bluuebunny/crossref_metadata_2025 huggingface dataset:
The Impact of Age and Severity on Dementia After Traumatic Brain Injury: A Comparison Study
Authors: Stopa Brittany M , Tahir Zabreen , Mezzalira Elisabetta , Boaro Alessandro , Khawaja Ayaz , Grashow Rachel , Zafonte Ross D , Smith Timothy R , Gormley William B , Izzy Saef
Published: July 2021

BACKGROUND

Growing evidence associates traumatic brain injury (TBI) with increased risk of dementia, but few studies have evaluated associations in patients younger than 55 yr using non-TBI orthopedic trauma (NTOT) patients as controls to investigate the influence of age and TBI severity, and to identify predictors of dementia after trauma.

OBJECTIVE

To investigate the relationship between TBI and dementia in an institutional group.

METHODS

Retrospective cohort study (2000-2018) of TBI patients aged 45 to 100 yr vs NTOT controls. Primary outcome was dementia after TBI (followed ≤10 yr). Cox proportional hazards models were used to assess risk of dementia; logistic regression models assessed predictors of dementia.

RESULTS

Among 24 846 patients, TBI patients developed dementia (7.5% vs 4.6%) at a younger age (78.6 vs 82.7 yr) and demonstrated higher 10-yr mortality than controls (27% vs 14%; P < .001). Mild TBI patients had higher incidence of dementia (9%) than moderate/severe TBI (5.4%), with lower 10-yr mortality (20% vs 31%; P < .001). Risk of dementia was significant in all mild TBI age groups, even 45 to 54 yr (hazard ratio 4.1, 95% CI 2.7-7.8). A total of 10-yr cumulative incidence was higher in mild TBI (14.4%) than moderate/severe TBI (11.3%) and controls (6.8%) (P < .001). Predictors of dementia include TBI, sex, age, hypertension, hyperlipidemia, stroke, depression, anxiety, and Injury Severity Score.

CONCLUSION

Mild and moderate/severe TBI patients experienced higher incidence of dementia, even in the youngest group (45-54 yr old), than NTOT controls. All TBI patients, especially middle-aged adults with minor injury who are more likely to be overlooked, should be monitored for dementia.
Defining cardiac involvement in idiopathic inflammatory myopathies: a systematic review
Authors: Fairley Jessica L , Wicks Ian , Peters Stacey , Day Jessica
Published: July 2021

Objective

Recent advances in cardiac MRI (CMR) and other diagnostic techniques have made it easier to identify subclinical cardiac inflammation and dysfunction in the idiopathic inflammatory myopathies (IIM). Herein, we systematically review the literature regarding cardiac involvement in IIM.

Methods

We searched Medline and EMBASE from 1990 to 2020 using keywords related to IIM and cardiac disease. We included English language studies in adults with any immune-mediated, inflammatory muscle pathology.

Results

We identified 10 425 potentially relevant abstracts, of which 29 were included. Most frequently these included patients with PM or DM without symptomatic myocarditis. Five categories of cardiac investigation were used in these patients: cardiac enzyme testing, ECG, transthoracic echocardiography, CMR and nuclear medicine testing. Patients with clinical myocarditis had universally abnormal cardiac troponin levels and ECG. Elevated cardiac troponin T was more common than cardiac troponin I and may correlate with disease activity, whereas cardiac troponin I was more specific for cardiac involvement. Non-specific ECG changes were common. The major finding on transthoracic echocardiography was abnormal ejection fraction. Gross systolic dysfunction was unusual, but subclinical systolic dysfunction was reported in several studies. Abnormal diastolic function was common and may be associated with disease duration. Late gadolinium enhancement (reflecting regional necrosis or scarring) and abnormal myocardial mapping parameters (reflecting myocardial inflammation, fibrosis and oedema) were frequently identified on CMR, suggesting significant subclinical myocardial pathology (despite typically normal ejection fraction).

Conclusion

Abnormal cardiac investigations are commonly found in asymptomatic IIM patients, which has potential prognostic and treatment implications.
Species and Trichothecene Genotype of Pathogens Causing Fusarium Head Blight of Wheat in Nebraska, U.S.A.
Authors: Valverde-Bogantes Esteban , Bianchini Andreia , Wegulo Stephen N. , Hallen-Adams Heather E.
Published: July 2021

Fusarium head blight (FHB) is an economically important disease caused by several Fusarium species affecting wheat and other small grain cereals. In recent years, reports of shifts in populations of FHB pathogens around the world have shown that these populations are dynamic and change continuously, often resulting in increased yield losses or changes in the mycotoxins produced in the grain, which highlights the need for increased vigilance. The objective of this research was to identify the species and trichothecene genotypes of FHB pathogens in Nebraska in order to monitor their populations and the major toxigenic risks in the state. A total of 74 single-spore Fusarium isolates were obtained from 42 FHB-symptomatic wheat spikes collected from Nebraska fields during the growing seasons in 2015 to 2018. Most of the isolates were identified as F. graminearum (n = 67) based on translation elongation factor 1α (TEF1), trichothecene 3-O-acetyltransferase (TRI101), and reductase (RED) sequences. Additional species included F. boothii (n = 3), F. poae (n = 2), F. acuminatum (n = 1), and one isolate was an F. graminearum × F. boothii interspecific hybrid. All F. graminearum and F. boothii isolates had the 15-ADON trichothecene genotype. This study shows that F. graminearum is not the only pathogen causing FHB in Nebraska and helps expand knowledge on the worldwide distribution of F. boothii. The information obtained from this survey will be useful in developing effective FHB management strategies in Nebraska, because different pathogen populations can cause varying levels of disease intensity and can be selectively sensitive to management tactics.
Efficacy of Pecan Husk and Shell Phenolic Extracts Against Phytophthora Blight in Chile Pepper
Authors: Lujan Phillip , Dura Srijana , Guzman Ivette , Grace Mary , Lila Mary A. , Steiner Robert , Sanogo Soum
Published: July 2021

