bluuebunny/crossref_metadata_2025 huggingface dataset:
Mass-loss law for red giant stars in simple population globular clusters
Authors: Tailo M , Milone A P , Lagioia E P , D’Antona F , Jang S , Vesperini E , Marino A F , Ventura P , Caloi V , Carlos M , Cordoni G , Dondoglio E , Mohandasan A , Nastasio J E , Legnardi M V
Published: February 2021

The amount of mass lost by stars during the red-giant branch (RGB) phase is one of the main parameters to understand and correctly model the late stages of stellar evolution. Nevertheless, a fully comprehensive knowledge of the RGB mass-loss is still missing. Galactic Globular Clusters (GCs) are ideal targets to derive empirical formulations of mass-loss, but the presence of multiple populations with different chemical compositions has been a major challenge to constrain stellar masses and RGB mass-losses. Recent work has disentangled the distinct stellar populations along the RGB and the horizontal branch (HB) of 46 GCs, thus providing the possibility to estimate the RGB mass-loss of each stellar population. The mass-losses inferred for the stellar populations with pristine chemical composition (called first-generation or 1G stars) tightly correlate with cluster metallicity. This finding allows us to derive an empirical RGB mass-loss law for 1G stars. In this paper, we investigate seven GCs with no evidence of multiple populations and derive the RGB mass-loss by means of high-precision Hubble-Space Telescope photometry and accurate synthetic photometry. We find a cluster-to-cluster variation in the mass-loss ranging from ∼0.1 to ∼0.3 M⊙. The RGB mass-loss of simple-population GCs correlates with the metallicity of the host cluster. The discovery that simple-population GCs and 1G stars of multiple population GCs follow similar mass-loss versus metallicity relations suggests that the resulting mass-loss law is a standard outcome of stellar evolution.
Tomographic constraints on gravity from angular redshift fluctuations in the late Universe
Authors: Hernández–Monteagudo Carlos , Chaves-Montero Jonás , Angulo Raúl E , Aricò Giovanni
Published: February 2021

Fluctuations in sky maps of galaxy redshifts, dubbed angular redshift fluctuations (ARF), contain precise information about the growth rate of structures and the nature of gravity in the Universe. Specifically, ARFs constrain the combination of cosmological parameters $H/H_0\, f\sigma _8(z)$, while being an intrinsically tomographic probe and largely insensitive to many observational systematic errors, all without requiring the assumption of any redshift-to-distance relation under a given fiducial cosmology. We present the first cosmological constraints derived from ARF by using Baryon Oscillation Spectroscopic Survey (BOSS) LOWZ(Low redshift(Z))+CMASS(Constant MASS) DR12(Data Release 12) galaxy samples, obtaining 7 per cent accurate constraints on H/H0fσ8(z) at more than 20 redshifts over the range z ∈ [0.26, 0.72]. Our best-fitting value is $10{{\ \rm per\ cent}}$ larger, but compatible at the 1.4σ level, than the ΛCDM expectation set by Planck observations of cosmic microwave background (CMB) radiation. Our tomographic measurements, combined with these CMB data, provide one of the strongest constraints on the gravity index γ, $\gamma =0.44^{+0.09}_{-0.07}$, which lies within 2σ of the prediction of General Relativity (γGR ≃ 0.55).
The Validity of the Koos Classification System With Respect to Facial Nerve Function
Authors: Erickson Nicholas J , Mooney James H , Walters Beverly C , Agee Bonita , Fisher Winfield S
Published: February 2021

BACKGROUND

The Koos classification of vestibular schwannomas is designed to stratify tumors based on extrameatal extension and compression of the brainstem. Our prior study demonstrated excellent reliability. No study has yet assessed its validity.

OBJECTIVE

To present a retrospective study designed to assess the validity of the Koos grading system with respect to facial nerve function following treatment of 81 acoustic schwannomas.

METHODS

We collected data retrospectively from 81 patients with acoustic schwannomas of various Koos grades who were treated with microsurgical resection or stereotactic radiosurgery. House-Brackmann (HB) scores were used to assess facial nerve function and obtained at various time points following treatment. We generated Spearman's rho and Kendall's tau correlation coefficients along with a logistic regression curve.

RESULTS

We found no significant difference in the presence or absence of facial dysfunction by Koos classification when looking at all patients. There was a positive but fairly weak correlation between HB score and Koos classification, which was only significant at the first postoperative clinic appointment. There was a statistically significant difference in the presence or absence of facial dysfunction between patients treated with surgery vs radiation, which we expected. We found no statistically significant difference when comparing surgical approaches. Logistic regression modeling demonstrated a poor ability of the Koos grading system to predict facial nerve dysfunction following treatment.

CONCLUSION

The Koos grading system did not predict the presence of absence of facial nerve dysfunction in our study population. There were trends within subgroups that require further exploration.
Cracking the superheavy pyrite enigma: possible roles of volatile organosulfur compound emission
Authors: Lang Xianguo , Zhao Zhouqiao , Ma Haoran , Huang Kangjun , Li Songzhuo , Zhou Chuanming , Xiao Shuhai , Peng Yongbo , Liu Yonggang , Tang Wenbo , Shen Bing
Published: February 2021

