bluuebunny/crossref_metadata_2025 huggingface dataset:
Inflammatory Bowel Disease Clinical Activity is Associated with COVID-19 Severity Especially in Younger Patients
Authors: Ricciuto Amanda , Lamb Christopher A , Benchimol Eric I , Walker Gareth J , Kennedy Nicholas A , Kuenzig M Ellen , Kaplan Gilaad G , Kappelman Michael D , Ungaro Ryan C , Colombel Jean-Frederic , Brenner Erica J , Agrawal Manasi , Reinisch Walter , Griffiths Anne M , Sebastian Shaji
Published: September 2021

Background and Aims

Age is a major prognostic factor for COVID-19 outcomes. The effect of inflammatory bowel disease [IBD] activity on COVID-19 is unclear. We examined the relationship between IBD activity and COVID-19 severity according to age.

Methods

We included IBD patients diagnosed with COVID-19, reported to SECURE-IBD between March 13, 2020 and August 3, 2021. Clinical IBD activity was measured by physician global assessment [PGA]. COVID-19-related outcomes were [1] intensive care unit [ICU] admission, ventilation or death, and [2] hospitalization. Using generalized estimating equations, we determined adjusted odds ratios [aOR, 95% confidence interval] for moderate and severe PGA vs clinical remission/mild PGA, controlling for demographics, medications and COVID-19 diagnosis period. We performed stratified analyses by age [≤50 vs >50 years].

Results

Among 6078 patients, adverse COVID-19 outcomes were more common with active IBD: ICU/ventilation/death in 3.6% [175/4898] of remission/mild, 4.9% [45/920] of moderate and 8.8% [23/260] of severe [p < 0.001]; and hospitalization in 13% [649/4898] of remission/mild, 19% [178/920] of moderate and 38% [100/260] of severe [p < 0.001]. Stratified by decade, effect sizes were larger for younger patients. In patients ≤50 years, severe PGA was independently associated with ICU/ventilation/death (aOR 3.27 [1.15–9.30]) and hospitalization (aOR 4.62 [2.83–7.55]). In contrast, severe PGA was not independently associated with COVID-19 outcomes in those older than 50 years.

Conclusions

Clinically active IBD may be a risk factor for severe COVID-19, particularly in younger patients. IBD disease control, including through medication compliance, and strategies to mitigate the risk of COVID-19 infection amongst patients with active IBD [e.g. distancing, immunization] are key to limit adverse COVID-19 outcomes.
Long-term outcomes in children undergoing vascular ring division: a multi-institution experience
Authors: Yu Di , Guo Zhangke , You Xin , Peng Wei , Qi Jirong , Sun Jian , Wu Kaihong , Li Xiaofeng , Mo Xuming
Published: September 2021

OBJECTIVES

Vascular rings are rare anomalies of congenital heart disease that cause respiratory and gastrointestinal symptoms. This study assessed the long-term outcomes of patients with vascular ring division.

METHODS

A multi-institution retrospective review of 371 patients with vascular rings undergoing surgical division at 3 paediatric cardiac institutions between November 2007 and October 2019 was performed.

RESULTS

The complete vascular rings consisted of a double aortic arch (24.5%), right aortic arch with left ligamentum arteriosum (36.7%) and left aortic arch, with right ligamentum arteriosum (0.5%). The incomplete vascular rings consisted of a pulmonary artery sling (22.9%), left aortic arch with aberrant right subclavian artery (15.1%) and innominate artery compression syndrome (0.3%). Respiratory symptoms included stridor (71.4%), wheezing (49.1%), coughing (31.5%), gastrointestinal symptoms included choking (12.4%), dysphagia (3.2%) and emesis (1.9%). Only one patient died after discharge, yielding a late mortality rate of 0.3% (1/360). The 10-year overall survival rate was 96.8%. Postoperative complications were reported in 51 patients, 15 of whom required reoperation. The 10-year freedom from reoperation rate was 95.9%. Follow-up was completed in 95.4% (354/371) of patients, with a mean follow-up time of 4.3 ± 2.9 years (range from 1 to 13 years). Twenty patients (5.6%) experienced residual symptoms during long-term follow-up.

CONCLUSIONS

The outcomes of vascular ring division are excellent. A Kommerell diverticulum >1.5 times the aberrant left subclavian artery origin is an operative indication for primary resection. Tracheomalacia is a risk factor for reoperation and residual symptoms, and preoperative fibrobronchoscopy is important for evaluation.
Telehealth Use for Enhancing the Health of Rural Older Adults: A Systematic Mixed Studies Review
Authors: Rush Kathy L , Singh Sarah , Seaton Cherisse L , Burton Lindsay , Li Eric , Jones Charlotte , Davis Jennifer C , Hasan Khalad , Kern Brodie , Janke Robert
Published: September 2021

Background and Objectives

Telehealth holds potential for inclusive and cost-saving health care; however, a better understanding of the use and acceptance of telehealth for health promotion among rural older adults is needed. This systematic review aimed to synthesize evidence for telehealth use among rural-living older adults and to explore cost-effectiveness for health systems and patients.

Research Design and Methods

This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study designs reporting health promotion telehealth interventions with rural-living adults aged 55 and older were eligible for review. Following screening and inclusion, articles were quality-rated and ranked by level of evidence. Data extraction was guided by the Technology Acceptance Model and organized into outcomes related to ease of use, usefulness, intention to use, and usage behavior along with cost-effectiveness.