Phytophthora blight, caused by Phytophthora capsici, is detrimental to chile peppers (Capsicum sp.). In this study, phenolics extracted from pecan (Carya illinoinensis) husk and shell were foliarly applied to chile pepper (Capsicum annuum L., cultivar NM 6-4) to induce a resistance response against plant infection by P. capsici. Several pecan metabolite extractions were tested, and an acetic acid (2%) in aqueous methanol (80%) solution was the best extraction solvent, yielding total polyphenolic content of 290 mg/g dry weight from husk and 641 mg/g from shell. The phenolic extracts from husk and shell were applied as foliar sprays at different concentrations to chile plants inoculated with a virulent isolate of P. capsici. Chile plants treated with 1% phenolic husk or shell extracts or 0.1% salicylic acid remained alive throughout the study, whereas plants subjected to all other treatments (including a water control treatment) died. Analyses of the extracts through spectrophotometry and high-performance liquid chromatography indicated that the phenolic content in the extracts was largely made up of proanthocyanidins also known as condensed tannins. Pecan byproducts may be used as additional options for management of Phytophthora blight.
Detection of Oomycide-Insensitive Phytophthora Isolates in Maryland Ornamental Nurseries and Mid-Atlantic Landscapes Provide Data for Reconsidering Management Strategies
Authors: Beaulieu Justine , Del Castillo Munera Johanna , Balci Yilmaz
Published: July 2021

Five Phytophthora species comprising a total of 243 isolates (77 P. cinnamomi, 23 P. citrophthora, 18 P. multivora, 18 P. pini, and 107 P. plurivora) were screened for sensitivity to mefenoxam, fosetyl-Al, dimethomorph, dimethomorph + ametoctradin, and fluoxastrobin using amended agar assays. Mefenoxam-insensitive isolates were detected within P. cinnamomi (4%), P. multivora (11%), and P. plurivora (12%) even at approximately 2.5× the recommended label rate. These isolates were also insensitive to higher (off-label) concentrations of fluoxastrobin. Concentrations of dimethomorph (400 μg/ml) and dimethomorph + ametoctradin (100 μg/ml) were mostly effective in mycelial growth inhibition, but two P. plurivora isolates were insensitive, suggesting that resistance management is required. All mefenoxam-insensitive isolates were sensitive to fosetyl-Al at the label rate. Surprisingly, populations of P. cinnamomi from mid-Atlantic oak forests included insensitive isolates. For most species, isolates recovered from asymptomatic hosts (e.g., soil/potting media collected from randomly selected asymptomatic hosts) had a significantly greater relative growth rate when compared with isolates recovered from symptomatic hosts (e.g., isolates recovered from lesions or wilted plants). These findings suggest that mefenoxam and fluoxastrobin should be used sparingly to manage oomycetes in Maryland ornamental nurseries.
Detection of Soilborne Disease Utilizing Sensor Technologies: Lessons Learned from Studies on Stem Rot of Peanut
Authors: Wei Xing , Aguilera Marcela , Walcheck Rachael , Tholl Dorothea , Li Song , Langston David B. , Mehl Hillary L.
Published: July 2021

Soilborne plant diseases are a major constraint to crop production worldwide. Effective and economical management of these diseases is dependent on the ability to accurately detect and diagnose their signs and/or symptoms prior to widespread development in a crop. Sensor-based technologies are promising tools for automated crop disease detection, but research is still needed to optimize and validate methods for the detection of specific plant diseases. The overarching goal of our research is to use the peanut-stem rot plant disease system to identify and evaluate sensor-based technologies that can be utilized for the detection of soilborne plant diseases. Here we summarize the current state of sensor-based technologies for plant disease detection and provide examples from our own research that illustrate the advantages and limitations of different sensor-based methods for detecting soilborne diseases. In addition, the potential to adapt different sensor-based technologies to practical use in the field is discussed.
Fusarium Species Associated with Root Rot of Lentil (Lens culinaris) in North Dakota
Authors: Zitnick-Anderson Kim , Gargouri Jbir Taheni , Carlson Adam , Postovit Shawn , Pasche Julie , Kalil Audrey
Published: July 2021

Root rot of lentils is caused by a pathogen complex that includes several Fusarium species as well as Aphanomyces euteiches, Rhizoctonia solani, and Pythium species. Surveys of lentil fields were conducted in 2016 and 2018 in North Dakota to identify Fusarium species associated with root rot. Isolations were performed from lentil roots exhibiting disease, and isolates were identified via morphology and sequencing. In total, 114 fields were surveyed, and 391 Fusarium isolates were collected. A diversity of Fusarium species was recovered, as 10 different species were represented; however, F. oxysporum was the most frequently isolated species, present in 71% of fields. Based on correlation with disease severity data, it is likely that some of these isolates are pathogenic. F. avenaceum was relatively uncommon, unlike previous survey efforts on field pea in North Dakota. Further research is needed to determine how the Fusarium population responsible for root rot of lentil may be affected by cropping practices or seasonal climatic variation. Assessment of the virulence and host range of Fusarium species associated with root rot of lentil will further enhance our understanding of the root rot complex in lentil and the development and integration of effective management practices.
Management of Hop Powdery Mildew in the Context of Recent Advances in Pathogen Ecology and Population Genetics
Authors: Weldon William A. , Gent David H. , Gadoury David M.
Published: July 2021

