bluuebunny/crossref_metadata_2025 huggingface dataset:
Anteroposterior pelvic radiograph is not sufficient to confirm hip reduction after conservative treatment of developmental dysplasia of the hip
Authors: Fan Minjie , Wang Yiwei , Pang Haotian , Lou Yue , Zheng Pengfei
Published: May 2022

The purpose of this study was to investigate whether an anteroposterior pelvic radiograph alone is sufficient to confirm hip reduction after conservative treatment or whether MRI could be alternatively performed. A total of 133 children (145 hips) were enrolled. All children were examined by anteroposterior pelvic radiographs and MRI. Three experts interpreted anteroposterior pelvic radiographs and then verified these results on MRI. For patients with inconsistent results between anteroposterior pelvic radiographs and MRI, the continuity of Shenton’s line and Calve’s line was recorded, and the medial clear space of bilateral hips was measured for unilateral cases. There was complete agreement between the three experts in the interpretation of anteroposterior pelvic radiographs of 111 (76.55%) hips; there was disagreement in the remaining 34 hips, with two experts diagnosing satisfactory reduction in 13 hips and dislocation in 21 hips. Assuming that the judgment of two or more doctors on anteroposterior pelvic radiographs was taken as the final result, 17 hips (11.72%) were misjudged. There was no statistically significant difference between the actual in-position group and the actual dislocation group in terms of the continuity of Shenton’s line (P = 0.62) and Calve’s line (P = 0.10) and the medial clear space of bilateral hips (P = 0.08). In children less than 1 year of age with developmental dysplasia of the hip treated conservatively, the use of anteroposterior pelvic radiographs alone to judge hip reduction might result in misdiagnosis and missed diagnosis. MRI could be alternatively used to detect hip reduction after conservative treatment, especially when the doctor was not familiar with ultrasound in the presence of plaster.
Sacral-Alar-Iliac (SAI) Fixation in Patients With Previous Pelvic Osteotomy
Authors: Mun Frederick , Vankara Ashish , Suresh Krishna V. , Margalit Adam , Sponseller Paul D.
Published: May 2022

Study Design:

This was a retrospective study.

Objective:

The purpose of this study was to investigate the technical challenges and outcomes of sacral-alar-iliac (SAI) fixation for scoliosis in patients who had previously undergone a pelvic osteotomy for hip dysplasia.

Summary of Background Data:

Patients with neuromuscular disease are at high risk for developing hip dislocation and scoliosis. Surgical correction of one may affect the other.

Methods:

We reviewed the records of patients aged 18 years and below who underwent spinal fusion using SAI screws after having undergone a pelvic osteotomy, with ≥2-year follow-up. We recorded the SAI screw dimensions, time from osteotomy to SAI fixation, type of osteotomy, and any complications performing SAI fixation due to the pelvic osteotomy. Bivariate statistics were used to analyze the data with statistical significance defined as P-value <0.05.

Results:

Thirty-two patients were included. The average age was 10.3±3.2 years at pelvic osteotomy and 13.5±3.4 years at SAI fixation. Most patients had cerebral palsy (87.5%) and a unilateral Dega osteotomy (78.1%). Average screw dimensions were significantly shorter on the side of the osteotomy (66 vs. 72 mm, P<0.05). SAI screw placement was technically challenging in 8 patients (25%), due to pelvic distortion from the pelvic osteotomy. The use of a curved awl helped to find the intracortical channel. No patients had complications due to the SAI screw, and there were no significant differences in pelvic obliquity and major coronal curve correction. Two patients (6.3%) had screw lucency >2 mm around the SAI screw on the side of the pelvic osteotomy but no clinical symptoms.

Conclusions:

SAI fixation in patients with previous pelvic osteotomy is technically challenging due to pelvic morphology and prior implants. Often, a shorter SAI screw is required on the side of the osteotomy. However, outcomes in this patient population are satisfactory, with no significant complications at a 2-year follow-up.

Level of Evidence:

Level IV.
Clinicopathologic Features of Facial Dermatofibromas, a Cohort Study, and a Systematic Review of Literature
Authors: Alsawas Mouaz , Dundar Bilge , Prokop Larry , Murad M. Hassan , Swick Brian
Published: May 2022

Background:

Dermatofibromas are common skin tumors that typically occur on the extremities and trunk and demonstrate benign behavior, frequent recurrences, and very rare metastasis. Facial dermatofibromas are rare and not well studied. We analyzed clinicopathologic features of facial dermatofibromas.

Design:

Considering the rarity of the condition, we conducted a cohort study and a systematic review. We queried medical records of a single tertiary care center for dermatofibromas from January 1, 2000, to July 1, 2021. A systematic review of multiple databases was conducted through October 27, 2021, to include studies reporting facial dermatofibromas. Random-effects meta-analysis was used to estimate pooled odds ratio and proportions with associated 95% confidence interval (CI).

Results:

The cohort study identified 2858 cases of dermatofibromas, of which, 23 cases from 18 patients were on the face (1%). The mean age was 52.7 ± 17.8 years. Fifty-six percent of the cases were women. The most common location was the forehead (6 cases). The mean follow-up was 54 months. Forty-four percent of the cases had subcutaneous involvement, and 39% were the cellular type. Margins were positive in 89% of the cases, recurrence rate was 22%, and no metastases were observed. The systematic review included 10 studies (119 patients). Meta-analyses showed that facial dermatofibromas were 2% of all dermatofibromas (95% CI: 1%–3%). The local recurrence rate was 14% (95% CI: 6%–26%). Facial dermatofibromas with subcutaneous involvement were more likely to recur [odds ratio 4.53 (95% CI: 1.12–18.24)]. Before histopathologic examination, clinical differential diagnosis included dermatofibromas in only 9% of the cases (95% CI: 2%–19%).

