bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of Serial Chest Radiographs of High-Altitude Pulmonary Edema Requiring Medical Evacuation from South Pole Station, Antarctica: From Diagnosis to Recovery
Authors: Nowadly Craig D , Solomon Alex J , Burke Sean M , Rose John S
Published: December 2020

Introduction

Chest radiography is a diagnostic tool commonly used by medical providers to assess high-altitude pulmonary edema (HAPE). Although HAPE often causes a pattern of pulmonary edema with right lower lung predominance, previous research has shown that there is no single radiographic finding associated with the condition. The majority of research involves a retrospective analysis of chest radiographs taken at the time of HAPE diagnosis. Little is known about the radiographic progression of HAPE during treatment or medical evacuation.

Materials and Methods

Three sequential chest radiographs were obtained from two patients diagnosed with HAPE at the Amundsen-Scott South Pole Station, Antarctica, who required treatment and medical evacuation. Deidentified and temporally randomized images were reviewed in a blinded fashion by two radiologists. A score of 0 (normal lung) to 4 (alveolar disease) was assigned for each of the four lung quadrants for an aggregate possible score ranging from 0 to 16 for each radiograph.

Results

Patient 1’s initial radiograph showed severe HAPE with an initial score of 13. Despite a rapid clinical improvement after medical evacuation, he continued to show multifocal radiographic evidence of disease in all the lung quadrants on day 1 (score of 11) and day 2 (score of 5). Patient 2’s radiographs showed less severe disease at presentation (score of 6). Despite the need for continued treatment, his radiographs showed a rapid improvement, with radiographic score decreasing to 3 on day 1 and 1 on day 3.

Conclusion

The chest radiographs showed serial improvement after medical evacuation in both patients. There was not a strong correlation between clinical symptoms and radiographic severity in subsequent images.
Crystal structures of the EVE-HNH endonuclease VcaM4I in the presence and absence of DNA
Authors: Pastor Michal , Czapinska Honorata , Helbrecht Igor , Krakowska Katarzyna , Lutz Thomas , Xu Shuang-yong , Bochtler Matthias
Published: December 2020

Many modification-dependent restriction endonucleases (MDREs) are fusions of a PUA superfamily modification sensor domain and a nuclease catalytic domain. EVE domains belong to the PUA superfamily, and are present in MDREs in combination with HNH nuclease domains. Here, we present a biochemical characterization of the EVE-HNH endonuclease VcaM4I and crystal structures of the protein alone, with EVE domain bound to either 5mC modified dsDNA or to 5mC/5hmC containing ssDNA. The EVE domain is moderately specific for 5mC/5hmC containing DNA according to EMSA experiments. It flips the modified nucleotide, to accommodate it in a hydrophobic pocket of the enzyme, primarily formed by P24, W82 and Y130 residues. In the crystallized conformation, the EVE domain and linker helix between the two domains block DNA binding to the catalytic domain. Removal of the EVE domain and inter-domain linker, but not of the EVE domain alone converts VcaM4I into a non-specific toxic nuclease. The role of the key residues in the EVE and HNH domains of VcaM4I is confirmed by digestion and restriction assays with the enzyme variants that differ from the wild-type by changes to the base binding pocket or to the catalytic residues.
Variable interplay of UV-induced DNA damage and repair at transcription factor binding sites
Authors: Frigola Joan , Sabarinathan Radhakrishnan , Gonzalez-Perez Abel , Lopez-Bigas Nuria
Published: December 2020

An abnormally high rate of UV-light related mutations appears at transcription factor binding sites (TFBS) across melanomas. The binding of transcription factors (TFs) to the DNA impairs the repair of UV-induced lesions and certain TFs have been shown to increase the rate of generation of these lesions at their binding sites. However, the precise contribution of these two elements to the increase in mutation rate at TFBS in these malignant cells is not understood. Here, exploiting nucleotide-resolution data, we computed the rate of formation and repair of UV-lesions within the binding sites of TFs of different families. We observed, at certain dipyrimidine positions within the binding site of TFs in the Tryptophan Cluster family, an increased rate of formation of UV-induced lesions, corroborating previous studies. Nevertheless, across most families of TFs, the observed increased mutation rate within the entire DNA region covered by the protein results from the decreased repair efficiency. While the rate of mutations across all TFBS does not agree with the amount of UV-induced lesions observed immediately after UV exposure, it strongly agrees with that observed after 48 h. This corroborates the determinant role of the impaired repair in the observed increase of mutation rate.
Supplementation of Screw-Rod C1-C2 Fixation With Posterior Arch Femoral Head Allograft Strut
Authors: Liu David D , Rivera-Lane Kendall , Leary Owen P , Pertsch Nathan J , Niu Tianyi , Camara-Quintana Joaquin Q , Oyelese Adetokunbo A , Fridley Jared S , Gokaslan Ziya L
Published: December 2020

BACKGROUND

Numerous C1-C2 fixation techniques exist for the treatment of atlantoaxial instability. Limitations of screw-rod and sublaminar wiring techniques include C2 nerve root sacrifice and dural injury, respectively. We present a novel technique that utilizes a femoral head allograft cut with a keyhole that rests posteriorly on the arches of C1 and C2 and straddles the C2 spinous process, secured by sutures.

OBJECTIVE

To offer increased fusion across C1-C2 without the passage of sublaminar wiring or interarticular arthrodesis.

