bluuebunny/crossref_metadata_2025 huggingface dataset:
The association of beta-blocker use with mortality in elderly patients with congestive heart failure and advanced chronic kidney disease
Authors: Molnar Amber O , Petrcich William , Weir Matthew A , Garg Amit X , Walsh Michael , Sood Manish M
Published: July 2019

Background

Whether the survival benefit of β-blockers in congestive heart failure (CHF) from randomized trials extends to patients with advanced chronic kidney disease (CKD) [estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m2 but not receiving dialysis] is uncertain.

Methods

This was a retrospective cohort study using administrative datasets. Older adults from Ontario, Canada, with incident CHF (median age 79 years) from April 2002 to March 2014 were included. We matched new users of β-blockers to nonusers on age, sex, eGFR categories (>60, 30–60, <30), CHF diagnosis date and a high-dimensional propensity score. Using Cox proportional hazards models, we examined the association of β-blocker use versus nonuse with all-cause mortality.

Results

We matched 5862 incident β-blocker users (eGFR >60, n = 3136; eGFR 30–60, n = 2368; eGFR <30, n = 358). There were 2361 mortality events during follow-up. β-Blocker use was associated with reduced all-cause mortality [adjusted hazard ratio (HR) 0.58, 95% confidence interval (CI) 0.54–0.64]. This result was consistent across all eGFR categories (>60: adjusted HR 0.55, 95% CI 0.49–0.62; 30–60: adjusted HR 0.63, 95% CI 0.55–0.71; <30: adjusted HR 0.55, 95% CI 0.41–0.73; interaction term, P = 0.30). The results were consistent in an intention-to-treat analysis and with β-blocker use treated as a time-varying exposure.

Conclusions

β-Blocker use is associated with reduced all-cause mortality in elderly patients with CHF and CKD, including those with an eGFR <30. Randomized trials that examine β-blockers in patients with CHF and advanced CKD are needed.
Sensor Modalities for Brain-Computer Interface Technology: A Comprehensive Literature Review
Authors: Martini Michael L , Oermann Eric Karl , Opie Nicholas L , Panov Fedor , Oxley Thomas , Yaeger Kurt
Published: July 2019

Brain-computer interface (BCI) technology is rapidly developing and changing the paradigm of neurorestoration by linking cortical activity with control of an external effector to provide patients with tangible improvements in their ability to interact with the environment. The sensor component of a BCI circuit dictates the resolution of brain pattern recognition and therefore plays an integral role in the technology. Several sensor modalities are currently in use for BCI applications and are broadly either electrode-based or functional neuroimaging-based. Sensors vary in their inherent spatial and temporal resolutions, as well as in practical aspects such as invasiveness, portability, and maintenance. Hybrid BCI systems with multimodal sensory inputs represent a promising development in the field allowing for complimentary function. Artificial intelligence and deep learning algorithms have been applied to BCI systems to achieve faster and more accurate classifications of sensory input and improve user performance in various tasks. Neurofeedback is an important advancement in the field that has been implemented in several types of BCI systems by showing users a real-time display of their recorded brain activity during a task to facilitate their control over their own cortical activity. In this way, neurofeedback has improved BCI classification and enhanced user control over BCI output. Taken together, BCI systems have progressed significantly in recent years in terms of accuracy, speed, and communication. Understanding the sensory components of a BCI is essential for neurosurgeons and clinicians as they help advance this technology in the clinical setting.
Is Excellence in the Cards?
Authors: McPoil Thomas G
Published: July 2019

Thomas G. McPoil, PT, PhD, FAPTA, is Emeritus Professor of Physical Therapy at Regis University, Denver, Colorado, and Emeritus Regents’ Professor of Physical Therapy at Northern Arizona University. He has served as an Adjunct Honorary Professor in the School of Physiotherapy at the University of Queensland, Brisbane, Australia, and currently serves as a consultant to the Physical Therapy Orthotics Clinic at Denver Health Medical Center, Denver, Colorado. Dr. McPoil is known nationally and internationally for his scholarly contributions that have systematically examined foot and ankle function from both scientific and clinical perspectives. Dr. McPoil is an author or coauthor of 130 publications in peer-reviewed journals, coeditor of 2 books, and coauthor of 6 book chapters. His work reaches beyond the profession of physical therapy, as he served on the editorial boards of Foot and Ankle International, the Journal of Foot and Ankle Research, and Research in Sports Medicine and is currently on the editorial boards of the Journal of the American Podiatric Medical Association and The FOOT.

Dr McPoil received his PhD in kinesiology with a specialization in biomechanics from University of Illinois at Urbana–Champaign. He holds an MS in physical education with a specialization in athletic training from Louisiana State University and a BA in physical education from the California State University, Sacramento. During his career, he has held faculty appointments at the University of Illinois at Chicago, Northern Arizona University, and Regis University. Dr McPoil’s clinical practice has focused on the management of chronic orthopedic foot and ankle disorders for the past 38 years.

