboration, and influences their understanding of ethical decision-making.

Methods:

Researchers conducted semi-structured interviews with 24 intervention participants, observed 12 interventions, facilitated a validation focus group, and performed a constructionist thematic analysis and triangulation based on data from transcribed recordings.

Findings:

PEACE Rounds improved interdisciplinary communication and collaboration and demonstrated restorative value through the benefits of voice and collective support. The intervention may reduce, but not replace, the need for formal ethics consultations.

Implications for Practice:

PEACE Rounds may potentially improve interdisciplinary communications and collaboration, relieve employee distress, and reduce ethics consultations.

Implications for Research:

Studies of PEACE Rounds undertaken in other clinical settings, and facilitated by a nurse educator, will help assess the potential benefits of greater reach and access and the efficacy of less structured ethics discussions.
Severe acute respiratory syndrome coronavirus 2, original antigenic sin, and antibody-dependent enhancement: ménage à trois
Authors: Kadkhoda Kamran
Published: July 2020

Background

Shortly after its emergence in December 2019, the coronavirus disease 2019 (COVID-19) was declared as a pandemic by the World Health Organization. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is the seventh member of the Coronaviridae family of viruses that causes disease in humans.

The problem

Despite the established role of molecular diagnostics, COVID-19 serodiagnosis remains a poorly discovered and enigmatic area. Although there are numerous commercial serological products available globally, there is a severe paucity of high-quality peer-reviewed literature on their true performance characteristics. That being said, publications including in-house developed serological tests started to shed light on the kinetics of the humoral response.

In spite of intense focus of assessing the performance characteristics of the commercially-available kits, the main issue remains rather invisible, that is, lack of solid science behind COVID-19 serology its clinical usefulness thereof. This short review summarizes the key points as to why COVID-19 is not jest ready to fly.

Purpose of review

Despite having been mentioned as a testing option, COVID-19 serology has significant shortcomings that needs discussing. This short review is meant to shed light on one of those aspects.
Are Hospitals Safe? A Prospective Study on SARS-CoV-2 Prevalence and Outcome on Surgical Fracture Patients: A Closer Look at Hip Fracture Patients
Authors: Segarra Borja , Ballesteros Heras Nuria , Viadel Ortiz Marian , Ribes-Iborra Julio , Martinez-Macias Olalla , Cuesta-Peredo David
Published: July 2020

Objectives:

To describe clinical characteristics of fracture patients, including a closer look to hip fracture patients, and determine how epidemiological variables may have influenced on a higher vulnerability to SARS-CoV-2 infection, as the basis for the considerations needed to reintroduce elective surgery during the pandemic.

Design:

Longitudinal prospective cohort study.

Setting:

Level I Trauma Center in the East of Spain.

Patients/Participants:

One hundred forty-four consecutive fracture patients 18 years or older admitted for surgery.

Intervention:

Patients were tested for SARS-CoV-2 with either molecular and/or serological techniques and screened for presentation of COVID-19.

Main Outcome Measurements:

Patients were interviewed and charts reviewed for demographic, epidemiological, clinical, and surgical characteristics.

Results:

We interviewed all patients and tested 137 (95.7%) of them. Three positive patients for SARS-CoV-2 were identified (2.1%). One was asymptomatic and the other 2 required admission due to COVID-19-related symptoms. Mortality for the whole cohort was 13 patients (9%). Significant association was found between infection by SARS-CoV-2 and epidemiological variables including: intimate exposure to respiratory symptomatic patients (P = 0.025) and intimate exposure to SARS-CoV-2-positive patients (P = 0.013). No association was found when crowding above 50 people was tested individually (P = 0.187). When comparing the 2020 and 2019 hip fracture cohorts we found them to be similar, including 30-day mortality. A significant increase in surgical delay from 1.5 to 1.8 days was observed on the 2020 patients (P = 0.034).

Conclusions:

Patients may be treated safely at hospitals if strict recommendations are followed. Both cohorts of hip fracture patients had similar 30-day mortality.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
The Association Between the Utilization of Traction and Postoperative Complications Following Growing Rod Instrumentation for Early-onset Scoliosis
Authors: Roye Benjamin D. , Fields Michael W. , Matsumoto Hiroko , Sponseller Paul , Pérez-Grueso Francisco J.S. , Boachie-Adjei Oheneba , Hammerberg Kim , Welborn Michelle C. , Vitale Michael G.
Published: July 2020

Background:

Preoperative and/or intraoperative traction have been proposed as adjunctive methods to limit complications associated with growth-friendly instrumentation for early-onset scoliosis (EOS). By gradually correcting the deformity before instrumentation, traction can, theoretically, allow for better overall correction without the complications associated with the immediate intraoperative correction. The purpose of this multicenter study was to investigate the association between preoperative/intraoperative traction and complications following growth-friendly instrumentation for EOS.

Methods:

Patients with EOS who underwent growth rod instrumentation before 2017 were identified from 2 registries. Patients were divided into 2 groups: preoperative traction group versus no preoperative traction group. A subgroup analysis was done to compare intraoperative traction only versus no traction. Data was collected on any postoperative complication from implantation to up to 2 years postimplantation.