METHODS

A total of 6 patients with atlantoaxial instability underwent C1-C2 fixation using our method from 2015 to 2016. After placement of a C1-C2 screw/rod construct, a cadaveric frozen femoral head allograft was cut into a half-dome with a keyhole and placed over the already decorticated dorsal C1 arch and C2 spinous process. Notches were created in the graft and sutures were placed in the notches and around the rods to secure it firmly in place.

RESULTS

The femoral head's shape allowed for creation of a graft that provides excellent surface area for fusion across C1-C2. There were no intraoperative complications, including dural tears. Postoperatively, no patients had sensorimotor deficits, pain, or occipital neuralgia. 5 patients demonstrated clinical resolution of symptoms by 3 mo and radiographic (computed tomography) evidence of fusion at 1 yr. One patient had good follow-up at 1 mo but died due to complications of Alzheimer disease.

CONCLUSION

The posterior arch femoral head allograft strut technique with securing sutures is a viable option for supplementing screw-rod fixation in the treatment of complex atlantoaxial instability.
Tuning osteoporotic macrophage responses to favour regeneration by Cu-bearing titanium alloy inPorphyromonas gingivalislipopolysaccharide-induced microenvironments
Authors: Xu Xiongcheng , Lu Yanjin , Zhou Ling , He Mengjiao , Zhuo Jin , Zhong Quan , Luo Kai , Lin Jinxin
Published: December 2020

Guided bone regeneration in inflammatory microenvironments of osteoporotic patients with large alveolar bone defects remains a great challenge. Macrophages are necessary for alveolar bone regeneration via their polarization and paracrine actions. Our previous studies showed that Cu-bearing Ti6Al4V alloys are capable of regulating macrophage responses. When considering the complexity of oral microenvironments, the influences of Cu-bearing Ti6Al4V alloys on osteoporotic macrophages in infectious microenvironments are worthy of further investigations. In this study, we fabricated Ti6Al4V-Cu alloy by selective laser melting technology and used Porphyromonas gingivalis lipopolysaccharide (P.g-LPS) to imitate oral pathogenic bacterial infections. Then, we evaluated the impacts of Ti6Al4V-Cu on osteoporotic macrophages in infectious microenvironments. Our results indicated that Ti6Al4V-Cu not only inhibited the P.g-LPS-induced M1 polarization and pro-inflammatory cytokine production of osteoporotic macrophages but also shifted polarization towards the pro-regenerative M2 phenotype and remarkably promoted anti-inflammatory cytokine release. In addition, Ti6Al4V-Cu effectively promoted the activity of COMMD1 to potentially repress NF-κB-mediated transcription. It is concluded that the Cu-bearing Ti6Al4V alloy results in ameliorated osteoporotic macrophage responses to create a favourable microenvironment under infectious conditions, which holds promise to develop a GBR-barrier membrane for alveolar bone regeneration of osteoporosis patients.
Antibacterial Ti-Mn-Cu alloys for biomedical applications
Authors: Alqattan Mohammad , Peters Linda , Alshammari Yousef , Yang Fei , Bolzoni Leandro
Published: December 2020

Titanium alloys are common biomedical materials due to their biocompatibility and mechanical performance. However, titanium alloys are expensive and, unless surface treated, generally cannot prevent surgical infections related to bacteria which can damage the integrity of the implant. In this study, new titanium alloys were developed via powder metallurgy and the addition of manganese and copper, respectively, aiming to limit the manufacturing costs and induce new functionality on the materials including antibacterial response. The addition of manganese and copper to titanium significantly changes the behaviour of the Ti-Mn-Cu alloys leading to the successful stabilization of the beta titanium phase, great refinement of the typical lamellar structure, and achievement of materials with low level of porosity. Consequently, it is found that the mechanical performance and the antibacterial efficacy are enhanced by the addition of a higher amount of alloying elements. The manufactured Ti-Mn-Cu alloys fulfil the requirements for structural biomedical implants and have antibacterial response making them potential candidates for permanent medical implants.
Emotional news affects social judgments independent of perceived media credibility
Authors: Baum Julia , Abdel Rahman Rasha
Published: December 2020

How does the credibility we attribute to media sources influence our opinions and judgments derived from news? Participants read headlines about the social behavior of depicted unfamiliar persons from websites of trusted or distrusted well-known German news media. As a consequence, persons paired with negative or positive headlines were judged more negative or positive than persons associated with neutral information independent of source credibility. Likewise, electrophysiological signatures of slow and controlled evaluative brain activity revealed a dominant influence of emotional headline contents regardless of credibility. Modulations of earlier brain responses associated with arousal and reflexive emotional processing show an effect of negative news and suggest that distrusted sources may even enhance the impact of negative headlines. These findings demonstrate that though we may have distinct perceptions about the credibility of media sources, information processing and social judgments rely on the emotional content of headlines, even when they stem from sources we distrust.
Beyond the average brain: individual differences in social brain development are associated with friendship quality
Authors: Becht Andrik I , Wierenga Lara M , Mills Kathryn L , Meuwese Rosa , van Duijvenvoorde Anna , Blakemore Sarah-Jayne , Güroğlu Berna , Crone Eveline A
Published: December 2020