Dr McPoil is the founding president of the Foot and Ankle Special Interest Group of the Academy of Orthopaedic Physical Therapy. He has served as Vice President of the Academy of Orthopaedic Physical Therapy and as the Treasurer of the Journal of Orthopaedic and Sports Physical Therapy. He has received numerous teaching awards, including APTA’s Dorothy E. Baethke & Eleanor J. Carlin Award for Excellence in Academic Teaching and the Academy of Orthopaedic Physical Therapy’s James A. Gould Excellence in Teaching Orthopaedic Physical Therapy Award. He is a recipient of a Fulbright Senior Scholar Award, the William J. Stickel Award for Research in Podiatric Medicine, the Academy of Orthopaedic Physical Therapy’s Stanley Paris Distinguished Service Award and was elected a Catherine Worthingham Fellow of APTA in 2007.
Long-Term Impacts of Childhood Medicaid Expansions on Outcomes in Adulthood
Authors: Brown David W , Kowalski Amanda E , Lurie Ithai Z
Published: July 2019

We use administrative data from the Internal Revenue Service to examine long-term impacts of childhood Medicaid eligibility expansions on outcomes in adulthood at each age from 19 to 28. Greater Medicaid eligibility increases college enrolment and decreases fertility, especially through age 21. Starting at age 23, females have higher contemporaneous wage income, although male increases are imprecise. Together, both genders have lower mortality. These adults collect less from the earned income tax credit and pay more in taxes. Cumulatively from ages 19 to 28, at a 3% discount rate, the federal government recoups 58 cents of each dollar of its “investment” in childhood Medicaid.
The many faces of psoriatic arthritis: their genetic determinism
Authors: Winchester Robert , FitzGerald Oliver
Published: July 2019

In this review, we propose a model of PsA as a complex genetically determined autoimmune-mediated disease having a heterogeneous variety of subphenotypes, with each subphenotype under the control of a different susceptibility-associated HLA allele. Since the specific HLA molecules encoded by each susceptibility allele dominantly select a T cell repertoire with the property of recognizing different peptides, we hypothesize each subphenotype reflects a distinct adaptive autoimmune response directed to different target molecules that is mediated by T cells within each selected repertoire. The interaction among the patients’ susceptibility alleles in the selection of their T cell repertoires determines a spectrum of overall clinical disease severity, varying from mild to severe. We further speculate that these different immune responses may result in activation of different immune effector pathways, which might therefore respond differently to various specific biologic agents.
Defining remission in rheumatoid arthritis: does it matter to the patient? A comparison of multi-dimensional remission criteria and patient reported outcomes
Authors: Gul Hanna L , Eugenio Gisella , Rabin Thibault , Burska Agata , Parmar Rekha , Wu Jianhua , Ponchel Frederique , Emery Paul
Published: July 2019

Objectives

In a cross-sectional study, we evaluated the prevalence of ‘multi-dimensional remission’ (MDR) and its component parameters, assessed using objective measures in a cohort of RA patients in treatment-induced DAS28-remission, and their relationship with patient-reported outcome measures. We sought to confirm the feasibility and face validity of the MDR construct, providing a platform for future longitudinal studies in which its clinical utility might be further established.

Methods

605 patients were selected from an inflammatory arthritis register using DAS28(CRP)<2.6. Demographic, clinical and patients reported outcomes (PRO) data were collected. Ultrasound power doppler synovitis (n = 364) and T-cell subsets (n = 297) were also measured. Remission using clinical parameters was defined as: tender and swollen joint count (TJC/SJC) and CRP all ⩽1; ultrasound remission: total power doppler = 0 and T cell remission: positive normalized naïve T-cell frequency. MDR was defined as the achievement of all three dimensions.

Results

Overall, only 53% (321/605) of the patients achieved clinical parameters, failures being mainly due to raised CRP (52%), TJC (28)>1 (37%) or SJC (28)>1 (16%). 211/364 (58%) of patients achieved ultrasound remission and 193/297 (65%) patients showed T-cell remission. Complete data were available for 231 patients. MDR was observed in only 35% and was associated with the best (lower) PRO scores (all P ⩽ 0.05 vs non-MDR) when compared with the other definitions of remission assessed. The MDR rate was similar in early and established RA patients on b-DMARDs; however, it was lower in established RA patients who received multiple cs-DMARDs (P = 0.011).

Conclusions

In this study, MDR, which may represent a state closer to normality, was found to occur in about a third of DAS28-remission patients and was associated with better patient-reported outcome measures. MDR could be a novel optimal treatment target, notably from a patient’s perspective. The relevance of these findings needs further assessment.
Conducting research in psoriatic arthritis: the emerging role of patient research partners
Authors: Goel Niti
Published: July 2019

Since 2003, patients have become increasingly involved in research endeavours related to psoriatic arthritis (PsA), progressing into a patient research partner (PRP) role. This paper reviews the general considerations related to PRP involvement in research endeavours and more specifically, the evolution of PRP contributions related to PsA research. The addition of the perspective from individuals with lived experience of PsA can bring unique insights to the research process, and increase the likelihood that the results of research are meaningful and relevant to PsA patients. There are also potential issues to address when incorporating PRPs, such as the need for additional time and effort to identify, train, and collaborate with PRPs as members of a research team. Overall, while there are challenges to overcome, and the opportunities to include PRPs are sometimes overlooked, efforts to include PRPs in PsA research should offer significant benefits to patients, researchers, and trials.
Effect of Risperidone Monotherapy on Dynamic Functional Connectivity of Insular Subdivisions in Treatment-Naive, First-Episode Schizophrenia
Authors: Duan Xujun , Hu Maolin , Huang Xinyue , Su Chan , Zong Xiaofen , Dong Xia , He Changchun , Xiao Jinming , Li Haoru , Tang Jinsong , Chen Xiaogang , Chen Huafu
Published: July 2019

Objective

The insula consists of functionally diverse subdivisions, and each division plays different roles in schizophrenia neuropathology. The current study aimed to investigate the abnormal patterns of dynamic functional connectivity (dFC) of insular subdivisions in schizophrenia and the effect of antipsychotics on these connections.