Results

Of 2,247 articles screened, 42 were included. Positive findings for the usefulness of telehealth for promoting rural older adults’ health were reported in 37 studies. Evidence for ease of use and usage behavior was mixed. Five studies examined intention to continue to use telehealth and in 4 of these, patients preferred telehealth. Telehealth was cost-effective for health care delivery (as a process) compared to face to face. However, findings were mixed for cost-effectiveness with both reports of savings (e.g., reduced travel) and increased costs (e.g., insurance).

Discussion and Implications

Telehealth was useful for promoting health among rural-living older adults. Technological supports are needed to improve telehealth ease of use and adherence. Cost-effectiveness of telehealth needs more study, particularly targeting older adults.
Addressing COVID-19 Vaccine Hesitancy in Patients with IBD
Authors: Hudhud Dania , Caldera Freddy , Cross Raymond K
Published: September 2021

Lay Summary

It is recommended that all patients with IBD undergo vaccination against COVID-19. In this commentary, we encourage IBD providers to serve as vaccine advocates and suggest implementing different methods for battling misinformation, paying careful attention to minority population.
Localized malignant mesothelioma in the stomach and mediastinum
Authors: Jeppesen Tanita Drejer , Højsgaard Anette , Kjær Daniel , Christensen Thomas Decker
Published: September 2021

Localized malignant mesothelioma is rare. It has a histological pattern identical to diffuse malignant mesothelioma but without diffuse serosal spread. Localized malignant mesothelioma typically originates from the pleura, peritoneum or pericardium, but can occasionally develop from organs. Our cases represent what might be the largest mediastinal localized malignant mesothelioma described and the first presentation of the epithelioid type in the stomach of an adult.
Topological Entropy of Pseudo-Anosov Maps from a Typical Thurston’s Construction
Authors: Baik Hyungryul , Choi Inhyeok , Kim Dongryul M
Published: September 2021

In this paper, we develop a way to extract information about a random walk associated with a typical Thurston’s construction. We first observe that a typical Thurston’s construction entails a free group of rank 2. We also present a proof of the spectral theorem for random walks associated with Thurston’s construction that have finite 2nd moment with respect to the Teichmüller metric. Its general case was remarked by Dahmani and Horbez. Finally, under a hypothesis not involving moment conditions, we prove that random walks eventually become pseudo-Anosov. As an application, we first discuss a random analogy of Kojima and McShane’s estimation of the hyperbolic volume of a mapping torus with pseudo-Anosov monodromy. As another application, we discuss non-probabilistic estimations of stretch factors from Thurston’s construction and the powers for Salem numbers to become the stretch factors of pseudo-Anosovs from Thurston’s construction.
Identification of a novel plasmid-mediated tigecycline resistance-related gene,tet(Y), inAcinetobacter baumannii
Authors: Wang Zhiren , Li Henan , Zhang Jiangang , Wang Xiaojuan , Zhang Yawei , Wang Hui
Published: September 2021

Objectives

To characterize a novel plasmid-mediated tigecycline resistance-related gene, tet(Y), in a clinical Acinetobacter baumannii isolate from China.

Methods

The tet(Y)-encoded tigecycline-resistant A. baumannii 2016GDAB1 was screened through antimicrobial susceptibility testing and WGS. The function of tet(Y) was verified by complementation of tet(Y). The plasmid transferability and stability were detected via plasmid conjugation and in vitro bacterial passaging. The 3D structure of Tet(Y) was predicted and docked using tFold and AutoDock Vina.

Results

The tigecycline-resistant A. baumannii 2016GDAB1 was isolated from bronchoalveolar lavage fluid of a patient with hospital-acquired pneumonia. However, this strain did not harbour any common tigecycline resistance genes, determinants or mutations. 2016GDAB1 belongs to the non-epidemic clone ST355 (Oxford scheme), which has been mainly reported in animals. The tet(Y) gene was located on a 72 156 bp plasmid and genomic environment analysis revealed that Tn5393 may play a role in tet(Y) transmission, whereas phylogenetic analysis indicated the origin of tet(Y) as from Aeromonas. Overexpression of tet(Y) resulted in a 2- to 4-fold increase in tigecycline MIC. Introduction of the tet(Y)-harbouring plasmid p2016GDAB1 via electroporation resulted in a 16-fold increase in tigecycline MIC but failed to transfer into the tigecycline-susceptible A. baumannii recipient via conjugation. Isolates carrying the tet(Y) gene were vulnerable to tigecycline pressure and exhibited decreased susceptibility to tigecycline. A tet(Y)-carrying plasmid was stably maintained in the host strains.

Conclusions

This study identified the tigecycline resistance-related gene tet(Y) in A. baumannii. This gene conferred an increased tigecycline MIC and the transposable element Tn5393 may play a role in its transmission across isolates.
Potential use of ground brown rice for weanling pigs
Authors: Lee Jeong Jae , Kim Sheena , Cho Jin Ho , Kyoung Hyunjin , Lee Seonmin , Choe Jeehwan , Liu Yanhong , Ji Peng , Xiong Xia , Kim Younghoon , Kim Hyeun Bum , Song Minho
Published: September 2021