Conclusion:

Facial dermatofibromas are rare and are difficult to fully excise. Cellular type and subcutaneous or muscular involvement are common in these cases and tend to have higher local recurrence rate than other nonfacial dermatofibromas. Wider excisions might be necessary for complete excision.
Connexin 43 Expression in Cutaneous Biopsies of Lupus Erythematosus
Authors: Fernandez-Flores Angel , Varela-Vazquez Adrian , Mayan Maria D. , Cassarino David , Fonseca Eduardo
Published: May 2022

Introduction:

Gap junctions are channels between adjacent cells formed by connexins (Cxs). Cxs also form hemichannels that connect the cell with its extracellular milieu. These channels allow the transport of ions, metabolites, and small molecules; therefore, Cxs, and more specifically, connexin (Cx) 43 has been demonstrated to be in control of several crucial events such as inflammation and cell death.

Material and methods:

We examined the immunostaining of Cx43 in the endothelia of the cutaneous blood vessels of biopsies from 28 patients with several variants of lupus erythematosus.

Results:

In 19 cases (67.86%), staining of more than half of the dermal vessels including both vessels of the papillary and of the reticular dermis was identified. Only in 4 cases (14.28%), less than 25% of the vessels in the biopsy showed expression of the marker.

Conclusions:

Our results suggest a role of Cx43 in regulating the endothelial activity in lupus erythematosus, which also opens a door for targeted therapeutic options.
DELAYED FOLLOW-UP IN PATIENTS WITH NEOVASCULAR AGE-RELATED MACULAR DEGENERATION TREATED UNDER UNIVERSAL HEALTH COVERAGE
Authors: Rozon Jean-Philippe , Hébert Mélanie , Laverdière Carolane , Lachance Alexandre , Bourgault Serge , Caissie Mathieu , Letartre Laurence , Tourville Eric , Dirani Ali
Published: May 2022

Background/Purpose:

To report the rate of delayed follow-up visits (DFU), to identify risk factors of DFU, and to assess the impact of DFU on outcomes in neovascular age-related macular degeneration.

Methods:

This retrospective study included all patients with neovascular age-related macular degeneration (n = 1,291) treated with antivascular endothelial growth factor injections between January 2013 and December 2020 in 2 centers in Quebec, Canada. A DFU was defined as a delay of ≥4 weeks than scheduled. Visual outcomes, especially ≥15 letters loss, were reported.

Results:

A total of 351 patients (27.2%) experienced ≥1 DFU. Odds were greater among older patients (P = 0.005), patients treated at the hospital rather than the clinic (P < 0.001), and patients with worse initial visual acuity (P = 0.024). A DFU was associated with a mean visual acuity loss of 4.2 ± 13.4 letters (P < 0.001) and an increased incidence of intraretinal fluid and subretinal fluid (P = 0.001, P = 0.005) at 6 months despite resumption of injections. Central foveal thickness increased after DFU but returned to pre-DFU visit at 6 months.

Conclusion:

The DFU rate in patients with neovascular age-related macular degeneration treated under a universal health care system was around 27%. Delayed follow-up visits caused significant decreases in visual acuity and increases in intraretinal fluid and subretinal fluid on optical coherence tomography that did not recover after injections resumption despite normalization of central foveal thickness.
FLOW AND GEOMETRICAL ALTERATIONS IN RETINAL MICROVASCULATURE CORRELATED WITH THE OCCURRENCE OF DIABETIC RETINOPATHY
Authors: Wang Wei , Chen Yanping , Kun Xiong , Gong Xia , Liu Hua , Wei Daheng , Wang Dongning , Liang Xiaolin , Huang Wenyong
Published: May 2022

Purpose:

To assess the relationship between flow and geometric parameters in optical coherence tomography angiography images and the risk of incident diabetic retinopathy (DR).

Methods:

This prospective, observational cohort study recruited patients with Type 2 diabetes without DR in Guangzhou, China, and followed up annually. A commercially available optical coherence tomography angiography device (DRI OCT Triton; Topcon Inc, Tokyo, Japan) was used to obtain a variety of flow (foveal avascular zone area, vessel density, and vessel length density) and geometric (fractal dimension and blood vessel tortuosity) parameters in superficial capillary plexus (SCP) and deep capillary plexus. The odds ratio (OR) and its 95% confidence interval (CI) were calculated per 1-SD increase in each optical coherence tomography angiography parameter.

Results:

Over a follow-up of 1 year, 182 of 1,698 participants (10.7%) developed incident DR. After adjusting for conventional risk factors and image quality score, the higher risk of DR onset was significantly associated with the reduced parafoveal vessel density of SCP (OR = 0.81; 95% CI: 0.69, 0.96; P = 0.016), reduced parafoveal vessel length density of SCP (OR = 0.73; 95% CI: 0.59, 0.90; P = 0.003), reduced fractal dimension of SCP (OR = 0.73; 95% CI: 0.61, 0.87; P < 0.001), increased blood vessel tortuosity of SCP (OR = 1.39; 95% CI: 1.18, 1.64; P < 0.001), and increased blood vessel tortuosity of deep capillary plexus (OR = 1.19; 95% CI: 1.01, 1.40; P = 0.033).

