bluuebunny/crossref_metadata_2025 huggingface dataset:
Aberration-corrected ultrafine analysis of miRNA reads at single-base resolution: a k-mer lattice approach
Authors: Zhang Xuan , Ping Pengyao , Hutvagner Gyorgy , Blumenstein Michael , Li Jinyan
Published: July 2021

Raw sequencing reads of miRNAs contain machine-made substitution errors, or even insertions and deletions (indels). Although the error rate can be low at 0.1%, precise rectification of these errors is critically important because isoform variation analysis at single-base resolution such as novel isomiR discovery, editing events understanding, differential expression analysis, or tissue-specific isoform identification is very sensitive to base positions and copy counts of the reads. Existing error correction methods do not work for miRNA sequencing data attributed to miRNAs’ length and per-read-coverage properties distinct from DNA or mRNA sequencing reads. We present a novel lattice structure combining kmers, (k – 1)mers and (k + 1)mers to address this problem. The method is particularly effective for the correction of indel errors. Extensive tests on datasets having known ground truth of errors demonstrate that the method is able to remove almost all of the errors, without introducing any new error, to improve the data quality from every-50-reads containing one error to every-1300-reads containing one error. Studies on experimental miRNA sequencing datasets show that the errors are often rectified at the 5′ ends and the seed regions of the reads, and that there are remarkable changes after the correction in miRNA isoform abundance, volume of singleton reads, overall entropy, isomiR families, tissue-specific miRNAs, and rare-miRNA quantities.
Stabilization and structural changes of 2D DNA origami by enzymatic ligation
Authors: Rajendran Arivazhagan , Krishnamurthy Kirankumar , Giridasappa Amulya , Nakata Eiji , Morii Takashi
Published: July 2021

The low thermal stability of DNA nanostructures is the major drawback in their practical applications. Most of the DNA nanotubes/tiles and the DNA origami structures melt below 60°C due to the presence of discontinuities in the phosphate backbone (i.e., nicks) of the staple strands. In molecular biology, enzymatic ligation is commonly used to seal the nicks in the duplex DNA. However, in DNA nanotechnology, the ligation procedures are neither optimized for the DNA origami nor routinely applied to link the nicks in it. Here, we report a detailed analysis and optimization of the conditions for the enzymatic ligation of the staple strands in four types of 2D square lattice DNA origami. Our results indicated that the ligation takes overnight, efficient at 37°C rather than the usual 16°C or room temperature, and typically requires much higher concentration of T4 DNA ligase. Under the optimized conditions, up to 10 staples ligation with a maximum ligation efficiency of 55% was achieved. Also, the ligation is found to increase the thermal stability of the origami as low as 5°C to as high as 20°C, depending on the structure. Further, our studies indicated that the ligation of the staple strands influences the globular structure/planarity of the DNA origami, and the origami is more compact when the staples are ligated. The globular structure of the native and ligated origami was also found to be altered dynamically and progressively upon ethidium bromide intercalation in a concentration-dependent manner.
An intradialytic non-immersive virtual reality exercise programme: a crossover randomized controlled trial
Authors: Martínez-Olmos Francisco J , Gómez-Conesa Antonia A , García-Testal Alicia , Ortega-Pérez-de-Villar Lucía , Valtueña-Gimeno Noemí , Gil-Gómez José A , Garcia-Maset Rafael , Segura-Ortí Eva
Published: July 2021

Background

Chronic kidney disease is closely related to a high risk of death and disability, poor physical performance and frailty. The main objective of this research was to analyse how intradialytic administration of a non-immersive virtual reality (VR) exercise programme would affect physical function and adherence to exercise in these patients.

Methods

A total of 56 individuals participated in two 12-week periods in a crossover randomized controlled trial. Each patient underwent a functional capacity evaluation before and after each study period. The functional tests administered included the 4-m gait speed test, Short Physical Performance Battery (SPPB), timed up-and-go (TUG) test, one-legged stance test (OLST) for balance, sit-to-stand 10 (STS-10) and sit-to-stand 60 (STS-60) tests and 6-min walking test (6MWT). Adherence to the exercise programme was also recorded. To assess the effect of VR exercise on the functional test outcomes over time, the patients were analysed using a two-way repeated-measures analysis of variance with time and treatment as the within-participant factors.

Results

By the end of the 12 weeks of exercise, compared with the control period, 33 participants showed significant change in physical function as measured through the 4-m gait speed test (0.14 m/s), SPPB (1.2 points), TUG (−1.7 s), OLST (7.1 s), STS-10 (−5.8 s), STS-60 (5 repetitions) and 6MWT (85.2 m), with adherence rates exceeding 70%. There were no changes in the biochemical data or in the medications in the period of the study.

Conclusion

An intradialytic non-immersive VR exercise programme improves patient physical function.
Prevalence of vitamin D deficiency and impact on clinical outcomes after kidney transplantation: a systematic review and meta-analysis
Authors: Yin Saifu , Wang Xianding , Li Linde , Huang Zhongli , Fan Yu , Song Turun , Lin Tao
Published: July 2021

Context

The prevalence of vitamin D deficiency (VDD) and its impact on clinical outcomes after kidney transplant (KT) remain poorly defined.

Objectives

We conducted a meta-analysis to evaluate the impact of early VDD on clinical outcomes after KT.

Data Sources

Electronic databases (PubMed, Embase, Web of Science, and The Cochrane Library) were systematically searched for eligible publications up to April 30, 2020.