Methods

Longitudinal study of the dFC of insular subdivisions was conducted in 42 treatment-naive first-episode patients with schizophrenia at baseline and after 8 weeks of risperidone treatment based on resting-state functional magnetic resonance image (fMRI).

Results

At baseline, patients showed decreased dFC variance (less variable) between the insular subdivisions and the precuneus, supplementary motor area and temporal cortex, as well as increased dFC variance (more variable) between the insular subdivisions and parietal cortex, compared with healthy controls. After treatment, the dFC variance of the abnormal connections were normalized, which was accompanied by a significant improvement in positive symptoms.

Conclusions

Our findings highlighted the abnormal patterns of fluctuating connectivity of insular subdivision circuits in schizophrenia and suggested that these abnormalities may be modified after antipsychotic treatment.
Social Norms about Father Involvement and Women’s Fertility
Authors: Lappegård Trude , Kornstad Tom
Published: July 2019

We argue that father involvement at the societal level influences women’s fertility decisions. If father involvement becomes a social norm, it provides expectations about shared parenthood and father involvement in care for young children, making it easier to realize childbearing plans. We test our theoretical assumption using administrative register data from Norway covering 25 years of exposure to a social policy aiming at fathers becoming more involved in childcare and an equal division of labor within the family. Hazard model regression analyses including macro indicators of father involvement reveal that father engagement – in the sense that fathers are visible in the community being on parental leave – is positively associated with women becoming mothers and one-child mothers’ transition to second birth, but the effect is strongest for the second birth. Simulation experiments show that in a scenario where no fathers take parental leave, only 63 percent of all women have a second child, while in the scenario where almost all fathers take leave, as many as 74 percent of all women will do so. In many low fertility countries, women often stop at one child. Our results suggest that in such societies that are concerned about low fertility, policies that encourage father involvement could be a valuable investment.
Fighting for Their Neighborhood: Urban Policy and Anti-State Riots in France
Authors: Moutselos Michalis
Published: July 2019

Why does anti-state, violent rioting take place in advanced democracies? The paper investigates the role of the urban environment in shaping grievances expressed and mobilization/counter-mobilization processes observed during a riotous episode. In particular, I look at large social-housing estates as a propitious urban setting for the eruption and sustenance of anti-state violence. I identify three mechanisms (stigma amplification and inversion, failure of state intervention in the form of everyday administration and emergency policing, and advantages for network activation and resource mobilization among potential rioters) that complement standard explanations of rioting based on socioeconomic and ethno-cultural grievances. I test the theoretical model using a controlled case study of two neighboring suburbs in the North of Paris, with similar socioeconomic, demographic, and political characteristics but different violent outcomes in the 2005 nation-wide wave of French riots. The paper traces the source of local variation to the exogenous presence of large, concentrated social-housing estates in one, but not the other. The analysis here treats anti-state rioting as a form of urban protest and looks at state-society divisions rooted in urban geography and policy that have been overlooked in conventional scholarship on minority mobilization in Europe.
Graph Splitting: A Graph-Based Approach for Superfamily-Scale Phylogenetic Tree Reconstruction
Authors: Matsui Motomu , Iwasaki Wataru
Published: July 2019

A protein superfamily contains distantly related proteins that have acquired diverse biological functions through a long evolutionary history. Phylogenetic analysis of the early evolution of protein superfamilies is a key challenge because existing phylogenetic methods show poor performance when protein sequences are too diverged to construct an informative multiple sequence alignment (MSA). Here, we propose the Graph Splitting (GS) method, which rapidly reconstructs a protein superfamily-scale phylogenetic tree using a graph-based approach. Evolutionary simulation showed that the GS method can accurately reconstruct phylogenetic trees and be robust to major problems in phylogenetic estimation, such as biased taxon sampling, heterogeneous evolutionary rates, and long-branch attraction when sequences are substantially diverge. Its application to an empirical data set of the triosephosphate isomerase (TIM)-barrel superfamily suggests rapid evolution of protein-mediated pyrimidine biosynthesis, likely taking place after the RNA world. Furthermore, the GS method can also substantially improve performance of widely used MSA methods by providing accurate guide trees.
GHOST: Recovering Historical Signal from Heterotachously Evolved Sequence Alignments
Authors: Crotty Stephen M , Minh Bui Quang , Bean Nigel G , Holland Barbara R , Tuke Jonathan , Jermiin Lars S , Haeseler Arndt Von
Published: July 2019