The global deposition of superheavy pyrite (pyrite isotopically heavier than coeval seawater sulfate in the Neoproterozoic Era and particularly in the Cryogenian Period) defies explanation using the canonical marine sulfur cycle system. Here we report petrographic and sulfur isotopic data (δ34Spy) of superheavy pyrite from the Cryogenian Datangpo Formation (660–650 Ma) in South China. Our data indicate a syndepositional/early diagenetic origin of the Datangpo superheavy pyrite, with 34S-enriched H2S supplied from sulfidic (H2S rich) seawater. Instructed by a novel sulfur-cycling model, we propose that the emission of 34S-depleted volatile organosulfur compounds (VOSC) that were generated via sulfide methylation may have contributed to the formation of 34S-enriched sulfidic seawater and superheavy pyrite. The global emission of VOSC may be attributed to enhanced organic matter production after the Sturtian glaciation in the context of widespread sulfidic conditions. These findings demonstrate that VOSC cycling is an important component of the sulfur cycle in Proterozoic oceans.
The effects of nondigestible fermentable carbohydrates on adults with overweight or obesity: a meta-analysis of randomized controlled trials
Authors: Xu Bocheng , Cao Jinping , Fu Jie , Li Zhi , Jin Mingliang , Wang Xinxia , Wang Yizhen
Published: February 2021

Context

Nondigestible fermentable carbohydrates (NDFCs) can be fermented by microbiota, thereby yielding metabolites that have a beneficial role in the prevention and treatment of obesity and its complications. However, to our knowledge, no meta-analysis has been conducted to evaluate the effects of NDFCs on obesity.

Objective

To conduct a meta-analysis of randomized controlled trials (RCTs) to summarize existing evidence on the effects of numerous NDFCs on adiposity and cardiovascular risk factors in adults with overweight or obesity with ≥2 weeks of follow-up.

Data Sources

The following databases were searched: MEDLINE, Embase, and CINAHL.

Data Extraction

Seventy-seven RCTs with 4535 participants were identified for meta-analysis from the 3 databases.

Data Analysis

The findings suggest that increased intake of NDFCs is significantly effective in reducing body mass index by 0.280 kg/m2, weight by 0.501 kg, hip circumference by 0.554 cm, waist circumference by 0.649 cm, systolic blood pressure by 1.725 mmHg, total cholesterol by 0.36 mmol/L, and low-density lipoprotein by 0.385 mmol/L, with evidence of moderate-to-high quality.

Conclusion

Convincing evidence from meta-analyses of RCTs indicates that increased NDFC intake improves adiposity, blood lipid levels, and systolic blood pressure in people with overweight and obesity.
Trends in RPR Seropositivity among Children Younger than 2 Years in South Africa, 2010–2019
Authors: Mathebula Rudzani , Kuonza Lazarus , Musekiwa Alfred , Kularatne Ranmini , Puren Adrian , Reubenson Gary , Sherman Gayle , Kufa Tendesayi
Published: February 2021

A positive rapid plasma reagin (RPR) result in children under the age of 2 years indicates either passive transplacental transfer of maternal antibodies or active infection with syphilis (possible congenital syphilis). We describe trends in RPR seropositivity in this population using centralized laboratory data. A secondary analysis of laboratory data collected through the National Health Laboratory Service, Corporate Data Warehouse from 2010 to 2019 was conducted. Of the 127 150 children <2 years included in the analysis, 10 969 [8.6%; 95% confidence interval (95% CI) 85–88]) were RPR seropositive. RPR seropositivity increased from 6.5% to 13.0% between 2010 and 2019. Overall, the annual rate of RPR seropositivity was relatively stable between 2010 and 2018 with a range of 89–127/100 000 live births, increasing sharply to 165/100 000 livebirths in 2019. KwaZulu–Natal and North West provinces recorded the largest increases in annual seropositivity rate, while Eastern Cape and Western Cape had the most significant declines. Although this analysis is limited to laboratory results, in the absence of major changes in testing practices, there may be a rise in the burden of antenatal syphilis exposure in utero indicating an increase in maternal syphilis and syphilis transmission in the general population. South Africa needs to intensify Mother-to-Child Transmission of syphilis elimination efforts to reach the WHO target of ≤50 cases per 100 live births by 2030.
High-Density Genetic Linkage Map Construction and White Rot Resistance Quantitative Trait Loci Mapping for Genus Vitis Based on Restriction Site-Associated DNA Sequencing
Authors: Su Kai , Guo Yinshan , Zhong Weihao , Lin Hong , Liu Zhendong , Li Kun , Li Yuanyuan , Guo Xiuwu
Published: February 2021

Grape white rot (Coniothyrium diplodiella) is a major fungal disease affecting grape yield and quality. Quantitative trait locus (QTL) analysis is an important method for studying important horticultural traits of grapevine. This study was conducted to construct a high-density map and conduct QTL mapping for grapevine white rot resistance. A mapping population with 177 genotypes was developed from interspecific hybridization of a white rot-resistant cultivar (Vitis vinifera × V. labrusca ‘Zhuosexiang’) and white rot-susceptible cultivar (V. vinifera ‘Victoria’). Single-nucleotide polymorphism (SNP) markers were developed by restriction site-associated DNA sequencing. The female, male, and integrated maps contained 2,501, 4,110, and 6,249 SNP markers with average genetic distances of adjacent markers of 1.25, 0.77, and 0.50 cM, respectively. QTL mapping was conducted based on white rot resistance identification of 177 individuals in July and August of 2017 and 2018. Notably, one stable QTL related to white rot resistance was detected and located on linkage group LG14. The phenotypic variance ranged from 12.93 to 13.43%. An SNP marker (chr14_3929380), which cosegregated with white rot resistance, was discovered and shows potential for use in marker-assisted selection to generate new grapevine cultivars with resistance to white rot.
Risk Factors of Endotracheal Intubation-Related Pressure Injury among Patients Admitted to the ICU
Authors: Qin Lili , Yun Wenjuan , Hang Cheng
Published: February 2021

OBJECTIVE

To investigate the characteristics and risk factors of endotracheal intubation-related pressure injury (EIRPI) in patients admitted to the ICU and provide a basis for EIRPI prevention and treatment.