We tested whether adolescents differ from each other in the structural development of the social brain and whether individual differences in social brain development predicted variability in friendship quality development. Adolescents (N = 299, Mage T1 = 13.98 years) were followed across three biannual waves. We analysed self-reported friendship quality with the best friend at T1 and T3, and bilateral measures of surface area and cortical thickness of the medial prefrontal cortex (mPFC), posterior superior temporal sulcus (pSTS), temporoparietal junction (TPJ) and precuneus across all waves. At the group level, growth curve models confirmed non-linear decreases of surface area and cortical thickness in social brain regions. We identified substantial individual differences in levels and change rates of social brain regions, especially for surface area of the mPFC, pSTS and TPJ. Change rates of cortical thickness varied less between persons. Higher levels of mPFC surface area and cortical thickness predicted stronger increases in friendship quality over time. Moreover, faster cortical thinning of mPFC surface area predicted a stronger increase in friendship quality. Higher levels of TPJ cortical thickness predicted lower friendship quality. Together, our results indicate heterogeneity in social brain development and how this variability uniquely predicts friendship quality development.
Obsessive-Compulsive Symptoms and Other Symptoms of the At-risk Mental State for Psychosis: A Network Perspective
Authors: Ong Hui Lin , Isvoranu Adela-Maria , Schirmbeck Frederike , McGuire Philip , Valmaggia Lucia , Kempton Matthew J , van der Gaag Mark , Riecher-Rössler Anita , Bressan Rodrigo A , Barrantes-Vidal Neus , Nelson Barnaby , Amminger G Paul , McGorry Patrick , Pantelis Christos , Krebs Marie-Odile , Nordentoft Merete , Glenthøj Birte , Ruhrmann Stephan , Sachs Gabriele , Rutten Bart P F , van Os Jim , de Haan Lieuwe , Borsboom Denny ,   EU-GEI High Risk Study, Calem Maria , Tognin Stefania , Modinos Gemma , Pisani Sara , Hedges Emily , Velthorst Eva , Kraan Tamar C , van Dam Daniella S , Burger Nadine , Politis Athena , Goodall Joanne , Borgwardt Stefan , Studerus Erich , Gadelha Ary , Brietzke Elisa , Asevedo Graccielle , Asevedo Elson , Zugman Andre , Domínguez-Martínez Tecelli , Monsonet Manel , Hinojosa Lidia , Racioppi Anna , Kwapil Thomas R , Kazes Mathilde , Daban Claire , Bourgin Julie , Gay Olivier , Mam-Lam-Fook Célia , Nordholm Dorte , Randers Lasse , Krakauer Kristine , Glenthøj Louise Birkedal , Gebhard Dominika , Arnhold Julia , Klosterkötter Joachim , Lasser Iris , Winklbaur Bernadette , Delespaul Philippe A
Published: December 2020

Background

The high prevalence of obsessive-compulsive symptoms (OCS) among subjects at Ultra-High Risk (UHR) for psychosis is well documented. However, the network structure spanning the relations between OCS and symptoms of the at risk mental state for psychosis as assessed with the Comprehensive Assessment of At Risk Mental States (CAARMS) has not yet been investigated. This article aimed to use a network approach to investigate the associations between OCS and CAARMS symptoms in a large sample of individuals with different levels of risk for psychosis.

Method

Three hundred and forty-one UHR and 66 healthy participants were included, who participated in the EU-GEI study. Data analysis consisted of constructing a network of CAARMS symptoms, investigating central items in the network, and identifying the shortest pathways between OCS and positive symptoms.

Results

Strong associations between OCS and anxiety, social isolation and blunted affect were identified. Depression was the most central symptom in terms of the number of connections, and anxiety was a key item in bridging OCS to other symptoms. Shortest paths between OCS and positive symptoms revealed that unusual thought content and perceptual abnormalities were connected mainly via anxiety, while disorganized speech was connected via blunted affect and cognitive change.

Conclusions

Findings provide valuable insight into the central role of depression and the potential connective component of anxiety between OCS and other symptoms of the network. Interventions specifically aimed to reduce affective symptoms might be crucial for the development and prospective course of symptom co-occurrence.
Uncertainty in Divergence Time Estimation
Authors: Carruthers Tom , Scotland Robert W
Published: December 2020

Understanding and representing uncertainty is crucial in academic research because it enables studies to build on the conclusions of previous studies, leading to robust advances in a particular field. Here, we evaluate the nature of uncertainty and the manner by which it is represented in divergence time estimation, a field that is fundamental to many aspects of macroevolutionary research, and where there is evidence that uncertainty has been seriously underestimated. We address this issue in the context of methods used in divergence time estimation, and with respect to the manner by which time-calibrated phylogenies are interpreted. With respect to methods, we discuss how the assumptions underlying different methods may not adequately reflect uncertainty about molecular evolution, the fossil record, or diversification rates. Therefore, divergence time estimates may not adequately reflect uncertainty and may be directly contradicted by subsequent findings. For the interpretation of time-calibrated phylogenies, we discuss how the use of time-calibrated phylogenies for reconstructing general evolutionary timescales leads to inferences about macroevolution that are highly sensitive to methodological limitations in how uncertainty is accounted for. By contrast, we discuss how the use of time-calibrated phylogenies to test specific hypotheses leads to inferences about macroevolution that are less sensitive to methodological limitations. Given that many biologists wish to use time-calibrated phylogenies to reconstruct general evolutionary timescales, we conclude that the development of methods of divergence time estimation that adequately account for uncertainty is necessary. [Divergence time estimation; macroevolution; uncertainty.]
Evaluating digestibility and toxicity of native warm-season grasses for equines
Authors: Ghajar S M , McKenzie H , Fike J , McIntosh B , Tracy B F
Published: December 2020