The purpose of the current study was to assess the effects of substituting corn with ground brown rice on growth performance, immune status, and gut microbiota in weanling pigs. Seventy-two weanling pigs (28 d old with 6.78 ± 0.94 kg body weight [BW]) were randomly allotted to two dietary treatments with six pens and six pigs (three barrows and gilts) per pen within a randomized complete block design. The control pigs were fed a typical diet for weanling pigs based on corn and soybean meal diet (control diet: CON), and the other pigs were fed a formulated diet with 100% replacement of corn with ground brown rice for 35d (treatment diet: GBR). Growth performance, immune status, and gut microbiota of weanling pigs were measured. The substitution of corn with GBR did not affect growth performance or diarrhea frequency. Additionally, there were no differences in white blood cell number, hematocrit, cortisol, C-reactive protein, and serum tumor necrosis factor-alpha levels between pigs fed CON or GBR for the first 2 wk after weaning. However, weanling pigs fed GBR had lower (P < 0.05) serum transforming growth factor-beta 1 level than those fed CON. Furthermore, weanling pigs fed GBR had increased (P < 0.05) relative abundance of phylum Firmicutes and genus Lactobacillus and Streptococcus and decreased (P < 0.05) relative abundance of phylum Bacteroidetes and genus Clostridium and Prevotella in the gut microbiota compared with those fed CON. In conclusion, there was no significant difference in growth performance when corn was replaced with ground brown rice in diets for weanling pigs. Furthermore, the substitution of corn with ground brown rice in weaning diet modulated immune status and gut microbiota of pigs by increasing beneficial microbial communities and reducing harmful microbial communities. Overall, ground brown rice-based diet is a potential alternative to corn-based diet without negative effects on growth performance, immune status, and gut microbiota changes of weanling pigs.
“Dando las Gracias a Mis Papás”: Analyzing the Enactment of Callings across Generations of Latinx Immigrants
Authors: Sánchez Sánchez Virginia
Published: September 2021

Callings, a prominent way in which communication scholars have spoken about meaningful work, are often used to describe individual pulls towards an occupation. Calling research has also been criticized for lacking participants with diverse backgrounds and occupations. This study addressed these gaps by investigating how Latinx immigrants across two generations made sense of their work as callings. By interviewing Latinx immigrants (N = 36) this study revealed that first- and second-generation immigrants co-constructed integrated callings. Unlike individual callings, integrated callings are tied to a common understanding of how various journeys are connected. Within immigrant families, there was an understanding about the relationship between first-generation immigrants’ migration journeys and second-generation immigrants’ occupational journeys. Across the two generations, work was tied to educational, occupational, and non-occupational outcomes that served to improve the lives of immigrants. The proposed framework, integrated callings, is one that accounts for non-occupational outcomes and the experiences of diverse workers.
Which ‘That’ Was Amharic Yä-? An Alternative Origin for the Amharic Relative-Genitive Marker
Authors: Zhang Hongwei
Published: September 2021

This article re-evaluates arguments regarding the previously proposed origin of the Amharic relative-genitive marker yä-. The traditional proposal relies on the attestation of a ž- form in Tigrinya (Praetorius 1874) and reconstructs a form *zä- (the same as the Ge′ez relative) for yä-. However, no such form is attested in Old Amharic writing (Girma Awgichew 2014), even though it has convenient orthographic conventions for recording palatalized consonants. Based on the attested levelling of l- forms of the relative marker in Ethiopian Semitic and Modern Arabic, I propose deriving the Amharic relative- genitive marker yä- from a levelled plural relative marker containing l, an element visible in the demonstrative paradigms of Ethiopian Semitic. This alternative derivation fits the synchronic Amharic phonology in which the lateral liquid l becomes the palatal glide y. In addition, it follows the cross-linguistically common palatalization process similarly attested for l in the historical phonology of other languages, e.g. Berber, Romance and Chinese.
The Relationship of Thyroid Functions with ADMA, IMA, and Metabolic Laboratory Parameters in Euthyroid Adults with and without Autoimmune Thyroiditis
Authors: Cetin Zeynep , Kosem Arzu , Catak Merve , Can Bulent , Baser Ozden , Guler Serdar
Published: September 2021

Objective

To investigate the relationship between thyroid functions and asymmetric dimethylarginine (ADMA), ischemia-modified albumin (IMA), and other metabolic laboratory markers in euthyroid adults and whether narrower thyroidal targets are required for lower metabolic risk.

Materials and Methods

Thyroid functions, antithyroid autoantibodies, and metabolic parameters were measured for 115 patients. Forty-seven had autoimmune thyroiditis (AIT). Analyses were performed according to cutoff values of 1, 2, 2.5, and 3 mIU/L for thyrotropin, 0.84 ng/dL for free thyroxine (fT4), and 3.59 ng/dL for free tri-iodothyronine (fT3).

Results

There was no relationship between thyrotropin and fT3 cutoff values and metabolic parameters. Only C-reactive protein was lower in the group with thyrotropin ≤2.5 μIU/L. A weak positive correlation was found between fT4 with IMA and IMA corrected for albumin (r = 0.187, P = .05; r = 0.204, P = .034, respectively). There was no difference between AIT and the metabolic laboratory parameters examined in the study.

Conclusion

This study is the first to evaluate ADMA in AIT. Narrower thyroid function targets are not required for better metabolic control in euthyroid adults.
MALBEC: fine-tuning of the pointing direction of cameras for stratospheric double-station observation of meteor showers
Authors: Vaubaillon J , Rietze A , Zilkova D
Published: September 2021

To guarantee the successful observation of a meteor shower, the ‘Meteor Automated Light Balloon Experimental Camera’ will put two meteor cameras aboard stratospheric nacelles, at altitudes where clouds can no longer hinder the observation. After simulating the 3D trajectory of each nacelle and checking the overall feasibility of double-station meteor observation, the attitude of each camera is set and different configurations are explored. It often happens in meteor sciences that the two cameras are pointing towards each other. However, we show that an azimuth offset sometimes better suits the observation constraints and yields a high number of observed double-station meteors. A roll offset of the camera might be applied in order to maximize the atmosphere area overlap by the two cameras. Similarly, to increase the size of the field of view or to decrease the elevation of the camera, both result in a higher number of detected meteors, as expected. However, this comes with a loss of spatial resolution, which decreases the number of accurate measurements of meteoroid orbits. A satisfactory compromise is to increase the time of flight thanks to ceiling-balloon capabilities. In addition, we find that the current method used to compute the expected number of meteors from a stratospheric platform underestimates this number. More work is needed to understand the link between visual ground-based observations and stratospheric video records.
Physical conditions and chemical abundances in PN M 2-36. Results from deep echelle observations
Authors: Espíritu José N , Peimbert Antonio
Published: September 2021

