bluuebunny/crossref_metadata_2025 huggingface dataset:
How Media Stories in Low- and Middle-Income Countries Discussed the U.S. Food and Drug Administration’s Modified Risk Tobacco Product Order for IQOS
Authors: Robichaud Meagan O , Puryear Tyler , Cohen Joanna E , Kennedy Ryan David
Published: June 2023

Introduction

In 2020, the U.S. Food and Drug Administration authorized the marketing of IQOS as a modified risk tobacco product (MRTP) with reduced exposure information (reduces exposure to harmful chemicals compared to cigarettes) but prohibited Philip Morris International from making reduced risk claims (reduces risk of disease compared to cigarettes). We aimed to assess how news media in low- and middle-income countries (LMICs) discussed this authorization and whether articles discussed IQOS as a reduced exposure versus reduced risk product.

Aims and Methods

News articles published between July 7, 2020 and January 7, 2021 were obtained by searching Tobacco Watcher (www.tobaccowatcher.org), a surveillance platform for tobacco-related news. Articles were eligible if they were published in an LMIC and mentioned the IQOS MRTP order. Non-English language articles were professionally translated. Articles were double coded to identify country of origin, reduced risk and reduced exposure language, discussions of potential impacts of the authorization on regulations in LMICs, and quotes from tobacco industry and public health stakeholders.

Results

We identified 50 eligible articles published in 20 LMICs. Twenty-six (52%) and 40 (80%) included reduced risk and reduced exposure language, respectively. Twenty-two (44%) discussed potential impacts of the MRTP order on regulations in LMICs. Thirty (60%) included quotes from tobacco industry representatives, 6 (12%) included quotes from public health or medical professionals, and 2 (4%) included both.

Conclusions

News articles in LMICs frequently misreported the MRTP order by using reduced risk language. The authorization is potentially being used to shape perspectives on tobacco regulations in LMICs. Tobacco control experts need to more frequently share their perspectives with the news media.

Implications

News articles from LMICs frequently misrepresented the IQOS MRTP order by using reduced risk language (reduces harm compared to cigarettes) rather than only using reduced exposure language (reduces exposure to harmful chemicals compared to cigarettes). Many articles referred to IQOS as a “better alternative” to cigarettes without specifically referencing reduced risk. Few articles included perspectives from public health or medical professionals, while most included tobacco industry quotes, suggesting that tobacco control experts need to more frequently engage with the news media. These findings also highlight how the U.S. FDA’s actions can potentially shape perspectives on tobacco product regulations in LMICs.
Passive Smoking and Oral Health of Infants, Preschoolers, and Children: A Systematic Review
Authors: Uthayakumar Thusheka , Bennett Josephine Xanthe , Cartas Hazel Leah , Brunet Mylène , Vo Kim Loan , Kroon Jeroen
Published: June 2023

Introduction

Almost half of the world’s children experience passive smoking, which is linked to numerous oral health conditions. The aim is to synthesize data on the impact of passive smoking on oral health of infants, preschoolers, and children.

Aims and Methods

A search was conducted across Medline (via EBSCOhost), PubMed, and Scopus up to February 2023. Risk of bias was assessed according to the Newcastle-Ottawa Scale (NOS).

Results

The initial search produced 1221 records and after removal of duplicates, screening by title and abstract, and full-text assessment, 25 studies were eligible for review and data extraction. The majority of studies (94.4%) found a correlation between passive smoking and increased prevalence of dental caries with three studies suggesting a dose–response relationship. Prenatal passive smoking exposure in 81.8% of studies indicated an increased dental caries experience compared to postnatal exposure. Low parental education, socioeconomic status, dietary habits, oral hygiene, and gender affected the level of environmental tobacco smoke (ETS) exposure and dental caries risk.

Conclusions

The results of this systematic review strongly suggest a significant association between dental caries in the deciduous dentition and passive smoking. Early intervention and education on the effects of passive smoking on infants and children will allow for the improvement in oral health outcomes and reduction in smoking-associated systemic conditions. The results justify all health professionals paying more attention to passive smoking when conducting pediatric patient histories, contributing to improved diagnosis and appropriate treatment planning with more suitable follow-up schedules.

Implications

The evidence from this review that environmental tobacco smoke and passive smoking is a risk factor for oral health conditions, both prenatally and postnatally during early childhood, justifies all health professionals paying more attention to passive smoking when conducting pediatric patient histories. Early intervention and appropriate parental education regarding the effects of secondhand smoke on infants and children will allow for the minimization of dental caries, improvement in oral health outcomes and overall reduction in smoking-associated systemic conditions for the children exposed.
Lead, trash, DDE, and young age of breeders linked to lower fertility in the first two decades of reintroduction for critically endangered California Condors in California
Authors: Bakker Victoria J , Finkelstein Myra E , Doak Daniel F , Wolstenholme Rachel , Welch Alacia , Burnett Joe , Punzalan Arianna , Brandt Joseph , Kirkland Steve , Seal Faith Nadya E , Lehnert Erin R , Sandhaus Estelle A
Published: June 2023