The recent surge in the craft brewing market has renewed hop production throughout much of the Midwestern and Eastern United States, adding an element of locally sourced hops for use by regional breweries. All the while, the U.S. Pacific Northwest remains the stronghold of U.S. hop production, supplying hops for breweries worldwide. As the industry has evolved, so too have the challenges associated with managing the major pathogens of hop, especially with respect to Podosphaera macularis, the causal agent of hop powdery mildew. Uniquely virulent stains have evolved that can overcome widely deployed host resistance genotypes. Throughout the Midwestern and Eastern United States, sexually reproducing populations of P. macularis reside on noncultivated hop and threaten introduction into commercial hop yards. The disease was recently reported in Brazil, a first for hop-production systems of the Southern Hemisphere. Also, as is the case for many pathosystems, the acceptance and availability of efficacious chemical control products is constantly changing. All of these factors combine to require disease management programs be as efficient, thorough, and precise as possible. Herein, this review aims to summarize research progress within the P. macularis pathosystem and synthesize major findings as they relate to disease management, placing special emphasis on recent work that has expanded the molecular tools available to study P. macularis population structure, epidemiological models that describe aspects of pathogen overwintering, and improvements in our understanding of basic pathogen ecology.
Survival of Xanthomonas cucurbitae in Different Crop Rotations, Plant Debris, and Weeds in Pumpkin Fields
Authors: Sulley Salisu , Hind Sarah R. , Babadoost Mohammad
Published: July 2021

This study was conducted to evaluate the effectiveness of crop rotation in managing Xanthomonas cucurbitae, the causal agent of Xanthomonas leaf spot, in pumpkin fields. The study was conducted using ‘Howden’ pumpkin, a susceptible pumpkin cultivar, at four sites with no history of cucurbit production. All sites were planted with pumpkins in the first year of crop rotations. The disease developed at all four sites. In a 3-year rotation with nonhost crops, the severity of Xanthomonas leaf spot in pumpkin plots was significantly (P < 0.05) lower than those of plots in the 2-year rotation with nonhost crops and continuous pumpkin production. Furthermore, X. cucurbitae was recovered from pumpkin plant debris 15 months after harvesting pumpkins in commercial fields, and the pathogen was viable. X. cucurbitae was also isolated from asymptomatic weeds in pumpkin fields. In a greenhouse inoculation of weeds with X. cucurbitae, however, Xanthomonas leaf spot developed only on leaves of burcucumber (Sicyos angulatus) and velvetleaf (Abutilon theophrasti) weeds. In the infested soil with X. cucurbitae, the bacterium was not recovered after 15, 42, and 56 days at 22, 12, and 4°C, respectively. The results showed that crop rotation alone does not provide adequate protection of pumpkin plants against X. cucurbitae.
Ultrasound of Soft Tissue Masses: Part II
Authors: Harris Kaylee M. , Montgomery Justin R. , Spicer Paul J.
Published: July 2021

In part I of this two-part series, we discussed the utility of ultrasound (US) for evaluation of soft tissue masses. Optimal scanning techniques were addressed. Multiple benign masses were highlighted in the first article, with particular attention to the features that were characteristic for a specific begin diagnosis. This article addresses more benign masses. Additionally, features of malignant soft tissue masses are reviewed and these findings reinforced with a discussion of several malignant diagnoses.
The effects of the COVID-19 pandemic on the treatment of allergic eye diseases
Authors: Leonardi Andrea , Salami Elena , Feuerman Oren Mark , Cavarzeran Fabiano
Published: July 2021

Purpose of review

To analyze if recommendations given before and during the COVID-19 pandemic are still a valid option for patients suffering of ocular allergy (OA).

Recent findings

During the last year many doctors and patients requested suggestions for the treatment of OA patients in COVID-19 time. Most of them were given by phone calls and emails following the recommendations given by Scientific Societies.

Considering the current multiple problems related to the COVID-19 pandemic, OA has not been considered a priority, even though patients need treatments. Topical antiallergic drugs are still the first option to treat all kind of OA, with the addition of topical corticosteroids in the severe forms of vernal and atopic keratoconjunctivitis (VKC and AKC) even in patients at risk of COVID-19. Topical immunomodulation is still recommended in severe forms of VKC and AKC unless the patient is infected. The number of patients treated with these drugs in our Center was similar than previous years. The risk to have a VKC patient affected by COVID-19 is similar to the general pediatric population but with a lower OR. In 2021, still in COVID-time, the management of OA should follow the previous recommendations with an update due to the risk of infection.
A Review of the Concept of Impulsivity
Authors: Al-Hammouri Mohammed Munther , Rababah Jehad A. , Shawler Celeste
Published: July 2021

Impulsivity is a central concept for many psychological models and interventions. Despite extensive research, the concept of impulsivity lacks clarity due to the diversity of definitions provided. The aims of this study were to conduct a concept analysis of impulsivity to provide a clear and workable definition of impulsivity for future nursing research. This study used Rodgers' evolutionary concept analysis approach to analyze 37 articles from various disciplines. Our analysis offers promising direction in refining the concept. The findings can drive future research and enhance nurse researchers' ability to attend and explore health-related issues associated with the concept.
Frailty in the Context of Older People Living With HIV
Authors: Iriarte Evelyn , Cianelli Rosina , De Santis Joseph
Published: July 2021