We present a spectrum of the planetary nebula (PN) M 2-36 obtained using the Ultraviolet and Visual Echelle Spectrograph (UVES) at the Very Large Telescope. 446 emission lines are detected. We perform an analysis of the chemical composition using multiple electron temperature (Te) and density (ne) diagnostics. Te and ne are computed using a variety of methods, including collisionally excited line (CEL) ratios, O++ optical recombination lines (ORLs), and measuring the intensity of the Balmer jump. Besides the classical CEL abundances, we also present robust ionic abundances from ORLs of heavy elements. From CELs and ORLs of O++, we obtain a new value for the Abundance Discrepancy Factor (ADF) of this nebula, being ADF(O++) = 6.76 ± 0.50. From all the different line ratios that we study, we find that the object cannot be chemically homogeneous; moreover, we find that two-phased photoionization models are unable to simultaneously reproduce critical ${\rm O\, \small {II}}$ and [${\rm O\, \small {III}}$] line ratios. However, we find a three-phased model able to adequately reproduce such ratios. While we consider this to be a toy model, it is able to reproduce the observed temperature and density line diagnostics. Our analysis shows that it is important to study high ADF PNe with high spectral resolution, since its physical and chemical structure may be more complicated than previously thought.
Chemical abundances in Seyfert galaxies – VIII. Argon abundance estimates
Authors: Monteiro A F , Dors O L
Published: September 2021

For the first time, the argon abundance relative to hydrogen abundance (Ar/H) in the narrow line region of a sample of Seyfert 2 nuclei has been derived. In view of this, optical narrow emission line intensities of a sample of 64 local Seyfert 2 nuclei (z < 0.25) taken from Sloan Digital Sky Survey DR7 and measured by the MPA/JHU group were considered. We adopted the Te-method for AGNs, which is based on direct determination of the electron temperature, together with a grid of photoionization model results, built with the cloudy code, to obtain a method for the derivation of the Ar/H abundance. We find that for a metallicity range of $\rm 0.2 \: \lesssim \: (\mathit{ Z}/{\rm Z_{\odot }}) \: \lesssim \: 2.0$, Seyfert 2 nuclei present Ar/H abundance ranging from ∼0.1 to ∼3 times the argon solar value, adopting $\rm log(O/H)_{\odot }=-3.31$ and $\rm log(Ar/H)_{\odot }=-5.60$. These range of values correspond to $\rm 8.0 \: \lesssim \: (12+log(O/H) \: \lesssim \: 9.0$ and $\rm 5.4 \: \lesssim \: (12+log(Ar/H) \: \lesssim \: 6.9$, respectively. The range of Ar/H and Ar/O abundance values obtained from our sample are in consonance with estimations from extrapolations of the radial abundance gradients to the central parts of the disc for four spiral galaxies. We combined our abundance results with estimates obtained from a sample of H ii galaxies, which were taken from the literature, and found that the Ar/O abundance ratio decreases slightly as the O/H abundance increases.
Constraints on planets in nearby young moving groups detectable by high-contrast imaging and Gaia astrometry
Authors: Wallace A L , Ireland M J , Federrath C
Published: September 2021

The formation of giant planets can be studied through direct imaging by observing planets both during and after formation. Giant planets are expected to form either by core accretion, which is typically associated with low initial entropy (cold-start models) or by gravitational instability, associated with high initial entropy of the gas (hot-start models). Thus, constraining the initial entropy can provide insight into a planet’s formation process and determines the resultant brightness evolution. In this study, we find that, by observing planets in nearby moving groups of known age both through direct imaging and astrometry with Gaia, it will be possible to constrain the initial entropy of giant planets. We simulate a set of planetary systems in stars in nearby moving groups identified by BANYAN Σ and assume a model for planet distribution consistent with radial-velocity detections. We find that Gaia should be able to detect approximately 25 per cent of planets in nearby moving groups greater than $\sim 0.3\, M_\text{J}$. Using 5σ contrast limits of current and future instruments, we calculate the flux uncertainty, and using models for the evolution of the planet brightness, we convert this to an initial entropy uncertainty. We find that future instruments such as METIS on E-ELT as well as GRAVITY and VIKiNG with VLTI should be able to constrain the entropy to within 0.5 kB/baryon, which implies that these instruments should be able to distinguish between hot- and cold-start models.
Microsurgical Resection of a Petroclival Epidermoid Cyst Using an Anterior Petrosectomy Approach: 2-Dimensional Operative Video
Authors: Vakharia Kunal V , Naylor Ryan M , Nassiri Ashley M , Driscoll Colin L W , Link Michael J
Published: September 2021

Epidermoid cysts are rare, benign lesions that result from inclusion of ectodermal elements during neural tube closure.
1
Cysts are composed of desquamated epithelial cells and restrict diffusion on magnetic resonance imaging (MRI).
2,3
Symptoms are attributable to anatomic location.
4,5
In this video, we illustrate the surgical treatment of an epidermoid cyst located in the right cerebellopontine angle, petrous apex, and Meckel's cave. The patient, a 33-yr-old female with right-sided V1 trigeminal hypoesthesia, underwent surveillance imaging for 2 yr. However, she developed progressive V1 and V2 trigeminal hypoesthesia and imaging revealed enlargement of the lesion. Therefore, surgical resection was pursued. The patient consented to the procedure.