Molecular sequence data that have evolved under the influence of heterotachous evolutionary processes are known to mislead phylogenetic inference. We introduce the General Heterogeneous evolution On a Single Topology (GHOST) model of sequence evolution, implemented under a maximum-likelihood framework in the phylogenetic program IQ-TREE (http://www.iqtree.org). Simulations show that using the GHOST model, IQ-TREE can accurately recover the tree topology, branch lengths, and substitution model parameters from heterotachously evolved sequences. We investigate the performance of the GHOST model on empirical data by sampling phylogenomic alignments of varying lengths from a plastome alignment. We then carry out inference under the GHOST model on a phylogenomic data set composed of 248 genes from 16 taxa, where we find the GHOST model concurs with the currently accepted view, placing turtles as a sister lineage of archosaurs, in contrast to results obtained using traditional variable rates-across-sites models. Finally, we apply the model to a data set composed of a sodium channel gene of 11 fish taxa, finding that the GHOST model is able to elucidate a subtle component of the historical signal, linked to the previously established convergent evolution of the electric organ in two geographically distinct lineages of electric fish. We compare inference under the GHOST model to partitioning by codon position and show that, owing to the minimization of model constraints, the GHOST model offers unique biological insights when applied to empirical data.
Polycyclic Aromatic Hydrocarbons Can Trigger Hepatocyte Release of Extracellular Vesicles by Various Mechanisms of Action Depending on Their Affinity for the Aryl Hydrocarbon Receptor
Authors: van Meteren Nettie , Lagadic-Gossmann Dominique , Chevanne Martine , Gallais Isabelle , Gobart Dimitri , Burel Agnès , Bucher Simon , Grova Nathalie , Fromenty Bernard , Appenzeller Brice M R , Chevance Soizic , Gauffre Fabienne , Le Ferrec Eric , Sergent Odile
Published: July 2019

Extracellular vesicles (EVs) are membrane-enclosed nanostructures released by cells into the extracellular environment. As major actors of physiological intercellular communication, they have been shown to be pathogenic mediators of several liver diseases. Extracellular vesicles also appear to be potential actors of drug-induced liver injury but nothing is known concerning environmental pollutants. We aimed to study the impact of polycyclic aromatic hydrocarbons (PAHs), major contaminants, on hepatocyte-derived EV production, with a special focus on hepatocyte death. Three PAHs were selected, based on their presence in food and their affinity for the aryl hydrocarbon receptor (AhR): benzo[a]pyrene (BP), dibenzo[a,h]anthracene (DBA), and pyrene (PYR). Treatment of primary rat and WIF-B9 hepatocytes by all 3 PAHs increased the release of EVs, mainly comprised of exosomes, in parallel with modifying exosome protein marker expression and inducing apoptosis. Moreover, PAH treatment of rodents for 3 months also led to increased EV levels in plasma. The EV release involved CYP metabolism and the activation of the transcription factor, the AhR, for BP and DBA and another transcription factor, the constitutive androstane receptor, for PYR. Furthermore, all PAHs increased cholesterol levels in EVs but only BP and DBA were able to reduce the cholesterol content of total cell membranes. All cholesterol changes very likely participated in the increase in EV release and cell death. Finally, we studied changes in cell membrane fluidity caused by BP and DBA due to cholesterol depletion. Our data showed increased cell membrane fluidity, which contributed to hepatocyte EV release and cell death.
Rapid Detection of Xanthomonas citri pv. fuscans and Xanthomonas phaseoli pv. phaseoli in Common Bean by Loop-Mediated Isothermal Amplification
Authors: de Paiva Bruna Alicia Rafael , Wendland Adriane , Teixeira Nara Cristina , Ferreira Marisa A. S. V.
Published: July 2019

A single loop-mediated isothermal amplification (LAMP) assay was developed for specific detection of both pathogens that cause bacterial blight in common bean, Xanthomonas phaseoli pv. phaseoli (Xpp) and Xanthomonas citri pv. fuscans (Xcf). The objective was to provide a simple, easy-to-use, specific, and sensitive method to investigate the presence of one or both pathogens in plant material and seeds for routine diagnosis. The detection limits for both pathogens were 10 CFU/ml for cell suspensions and 1 fg of DNA, whereas in conventional PCR, the primers detected up to 105 CFU/ml and 1 ng of DNA. Specificity was confirmed by testing DNA from bean leaves, other Xanthomonas species, common fungal and bacterial bean pathogens, and bacteria from the leaf microbiota. The method was tested with bean leaves inoculated with Xpp, and the pathogen could be detected from 4 h up to 15 days postinoculation, even before disease symptoms were visible. When the method was applied to bacterium detection (Xpp or Xcf) in seed lots from infected plants, the bacterium detection rate was 100% (24 of 24). The pathogens were detected in seeds incubated for just 1 h in saline solution (0.85%), reducing the time needed for bacterium detection. The LAMP assay could be useful as a tool in bean bacterial blight management. Rapid and sensitive detection of bacteria in bean seed lots would reduce the risks of planting highly contaminated seeds in environments favorable to blight multiplication.
Presence of a Sexual Population of Puccinia graminis f. sp. tritici in Georgia Provides a Hotspot for Genotypic and Phenotypic Diversity
Authors: Olivera Pablo D. , Sikharulidze Zoya , Dumbadze Rusudan , Szabo Les J. , Newcomb Maria , Natsarishvili Ketino , Rouse Matthew N. , Luster Douglas G. , Jin Yue
Published: July 2019

Wheat stem rust, caused by Puccinia graminis f. sp. tritici, is a re-emerging disease exemplified by recent epidemics caused by new virulent races. Understanding the sources and origins of genetic variations in the pathogen populations globally can facilitate the development of better strategies in disease management. We analyzed 68 wheat stem rust samples collected between 2013 and 2015 from Georgia where stem rust incidences are frequent and the alternate host, common barberry, is present. A total of 116 single-pustule isolates were derived and evaluated on stem rust differential lines to determine the virulence phenotypes and 23 races were identified, many of which were detected for the first time. Unique virulence combinations including, Sr22+Sr24 and Sr13b+Sr35+Sr37 were detected. These virulence combinations pose new challenges to breeding programs because many of these genes are used in breeding for resistance to the Ug99 race group. Sixty-one isolates were genotyped using a custom single-nucleotide polymorphism chip and 17 genotypes were identified. The 2013 isolates contained 11 multilocus genotypes compared with isolates of 2014 and 2015, with five and three genotypes, respectively. The higher levels of virulence and genotypic diversity observed in the 2013 samples strongly indicated that sexual recombination occurs in the Georgian P. graminis f. sp. tritici population, and that the Caucasus region of Eurasia may be an important source of new races.