METHODS

A total of 156 patients with endotracheal intubation who were admitted to ICU at a first-class hospital from January to December 2018 were enrolled in this study. Investigators collected and analyzed data and outcomes such as patient characteristics (demographic and clinical), endotracheal catheter-related factors, and the assessment and features of pressure injuries.

RESULTS

The incidence of EIRPI was 23.7%. The most commonly affected site was the lip (76.7%). The incidence was affected by endotracheal intubation types, endotracheal catheter indwelling time, subglottic suction, catheter fixation, and fixator types (P < .05). In addition, the moisture, mobility, and friction/shear Braden subscale scores were also correlated with the incidence of pressure injury (P < .05). Long endotracheal catheter indwelling time, the use of catheters with subglottic suction, high Braden moisture subscale score, low Braden mobility subscale score, and low Braden friction and shear subscale scores were predictive factors for EIRPI (P < .05).

CONCLUSIONS

Patients in the ICU are at higher risk of developing EIRPI. Early identification of risk factors and timely intervention are the keys to preventing EIRPI.
Lipomatous Soft Tissue Masses of the Extremities: A Spectrum From Benign to Malignant
Authors: Nijor Sohn , Ali Sayed , Ling Stephen , Jonnalagadda Padmaja
Published: February 2021

Fat-containing masses are the most common solid, soft tissue masses encountered by radiologists and clinicians in everyday practice. The vast majority of these are benign. The imaging appearance of many fat-containing masses is frequently characteristic enough to suggest a specific diagnosis such as lipoma. However, there is a spectrum of benign and malignant fat-containing tumors with overlapping features. It is important to differentiate simple lipomas from well-differentiated liposarcomas due to differences in treatment, prognosis, and long-term follow-up. As molecular markers are increasingly being used for definitive characterization of tumors, we discuss their role and histopathologic characteristics of fat-containing soft tissue masses.
Maternal and Neonatal Outcomes Following a Prolonged Second Stage of Labor: A Meta-analysis of Observational Studies
Authors: Pergialiotis Vasilios , Bellos Ioannis , Antsaklis Aris , Papapanagiotou Angeliki , Loutradis Dimitrios , Daskalakis George
Published: February 2021

(Abstracted from Eur J Obstet Gynecol Reprod Biol 2020;252:62–69)

Prolonged second stage of labor and its impact on maternal and neonatal outcomes have been the focus of a number of research articles. Yet, strict consensus on these outcomes remains unclear.
Salpingectomy vs Tubal Ligation for Sterilization: A Systematic Review and Meta-analysis
Authors: Mills Kerry , Marchand Greg , Sainz Katelyn , Azadi Ali , Ware Kelly , Vallejo Janelle , Anderson Sienna , King Alexa , Osborn Asya , Ruther Stacy , Brazil Giovanna , Cieminski Kaitlynne , Hopewell Sophia , Rials Lisa , Klipp Angela
Published: February 2021

(Abstracted from Am J Obstet Gynecol 2020; doi: 10.1016/j.ajog.2020.09.011)

The association between removal of the fallopian tubes and decreased risk of ovarian cancer is well documented. Although complete removal of the fallopian tubes (salpingectomy) for the prevention of ovarian cancer seems promising, no unequivocal evidence supports this practice in women seeking sterilization.
Hemodynamic Parameters in the Assessment of Fluid Status in a Porcine Hemorrhage and Resuscitation Model
Authors: Wise Eric S. , Hocking Kyle M. , Polcz Monica E. , Beilman Gregory J. , Brophy Colleen M. , Sobey Jenna H. , Leisy Philip J. , Kiberenge Roy K. , Alvis Bret D.
Published: February 2021

Background

Measuring fluid status during intraoperative hemorrhage is challenging, but detection and quantification of fluid overload is far more difficult. Using a porcine model of hemorrhage and over-resuscitation, it is hypothesized that centrally obtained hemodynamic parameters will predict volume status more accurately than peripherally obtained vital signs.

Methods

Eight anesthetized female pigs were hemorrhaged at 30 ml/min to a blood loss of 400 ml. After each 100 ml of hemorrhage, vital signs (heart rate, systolic blood pressure, mean arterial pressure, diastolic blood pressure, pulse pressure, pulse pressure variation) and centrally obtained hemodynamic parameters (mean pulmonary artery pressure, pulmonary capillary wedge pressure, central venous pressure, cardiac output) were obtained. Blood volume was restored, and the pigs were over-resuscitated with 2,500 ml of crystalloid, collecting parameters after each 500-ml bolus. Hemorrhage and resuscitation phases were analyzed separately to determine differences among parameters over the range of volume. Conformity of parameters during hemorrhage or over-resuscitation was assessed.