In the first comprehensive assessment of the reproductive rates of critically endangered California Condors (Gymnogyps californianus) recovering from complete extirpation in the wild, we analyzed 20 years (1999–2018) of data from condor flocks in southern and central California. We found that several anthropogenic threats affected reproductive rates: (1) coastal space use by female condors was associated with lower hatch probability, presumably due to foraging on marine mammals and associated DDE exposure; (2) trash ingestion by chicks decreased fledging probability prior to implementation of trash management in 2007; and (3) all parent deaths during rearing resulted in chick or early fledgling deaths, and most parental deaths were due to lead poisoning. We also detected several effects on reproductive rates from the complex individual-based management of condors, which involves ongoing releases of captive-bred individuals and health interventions including treatment of lead poisoning. Recruitment rates were lower for new release sites, which we attribute to a lack of individual- and flock-level experience. In addition, the number of free-flying days in the wild in the year before first breeding and in the 8 weeks before subsequent breeding was positively associated with female and male recruitment and with female rebreeding probabilities, respectively, indicating that removing individuals from the wild may reduce their breeding success. Finally, probabilities of recruitment, rebreeding, and fledging all increased with age, and given the age distribution skew of the recovering flocks toward younger individuals, overall reproductive success was lower than would be expected at the stable age distribution. Thus, reproductive rates should increase over time as the mean age of California Condors increases if current and emerging threats to reproduction, including the loss of breeders due to lead poisoning, can be addressed.
A polarized nuclear position specifies the correct division plane during maize stomatal development
Authors: Ashraf M Arif , Liu Le , Facette Michelle R
Published: June 2023

Asymmetric cell division generates different cell types and is a feature of development in multicellular organisms. Prior to asymmetric cell division, cell polarity is established. Maize (Zea mays) stomatal development serves as an excellent plant model system for asymmetric cell division, especially the asymmetric division of the subsidiary mother cell (SMC). In SMCs, the nucleus migrates to a polar location after the accumulation of polarly localized proteins but before the appearance of the preprophase band. We examined a mutant of an outer nuclear membrane protein that is part of the LINC (linker of nucleoskeleton and cytoskeleton) complex that localizes to the nuclear envelope in interphase cells. Previously, maize linc kash sine-like2 (mlks2) was observed to have abnormal stomata. We confirmed and identified the precise defects that lead to abnormal asymmetric divisions. Proteins that are polarly localized in SMCs prior to division polarized normally in mlks2. However, polar localization of the nucleus was sometimes impaired, even in cells that have otherwise normal polarity. This led to a misplaced preprophase band and atypical division planes. MLKS2 localized to mitotic structures; however, the structure of the preprophase band, spindle, and phragmoplast appeared normal in mlks2. Time-lapse imaging revealed that mlks2 has defects in premitotic nuclear migration toward the polarized site and unstable position at the division site after formation of the preprophase band. Overall, our results show that nuclear envelope proteins promote premitotic nuclear migration and stable nuclear position and that the position of the nucleus influences division plane establishment in asymmetrically dividing cells.
Cystathionine γ-synthase expression in seeds alters metabolic and DNA methylation profiles in Arabidopsis
Authors: Girija Aiswarya , Hacham Yael , Dvir Shachar , Panda Sayantan , Lieberman-Lazarovich Michal , Amir Rachel
Published: June 2023

Arabidopsis (Arabidopsis thaliana) seeds expressing the feedback-insensitive form of cystathionine γ-synthase (AtD-CGS), the key gene of methionine (Met) synthesis, under the control of a seed-specific phaseolin promoter (SSE plants) show a significant increase in Met content. This elevation is accompanied by increased levels of other amino acids (AAs), sugars, total protein, and starch, which are important from a nutritional aspect. Here, we investigated the mechanism behind this phenomenon. Gas chromatography–mass spectrometry (GC-MS) analysis of SSE leaves, siliques, and seeds collected at 3 different developmental stages showed high levels of Met, AAs, and sugars compared to the control plants. A feeding experiment with isotope-labeled AAs showed an increased flux of AAs from nonseed tissues toward the developing seeds of SSE. Transcriptome analysis of leaves and seeds displayed changes in the status of methylation-related genes in SSE plants that were further validated by methylation-sensitive enzymes and colorimetric assay. These results suggest that SSE leaves have higher DNA methylation rates than control plants. This occurrence apparently led to accelerated senescence, together with enhanced monomer synthesis, which further resulted in increased transport of monomers from the leaves toward the seeds. The developing seeds of SSE plants, however, show reduced Met levels and methylation rates. The results provide insights into the role of Met in DNA methylation and gene expression and how Met affects the metabolic profile of the plant.
Two splice forms of OsbZIP1, a homolog of AtHY5, function to regulate skotomorphogenesis and photomorphogenesis in rice
Authors: Bhatnagar Akanksha , Burman Naini , Sharma Eshan , Tyagi Akhilesh , Khurana Paramjit , Khurana Jitendra P
Published: June 2023

Plants possess well-developed light sensing mechanisms and signal transduction systems for regulating photomorphogenesis. ELONGATED HYPOCOTYL5 (HY5), a basic leucine zipper (bZIP) transcription factor, has been extensively characterized in dicots. In this study, we show that OsbZIP1 is a functional homolog of Arabidopsis (Arabidopsis thaliana) HY5 (AtHY5) and is important for light-mediated regulation of seedling and mature plant development in rice (Oryza sativa). Ectopic expression of OsbZIP1 in rice reduced plant height and leaf length without affecting plant fertility, which contrasts with OsbZIP48, a previously characterized HY5 homolog. OsbZIP1 is alternatively spliced, and the OsbZIP1.2 isoform lacking the CONSTITUTIVELY PHOTOMORPHOGENIC1 (COP1)-binding domain regulated seedling development in the dark. Rice seedlings overexpressing OsbZIP1 were shorter than the vector control under white and monochromatic light conditions, whereas RNAi knockdown seedlings displayed the opposite phenotype. While OsbZIP1.1 was light-regulated, OsbZIP1.2 showed a similar expression profile in both light and dark conditions. Due to its interaction with OsCOP1, OsbZIP1.1 undergoes 26S proteasome-mediated degradation under dark conditions. Also, OsbZIP1.1 interacted with and was phosphorylated by CASEIN KINASE2 (OsCK2α3). In contrast, OsbZIP1.2 did not show any interaction with OsCOP1 or OsCK2α3. We propose that OsbZIP1.1 likely regulates seedling development in the light, while OsbZIP1.2 is the dominant player under dark conditions. The data presented in this study reveal that AtHY5 homologs in rice have undergone neofunctionalization, and alternative splicing of OsbZIP1 has increased the repertoire of its functions.
Comparisons between fast algorithms for the continuous wavelet transform and applications in cosmology: the 1D case
Authors: Wang Yun , He Ping
Published: June 2023