[Formula: see text] Copyright © 2019 The Author(s). This is an open access article distributed under the CC BY 4.0 International license .
The role of component-resolved diagnosis in Hymenoptera venom allergy
Authors: Bilò Maria B. , Ollert Markus , Blank Simon
Published: July 2019

Purpose of review

Component-resolved diagnostics (CRD) is a new tool aiming at detecting IgE-mediated sensitizations against individual, relevant allergens. Here, we discuss recent literature on molecular diagnosis in the field of Hymenoptera venom allergy (HVA) as well as CRD strengths and weaknesses.

Recent findings

CRD, using single molecules or panels of allergens, may discriminate between primary sensitization and cross-reactivity in patients with double/multiple positivity in diagnostic tests with whole extracts, allowing the specialist to choose the most suitable venom for specific immunotherapy (VIT), avoiding unnecessary VIT and reducing the risk of side effects. Future availability of the cross-reactive recombinant pairs of allergens of different species may further increase the diagnostic performance. CRD may be useful in patients with negative allergy tests and a proven history of a previous systemic reaction, including those with mast cell disorders, who could benefit from VIT. In honeybee venom allergy, different sensitization profiles have been identified, which could be associated with a greater risk of VIT failure or treatment side effects.

CRD is undoubtedly an innovative diagnostic method that leads to a more precise definition of the sensitization profile of the HVA patient. Together with a better knowledge of the molecular composition of different venom extracts, CRD may contribute to optimize patient-tailored therapy.
Emerging indications for hyperbaric oxygen
Authors: Bennett Michael H. , Mitchell Simon J.
Published: July 2019

Purpose of review

To identify and discuss emerging trends in the therapeutic use of hyperbaric oxygen.

Recent findings

There has been a maturing of the clinical evidence to support the treatment of sudden hearing loss, a wide range of problematic chronic wound states and the prevention and treatment of end-organ damage associated with diabetes mellitus. On the other hand, the controversy continues concerning the use of hyperbaric oxygen therapy (HBOT) to treat sequelae of mild traumatic brain injury. HBOT remains poorly understood by many medical practitioners despite more than 50 years of clinical practice. Pharmacological actions arise from increased pressures of oxygen in the blood and tissues. Most therapeutic mechanisms identified are not the simple result of the reoxygenation of hypoxic tissue, but specific effects on immunological and metabolic pathways by this highly reactive element. HBOT remains controversial despite biological plausibility and a solid clinical evidence base in several disease states.

Multiple proposals for new indications for HBOT continue to emerge. Although many of these will likely prove of limited clinical importance, some show significant promise. Responsible practitioners remain acutely aware of the need for high-quality clinical evidence before introducing emerging indications into routine practice.
Opioid Consumption Patterns After Lumbar Microdiscectomy or Decompression
Authors: Lovecchio Francis , Premkumar Ajay , Stepan Jeffrey G. , Mejia Dianna , Stein Daniel , Patel Dil V. , Lafage Virginie , Derman Peter , Khechen Benjamin , Iyer Sravisht , Lebl Darren , Qureshi Sheeraz , Huang Russel , Singh Kern , Albert Todd J.
Published: July 2019

Study Design.

Prospective observational study

Objective.

The aim of this study was to record daily opioid use and pain levels after 1-level lumbar decompression or microdiscectomy.

Summary of Background Data.

The standardization of opioid-prescribing practices through guidelines can decrease the risk of misuse and lower the number of pills available for diversion in this high-risk patient population. However, there is a paucity of quantitative data on the “minimum necessary amount” of opioid appropriate for post-discharge prescriptions.

Methods.

At two institutions between September 2017 and 2018, we prospectively enrolled 85 consecutive adult patients who underwent one-level lumbar decompression or microdiscectomy. Patients with a history of opioid dependence were excluded. Daily opioid consumption and pain scores were collected using an automated text-messaging-based platform for 6 weeks or until consumption ceased. Refills during the study period were monitored. Patients were asked for the number of pills left over and the method of disposal. Opioid use was converted to oral morphine equivalents (OMEs). Results are also reported in terms of “pills” (oxycodone 5 mg equivalents) to facilitate clinical applications. Risk factors were compared between patients in the top and bottom half of opioid consumption.

Results.

Total opioid consumption ranged from 0 to 118 pills, with a median consumption of 32 pills (236.3 OME). Seventy-five percent of patients consumed ≤57 pills (431.3 OME). Mean Numeric Rating Scale pain scores declined steadily over the first 2 weeks. By postoperative day 7 half of the study population had ceased taking opioids altogether. Only 22.4% of patients finished their initial prescription, and only 9.4% of patients obtained a refill.

Conclusion.

These data may be used to formulate evidence-based opioid prescription guidelines, establish benchmarks, and identify patients at the higher end of the opioid use spectrum.