Conclusion:

Reduced vessel density and impaired vessel geometry posed higher susceptibility for DR onset in patients with Type 2 diabetes, supporting the adoption of optical coherence tomography angiography parameters as early monitoring indicators of the newly incident DR.
Presenting Characteristics for Symptomatic, as Compared to Asymptomatic (assumed), Orbital Cavernous Venous Malformations
Authors: Vahdani Kaveh , Rose Geoffrey E.
Published: May 2022

Aims:

To compare the characteristics for symptomatic and asymptomatic orbital cavernous venous malformations (OCVMs).

Methods:

A retrospective case-note review for patients with OCVMs was performed for demographics and presenting features.

Results:

Four hundred and fourteen patients (258 female; 62%) presented at a mean age of 49.4 years and all were unilateral. Ninety-two (22%) asymptomatic OCVMs were found a decade later than 322 symptomatic patients (57.8 vs. 47.0 years; p < 0.001). Patients with symptomatic OCVMs had an average symptom duration of 3.3 years with the commonest being altered vision (57%), proptosis (55%), orbital ache (21%), and diplopia (13%). Visual obscurations were reported by 11% of symptomatic patients, whereas 30% had a hyperopic shift.

Mean LogMAR was 0.39 for symptomatic OCVMs and 0.1 for asymptomatic (p < 0.001), and a relative afferent pupillary defect was detected in 38% symptomatic and 7% asymptomatic patients (p < 0.001). Mean relative exophthalmos was 3.9 mm in symptomatic patients and 1.5 mm in asymptomatic (p < 0.001), but there was no correlation between age and exophthalmos. Symptomatic lesions had higher rates of nonaxial displacement (30% vs. 7%; p < 0.00001), more palpable masses (17% vs. 2%; p = 0.0001), and more impairment of motility (29% vs. 10%; p = 0.0024). Fundal abnormalities were noted in 63% of patients with symptomatic OCVMs, as compared to 26% of asymptomatic (p < 0.0001).

Conclusion:

Symptomatic OCVMs may present with reduced visual function, either due to the globe or optic nerve compression, or proptosis. Asymptomatic (presumed) OCVMs— representing 22% of all OCVMs—are usually found a decade later than symptomatic lesions, and a few may have only mild functional impairment.
Functional Versus Anatomical Nasolacrimal Obstruction: Are There Differences in Epiphora Severity, Symptoms, or Effects on Quality of Life?
Authors: Shapira Yinon , Macri Carmelo , Selva Dinesh
Published: May 2022

Purpose:

To elucidate whether the specific cause of nasolacrimal duct drainage impairment impacts the severity, symptoms, and implications on visual tasks and quality of life (QOL) in epiphora.

Methods:

A retrospective review of consecutive adult patients with epiphora attending a tertiary lacrimal clinic from June 2011 to March 2021 was conducted. Cases with evidence of canalicular stenosis, a mucocele, or other identifiable causes of epiphora were excluded. A structured interview assessed the epiphora severity (Munk), symptomatology, precipitating factors, and effects on visual tasks and QOL. Following lacrimal syringing, all eyes were investigated with dacryocystography and dacryoscintigraphy. The domains of the interview were compared between nasolacrimal duct obstruction (NLDO), stenosis (NLDS), and nonanatomical functional delay (FNLDO).

Results:

One hundred twenty-two symptomatic eyes (63 patients; mean age 63.3 ± 17.2 years; 59% females) were included. There was no difference in Munk score between the groups (NLDO = 3.71 ± 0.18, NLDS = 3.79 ± 2.0, FNLDO = 3.85 ± 0.15; p = 0.82). In all 3 groups, most cases had a Munk >2 (86.8%, 75.9%, and 89.1%, respectively; p = 0.25). Discharge was more common in NLDO (65.7%) compared with NLDS (30.0%) and FNLDO (36.4%, p = 0.006). Worsening in the cold/wind was more frequent in FNLDO (77.1%) compared with NLDO (48.5%, p = 0.029). Effects on visual tasks and QOL were not significantly different.

Conclusions:

FNLDO patients experience a high severity of epiphora, comparable to patients with NLDS and those with complete NLDO. The distinction between FNLDO and NLDS had little consequence on reported symptoms, precipitating factors, visual tasks, and QOL. Discharge may be more specific to NLDO, whereas precipitating cold or wind is more specific to FNLDO.
Qualitative evidence synthesis using meta-ethnography to understand the experience of living with osteoarthritis pain
Authors: Toye Francine , Seers Kate , Barker Karen Louise
Published: May 2022