Introduced cool-season grasses are dominant in Virginia’s grasslands, but their high digestible energy and nonstructural carbohydrate (NSC) levels pose a risk for horses prone to obesity and laminitis. Native warm-season grasses (NWSGs) have lower digestible energy and NSC levels that may be more suitable for horses susceptible to laminitis. Although NWSGs have desirable characteristics, they are novel forages for horses. Little is known about NWSG intake or potential toxicity to horses or how grazing by horses may affect NWSG swards. The overall objectives of this research were to 1) assess voluntary intake, toxicological response, and apparent digestibility of NWSG hays fed to horses; and 2) evaluate the characteristics of three NWSG species under equine grazing. For the first objective, a hay feeding trial using indiangrass (IG) (Sorghastrum nutans) and big bluestem (BB) (Andropogon gerardii) was conducted with nine Thoroughbred geldings in a replicated 3 × 3 Latin square design. Voluntary dry matter intake of IG and BB hays by horses were 1.3% and 1.1% of BW/d, lower than orchardgrass (Dactylis glomerata), an introduced cool-season grass, at 1.7% of BW/d (P = 0.0020). Biomarkers for hepatotoxicity remained within acceptable ranges for all treatments. Apparent dry matter digestibility (DMD) did not differ among hays, ranging from 39% to 43%. NSC levels ranged from 4.4% to 5.4%, below maximum recommended concentrations for horses susceptible to laminitis. For the second objective, a grazing trial was conducted comparing IG, BB, and eastern gamagrass (EG) (Tripsacum dactyloides) yields, forage losses, changes in vegetative composition, and effects on equine bodyweight. Nine, 0.1-ha plots were seeded with one of the three native grass treatments, and each plot was grazed by one Thoroughbred gelding in two grazing bouts, one in July and another in September 2019. IG had the greatest available forage, at 4,340 kg/ha, compared with 3,590 kg/ha from BB (P < 0.0001). EG plots established poorly, and had only 650 kg/ha available forage during the experiment. Grazing reduced standing cover of native grasses in IG and BB treatments by about 30%. Horses lost 0.5–1.5 kg BW/d on all treatments. Findings suggest IG and BB merit further consideration as forages for horses susceptible to obesity and pasture-associated laminitis.
Circulating Vascular Endothelial Growth Factor and Soluble fms-Like Tyrosine Kinase-1 as Biomarkers for Endometrial Remodeling Across the Menstrual Cycle
Authors: Zolton Jessica R. , Sjaarda Lindsey A. , Mumford Sunni L. , DeVilbiss Elizabeth A. , Kim Keewan , Flannagan Kerry S. , Radoc Jeannie G. , Perkins Neil J. , Silver Robert M. , Wactawski-Wende Jean , Hill Micah J. , DeCherney Alan H. , Schisterman Enrique F.
Published: December 2020

OBJECTIVE:

To characterize variation in circulating vascular endothelial growth factor (VEGF) and its receptor, soluble fms-like tyrosine kinase-1 (sFLT-1), across the menstrual cycle in normal ovulating women in relation to reproductive hormones to identify the utility of VEGF and sFLT-1 as peripheral biomarkers of endometrial remodeling.

METHODS:

Ninety-six healthy, regularly menstruating ovulatory women, aged 18–44 years, enrolled in the BioCycle Study, a prospective cohort study at a U.S. academic research center. Vascular endothelial growth factor and sFLT-1 were measured in concurrently collected plasma, serum, and urine up to eight times across a single cycle. Reproductive hormones were measured in serum. Mean concentrations of VEGF and sFLT-1 were compared across phases of the cycle, and correlations between specimen types were calculated. Harmonic models estimated associations between VEGF and sFLT-1 and characteristics of hormonal patterns.

RESULTS:

No variation in VEGF or sFLT-1 levels were detected over the menstrual cycle. Median (25th percentile, 75th percentile) concentrations of VEGF during the menstrual cycle were 31.2 pg/mL (24.1, 56.9) in plasma, 194.1 pg/mL (125.4, 350.2) in serum, and 101.7 pg/mL (64.2, 165.8) in urine. Plasma and serum measures were consistently correlated, whereas urinary measures were not. Vascular endothelial growth factor was not consistently associated with reproductive hormone concentrations, although sFLT-1 was associated with higher mean and amplitude of estradiol.

CONCLUSION:

Circulating VEGF and sFLT-1 did not vary across the menstrual cycle and therefore are unlikely to be useful peripheral biomarkers of endometrial changes across the menstrual cycle. For studies measuring circulating VEGF for other reasons, plasma may be the preferred medium and timing to menstrual cycle phase need not be considered for reproductive-age women.
Updates and New Options in Advanced Epithelial Ovarian Cancer Treatment
Authors: Kurnit Katherine C. , Fleming Gini F. , Lengyel Ernst
Published: December 2020