The patient underwent a right middle fossa craniotomy and anterior petrosectomy. After identifying the greater superficial petrosal nerve and cutting the middle meningeal artery as it exited foramen spinosum, Kawase's triangle was drilled, and the dura over Meckel's cave and the subtemporal dura were opened. The lesion was resected, taking care to preserve the trigeminal nerve and the basilar artery. A retrosigmoid craniotomy was then fashioned. The cyst and its capsule were dissected off the brainstem and cranial nerves utilizing natural corridors between the trigeminal and vestibulocochlear nerves as well as between the facial and lower cranial nerves.

Gross total resection was confirmed on postoperative MRI, and she was discharged home on postoperative day 5. Three months after surgery, she underwent formal pinprick testing, which revealed 95% loss of sensation in V1, 20% loss in V2, and normal sensation in V3. Three-month postoperative MRI showed no residual tumor.
Paternal Cannabis Exposure Prior to Mating, but Not Δ9-Tetrahydrocannabinol, Elicits Deficits in Dopaminergic Synaptic Activity in the Offspring
Authors: Slotkin Theodore A , Levin Edward D , Seidler Frederic J
Published: September 2021

The legalization and increasing availability of cannabis products raises concerns about the impact on offspring of users, and little has appeared on the potential contribution of paternal use. We administered cannabis extract to male rats prior to mating, with two different 28-day exposures, one where there was a 56-day interval between the end of exposure and mating (“Early Cannabis”), and one just prior to mating (“Late Cannabis”); the extract delivered 4 mg/kg/day of the main psychoactive component, Δ9-tetrahydrocannabinol. We then assessed the impact on dopamine (DA) systems in the offspring from the onset of adolescence (postnatal day 30) through middle age (postnatal day 150), measuring the levels of DA and its primary metabolite, 3,4-dihydroxyphenylacetic acid (DOPAC) in various brain regions. Paternal cannabis with either regimen elicited a profound and persistent deficit in DA utilization (DOPAC/DA ratio) in the offspring, indicative of subnormal presynaptic activity. However, the two regimens differed in the underlying mechanism, with Early Cannabis reducing DOPAC whereas Late Cannabis increased DA and elicited a smaller reduction in DOPAC. Effects were restricted to male offspring. The effects of cannabis were not reproduced by equivalent exposure to its Δ9-tetrahydrocannabinol, nor did we see the effects with perinatal exposure to tobacco smoke or some of its fetotoxic contributors (benzo[a]pyrene without or with nicotine). Our studies provide some of the first evidence for adverse effects of paternal cannabis administration on neurodevelopment in the offspring, and reinforce the important consequences of paternal drug use in the preconception period.
Pedicle Screw Plowing in Adolescent Idiopathic Scoliosis
Authors: Klyce Walter , Suresh Krishna V. , Jain Amit , Parent Stefan , Shah Suken A. , Cahill Patrick J. , George Stephen , Clements David , Upasani Salil , Yaszay Burt , Miyanji Firoz , Kelly Michael P. , Lonner Baron S. , Sponseller Paul D.
Published: September 2021

Study Design.

Multicenter retrospective review.

Objective.

To calculate overall incidence of pedicle screw “plowing” in adolescent idiopathic scoliosis (AIS) patients who underwent posterior spinal fusion (PSF). To identify risk factors for pedicle screw plowing and associated postoperative outcomes, including loss of correction and revision rate.

Summary of Background Data.

Curve correction of AIS generates perpendicular stresses that can cause pedicle screws to lose alignment and “plow” through pedicles craniocaudally.

Methods.

We reviewed records of 1057 patients who underwent PSF for AIS from 2002 to 2015. Preoperative and first postoperative erect radiographs were evaluated by two observers to determine (1) presence of plowing and (2) subsequent loss of correction (LOC). Plowing was defined as more than 25° sagittal angulation compared with pedicle axis or entry of the most dorsal part of the screw outside the pedicle projection. LOC was defined as postoperative change in focal angulation of an instrumented spinal level, when in consensus of both reviewers. Bivariate analyses were performed (alpha = 0.05).

Results.

Nineteen thousand five hundred sixty nine screws were assessed across our cohort of 1057 patients. Both observers agreed that 48 patients (4.5%) demonstrated plowing of more than or equal to one pedicle screw. For 72 screws (0.4%), both observers noted plowing, most commonly through the cranial cortex of the pedicle (65/72 screws) and at the lowest instrument vertebra (LIV) (17/72 screws). Factors associated with plowing included larger curves (P = 0.02); lower mean pedicle screw density (P = 0.0003); skeletal immaturity as measured by open triradiate cartilage (P = 0.04); and younger chronological age at time of surgery (P = 0.04). LOC occurred in 13 patients, most commonly at LIV (P < 0.0001). Revision rate for loss of screw fixation was higher in the plowing group (P = 0.003).

Conclusion.

Pedicle screw plowing occurred in 4.5% of AIS patients, especially in those skeletally immature and with decreased implant density. Plowing commonly occurred in the cranial direction and was associated with LOC, particularly at the LIV.

Level of Evidence: 3
Trends in Diagnosis and Treatment of Metastatic Cancer in the United States
Authors: Lehrer Eric J. , Stoltzfus Kelsey C. , Jones Brianna M. , Gusani Niraj J. , Walter Vonn , Wang Ming , Trifiletti Daniel M. , Siva Shankar , Louie Alexander V. , Zaorsky Nicholas G.
Published: September 2021

Objectives:

Metastatic cancer has historically been considered fatal; however, there is a paucity of evidence characterizing the epidemiology of incidence, treatment, and outcomes in these patients.