Osteoarthritis pain affects the lives of a large number of people around the world. Understanding other people's experience is integral to effective care, and qualitative research can have an important part to play in education and good clinical practice. We aimed to systematically search for, identify, and synthesise qualitative research exploring the experience of living with osteoarthritis to incorporate this knowledge into an educational resource. We comprehensively searched 4 bibliographic databases and used the methods of meta-ethnography to synthesise qualitative research findings. We screened 10,123 titles, 548 abstracts, and 139 full texts. We included findings from 118 reports (105 unique samples) of at least 2534 adults living with osteoarthritis around the world. We developed 7 themes from more than 600 findings: it is part of my life's tapestry; (yet) it is consuming me; it constrains my body and my occupations; I am becoming separated, yet dependent; I accept, but I will not let it define me; and (yet) this makes me feel less than the person I was. Our findings highlight the profound impact that osteoarthritis can have on people's lives and the struggle to hold onto a sense of self. They indicate that recognising these losses, and taking osteoarthritis seriously, is an integral part of effective health care. This finding may be transferable beyond this condition.
Efficacy and safety of S-1 based adjuvant chemoradiotherapy for resected pancreatic ductal adenocarcinoma with high-risk pathological feature: a prospective, single-arm, interventional study
Authors: Wu Lili , Xu Yaolin , Zeng Zhaochong , Chen Yixing , Zhou Yuhong , Wang Dansong , Sun Jing , Lv Minzhi , Du Shisuo , Lou Wenhui
Published: May 2022

Objective:

It remains unclear whether adjuvant chemoradiotherapy (CRT) improves survival outcome of pancreatic ductal adenocarcinoma (PDAC) patients after surgery. This study aimed to investigate the efficacy and safety of tegafur/gimeracil/oteracil (S-1)-based adjuvant concurrent chemoradiotherapy in resected PDAC patients with defined high-risk pathological features.

Methods:

We conducted a single-arm, prospective, and interventional study at Zhongshan Hospital Fudan University from December 2012 to December 2019 and the last follow-up was conducted in December 2021. This study was approved by the Ethics Committee of Zhongshan Hospital Fudan University on December 27, 2012 (approval No. B2012-139). Resected PDAC patients with high-risk pathological features, including positive resection margin, pathological T3-4N1-2M0 disease, peripancreatic fat invasion, microvascular invasion, and perineural invasion, were recruited. Primary endpoint was overall survival and secondary endpoints were disease-free survival, treatment toxicity, and 2-, 5-year survival rates.

Results:

A total of 54 patients were recruited. Mean age was 63.6 years old (±7.2). The distribution of T and N stages were 24.1% for T1, 46.3% for T2, 27.8% for T3, 1.9% for T4, 33.3% for N1, and 11.1% for N2. Seven patients had R1 resection. The median overall survival and disease-free survival were 27.1 and 13.7 months, respectively, while no fatal adverse events were recorded. Subgroup analyses showed differences in survival outcomes among patients with microvascular invasion, different N stages, and preoperative CA 19-9 levels. Further, a Cox proportional hazard model demonstrated associations of lymph node metastases, CA 19-9 level, and microvascular invasion with overall survival and disease-free survival.

Conclusion:

S-1-based adjuvant CRT showed promising efficacy and manageable toxicity in resected PDAC patients with high-risk pathological features.
Acute venous thromboembolism in acute pancreatitis based on the severity: a retrospective cohort study
Authors: Ali Hassam , Manickam Swethaa , Pamarthy Rahul , Farooq Muhamad Fahd , Leland William
Published: May 2022

Objective:

Acute pancreatitis (AP) results in systemic inflammatory responses and activates coagulation pathways. We intend to investigate the risk and hospital outcomes of acute venous thromboembolisms (VTE) in patients with AP.

Methods:

We retrospectively analyzed patients with AP from 2016 to 2019 using the National Inpatient Sample database. Primary outcome was the effect of VTE on the length of stay, inpatient costs, and mortality. Hierarchical multivariate logistic regression models were built using univariate screens.

Results:

The study included 909,354 weighted discharges with AP. 2.1% of cases had an acute VTE. The length of stay was 5.9 days longer in the hospital of AP patients with VTE compared to AP with no VTE (P < 0.001). Total hospital charge per patient was $71,914 in patients with VTE compared to AP with no VTE (P < 0.001). Mortality was higher in AP patients with VTE compared to AP with no VTE (adjusted odds ratio [AOR] 4.2, 95% confidence interval [CI]: 3.4–5.3, P < 0.001). AP was associated with an increased VTE risk during inpatient stay (AOR 1.06, 95% CI 1.04–1.1, P < 0.001) There was an increased association of lower and upper extremity deep venous thrombosis with AP without necrosis (AOR 6.9, 95% CI 6.4–7.4, P < 0.001) and AP with infected necrosis (AOR 12.2, 95% CI 10.6–14.1, P < 0.001) but not in AP without necrosis (AOR 0.77, 95% CI 0.74–0.81, P < 0.001).

Conclusion:

VTE in AP increases length of stay and inpatient costs. The prognosis is poor in such patients, with increased inpatient mortality compared to no VTE. AP with necrosis can increase chances of all VTE subtypes; however, AP without necrosis does not increase upper and lower extremity VTE risk.
The Essential Elements of the Clinical Reasoning Process
Authors: Joplin-Gonzales Pamela , Rounds Linda
Published: May 2022

Background:

Clinical reasoning is an important skill that enables health care professionals to identify and evaluate patients' real or potential problems, implement appropriate interventions, solve clinical problems, and improve the quality of health care and patient outcomes.

Purpose:

The goal of this study was to go beyond individual professions and seek consensus across health care professions on the essential elements of the clinical reasoning process.

Methods:

This study used a traditional Delphi methodology to seek consensus from clinical reasoning experts from the fields of nursing, medicine, and physical and occupational health.

Results:

The experts reached a consensus on 56 essential elements identified from the clinical reasoning literature. This is the first time health care professions have reached a consensus on the essential elements of the clinical reasoning process using a Delphi study.