Despite advances in knowledge about older people living with HIV infection (PLWH), frailty remains a challenge to HIV care. Numerous studies have documented its impact; however, the concept remains unclear. Concept exploration of frailty in the context of older PLWH was conducted to provide a comprehensive understanding of the concept based on the Walker and Avant method. After the literature review, a concept analysis and a definition of frailty among older PLWH emerged. Implications for further practice, education, public policy, and research are presented to use the concept consistently, develop interventions to prevent frailty, and improve health outcomes.
Unilateral limb orthosis for maintenance of deformity correction following treatment of clubfoot with Ponseti technique: a systematic review
Authors: Agarwal Anil , Rastogi Anuj , Talwar Jatin , Deo Nitish Bikram , Rastogi Prateek
Published: July 2021

The systematic review study aimed to investigate the following details in the clubfoot children treated with the Ponseti technique: (1) to review the various designs and prescriptions of unilateral limb orthosis described in literature; (2) to find the outcome following use of this orthosis, especially patient adherence and recurrence; (3) comparison with standard bilateral limb foot abduction orthosis. A literature search was performed for articles published in ‘Pubmed (includes Medline indexed journals)’ electronic databases for broad key words: ‘Clubfoot or CTEV or congenital talipes equinovarus’, ‘orthosis or brace or splint’. Included were studies that addressed the treatment of idiopathic clubfoot in children up to 2 years of age using the Ponseti technique and use of unilateral limb orthosis for the subsequent maintenance phase. We excluded studies reporting Ponseti technique for nonidiopathic clubfoot, child age older than 2 years at the time of primary treatment, studies where unilateral limb orthosis was used as a tool for primary correction of all or some components of clubfoot and design descriptions of orthosis without practical usage data. Of the 1537 articles from the database, 10 articles were included in the final review. Most studies were retrospective, underpowered and had a short term follow-up. In some series, the use of this orthosis was driven by personal experiences and regional preferences rather than a just scientific explanation. The tested designs were variable and nonstandardized. Being less restrictive, unilateral limb orthosis may have an edge over bilateral limb orthosis in terms of patient adherence. The available comparative studies however showed inferiority of unilateral orthoses when compared to the bilateral limb orthosis in preventing recurrences in clubfoot treatment. There is insufficient evidence to support use of unilateral limb orthosis for maintenance of deformity correction following treatment of clubfoot with the Ponseti technique. Their use was found associated with high recurrence rates.
Dose reduction for minimizing radiation in displaced paediatric supracondylar humerus fractures: single vs. automated pulse mode
Authors: Mishra Neeraj , Yap Shu Ting , Lee Nicole Kim Luan , Lua Jameson Yao Chung , Tay Yong Heng , Saffari Seyed Ehsan , Mahadev Arjandas , Chew Ee Ming , Wong Kenneth Pak Leung
Published: July 2021

Conventional C-arm image intensifiers (CCA) are an essential and indispensable aid in modern orthopaedic surgery. CCAs are defaulted to auto-pulse mode which emit multiple pulses (or bursts) of radiation to obtain optimum image quality. The number of pulses per shot can be configured manually. The purpose of this study is to investigate the efficacy of the single pulse mode of CCA in reducing and fixing paediatric supracondylar humeral fractures (SCHF). A retrospective chart review of 99 paediatric patients who underwent closed reduction and percutaneous pinning of displaced SCHF was performed. Fifty-one consecutive cases operated with auto-pulse mode (group A). Another 48 consecutive cases were operated with the single-pulse mode (group B). Baumann’s angle, operative duration and average radiation dose rate were recorded for comparison between both groups. Twenty postpinning images were randomly selected (10 from each group) to study intra- and interobserver reliability. Twelve doctors were recruited and tasked to identify if each X-ray was taken with the auto-pulse or single-pulse mode. This was repeated after 2 weeks. The patients in the auto-pulse mode group had a significantly higher mean radiation dose of 40.4 ± 32.51 cGycm2/min compared to that of 14.8 ± 3.24 cGycm2/min for the single-pulse group (P ≤ 0.001). All patients in both groups had Baumann’s angle within normal range of 64–81°. No significant difference was noted in average intraoperative timings between both groups (P = 0.869). In the majority of cases, the doctors were unable to visually differentiate between the modes of CCA used. The single-pulse mode is an excellent alternative to the auto-pulse mode in fixing SCHF. It gives significantly lower radiation without compromising the surgical outcome. Level of evidence: Level III retrospective comparative study.
Getting Them Back in the Game: When Can Athletes With Adolescent Idiopathic Scoliosis Safely Return to Sports? A Mixed-effects Study of the Pediatric Orthopaedic Association of North America
Authors: Ho Dedi , Du Jerry Y. , Erkilinc Mehmet , Glotzbecker Michael P. , Mistovich R. Justin
Published: July 2021

Background:

Despite the relative frequency of posterior spinal fusion (PSF) and instrumentation for adolescent idiopathic scoliosis (AIS), there are limited guidelines for postoperative return to sports. Few studies explore factors influencing treating surgeons’ recommendations.

Methods:

A survey presenting several clinical vignettes of patients who had undergone PSF for AIS was distributed to 1496 Pediatric Orthopaedic Society of North America (POSNA) members. Of the 257 returned surveys, 170 met the inclusion criteria. Mixed-effects models were created to assess the effects of the surgeon and hypothetical patient characteristics on return to jogging, noncontact, contact, and collision sports.