Level of Evidence: 2
A Rare Spinal Injury
Authors: Bayram Serkan , Akgül Turgut , Özmen Emre , Şar Cüneyt
Published: July 2019

Study Design.

Case report.

Objective.

We present a 18-year-old male patient with gunshot injury through right scapular region with the bullet ending up and causing a fracture in the odontoid process.

Summary of Background Data.

Odontoid fracture owing to gunshot wound is an extremely rare injury.

Methods.

An 18-year-old male patient was brought to the emergency department with gunshot injury. x-Ray imaging showed retained bullet in the odontoid process. Computed tomography scan showed fracture of the odontoid and body of scapula consistent with the trajectory of the bullet. Owing to a normal neurological examination, conservative follow-up was decided and given a Philadelphia collar.

Results.

At 2 years’ follow-up, patient demonstrated limited axial rotation and flexion/extension. However, no pain and neurologic problem were observed.

Conclusion.

Odontoid fracture owing to gunshot wound can be treated conservatively; emergency or elective surgical intervention was not necessary. In the follow-up, patient did not demonstrate any signs of neurological impairment or infection.

Level of Evidence: 5
Syndromic Scoliosis: National Trends in Surgical Management and Inpatient Hospital Outcomes
Authors: Chung Andrew S. , Renfree Sean , Lockwood Donovan B. , Karlen Judson , Belthur Mohan
Published: July 2019

Study Design.

Retrospective cohort study.

Objective.

Evaluate the trends in management and inpatient outcomes in patients with syndromic scoliosis undergoing spinal deformity correction.

Summary of Background Data.

Syndromic scoliosis (SS) refers to scoliosis that is most commonly associated with systemic disease including Ehler Danhlos syndrome (EDS), Marfan syndrome (MF), Down syndrome (DS), Achondroplasia (AP), and Prader-Willi syndrome (PWS). Limited data exist evaluating hospital outcomes in patients with SS undergoing spinal deformity correction.

Methods.

The Kids’ Inpatient Database (KIDS) was queried from 2001 to 2012 to identify all pediatric patients with scoliosis undergoing spinal fusion. These patients were then sub-divided into two cohorts: (1) patients with idiopathic scoliosis (IS) and (2) patients with syndromic scoliosis. Trends in surgical management, and postoperative morbidity and mortality were assessed. Length of stay and total hospital charges were additionally analyzed. A sub-analysis to characterize outcomes in each syndrome was also performed.

Results.

An estimated 1071 patients with SS were identified and compared with 24,989 pediatric patients with IS. MF (36.8%), Down syndrome (16.0%), and PWS (14.9%) were the most common diagnoses among patients with SS. Between 2001 and 2012, there was a significant decline in the number of anterior procedures performed in both cohorts. Conversely, the number of posterior based procedures increased. SS was associated with increased major complications (2.7% compared with 1.0% in IS; P < 0.001) and minor complication rates (41.0% compared with 28.5% in IS; P < 0.001). Patients with AP incurred the highest rate of major complications (10.7%), minor complications (60.8%), and intraoperative durotomies (6.1%). Total hospital charges increased significantly over the 12-year span.

Conclusion.

Trends in management of syndromic scoliosis have paralleled that of idiopathic scoliosis. Syndromic scoliosis is associated with increased risks with surgical deformity correction. Further prospective studies are warranted to evaluate the reasons for these differences.

Level of Evidence: 3
Mesenchymal Stem Cell Homing Into Intervertebral Discs Enhances the Tie2-positive Progenitor Cell Population, Prevents Cell Death, and Induces a Proliferative Response
Authors: Wangler Sebastian , Peroglio Marianna , Menzel Ursula , Benneker Lorin M. , Haglund Lisbet , Sakai Daisuke , Alini Mauro , Grad Sibylle
Published: July 2019

Study Design.

Experimental study with human mesenchymal stem cells (MSCs) and intervertebral disc (IVD) tissue samples.

Objective.

This study aimed to characterize the effect of MSC homing on the Tie2-positive IVD progenitor cell population, IVD cell survival, and proliferation.

Summary of Background Data.

Homing of human MSCs has been described as potential alternative to MSC injection, aiming to enhance the regenerative capacity of the IVD. IVD cells expressing Tie2 (also known as CD202b or Angiopoietin-1 receptor TEK tyrosine kinase) represent a progenitor cell population with discogenic differentiation potential. However, the fraction of Tie2-positive progenitor cells decreases with aging and degree of IVD degeneration, resulting in a potential loss of the IVD's regenerative capacity.

Methods.

Human MSCs, isolated from vertebral bone marrow aspirates, were labeled and seeded onto the endplate of bovine IVDs and human IVD tissue. Following MSC migration for 5 days, IVD cells were isolated by tissue digestion. The fractions of Tie2-positive, dead, apoptotic, and proliferative IVD cells were evaluated by flow cytometry and compared to untreated IVDs. For human IVDs, 3 groups were investigated: nondegenerated (organ donors), IVDs of patients suffering from spinal trauma, and degenerative IVD tissue samples.

Results.

MSC homing enhanced the fraction of Tie2-positive IVD cells in bovine and human IVD samples. Furthermore, a proliferative response and lower fraction of dead cells were observed after MSC homing in both bovine and human IVD tissues.

Conclusion.