The medical and surgical treatment strategies for women with epithelial ovarian cancer continue to evolve. In the past several years, there has been significant progress backed by landmark clinical trials. Although primary epithelial ovarian cancer is still treated with a combination of surgery and systemic therapy, more complex surgical procedures and novel therapeutics have emerged as standard of care. Cytotoxic chemotherapy and maximal surgical effort remain mainstays, but targeted therapies are becoming more widespread and new data have called into question the role of surgery for women with recurrent disease. Poly ADP-ribose polymerase inhibitors have improved progression-free survival outcomes in both the frontline and recurrent settings, and their use has become increasingly widespread. The recent creation of treatment categories based on genetic changes reinforces the recommendation that all women with epithelial ovarian cancer have germline genetic testing, and new biomarker-driven drug approvals indicate that women may benefit from somatic molecular testing as well. To continue to identify novel strategies, however, enrollment on clinical trials remains of the utmost importance. With the evolving data on surgical approaches, targeted therapies such as antiangiogenics and poly ADP-ribose polymerase inhibitors, and the new therapeutic agents and combinations in development, we hope that advanced epithelial ovarian cancer will eventually transition from an almost universally fatal disease to one that can increasingly be cured.
Herpes Simplex Virus Serotyping in Pregnant Women With a History of Genital Herpes and an Outbreak in the Third Trimester of Pregnancy
Authors: Chatroux Isabelle C. , Hersh Alyssa R. , Caughey Aaron B.
Published: December 2020

OBJECTIVE:

To estimate whether serotyping women with a history of genital herpes simplex virus (HSV) and an outbreak during the third trimester of pregnancy is cost effective compared with no serotyping.

METHODS:

We designed a decision-analytic model using TreeAge Pro software to assess an approach of routine HSV serotyping in a theoretical cohort of 63,582 women (an estimate of the number of women in the United States with a history of genital HSV and an outbreak during the third trimester of pregnancy). Outcomes included mild, moderate, and severe neonatal HSV, neonatal death, costs, and quality-adjusted life-years (QALYs) for both the woman and neonate. Probabilities, utilities, and costs were derived from the literature, and we used a willingness-to-pay threshold of $100,000 per QALY. Sensitivity analyses were performed to assess the robustness of the results.

RESULTS:

In our theoretical cohort, HSV serology screening resulted in 519, 8, and 15 cases of mild, moderate, and severe neonatal HSV, whereas no serology screening resulted in 745, 65, and 85 cases, respectively. Thus, HSV serology screening led to 226, 57, and 70 fewer cases of mild, moderate, and severe neonatal HSV, respectively, as well as 91 fewer neonatal deaths. Additionally, serology screening saved $61 million and gained 7,900 QALYs, making it a dominant strategy. Univariate sensitivity analysis demonstrated that serology screening was cost effective until the chance of progression from neonatal HSV infection to disease despite empiric antiviral treatment was greater than 23%.

CONCLUSION:

Serology screening in pregnant women with an outbreak in the third trimester of pregnancy and a history of genital HSV resulted in improved outcomes and decreased costs.
Foley Bulb Insertion by Blind Placement Compared With Direct Visualization
Authors: Kuhlmann Maggie J. , Spencer Nicholas , Garcia-Jasso Carlos , Singh Prapti , Abdelwahab Mahmoud , Vaughn Micah , Marshall Karis , Prasad Nikita , Soulsby-Monroy Ruth , Saade George R. , Saad Antonio F.
Published: December 2020

OBJECTIVE:

To test the hypothesis that digital placement of a balloon catheter is not inferior to the speculum method in terms of rate of maternal infection.

METHODS:

In an open-label noninferiority randomized trial, pregnant women who were undergoing induction of labor with unfavorable cervix (less than 3 cm dilated and less than 60% effaced) were randomly assigned to balloon catheter that was placed either digitally or using a sterile speculum. The primary outcome was a composite of maternal infection, defined by occurrence of fever (temperature 38°C or higher), chorioamnionitis, or endometritis (diagnoses were made by the managing obstetric physician or midwife). Prespecified secondary outcomes included outcomes in the primary composite, cesarean delivery rates, and maternal and neonatal outcomes. A patient satisfaction survey was also obtained. On the basis of a noninferiority margin of 10% and an expected primary outcome frequency of 10%, a sample size of 372 women was needed (90% power to confirm noninferiority with 90% protocol adherence).

RESULTS:

From February 2018 through February 2019, 372 women were randomized (185 digital placement, 187 sterile speculum). Baseline characteristics were similar between groups. The composite maternal infection rate was not different between groups (digital placement arm: 15.7% vs speculum arm: 12.8%), with an absolute difference with respect to the sterile speculum arm of 2.8% (95% CI −4.3 to 9.9%), indicating noninferiority for the prespecified margin. Secondary outcomes were not different between groups, except for a higher need for a second balloon catheter in the sterile speculum arm. Maternal and neonatal adverse events were not different between groups. Irrespective of method of placement, women were equally satisfied with the explanation of the method before placement, anxiety regarding the procedure, and pain during placement. More women in the sterile speculum group would choose the digital placement method for the subsequent pregnancy (37.6% vs 25.7%; P=.02.)

CONCLUSION:

Digital placement of a balloon catheter for preinduction cervical ripening is noninferior to the sterile speculum method, in terms of maternal infection. Women in the sterile speculum group more frequently required a second round of the mechanical dilator. The blind digital approach is a reasonable option for balloon placement for cervical ripening.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT03450408.
Chromopertubation of an Ectopic Pregnancy
Authors: Sunkara Sowmya , Bardawil Elise , Nijjar J. Biba
Published: December 2020

BACKGROUND:

An ectopic pregnancy is a nonviable pregnancy located outside of the endometrial cavity of the uterus, which can be managed medically or surgically.