Results

During the course of hemorrhage, changes from baseline euvolemia were observed in vital signs (systolic blood pressure, diastolic blood pressure, and mean arterial pressure) after 100 ml of blood loss. Central hemodynamic parameters (mean pulmonary artery pressure and pulmonary capillary wedge pressure) were changed after 200 ml of blood loss, and central venous pressure after 300 ml of blood loss. During the course of resuscitative volume overload, changes were observed from baseline euvolemia in mean pulmonary artery pressure and central venous pressure after 500-ml resuscitation, in pulmonary capillary wedge pressure after 1,000-ml resuscitation, and cardiac output after 2,500-ml resuscitation. In contrast to hemorrhage, vital sign parameters did not change during over-resuscitation. The strongest linear correlation was observed with pulmonary capillary wedge pressure in both hemorrhage (r

2
= 0.99) and volume overload (r

2
= 0.98).

Conclusions

Pulmonary capillary wedge pressure is the most accurate parameter to track both hemorrhage and over-resuscitation, demonstrating the unmet clinical need for a less invasive pulmonary capillary wedge pressure equivalent.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Median Effective Volume of 0.5% Ropivacaine for Ultrasound-guided Costoclavicular Block
Authors: Kewlani Anu , Bhatia Nidhi , Makkar Jeetinder Kaur , Kumar Vishal
Published: February 2021

Background

The median effective dose of ropivacaine required for producing an effective costoclavicular block has not yet been determined. The authors conducted this dose-finding study with the objective of determining the median effective dose of 0.5% ropivacaine required to produce a successful costoclavicular block for surgical anesthesia in 50% of the patients (ED50) as well as the calculated dose required for effective blockade in 95% of the patients (ED95).

Methods

This single-armed prospective study was conducted on 40 American Society of Anesthesiologists physical status I or II patients, aged 18 to 60 yr, with a body mass index of 18 to 30 kg/m2, scheduled to undergo forearm and hand surgeries under ultrasound-guided costoclavicular block. A volume of 0.5% ropivacaine administered in the costoclavicular space was determined using the sample up-and-down sequential allocation study design of binary response variables. The first patient received a volume of 26 ml of 0.5% ropivacaine. After a successful or unsuccessful block, the volume of local anesthetic was decreased or increased, respectively, by 2 ml in the next patient. Evaluation of sensory and motor block was performed every 5 min for 30 min and graded using a 3-point scale. Surgical anesthesia was considered to be successful if a minimum score of 14 was achieved and the surgeon was able to proceed with surgery without needing to supplement anesthesia.

Results

The volume of local anesthetic administered ranged from 8 to 26 ml. Centered isotonic regression with a bias-corrected Morris 95% CI derived by bootstrapping showed ED50 of 13.5 ml (95% CI, 11.5 to 15.4 ml) and ED95 of 18.9 ml (95% CI, 17.9 to 27.5 ml).

Conclusions

A 19-ml dose of 0.5% ropivacaine is likely to produce an effective ultrasound-guided costoclavicular block for providing adequate surgical anesthesia to 95% of the patients.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Associations Between Sexual Assault and Reproductive and Family Planning Behaviors and Outcomes in Female Veterans
Authors: Edmonds Stephanie W. , Mengeling Michelle A. , Syrop Craig H. , Torner James C. , Sadler Anne G.
Published: February 2021

OBJECTIVE:

To examine the relationship between lifetime sexual assault (defined as someone having experienced sexual assault in their lifetime) and reproductive health care seeking, contraception usage, and family planning outcomes in female veterans.

METHODS:

We conducted a secondary analysis of data collected between 2005 and 2008 from computer-assisted telephone interviews with 1,004 female veterans aged 20–52 years who were enrolled at two Midwestern Department of Veterans Affairs (VA) health care systems. Participants were asked about reproductive, mental, and general health histories, and about lifetime sexual assault. We assessed associations between reproductive histories and contraceptive use among participants who reported lifetime sexual assault, compared with those who had not experienced lifetime sexual assault, by using bivariate and multivariable logistic regression analyses. Lastly, we examined reasons why these participants had not sought Pap test screening.

RESULTS:

More than half (62%) of participants reported experiencing lifetime sexual assault. Because there was an association between older age and history of lifetime sexual assault (P<.001), we stratified the analysis by age. Women with a history of lifetime sexual assault were more likely to have had unprotected intercourse for a year or more (adjusted odds ratio [aOR] 2.31, 95% CI 1.35–3.96) and a teen pregnancy (aOR 2.10, 95% CI 1.07–4.12) than women who did not report lifetime sexual assault. When stratified by age, women aged 40–52 years with a history of lifetime sexual assault were more likely to report more than a year of unprotected sex, teen pregnancy, and not seeking prenatal care with their first pregnancy, than women aged 40–52 who did not report lifetime sexual assault. Women who experienced lifetime sexual assault were more likely to report not seeking Pap tests in the past owing to fear and anxiety when compared with women who had not experienced lifetime sexual assault.

CONCLUSION:

Female veterans who reported lifetime sexual assault had differences in family planning behaviors compared with women who did not report lifetime sexual assault. These findings have implications for clinicians and VA policymakers when determining family planning and reproductive care delivery needs for female veterans of reproductive age.
Locating Hormone-Releasing Contraceptive Implants Using Near-Infrared Light
Authors: Akturk Halis Kaan
Published: February 2021

BACKGROUND:

Long-term hormone-releasing contraceptive (etonogestrel) implants are highly effective in preventing pregnancy. In a minority of patients, implants cannot be located by palpation, increasing the risk of complications related to removal. Ultrasonography can be used to locate migrated or deeply inserted implants, but this requires expertise. Thus, alternative methods to locate contraceptive implants are needed.

METHOD:

Near-infrared light is sometimes used to facilitate venipuncture and has been described as a technique to locate implanted glucose sensors. Herein, I describe using near-infrared light to locate contraceptive implants. The near-infrared light was positioned perpendicularly and held 33 cm away from the arm. As soon as it is powered up, a reflection of the contraceptive implant is noticeable on the skin. The location of the implant is then marked before the removal procedure.