Conclusions:

Achieving consensus on the essential elements of the clinical reasoning process is essential to better understanding, improved teaching, and evaluation of clinical reasoning skills.
Randomized Controlled Trial of Healthy Divas: A Gender-Affirming, Peer-Delivered Intervention to Improve HIV Care Engagement Among Transgender Women Living With HIV
Authors: Sevelius Jae M. , Dilworth Samantha E. , Reback Cathy J. , Chakravarty Deepalika , Castro Danielle , Johnson Mallory O. , McCree Breonna , Jackson Akira , Mata Raymond P. , Neilands Torsten B.
Published: May 2022

Background:

Transgender women are disproportionately affected by HIV and are less likely to be optimally engaged in care than other groups because of psychosocial challenges. With community collaboration, we developed Healthy Divas, an individual-level intervention to increase healthcare empowerment and gender affirmation to improve engagement in HIV care. Healthy Divas comprises 6 peer-led individual sessions and one group workshop facilitated by a healthcare provider with expertise in HIV care and transgender health.

Setting/Methods:

To test the intervention's efficacy, we conducted a randomized controlled clinical trial in San Francisco and Los Angeles among transgender women living with HIV; control was no intervention. Transgender field staff conducted recruitment. Assessments occurred at baseline and 3, 6, 9, and 12 months postrandomization. The primary outcome was engagement in HIV care, defined as the sum of (1) self-reported HIV care provider visit, past 6 months, (2) knowledge of most recent CD4 count, (3) self-reported antiretroviral therapy adherence ≥90%, and (4) self-reported antiretroviral therapy adherence ≥80%.

Results:

We enrolled 278 participants; almost half (46%) were African American/Black and one-third (33%) were Hispanic/Latina. At 6 months, participants in the intervention arm had over twice the odds of being in a higher HIV care engagement category than those in the control arm (aOR = 2.17; 95% CI: 1.06 to 4.45; P = 0.04); there were no significant study arm differences in the outcome at the other time points.

Conclusions:

This trial demonstrates the short-term efficacy of an urgently needed behavioral intervention to improve engagement in HIV care among transgender women living with HIV; ongoing intervention may be needed to maintain positive impact over time.

Trial Registration:

Clinicaltrials.gov identifier: NCT03081559.
Opioid Prescribing Practices Among Plastic Surgeons
Authors: Oberhofer Haley M. , Rao Adityanarayan , Carlson Jacob T. , Mast Bruce A. , Simmons Christopher J. , Gutowski Karol A. , Satteson Ellen S.
Published: May 2022

Background

Health care providers play an important role in the national opioid crisis with 40% of opioid-related deaths being attributed to prescription medications (Centers for Disease Control and Prevention, U.S. Department of Health and Human Services. 2018) and as many as half of the opioid pills prescribed after outpatient plastic surgery may go unused (Plast Reconstr Surg 2019;143:929-938). The purpose of this study was to provide broad foundational data regarding postoperative analgesic prescribing patterns among members of the American Society of Plastic Surgeons (ASPS) to facilitate inclusion of opioid data fields in the ASPS Tracking Operations and Outcomes for Plastic Surgeons database for longitudinal evaluation.

Methods

A survey regarding opioid prescribing practices was electronically distributed to a representative cohort of 2555 ASPS members. Two hundred seventy-nine responses (11% response rate) were received.

Results

The majority of respondents reported prescribing opioids following 1 or more types of cosmetic and reconstructive procedures (90.2% and 81.7%, respectively; p = 0.0057), most commonly oxycodone and hydrocodone. Most (61.9%) reported less than 5% of patients request an opioid refill. Nonopioid medications, most commonly acetaminophen and ibuprofen/naproxen, were also prescribed but less commonly so for cosmetic (80.7–85.8%) than reconstructive (86.3–91.5%) procedures. Local anesthetic was less commonly used for mastopexy (83.7%) than augmentation (91.8%, p = 0.02).

Conclusions

Based on survey responses, potential areas of improvement to reduce opioid prescribing and use include provider education on the use of multimodal pain regimens including nonopioid medication and “as needed” rather than scheduled dosing, use of local anesthetic blocks, as well as patient education on opioid safety and proper disposal of unused medication.
Is Routine Imaging Necessary for the Management of Pediatric Hand Fractures Postoperatively?
Authors: Sleiwah Aseel , Al-Jabir Ahmed , Mughal Maleeha , Syed Mobinulla
Published: May 2022

Background

Pediatric hand fractures heal remarkedly well, and clinically significant displacement after operative fixation is rare. Radiation exposure in medical practice is regulated by the Ionizing Radiation Medical Exposure Regulations 2017, and unnecessary radiation should be avoided. In the literature, there is paucity of information regarding the number of radiographs required in the postoperative period and guidelines are lacking.

Methods

This study aims to examine whether routine imaging or the lack of it influences functional outcome and time to discharge from the clinic. A retrospective data of pediatric hand fractures requiring intervention between 2014 and 2018 at our institution were conducted before and after elimination of routine postoperative imaging. A total of 230 patients were included in the study.

Results

Two cohorts of patients were identified. The first had routine postoperative radiographs, whereas the second did not have routine radiographs. There was no change in management and difference in the range of motion at discharge between the 2 groups (P = 0.74). Patients without routine imaging were discharged earlier from clinic (74.4 vs 108.2 days, P = 0.012).