Results:

Of 381 patients identified, 57 (15%) and 69 (18%) patients received preoperative and intraoperative traction, respectively. After adjusting for etiology and degree of kyphosis, there was no evidence to suggest that preoperative halo traction reduced the risk of any complication following surgical intervention. Although not statistically significant, a subgroup analysis of patients with severe curves demonstrated a trend toward a markedly reduced hardware failure rate in patients undergoing preoperative halo traction [preoperative traction: 1 (3.1%) vs. no preoperative traction: 11 (14.7%), P=0.083]. Nonidiopathic, hyperkyphotic patients treated with intraoperative traction were 61% less likely to experience any postoperative complication (P=0.067) and were 74% (P=0.091) less likely to experience an unplanned return to the operating room when compared with patients treated without traction.

Conclusions:

This multicenter study with a large sample size provides the best evidence to date of the association between the use of traction and postoperative complications. Our results justify the need for future Level I studies aimed at characterizing the complete benefit and risk profile for the use of traction in surgical intervention for EOS.

Level of Evidence:

Level III.
What’s New in Congenital Hand Surgery
Authors: Pino Paula A. , Zlotolow Dan A. , Kozin Scott H.
Published: July 2020

Background:

Congenital conditions of the hand and upper extremity are a frequent source of consultation among pediatric orthopaedists and hand surgeons. Advances in the fields of molecular biology and genetics have helped to better understand some of these conditions and redefine previous classification systems. New outcome measurement tools have been used to assess surgical results and have brought into focus a different aspect of the patients’ experience.

Methods:

We searched PubMed database for papers related to the treatment of congenital hand anomalies published from January 1, 2015 to October 31, 2018. The search was limited to English articles yielding 207 papers. Three pediatric hand surgeons selected the articles based upon the criteria that the topic was germane, the article fell under the subheadings within the manuscript, and the conclusions were meaningful.

Results:

A total of 40 papers were selected for review, based upon their quality and new findings. Research articles with significant findings were included for syndactyly, symbrachydactyly, cleft hand, polydactyly, radial longitudinal deficiency, congenital radio-ulnar synostosis, and macrodactyly.

Conclusions:

Our knowledge of the embryology and pathophysiology of congenital upper extremity conditions continues to evolve. Functional assessments combined with patient and parent-reported outcomes have our understanding of the results following surgical procedures. Further research and standardization of our scientific data will provide better answers and higher quality of evidence.

Level of Evidence:

Level V—literature review and expert opinion.
Pediatric Chondroblastoma and the Need for Lung Staging at Presentation
Authors: Arkader Alexandre , Williams Amy , Binitie Odion , Thacker Mihir M. , Farfalli German L.
Published: July 2020

Purpose:

Chondroblastoma is a benign, but potentially locally aggressive, bone tumor with predilection for the epiphysis of long bones in growing children. Historically, there is a reported 2% risk of lung metastasis, however these cases are mostly in the form of isolated single reports and the vast majority in adults. The purpose of this study was to identify the “true” risk of lung metastases at presentation in skeletally immature patients with a benign chondroblastoma, and therefore revisit the need for routine chest staging.

Methods:

This was a multi-institution, international retrospective study of children and adolescents diagnosed and treated for a benign chondroblastoma. We focused on the screening and diagnosis of lung metastasis, type of staging utilized and the incidence of local recurrence. Detailed review of the available literature was also performed for comparison.

Results:

The final studied cohort included 130 children with an average age of 14.5 years (range: 6 to 18 y). There were 94 boys and 36 girls. Lesions more often involved the proximal humerus (32/130), proximal tibia (30/130), and proximal femur (28/130). At an average follow-up of 50 months, there were 15 local recurrences (11% rate) and no cases of lung metastasis. All patients underwent chest imaging at presentation. The overall reported lung metastases rate in the pulled literature review (larger series only) was 0.4% (7/1625), all patients were skeletally mature.

Conclusions:

This is the largest cohort of pediatric-exclusive chondroblastoma in the literature. Despite minor differences in management between the centers included, the recurrence rate was similar and there was no evidence of lung metastasis (0 in 130). The incidence of distant involvement in a true benign chondroblastoma in children is much lower than the 2% previously reported in the literature, and the need for routine chest staging should be revisited.

Level of Evidence:

Level III.
Humerus Rotation Has a Negligible Effect on Baumann Angle in a Wide Range of Rotational Positions
Authors: Segal David , Emery Kathleen , Zeitlinger Lauren , Rosenbaum Joseph A. , Little Kevin J.
Published: July 2020

Background:

Rotation of the humerus out of the coronal plane is presumed to alter the Baumann angle (BA) value. Identifying the rotational limits of the humerus at which the BA can be accurately and reliably measured will circumvent repeated radiographs and unnecessary exposure to radiation, may improve patient comfort, and save time and medical resources.