Results:

Estimated marginal mean time to return to sporting activities increased for more physically demanding sports [jogging: 4.1 mo, 95% confidence interval (CI): 3.8-4.3; noncontact: 4.6 mo, 95% CI: 4.3-4.9; contact: 6.8 mo, 95% CI: 6.4-7.1; collision: 9.8 mo, 95% CI: 9.2-10.4]. Hypothetical patient characteristics (sex, age, obesity, skeletal maturity, levels fused, and fusions ending in thoracic versus lumbar spine) were not associated with changes in return to sport recommendations for jogging, noncontact, contact, or collision activities. Surgeon volume, experience, fellowship type, and practice setting all affected return to all activities (P<0.05). Surgeons with prior complications from return to sport delayed return to collision activities (9.4 mo, 95% CI: 8.4-10.3) versus surgeons without complications (7.2 mo, 95% CI: 5.7-8.7, P<0.001).

Conclusions:

Surgeons currently allow earlier return to high-intensity sports after PSF for AIS compared with previous studies. Protocol trends vary based on physician-related factors such as years in practice, case volume, fellowship training, practice type, and prior experience with complications. Patient-related factors were not found to impact return to sport protocols. This survey provides a portrait of current practice trends and serves as a foundation for future investigation.

Level of Evidence:

Level V—survey study.
High Incidence of Intra-articular Injuries With Segond Fractures of the Tibia in the Pediatric and Adolescent Population
Authors: Kushare Indranil , McHorse Grant , Ghanta Ramesh , Kastan Kristen , Stone Tracie , Wunderlich Nicole A.
Published: July 2021

Background:

Segond fractures (avulsion fractures of the proximal lateral tibia) are highly associated with anterior cruciate ligament (ACL) tears in adult patients. This large case series of pediatric Segond fractures describes the associated intra-articular knee injuries to determine if these fractures have a high incidence of ACL tears or its equivalent injury in young patients.

Methods:

Institutional review board approved retrospective study at a tertiary children’s hospital of patients under 19 years who were diagnosed with a Segond fracture between 2009 and 2019 was conducted. Demographics, clinical data, imaging features, associated injuries, and treatment information were collected.

Results:

Fifty-three patients (44 males and 9 females) with median age 15.4 (11.8 to 19) years with Segond fractures of the proximal tibia on radiographic imaging were included. Diagnosis of associated injuries was established based on clinical examination, radiology report, and arthroscopic findings. Median Segond fracture size was 2.0×9.0 mm measured on standard anteroposterior knee radiographs. Magnetic resonance imaging (MRI) was obtained in 49/53 (92.5%) patients. Associated injuries included ACL tears (39 patients, 73.6%), tibial spine fractures (9, 17.0%), and other injuries (5, 9.4%). 37/53 (69.8%) patients had meniscal injury. Three (5.7%) patients sustained multiligament injuries. All associated injuries were confirmed by either MRI/computerized tomography or direct operative examination. Among Segond fractures found with ACL tears, 12 (30.8%) were contact injuries, 30 (76.9%) were sports injuries. In associated tibial spine fractures, 7 (78%) injuries were contact in nature and were sports related. There was a statistically significant difference (P=0.013) in age, patients with tibial spine fractures (median 13.6 y) being younger than those with ACL tears (median 15.4 y). 12/53 (22.6%) had associated articular cartilaginous injuries, 3 of which were treated surgically. Overall, 81.1% of patients were treated operatively for associated intra-articular injuries.

Conclusions:

This large case series of Pediatric Segond fractures suggests a high association with intra-articular injuries, specifically, ACL tears and its equivalent injury, that is, tibial spine fractures, the later more common in the younger patient population. An MRI is recommended in patients with a Segond fracture for characterizing the exact intra-articular injury to help plan the appropriate management.

Level of Evidence:

Level IV—prognostic.
Sarcopenia, Ectopic Fat Infiltration Into the Lumbar Paravertebral Muscles, and Lumbo-Pelvic Deformity in Older Adults Undergoing Lumbar Surgery
Authors: Lee Deokcheol , Kuroki Tomofumi , Nagai Takuya , Kawano Keisuke , Higa Kiyoshi , Kurogi Syuji , Hamanaka Hideaki , Chosa Etsuo
Published: July 2021

Study Design.

A retrospective analysis of a prospective, non-randomized cohort dataset.

Objective.

To cross-sectionally examine the prevalence of sarcopenia and the association between spine-pelvic deformity and skeletal muscle volume loss and ectopic fat infiltration into lumbar paravertebral muscles (PVMs) in patients who underwent lumbar surgery.

Summary of Background Data.

Muscle quality deterioration has been considered the main pathology of sarcopenia, reducing muscle strength directly. The qualitative deterioration as well as volume loss in PVM, which contributes significantly to core body extension, might cause aging-related spine deformity.

Methods.

In total, 184 patients were included. Sarcopenia was diagnosed at baseline, and all patients underwent whole-body X-ray. The amount of fat in lumbar PVM was evaluated with the Goutallier classification in magnetic resonance imaging findings. The expression of adipogenesis- and atrophy-promoting factors in PVM was evaluated with quantitative polymerase chain reaction.

Results.