Data Extraction

Relative risk was presented as hazard ratios (HRs) or odds ratios (ORs) and 95%CIs for dichotomous outcomes. Mean difference (MD) and 95%CIs were presented for continuous outcomes.

Results

A total of 28 studies (13 prospective and 15 retrospective) were included. VDD was common early after KT, with a prevalence of 52% (95%CI: 41%–64%) at transplant, 34% (95%CI: 17%–51%) at 3 months, and 23% (95%CI: 10%–35%) at 6 months. Early VDD was associated with higher mortality rate after KT (HR, 1.56; 95%CI: 1.32–1.84; P < 0.001). In addition, early VDD led to higher risk of bacterial infection (OR, 1.82; 95%CI: 1.40–2.36; P < 0.001), BK polyomavirus infection (OR, 2.11, 95%CI: 1.23–3.61; P = 0.006), and cytomegalovirus infection (OR, 1.69; 95%CI: 1.24–2.31; P = 0.001). Early VDD increased the risk of acute rejection as well (HR, 2.28; 95%CI: 1.57–3.30; P < 0.001). Recipients with early VDD had lower estimated glomerular filtration rates (mean difference: −5.06; 95%CI: −7.28 to 2.83 mL/min; P < 0.001). Sensitivity analyses showed good stability of the pooled results.

Conclusion

VDD was common early after KT and associated with higher risk of death and adverse outcomes.
Experience From 211 Transcortical Selective Amygdalohippocampectomy Procedures: Relevant Surgical Anatomy and Review of the Literature
Authors: Ali Rushna , Englot Dario J , Yu Hong , Naftel Robert , Haas Kevin F , Konrad Peter E
Published: July 2021

BACKGROUND

Selective amygdalohippocampectomy (SelAH) is designed to treat medically refractory mesial temporal lobe epilepsy with reduced morbidity compared to standard anterior temporal lobectomy. At our institution, we perform SelAH via a transcortical approach via small corticectomy in the middle temporal gyrus.

OBJECTIVE

To discuss the surgical anatomy and nuances of SelAH, share our institutional experience, and perform a review of literature.

METHODS

Institutional experience was recorded by collecting demographic and outcome data from 1999 to 2017 under an Institutional Review Board protocol in a prospective manner using a REDCap database.

RESULTS

A total of 211 SelAH procedures were performed at our institution between 1999 and 2017. Of these patients, 54% (113/211) were females. The average age at surgery was 39.4 yr. Two-year Engel outcome data were available for 168 patients, of which 73% (123/168) had Engel I outcomes. Engel II outcomes were reported in 16.6% (28/168), III in 4.7% (8/168), and IV in 5.3% (9/168). Our review of literature showed that this is comparable to the seizure freedom rates reported by other groups. We then reviewed our surgical methodology based on operative reports and created illustrations of the surgical anatomy of temporal lobe approach. These illustrations were compared with postoperative magnetic resonance imaging to provide a better 3D understanding of the complex architecture of mesial temporal structures.

CONCLUSION

SelAH is a minimally invasive, safe, and effective approach for the treatment of medically refractory epilepsy with good surgical outcomes and low morbidity. We feel that mastering the complex anatomy of this approach helps achieve successful outcomes.
Golden Eagle dietary shifts following wildfire and shrub loss have negative consequences for nestling survivorship
Authors: Heath Julie A , Kochert Michael N , Steenhof Karen
Published: July 2021

Wildfires and invasive species have caused widespread changes in western North America’s shrub-steppe landscapes. The bottom–up consequences of degraded shrublands on predator ecology and demography remain poorly understood. We used a before–after paired design to study whether Golden Eagle (Aquila chrysaetos) diet and nestling survivorship changed following wildfires in southwestern Idaho, USA. We assessed burn extents from 1981 to 2013 and vegetation changes between 1979 (pre-burn) and 2014 (post-burn) within 3 km of Golden Eagle nesting centroids. We measured the frequency and biomass of individual prey, calculated diet diversity indexes, and monitored nestling survivorship at 15 territories in 1971–1981 and 2014–2015. On average, 0.70 of the area within 3 km of nesting centroids burned between 1981 and 2013, and the mean proportion of unburned shrubland decreased from 0.73 in 1979 to 0.22 in 2014. Diets in post-burn years were more diverse and had a lower proportion of some shrub-associated species, such as black-tailed jackrabbits (Lepus californicus) and mountain cottontails (Sylvilagus nuttallii), and a higher proportion of American Coots (Fulica americana), Mallards (Anas platyrhynchos), Piute ground squirrels (Urocitellus mollis), and Rock Pigeons (Columba livia) compared with pre-burn years. A high proportion of waterfowl represented a novel change in Golden Eagle diets, which are typically dominated by mammalian prey. Nestling survivorship was positively associated with the proportion of black-tailed jackrabbits and negatively associated with the proportion of Rock Pigeons in eagle diets. Rock Pigeons are a vector for Trichomonas gallinae, a disease-causing protozoan lethal to young eagles. Nesting attempts were more likely to fail (all young die) in the post-burn period compared with the pre-burn period. Dietary shifts are a common mechanism for predators to cope with landscape change, but shifts away from preferred prey to disease vectors affect nestling survivorship and could lead to population-level effects on productivity.
Enrichment Nature of Ultrapotassic Rocks in Southern Tibet Inherited from their Mantle Source
Authors: Li Weikai , Yang Zhiming , Chiaradia Massimo , Zhou Limin , Hou Zengqian
Published: July 2021