The continuous wavelet transform (CWT) is very useful for processing signals with intricate and irregular structures in astrophysics and cosmology. It is crucial to propose precise and fast algorithms for the CWT. In this work, we review and compare four different fast CWT algorithms for the 1D signals, including the FFTCWT, the V97CWT, the M02CWT, and the A19CWT. The FFTCWT algorithm implements the CWT using the Fast Fourier Transform (FFT) with a computational complexity of $\mathcal {O}(N\log _2N)$ per scale. The rest algorithms achieve the complexity of $\mathcal {O}(N)$ per scale by simplifying the CWT into some smaller convolutions. We illustrate explicitly how to set the parameters as well as the boundary conditions for them. To examine the actual performance of these algorithms, we use them to perform the CWT of signals with different wavelets. From the aspect of accuracy, we find that the FFTCWT is the most accurate algorithm, though its accuracy degrades a lot when processing the non-periodic signal with zero boundaries. The accuracy of $\mathcal {O}(N)$ algorithms is robust to signals with different boundaries, and the M02CWT is more accurate than the V97CWT and A19CWT. From the aspect of speed, the $\mathcal {O}(N)$ algorithms do not show an overall speed superiority over the FFTCWT at sampling numbers of N ≲ 106, which is due to their large leading constants. Only the speed of the V97CWT with real wavelets is comparable to that of the FFTCWT. However, both the FFTCWT and V97CWT are substantially less efficient in processing the non-periodic signal because of zero padding. Finally, we conduct wavelet analysis of the 1D density fields, which demonstrate the convenience and power of techniques based on the CWT. We publicly release our CWT codes as resources for the community.
Solid validity evidence for two tools assessing competences in musculoskeletal ultrasound: a validity study
Authors: Carstensen Stine Maya Dreier , Just Søren Andreas , Pfeiffer-Jensen Mogens , Østergaard Mikkel , Konge Lars , Terslev Lene
Published: June 2023

Objectives

Musculoskeletal ultrasound (MSUS) is increasingly used by rheumatologists in daily clinical practice. However, MSUS is only valuable in trained hands, and assessment of trainee competences is therefore essential before independent practice. Thus, this study aimed to establish validity evidence for the EULAR and the Objective Structured Assessment of Ultrasound Skills (OSAUS) tools used for assessing MSUS competences.

Methods

Thirty physicians with different levels of MSUS experience (novices, intermediates, and experienced) performed four MSUS examinations of different joint areas on the same rheumatoid arthritis patient. All examinations were video recorded (n = 120), anonymized, and subsequently assessed in random order by two blinded raters using first the OSAUS assessment tool followed by the EULAR tool 1 month after.

Results

The inter-rater reliability between the two raters was high for both the OSAUS and EULAR tools, with a Pearson correlation coefficient (PCC) of 0.807 and 0.848, respectively. Both tools demonstrated excellent inter-case reliability, with a Cronbach’s alpha of 0.970 for OSAUS and 0.964 for EULAR. Furthermore, there was a strong linear correlation between the OSAUS and the EULAR performance scores and the participants’ experience levels (R2 = 0.897 and R2 = 0.868, respectively) and a significant discrimination between different MSUS experience levels (P < 0.001 for both).

Conclusions

MSUS operator competences can be assessed reliably and valid using either the OSAUS or the EULAR assessment tool, thereby allowing a uniform competency-based MSUS education in the future. Although both tools demonstrated high inter-rater reliability, the EULAR tool was superior to OSAUS.

Trial registration

ClinicalTrials.gov, http://clinicaltrials.gov, NCT05256355
Experimental and computational study of the beta shielding properties of polycarbonate filled with lead nitrate
Authors: Chandrappa Koramar Manjappa , Lobo Blaise
Published: June 2023

The mass attenuation coefficient of lead nitrate (Pb(NO3)2)-filled polycarbonate (PC) composite films were determined both computationally (using Baltakmen’s and Thummel empirical formulae) and experimentally using 204Tl and 90Sr-90Y radio-isotopes for films at different filler levels 0, 5, 15, 25, 35 and 50 weight percent (Wt.%). In comparison with Thummel empirical formula, the values obtained from Baltakmen’s empirical formula is in good agreement with the experiment. The percentage decrease of half value layer values were (52 ± 8) and (60 ± 10)% for 204Tl and 90Sr-90Y, on comparing the values for 0 and 50 Wt.% films, and so the prepared composite films shield the beta particles effectively. The PC that used to shield the low-energy beta particles of 90Sr-90Y can also moderate the higher energy beta particles; the plot of end point energy of 90Sr-90Y versus thickness of PC exhibits a decreasing trend, which confirms that PC acts as an electron moderator.
Ethnopharmacological survey on medicinal plants utilization in Freetown, Sierra Leone
Authors: Olufemi Adepoju Adeyinka , Oyedeji Amusa Mariam , Oluwasegun Samson Awotunde , Okechukwu Paul-Chima Ugwu
Published: June 2023

Objectives

Ethnopharmacological survey of medicinal plants utilized in Freetown Sierra Leone in the management and treatment of diseases.

