bluuebunny/crossref_metadata_2025 huggingface dataset:
CT of the coronary arteries in patients with non-coronary chest pain. An educational intervention aimed at improving reliance and reducing episodes of recurring chest pain
Authors: Krohn I , Rygh CB , Norekvaal TM
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Chest pain is a symptom closely linked to coronary disease (CAD) and a common complaint in the general practitioner’s office. Nevertheless, most of these complaints are benign and of non-coronary origin. Computed Tomography (CT) is the main diagnostic tool to investigate the coronary arteries, an examination with a low probability of false-negative result (<1%). Despite negative findings of CAD, this patient group still experience higher degree of morbidity and anxiety and decreased quality of life when compared to a population without chest pain.

Purpose

To determine the effect of an intervention for reliance in the CT-examination and recurring chest pain in patients with non-coronary chest pain in follow-up after one month.

Methods

Patients with chest pain, but with normal CT-findings, i.e. no CAD, were randomised into two groups. The intervention group received extended information about the examination, such as the reliability of the result due to CTs low probability of false-negative result and also the great prognostic value it provides. The examination result was then conveyed to the patient. The control group received standard care; i.e no extended information was given and the examination result was obtained from their general practitioner after one week. The effect of the intervention was measured with a specific question regarding reliance in the CT-examination and the Seattle Angina Questionnaire (SAQ) at follow-up after one month.

Results

The study included 92 patients; follow-up response rate was 80%. Of the participants were 63 females (68%), and the mean age was 51 years. Analysis showed that the intervention group had significantly higher reliance in the CT-examination (p = 0.016) and significantly reduced incidences of chest pain (p = 0.042) when compared to the control group at 1-month follow-up (Figure 1).

Conclusion

This intervention demonstrates that relatively simple actions may have a great impact on patient care. Providing patients with extended information and an early communication of CT results have a positive effect on reliance and chest pain after one month. Such an effect may lead to lower morbidity, less anxiety and a higher quality of life in this group. Further examinations after six or twelve months might provide additional knowledge of the long-term effect of the performed intervention.

Abstract Figure 1
Delayed radiofrequency ablation efficacy in slow pathway ablation: a case report
Authors: Zeljković Ivan , Pavlović Nikola , Radeljić Vjekoslav , Manola Šime
Published: February 2021

Background

The delayed effect of radiofrequency (RF) ablation was described in cases of accessory pathway and premature ventricular contraction ablation, as well as delayed atrioventricular (AV) block after slow pathway ablation.

Case summary

We report a case of a female patient with AV nodal re-entry tachycardia (AVNRT), in whom the first electrophysiology study ended with acute failure of slow pathway ablation, despite using long steerable sheath, both right and left-sided ablation with >15 min of RF energy application and repeatedly achieving junctional rhythm. Six weeks afterwards, during scheduled three-dimensional electroanatomical mapping procedure, there was no proof of dual AV nodal conduction nor could the tachycardia be induced. Also, the patient did not have palpitations between the two procedures nor during the 12-month follow-up period.

Discussion

This case illustrates that watchful waiting for delayed RF ablation efficacy in some cases of AVNRT ablation could be reasonable, in order to reduce the risk of complications associated with slow pathway ablation.
A rare cause of culture negative bioprosthetic valve endocarditis: a case report of Aggregatibacter aphrophilus infection
Authors: Wassef Nancy , Sarkar David , Viswanathan Girish , Hughes Gareth Morgan , Salisbury Thomas , Kuo James , de Silva Ravi
Published: February 2021

Background

The prevalence of culture negative infective endocarditis (IEC) is reported as 2–7% though this figure may be as high as 70% in developing countries.1 This higher rate will, at least in part, be due to reduced diagnostic facilities though some data suggests higher rates even when appropriate cultures were taken. The frequency is significantly elevated in patients who have already been exposed to antibiotics prior to blood cultures.1,2 A rare cause of culture negative IEC is the HACEK group of organisms that are normal habitants of the oropharyngeal flora and account for 1–3% of native valve endocarditis.3  Aggregatibacter aphrophilus (A. aphrophilus) is a member of the HACEK group of organisms.

Case summary

A 32-year-old gentleman with a previous bioprosthetic aortic valve presented with a 1-week history of diarrhoea, vomiting, malaise, and weight loss. He was awaiting redo surgery for stenosis of the bioprosthesis, which had been inserted aged 17 for aortic stenosis secondary to a bicuspid valve. The initial blood tests revealed liver and renal impairment with anaemia. A transoesophageal echocardiogram demonstrated a complex cavitating aortic root abscess, complicated by perforation into the right ventricle. He underwent emergency redo surgery requiring debridement of the aortic abscess, insertion of a mechanical aortic prosthesis (St Jude Medical, USA), annular reconstruction and graft replacement of the ascending aorta. Despite antibiotic therapy, he remained septic with negative blood and tissue cultures. Bacterial 16S rRNA gene sequencing confirmed A. aphrophilus infection, for which intravenous ceftriaxone was initiated. This was subsequently changed to ciprofloxacin due to neutropenia. The patient self-discharged from the hospital during the third week of antibiotic therapy. One week later, he was re-admitted with fever, night sweats, and dyspnoea. Transthoracic echocardiogram revealed a large recurrent aortic abscess cavity around the aortic annulus fistulating into the right heart chambers; this was confirmed by a computed tomography scan. There was dehiscence of the patch repair. Emergency redo aortic root replacement (25 mm mechanical valve conduit, ATS Medical, USA) and annular reconstruction was performed with venoarterial extracorporeal membrane oxygenation (VA-ECMO) support. VA-ECMO was weaned after 3 days. The patient completed a full course of intravenous meropenem and ciprofloxacin and made a good recovery.