CASE:

A 35-year-old woman with a prior ectopic pregnancy, who reported tubal surgery of unknown location and extent, presented with a recurrent ectopic pregnancy. Ultrasound imaging showed a complex cystic lesion adjacent to the ovary, moderate complex free fluid, and no intrauterine pregnancy. She underwent an urgent diagnostic laparoscopy. Chromopertubation was performed to demonstrate absence of the left fallopian tube. The ectopic pregnancy was incidentally noted to be mobile and was expelled from the right fallopian tube.

CONCLUSION:

Chromopertubation offers a minimally invasive technique for management of ectopic pregnancy that may reduce injury as a result of less surgical manipulation of the fallopian tube.
Racial Disparities in Mental Health Outcomes Among Women With Early Pregnancy Loss
Authors: Shorter Jade M. , Koelper Nathanael , Sonalkar Sarita , Oquendo Maria A. , Sammel Mary D. , Schreiber Courtney A.
Published: December 2020

OBJECTIVE:

To explore the relationship between race and depression symptoms among participants in an early pregnancy loss clinical trial.

METHODS:

We performed a planned secondary analysis of a randomized trial by comparing treatments for medical management of early pregnancy loss. We hypothesized that Black participants would have higher odds of risk for major depression (measured with the CES-D [Center for Epidemiological Studies-Depression] scale) 30 days after early pregnancy loss treatment when compared with non-Black participants. We analyzed the data as a cohort, with the primary exposure being race and secondary exposure being high adverse childhood experience scores (measured with the Adverse Childhood Experience scale). Our primary outcome was risk for major depression (score of 21 or higher on the CES-D scale) 30 days after early pregnancy loss treatment.

RESULTS:

Three hundred participants diagnosed with a nonviable intrauterine pregnancy from 5 to 12 weeks of gestation were randomized as part of the original trial from May 2014 to April 2017. Of 275 respondents included in this analysis, 120 [44%] self-identified as Black and 155 [56%] self-identified as non-Black. After early pregnancy loss treatment, 65 [24%] participants were at risk for major depression. Black participants had an increased risk for major depression (57%) after early pregnancy loss treatment compared with non-Black participants (43%; odds ratio [OR] 2.02; 95% CI 1.15–3.55). After adjustment for risk for baseline depression, adverse childhood experience score, and parity, the odds of risk for major depression 30 days after pregnancy loss treatment remained higher for Black participants when compared with non-Black participants (OR 2.02; 95% CI 1.15–3.55; adjusted OR 2.48; 95% CI 1.28–4.81).

CONCLUSION:

Overall, approximately one quarter of women who experience an early pregnancy loss are at an increased risk for major depression 30 days after treatment. This risk is about twice as high for Black women compared with non-Black women. There is a need for appropriate mental health resources for women undergoing early pregnancy loss care.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT02012491.
Use of Intraoperative CT Improves Accuracy of Spinal Navigation During Screw Fixation in Cervico-thoracic Region
Authors: Habib Nermine , Filardo Giuseppe , Distefano Daniela , Candrian Christian , Reinert Michael , Scarone Pietro
Published: December 2020

Study Design.

A retrospective analysis of a single-center consecutive series of patients.

Objective.

To test the hypothesis that using a mobile intraoperative computed tomography in combination with spinal navigation would result in better accuracy of lateral mass and pedicle screws between C3 and T5 levels, compared to cone-beam computed tomography and traditional 2D fluoroscopy.

Summary of Background Data.

Use of spinal navigation associated with 3D imaging has been shown to improve accuracy of screw positioning in the cervico-thoracic region. However, use of iCT imaging compared to a cone-beam CT has not been fully investigated in these types of surgical interventions.

Methods.

We retrospectively analyzed a series of patients who underwent posterior cervico-thoracic fixations using different intraoperative imaging systems in a single hospital. We identified three different groups of patients: Group A, operated under 2D-fluoroscopic guidance without navigation; Group B: O-arm guidance with navigation; Group C: iCT AIRO guidance with navigation. Primary outcome was the rate of accurately placed screws, measured on intra or postoperative CT scan with Neo et al. classification for cervical pedicles screws and Gertzbein et al. for thoracic pedicle screws. Screws in cervical lateral masses were evaluated according to a new classification created by the authors.

Results.

Data on 67 patients and 495 screws were available. Overall screw accuracy was 92.8% (95.6% for lateral mass screws, 81.6% for cervical pedicle screws, and 90% for thoracic pedicle screws). Patients operated with iCT AIRO navigation had significantly fewer misplaced screws (2.4%) compared to 2D-fluoroscopic guidance (9.1%) and O-arm navigation (9.7%) (P = 0.0152). Accuracy rate of iCT navigation versus O-arm navigation was significantly higher (P = 0.0042), and there was no statistically significant difference in surgical time between the three Groups (P = 0.5390).

Conclusion.

Use of high-quality CT associated with spinal navigation significantly improved accuracy of screw positioning in the cervico-thoracic region.

Level of Evidence: 3.
Deep Learning Automates Measurement of Spinopelvic Parameters on Lateral Lumbar Radiographs
Authors: Schwartz John T. , Cho Brian H. , Tang Peter , Schefflein Javin , Arvind Varun , Kim Jun S. , Doshi Amish H. , Cho Samuel K.
Published: December 2020

Study Design.

Cross-sectional database study.

Objective.

The objective of this study was to develop an algorithm for the automated measurement of spinopelvic parameters on lateral lumbar radiographs with comparable accuracy to surgeons.

Summary of Background Data.