Conclusions

This study shows that clinically significant fracture displacement is rare after operative reduction and fixation in pediatric age group. It demonstrates our experience in refraining from routine postoperative radiographs. The overall benefit is to avoid unnecessary radiation and subsequent costs implicated.
To Decline or Accept
Authors: Warden Aleah M. , Soteropulos Carol E. , Eftekari Sahand C. , Nicksic Peter J. , Dingle Aaron M. , Poore Samuel O.
Published: May 2022

Importance

After the rise of predatory journals characterized by false claims of legitimacy and a pay-to-publish model, similar “predatory conferences” have become increasingly common. The email inbox of an academic physician can be filled with daily announcements encouraging conference attendance, abstract submission, and often panel or keynote speaker invitations. It therefore becomes important for the plastic surgeon to be able to discern whether these invitations are from “predatory” conferences or legitimate career advancement opportunities, especially early in practice.

Objective

To aid the invited physician in determining the legitimacy of a conference, we aimed to characterize objective features of conferences for which email invitations have been received and use this information to build a decision-making guide.

Design

We analyzed all conference invitations received by the email of one academic plastic surgeon in a 4-month period. These conferences were organized into 3 groups based on affiliation with known professional societies. The following information was collected if available: affiliation with a professional society, type of invitation, conference location, conference format (in-person, virtual, or hybrid), conference title, conference fees, conference organizer, associated journals or publishers, abstract journal submission, grammar, headshots, time to abstract review, and acceptance.

Results

There were 56 unique conference invitations. These were categorized into 15 affiliated conferences, 28 unaffiliated conferences, and 17 conferences of undetermined affiliation. Unaffiliated conferences were more likely to solicit speaker invitations (P < 0.001), claim to be “international” (P = 0.001), send emails with grammatical errors (P < 0.001), use unprofessional headshots on the conference Web site (P < 0.001), and have reduced virtual conference fees (P = 0.0032) as compared with conferences affiliated with known professional societies. When comparing the attendance and presenter fees of in-person venues, there was no significant difference between affiliated and unaffiliated conferences (P = 0.973, P = 0.604). Affiliated conferences were more likely to take place in the United States (P = 0.014).

Conclusions and Relevance

We present a method to quickly assess the legitimacy of an academic meeting by way of a few important questions. Based on our findings, emails soliciting conference speakers, claims of international presence, grammatical errors, unprofessional headshots, and reduced virtual conference fees are all characteristics that should raise red flags.
Intraosseous Lipoma of the Carpus
Authors: Park Il-Jung , Lee Jiwon , Lee Heejeong , Kang Soo-Hwan
Published: May 2022

Intraosseous lipoma is a very rare benign lipoma, accounting for less than 0.1% of primary bone tumors. Incidentally found in most cases, it frequently involves the metaphysis of the long bones of the lower extremity or calcaneus but rarely occurs in the upper extremity. Intraosseous lipoma of the carpal bones, especially, has yet to be reported, except for 3 cases of scaphoid and capitate involvement. Herein, we report 2 cases of intraosseous lipoma in the capitate and hamate bones with a literature review. Two patients complained of wrist discomfort despite conservative treatment and were diagnosed by computed tomography, magnetic resonance imaging, and surgical biopsy. They were treated with intralesional curettage and autologous bone graft, and their symptoms improved and showed no evidence of recurrence, both clinically and radiologically.
Evolutionary analysis of p38 stress-activated kinases in unicellular relatives of animals suggests an ancestral function in osmotic stress
Authors: Shabardina Victoria , Charria Pedro Romero , Saborido Gonzalo Bercedo , Diaz-Mora Ester , Cuenda Ana , Ruiz-Trillo Iñaki , Sanz-Ezquerro Juan Jose
Published: May 2022

p38 kinases are key elements of the cellular stress response in animals. They mediate the cell response to a multitude of stress stimuli, from osmotic shock to inflammation and oncogenes. However, it is unknown how such diversity of function in stress evolved in this kinase subfamily. Here, we show that the p38 kinase was already present in a common ancestor of animals and fungi. Later, in animals, it diversified into three JNK kinases and four p38 kinases. Moreover, we identified a fifth p38 paralog in fishes and amphibians. Our analysis shows that each p38 paralog has specific amino acid substitutions around the hinge point, a region between the N-terminal and C-terminal protein domains. We showed that this region can be used to distinguish between individual paralogs and predict their specific. Finally, we showed that the response to hyperosmotic stress in Capsaspora owczarzaki, a close unicellular relative of animals, follows a typical for the p38 kinases pattern of phosphorylation-dephosphorylation. At the same time, Capsaspora’s cells upregulate the expression of GPD1 protein resembling an osmotic stress response in yeasts. Overall, our results show that the ancestral p38 stress pathway originated in the root of opisthokonts, most likely as a cell’s reaction to salinity change in the environment. In animals, the pathway became more complex and incorporated more stimuli and downstream targets due to the p38 sequence evolution in the docking and substrate binding sites around the hinge region. Overall, this study improves our understanding of the p38 evolution and opens new perspectives for the p38 research.
Multi-omics identify LRRC15 as a COVID-19 severity predictor and persistent pro-thrombotic signals in convalescence
Authors: Gisby Jack S. , Buang Norzawani B. , Papadaki Artemis , Clarke Candice L. , Malik Talat H. , Medjeral-Thomas Nicholas , Pinheiro Damiola , Mortimer Paige M. , Lewis Shanice , Sandhu Eleanor , McAdoo Stephen P. , Prendecki Maria F. , Willicombe Michelle , Pickering Matthew C. , Botto Marina , Thomas David C. , Peters James E.
Published: May 2022