Discussion

IEC with oropharyngeal HACEK organisms is rare and difficult to diagnose, due to negative blood culture results. The broad-range polymerase chain reaction and gene sequencing with comparison to the DNA database is useful in these circumstances. This case demonstrates the importance of the 16S rRNA gene sequencing for HACEK infection diagnosis and appropriate antibiotic treatment.
Catheter-based closure of a large atrial septal defect with inferior rim deficiency using pulmonary vein slide-out assisted implantation technique: a case report
Authors: Evola Salvatore , Triolo Oreste Fabio , Novo Giuseppina , Onorato Eustaquio Maria
Published: February 2021

Background

Transcatheter approach for large and complex atrial septal defects may represent a therapeutic challenge, particularly when the postero-inferior rim is deficient and floppy.

Case summary

Here, we describe a successful catheter-based closure of a large (>30 mm) secundum atrial septal defect associated with postero-inferior rim deficiency in a 35-year-old female with congestive heart failure using pulmonary vein slide-out assisted implantation technique.

Discussion

Inferior–posterior rim deficiency is a well-known risk factor for device instability or embolization. Transcatheter closure may represent a safe and effective alternative to the traditional surgical approach provided that modified implantation techniques are employed.
Heterophile antibodies, false-positive troponin, and acute coronary syndrome: a case report indicating a pitfall in clinical practice
Authors: Lakusic Nenad , Sopek Merkas Ivana , Lucinger Daren , Mahovic Darija
Published: February 2021

Background

Heterophile antibodies are one of the most common causes of false-positive troponin.

Case summary

We report a case of a 53-year-old woman with false-positive troponin elevation and a clinical presentation understood and treated as non-ST-elevation acute coronary syndrome. Because of chronic basal elevation of troponin (at a ‘plateau’ level) and chest pain, the patient underwent several invasive coronary angiograms until false-positive increase of troponin due to heterophile antibodies was suspected. Borderline stenosis of a left circumflex coronary artery found on first coronary angiogram was a coincidental finding and heterophile antibodies in the patient’s serum were confirmed.

Discussion

This interesting case report aims to remind the clinicians about the possibility of false-positive troponin level due to laboratory analytical interference caused by heterophile antibodies. In this case, it is important to suspect false-positive troponin elevation, even when coronary artery disease is found. This rare and less mentioned and/or recognized cause of troponin elevation may lead to unnecessary invasive diagnostics and aggressive treatment of patients.
UK house prices and three decades of decline in the risk-free real interest rate
Authors: Miles David , Monro Victoria
Published: February 2021

House prices have risen substantially faster than the prices of consumer goods in most G7 countries over the past few decades. This raises major policy issues: such rises affect the distribution of wealth within and between generations, the mobility of labour and financial stability. This paper explores why such rises have happened, and what the policy implications are. The price rises have been greatest in the United Kingdom, where real house prices have risen more than three and a half times since the 1970s, substantially outpacing real income growth. Meanwhile, rental yields have been trending downwards—particularly since the mid-90s. This paper reconciles these observations by analysing the contribution of a number of drivers of house prices. It shows that the rise in house prices relative to incomes between 1985 and 2018 in the United Kingdom can be more than accounted for by the substantial decline in real risk-free interest rates over the period. This is slightly offset by net increases in home-ownership costs from higher rates of tax. Changes in the risk-free real rate are likely to have been a major driver of changes in house prices. We analyse why they have driven house prices up faster in the United Kingdom than in other advanced economies. Our model predicts that a 1% sustained increase in index-linked gilt yields from current rates could ultimately result in a fall in real house prices of around 20%.
Drosophilasensory receptors—a set of molecular Swiss Army Knives
Authors: Montell Craig
Published: February 2021

Genetic approaches in the fruit fly, Drosophila melanogaster, have led to a major triumph in the field of sensory biology—the discovery of multiple large families of sensory receptors and channels. Some of these families, such as transient receptor potential channels, are conserved from animals ranging from worms to humans, while others, such as “gustatory receptors,” “olfactory receptors,” and “ionotropic receptors,” are restricted to invertebrates. Prior to the identification of sensory receptors in flies, it was widely assumed that these proteins function in just one modality such as vision, smell, taste, hearing, and somatosensation, which includes thermosensation, light, and noxious mechanical touch. By employing a vast combination of genetic, behavioral, electrophysiological, and other approaches in flies, a major concept to emerge is that many sensory receptors are multitaskers. The earliest example of this idea was the discovery that individual transient receptor potential channels function in multiple senses. It is now clear that multitasking is exhibited by other large receptor families including gustatory receptors, ionotropic receptors, epithelial Na+ channels (also referred to as Pickpockets), and even opsins, which were formerly thought to function exclusively as light sensors. Genetic characterizations of these Drosophila receptors and the neurons that express them also reveal the mechanisms through which flies can accurately differentiate between different stimuli even when they activate the same receptor, as well as mechanisms of adaptation, amplification, and sensory integration. The insights gleaned from studies in flies have been highly influential in directing investigations in many other animal models.
Deformation due to surface temperature variation on a spherically layered, transversely isotropic and self-gravitating Earth
Authors: Zhou Jiangcun , Pan Ernian , Bevis Michael
Published: February 2021