Methods

The study utilized a cross-sectional descriptive study and face-to-face interviews with a pre-checklist of 20 Traditional Herbal Medicine Practitioners in Freetown. The survey included socio-segment information, data on the kinds of herbal medication, their constituents, wellsprings of the plants, diseases managed and details on preparation. Twenty traditional medicine practitioners consented to this study.

Key findings

The results showed that 15 (75%) were men and 5 (25%) were women, while all of them are above the age of 30 years. Some of the respondents have some level of formal education, ranging from twelve (12) with primary/secondary education to three (3) with tertiary education while five (5) do not have any formal education at all. Thirty percent practice herbal medicine as a family trade (inherited), 10% got involved in it through training, or both, while 10% claimed the knowledge as a natural gift. Traditional Herbal Medicine Practitioners (THMPs) in the study area updated their knowledge of medical practice through a wide range of choices such as by intuition (70%), participation at health talks or meetings (20%), while 10% of them adopted various forms of a combination of these and other choices. However, there was the problem of plant misidentification with some practitioners. According to our data, Freetown, Sierra Leone has a rich wellspring of restorative plants and an enormous part of the populace actually depends on customary plant drugs which are plentifully and promptly accessible.

Conclusions

Traditional Herbal Medicine Practitioners (THMPs) in this research updated their knowledge of medical practice through intuition, participation at health talks or meetings and also via various forms of a combination of these and other choices. The involvement of certified Plant Taxonomists is important, in order to avoid the consequences which may arise through misidentification.
Investigating Specific Associations Between Childhood Victimization Profiles and Positive Psychosis Symptoms: The Mediating Roles of Anxiety, Depression, and Schema
Authors: Barnes Georgina L , Emsley Richard , Garety Philippa , Hardy Amy
Published: June 2023

Background

Childhood trauma is a risk factor for psychosis. It is proposed this is due to traumatic events giving rise to psychological mechanisms that are implicated in the development and maintenance of symptoms. Investigation of the psychological mechanisms accounting for relationships between trauma and psychosis will be assisted by focusing on specific trauma profiles, hallucination modalities, and delusion subtypes.

Study Design

In 171 adults with schizophrenia-spectrum diagnoses and high-conviction delusions, associations between childhood trauma classes, and hallucination and delusion factors, were tested using structural equation models (SEMs). Anxiety, depression, and negative schema were examined as potential mediators of trauma class-psychosis symptom factor links.

Study Results

Significant associations were found between the emotional abuse/neglect and poly-victimization classes with persecutory delusions and delusions of influence, that were all mediated through anxiety (β = 1.24–0.23, P = < .05). There was an association between the physical abuse class and grandiose/religious delusions that was not explained by the mediators (β = 1.86, P = < .05). Trauma class was not significantly associated with any hallucination modality (β = 0.004–1.46, P = > .05).

Conclusions

In a sample of people with strongly held delusions, this study demonstrates that childhood victimization is associated with delusions of influence and grandiose beliefs, as well as with persecutory delusions in psychosis. Consistent with previous findings, the potent, mediating role of anxiety supports affective pathway theories and the utility of targeting threat-related processes when treating trauma effects in psychosis.
Geriatric Distal Femur Fractures Treated With Distal Femoral Replacement Are Associated With Higher Rates of Readmissions and Complications
Authors: Dekeyser Graham J. , Martin Brook I. , Marchand Lucas S. , Rothberg David L. , Higgins Thomas F. , Haller Justin M.
Published: June 2023

Objective:

Compare mortality and complications of distal femur fracture repair among elderly patients who receive operative fixation versus distal femur replacement (DFR).

Design:

Retrospective comparison.

Setting:

Medicare beneficiaries.

Patients/Participants:

Patients 65 years of age and older with distal femur fracture identified using Center for Medicare & Medicaid Services data from 2016 to 2019.

Intervention:

Operative fixation (open reduction with plating or intramedullary nail) or DFR.

Main Outcome Measurements:

Mortality, readmissions, perioperative complications, and 90-day cost were compared between groups using Mahalanobis nearest-neighbor matching to account for differences in age, sex, race, and the Charlson Comorbidity Index.

Results:

Most patients (90%, 28,251/31,380) received operative fixation. Patients in the fixation group were significantly older (81.1 vs. 80.4 years, P < 0.001), and there were more an open fractures (1.6% vs. 0.5%, P < 0.001). There were no differences in 90-day (difference: 1.2% [−0.5% to 3%], P = 0.16), 6-month (difference: 0.6% [−1.5% to 2.7%], P = 0.59), and 1-year mortality (difference: −3.3% [−2.9 to 2.3], P = 0.80). DFR had greater 90-day (difference: 5.4% [2.8%–8.1%], P < 0.001), 6-month (difference: 6.5% [3.1%–9.9%], P < 0.001), and 1-year readmission (difference: 5.5% [2.2–8.7], P = 0.001). DFR had significantly greater rates of infection, pulmonary embolism, deep vein thrombosis, and device-related complication within 1 year from surgery. DFR ($57,894) was significantly more expensive than operative fixation ($46,016; P < 0.001) during the total 90-day episode.