Sagittal alignment measurements are important for the evaluation of spinal disorders. Manual measurement methods are time-consuming and subject to rater-dependent error. Thus, a need exists to develop automated methods for obtaining sagittal measurements. Previous studies of automated measurement have been limited in accuracy, inapplicable to common plain films, or unable to measure pelvic parameters.

Methods.

Images from 816 patients receiving lateral lumbar radiographs were collected sequentially and used to develop a convolutional neural network (CNN) segmentation algorithm. A total of 653 (80%) of these radiographs were used to train and validate the CNN. This CNN was combined with a computer vision algorithm to create a pipeline for the fully automated measurement of spinopelvic parameters from lateral lumbar radiographs. The remaining 163 (20%) of radiographs were used to test this pipeline. Forty radiographs were selected from the test set and manually measured by three surgeons for comparison.

Results.

The CNN achieved an area under the receiver-operating curve of 0.956. Algorithm measurements of L1-S1 cobb angle, pelvic incidence, pelvic tilt, and sacral slope were not significantly different from surgeon measurement. In comparison to criterion standard measurement, the algorithm performed with a similar mean absolute difference to spine surgeons for L1-S1 Cobb angle (4.30° ± 4.14° vs. 4.99° ± 5.34°), pelvic tilt (2.14° ± 6.29° vs. 1.58° ± 5.97°), pelvic incidence (4.56° ± 5.40° vs. 3.74° ± 2.89°), and sacral slope (4.76° ± 6.93° vs. 4.75° ± 5.71°).

Conclusion.

This algorithm measures spinopelvic parameters on lateral lumbar radiographs with comparable accuracy to surgeons. The algorithm could be used to streamline clinical workflow or perform large scale studies of spinopelvic parameters.

Level of Evidence: 3
Extensive Periprosthetic Metallosis Associated to Osteolysis and Spinal Instrumentation Failure
Authors: Rasmussen Jorge , Estefan Valentin , Estefan Martín , Estefan Guillermo
Published: December 2020

Study Design.

Case-report and literature review.

Objective.

To depict main features of a potentially deleterious postoperative spinal fixation complication.

Summary of Background Data.

Tisular deposit of metal particles from prosthetic systems—metallosis—is an uncommon complication of spinal fixation surgery. Manifestations as chronic postoperative pain, instrumentation failure, infection, or neurological impairment can be developed, but metallosis often appears as an unexpected intraoperative finding.

Methods.

A 70-year-old female underwent several spinal fixation procedures due to progressive degenerative adult scoliosis, who developed instrumentation failure. Unexpected metallosis was evidenced extensively surrounding the dislodged construct due to vertebral osteolysis. Instrumentation replacement and debridement of metallotic tissue was performed. We also conduct a literature review for the terms “spinal metallosis” and “spinal corrosion” on the PubMed/MEDLINE database. Previous publications depicting black/dark staining, discoloration and/or fibrotic tissue, as well as histopathological metal particle deposits, or merely metallosis, were reviewed. Articles reporting individual cases or case-series/cohorts with patient-discriminated findings were included.

Results.

The histopathological analysis of our patient revealed dense fibroconnective tissue with black metallic pigment associated. She evolved with great pain relief in the immediately postoperative period. The patient achieved pain-free standing with significant pharmacotherapy reduction and independent ambulation. The literature search retrieved 26 articles for “spinal metallosis” and 116 for “spinal corrosion”; 16 articles met selection criteria. Approximately 60% of the reported cases accounted for patients younger than 30 years old, mainly related to expandable fixation system (65%) for idiopathic scoliosis. Usually, the symptoms were correlated with abnormal radiological findings: instrumentation breakage, dislodgement, loosening, expandable systems fracture. All the reviewed patients evolved free of pain and neurologically recovered.

Conclusion.

Instrumentation removal and metallosis debridement seems to be useful for symptomatic patients, but remains controversial on fixed asymptomatic patients. If solid fusion has not been achieved, extension, and reinforcement of the failed fixation could be required.

Level of Evidence: 4
Tcf12 balances the reconstitution and differentiation capacity of hematopoietic stem cell
Authors: Liao Min , Wang Jianwei
Published: December 2020

Tcf12 has been identified as one of the main helix-loop-helix transcription factors that regulates T cell development from double negative to double positive stage transition. While, the function of Tcf12 in hematopoietic stem cells remains not investigated. In this study, we observed that Tcf12 is expressed in HSCs and targeted deletion of Tcf12 in hematopoietic cells results in increased frequency and absolute number of HSCs, but compromises the reconstitution capacity of HSCs. Further analysis reveals that Tcf12 is dispensable for the self-renewal of HSCs. The declined reconstituted capacity of Tcf12−/− HSCs stems from the decrease in the ability to differentiate into lymphoid-primed multipotent progenitors, and furthermore B and T lineages.
Single Antegrade Intramedullary Kirschner Wire Fixation For Transverse Metacarpal Shaft Fractures: A Retrospective Review
Authors: Collins Devin W. , Rehak Christopher , Rehak David
Published: December 2020

Introduction:

Fractures of the metacarpals are frequently encountered. Transverse metacarpal shaft fractures are inherently unstable and amenable to surgical intervention. Few studies have evaluated outcomes of patients with a singular transverse metacarpal shaft fracture surgically corrected with an antegrade intramedullary Kirschner (K) wire. We present our series of patients and their outcomes performed by a single surgeon.