We present a theory of modern, thermally induced deformation in a realistic Earth. The heat conduction equation is coupled with standard elastic deformation theory to construct a boundary-value problem comprised of eighth-order differential equations. The accurate and stable dual variable and position propagating matrix technique is introduced to solve the boundary-value problem. The thermal load Love numbers are defined to describe the displacements and potential changes driven by thermally induced deformation. The proposed analytical method is validated by comparing the present results with exact solutions for a homogeneous sphere, which are also derived in this paper. The analytical method is then applied to a realistic Earth model to evaluate the effects of layering and self-gravitation of the Earth on displacement and changes of potential. Furthermore, the frequency dependence in the thermal load is illustrated by invoking different thermal periodicities in the computation. Thermal anisotropy is also considered by comparing the results obtained using isotropic and transversely isotropic Earth models. Results show that, when simulating thermally induced deformation, invoking a homogeneous spherical Earth leads to results that substantially differ from those obtained using a more realistic Earth model.
A recurrent ZSWIM7 mutation causes male infertility resulting from decreased meiotic recombination
Authors: Li Yang , Wu Yufan , Zhou Jianteng , Zhang Huan , Zhang Yuanwei , Ma Hui , Jiang Xiaohua , Shi Qinghua
Published: February 2021

STUDY QUESTION

Are mutations in the zinc finger SWIM domain-containing protein 7 gene (ZSWIM7) associated with human male infertility?

SUMMARY ANSWER

The homozygous frameshift mutation (c.231_232del) in ZSWIM7 causes decreased meiotic recombination, spermatogenesis arrest, and infertility in men.

WHAT IS KNOWN ALREADY

ZSWIM7 is a SWIM domain-containing Shu2/SWS1 protein family member and a subunit of the Shu complex. Zswim7 knockout mice were infertile due to impaired meiotic recombination. However, so far there is no direct evidence that mutations of ZSWIM7 cause human infertility.

STUDY DESIGN, SIZE, DURATION

Screening for mutations of ZSWIM7 was performed using in-house whole-exome sequencing data from 60 men with non-obstructive azoospermia (NOA). Mice with a corresponding Zswim7 mutation were generated for functional verification.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Sixty Chinese patients, who were from different regions of China, were enrolled. All the patients were diagnosed with NOA owing to spermatocyte maturation arrest based on histopathological analyses and/or immunostaining of spermatocyte chromosome spreads. ZSWIM7 mutations were screened from the whole-exome sequencing data of these patients, followed by functional verification in mice.

MAIN RESULTS AND THE ROLE OF CHANCE

A homozygous frameshift mutation (c.231_232del) in ZSWIM7 was found in two out of the 60 unrelated NOA patients. Both patients displayed small testicular size and spermatocyte maturation arrest in testis histology. Spermatocyte chromosome spreads of one patient revealed meiotic maturation arrest in a pachytene-like stage, with incomplete synapsis and decreased meiotic recombination. Male mice carrying a homozygous mutation similar to that of our patients were generated and also displayed reduced recombination, meiotic arrest and azoospermia, paralleling the spermatogenesis defects in our patients.

LIMITATIONS, REASONS FOR CAUTION

As Zswim7 is also essential for meiosis in female mice, future studies should evaluate the ZSWIM7 mutations more in depth and in larger cohorts of infertile patients, including males and females, to validate the findings.

WIDER IMPLICATIONS OF THE FINDINGS

These findings provide direct clinical and functional evidence that the recurrent ZSWIM7 mutation (c.231_232del) causes decreased meiotic recombination and leads to male infertility, illustrating the genotype-phenotype correlations of meiotic recombination defects in humans.

STUDY FUNDING/COMPETING INTEREST(S)

This work was supported by the National Natural Science Foundation of China (31890780, 31630050, 32061143006, 82071709, and 31871514), the Strategic Priority Research Program of the Chinese Academy of Sciences (XDB19000000), and the National Key Research and Developmental Program of China (2018YFC1003900 and 2019YFA0802600).