EXPERIENCE:

This method allowed the easy location of nonpalpable etonogestrel implants in five women.

CONCLUSION:

Near-infrared light was successful in locating nonpalpable etonogestrel implants. This novel method can be used as an alternative to ultrasonography.
Preimplantation Genetic Testing for Aneuploidy
Authors: Dahdouh Elias M.
Published: February 2021

Preimplantation genetic testing for aneuploidy was developed as an invasive embryo-selection technique and is extensively used in in vitro fertilization (IVF) cycles. Around 95,000 preimplantation genetic testing cycles were carried out in the United States between 2014 and 2016, the majority of which were performed for aneuploidy. The objective of preimplantation genetic testing for aneuploidy is to select for transfer a euploid embryo, after embryo biopsy and cytogenetic analysis. The current technique consists of applying comprehensive chromosome screening on trophectoderm cells after blastocyst-stage embryo biopsy. This article reviews all the published randomized controlled trials on preimplantation genetic testing for aneuploidy with comprehensive chromosome screening and comments on the subject of embryo mosaicism detected by this technique. Most of these trials have been criticized because they only included good prognosis patients having normal ovarian reserve producing a high number of embryos available for biopsy. Preimplantation genetic testing for aneuploidy does not improve ongoing pregnancy rates per cycle started when routinely applied on the general IVF population but seems to be a good tool of embryo selection for a selected category of patients with normal ovarian reserve, yet should be only practiced by experienced IVF clinics. If no euploid embryo is available after preimplantation genetic testing for aneuploidy, a low-level mosaic embryo can be considered and prioritized for transfer after appropriate genetic counseling.
Leveraging Real-World Evidence: A Paradigm Shift in Regulation
Authors: De Sugato , Larson Leanne , Kelly Kim , Hanson Beate , Mack Christina D.
Published: February 2021

The study methodology and regulatory frameworks for real-world data collection is quickly evolving, opening new avenues to use valid and robust real-world evidence (RWE) to support regulatory decision making. Although the Food and Drug Administration has historically accepted specific applications of RWE to support regulatory determinations, significant progress has been made in recent years to examine conditions in which this information can be used to support specific types of premarket decisions. Of note, hybrid study designs that incorporate aspects of randomized clinical trials, including randomization and pragmatic outcomes, are expected to be a driving factor to accelerate the adoption of RWE in regulatory contexts. Generation of RWE to better understand effectiveness and safety of orthopaedic- and trauma-related devices requires careful planning, but it is achievable as demonstrated by the Bioventus Observational Non-Interventional EXOGEN Studies (BONES) clinical development program. This article examines the role of RWE in regulatory decision making and reviews key concepts in RWE study design methodology to facilitate creation of valid scientific evidence in support of marketing authorizations.
Percent of Normal: A Pragmatic Patient-Reported Outcome Measure for the Orthopaedic Trauma Clinic
Authors: Parry Joshua A. , Peterson Shian L. , Strage Katya E. , Hadeed Michael , Heare Austin , Stacey Stephen C. , Mauffrey Cyril
Published: February 2021

Objectives:

To compare a single numerical patient-reported outcome measure (PROM) to general health and injury-specific PROMs.

Design:

Retrospective cohort.

Setting:

Urban Level 1 trauma center.

Patients/Participants:

The study included 175 patients with 34 humerus, 54 pelvis, 31 acetabular, and 56 ankle fractures.

Main Outcome Measurements:

Patients were administered 3 PROMs: the 12-item short-form (SF-12), an injury-specific PROM (QuickDASH—humerus; Majeed Pelvic Outcome Score (Majeed)—pelvis; modified Merle d’Aubigne score (Merle)—acetabular; Foot and Ankle Disability Index (FADI)—ankle, and the Percent of Normal (PON) PROM, a single numerical PROM, which asked, “How would you rate yourself, if 100% is back to normal?” Floor/ceiling effect, convergent validity, and responsiveness of PROMs were assessed.

Results:

None of the PROMs demonstrated a floor effect. The Merle was the only PROM with a ceiling effect (19%). The PON had a strong correlation with the QuickDASH (r = 0.78) and Majeed (r = 0.78); a moderate association with the SF-12 physical component score (r = 0.63), Merle (r = 0.67), and FADI (r = 0.55); and a weak association with the SF-12 mental component score (r = 0.22). The regression coefficient for change in PROM over time, a measure of responsiveness, was greater for the PON compared with the SF-12 physical component score/mental component score, Majeed, Merle, and FADI, but not the QuickDASH.

Conclusions:

The PON is a pragmatic PROM that can be easily administered in clinic by the physician to quickly assess and manage a variety of fractures, avoiding the disadvantages of nonrelative general or region-specific PROMs.
Modified K-Line in Neck Extension Is a Prognostic Indicator of the Surgical Outcome at 5 Years After Cervical Laminoplasty for Cervical Spondylotic Myelopathy
Authors: Takeuchi Kazunari , Yokoyama Toru , Wada Kanichiro , Kumagai Gentaro , Kudo Hitoshi , Tanaka Sunao , Asari Toru , Sasaki Eiji , Koyama Kazushige , Ichinohe Masayuki , Ishibashi Yasuyuki
Published: February 2021

Study Design.