Materials and Methods:

Incidence rates, annual percent change (APC), descriptive epidemiological statistics, and odds ratios for survival were calculated using registry data from the Surveillance, Epidemiology, and End Results (SEER) and the National Cancer Database (NCDB), 1998 to 2015.

Results:

There were a total of 1,055,860 patients with metastatic cancer. The most frequent primary cancers were lung (42.6%), colorectal (9.5%), and ovarian (5.5%). Metastatic lung and colorectal cancer incidence decreased, APC: −1.57 (P<0.001) and APC: −1.48 (P<0.001), respectively; metastatic pancreatic cancer incidence increased, APC: 0.62 (P=0.001). The use of local therapies decreased for almost all sites, and the use of systemic therapies increased across multiple sites: single-agent chemotherapy in kidney (2.54% increase/year), female breast (1.14% increase/year), and prostate cancer (1.08% increase/year); multiagent chemotherapy, most notably in pancreas (2.23% increase/year), uterus (1.81% increase/year), and colorectal cancer (1.54% increase/year). Increased utilization of immunotherapy was observed across the majority of sites, most notably in melanoma (2.14% increase/year). Patients diagnosed from 2006 to 2010 had 17.4% higher odds of surviving at least 60 months compared with 1998 to 2002.

Conclusions:

In this study, metastatic disease has been shown to have unique epidemiological patterns, and survival has improved. Continued research on metastatic disease is important in understanding and addressing the distinct health concerns of this population.
Resilience, Physical Activity, and Depression in Women Living With HIV in the San Francisco Bay Area: A Cross-sectional Study
Authors: Ambrose Patricia R. , Cuca Yvette P. , Baguso Glenda N. , Hoffmann Thomas J. , Dawson-Rose Carol
Published: September 2021

There is a lack of literature on the effects of physical activity and depression on resilience in women living with HIV. This cross-sectional study examined the associations of sociodemographic factors, physical activity, and depression on resilience among 97 women living with HIV using linear regression models. Among these women, the mean resilience score was 70.7 (SD 16.3), the majority were insufficiently active (67.0%), and 45.4% had a Patient Health Questionnaire-9 score that indicated at least moderate depression. In a multivariable analysis, depression was negatively associated with resilience, and education was positively associated with resilience (p < .0001; p = .031). There was no significant correlation between physical activity and depression or resilience. An exploratory analysis did not indicate that depression mediated the relationship between physical activity and resilience. There is a need to address low levels of physical activity in women living with HIV. Interventions that address resilience and depressive symptoms may lead to improved mental health.
Computed tomography features of COVID-19 in children
Authors: Wang Ji-gan , Mo Yu-fang , Su Yu-heng , Wang Li-chuan , Liu Guang-bing , Li Meng , Qin Qian-qiu
Published: September 2021

Background:

There are few reports on the chest computed tomography (CT) imaging features of children with coronavirus disease 2019 (COVID-19), and most reports involve small sample sizes.

Objectives:

To systematically analyze the chest CT imaging features of children with COVID-19 and provide references for clinical practice.

Data sources:

We searched PubMed, Web of Science, and Embase; data published by Johns Hopkins University; and Chinese databases CNKI, Wanfang, and Chongqing Weipu.

Methods:

Reports on chest CT imaging features of children with COVID-19 from January 1, 2020 to August 10, 2020, were analyzed retrospectively and a meta-analysis carried out using Stata12.0 software.

Results:

Thirty-seven articles (1747 children) were included in this study. The heterogeneity of meta-analysis results ranged from 0% to 90.5%. The overall rate of abnormal lung CT findings was 63.2% (95% confidence interval [CI]: 55.8%–70.6%), with a rate of 61.0% (95% CI: 50.8%–71.2%) in China and 67.8% (95% CI: 57.1%–78.4%) in the rest of the world in the subgroup analysis. The incidence of ground-glass opacities was 39.5% (95% CI: 30.7%–48.3%), multiple lung lobe lesions was 65.1% (95% CI: 55.1%–67.9%), and bilateral lung lesions was 61.5% (95% CI: 58.8%–72.2%). Other imaging features included nodules (25.7%), patchy shadows (36.8%), halo sign (24.8%), consolidation (24.1%), air bronchogram signs (11.2%), cord-like shadows (9.7%), crazy-paving pattern (6.1%), and pleural effusion (9.1%). Two articles reported 3 cases of white lung, another reported 2 cases of pneumothorax, and another 1 case of bullae.

Conclusions:

The lung CT results of children with COVID-19 are usually normal or slightly atypical. The lung lesions of COVID-19 pediatric patients mostly involve both lungs or multiple lobes, and the common manifestations are patchy shadows, ground-glass opacities, consolidation, partial air bronchogram signs, nodules, and halo signs; white lung, pleural effusion, and paving stone signs are rare. Therefore, chest CT has limited value as a screening tool for children with COVID-19 and can only be used as an auxiliary assessment tool.
Multimodal and systemic therapy with cabozantinib for treatment of recurrent hepatocellular carcinoma after liver transplantation
Authors: Mahn Robert , Sadeghlar Farsaneh , Bartels Alexandra , Zhou Taotao , Weismüller Tobias , Kupczyk Patrick , Meyer Carsten , Gaertner Florian C. , Toma Marieta , Vilz Tim , Knipper Petra , Glowka Tim , Manekeller Steffen , Kalff Jörg , Strassburg Christian P. , Gonzalez-Carmona Maria A.
Published: September 2021

Rationale:

Recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT) remains a major therapeutic challenge. In recent years, new molecular-targeted therapies, such as cabozantinib, have been approved for the treatment of advanced HCC. However, clinical experience with these new drugs in the treatment of HCC in the LT setting is very limited.