In total, 36.1% of adults aged ≥60 years were diagnosed with sarcopenia. The values of skeletal muscle indexes of the limb and trunk were inversely correlated with the sagittal vertical axis, pelvic tilt (PT), and pelvic incidence minus lumbar lordosis (PI-LL) values. The PT and PI-LL were greater, PVM area was smaller, and Goutallier grade was greater in sarcopenic adults than in non-sarcopenic older adults. Additionally, the PVM area correlated with the LL value, and Goutallier's grade correlated with the PT and PI-LL values. Moreover, the amount of ectopic fat in PVMs inversely correlated with skeletal muscle indexes. The expression levels of atrophy gene-1 and muscle ring-finger protein-1 did not differ between the groups and did not correlate with the PVM area. In contrast, the expression of Pparg and Cebpa was upregulated in sarcopenic older adults, where it correlated with Goutallier's grade.

Conclusion.

The volume loss of skeletal muscle, including lumbar PVM, and ectopic fat infiltration into the PVM, may cause the lumbo-pelvic deformity.

Level of Evidence: 3
Mortality Among Noncoronavirus Disease 2019 Critically Ill Patients Attributable to the Pandemic in France
Authors: Payet Cécile , Polazzi Stéphanie , Rimmelé Thomas , Duclos Antoine
Published: July 2021

Objectives:

We investigated whether the risk of death among noncoronavirus disease 2019 critically ill patients increased when numerous coronavirus disease 2019 cases were admitted concomitantly to the same hospital units.

Design:

We performed a nationwide observational study based on the medical information system from all public and private hospitals in France.

Setting:

Information pertaining to every adult admitted to ICUs or intermediate care units from 641 hospitals between January 1, 2020, and June 30, 2020 was analyzed.

Patients:

A total of 454,502 patients (428,687 noncoronavirus disease 2019 and 25,815 coronavirus disease 2019 patients) were included.

Interventions:

For each noncoronavirus disease 2019 patient, pandemic exposure during their stay was calculated per day using the proportion of coronavirus disease 2019 patients among all patients treated in ICU.

Measurements and Main Results:

We computed a multivariable logistic regression model to estimate the influence of pandemic exposure (low, moderate, and high exposure) on noncoronavirus disease 2019 patient mortality during ICU stay. We adjusted on patient and hospital confounders. The risk of death among noncoronavirus disease 2019 critically ill patients increased in case of moderate (adjusted odds ratio, 1.12; 95% CI, 1.05–1.19; p < 0.001) and high pandemic exposures (1.52; 95% CI, 1.33–1.74; p < 0.001).

Conclusions:

In hospital units with moderate or high levels of coronavirus disease 2019 critically ill patients, noncoronavirus disease deaths were at higher levels.
The impact of the coronavirus disease 2019 pandemic on the diagnosis and treatment of cancer in Northern Portugal
Authors: Morais Samantha , Antunes Luís , Rodrigues Jéssica , Fontes Filipa , Bento Maria José , Lunet Nuno
Published: July 2021

Objectives

The coronavirus disease 2019 (COVID-19) pandemic has affected the availability of healthcare resources, and adjustments to cancer care have been necessary considering the risk of morbidity by COVID-19 and of cancer progression. This study aims to quantify the impact of the COVID-19 pandemic on the care of patients with cancer by comparing a period of 4 months after the outbreak began (2 March 2020) with an equal period from 2019.

Methods

Cancer cases of the esophagus, stomach, colon and rectum, pancreas, lung, skin-melanoma, breast, cervix, prostate, non-Hodgkin lymphoma, and leukemia from the Portuguese Oncology Institute of Porto, and diagnosed between 2 March and 1 July 2019 (before COVID-19) and 2020 (after COVID-19) were identified. Those with the first treatment outside the Portuguese Oncology Institute of Porto were excluded. Sociodemographic, clinical and treatment characteristics were obtained from the cancer registry database and clinical files.

Results

The absolute number of new cancer cases decreased nearly 40% after the COVID-19 pandemic (from 1430 to 866). The largest decreases were observed for cervical (−74.3%) and prostate (−71.7%) cancers. Cases were more often diagnosed at more advanced stages in 2020 (P = 0.001), and the proportion of patients not starting any treatment until 1 July was just under 20% in 2019 and nearly 40% in 2020. The median times from symptoms onset, first medical exam and first appointment to diagnosis, and from diagnosis to first appointment, multidisciplinary tumor board meeting and first treatment were shorter after COVID-19.

Conclusions

There was a notable overall decrease in cancer diagnoses after COVID-19, with changes in the characteristics of incident cases.
Risk factors of cervical cancer among ethnic minorities in Yunnan Province, China: a case–control study
Authors: Zhao Min , Gu Rong-yan , Ding Song-rui , Luo Lei , Jia Yue , Gao Chen-xin , Chen Bin , Xu Xue-bin , Chen Hong-fen
Published: July 2021

Background

Cervical cancer is a common malignant tumor of the female reproductive system in the world, which is a serious threat to women’s life and health. According to the latest report, the incidence of cervical cancer is 11.42 per 100 000, and the mortality rate is 3.77 per 100 000 in Yunnan Province, which is still higher than the national average. Although there have been some relevant studies on the risk factors of cervical cancer in recent years, research on ethnic minorities is lacking in Yunnan Province.

Objective

To analyze and explore the related risk factors of cervical cancer in women of ethnic minorities in Yunnan Province, to provide the scientific basis for the development of cervical cancer prevention and control strategies and measures in this region.

Methods

In total 1119 cervical cancer patients diagnosed by histopathology at the Yunnan Cancer Center (Yunnan Cancer Hospital) from January 2010 to December 2019 were selected as the case group. According to the 1:1 matching principle of the case–control study, 1119 patients with nonmalignant tumors of the same nationality, the same hospital, age difference less than 3 years old, were selected as the control group. Univariate and multivariate conditional logistic regression were used for statistical analysis.