Conclusions:

Elderly patients with distal femur fracture have a 22.5% 1-year mortality rate. DFR was associated with significantly greater infection, device-related complication, pulmonary embolism, deep vein thrombosis, cost, and readmission within 90 days, 6 months, and 1 year of surgery.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Acute Fixation Protocol for High-Energy Tibial Pilon Fractures Decreases Time to Fixation and Lowers Operative Costs Without Affecting Wound Complications and Reoperations
Authors: Kim Ye Joon , Richard Raveesh D. , Scott Bryan L. , Parry Joshua A.
Published: June 2023

Objectives:

To determine whether an acute fixation protocol for high-energy tibial pilon fractures increases the rate of wound complications.

Design:

Retrospective comparative study.

Setting:

Urban level 1 trauma center.

Patients/Participants:

One hundred forty-seven patients with OTA/AO 43B and 43C high-energy tibial pilon fractures treated with open reduction and internal fixation (ORIF).

Intervention:

Acute (<48 hours) versus delayed ORIF protocols.

Main Outcome Measurement:

Wound complications, reoperations, time to fixation, operative costs, and hospital length of stay (LOS). Patients were compared by protocol, regardless of ORIF timing, for an intention-to-treat analysis.

Results:

Thirty-five and 112 high-energy pilon fractures were treated under the acute and delayed ORIF protocols, respectively. In the acute ORIF protocol group, 82.9% of patients received acute ORIF versus 15.2% of patients in the standard delayed protocol group. The 2 groups had no observed difference (OD) in the rate of wound complications (OD −5.7%, confidence interval (95% CI) −16.1% to 7.8%; P = 0.56) or reoperations (OD −3.9%, 95% CI, −14.1% to 9.4%; P = 0.76). The acute ORIF protocol group had a shorter LOS (OD −2.0, 95% CI, −4.0 to 0.0; P = 0.02) and lower operative costs (OD $−2709.27, 95% CI, −3582.02 to −1601.16; P < 0.01). On multivariate analysis, wound complications were associated with open fractures (odds ratio 3.36, 95% CI, 1.06–10.69; P = 0.04) and an American Society of Anesthesiologists score >2 (odds ratio 3.68, 95% CI, 1.07–12.67; P = 0.04).

Conclusion:

This study suggests that an acute fixation protocol for high-energy pilon fractures decreases time to definitive fixation, lowers operative costs, and shortens hospital LOS without affecting wound complications or reoperations.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Post Post-Mobilization Films for LC1 Pelvic Ring Injuries: Follow up Stress Imaging Demonstrates Minimal Utility
Authors: Lawson Michelle M. , Rodgers Frank L. , Ramsey Duncan C. , Friess Darin M. , Working Zachary M.
Published: June 2023

Objective:

To assess the utility of outpatient postmobilization radiographs in the nonoperative treatment of lateral compression type I (LC1) (OTA/AO 61-B1) pelvic ring injuries.

Design:

Retrospective series.

Setting:

Academic, Level 1 trauma center, 2008–2018.

Patients/Participants:

A series of 173 patients with nonoperatively treated LC1 pelvic ring injuries was identified. Of these, 139 received a complete set of outpatient pelvic radiographs with which to assess displacement.

Intervention:

Outpatient pelvic radiographs to assess additional fracture displacement and potential need for surgical intervention.

Main Outcome Measurements:

Rate of conversion to late operative intervention based on radiographic displacement.

Results:

No patient in this cohort received late operative intervention. A majority of the patients sustained incomplete sacral fractures (82.6%) and unilateral rami fractures (75.1%), and 92.8% demonstrated less than 10 mm of displacement on their final radiographs.

Conclusions:

There is a low utility of repeat outpatient radiographs of stable, nonoperative LC1 pelvic ring injuries as they do not undergo late displacement.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Dual-Plate Fixation for Proximal Humerus Fractures With Unstable Medial Column in Patients With Osteoporosis
Authors: Seok Hyun-Gyu , Park Sam-Guk
Published: June 2023

Objectives:

To compare radiological and clinical outcomes between lateral locking plate (LLP) and dual-plate fixation (LLP and additional medial buttress plate) for proximal humerus fractures with medial column comminution and varus deformity in patients with osteoporosis.

Design:

Retrospective.

Setting:

Academic medical center.

Patients/Participants:

Overall, 52 patients were enrolled. Of these, 26 patients underwent dual-plate fixation. The control group (LLP) was matched to the dual-plate group for age, sex, injured side, and fracture type.

Intervention:

Patients in the dual-plate group were treated with LLP and medial buttress plate, whereas patients in the LLP group were treated with only an LLP.

Main Outcome Measurements:

Demographic factors, operative time, and level of hemoglobin of the 2 groups obtained from medical records. Changes in the neck-shaft angle and the development of postoperative complications were recorded. Clinical outcomes were measured based on the visual analog scale; American Shoulder and Elbow Surgeons; Disabilities of the Arm, Shoulder, and Hand; and Constant–Murley scores.

Results:

The operation time and hemoglobin loss did not differ significantly between the groups. Radiographic evaluation showed a significantly lower change in neck-shaft angle in the dual-=plate group than in the LLP group. The dual-plate group also showed better Disabilities of the Arm, Shoulder, and Hand; American Shoulder and Elbow Surgeons; and Constant–Murley scores than the LLP group.

Conclusion:

Fixation using additional medial buttress plate with LLP may be considered for treating proximal humerus fractures in patients with an unstable medial column, varus deformity, and osteoporosis.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Primary and periprosthetic distal femur fractures in older adults: No difference in 12-month mortality and patient reported outcomes
Authors: Mather Anne M. , Edwards BBiomed (Honours); Elton , Hau F.R.A.C.S; Raphael , Ekegren F.R.A.C.S; Christina L.
Published: June 2023

Objectives:

To compare fracture incidence, mortality and patient reported health outcomes at six and 12 months post-injury between primary and periprosthetic distal femur fractures in older adults.