TRIAL REGISTRATION NUMBER

Not applicable.
Ischiofemoral impingement: the evolutionary cost of pelvic obstetric adaptation
Authors: Audenaert E A , Duquesne K , De Roeck J , Mutsvangwa T , Borotikar B , Khanduja V , Claes P
Published: February 2021

The risk for ischiofemoral impingement has been mainly related to a reduced ischiofemoral distance and morphological variance of the femur. From an evolutionary perspective, however, there are strong arguments that the condition may also be related to sexual dimorphism of the pelvis. We, therefore, investigated the impact of gender-specific differences in anatomy of the ischiofemoral space on the ischiofemoral clearance, during static and dynamic conditions. A random sampling Monte-Carlo experiment was performed to investigate ischiofemoral clearance during stance and gait in a large (n = 40 000) virtual study population, while using gender-specific kinematics. Subsequently, a validated gender-specific geometric morphometric analysis of the hip was performed and correlations between overall hip morphology (statistical shape analysis) and standard discrete measures (conventional metric approach) with the ischiofemoral distance were evaluated. The available ischiofemoral space is indeed highly sexually dimorphic and related primarily to differences in the pelvic anatomy. The mean ischiofemoral distance was 22.2 ± 4.3 mm in the females and 29.1 ± 4.1 mm in the males and this difference was statistically significant (P < 0.001). Additionally, the ischiofemoral distance was observed to be a dynamic measure, and smallest during femoral extension, and this in turn explains the clinical sign of pain in extension during long stride walking. In conclusion, the presence of a reduced ischiofemroal distance and related risk to develop a clinical syndrome of ischiofemoral impingement is strongly dominated by evolutionary effects in sexual dimorphism of the pelvis. This should be considered when female patients present with posterior thigh/buttock pain, particularly if worsened by extension. Controlled laboratory study.
Phytochrome B links the environment to transcription
Authors: Hernando Carlos Esteban , Murcia Mauro Germán , Pereyra Matías Ezequiel , Sellaro Romina , Casal Jorge José
Published: February 2021

Phytochrome B (phyB) senses the difference between darkness and light, the level of irradiance, the red/far-red ratio, and temperature. Thanks to these sensory capacities, phyB perceives whether plant organs are buried in the soil, exposed to full sunlight, in the presence of nearby vegetation, and/or under risk of heat stress. In some species, phyB perceives seasonal daylength cues. phyB affects the activity of several transcriptional regulators either by direct physical interaction or indirectly by physical interaction with proteins involved in the turnover of transcriptional regulators. Typically, interaction of a protein with phyB has either negative or positive effects on the interaction of the latter with a third party, this being another protein or DNA. Thus, phyB mediates the context-dependent modulation of the transcriptome underlying changes in plant morphology, physiology, and susceptibility to biotic and abiotic stress. phyB operates as a dynamic switch that improves carbon balance, prioritizing light interception and photosynthetic capacity in open places and the projection of the shoot towards light in the soil, under shade and in warm conditions.
The ATG4 protease integrates redox and stress signals to regulate autophagy
Authors: Pérez-Pérez María Esther , Lemaire Stéphane D , Crespo José L
Published: February 2021

Autophagy is a highly conserved degradative pathway that ensures cellular homeostasis through the removal of damaged or useless intracellular components including proteins, membranes, or even entire organelles. A main hallmark of autophagy is the biogenesis of autophagosomes, double-membrane vesicles that engulf and transport to the vacuole the material to be degraded and recycled. The formation of autophagosomes responds to integrated signals produced as a consequence of metabolic reactions or different types of stress and is mediated by the coordinated action of core autophagy-related (ATG) proteins. ATG4 is a key Cys-protease with a dual function in both ATG8 lipidation and free ATG8 recycling whose balance is crucial for proper biogenesis of the autophagosome. ATG4 is conserved in the green lineage, and its regulation by different post-translational modifications has been reported in the model systems Chlamydomonas reinhardtii and Arabidopsis. In this review, we discuss the major role of ATG4 in the integration of stress and redox signals that regulate autophagy in algae and plants.
Do ultracompact dwarf galaxies form monolithically or as merged star cluster complexes?
Authors: Mahani Hamidreza , Zonoozi Akram Hasani , Haghi Hosein , Jeřábková Tereza , Kroupa Pavel , Mieske Steffen
Published: February 2021

Some ultracompact dwarf galaxies (UCDs) have elevated observed dynamical V-band mass-to-light (M/LV) ratios with respect to what is expected from their stellar populations assuming a canonical initial mass function (IMF). Observations have also revealed the presence of a compact dark object in the centres of several UCDs, having a mass of a few to 15 per cent of the present-day stellar mass of the UCD. This central mass concentration has typically been interpreted as a supermassive black hole, but can in principle also be a subcluster of stellar remnants. We explore the following two formation scenarios of UCDs: (i) monolithic collapse and (ii) mergers of star clusters in cluster complexes as are observed in massively starbursting regions. We explore the physical properties of the UCDs at different evolutionary stages assuming different initial stellar masses of the UCDs and the IMF being either universal or changing systematically with metallicity and density according to the integrated Galactic IMF theory. While the observed elevated M/LV ratios of the UCDs cannot be reproduced if the IMF is invariant and universal, the empirically derived IMF that varies systematically with density and metallicity shows agreement with the observations. Incorporating the UCD-mass-dependent retention fraction of dark remnants improves this agreement. In addition, we apply the results of N-body simulations to young UCDs and show that the same initial conditions describing the observed M/LV ratios reproduce the observed relation between the half-mass radii and the present-day masses of the UCDs. The findings thus suggest that the majority of UCDs that have elevated M/LV ratios could have formed monolithically with significant remnant-mass components that are centrally concentrated, while those with small M/LV values may be merged star cluster complexes.
Taxonomic Sampling and Rare Genomic Changes Overcome Long-Branch Attraction in the Phylogenetic Placement of Pseudoscorpions
Authors: Ontano Andrew Z , Gainett Guilherme , Aharon Shlomi , Ballesteros Jesús A , Benavides Ligia R , Corbett Kevin F , Gavish-Regev Efrat , Harvey Mark S , Monsma Scott , Santibáñez-López Carlos E , Setton Emily V W , Zehms Jakob T , Zeh Jeanne A , Zeh David W , Sharma Prashant P
Published: February 2021