Results

Basic medical insurance for rural residents (OR = 3.659; P = 0.003), human papilloma virus (HPV) infection (OR = 90.030; P < 0.001) and concurrent reproductive tract infections (OR = 1.992; P = 0.047) were risk factors for cervical cancer. Late first marriage(OR = 0.881; P = 0.032), the number of normal childbirths ≤2 (OR = 0.480, P = 0.033) and contraception (OR = 0.291; P = 0.002) were positive factors for cervical cancer.

Conclusion

The high incidence of cervical cancer in Yunnan minority women is the result of many factors: HPV infection is the highest risk factor for cervical cancer, women with reproductive tract infections and basic medical insurance for rural residents have a higher risk for cervical cancer; Late first marriage, the number of deliveries ≤2 and contraception are positive factors for cervical cancer.
Elevated serum Dickkopf-1 is a biomarker for bone erosion in patients with psoriatic arthritis
Authors: Chung Yukchiu , Li Zhi-Chang , Sun Xiao-Lin , Liu Yan-Ying , Shao Miao , Gan Yu-Zhou , Li Yi-Min , Li Yu-Hui , Zhang Xue-Wu
Published: July 2021

Background:

Psoriatic arthritis (PsA) is an inflammatory arthropathy characterized by psoriasis and bone erosion on radiology. Dickkopf-1 (Dkk-1) is considered to be the main inhibitor of the Wnt signaling pathway and results in reduced osteoblast proliferation. The aim of this study was to investigate the serum level of Dkk-1 and its association with bone erosion in PsA patients.

Methods:

Serum Dkk-1 levels were measured by enzyme-linked immunosorbent assay (ELISA) in 69 patients with PsA and 60 controls, including 39 rheumatoid arthritis (RA) patients, and 21 healthy controls (HCs). Rheumatoid factor and anti-cyclic citrullinated peptide levels were also determined by ELISA. The association of Dkk-1 level with clinical and laboratory features of PsA was analyzed. Logistic regression analysis was used to analyze the risk factors for bone erosion in PsA.

Results:

Dkk-1 was elevated in 68.1% (47/69) of the patients with PsA, 46.2% (18/39) of RA patients, and 9.5% (2/21) of HCs. Serum Dkk-1 concentration was significantly higher in PsA patients compared with that in HCs. The level of serum Dkk-1 was correlated with a swollen joint count, and levels of complement components 3 and 4. Elevated Dkk-1 level (odds ratio = 4.440, 95% confidence interval: 1.246–15.817, P = 0.021) was identified as the risk factor for bone erosion in PsA.

Conclusions:

The serum level of Dkk-1 is abnormally elevated in PsA patients. The elevation of Dkk-1 might be involved in the mechanism of bone erosion in patients with PsA.
Concomitant Use of Proton Pump Inhibitors With Capecitabine Based Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Cancer
Authors: Menon Anjali , Abraham Aswin G. , Mahfouz Maria , Thachuthara Joseph J. , Usmani Nawaid , Warkentin Heather , Ghosh Sunita , Nijjar Tirath , Severin Diane , Tankel Keith , Paulson Kim , Mulder Karen , Roa Wilson , Joseph Kurian
Published: July 2021

Aim:

Capecitabine (Cape) is routinely used for the neoadjuvant chemoradiation treatment (NACRT) of locally advanced rectal cancers (LARCs). Previous reports have suggested that the concomitant use of proton pump inhibitors (PPIs) may affect the efficacy of Cape, although the true effect of PPIs when used with Cape as a radiosensitizer for neoadjuvant radiation is unclear. The aim of our study was to evaluate the impact of concurrent PPI use along with fluorouracil (FU) and Cape based NACRT in terms of pathologic and oncological outcomes, in patients with LARC.

Methods:

LARC patients treated at our center with NACRT from 2010 to 2016 were identified. Postoperative pathology and follow-up outcomes were examined for any differences with relation to the use of PPIs concurrently with FU and Cape based NACRT and adjuvant chemotherapy regimens.

Results:

Three hundred four and 204 patients received treatment with FU and Cape based NACRT. No difference in pathologic complete response rate was noted between the 2 arms with the concurrent use of PPIs (25.8% and 25%, respectively, P=0.633); or with and without the use of PPIs in the Cape-NACRT arm specifically (20% and 20.7%, P=0.945). At a median follow-up of 5 years, no statistical difference in local or distant control was noted in the Cape-NACRT patients, with and without concomitant PPI use (P=0.411 and 0.264, respectively).

Multivariate analysis showed no association of PPI use and NACRT with Cape, in terms of local control (hazard ratio=0.001, P=0.988) or overall survival (hazard ratio=1.179, confidence interval=0.249-5.579, P=0.835).

Conclusions:

Our study revealed that there was no adverse pathologic or oncological outcome with the concurrent use of PPIs along with Cape-NACRT in the treatment of LARC. We report that it may be safe to use PPIs if essential, in this clinical setting, although it would be wise to exercise caution.
Immunological effector mechanisms in HIV-1 elite controllers
Authors: Hartana Ciputra Adijaya , Yu Xu G.
Published: July 2021

Purpose of review

HIV-1 elite controllers encompass small populations of people infected with HIV-1 who can spontaneously control plasma viral loads below the limit of detection, in the absence of antiretroviral treatment. Antiviral immune responses are likely to contribute to such an impressive HIV-1 disease outcome. In this review, we discuss recent novel findings regarding antiviral innate and adaptive immune responses in elite controllers.