Methods:

A registry-based cohort study was carried out including all adults aged 70 years or older registered by the Victorian Orthopaedic Trauma Outcomes Registry who experienced a primary or periprosthetic distal femur fracture between 2007 and 2017. Outcomes included mortality and health status (EQ-5D-3L) collected six and 12 months post-injury. All distal femur fractures were confirmed by radiological review. Multivariable logistic regression was conducted to report associations between fracture type, and mortality and health status.

Results:

A final cohort of 292 participants was identified. Overall mortality for the cohort was 29.8% and no significant differences were found in mortality rate or EQ-5D-3L outcomes between fracture types (i.e. primary vs. periprosthetic). A large proportion of participants reported problems across all EQ-5D-3L domains at six and 12 months post-injury, with slightly worse outcomes in the primary fracture group.

Conclusions:

This study reports high mortality and poor 12-month outcomes in an older adult cohort with both periprosthetic and primary distal femur fractures. Given these poor outcomes, fracture prevention and a greater focus on long-term rehabilitation is needed in this cohort. Additionally, the involvement of an ortho-geriatrician should be considered as a routine component of care.
Patterns of Misdiagnosis and Discordance in Detecting Osteoporosis
Authors: Aynaszyan Stephan , Devia Luis G. , Parry Matthew W. , Badve Siddharth , DelSole Edward M.
Published: June 2023

Study Design:

This was a retrospective chart review.

Objective:

This study aims to identify the prevalence of osteoporosis (OP) by lumbar computed tomography (CT) Hounsfield units (HUs) in patients who have normal or osteopenic bone determined by dual-energy x-ray absorptiometry (DEXA).

Summary of Background Data:

OP is a critical issue in the postmenopausal and aging population. Bone mineral density assessment by DEXA has been described as insensitive for diagnosing OP in the lumbar spine. Improving the detection of OP can bring more patients to treatment and reduce the risks associated with low bone mineral density.

Patients and Methods:

We retrospectively reviewed all patients with DEXA scans and noncontrast CTs of the lumbar spine over a 15-year period. Patients were diagnosed as non-OP if they had a normal DEXA T-score (≥ −1) or osteopenic DEXA T-score (between −1.1 and −2.4). Patients in this cohort were considered osteoporotic by CT if L1-HU ≤110. Demographics and lumbar HUs were compared between these stratified groups.

Results:

A total of 74 patients were included for analysis. All patients were demographically, similar, and the average patient age was 70 years. The prevalence of OP determined by CT L1-HU ≤110 was 46% (normal DEXA: 9%, osteopenic DEXA: 63%). A significant number of males in our study were considered osteoporotic by L1-HU ≤110 (74%, P = 0.03). All individual axial and sagittal lumbar HU measurements including L1–L5 average lumbar HUs were statistically significant among non-OP and OP groups except for the lower lumbar levels (P > 0.05 for L4 axial HUs, and L4–L5 sagittal HUs).

Conclusions:

The prevalence of OP in patients with normal or osteopenic T-scores is high. Among those with osteopenia by DEXA, more than 50% may lack appropriate medical treatment. The DEXA scan may be particularly insensitive to male bone quality making the CT HU the diagnostic method of choice for detecting OP.

Level of Evidence:

Level III.
Cost-utility Analysis of Anterior Cervical Discectomy and Fusion for Cervical Spondylosis Patients Comparing Polyetheretherketone Versus Tricortical Iliac Crest Bone Graft
Authors: Hajeeyeh Muhammadakbar , Wilartratsami Sirichai , Phisalprapa Pochamana , Piyapromdee Urawit , Sornsa-Ard Tuanrit , Kositamongkol Chayanis , Vamvanij Visit , Luksanapruksa Panya
Published: June 2023

Study design:

Prospective cohort study.

Objectives:

To perform a cost-utility analysis and to investigate the clinical outcomes and patient’s quality of life after anterior cervical discectomy and fusion (ACDF) to treat cervical spondylosis compared between fusion with polyetheretherketone (PEEK) and fusion with tricortical iliac bone graft (IBG) in Thailand.

Summary of Background Data:

ACDF is one of the standard treatments for cervical spondylosis. The fusion material options include PEEK and tricortical IBG. No previous studies have compared the cost-utility between these 2 fusion material options.

Patients and Methods:

Patients with cervical spondylosis who were scheduled for ACDF at Siriraj Hospital (Bangkok, Thailand) during 2019–2020 were prospectively enrolled. Patients were allocated to the PEEK or IBG fusion material group according to the patient’s choice of fusion material. EuroQol-5 dimensions 5 levels and relevant costs were collected during the operative and postoperative periods. A cost-utility analysis was performed using a societal perspective. All costs were converted to 2020 United States dollars (USD), and a 3% discount rate was used. The outcome was expressed as the incremental cost-effectiveness ratio.

Results:

Thirty-six patients (18 ACDF-PEEK and 18 ACDF-IBG) were enrolled. Except for Nurick grading, there was no significant difference in patient baseline characteristics between groups. The average utility at 1 year after ACDF-PEEK and ACDF-IBG were 0.939 ± 0.061 and 0.798 ± 0.081, respectively (P < 0.001). The total lifetime cost of ACDF-PEEK and ACDF-IBG was 83,572 USD and 73,329 USD, respectively. The incremental cost-effectiveness ratio of ACDF-PEEK when compared with that of ACDF-IBG showed a gain of 4468.52 USD/quality-adjusted life-years, which is considered cost-effective at the Thailand willingness-to-pay threshold of 5115 USD/quality-adjusted life-year gained.