Materials and Methods:

A retrospective chart review of cases at our institution was performed on transverse metacarpal fracture treated with an intramedullary K-wire. Fifteen patients met the inclusion criteria. Data extracted included metacarpal involved, laterality, sex, age, if removal of hardware was performed, time from initial injury to surgery, tourniquet time, complications, range of motion, clinical outcome, among others.

Results:

All fractures occurred about the right hand with 7 involving the small finger metacarpal, 4 involving the index, 3 involving the ring, and 1 involving the middle. The average patient age was 25 years (range: 18 to 58 y). The average tourniquet time was 16 minutes (range: 10 to 20 min). There were no intraoperative complications and 1 patient had hardware removed at 8 weeks due to proximal pin site pain. All patients achieved clinical union with a return of full function.

Discussion:

Single antegrade intramedullary K-wire fixation is a simple, reliable, and potentially cost-effective treatment option for transverse metacarpal shaft fractures. Further research is needed to determine long-term outcomes and formal cost analysis. Our series indicate this technique can be safely utilized, with a low risk of complications and good clinical outcomes.

Level of Evidence:

Level IV—therapeutic.
Role of gut microbiota in metabolic syndrome: a review of recent evidence
Authors: Alveirinho Manuel , Freitas Paula , Faleiro Maria Leonor
Published: December 2020

The metabolic syndrome is a complex entity comprised of multiple cardiovascular risk factors grouped in a single individual, contributing to an increased rate of cardiovascular events which goes beyond what would be expected given the impact of each individual risk factor. It is a multifactorial condition whose complete pathogenesis is not yet fully understood. Several studies have shown that not only the intestinal microbiota and dysbiosis may play a role in its pathogenesis, but also that modulating said microbiota may play a role in treating or at least ameliorating the metabolic syndrome. The purpose of this article is to review some of the most recent evidence linking the gut microbiome and the metabolic syndrome to help further understand this relationship and try to identify further research directions.
Dietary Intake Among Members of a Volunteer Fire Department Compared With US Daily Dietary Recommendations
Authors: Kadiwar Payal , Shah Nimit , Black Taylor , Caban-Martinez Alberto J. , Steinberg Michael , Black Kathleen , Sackey Joachim , Graber Judith
Published: December 2020

Objective:

To characterize the diet of volunteer firefighters compared with the United States recommended dietary intake.

Methods:

A survey was administered to members of volunteer fire department which collected information on demographics, behavioral risks, fire service history, and dietary intake using the Dietary Screener Questionnaire. Dietary intake was compared with US recommendations; associations between dietary intake and years of firefighting, were assessed using bi- and multivariate analysis.

Results:

The 122 male study participants were majority non-Hispanic white (96.4%), and over 90% were overweight or obese. Participants had lower mean intakes of fruit and vegetables, whole grains, and dietary fiber, and a higher mean intake of added sugars compared with the US recommended dietary intake.

Conclusion:

Volunteer firefighters in our study had suboptimal daily dietary intake of fruits and vegetables, dietary fiber, whole grains, and added sugars.
Antiphospholipid antibodies in patients with coronavirus disease 2019 infection hospitalized in conventional unit
Authors: Hamadé Amer , Woehl Bastien , Harzallah Ines , Talbot Marjolaine , Tousch Jonathan , Jambert Lucas
Published: December 2020

Antiphospholipid (aPL) antibodies can arise transiently at times of viral diseases. The objective of this work was to evaluate the incidence of aPL antibodies in patients hospitalized in conventional unit for coronavirus disease 2019 (COVID-19) infection and confirmed venous thromboembolic events (VTE) associated with aPL antibodies. 41 patients infected with COVID-19 were tested for aPL antibodies. None had reported history of aPL syndrome. Arterial and venous duplex ultrasound of lower limbs was performed in all patients at Day 0 and Day 5. All patients had antithrombotic-prophylaxis upon admission using lower molecular weight heparin with Enoxaparin. Biological parameters were collected and analyzed. Nine patients (22%) developed VTE and seven (17%) were positive for aPL antibodies of which five had isolated positive lupus anticoagulant. The sixth patient was double aPL positive IgM anticardiolipin (147.8 U/ml) and anti-Beta2 Glyco protein 1 (97.3 U/ml) antibodies. The seventh was triple positive, IgM anticardiolipin 85.6 UI/ml, IgM anti-Beta2 Glyco protein 1 63.0 U/ml and positive lupus anticoagulant. Among the seven patients with aPL antibodies 2 (28.60%) had VTE. However, the incidence of VTE in patients negative for aPL antibodies was also significant as 20.6% (seven of 34). aPL antibodies were significantly associated with the transfer to ICUs of, P = 0.018. Not only the incidence of aPL antibodies was quite significant within our cohort, but also we observed 28.6% of VTE in aPL-positive patients. We strongly recommend routine testing for aPL antibodies in COVID-19 patients and systematic screening with duplex ultrasound search of vascular complications.
Joy and Meaning in Nurse Manager Practice
Authors: Hahn Judith , Galuska Lee , Polifroni E. Carol , Dunnack Hayley
Published: December 2020

Nurse managers are an integral part of the healthcare system and have powerful influence at the point of service. The experience of joy and meaning in the work of healthcare contributes to achievement of positive outcomes. This study aimed to learn how nurse managers described joy and meaning in their practice. Results included 5 themes: to mentor and be mentored, to focus on the patient, to create and cultivate environments, to be optimistic, and to be empowered by leaders. The themes are described and illustrated with participant quotes. Specific implications for organizations and leaders are discussed.