Long-branch attraction is a systematic artifact that results in erroneous groupings of fast-evolving taxa. The combination of short, deep internodes in tandem with long-branch attraction artifacts has produced empirically intractable parts of the Tree of Life. One such group is the arthropod subphylum Chelicerata, whose backbone phylogeny has remained unstable despite improvements in phylogenetic methods and genome-scale data sets. Pseudoscorpion placement is particularly variable across data sets and analytical frameworks, with this group either clustering with other long-branch orders or with Arachnopulmonata (scorpions and tetrapulmonates). To surmount long-branch attraction, we investigated the effect of taxonomic sampling via sequential deletion of basally branching pseudoscorpion superfamilies, as well as varying gene occupancy thresholds in supermatrices. We show that concatenated supermatrices and coalescent-based summary species tree approaches support a sister group relationship of pseudoscorpions and scorpions, when more of the basally branching taxa are sampled. Matrix completeness had demonstrably less influence on tree topology. As an external arbiter of phylogenetic placement, we leveraged the recent discovery of an ancient genome duplication in the common ancestor of Arachnopulmonata as a litmus test for competing hypotheses of pseudoscorpion relationships. We generated a high-quality developmental transcriptome and the first genome for pseudoscorpions to assess the incidence of arachnopulmonate-specific duplications (e.g., homeobox genes and miRNAs). Our results support the inclusion of pseudoscorpions in Arachnopulmonata (new definition), as the sister group of scorpions. Panscorpiones (new name) is proposed for the clade uniting Scorpiones and Pseudoscorpiones.
Case Volume Analysis of Neurological Surgery Training Programs in the United States: 2017-2019
Authors: Hopkins Benjamin S , Shlobin Nathan A , Kesavabhotla Kartik , Smith Zachary A , Dahdaleh Nader S
Published: February 2021

BACKGROUND

Neurological surgery resident applicants seek out certain aspects of training, including case volume. While graduating Accreditation Council for Graduate Medical Education (ACGME) summary data are available yearly, they are not program specific and drawing conclusions is difficult.

OBJECTIVE

To model general benchmarks for resident case volume across US programs to increase transparency and allow comparison of programs.

METHODS

ACGME neurosurgical resident national reports from 2017 to 2019 were downloaded. Averages, standard deviations, and medians were recorded from each of the 27 procedural categories. Monte Carlo simulations were performed. Each distribution was run independently 1 to 4 times to represent the number of residents in a given program per year. Cases were divided into different categories: endovascular, open vascular, tumor, spine, and pediatrics.

RESULTS

Average derived graduating case volumes were 1558 cases in 2017, 1599 cases in 2018, and 1618 cases in 2019. Programs with 3 residents per year averaged 4755 cases per year, with 90th percentile of 5401 cases per year. After removing endovascular cases, radiosurgery cases, and critical care procedures, the average was 3794 cases, with 90th percentile of 4197 cases per year. Categorically, the 90th percentile was 241 for open vascular, 373 for endovascular, 1600 for spine, 769 for tumor, and 352 for pediatrics.

CONCLUSION

Case volume is an important part of neurosurgical training and a major factor in determining applicant residency program ranking. Through Monte Carlo simulation, the average case volume for programs with 3 residents per year was determined. Metrics and benchmarking remain an important part of applicant and program growth.
Hiding in plain sight—Euplokamis dunlapae(Ctenophora) in Norwegian waters
Authors: Majaneva Sanna , Ringvold Halldis , Johansen Ellie , Østensen Mari-Ann , Hosia Aino
Published: February 2021

Cydippid ctenophores of genus Euplokamis have been rarely reported from the north-east Atlantic in the scientific literature. The conspicuous lack of previous records is likely attributable to methodological constraints detrimental to sampling ctenophores, including the use of plankton nets and preservation of samples as well as poor identification literature and a lack of taxonomic expertise on gelatinous zooplankton. Here, we have compiled published and novel records as well as documented diver observations, of Euplokamis spp. in Norwegian waters. Despite scant earlier reports, our data suggest that the genus Euplokamis is widely distributed and relatively common along the entire Norwegian coast, including Svalbard. Euplokamis was recorded from samples taken from several hundred meters depth to surface, from fjords as well as offshore. Most of the observations reported in this study are from the period between April and July, whereas specimens have been found nearly throughout the year. Specimens from Norwegian waters were morphologically most similar to Euplokamis dunlapae, and conservative 18S rDNA sequences of some specimens had a 100% match with an E. dunlapae specimen from Friday Harbor, USA, the type locality for the species. However, the morphological and molecular variation of Euplokamis demonstrates the need for systematic global sampling of multiple individuals of many ctenophore species.
Is fibromyalgia associated with a unique cytokine profile? A systematic review and meta-analysis
Authors: O’Mahony Luke Furtado , Srivastava Arnav , Mehta Puja , Ciurtin Coziana
Published: February 2021