Conclusions:

ACDF-PEEK was found to be more cost-effective than ACDF-IBG for treating cervical spondylosis in Thailand.

Level of Evidence:

Level II.
Oxycodone, Morphine, and Fentanyl in Patients With Chronic Pain: Proposal of Dose-Specific Concentration Ranges
Authors: Thaulow Cecilie Hasselø , Helland Arne , Kongsgaard Ulf Erik , Høiseth Gudrun
Published: June 2023

Background:

Interpreting opioid concentrations is challenging because of the lack of reference ranges. Therefore, the authors aimed to propose dose-specific concentration ranges in serum for oxycodone, morphine, and fentanyl in patients with chronic pain, based on concentration measurements from a large number of patients and supported by theoretical pharmacokinetic calculations and previously published concentrations.

Methods:

The opioid concentrations in patients undergoing therapeutic drug monitoring (TDM) for various indications (TDM group) and patients with cancer (cancer group) were investigated. Patients were divided based on the daily opioid doses, and the 10th and 90th percentiles of the concentrations in each dose interval were evaluated. In addition, the expected average serum concentrations were calculated for each dose interval based on published pharmacokinetic data, and a targeted literature search for previously reported dose-specific concentrations was performed.

Results:

The opioid concentrations in 1054 patient samples were included: 1004 in the TDM group and 50 in the cancer group. In total, 607 oxycodone, 246 morphine, and 248 fentanyl samples were evaluated. The authors proposed dose-specific concentration ranges based mainly on 10th–90th percentiles of the concentrations measured in patient samples, whereas the calculated average concentrations and previously published concentrations were used to adjust the ranges. In general, results from calculations and concentrations retrieved from previous literature were within the 10th–90th percentiles of concentrations from patient samples. However, the lowest calculated average concentrations of fentanyl and morphine were below the 10th percentiles of patient samples in all dose groups.

Conclusions:

The proposed dose-specific ranges may be useful for interpreting steady-state opioid serum concentrations in clinical and forensic settings.
Pharmacokinetic/Pharmacodynamic Target Attainment of Tigecycline in Patients with Hepatic Impairment in a Real-World Setting
Authors: Yang Xiaoxuan , Jin Lu , Luo Xuemei , An Shurun , Wang Min , Zhu Huaijun , Zhou Yujie , Liu Hang
Published: June 2023

Background:

This study aimed to investigate the pharmacokinetic/pharmacodynamic (PK/PD) target attainment of various tigecycline dosing regimens in real-world patients with impaired liver function.

Methods:

The clinical data and serum concentrations of tigecycline were extracted from the patients' electronic medical records. Patients were classified into Child-Pugh A, Child-Pugh B, and Child-Pugh C groups, according to the severity of liver impairment. Furthermore, the minimum inhibition concentration (MIC) distribution and PK/PD targets of tigecycline from the literature were used to obtain a proportion of PK/PD targets attainment of various tigecycline dosing regimens at different infected sites.

Results:

The pharmacokinetic parameters revealed significantly higher values in moderate and severe liver failure (groups Child-Pugh B and Child-Pugh C) than those in mild impairment (Child-Pugh A). Considering the target area under the time–concentration curve (AUC0-24)/MIC ≥4.5 for patients with pulmonary infection, most patients with high-dose (100 mg, every 12 hours) or standard-dose (50 mg, every 12 hours) for tigecycline achieved the target in groups Child-Pugh A, B, and C. Considering the target AUC0-24/MIC ≥6.96 for patients with intra-abdominal infection, when MIC ≤1 mg/L, more than 80% of the patients achieved the target. For an MIC of 2–4 mg/L, only patients with high-dose tigecycline in groups Child-Pugh B and C attained the treatment target. Patients experienced a reduction in fibrinogen values after treatment with tigecycline. In group Child-Pugh C, all 6 patients developed hypofibrinogenemia.

Conclusions:

Severe hepatic impairment may attain higher PK/PD targets, but carries a high risk of adverse reactions.
The experience of neoadjuvant chemotherapy versus upfront surgery in resectable pancreatic cancer. a cross sectional study
Authors: Su Yung-Yeh , Chao Ying-Jui , Wang Chih-Jung , Liao Ting-Kai , Su Ping-Jui , Huang Chien-Jui , Chiang Nai-Jung , Yu Yu-Ting , Tsai Hong-Ming , Chen Li-Tzong , Shan Yan-Shen
Published: June 2023

Background:

Upfront resection (UR) followed by adjuvant chemotherapy remains the standard treatment for resectable pancreatic cancer. There is increasing evidence suggesting favorable outcomes toward neoadjuvant chemotherapy followed by surgery (NAC).

Methods:

All clinical staging with resectable pancreatic cancer patients treated at a tertiary medical center from 2013 to 2020 were identified. The baseline characteristics, treatment course, surgery outcome, and survival results of UR or NAC were compared.

Results:

Finally, in 159 resectable patients, 46 patients (29%) underwent NAC and 113 patients (71%) received UR. In NAC, 11 patients (24%) did not receive resection, 4 (36.4%) for comorbidity, 2 (18.2%) for patient refusal and 2 (18.2%) for disease progression. In UR, 13 patients (12%) were unresectable intraoperatively; 6 (46.2%) for locally advanced and 5 (38.5%) for distant metastasis. Overall, 97% of patients in NAC and 58% of patients in UR completed adjuvant chemotherapy. As of data cut-off, 24 patients (69%) in NAC and 42 patients (29%) in UR were still tumor free. The median recurrence-free survival (RFS) in NAC, UR with adjuvant chemotherapy and without adjuvant chemotherapy were 31.3 months (95% CI, 14.4 - not estimable), 10.6 months (95% CI, 9.0–14.3) and 8.5 months (95% CI, 5.8–11.8), P=0.036; and the median overall survival (OS) in each group were not reached (95% CI, 29.7 - not estimable), 25.9 months (95% CI, 21.1–40.5) and 21.7 months (12.0–32.8), P=0.0053. Based on initial clinical staging, the median OS of NAC was not significantly different from UR with a tumor ≤2 cm, P=0.29. NAC patients had a higher R0 resection rate (83% vs. 53%), lower recurrence rate (31% vs. 71%), and harvested median number LN (23 vs. 15).