Post-collisional ultrapotassic rocks (UPRs) in the Tibetan Plateau exhibit extreme enrichment in incompatible elements and radiogenic isotopes. Such enrichment is considered to be either inherited from a mantle source or developed during crustal evolution. In this study, to solve this debate we combined mineral textures and in situ geochemical composition of clinopyroxene phenocrysts in UPRs from southern Tibet to reveal their crustal evolution, enrichment cause and constrain metasomatism in their mantle source. Results show that the UPRs experienced an array of crustal processes, i.e., fractional crystallization, mixing, and assimilation. Fractional crystallization is indicated by decreases in Mg# and Ni and enrichment in incompatible elements (e.g. rare earth element (REE), Sr, Zr) toward the rims of normally zoned clinopyroxene phenocrysts (type-I). Magma mixing is evidenced by the presence of some clinopyroxene phenocrysts (type-II, -III) showing disequilibrium textures (e.g. reversed and overgrowth zoning), but in situ Sr isotope and trace element analysis of those disequilibrium zones indicate that late-stage recharged mafic magmas are depleted (87Sr/86Sr: 0.70659–0.71977) compared with the primitive ultrapotassic magmas (87Sr/86Sr: 0.70929–0.72553). Assimilation is revealed by the common presence of crustal xenoliths in southern Tibetan UPRs. Considering the much lower 87Sr/86Sr values (0.707759–0.709718) and incompatible element contents of these crustal xenoliths relative to their host UPRs, assimilation should have resulted in geochemical depletion of southern Tibetan UPRs rather than enrichment. The diluting impact of both assimilation and mixing is also supported by the modeling results based on the EC-E′RAχFC model combining the growth history of clinopyroxene. Trace elements ratios in clinopyroxenes also imply that the mantle source of southern Tibetan UPRs suffered an enriched and carbonatite-dominated metasomatism. Thus, we conclude that enrichment of southern Tibetan UPRs was inherited from the mantle source.
Gondomar and the Stage: Diego Sarmiento de Acuña and the Lost Theatrical Connection
Authors: Pérez Díez José A
Published: July 2021

Don Diego Sarmiento de Acuña, first Count of Gondomar (1567–1626), was twice appointed by the King of Spain to the delicate embassy in the court of James I in London, where he played a decisive role in Anglo-Spanish relations in the aftermath of the treaty of peace between the two monarchies signed in London in 1604. Beyond his uncontested political significance, Gondomar was also Spain’s premier bibliophile. His famous library comprised over 6000 volumes in nine languages, including a surprisingly large collection of plays. His interests in drama as an art form and in the theatre as a profession are well attested in his vast correspondence and the sizeable body of documents that have survived. While these interests have been noted, this is the first study that has attempted to analyse this body of evidence in a systematic way to suggest a closer connection to drama and the professional theatre of England and Spain. In particular, this study aims to shed some light on the untraced connections between Gondomar and the English playwrights and actors active in London during his time as ambassador. Gondomar’s library in London contained a number of recent and relatively rare works whose presence in the English metropolis at the right time might help to explain some cases of early adaptation of Spanish contemporary literature to the English drama of the period.
Risk of major adverse cardiovascular events in patients initiating biologics/apremilast for psoriatic arthritis: a nationwide cohort study
Authors: Pina Vegas Laura , Le Corvoisier Philippe , Penso Laetitia , Paul Muriel , Sbidian Emilie , Claudepierre Pascal
Published: July 2021

Objective

Several biological DMARDs (bDMARDs) have demonstrated anti-inflammatory effects in PsA. However, their comparative cardiovascular safety profiles remain unknown. We evaluated the risk of major adverse cardiovascular events (MACEs) in PsA patients on therapy with different classes of bDMARDs and apremilast.

Methods

This nationwide cohort study involved the administrative healthcare database of the French health insurance scheme linked to the hospital discharge database. All adults with PsA who were new users of bDMARDs/apremilast (neither in the year before the index date) during 2015–19 were included. Patients with previous cardiovascular diseases were excluded. End of follow-up was 31 December 2019. The primary endpoint was an occurrence of MACEs in a time-to-event analysis with propensity score-weighted Cox and Fine–Gray models.

Results

Between 2015 and 2019, we included 9510 bDMARD new users [mean age 48.5 (s.d. 12.7) years; 42% men], including 7289 starting a TNF inhibitor, 1058 an IL-12/23 inhibitor and 1163 an IL-17 inhibitor, with 1885 apremilast new users [mean age 54.0 (s.d. 12.5) years; 44% men]. MACEs occurred in 51 (0.4%) patients. After propensity score weighting, the risk of MACEs was significantly greater with IL-12/23 (weighted hazard ratio 2.0, 95% CI 1.3, 3.0) and IL-17 (weighted hazard ratio 1.9, 95% CI 1.2, 3.0) inhibitors than TNF inhibitors, with no significant increased risk with apremilast (weighted hazard ratio 1.3, 95% CI 0.8, 2.2). Similar results were observed with the Fine–Gray competing risks survival model.