Our findings indicate that MSC homing enhances the survival and regenerative capability of IVD cells, which may be mediated by intercellular communication. MSC homing could represent a potential treatment strategy to prevent the onset of the degenerative cascade in IVDs at risk such as IVDs adjacent to a fused segment or IVDs after herniation.

Level of Evidence: N/A
Bladder Scans and Postvoid Residual Volume Measurement Improve Diagnostic Accuracy of Cauda Equina Syndrome
Authors: Venkatesan Muralidharan , Nasto Luigi , Tsegaye Magnum , Grevitt Michael
Published: July 2019

Study Design.

A prospective, observational cohort study.

Objective.

The aim of this study was to determine the role of pre and postvoid bladder scan in predicting cauda equina syndrome (CES). The thesis was that bladder scanning [specifically postvoid residual (PVR) volume] would have higher diagnostic accuracy than physical examination alone.

Summary of Background Data.

CES is an ill-defined condition with a spectrum of presenting symptoms. There is neither a combination of clinical symptoms and/or signs that reliably predicts cauda equina compression nor single defining clinical criterion that has 100% predictive value to confirm or exclude CES.

Methods.

Patients with suspected CES admitted over a 6-month period at a single institution were prospectively assessed by physical examination (including digital rectal examination and pin prick perianal sensation) and bladder ultrasound scanning (recording pre- and PVR volume). These results were compared with the subsequent magnetic resonance imaging (MRI) scans and those patients who had emergent surgery for CES.

Results.

Ninety-two patients were included in the study (52 women) with a mean age of 44.9 years.

An MRI scan demonstrating causing compression of the cauda equina was present in only 18% (17/92).

The sensitivity of anal tone to predict CES was 52.9%. Peri-anal numbness (either unilateral or bilateral) had sensitivity of 82.3% and negative predictive value of 92%.

For nonoperated group (without CES), mean PVR was 199 mL (95% confidence interval ± 59 mL). On the basis of receiver operating curves, the optimal bladder volume cut-off for predicting CES was ≥200 mL for PVR volume. A PVR of <200 mL gave CES probability of 3.6%. If >200 mL, then the probability of having CES is 43% (P < 0.000003). A PVR <200 mL had a negative predictive value of 97%.

Conclusion.

Bladder scanning was a useful adjunct in the diagnosis of CES. It had a better negative predictive value than physical examination.

Level of Evidence: 3
Reciprocal Change in Sagittal Profiles After Adolescent Idiopathic Scoliosis Surgery With Segmental Pedicle Screw Construct
Authors: Shimizu Takayoshi , Cerpa Meghan , Lehman Ronald A. , Sielatycki John Alex , Pongmanee Suthipas , Lenke Lawrence G.
Published: July 2019

Study Design.

Retrospective cohort.

Objective.

This radiographic analysis using a full-body x-ray evaluated the ways in which the sagittal profiles of the unfused spinal segments, pelvic, and lower extremities spontaneously change after adolescent idiopathic scoliosis (AIS) surgery with segmental pedicle screw constructs.

Summary of Background Data.

Reciprocal lordotic changes in unfused spinal segments after corrective surgery for AIS have been reported. However, a full-body analysis has not been studied.

Methods.

The sagittal profiles of 51 (age ≤18) patients with AIS undergoing corrective surgery with segmental pedicle screw constructs were investigated. Patients were divided into two groups: group T; selective thoracic fusion and group L; fusion to the low lumbar spine. They were further subcategorized according to preoperative thoracic kyphosis (TK: T5–12): hypokyphotic (TK <20°) and normohyperkyphotic (TK >20°) groups. The postoperative change in the sagittal parameters and the correlation between the instrumented thoracic alignment change (ΔT2−12) and reciprocal changes of unfused segments were analyzed.

Results.

At baseline, the entire cohort had a relatively hypokyphotic thoracic spine (TK: 25.5° ± 13.7°), low T1 slope (13.6° ± 7.7°), and kyphotic cervical spine (C2–7 lordosis: 7.7° ± 13.1°). The lower extremities were in neutral alignment overall. Postoperatively, the cervical alignment changed significantly lordotic (average −13.4° increased lordosis) after the adequate preservation of TK (average 17.8° increased kyphosis) in the hypokyphotic group T. Linear correlations were observed between ΔT2–12 and spontaneous reciprocal changes in C2–7 lordosis, lumbar lordosis, and knee flexion angle in group T.

Conclusion.

The sagittal profiles of patients with AIS can significantly change after adequate restoration of TK which averaged 17.8°, particularly in the cervical spine. Lordotic reciprocal change in the cervical spine as well as increase in lumbar lordosis can occur in a linear correlation after adequate restoration of TK. There were no significant changes that occurred in the pelvis or lower extremities after AIS corrective surgery.

Level of Evidence: 4
Predicting the Natural Course of Hemivertebra in Early Childhood
Authors: Chang Sam Yeol , Nam Yunjin , Lee Jeongik , Lee Na-Kyoung , Chang Bong-Soon , Lee Choon-Ki , Kim Hyoungmin
Published: July 2019

Study Design.

A retrospective cohort, radiographic study.

Objective.

The aim of this study was to compare the progression of scoliosis owing to single hemivertebra (HV) during early childhood, according to the anteroposterior discordance obtained from the three-dimensional computed tomography (3D-CT) studies.

Summary of Background Data.

Previous studies have utilized 3D-CT for the classification of congenital spinal deformities and have introduced the concept of two types of deformity: unison and discordant anomalies. However, there have been no further studies on the clinical significance of these discordant deformities, especially in the identification of deformities that will progress and require an operation.