Patients with end-stage kidney disease (ESKD) are at high risk of severe COVID-19. Here, we performed longitudinal blood sampling of ESKD haemodialysis patients with COVID-19, collecting samples pre-infection, serially during infection, and after clinical recovery. Using plasma proteomics, and RNA-sequencing and flow cytometry of immune cells, we identified transcriptomic and proteomic signatures of COVID-19 severity, and found distinct temporal molecular profiles in patients with severe disease. Supervised learning revealed that the plasma proteome was a superior indicator of clinical severity than the PBMC transcriptome. We showed that both the levels and trajectory of plasma LRRC15, a proposed co-receptor for SARS-CoV-2, are the strongest predictors of clinical outcome. Strikingly, we observed that two months after the acute infection, patients still display dysregulated gene expression related to vascular, platelet and coagulation pathways, including PF4 (platelet factor 4), which may explain the prolonged thrombotic risk following COVID-19.
A comprehensive accuracy assessment of Samsung smartwatch heart rate and heart rate variability
Authors: Sarhaddi Fatemeh , Kazemi Kianoosh , Azimi Iman , Cao Rui , Niela-Vilén Hannakaisa , Axelin Anna , Liljeberg Pasi , Rahmani Amir M.
Published: May 2022

Background

Photoplethysmography (PPG) is a low-cost and easy-to-implement method to measure vital signs, including heart rate (HR) and heart rate variability (HRV). The method is widely used in various wearable devices. For example, Samsung smartwatches are PPG-based open-source wristbands used in remote well-being monitoring and fitness applications. However, PPG is highly susceptible to motion artifacts and environmental noise. A validation study is required to investigate the accuracy of PPG-based wearable devices in free-living conditions.

Objective

We evaluate the accuracy of PPG signals – collected by the Samsung Gear Sport smartwatch in free-living conditions – in terms of HR and time-domain and frequency-domain HRV parameters against a medical-grade chest electrocardiogram (ECG) monitor.

Methods

We conducted 24-hours monitoring using a Samsung Gear Sport smartwatch and a Shimmer3 ECG device. The monitoring included 28 participants (14 male and 14 female), where they engaged in their daily routines. We evaluated HR and HRV parameters during the sleep and awake time. The parameters extracted from the smartwatch were compared against the ECG reference. For the comparison, we employed the Pearson correlation coefficient, Bland-Altman plot, and linear regression methods.

Results

We found a significantly high positive correlation between the smartwatch’s and Shimmer ECG’s HR, time-domain HRV, LF, and HF and a significant moderate positive correlation between the smartwatch’s and shimmer ECG’s LF/HF during sleep time. The mean biases of HR, time-domain HRV, and LF/HF were low, while the biases of LF and HF were moderate during sleep. The regression analysis showed low error variances of HR, AVNN, and pNN50, moderate error variances of SDNN, RMSSD, LF, and HF, and high error variances of LF/HF during sleep. During the awake time, there was a significantly high positive correlation of AVNN and a moderate positive correlation of HR, while the other parameters indicated significantly low positive correlations. RMSSD and SDNN showed low mean biases, and the other parameters had moderate mean biases. In addition, AVNN had moderate error variance while the other parameters indicated high error variances.

Conclusion

The Samsung smartwatch provides acceptable HR, time-domain HRV, LF, and HF parameters during sleep time. In contrast, during the awake time, AVNN and HR show satisfactory accuracy, and the other HRV parameters have high errors.
Heritability of Urinary Amines, Organic Acids, and Steroid Hormones in Children
Authors: Hagenbeek Fiona A. , van Dongen Jenny , Pool René , Harms Amy C. , Roetman Peter J. , Fanos Vassilios , van Keulen Britt J. , Walker Brian R. , Karu Naama , Hulshoff Pol Hilleke E. , Rotteveel Joost , Finken Martijn J.J. , Vermeiren Robert R. J. M. , Kluft Cornelis , Bartels Meike , Hankemeier Thomas , Boomsma Dorret I.
Published: May 2022

Variation in metabolite levels reflects individual differences in genetic and environmental factors. Here, we investigated the role of these factors in urinary metabolomics data in children. We examined the effects of sex and age on 86 metabolites, as measured on three metabolomics platforms that target amines, organic acids, and steroid hormones. Next, we estimated their heritability in a twin cohort of 1300 twins (age range: 5.7 - 12.9 years). We observed associations between age and 50 metabolites and between sex and 21 metabolites. The mean monozygotic (MZ) and dizygotic (DZ) correlations for urinary metabolites were 0.51 (range: 0.25-0.75) and 0.16 (range: 0.01-0.46) for the amines, 0.52 (range: 0.33-0.64) and 0.23 (range: 0.07-0.35) for the organic acids, and 0.61 (range: 0.43-0.81) and 0.25 (range: 0.11-0.44) for the steroids. Broad-sense heritability was 0.49 (range: 0.25-0.64), 0.50 (range: 0.33-0.62), and 0.64 (range: 0.43-0.81) for 50 amines, 13 organic acids, and 6 steroids, and narrow-sense heritability was 0.50 (range: 0.37-0.68), 0.50 (0.23-0.61), and 0.47 (range: 0.32-0.70) for 6 amines, 7 organic acids, and 4 steroids. We conclude that urinary metabolites in children have substantial heritability, with similar estimates for amines and organic acids, and higher estimates for steroid hormones.
A new highly-specific Natural Killer cell-specific gene signature predicting recurrence in colorectal cancer patients
Authors: Shembrey Carolyn , Behrenbruch Corina , Loveday Benjamin PT , Heriot Alexander G , Foroutan Momeneh , Hollande Frédéric
Published: May 2022