A retrospective comparison of the surgical outcome after cervical laminoplasty for cervical spondylotic myelopathy (CSM) using a modified K-line based on lordosis in neck extension as a predictor: in K-line Back CSM (KB group), the K-line crosses the ventral edge of any of the spinous processes, whereas in K-line Front CSM (KF group), the K-line does not.

Objective.

To investigate the neurological and radiological outcomes 5 years after surgery and the contact between the spinal cord and posterior elements after laminoplasty for CSM using the modified K-line.

Summary of Background Data.

No indicators on a lateral radiograph can predict the neurological outcome after laminoplasty for CSM.

Methods.

Patients with CSM were divided into KB (n = 20) and KF groups (n = 13). We compared the postoperative Japanese Orthopedic Association (JOA) score, recovery rate, grip-and-release and foot-tapping test results, alignment, and contact between the spinal cord and posterior elements between the two groups.

Results.

The postoperative JOA score and its recovery rate were significantly lower in the KB group (12.4 points and 34.1%, respectively) than in the KF group (14.1 points and 59.0%, respectively) at final follow-up (P = 0.0415 and 0.0458). The grip-and-release and foot-tapping test results improved significantly in the KF group but not in the KB group. In the KB group, a larger lordotic angle in extension at 1 year postoperatively continued until final follow-up. The rate of recovery of the JOA score in patients with contacts at both C4/5 and C5/6 and any contact in the KB group (−1.5% and 31.9%, respectively) were lower (P = 0.0013 and 0.0534, respectively) than those in the KF group (58.6% and 60.7%, respectively).

Conclusion.

The K-line Back predicts a poor neurological outcome after laminoplasty for CSM. Decompression with fusion may be recommended for these patients.

Level of Evidence: 4
Nocturnal Hypoglycemia in Patients With Diabetes Discharged From ICUs: A Prospective Two-Center Cohort Study*
Authors: Ali Abdelhamid Yasmine , Bernjak Alan , Phillips Liza K. , Summers Matthew J. , Weinel Luke M. , Lange Kylie , Chow Elaine , Kar Palash , Horowitz Michael , Heller Simon , Deane Adam M.
Published: February 2021

OBJECTIVES:

There is very limited information about glycemic control after discharge from the ICU. The aims of this study were to evaluate the prevalence of hypoglycemia in ICU survivors with type-2 diabetes and determine whether hypoglycemia is associated with cardiac arrhythmias.

DESIGN:

Prospective, observational, two-center study. Participants underwent up to 5 days of simultaneous blinded continuous interstitial glucose monitoring and ambulatory 12-lead electrocardiogram monitoring immediately after ICU discharge during ward-based care. Frequency of arrhythmias, heart rate variability, and cardiac repolarization markers were compared between hypoglycemia (interstitial glucose ≤ 3.5 mmol/L) and euglycemia (5–10 mmol/L) matched for time of day.

SETTING:

Mixed medical-surgical ICUs in two geographically distinct university-affiliated hospitals.

PATIENTS:

Patients with type-2 diabetes who were discharged from ICU after greater than or equal to 24 hours with greater than or equal to one organ failure and were prescribed subcutaneous insulin were eligible.

MEASUREMENTS AND MAIN RESULTS:

Thirty-one participants (mean ± sd, age 65 ± 13 yr, glycated hemoglobin 64 ± 22 mmol/mol) were monitored for 101 ± 32 hours post-ICU (total 3,117 hr). Hypoglycemia occurred in 12 participants (39%; 95% CI, 22–56%) and was predominantly nocturnal (40/51 hr) and asymptomatic (25/29 episodes). Participants experiencing hypoglycemia had 2.4 ± 0.7 discrete episodes lasting 45 minutes (interquartile range, 25–140 min). Glucose nadir was less than or equal to 2.2 mmol/L in 34% of episodes. The longest episode of nocturnal hypoglycemia was 585 minutes with glucose nadir less than 2.2 mmol/L. Simultaneous electrocardiogram and continuous interstitial glucose monitoring recordings were obtained during 44 hours of hypoglycemia and 991 hours of euglycemia. Hypoglycemia was associated with greater risk of bradycardia but did not affect atrial or ventricular ectopics, heart rate variability, or cardiac repolarization.

CONCLUSIONS:

In ICU survivors with insulin-treated type-2 diabetes, hypoglycemia occurs frequently and is predominantly nocturnal, asymptomatic, and prolonged.
Health-Related Quality-of-Life and Cost Utility Analyses in Critical Care: A Systematic Review*
Authors: Lau Vincent I. , Xie Feng , Basmaji John , Cook Deborah J. , Fowler Robert , Kiflen Michel , Sirotich Emily , Iansavichene Alla , Bagshaw Sean M. , Wilcox M. Elizabeth , Lamontagne François , Ferguson Niall , Rochwerg Bram
Published: February 2021

OBJECTIVES:

Cost utility analyses compare the costs and health outcome of interventions, with a denominator of quality-adjusted life year, a generic health utility measure combining both quality and quantity of life. Cost utility analyses are difficult to compare when methods are not standardized. It is unclear how cost utility analyses are measured/reported in critical care and what methodologic challenges cost utility analyses pose in this setting. This may lead to differences precluding cost utility analyses comparisons. Therefore, we performed a systematic review of cost utility analyses conducted in critical care. Our objectives were to understand: 1) methodologic characteristics, 2) how health-related quality-of-life was measured/reported, and 3) what costs were reported/measured.

DESIGN:

Systematic review.