Objectives

The aetiology of primary chronic pain syndromes (CPS) is highly disputed. We performed a systematic review and meta-analysis aiming to assess differences in circulating cytokine levels in patients with diffuse CPS (fibromyalgia) vs healthy controls (HC).

Methods

Human studies published in English from the PubMed, MEDLINE/Scopus and Cochrane databases were systematically searched from inception up to January 2020. We included full text cross-sectional or longitudinal studies with baseline cytokine measurements, reporting differences in circulating cytokine levels between fibromyalgia patients and HC. Random-effects meta-analysis models were used to report pooled effects and 95% CIs. This study is registered with PROSPERO (CRD42020193774).

Results

Our initial search yielded 324 papers and identified 29 studies (2458 participants) eligible for systematic review and 22 studies (1772 participants) suitable for meta-analysis. The systematic analysis revealed reproducible findings supporting different trends of cytokine levels when fibromyalgia patients were compared with HC, while the chemokine eotaxin, was consistently raised in fibromyalgia. Meta-analysis showed significantly increased TNF-α [standardized mean difference (SMD) = 0.36, 95% CI: 0.12, 0.60, P = 0.0034; I2 = 71%, Q2P = 0.0002], IL-6 (SMD = 0.15, 95% CI: 0.003, 0.29, P = 0.045; I2 = 39%, Q2P = 0.059), IL-8 (SMD = 0.26, 95% CI: 0.05, 0.47, P = 0.01; I2 = 61%, Q2P = 0.005) and IL-10 (SMD = 0.61, 95% CI: 0.34, 0.89, P < 0.001; I2 = 10%, Q2P = 0.34) in fibromyalgia patients compared with HC.

Conclusion

We found evidence of significant differences in the peripheral blood cytokine profiles of fibromyalgia patients compared with HC. However, the distinctive profile associated with fibromyalgia includes both pro-inflammatory (TNF-α, IL-6, IL-8) and anti-inflammatory (IL-10) cytokines in pooled analysis, as well as chemokine (eotaxin) signatures. Further research is required to elucidate the role of cytokines in fibromyalgia.
Sleep EEG microstructure in children and adolescents with attention deficit hyperactivity disorder: a systematic review and meta-analysis
Authors: Biancardi Carlo , Sesso Gianluca , Masi Gabriele , Faraguna Ugo , Sicca Federico
Published: February 2021

Attention deficit hyperactivity disorder (ADHD) is commonly associated with sleep problems, possibly due to shared pathophysiology. Microstructural sleep electroencephalographic (EEG) alterations may likely represent markers of disordered cortical maturation in ADHD, although literature data are still conflicting, deserving further assessment. After having systematically reviewed the literature, we included 11 studies from 598 abstracts, and assessed 23 parameters of cyclic alternating pattern (CAP), four parameters of sleep EEG power and one parameter of sleep graphoelements through 29 meta-analyses and, when possible, univariate meta-regressions. Slow wave activity (SWA) in ADHD was significantly higher in early childhood and lower in late childhood/adolescence compared to controls, with an inversion point at 10 years. Total CAP rate and CAP A1 index in non-rapid eye movement (NREM) stage 2 sleep, and CAP A1 rate in NREM sleep were significantly lower in ADHD patients than controls. SWA and CAP A1 changes are therefore possible markers of altered cortical maturation in ADHD, consistently with the neuropsychological deficits characterizing the disorder, likely fostering earlier detection of at-risk/milder conditions, and more tailored therapeutic interventions.
Maintaining continuity of nutrient intake after weaning. II. Review of post-weaning strategies
Authors: Wensley Madie R , Tokach Mike D , Woodworth Jason C , Goodband Robert D , Gebhardt Jordan T , DeRouchey Joel M , McKilligan Denny
Published: February 2021