Patient concerns:

In 2003, a 36-year-old woman was referred to the hospital with right upper abdominal pain.

Diagnosis:

An initial ultrasound of the liver demonstrated a large unclear lesion of the left lobe of the liver. The magnet resonance imaging findings confirmed a multifocal inoperable HCC in a non-cirrhotic liver. Seven years after receiving a living donor LT, pulmonary and intra-hepatic recurrence of the HCC was radiologically diagnosed and histologically confirmed.

Interventions:

Following an interdisciplinary therapy concept consisting of surgical, interventional-radiological (with radiofrequency ablation [RFA]) as well as systemic treatment, the patient achieved a survival of more than 10 years after tumor recurrence. As systemic first line therapy with sorafenib was accompanied by grade 3 to 4 toxicities, such as mucositis, hand-foot skin reaction, diarrhea, liver dysfunction, and hyperthyroidism, it had to be discontinued. After switching to cabozantinib from June 2018 to April 2020, partial remission of all tumor manifestations was achieved. The treatment of the remaining liver metastasis could be completed by RFA. The therapy with cabozantinib was well tolerated, only mild arterial hypertension and grade 1 to 2 mucositis were observed. Liver transplant function was stable during the therapy, no drug interaction with immunosuppressive drugs was observed.

Outcomes:

More than 10 years survival after recurrence of HCC after living-donor LT due to intensive multimodal therapy concepts, including surgery, RFA, and systemic therapy with cabozantinib in the second line therapy.

Lessons:

In conclusion, this report highlights the tolerability and effectiveness of cabozantinib for the treatment of HCC recurrence after LT. We show that our patient with a late recurrence of HCC after LT benefitted from intensive multimodal therapy concepts, including surgery, RFA, and systemic therapy.
Managing the difficult airway
Authors: Liu Hui-Hui , Wang Yong , Zhong Ming , Li Yu-Hui , Gao Huan , Zhang Jian-Feng , Ma Wu-Hua
Published: September 2021

Although equipment and human resources are vital elements of difficult airway management (DAM). But the approach and practice of DAM are more important. So, we conducted the present survey to address anesthesiologists of different working years in this knowledge gap.

This nationwide cross-sectional study was conducted from October 27, 2016 to November 27, 2016. The survey was completed online in New Youth Anesthesia Forum including DAM assessment, anticipated and unanticipated DAM, difficult airway algorithm, use of the front of neck access (FONA) technique and training, DAM outside the operation room, and difficult extubation management.

We received 1935 replies (44%). Mouth opening and Mallampati classification were the most common methods to evaluate difficult airways. When suffering from unanticipated difficult airway 63% less than 10 years anesthesiologists (LA) and 65% more than 10 years anesthesiologists (MA) would ask for help after trying 1 to 2 times (P = .000). More than 70% of LA and MA respondents reported preferring cannula cricothyrotomy to deal with emergency airway, 507 (41.6%) MA respondents reported that they used FONA techniques to save patients’ lives (P = .000). Nearly 70% respondents worried full stomach when intubated outside operation room and more than 80% respondents selected auscultation to identify the placement. More than 80% respondents had not used Bougie to assist extubation. A 73.2% respondents know ABS algorithm and 96.4% know Chinese airway expert consensus among MA respondents, this was significant to LA respondents (P = .000).

The respondents in the LA and MA have a training gap in their evaluation of difficult airways, trained and used FONA emergency skills, facilitated of the airway guidelines at home and abroad. Also, we should provide more airway theory and skill training to our young doctors to advanced airway skills.
Balanced crystalloids versus saline in critically ill patients
Authors: Zhu Yuhan , Guo Nan , Song Maifen , Xia Fei , Wu Yanqing , Wang Xusheng , Chen Tengfei , Yang Zhihai , Yang Siwen , Zhang Yu , Zhang Xin , Shi Qingquan , Shen Xiaoxu
Published: September 2021

Objective:

To compare the safety of balanced crystalloids and saline among critically ill patients in intensive care unit (ICU).

Methods:

The Medline, EMBASE, Web of Science, Cochrane Library databases were systematically searched from the inception dates to May 17, 2020 in order to identify randomized controlled trials which evaluated the safety of balanced crystalloids and saline in critically ill patients. The primary outcome was major adverse kidney events within 30 days (MAKE30). The second outcomes included 30-day mortality, ICU mortality, In-hospital mortality, ICU length of stay, hospital length of stay, creatinine highest before discharge (mg/dl) and needs for renal replacement therapy (RRT).