Recent findings

Elite controllers maintain a pool of infected cells in which intact HIV-1 proviruses are more frequently integrated into noncoding regions of the host genome, likely conferring a state of deep latency. This atypical viral reservoir configuration is best explained by potent antiviral immune responses that can successfully eliminate virally infected cells in which proviruses are integrated into permissive chromatin. However, identifying the specific type and nature of this immune selection pressure represents a formidable challenge. Recent studies continue to support the role of HIV-1-specific CD8+ T cells as the main driver of elite immune control of HIV-1, however, increasing evidence suggests that their role is complemented by a fine-tuned interplay with innate immune cell subsets. Therefore, the combination of different immune effector mechanisms may shape antiviral immunity in elite controllers.

Understanding the complex immune mechanisms responsible for natural, drug-free HIV-1 control represents a premier avenue to find and develop interventions for a cure of HIV-1 infection. Future single-cell assays designed to uncover the full genetic, epigenetic, transcriptional and functional complexity of antiviral immune responses in elite controllers may allow us to define correlates of antiviral immune protection in greater detail.
Psychopathology and Adaptive Functioning in Children, Adolescents, and Young Adults with Noonan Syndrome
Authors: Davico Chiara , Borgogno Marta , Campagna Filippa , D'Alessandro Rossella , Ricci Federica , Amianto Federico , Mussa Alessandro , Carli Diana , Ferrero Giovanni Battista , Vitiello Benedetto
Published: July 2021

Objective:

The objective of this study was to examine psychopathology and its impact on adaptive functioning in a sample of patients affected by Noonan syndrome (NS), a genetically heterogeneous condition with systemic manifestations.

Method:

Forty-two subjects affected by NS (23 males and 19 females), aged 5 to 21 years (mean 12.6 ± SD 5.1), were assessed for nonverbal cognitive abilities, with dimensional measures of psychopathology, adaptive functioning, and family quality of life.

Results:

The nonverbal intelligence quotient (IQ) mean was 99.4 ± SD 22.2, with 3 subjects (8%, 95% confidence interval [CI], 1.6%–20.9%) showing cognitive impairment (IQ<70). The Parent Child Behavior Checklist (CBCL) total psychopathology score was in the clinical range in 10% of sample and borderline in another 10%. On the Conners' Parent Rating Scales, scores suggestive of attention-deficit/hyperactivity disorder (ADHD) were in the clinical range in 20%. On the autism quotient, autism spectrum disorder symptoms were reported in 10%. Higher scores on the Adaptive Behavioral Assessment System–Second Edition and on the World Health Organization Quality of Life (26 items) were associated with lower problems on the CBCL (r = −0.63, 95% CI, −0.78 to −0.40 and r = −0.48, 95% CI, −0.69 to −0.20, respectively).

Conclusion:

Psychopathology was common in patients with NS and negatively correlated with global functioning and family quality of life. Treatable psychopathology, such as ADHD, may constitute a treatment target for improving adaptive functioning.
Circ-PRKCI Alleviates Lipopolysaccharide-induced Human Kidney 2 Cell Injury by Regulating miR-106b-5p/GAB1 Axis
Authors: Xiong Yueli , Wang Yang , Tian Hui , Li Yuanyuan , Xu Qingjie , He Zhenkun
Published: July 2021

Circular RNAs act as vital regulators in diverse diseases. However, the investigation of circular RNAs in sepsis-engendered acute kidney injury remains dismal. We aimed to explore the effects of circular RNA protein kinase C iota (circ-PRKCI) in lipopolysaccharide (LPS)-mediated HK2 cell injury. Sepsis in vitro model was established by LPS treatment. Quantitative real-time polymerase chain reaction assay was conducted for determining the levels of circ-PRKCI, microRNA-106b-5p (miR-106b-5p), and growth factor receptor binding 2-associated binding protein 1 (GAB1). Cell viability and apoptosis were evaluated using Cell Counting Kit-8 assay and flow cytometry analysis, respectively. The concentrations of interleukin-6, interleukin-1β, and tumor necrosis factor-α were measured with enzyme-linked immunosorbent assay kits. The levels of oxidative stress markers were determined using relevant commercial kits. Western blot assay was conducted for B-cell lymphoma-2 (Bcl-2), BCL2-Associated X (Bax), and GAB1 protein levels. Dual-luciferase reporter assay and RNA immunoprecipitation assay were used to verify the association between miR-106b-5p and circ-PRKCI or GAB1. We found the Circ-PRKCI level was decreased in sepsis patients and LPS-induced human kidney 2 (HK-2) cells. LPS exposure inhibited cell viability and facilitated apoptosis, inflammation, and oxidative stress in HK-2 cells. Circ-PRKCI overexpression abrogated the effects of LPS on cell apoptosis, inflammation, and oxidative stress in HK-2 cells. Furthermore, circ-PRKCI was identified as the sponge for miR-106b-5p to positively regulate GAB1 expression. Overexpression of circ-PRKCI relieved LPS-mediated HK-2 cell damage by sponging miR-106b-5p. MiR-106b-5p inhibition ameliorated the injury of HK-2 cells mediated by LPS, whereas GAB1 knockdown reversed the effect. Collectively, Circ-PRKCI overexpression attenuated LPS-induced HK-2 cell injury by regulating miR-106b-5p/GAB1 axis.