Low feed consumption during the first 3 d post-weaning disrupts nutrient intake and results in what is commonly known as a post-weaning growth check. While most pigs recover from this initial reduction in feed intake (FI), some pigs fail to successfully make this transition leading to morbidity and mortality. In this review, our objective is to describe the different post-weaning strategies that can be used to minimize nutrient intake disruption and improve FI in the immediate post-weaning period. Providing weanling pigs with an environment that encourages them to search out and consume feed is important. This includes appropriate barn temperatures, resource availability, and nursery placement strategies. Research is needed to better understand the ideal environmental temperatures to encourage pen exploration and reduce time to initial FI. Likewise, mat and gruel feeding are commonly practiced throughout the industry to increase feed accessibility; however, limited research data is available to validate protocols or benefits. Nursery placement strategies include sorting light weight pigs into uniform body weight groups and average or heavy weight pigs into variable body weight groups to provide benefit to light pigs while reducing initial aggression in heavy pigs. Furthermore, water enrichment with nutrient dense products have been shown to improve growth performance and reduce morbidity and mortality in the early post-weaning period. Because young pigs are sensitive to palatability, diet form and complexity should also be considered. Weanling pigs prefer diets manufactured with coarse ground corn (700 μm) compared to fine ground corn. Additionally, weanling pigs are more attracted to large diameter pellets (12 mm) compared with small pellets. Despite these preferences, impacts on growth are relatively small. Feeding complex diets with high levels of lactose, animal protein products, or other palatable ingredients is another strategy shown to improve growth performance during the first week post-weaning; however, the initial benefits quickly diminished as pigs become older. Other strategies that warrant further investigation include the effect of crumble diets on feed preference and the concept of perinatal or social interaction flavor learning. In summary, strategic post-weaning nutrition and management practices must focus on maintaining continuity of nutrient intake in order to reduce morbidity and mortality in the immediate post-weaning period.
Deep Learning Application in Spinal Implant Identification
Authors: Yang Hee-Seok , Kim Kwang-Ryeol , Kim Sungjun , Park Jeong-Yoon
Published: February 2021

Study Design.

Retrospective observational study.

Objective.

To demonstrate the clinical usefulness of deep learning by identifying previous spinal implants through application of deep learning.

Summary of Background Data.

Deep learning has recently been actively applied to medical images. However, despite many attempts to apply deep learning to medical images, the application has rarely been successful. We aimed to demonstrate the effectiveness and usefulness of deep learning in the medical field. The goal of this study was to demonstrate the clinical usefulness of deep learning by identifying previous spinal implants through application of deep learning.

Methods.

For deep learning algorithm development, radiographs were retrospectively obtained from clinical cases in which the patients had lumbar spine one-segment instrument surgery. A total of 2894 lumbar spine anteroposterior (AP: 1446 cases) and lateral (1448 cases) radiographs were collected. Labeling work was conducted for five different implants. We conducted experiments using three deep learning algorithms. The traditional deep neural network model built by coding the transfer learning algorithm, Google AutoML, and Apple Create ML. Recall (sensitivity) and precision (specificity) were measured after training.

Results.

Overall, each model performed well in identifying each pedicle screw implant. In conventional transfer learning, AP radiography showed 97.0% precision and 96.7% recall. Lateral radiography showed 98.7% precision and 98.2% recall. In Google AutoML, AP radiography showed 91.4% precision and 87.4% recall; lateral radiography showed 97.9% precision and 98.4% recall. In Apple Create ML, AP radiography showed 76.0% precision and 73.0% recall; lateral radiography showed 89.0% precision and 87.0% recall. In all deep learning algorithms, precision and recall were higher in lateral than in AP radiography.

Conclusion.

The deep learning application is effective for spinal implant identification. This demonstrates that clinicians can use ML-based deep learning applications to improve clinical practice and patient care.

Level of Evidence: 3
Spine Surgery HCAHPS Patient Satisfaction Survey Results Inversely Correlate with Survey Response Time
Authors: Kebaish Kareem J. , Mercier Michael R. , Duy Phan Q. , Malpani Rohil , Galivanche Anoop R. , Grauer Jonathan N.
Published: February 2021

Study Design.

Retrospective review.

Objective.

The aim of this study was to understand the potential correlation of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey response time on reported satisfaction following spine surgery hospitalization.

Summary of Background Data.

With increasing emphasis on patient satisfaction metrics, such as HCAHPS, hospital reputations, and reimbursements are being affected by the results of such surveys. HCAHPS is a 32-question survey about patient experience in the hospital and after discharge.

Methods.

HCAHPS surveys were routinely sent to all patients admitted after spine surgery at an academic medical center between January 2013 and August 2017. Survey data, survey return time, patient demographics, and 30-day postoperative outcomes were gathered for all spine surgery patients who returned the survey. Multivariate regression analysis controlling for age, sex, BMI, functional status, American Society of Anesthesiologists class, education, and race was used to determine whether there were differences in rates of “Top Box” response between different time ranges of survey return.

Results.

In total, 1495 consecutive spinal surgery patients who returned their HCAHPS survey were identified. Of these, 31.51% returned their surveys within 21 days, 48.09% returned them between 22 to 42 days, 13.58% returned them between 43 to 64 days, and 6.82% returned them ≥65 days after distribution. Multivariate regression demonstrated no statistical differences in reported satisfaction between surveys returned between days 0 to 21 and days 22 to 42. However, there were significantly lower scores reported by surveys returned on days 43 to 64 and 65 plus days.

Conclusion.

Centers for Medicare and Medicaid Services only considers HCAHPS surveys returned within the first 42 days. It appears that the survey responses are similar over this time period. Beyond this time, lower scores are reported. Further attention to this less satisfied, later HCAHPS survey returning group seems warranted.