Conclusion

Analysis of a large database revealed a small overall number of MACEs, and the risk of MACEs was greater for PsA new users of IL-12/23 and IL-17 vs TNF inhibitors.
Clinical Spectrum of Neurological Manifestations in Pediatric COVID-19 Illness: A Case Series
Authors: Khan Afreen , Chakravarty Aparna , Jain Abhinav , Harish Rekha , Naqishbandi Rizwan , Ishani Twisha
Published: July 2021

We describe a cohort of three patients with variable neurological presentations by SARS-COV-2 infection. It includes one case each of acute cerebellitis, acute encephalomyelitis and arterial ischemic stroke. To the best of our knowledge, we report the first pediatric case of acute cerebellitis due to SARS-CoV-2 infection. All critically ill patients were treated with methylprednisolone pulse therapy and dexamethasone. Patient with acute cerebellitis in addition required intravenous immunoglobulin infusion. All the patients responded to the treatment with complete neurological recovery.
Neurological Manifestations of Pediatric Acute COVID Infections: A Single Center Experience
Authors: Dilber Beril , Aydın Zeynep Gökçe Gayretli , Yeşilbaş Osman , Sağ Elif , Aksoy Nurdan Kaykı , Gündoğmuş Fırat , Küçükalioğlu Burcu Parıltan , Yılmaz Semra Atasoy , Demirhan Yeşeren Nil , Çelik Nurşen , Karaca Abdullah , Ertem Neşe Yalçın , Özdemir Ramazan , Aksoy Halil İbrahim , Öztürk Emine Esra , Saygın Berna , Acar Filiz Aktürk
Published: July 2021

Background

Coronavirus disease 2019 (COVID-19) usually leads to a mild infectious disease course in children, while serious complications may occur in conjunction with both acute infection and neurological symptoms, which have been predominantly reported in adults. The neurological complications in these patients vary based on patient age and underlying comorbidities. Data on clinical features, particularly neurological features, and prognostic factors in children and adolescents are limited. This study provides a concise overview of neurological complications in pediatric COVID-19 cases.

Materials and methods

The retrospective study reviewed medical records of all patients who were admitted to our hospital and were diagnosed with COVID-19 by real-time reverse-transcription polymerase-chain-reaction (RT–PCR) assay between 11 March 2020 and 30 January 2021. Patients with a positive PCR result were categorized into two groups: outpatient departments patients and inpatient departments (IPD).

Results

Of the 2530 children who underwent RT–PCR during the study period, 382 (8.6%) were confirmed as COVID-19 positive, comprising 188 (49.2%) girls and 194 (50.8%) boys with a mean age of 7.14±5.84 (range, 0–17) years. Neurological complications that required hospitalization were present in 34 (8.9%) patients, including seizure (52.9%), headache (38.2%), dizziness (11.1%) and meningoencephalitis (5.8%).

Conclusion

The results indicated that neurological manifestations are not rare in children suffering from COVID-19. Seizures, headaches, dizziness, anosmia, ageusia and meningoencephalitis are major neurological manifestations during acute COVID-19 disease. Although seizures were the most common cause of hospitalization in IPD patients, the frequency of meningoencephalitis was quite high. Seizures were observed as febrile seizures for children under 6 years of age and afebrile seizures for those over 6 years of age. Febrile seizure accounted for half of all seizure children.
Application of Target Enrichment Sequencing for Population Genetic Analyses of the Obligate Plant Pathogens Pseudoperonospora cubensis and P. humuli in Michigan
Authors: Bello Julian C. , Hausbeck Mary K. , Sakalidis Monique L.
Published: July 2021

Technological advances in genome sequencing have improved our ability to catalog genomic variation and have led to an expansion of the scope and scale of genetic studies over the past decade. Yet, for agronomically important plant pathogens such as the downy mildews (Peronosporaceae), the scale of genetic studies remains limited. This is, in part, due to the difficulties associated with maintaining obligate pathogens and the logistical constraints involved in the genotyping of these species (e.g., obtaining DNA of sufficient quantity and quality). To gain an evolutionary and ecological perspective of downy mildews, adaptable methods for the genotyping of their populations are required. Here, we describe a targeted enrichment (TE) protocol to genotype isolates from two Pseudoperonospora species (P. cubensis and P. humuli), using less than 50 ng of mixed pathogen and plant DNA for library preparation. We were able to enrich 830 target genes across 128 samples and identified 2,514 high-quality single nucleotide polymorphism (SNP) variants. Using these SNPs, we detected significant genetic differentiation (analysis of molecular variance [AMOVA], P = 0.01) between P. cubensis subpopulations from Cucurbita moschata (clade I) and Cucumis sativus (clade II) in the state of Michigan. No evidence of location-based differentiation was detected within the P. cubensis (clade II) subpopulation in Michigan. However, a significant effect of location on the genetic variation of the P. humuli subpopulation was detected in the state (AMOVA, P = 0.01). Mantel tests found evidence that the genetic distance among P. humuli samples was associated with the physical distance of the hop yards from which the samples were collected (P = 0.005). The differences in the distribution of genetic variation of the Michigan P. humuli and P. cubensis subpopulations suggest differences in the dispersal of these two species. The TE protocol described here provides an additional tool for genotyping obligate biotrophic plant pathogens and the execution of new genetic studies.