The protective role of Natural Killer (NK) cell tumour immunosurveillance has long been recognised in colorectal cancer (CRC). However, as most patients show limited intra-tumoral NK cell infiltration, improving our ability to identify those with high NK cell activity might aid in dissecting the molecular features which could trigger strong response to NK cell-mediated immune killing. Here, a novel CRC-specific NK cell gene signature capable of inferring NK cell load in primary tissue samples was derived and validated in multiple patient CRC cohorts. The specificity of the signature is substantiated in tumour-infiltrating NK cells from primary CRC tumours at the single cell level, and the expression profile of each constituent gene is explored in NK cells of different maturation states, activation status and anatomical origin. Thus, in contrast with other NK cell gene signatures that have several overlapping genes across different immune cell types, our NK cell signature has been extensively refined to be specific for CRC-infiltrating NK cells and includes genes which identify a broad spectrum of NK cell subtypes. Moreover, it was shown that this novel NK cell signature accurately discriminates murine NK cells, demonstrating the potential applicability of this signature when mining datasets generated from both clinical and animal studies. Differential gene expression analysis revealed tumour-intrinsic features associated with NK cell inclusion versus exclusion in CRC patients, with those tumours with predicted high NK activity showing strong evidence of enhanced chemotactic and cytotoxic transcriptional programs. Furthermore, survival modelling indicated that NK signature expression is associated with improved survival outcomes in two large cohorts of primary CRC patients. Thus, scoring CRC samples with this refined NK cell signature might aid in identifying patients with high NK cell activity who could be prime candidates for NK cell directed immunotherapies.
ADTnorm: Robust Integration of Single-cell Protein Measurement across CITE-seq Datasets
Authors: Zheng Ye , Caron Daniel P. , Kim Ju Yeong , Jun Seong-Hwan , Tian Yuan , Florian Mair , Stuart Kenneth D. , Sims Peter A. , Gottardo Raphael
Published: May 2022

CITE-seq enables paired measurement of surface protein and mRNA expression in single cells using antibodies conjugated to oligonucleotide tags. Due to the high copy number of surface protein molecules, sequencing antibody-derived tags (ADTs) allows for robust protein detection, improving cell-type identification. However, variability in antibody staining leads to batch effects in the ADT expression, obscuring biological variation, reducing interpretability, and obstructing cross-study analyses. Here, we present ADTnorm (https://github.com/yezhengSTAT/ADTnorm), a normalization and integration method designed explicitly for ADT abundance. Benchmarking against 14 existing scaling and normalization methods, we show that ADTnorm accurately aligns populations with negative- and positive-expression of surface protein markers across 13 public datasets, effectively removing technical variation across batches and improving cell-type separation. ADTnorm enables efficient integration of public CITE-seq datasets, each with unique experimental designs, paving the way for atlas-level analyses. Beyond normalization, ADTnorm includes built-in utilities to aid in automated threshold-gating as well as assessment of antibody staining quality for titration optimization and antibody panel selection. Applying ADTnorm to a published COVID-19 CITE-seq dataset allowed for identifying previously undetected disease-associated markers, illustrating a broad utility in biological applications.
Identification of Key Genes and Biological Pathways in Bipolar Disorder by Bioinformatics and Next Generation Sequencing Data Analysis
Authors: Vastrad Basavaraj , Vastrad Chanabasayya
Published: May 2022

Bipolar disorder (BD), also known as psychiatric disorder, affects millions of people all over the world. The aim of this investigation was to screen and verify hub genes involved in BD as well as to explore potential molecular mechanisms. The next generation sequencing (NGS) dataset GSE124326 was downloaded from the Gene Expression Omnibus (GEO) database, which contained 480 samples, including 240 BD and 240 normal controls. Differentially expressed genes (DEGs) were filtered and subjected to gene ontology (GO) and pathway enrichment analyses. A protein–protein interaction (PPI) network and module analysis were used to identify hub genes. The miRNA-hub gene regulatory network and TF-hub gene regulatory network were also constructed. Receiver operating characteristic curve (ROC) analysis was used to validate hub genes. In this work, 957 DEGs, including 477 up regulated and 480 down regulated, were obtained from NGS data. The GO and pathway enrichment analyses of the DEGs showed that the up regulated genes were enriched in the neutrophil degranulation, immune system, transport, cytoplasm and enzyme regulator activity, and the down regulated genes were enriched in extracellular matrix organization, diseases of metabolism, multicellular organismal process, cell periphery and metal ion binding. Finally, through analyzing the PPI network, miRNA-hub gene regulatory network and TF-hub gene regulatory network, we screened hub genes UBB, UBE2D1, TUBA1A, RPL11, RPS24, NOTCH3, CAV1, CNBD2, CCNA1 and MYH11 by the Cytoscape software. The current investigation illustrates a characteristic NGS data in BD, which might contribute to the interpretation of the progression of BD and provide novel biomarkers and therapeutic targets for BD.