Level of Evidence: 2
Circular RNA Expression Profile in Patients with Lumbar Spinal Stenosis Associated with Hypertrophied Ligamentum Flavum
Authors: Chen Jianwei , Yu Xiaosheng , Qiu Manle , Feng Fan , Liu Zude , Zhong Guibin
Published: February 2021

Study Design.

Sequencing and experimental analysis of the expression profile of circular RNAs (circRNAs) in hypertrophic ligamentum flavum (LFH).

Objectives.

The aim of this study was to identify differentially expressed circRNAs between LFH and nonhypertrophic ligamentum flavum tissues from lumbar spinal stenosis (LSS) patients.

Summary of Background Data.

Hypertrophy of the ligamentum flavum (LF) can cause LSS. circRNAs are important in various diseases. However, no circRNA expression patterns related to LF hypertrophy have been reported.

Methods.

A total of 33 patients with LSS participated in this study. LF tissue samples were obtained when patients underwent decompressive laminectomy during surgery. The expression profile of circRNAs was analyzed by transcriptome high-throughput sequencing and validated with quantitative real-time polymerase chain reaction (PCR). Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses were performed for the differentially expressed circRNA-associated genes and related pathways. The connections between circRNAs and microRNAs were explored using Cytoscape. The role of hsa_circ_0052318 on LF cell fibrosis was assessed by analyzing the expression of collagen I and collagen III.

Results.

The results showed that 2439 circRNAs of 4025 were differentially expressed between the LFH and nonhypertrophic ligamentum flavum tissues, including 1276 upregulated and 1163 downregulated circRNAs. The Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses revealed that these differentially expressed circRNAs functioned in biological processes, cellular components, and molecular functions. Autophagy and mammalian target of rapamycin were the top two signaling pathways affected by these circRNAs. Five circRNAs (hsa_circ_0021604, hsa_circ_0025489, hsa_circ_0002599, hsa_circ_0052318, and hsa_circ_0003609) were confirmed by quantitative real-time PCR. The network indicated a strong relationship between circRNAs and miRNAs. Furthermore, hsa_circ_0052318 overexpression decreased mRNA and protein expression of collagen I and III in LF cells from LFH tissues.

Conclusion.

This study identified circRNA expression profiles characteristic of hypertrophied LF in LSS patients, and demonstrated that hsa_circ_0052318 may play an important role in the pathogenesis of LF hypertrophy.

Level of Evidence: N/A
Failed Trapeziectomy Treated by Thumb Metacarpal Base Arthrodesis: A Case Series
Authors: Ashford-Wilson Sarah , Ghazala Christopher G. , McLaughlin Kealan , Harrison John W. K.
Published: February 2021

Trapeziometacarpal joint arthritis is a prevalent condition with a preponderance to women. Most cases are asymptomatic, but typical symptoms are pain, reduced dexterity, and functional decline. Trapeziectomy is the most common surgical treatment in the United Kingdom for patients who remain significantly symptomatic despite nonoperative measures, and this generally produces acceptable outcomes; however, a proportion of patients remain significantly symptomatic. The authors present a case series of 4 patients who underwent successful thumb metacarpal base to index metacarpal base arthrodesis with either distal radial or iliac crest bone grafting. Three of these patients had persisting symptoms after a primary trapeziectomy and 1 patient had gross subluxation of the thumb related to rheumatoid arthritis. Technically, this is a simple procedure to perform. All patients had improved symptoms with satisfactory functional outcomes and an improved cosmetic appearance of the hand.
Is Reading Performance Impaired in Glaucoma Patients With Preserved Central Vision?
Authors: Ikeda Mariana C. , Bando Andre H. , Hamada Koiti U. , Nakamura Vinicius P.L. , Prata Tiago S. , Paranhos Augusto , Tatham Andrew J. , Gracitelli Carolina P.B.
Published: February 2021

Precis:

Although this sample with glaucoma had preserved central vision, they presented worse reading performance compared with similarly aged controls.

Objective:

To determine whether patients with glaucoma with preserved central vision have impaired reading performance compared with healthy controls.

Methods:

A cross-sectional study of 35 patients with glaucoma and 32 similarly aged controls with visual acuity better than 0.4 logMAR in both eyes. Each participant had a detailed ophthalmological examination followed by a 5-chart reading performance test using a Portuguese version of the Minnesota Low Vision Reading Test (MNREAD). Correlation between reading performance (reading speed) and ocular parameters was investigated.

Results:

Participants had an average age of 63.0±12.6 years. In the glaucoma group, mean deviation in the better and worse eyes was −6.29±6.36 and −11.08±0.23 dB, respectively. There was no significant difference in age, sex, rage, education, visual acuity, or systemic comorbidities between groups. Participants with glaucoma had significantly slower reading speeds, with an average of 83.2±25.12 compared with 102.29±29.57 words per minute in controls (P=0.006). Reading speed was slower for all 5 charts. Odds of glaucoma increased by 1.29 (95% confidence interval, 1.07-1.56; P=0.009) for each 10 words per minute decrease in average reading speed, with this relationship maintained after accounting for age, schooling, and visual acuity.

Conclusions:

Patients with mild to moderate glaucoma had worse reading performance compared with similarly aged controls, despite both having preserved central vision.