Methods.

We retrospectively analyzed 97 cases of single HV with thoracolumbar scoliosis, diagnosed in children before the age of 3 years and followed up past the age of 6 years. The segmentation of the anterior and posterior components, and anteroposterior discordance of the HV were evaluated using 3D-CT images. Coronal segmental curve angle (SCA) and balance were measured using whole spine plain radiographs.

Results.

Using 3D-CT, 41 (42.3%) cases of unison HV and 56 (57.7%) discordant HV were identified. Unison HV comprised 21 (21.6%) cases of fully segmented (FS) unison HV and 20 (20.6%) cases of semi-segmented unison HV with corresponding anterior and posterior segmentation. Fifty-six cases of discordant HV were further classified into 4 different types. In the 86 patients who were followed without operation between the ages of 3 and 6 years, the average progression of SCA was significantly larger in FS unison HV (one-way analysis of variance, P < 0.001). Ten of 86 (11.6%) patients showed a coronal imbalance at the age of 6 years, but the proportion of patients with coronal imbalance was not significantly different among the deformity types.

Conclusion.

Anteroposterior discordance on 3D analysis is a useful indicator for the progression of congenital scoliosis due to single HV in early childhood.

Level of Evidence: 4
Treg-promoted New Bone Formation Through Suppressing Th17 by Secreting Interleukin-10 in Ankylosing Spondylitis
Authors: Xu Fan , Guanghao Chi , Liang Yan , Jun Wang , Wei Wu , Baorong He
Published: July 2019

Study Design.

Retrospective single-center study.

Objective.

We want to know whether interleukin (IL)-10-secreting regulatory T cells (Treg) promote the new bone formation (NBF) through suppressing Th17 in ankylosing spondylitis (AS).

Summary of Background Data.

NBF in AS is unknown. Since there are balances of bone remodeling in human body and proinflammatory helper T cells Th17 promoted bone resorption.

Methods.

Eighteen AS patients with or without NBF (both nine cases) and nine healthy individuals were selected and the demographic data, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), MRI sacroiliitis score (MRISIS), and computer tomography sacroiliitis score (CTSIS) were recorded. Removed hip ligament tissue in the lesions after arthroplasty was collected and the lymphocytes and the peripheral blood mononuclear cells were prepared. Second, pathological section in hematoxylin–eosin stain were analyzed and flow cytometry and quantitative polymerase chain reaction analyses were carried out to detect the levels of Th17, Treg, IL-10, and nuclear factor (NF)-κB, and the relevance between them. The effect of Treg on Th17 was further analyzed by using Transwell coculturing.

Results.

Compared to AS patients without NBF, AS patients with NBF had significantly higher CTSIS and complications (P < 0.05 and 0.01, respectively), but significantly lower BASDAI (3.0 ± 0.4) and MRISIS (3.3 ± 0.8) (P < 0.01 and 0.05, respectively) and no acute inflammation in HE stain for hip joint. Compared to healthy donors, the ratio of Th17/Treg was significantly higher in AS patients without NBF and lower in AS patient with NBF (both P < 0.01) in flow cytometry analysis (FCA). Furthermore, Th17 significantly decreased after indirectly coculturing with Treg in FCA (P < 0.01). Finally, IL-10 had significantly higher mRNA expression in AS patients with NBF (P < 0.01), and NF-κB had significantly higher mRNA expression in AS patients without NBF (P < 0.05) than healthy donors. Only the mRNA expression of IL-10 was significantly correlated to the ratio of Th17/Treg (r = −0.93, P < 0.01).

Conclusion.

Treg-induced NBF of AS through suppressing Th17 by secreting IL10 and declining of the ratio of Th17/Treg indicated the development of NBF. This is important not only for screening development of NBF, but also for control of NBF of AS by immune therapy.

Level of Evidence: N/A
Characteristics of Rapid Response Calls in the United States: An Analysis of the First 402,023 Adult Cases From the Get With the Guidelines Resuscitation-Medical Emergency Team Registry
Authors: Lyons Patrick G. , Edelson Dana P. , Carey Kyle A. , Twu Nicole M. , Chan Paul S. , Peberdy Mary Ann , Praestgaard Amy , Churpek Matthew M.
Published: July 2019

Objectives:

To characterize the rapid response team activations, and the patients receiving them, in the American Heart Association-sponsored Get With The Guidelines Resuscitation-Medical Emergency Team cohort between 2005 and 2015.

Design:

Retrospective multicenter cohort study.

Setting:

Three hundred sixty U.S. hospitals.

Patients:

Consecutive adult patients experiencing rapid response team activation.

Interventions:

Rapid response team activation.

Measurements and Main Results:

The cohort included 402,023 rapid response team activations from 347,401 unique healthcare encounters. Respiratory triggers (38.0%) and cardiac triggers (37.4%) were most common. The most frequent interventions—pulse oximetry (66.5%), other monitoring (59.6%), and supplemental oxygen (62.0%)—were noninvasive. Fluids were the most common medication ordered (19.3%), but new antibiotic orders were rare (1.2%). More than 10% of rapid response teams resulted in code status changes. Hospital mortality was over 14% and increased with subsequent rapid response activations.

Conclusions:

Although patients requiring rapid response team activation have high inpatient mortality, most rapid response team activations involve relatively few interventions, which may limit these teams’ ability to improve patient outcomes.