DATA SOURCES:

We systematically searched for cost utility analyses in critical care in MEDLINE, Embase, American College of Physicians Journal Club, CENTRAL, Evidence-Based Medicine Reviews’ selected subset of archived versions of UK National Health Service Economic Evaluation Database, Database of Abstracts of Reviews of Effects, and American Economic Association electronic databases from inception to April 30, 2020.

SETTING:

Adult ICUs.

PATIENTS:

Adult critically ill patients.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Of 8,926 citations, 80 cost utility analyse studies were eligible. The time horizon most commonly reported was lifetime (59%). For health utility reporting, health-related quality-of-life was infrequently measured (29% reported), with only 5% of studies reporting baseline health-related quality-of-life. Indirect utility measures (generic, preference-based health utility measurement tools) were reported in 85% of studies (majority Euro-quality-of-life-5 Domains, 52%). Methods of estimating health-related quality-of-life were seldom used when the patient was incapacitated: imputation (19%), assigning fixed utilities for incapacitation (19%), and surrogates reporting on behalf of incapacitated patients (5%). For cost utility reporting transparency, separate incremental costs and quality-adjusted life years were both reported in only 76% of studies. Disaggregated quality-adjusted life years (reporting separate health utility and life years) were described in only 34% of studies.

CONCLUSIONS:

We identified deficiencies which warrant recommendations (standardized measurement/reporting of resource use/unit costs/health-related quality-of-life/methodological preferences) for improved design, conduct, and reporting of future cost utility analyses in critical care.
The Association Between Antibiotic Delay Intervals and Hospital Mortality Among Patients Treated in the Emergency Department for Suspected Sepsis*
Authors: Taylor Stephanie Parks , Anderson William E. , Beam Kent , Taylor Brice , Ellerman Justin , Kowalkowski Marc A.
Published: February 2021

OBJECTIVES:

Rapid delivery of antibiotics is a cornerstone of sepsis therapy, although time targets for specific components of antibiotic delivery are unknown. We quantified time intervals comprising the task of antibiotic delivery and evaluated the association between interval delays and hospital mortality among patients treated in the emergency department for suspected sepsis.

DESIGN:

Retrospective cohort.

SETTING:

Twelve hospitals in Southeastern United States from 2014 to 2017.

PATIENTS:

Twenty-four thousand ninety-three encounters among 20,026 adults with suspected sepsis in 12 emergency departments.

MEASUREMENTS AND MAIN RESULTS:

We divided antibiotic administration into two intervals: time from emergency department triage to antibiotic order (recognition delay) and time from antibiotic order to infusion (administration delay). We used generalized linear mixed models to evaluate associations between these intervals and hospital mortality. Median time from emergency department triage to antibiotic administration was 3.4 hours (interquartile range, 2.0–6.0 hr), separated into a median recognition delay (time from emergency department triage to antibiotic order) of 2.7 hours(interquartile range, 1.5–4.7 hr) and median administration delay (time from antibiotic order to infusion) of 0.6 hours (0.3–1.2 hr). Adjusting for other risk factors, both recognition delay and administration delay were associated with mortality, but pairwise comparison with a no-delay reference group was not significant for up to 6 hours of recognition delay or up to 1.5 hours of administration delay.

CONCLUSIONS:

Both recognition delays and administration delays were associated with increased hospital mortality, but only for longer delays. These results suggest that both metrics may be important to measure and improve for patients with suspected sepsis but do not support targets less than 1 hour.
Sialic acid-binding immunoglobulin-like lectin 9 as a potential therapeutic target for chronic obstructive pulmonary disease
Authors: Chen Zi , Xu Shuang-Lan , Ge Lin-Yang , Zhu Jin , Zheng Tao , Zhu Zhou , Zhou Linfu
Published: February 2021

Chronic obstructive pulmonary disease (COPD) has become the third-leading cause of death worldwide, which is a severe economic burden to the healthcare system. Chronic bronchitis is the most common condition that contributes to COPD, both locally and systemically. Neutrophilic inflammation predominates in the COPD airway wall and lumen. Logically, repression of neutrophilia is an essential fashion to COPD treatment. However, currently available anti-neutrophilic therapies provide little benefit in COPD patients and may have serious side effects. Thus, there is an urgent need to explore an effective and safe anti-neutrophilic approach that might delay progression of the disease. Sialic acid-binding immunoglobulin-like lectin (Siglec)-9 is a member of the Siglec cell surface immunoglobulin family. It is noteworthy that Siglec-9 is highly expressed on human neutrophils and monocytes. Ligation of Siglec-9 by chemical compounds or synthetic ligands induced apoptosis and autophagic-like cell death in human neutrophils. Furthermore, administration of antibody to Siglec-E, mouse functional ortholog of Siglec-9, restrained recruitment and activation of neutrophils in mouse models of airway inflammation in vivo. Given the critical role that neutrophils play in chronic bronchitis and emphysema, targeting Siglec-9 could be beneficial for the treatment of COPD, asthma, fibrosis, and related chronic inflammatory lung diseases.
Impact of staging on survival outcomes: a nationwide real-world cohort study of metastatic uveal melanoma
Authors: Rantala Elina S. , Kivelä Tero T. , Hernberg Micaela M.
Published: February 2021