[Formula: see text] Copyright © 2021 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
COVID-19 Level-Loading
Authors: Lee Andy H. , Dunn Peter F. , Cooper Stephanie , Seger Robert , Raja Ali S. , Safavi Kyan C. , Yun Brian J.
Published: July 2021

COVID-19 continues to challenge bed capacity and the ability of hospitals to provide quality care for patients around the country. However, the COVID-19 pandemic at a given point in time does not impact all hospitals equally—even within a single healthcare system, one hospital may be caring for patients in the hallways, while another has available inpatient beds. Here, we demonstrate a program to level-load COVID-19 patients between 2 academic medical centers in a healthcare system by transferring patients at the time of admission from the emergency department of one institution directly to an inpatient bed of the other institution. Over 42 days, 50 patients were transferred which saved 432 bed-days at the home academic medical center without any adverse events during transfer or upgrades to the ICU within the first 24 hours of admission. Programs like this can expand a healthcare system’s ability to allocate personnel and resources efficiently for patients and maximize the quality of care delivered even during a pandemic.
The Impact of Simultaneous Hospital Participation in Accountable Care Organizations and Bundled Payments on Episode Outcomes
Authors: Liao Joshua M. , Wang Erkuan , Isidro Ulysses , Navathe Amol S.
Published: July 2021

Among hospitals accepting bundled payments, simultaneous “co-participation” in accountable care organizations (ACOs) could impact episode outcomes compared to bundled payment participation alone. Difference-in-differences (DID) analysis of 1 857 653 ACO-attributed Medicare beneficiaries. The study exposure was hospitalization for 24 procedure-based and 24 condition-based episodes at hospitals participating in bundled payments and ACOs (co-participant) versus only bundled payments. Study outcomes included episode quality, postacute utilization, and spending. For procedure-based episodes, patients hospitalized at co-participant and bundled payment hospitals did not exhibit differential changes in risk-adjusted mortality (DID 0.04 percentage points [p.p.], 95% confidence interval [CI] −0.28 p.p. to 0.37 p.p., P = 0.79), readmissions (DID −0.32 p.p., 95% CI −1.5 p.p. to 0.82 p.p., P = 0.59), postdischarge institutional spending (DID $119, 95% CI −$216 to $455, P = 0.49), or postacute utilization. Similarly, outcomes for condition-based episodes did not vary between co-participant and bundled payment hospitals. Payment model co-participation may produce neither synergistic benefits nor negative effects for patients.
Proximal Tibia Skeletal Traction: Technique and Indications
Authors: Obey Mitchel R. , Berkes Marschall B. , McAndrew Christopher M. , Miller Anna N.
Published: July 2021

Skeletal traction is a fundamental tool for the orthopaedic surgeon caring for patients with traumatic pelvic and lower-extremity orthopaedic injuries. Skeletal traction has proven to be an effective initial means of stabilization in patients with these injuries. Traction may be used for both temporary and definitive treatment in a variety of orthopaedic injuries. With the appropriate knowledge of regional anatomy, skeletal traction pins can be placed safely and with a low rate of complications. Several methods for placing skeletal traction have been described, and it is critical for orthopaedic surgeons to be proficient not only in their application but also understanding of the appropriate indications for use. Here we present a case example of a patient with a right femur fracture and discuss the technique and indications for placement of proximal tibia skeletal traction.
Management of Pediatric Femur Fracture Using 90-90 Traction
Authors: Kim Victoria , Milton Joe , Mashru Rakesh P. , Graf Kenneth W.
Published: July 2021

This video discusses treatment of pediatric femur fractures using 90-90 traction, followed by delayed spica casting. This study details the treatment of a 2-year-old girl with a subtrochanteric femur fracture featuring a 4-cm acute shortening and severe malalignment. The patient was placed in 90-90 traction in the operative setting. When adequate callous was observed radiographically, the patient was treated with a spica cast in the hospital on day 16. She was noted to have obtained uneventful healing of the fracture with no functional deficits, as detailed during serial office visits.
Tibia Antibiotic Intramedullary Nail
Authors: Tatman Lauren M. , Gajari Vamshi , Obremskey William T.
Published: July 2021

This video depicts the materials and steps for creating an antibiotic cement spacer in the form of an intramedullary nail and demonstrates how to insert the nail into a tibia. The indication for this patient was a history of a type 3B open tibia fracture 6 months before treated with an intramedullary nail that subsequently developed an infected nonunion.
Screening of Acute Traumatic Stress Disorder and Posttraumatic Stress Disorder in Pediatric Trauma Patients: A Pilot Study
Authors: Mazo Ashley , Waddell Megan , Raddatz Julia , Blankenship Kelly , Rachal James C. , Reynolds Stacy , Christmas A. Britton
Published: July 2021

Background:

Children who experience traumatic physical injuries are at risk of developing acute stress disorder and posttraumatic stress disorder (PTSD). Early identification and treatment of these high-risk children can lead to improved mental health outcomes in this population.

Objective:

This study assesses the feasibility of a study protocol that compares 3 screening tools for identifying patients at a high risk of later development of acute stress disorder or PTSD among pediatric trauma patients.

Methods:

This pilot study compared 3 questionnaires used as screening tools for predictors of later development of PTSD in a convenience sample of pediatric trauma patients aged 7–17 years. Patients were randomized to one of 3 screening tools. Families were contacted at 30, 60, and 90–120 days postinjury to complete the Child Report of Post-Traumatic Symptoms questionnaire. The sensitivity and negative predictive value of the screening tools were compared for the diagnosis of PTSD defined using the Child Report of Post-Traumatic Symptoms questionnaire.

Results:

Of the 263 patients identified for possible enrollment, 52 patients met full inclusion criteria and agreed to participate. Only 29 (55.7%) patients completed at least one follow-up questionnaire. The prevalence of acute stress disorder and PTSD in our population was 41% (95% CI [24, 61]) and 31% (95% CI [15, 51]), respectively.