Results:

A total of nine randomized controlled trials involving 19,578 critical ill patients fulfilled the inclusion criteria. The outcomes of this meta-analysis showed that balanced crystalloids treatment shared the same risk of MAKE30 with saline treatment among critical ill patients [RR = 0.95; 95%CI, 0.88 to 1.01; Z = 1.64 (P = .102)]. The clinical mortality which included 30-day mortality [RR = 0.92; 95%CI, 0.85 to 1.01; Z = 1.78 (P = .075)], ICU mortality [RR = 0.92; 95%CI, 0.83 to 1.02; Z = 1.67 (P = .094)] and In-hospital mortality [RR = 0.93; 95%CI, 0.71 to 1.21; Z = 0.55 (P = .585)] were similar between balanced crystalloids treatment and saline treatment among critical ill patients. Patients who received balanced crystalloids treatment or saline treatment needed the same length of ICU stay [WMD = 0.00; 95%CI, −0.09 to 0.10; Z = 0.09 (P = .932)] and hospital stay [WMD = 0.59; 95%CI, −0.33 to 1.51; Z = 1.26 (P = .209)]. Critical ill patients who received balanced crystalloids treatment or saline treatment had the same level of creatinine highest before discharge [WMD = 0.01; 95%CI, −0.02 to 0.04; Z = 0.76 (P = .446)] and needs for RRT [RR = 1.04; 95%CI, 0.75 to 1.43; Z = 0.21 (P = .830)]. Similar results were obtained in subgroups of trials stratified according to the age of patients (children or adults).

Conclusions:

When compared with saline, balanced crystalloids could not reduce the risk of MAKE30, 30-day mortality, ICU mortality and in-hospital mortality, could not reduce the length of ICU stay, length of hospital stay, the level of creatinine highest before discharge and the needs for RRT among critical ill children and adults. Therefore, it was still too early for balanced crystalloids to replace normal saline among critical ill patients.
Syncope as the initial presentation of pulmonary embolism in two patients with hepatocellular carcinoma
Authors: Deng Dayong , Wu Haidi , Wei Huafang , Song Zikai , Yu Yang , Zhang Chongyin , Yang Lei
Published: September 2021

Rationale:

Pulmonary embolism (PE) has diverse clinical manifestations and syncope might be the first or only symptom of PE. Tumor disease usually presents with symptoms associated with the primary site, however, PE may be the first manifestation of occult tumors.

Patient concerns:

Here, we report 2 patients admitted to our hospital because of syncope. One patient had a chronic hepatitis B history of more than 20 years and the other patient had chronic heavy drinking for many years. Neither patient had been diagnosed with neoplastic disease before admission.

Diagnoses:

Clinical examinations, including laboratory tests and imaging tests upon admission demonstrated PE resulting in syncope. Furthermore, malignant hepatocellular carcinoma (HCC), inferior vena cava, and right atrium tumor thrombus were diagnosed.

Interventions:

Thrombolysis and anti-coagulation therapy were performed immediately after the diagnosis of PE. Twenty-seven HCC patients with PE in 27 articles from 1962 to 2020 in the PubMed database were reviewed.

Outcomes:

The improvement was achieved that no syncope recurred after treatment of PE. The oxygen partial pressure increased and the D-dimer level decreased. The clinical characteristics of 27 HCC patients with PE were summarized and analyzed.

Lessons:

It is important for clinicians to be aware that occult carcinoma might be a reason for patients with PE presenting with syncope. If PE cannot be explained by common causes, such as our patient, and HCC should be highly suspected when inferior vena cava and right atrial mass are found on imaging tests.
Laparoscopic treatment of a recurrent biliary stone forming around a Hem-o-lok clip in a patient with previous gastrectomies
Authors: Jiang Chao , Liu Xueyan , Li Shuxuan , Wu Guangzhen , Wang Guangyi , Wang Meng
Published: September 2021

Rationale:

A history of gastrectomy is associated with an increased incidence of gallstones requiring surgery. Endoscopic retrograde cholangiopancreatography is challenging for patients who undergo total or Billroth II gastrectomy. Laparoscopic common bile duct exploration (LCBDE) has been attempted in such cases. Herein, we report a case of choledocholithiasis in which a stone formed around a migrated Hem-o-lok clip.

Patient concerns:

A 67-year-old man was admitted to the hospital for acute right upper abdominal pain. He had a history of 2 open gastric cancer surgeries in the previous seven years and had undergone LCBDE 12 months prior to this admission. Postoperative examination revealed recurrence of bile duct stones.

Interventions:

The patient underwent repeat LCBDE plus primary closure with an evaluation of abdominal adhesion. A stone had formed around a Hem-o-lok clip in the common bile duct was removed.

Outcomes:

The patient had an uneventful recovery with no stone recurrence or movement of the remaining Hem-o-lok clips after a 1-year follow-up.

Lessons:

LCBDE with primary closure should be carefully considered in patients with certain gallstone diseases after complicated upper abdominal surgery.

Postoperative clip migration is a rare complication; hence care must be taken in placing the clip appropriately to ensure that it is not too close to the common bile duct.
Prognostic significance of platelet lymphocyte ratio in patients with melanoma
Authors: Wang Enwen , Huang Hui , Tang Long , Tian Ling , Yang Liejun , Wang Sixiong , Ma Huiwen
Published: September 2021

Background:

The aim of this study was to systematically evaluate the prognostic role of platelet lymphocyte ratio (PLR) in patients with melanoma through performing a meta-analysis.

Methods:

PubMed, EMBASE, Web of Science, and China National Knowledge Infrastructure were searched for potential studies. The basic characteristics and relevant data were extracted. Hazard ratios with 95% confidence intervals (CIs) were pooled to evaluate the prognostic role of PLR in patients with melanoma.

Results:

Ten studies enrolling 2422 patients were included. The pooled hazard ratios of higher PLR for overall survival and progression-free survival in melanoma were 1.70 (95% CI, 1.22–2.37) and 1.65 (95% CI, 1.10–2.47), respectively. Sensitivity analysis and subgroup analyses were also performed. No significant publication bias was observed.

Conclusion:

Our results showed that higher PLR was associated with poorer overall survival and progression-free survival in patients with melanoma. These findings may help to determine the prognosis and explore future novel therapies based on modulating inflammation and immune responses in melanoma.