Methods:

A retrospective chart review was performed to identify patients under the age of 18 who underwent an elbow computed tomography (CT) scan without any humeral pathology and with an open distal humeral physis. For each patient, a 3-dimensional (3D) computerized model was generated with 30% transparency to mimic a plain radiograph. These models were rotated in 10-degree increments and the BA was measured on each position. In addition, the measurements were taken on an anteroposterior radiograph for each patient. Analysis of variance and the Pearson tests were performed to locate differences and define associations.

Results:

Fifteen 3D CT reconstructions were generated from 14 patients. The mean BA on the neutral position was found to be 72.2±3 degrees, which correlated with the 70.6±5.91 degrees measurement obtained on radiographs. The most extreme rotational positions on which the BA values were consistent with the neutral position values were +40 external rotation (70.97±7.01 degrees, P=1) and −70 degrees internal rotation (68.4±7.47 degrees, P=0.14). A negative correlation was found between the BA values and the extent at which the humerus was rotated from the neutral position. The variability of the BA between patients, implied by the SD of measurements on each position increased with increasing rotation from the neutral position (r=1, P<0.05).

Conclusions:

On the basis of 3D CT images, the BA is the most accurate when the arm is positioned at an exact anteroposterior position. It is reliable to measure the BA when the humerus is rotated no more than +40 degrees external rotation to −70 degrees internal rotation. This range of rotation can act as an “accurate zone” and help avoiding multiple radiographs.

Level of Evidence:

Level III.
Exposure to desflurane anesthesia confers colorectal cancer cells metastatic capacity through deregulation of miR-34a/LOXL3
Authors: Ren Junyi , Wang Xiaopeng , Wei Gang , Meng Yajing
Published: July 2020

Due to high potency and low toxicity, desflurane has been widely used during surgery. Recent evidence that the use of desflurane was associated with colorectal cancer (CRC) tumor metastasis and poor prognosis raising concerns about the safety of desflurane. However, the mechanism was uncovered. CRC cells were exposed to desflurane, the changes in morphology and epithelial–mesenchymal transition (EMT)-related genes were evaluated. Transwell assay was used to study the migration and invasion effect. Xenograft was performed to study the tumor formation ability of desflurane-treated cells in vivo. Dual-luciferase reporter assay was conducted to verify the target of microRNA (miR)-34a. Knockdown or overexpression of LOXL3 was used to investigate the mechanism of desflurane-induced EMT. The association of LOXL3 with CRC molecular subtypes and clinical relevance was studied by analysis of public datasets. Exposure to desflurane induced EMT, migration, and invasion in CRC cells. Mice injected with desflurane-treated cells formed more tumors in the lungs. Downregulation of miR-34a and upregulation of LOXL3 were required for desflurane-induced EMT in CRC cells. LOXL3 was a direct target of miR-34a. Overexpression of LOXL3 rescued miR-34a-repressed EMT after exposure to desflurane. Elevated expression of LOXL3 was enriched in CMS4 and CRIS-B subtypes. Patients with high expression of LOXL3 showed more lymph node metastasis, as well as poor survival. Desflurane induced EMT and metastasis in CRC through deregulation of miR-34a/LOXL3 axis. Clinical miR-34a mimic or inhibitor targeting LOXL3 might have a potential protective role when patients with CRC anesthetized by desflurane.
Increased serum CCL26 level is a potential biomarker for the effectiveness of anti-PD1 antibodies in patients with advanced melanoma
Authors: Fujimura Taku , Tanita Kayo , Ohuchi Kentaro , Sato Yota , Lyu Chunbing , Kambayashi Yumi , Fujisawa Yasuhiro , Tanaka Ryota , Hashimoto Akira , Aiba Setsuya
Published: July 2020

Nivolumab plus ipilimumab combined therapy is among the most effective therapies for advanced melanoma. However, this therapy is also associated with a high frequency of immune-related adverse events (irAEs). To avoid such severe irAEs caused by additional administration of anti-CTLA4 antibodies, biomarkers to distinguish responders from non-responders among patients treated with anti-PD1 antibodies are important. The purpose of this study is to evaluate the increased serum levels of CCL11, CCL24, and CCL26 as a predictive biomarker for the efficacy of anti-PD1 antibodies in advanced cutaneous melanoma patients. This study analyzed increased serum levels of CCL11, CCL24, and CCL26 in 46 cases of advanced cutaneous melanoma treated with anti-PD1 antibodies. Serum levels on day 42 were compared to baseline (day 0) and analyzed statistically. Receiver operating characteristic curves were established to evaluate the correlation between serum levels of CCL11, CCL24, and CCL26 and efficacy of anti-PD1 antibodies. Increased serum levels of CCL26 correlated significantly with the efficacy of anti-PD1 antibodies. In contrast, no significant correlations were seen between increased serum levels of CCL11 and CCL24 and efficacy of anti-PD1 antibodies. Increased serum levels of CCL26 may be a useful biomarker for identifying those patients with advanced cutaneous melanoma most likely to benefit from anti-melanoma immunotherapy.