Conclusions:

In this pilot study, we sought to determine the utility of the 3 commonly used screening instruments for measuring traumatic stress symptoms in pediatric trauma patients to predict the diagnosis of acute stress disorder or PTSD. Limitations include the use of the Child Report of Post-Traumatic Symptoms screening tool as the gold standard for calculating test characteristics and lack of 24/7 enrollment capabilities. As such, a significant portion of patients were discharged prior to our teams' engagement for enrollment.
Comprehensive Initiative to Decrease Trauma Venous Thromboembolism
Authors: Johns Tracy J. , Fabico-Dulin Josephine , Montgomery Anne , Dulin Janelle F. , Ashley Dennis W.
Published: July 2021

Background:

Our trauma center was a high outlier for pulmonary embolism on a 2017 American College of Surgeons Trauma Quality Improvement Program (TQIP) report. The odds ratio for developing a pulmonary embolus was 1.76 and was in the 10th decile (worst results). Of the patients who received chemoprophylaxis, only 69% of patients received the “gold standard” low-molecular-weight heparin.

Objective:

The purpose of this study was to describe and evaluate a multicomponent performance improvement project to prevent pulmonary embolus incidence.

Methods:

This descriptive study was a before-and-after time-series analysis of adult trauma patients. Ongoing data validation, concurrent monitoring, and analysis on incidence of venous thrombolytic events identified barriers to evidence-based chemoprophylaxis administration.

Results:

There were a total of 4,711 trauma patients in the analysis. Compared with preintervention (fall 2017), the fall 2019 TQIP report indicated the pulmonary embolus odds ratio dropped to 0.56, lowering the benchmark decile from 10 (worst) to 1 (best). The proportion of patients receiving no chemoprophylaxis decreased to 23% and was lower than all hospitals (32%). The rate of low-molecular-weight heparin use increased to 80% for patients receiving chemoprophylaxis, and unfractionated heparin use plummeted to 14%. The proportion of patients with no chemoprophylaxis in the severe traumatic brain injury cohort fell to 21%.

Conclusions:

The high pulmonary embolus rate was driven by inaccurate data, infrequent monitoring, suboptimal ordering, and administration of chemoprophylaxis. A sustained decrease in the pulmonary embolus incidence was achieved through collaboration, updated guidelines, expanded education, concurrent validation, monitoring, and frequent reporting.
Short-term Focused Feedback
Authors: Sauers-Ford Hadley , Statile Angela M. , Auger Katherine A. , Wade-Murphy Susan , Gold Jennifer M. , Simmons Jeffrey M. , Shah Samir S.
Published: July 2021

Background:

Our grant from the Patient-Centered Outcomes Research Institute (PCORI) focused on the use of nurse home visits postdischarge for primarily pediatric hospital medicine patients. While our team recognized the importance of engaging parents and other stakeholders in our study, our project was one of the first funded to address transitions of care issues in patients without chronic illness; little evidence existed about how to engage acute stakeholders longitudinally.

Objective:

This manuscript describes how we used both a short-term focused feedback model and longitudinal engagement methods to solicit input from parents, home care nurses, and other stakeholders throughout our 3-year study.

Results:

Short-term focused feedback allowed the study team to collect feedback from hundreds of stakeholders. Initially, we conducted focus groups with parents with children recently discharged from the hospital. We used this feedback to modify our nurse home visit intervention, then used quality improvement methods with continued short-term focus feedback from families and nurses delivering the visits to adjust the visit processes and content. We also used their feedback to modify the outcome collection. Finally, during the randomized controlled trial, we added a parent to the study team to provide longitudinal input, as well as continued to solicit short-term focused feedback to increase recruitment and retention rates.

Conclusion:

Research studies can benefit from soliciting short-term focused feedback from many stakeholders; having this variety of perspectives allows for many voices to be heard, without placing an undue burden on a few stakeholders.
Opening Pandora’s Box
Authors: Reeves Mathew J. , Fritz Michele C. , Osunkwo Ifeyinwa , Grudzen Corita R. , Hsu Lewis L. , Li Jing , Lawrence Raymona H. , Bettger Janet Prvu
Published: July 2021

Background:

Measuring the effectiveness of transitional care interventions has historically relied on health care utilization as the primary outcome. Although the Care Transitions Measure was the first outcome measure specifically developed for transitional care, its applicability beyond the hospital-to-home transition is limited. There is a need for patient-centered outcome measures (PCOMs) to be developed for transitional care settings (ie, TC-PCOMs) to ensure that outcomes are both meaningful to patients and relevant to the particular care transition. The overall objective of this paper is to describe the opportunities and challenges of integrating TC-PCOMs into research and practice.

Methods and Results:

This narrative review was conducted by members of the Patient-Centered Outcomes Research Institute (PCORI) Transitional Care Evidence to Action Network. We define TC-PCOMs as outcomes that matter to patients because they account for their individual experiences, concerns, preferences, needs, and values during the transition period. The cardinal features of TC-PCOMs should be that they are developed following direct input from patients and stakeholders and reflect their lived experience during the transition in question. Although few TC-PCOMs are currently available, existing patient-reported outcome measures could be adapted to become TC-PCOMs if they incorporated input from patients and stakeholders and are validated for the relevant care transition.