No data exist regarding whether any first-line treatment for metastatic uveal melanoma provides overall survival (OS) benefit, if staged and compared to best supportive care (BSC). We analyzed OS in a nationwide, consecutive cohort diagnosed with metastatic uveal melanoma between January 1999 and December 2016. The Helsinki University Hospital Working Formulation was used to assign patients to stage IVa, IVb and IVc, corresponding to predicted median OS ≥12, <12–6 and <6 months, respectively. OS of 216 actively treated patients was compared by treatment and working formulation stage against 108 similarly staged, concurrent patients managed with BSC using Kaplan–Meier analysis and Cox regression. The median OS with active treatment was 18 (range, 0.7–162), 6.9 (range, 1.3–30) and 1.9 (range, 0.2–18) months in working formulation stage IVa, IVb and IVc, respectively. Patients who received chemoimmunotherapy, selective internal radiation therapy, or underwent surgical resection survived longer – median OS 13, 16 and 24 months, respectively – than those receiving conventional chemotherapy – median OS 5.1 months – but only with surgical resection their OS exceeded that with BSC, both overall and in stage IVa (P < 0.001, P = 0.010). In stage IVb and IVc, no difference in OS was observed in any comparison. Staging of patients is crucial when comparing survival after metastatic uveal melanoma. Only surgical resection for stage IVa disease provided longer OS in our national cohort. We additionally recommend stage-specific comparison of novel treatments against available BSC data.
Long-standing Multifocal Motor Neuropathy Presenting With Delayed Clinical Features of Anti–Myelin-Associated Glycoprotein Neuropathy and Elevated Anti–Myelin-Associated Glycoprotein Antibody Titers
Authors: Bernardo Katrina A. , Weiss Michael D.
Published: February 2021

Multifocal motor neuropathy with conduction block (MMN) and anti–myelin-associated glycoprotein (MAG) neuropathy are rare chronic acquired demyelinating neuropathies with distinct clinical and electrophysiological characteristics. These neuropathies are generally not known to coexist. This report describes a patient with long-standing MMN who subsequently developed clinical features of anti-MAG neuropathy. This suggests that subtypes of chronic inflammatory neuropathies may not be sharply defined. In addition, a presentation of MMN with anti-MAG titers may be a prognostic indicator of poor response to standard MMN treatment.
The Impact of Nonpharmacological Interventions on Sleep Quality Among Older Adult Patients in the Intensive Care Unit
Authors: Bae Grace , Lim Fidelindo
Published: February 2021

Sleep is a basic human need that is required for good health and overall well-being. Adequate sleep is critical for cognitive functioning, memory consolidation, and emotional regulation by rejuvenating the body. Sleep may not be of significant concern unless it becomes lacking or disturbed as it alters the immune function, neurological processes, and intellectual and decision making of individuals. Hospitalized older adults are particularly vulnerable for the negative impact of poor sleep due to reduced physiological reserve and comorbidities. The purpose of this review is to appraise current evidence on nonpharmacological sleep interventions to promote better sleep quality and overall health outcomes among the general adult and older patients in the intensive care unit compared with no intervention at all. The findings of this integrative review will be useful in designing and implementing interdisciplinary plans of care that promote the use of nonpharmacological sleep protocols within the hospital setting.
Nursing Insights on Delirium in the Intensive Care Unit
Authors: Balasanova Alëna A. , Park Dongchan
Published: February 2021

Delirium is a common complication of critical illness. As frontline providers, nurses (registered nurses) are uniquely positioned to inform interventions to improve intensive care unit (ICU) patient outcomes. This article reports a study of attitudes and knowledge about ICU delirium assessment at an urban academic medical center. Findings suggest a knowledge deficit regarding the spectrum of delirium. ICU nurses also identified that a lack of effective collaboration within the treatment team was the biggest barrier to effective care for the patient with hypoactive delirium. The study findings indicate that both educational and management initiatives are needed to improve clinical practices for patients with manifestations of hypoactive and hyperactive delirium.
Prevalence and Correlates of Attention-Deficit Hyperactivity Disorder in a Diverse, Treatment-Seeking Pediatric Overweight/Obesity Sample
Authors: Merrill Brittany M. , Morrow Anne S. , Sarver Dustin , Sandridge Shanda , Lim Crystal S.
Published: February 2021

Objective:

Attention-deficit hyperactivity disorder (ADHD) and obesity are highly prevalent, impairing, and costly conditions, affecting about 10% of children each. Research indicates heightened prevalence of childhood obesity among youth with ADHD. However, more research is needed, examining comorbid ADHD among youth with overweight/obesity (OV/OB) from diverse demographic backgrounds and effects on medically relevant behaviors. The aim of the current study was to examine the prevalence of ADHD in a racially diverse sample of youth in a weight management clinic. Furthermore, we examined the effects of race, rurality, and ADHD on weight status and health behaviors in this under-researched population.

Method:

Participants included 1003 patients (Mage = 12.55; 58% female; 67% Black/African American; MBMI Z-Score = 2.54; 98.6% with obesity) in a pediatric weight management clinic serving a rural and urban/suburban area in the southern United States. Parent-reported demographics, ADHD diagnosis, and child health behaviors were recorded.

Result:

In total, 17.6% (n = 177) of the sample had an ADHD diagnosis. ADHD status interacted with race to predict standardized body mass index (BMIz), and rurality predicted higher BMIz. Children with comorbid ADHD had significantly more meals per day and fewer active days compared with children with OV/OB without ADHD.

Conclusion:

ADHD prevalence was higher in this diverse sample of children seeking obesity treatment (17.6%) compared with the prevalence nationally (9%–10%) and in other obesity samples. Comorbid ADHD was related to higher weight status among racial minority youth and increased engagement in unhealthy lifestyle behaviors often targeted in weight management treatment. It is critical to screen for ADHD in pediatric specialty clinics and assess healthy lifestyle behaviors.