Conclusion:

Our study demonstrates that NAC is superior to UR in resectable pancreatic cancer with better survival.
Effect of early achievement of energy target by different nutritional support strategies on nosocomial infections in patients undergoing major abdominal surgery: a secondary analysis of 2 randomized clinical trials
Authors: Gao Xuejin , Zhang Li , Zhang Yupeng , Zhou Da , Gao Tingting , Liu Yuxiu , Jin Gang , Wang Kunhua , Zhou Yanbing , Chi Qiang , Yang Hua , Li Mengbin , Yu Jianchun , Qin Huanlong , Tang Yun , Wu Xiaoting , Li Guoli , Wang Xinying
Published: June 2023

Background:

The effect of early achievement of energy targets using different nutritional support strategies in patients undergoing major abdominal surgery is unclear. This study determined the impact of early achievement of energy targets on the incidence of nosocomial infections in patients undergoing major abdominal surgery.

Methods:

This was a secondary analysis of two open-label randomized clinical trials. Patients from the general surgery department of 11 academic hospitals in China undergoing major abdominal surgery and at nutritional risk (Nutritional risk screening 2002≥3) were divided into two groups based on whether they met the 70% energy targets, the early achievement of energy target (521 EAET) and non-achievement of energy target (114 NAET) groups. The primary outcome was the incidence of nosocomial infections between postoperative day 3 and discharge, and the secondary outcomes were actual energy and protein intake, postoperative noninfectious complications, intensive care unit admission, mechanical ventilation, and hospital stay.

Results:

Overall, 635 patients (mean [standard deviation, SD]) age, 59.5 [11.3] years) were included. The EAET group received more mean energy between days 3 and 7 than the NAET group (22.7±5.0 kcal/kg/d vs. 15.1±4.8 kcal/kg/d; P<0.001). The EAET group had significantly fewer nosocomial infections than the NAET group (46/521[8.8%] versus 21/114[18.4%]; risk difference, 9.6%; 95% confidence interval [CI], 2.1%-17.1%; P=0.004). A significant difference was found in the mean (SD) number of noninfectious complications between the EAET and NAET groups (121/521[23.2%] vs. 38/114[33.3%]; risk difference, 10.1%; 95%CI, 0.7%-19.5%; P=0.024). The nutritional status of the EAET group was significantly improved at discharge compared with the NAET group (P<0.001), and other indicators were comparable between groups.

Conclusion:

Early achievement of energy targets was associated with fewer nosocomial infections and improved clinical outcomes, regardless of the nutritional support strategy (early enteral nutrition alone or combined with early supplemental parenteral nutrition).
Impact of adjuvant therapy in patients with invasive intraductal papillary mucinous neoplasms of the pancreas: an international multicenter cohort study
Authors: Choi Munseok , Wang Shin-E , Park Joon Seong , Kim Hyung Sun , Choi Sung Hoon , Lee Jin Ho , Chong Jae Uk , Nagakawa Yuichi , Wada Keita , Nakamura Yoshiharu , Sunagawa Hiroki , Dasari Bobby VM , Peng Cheng-Ming , Seng Lee Lip , Wolters Heiner , Gurbadam Unenbat , Park Byoung UK , Winslow Emily , Fishbein Thomas , Hawksworth Jason , Radkani Pejman , Kang Chang Moo
Published: June 2023

Background:

Adjuvant therapy prolongs survival in patients with pancreatic ductal adenocarcinoma (PDAC). However, no clear guidelines are available regarding the oncologic effects of AT in resected invasive intraductal papillary mucinous neoplasms (IPMN). The aim was to investigate the potential role of AT in patients with resected invasive IPMN.

Materials and Methods:

From 2001 to 2020, 332 patients with invasive pancreatic IPMN were retrospectively reviewed in 15 centers in eight countries. Propensity score-matched and stage-matched survival analyses were conducted.

Results:

A total of 289 patients were enrolled in the study after exclusion (neoadjuvant therapy, unresectable disease, uncertain AT status, and stage IV). A total of 170 patients were enrolled in a 1:1 propensity score-matched analysis according to the covariates. In the overall cohort, disease-free survival was significantly better in the surgery alone (SA) group than in the AT group (P=0.003), but overall survival (OS) was not (P=0.579). There were no significant differences in OS in the stage-matched analysis between the SA and AT groups (stage I, P=0.402; stage II, P=0.179). AT did not show a survival benefit in the subgroup analysis according to nodal metastasis (N0, P=0.481; N+, P=0.705). In multivariate analysis, node metastasis (hazard ratio [HR], 4.083; 95% confidence interval [CI], 2.408−6.772, P<0.001), and CA 19-9 ≥100 (HR, 2.058; 95% CI, 1.247−3.395, P=0.005) were identified as adverse prognostic factors in resected invasive IPMN.

Conclusion:

The current AT strategy may not be recommended to be performed with resected invasive IPMN in stage I and II groups, unlike PDAC. Further investigations of the potential role of AT in invasive IPMN are recommended.