Conclusion:

Establishing validated TC-PCOMs is crucial for measuring the responsiveness of transitional care interventions and optimizing care that is meaningful to patients.
Predictors of Elevated Social Risk in Pediatric Emergency Department Patients and Families
Authors: Rucker Alexandra C. , Watson Ar'Reon , Badolato Gia , Boyle Meleah , Hendrix Christian , Jarvis Lenore , Patel Shilpa J. , Goyal Monika K.
Published: July 2021

Objective

This study aimed to identify predictors of high unmet social needs among pediatric emergency department (ED) patients. We hypothesized that obesity, frequent nonurgent visits, reported food insecurity, or an at-risk chief complaint (CC) would predict elevated social risk.

Methods

We administered a tablet-based survey assessing unmet social needs in 13 domains to caregivers of patients aged 0 to 17 years presenting to an urban pediatric ED. Responses were used to tabulate a social risk score (SRS). We performed multivariable logistic regression to measure associations between a high SRS (≥3) and obesity, frequent nonurgent visits, food insecurity, or an at-risk CC (physical abuse, sexual abuse, assault, mammalian bites, reproductive/sexual health complaints, intoxication, ingestion/poisoning, psychiatric/behavioral complaints, or any complaint triaged as “least urgent”).

Results

Five hundred seventy caregivers completed the survey. Eighty-one percent reported at least one unmet social need, and 33% identified ≥3 social needs. Caregivers of patients with an at-risk CC had twice the odds of a high SRS (adjusted odds ratio [aOR], 1.8; 95% confidence interval [CI], 1.0–3.3). Caregivers of patients reporting food insecurity had 4 times the odds of a high SRS (aOR, 4.3; 95% CI, 2.5–7.3). Neither obesity (aOR, 1.5; 95% CI, 0.9–2.6) nor frequent nonurgent visits (aOR, 0.9; 95% CI, 0.4–1.9) were predictive of a high SRS.

Conclusions

Unmet social needs are prevalent among caregivers of pediatric ED patients, supporting universal screening in this population. Patients with an at-risk CC or reported food insecurity might benefit from proactive intervention. Future studies should examine optimal methods for ED-based interventions that address social determinants of health.
Testicular Torsion Patients Should Be Manually Detorsed at Diagnosis
Authors: Cabral Dias Filho Aderivaldo , Rincon Cintra da Cruz Pedro , Zanettini Riccetto Cassio Luis
Published: July 2021

Objective

The aim of the study was to assess organ salvage in testicular torsion patients submitted to manual detorsion according to interhospital transfer and surgical wait times.

Methods

Retrospective analysis of consecutive surgically treated testicular torsion patients between 2012 and 2018. We compared testicular surgical salvage in testicular torsion patients submitted to manual detorsion either at clinical diagnosis (immediate detorsion) or after interhospital transfer from lower level-of-care facilities (delayed detorsion) and estimated the influence of interhospital transfer and surgical wait times on outcomes. Analysis included Bayesian logistic regression after propensity score matching. We excluded patients first examined at off-state and private facilities, with prediagnostic time of more than 24 hours, not initially diagnosed with testicular torsion or not submitted to manual detorsion at any time.

Results

One hundred sixty-two patients (median age, 15.8 years) fulfilled inclusion criteria. The median prediagnostic, transfer, and surgical wait times were respectively 4.9, 2.4, and 4.3 hours, with 58 patients undergoing immediate and 104 delayed detorsion. Propensity score matching for prediagnostic and surgical wait times paired 58 immediate with 40 delayed detorsion patients, with corresponding surgical salvage rates of 54/58 (93%) and 33/40 (82%). Forty-seven patients (29%) still had torsion at surgery. Transfer time was inversely associated with testicular salvage, with median 13% greater probability of an unfavorable outcome for each hour of transfer time. Similarly, each hour of surgical wait time decreased surgical salvage by 6%.

Conclusions

Immediate detorsion led to improved surgical outcomes in testicular torsion patients. Because of residual torsion, surgery for detorsed patients should not be postponed.
Brief Report: Acute Kidney Injury in People Living With HIV Hospitalized With Coronavirus Disease 2019: Clinical Characteristics and Outcomes
Authors: Fisher Molly C. , Fazzari Melissa J. , Hanna David B. , Patel Viraj V. , Felsen Uriel R. , Alahiri Emad , Byju Arjun , Akiyama Matthew J. , Ginsberg Mindy S. , Anastos Kathryn , Ross Michael J.
Published: July 2021

Background:

Data on clinical characteristics and outcomes of people living with HIV (PLWH) hospitalized with coronavirus disease 2019 (COVID-19) who develop acute kidney injury (AKI) are limited.

Setting:

Large tertiary health care system in the Bronx, NY.

Methods:

We performed a retrospective cohort study of 83 PLWH and 4151 patients without HIV hospitalized with COVID-19 from March 10, 2020, to May 11, 2020. We compared the clinical characteristics and outcomes associated with AKI by HIV serostatus and evaluated HIV-related factors for AKI among PLWH. AKI was defined and staged using Kidney Disease Improving Global Outcomes criteria.

Results:

The incidence of AKI in hospitalized patients with COVID-19 did not differ significantly by HIV serostatus (54.2% in PLWH vs 49.5% in patients without HIV, P = 0.6). Despite a higher incidence of stage 3 AKI (28.9% vs 17.1% P = 0.05) in PLWH compared with those without HIV, there was no significant difference in the need for renal replacement therapy (22.2% vs 13.4% P = 0.12), renal recovery (76.9% vs 82.5% P = 0.61), or dependence on renal replacement therapy (7.7% vs 3.8% P = 0.27). CD4 T-cell count, HIV-1 RNA viral suppression, and antiretroviral therapy use were not associated with AKI. AKI was associated with increased need for invasive ventilation and in-hospital death, but HIV was not an independent risk factor of in-hospital death after AKI [adjusted hazard ratio 1.01 (95% CI: 0.59 to 1.72), P = 0.98].

Conclusions:

HIV-related factors were not associated with increased risk of AKI in PLWH hospitalized with COVID-19. PLWH hospitalized with COVID-19 had more stage 3 AKI, but outcomes after AKI were similar to those without HIV.
Robotic Gastrectomy Versus Laparoscopic Gastrectomy for Gastric Cancer
Authors: Li Zheng-Yan , Zhou Yan-Bing , Li Tai-Yuan , Li Ji-Peng , Zhou Zhi-Wei , She Jun-Jun , Hu Jian-Kun , Qian Feng , Shi Yan , Tian Yu-Long , Gao Geng-Mei , Gao Rui-Zi , Liang Cheng-Cai , Shi Fei-Yu , Yang Kun , Wen Yan , Zhao Yong-Liang , Yu Pei-Wu ,   on behalf of the Robotic, Laparoscopic Surgery Committee of Chinese Research Hospital Association
Published: July 2021

Objective:

A large-scale multicenter retrospective cohort study was conducted to compare the short- and long-term outcomes of robotic gastrectomy (RG) and laparoscopic gastrectomy (LG) for gastric cancer.

Summary of Background Data:

RG is being increasingly used worldwide, but data from large-scale multicenter studies on the short- and long-term oncologic outcomes of RG versus LG are limited. The potential benefits of RG compared with LG for gastric cancer remain controversial.

Methods:

Data from eligible patients who underwent RG or LG for gastric cancer of 11 experienced surgeons from 7 centers in China between March 2010 and October 2019 were collected. The RG group was matched 1:1 with the LG group by using propensity score matching. The primary outcome was postoperative complications.

Results:

After propensity score matching, a well-balanced cohort of 3552 patients was included for further analysis. The occurrence of overall complications (12.6% vs 15.2%, P = 0.023) was lower in the RG group than in the LG group. RG was associated with less blood loss (126.8 vs 142.5 mL, P < 0.001) and more retrieved lymph nodes in total (32.5 vs 30.7, P < 0.001) and in suprapancreatic areas (13.3 vs 11.6, P < 0.001).

The long-term oncological outcomes were comparable between the two groups.

Conclusions:

The results of this multicenter study demonstrate that RG is a safe and effective treatment for gastric cancer when performed by experienced surgeons, although longer operation time and higher costs are still concerns about RG. This study provides evidence suggesting that RG may represent an alternative surgical treatment to LG.
The Imperative of Assessing Quality of Life in Patients Presenting to a Pancreaticobiliary Surgery Clinic
Authors: Yeo Theresa P. , Fogg Ryan W. , Shimada Ayako , Marchesani Nicole , Lavu Harish , Nevler Avinoam , Hegarty Sarah , Brody Jonathan R. , Yeo Charles J.
Published: July 2021

Objective:

The objective of this study was to determine baseline health-related quality of life (QoL) in patients with pancreatic adenocarcinoma, periampullary cancers, and benign pancreaticobiliary (PB) conditions at the time of the first visit to a PB surgery clinic, and to explore the relationship between QoL, demographics, clinical parameters, complications, and survival.

Summary Background Data:

Few studies have examined baseline QoL measures, the impact of comorbidities, age, sex, and smoking on subsequent postoperative complications and survival in patients with pancreatic adenocarcinoma, related PB cancers, and with benign PB conditions.

Methods:

Data were collected from scheduled patients at a PB surgery clinic between 2013 and 2018. The Brief Pain Inventory, Fact-Hepatobiliary Scale, and Facit-Fatigue questionnaires were administered. QoL parameters were compared between PB cancer patients and those with benign disease.

Results:

A total of 462 individuals with PB cancers and benign diseases exhibited baseline physical well-being, functional well-being, fatigue, and overall QoL at or below the 75th percentile of wellness at the time of the first office visit. Younger age, smoking, and mental health comorbidities contributed significantly to decreased QoL. PA patients were 7 times more likely to die in the follow-up period than the benign disease group. Black patients had higher pain scores and were 3 times more likely to have a postsurgery complication. Sex differences were identified regarding fatigue, pain, and overall QoL.

Conclusions:

This large cohort of PB cancer and benign disease patients exhibited significantly impaired baseline QoL. GI problems, weight loss, smoking, cardiovascular, pulmonary disease, and history of anxiety and depression contributed significantly to reduced QoL. The study sheds a cautionary light on the burden of PB disease at the time of surgical evaluation and its relationship to diminished QoL.
ICTV Virus Taxonomy Profile: Inoviridae
Authors: Knezevic Petar , Adriaenssens Evelien M. ,   ICTV Report Consortium
Published: July 2021

Members of the family Inoviridae are non-enveloped flexible filamentous bacteriophages (600–2500×6–10 nm) with supercoiled, circular, positive-sense, single-stranded DNA genomes of 5.5–10.6 kb, encoding 7–15 proteins. They absorb to the pili of Gram-negative bacteria and replicate their DNA by a rolling-circle mechanism with progeny released from cells by extrusion without killing the host. Phage DNA can persist extra-chromosomally or integrate into the bacterial genome. This is a summary of the International Committee on Taxonomy of Viruses (ICTV) Report on the family Inoviridae, which is available at ictv.global/report/inoviridae.