bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of capillary refill time-vs. lactate-targeted fluid resuscitation on regional, microcirculatory and hypoxia-related perfusion parameters in septic shock: a randomized controlled trial
Authors: Castro Ricardo , Kattan Eduardo , Ferri Giorgio , Pairumani Ronald , Valenzuela Emilio Daniel , Alegría Leyla , Oviedo Vanessa , Pavez Nicolás , Soto Dagoberto , Vera Magdalena , Santis César , Astudillo Brusela , Cid María Alicia , Bravo Sebastian , Ospina-Tascón Gustavo , Bakker Jan , Hernández Glenn
Published: November 2020

Background

Persistent hyperlactatemia has been considered as a signal of tissue hypoperfusion in septic shock patients, but multiple non-hypoperfusion-related pathogenic mechanisms could be involved. Therefore, pursuing lactate normalization may lead to the risk of fluid overload. Peripheral perfusion, assessed by the capillary refill time (CRT), could be an effective alternative resuscitation target as recently demonstrated by the ANDROMEDA-SHOCK trial. We designed the present randomized controlled trial to address the impact of a CRT-targeted (CRT-T) vs. a lactate-targeted (LAC-T) fluid resuscitation strategy on fluid balances within 24 h of septic shock diagnosis. In addition, we compared the effects of both strategies on organ dysfunction, regional and microcirculatory flow, and tissue hypoxia surrogates.

Results

Forty-two fluid-responsive septic shock patients were randomized into CRT-T or LAC-T groups. Fluids were administered until target achievement during the 6 h intervention period, or until safety criteria were met. CRT-T was aimed at CRT normalization (≤ 3 s), whereas in LAC-T the goal was lactate normalization (≤ 2 mmol/L) or a 20% decrease every 2 h. Multimodal perfusion monitoring included sublingual microcirculatory assessment; plasma-disappearance rate of indocyanine green; muscle oxygen saturation; central venous-arterial pCO2 gradient/ arterial-venous O2 content difference ratio; and lactate/pyruvate ratio. There was no difference between CRT-T vs. LAC-T in 6 h-fluid boluses (875 [375–2625] vs. 1500 [1000–2000], p = 0.3), or balances (982[249–2833] vs. 15,800 [740–6587, p = 0.2]). CRT-T was associated with a higher achievement of the predefined perfusion target (62 vs. 24, p = 0.03). No significant differences in perfusion-related variables or hypoxia surrogates were observed.

Conclusions

CRT-targeted fluid resuscitation was not superior to a lactate-targeted one on fluid administration or balances. However, it was associated with comparable effects on regional and microcirculatory flow parameters and hypoxia surrogates, and a faster achievement of the predefined resuscitation target. Our data suggest that stopping fluids in patients with CRT ≤ 3 s appears as safe in terms of tissue perfusion.

Clinical Trials: ClinicalTrials.gov Identifier: NCT03762005 (Retrospectively registered on December 3rd 2018)
Research on mechanical vibration monitoring based on wireless sensor network and sparse Bayes
Authors: Lei Xinjun , Wu Yunxin
Published: November 2020

Mechanical vibration monitoring for rotating mechanical equipment can improve the safety and reliability of the equipment. The traditional wired monitoring technology faces problems such as high-frequency signal pickup and high-precision data collection. Therefore, this paper proposes optimization techniques for mechanical vibration monitoring and signal processing based on wireless sensor networks. First, the hardware design uses high-performance STM32 as the control center and Si4463 as the wireless transceiver core. The monitoring node uses a high-precision MEMS acceleration sensor with a 16-bit resolution ADC acquisition chip to achieve high-frequency, high-precision acquisition of vibration signals. Then, the bearing vibration signal optimization method is studied, and the sparse Bayes algorithm is proposed as a compressed sensing reconstruction algorithm. Finally, the difference in reconstruction accuracy between this method and the traditional reconstruction algorithm is compared through experiments and the effect of this method on the reconstruction performance is analyzed when different parameters are selected.
Fixed point results for Geraghty quasi-contraction type mappings in dislocated quasi-metric spaces
Authors: Umudu Joy C. , Olaleru Johnson O. , Mogbademu Adesanmi A.
Published: November 2020

In this paper, fixed point results for a newly introduced Geraghty quasi-contraction type mappings are proved in more general metric spaces called T-orbitally complete dislocated quasi-metric spaces. Geraghty quasi-contraction type mappings generalize, among others, Ciric’s quasi-contraction mappings and other Geraghty quasi-contractive type mappings in the literature. Fixed point results are obtained without imposing a continuity condition on the mapping, thereby further generalizing some other related work in the literature. An example is given to show the validity of results obtained.
Sustainability of residential environmental interventions and health outcomes in the elderly
Authors: Turcotte David A. , Woskie Susan , Gore Rebecca , Chaves Emily , Adejumo Kelechi L. , You Kim-Judy
Published: November 2020

Background

Research has documented that housing conditions can negatively impact the health of residents. Asthma has many known indoor environmental triggers including dust, pests, smoke and mold, as evidenced by the 25 million people in the U.S. population who have asthma. The paper describes a follow-up study involving elder adults with asthma who participated in a multifaceted home educational and environmental intervention shown to produce significant health benefits. On average the time between the end of the prior intervention study and the follow-up was 2.3 years. The objective of this study was to evaluate whether improvements in environmental conditions and health outcomes resulting from the original Older Adult Study (OAS, multifaceted educational and environmental interventions) would be maintained or decline over time for these low income seniors with asthma.

Methods

Health assessment included data on respiratory health outcomes included the Saint George’s Respiratory Questionnaire (SGRQ) and Asthma Control Test from the original Older Adult Study (OAS) and this follow-up Older Adult Study (OAFS) along with health care utilization data. Environmental assessments included evaluation of asthma trigger activities (ATAs) and exposures before and after the original healthy homes intervention (questionnaire, home survey) and at this follow-up. Assessments were conducted in English, Khmer and Spanish.

Results

At assessment in the Older Adult Follow-up Study (OAFS), the older adults maintained some of the health improvements gained during the OAS when compared to the OAS pre-intervention baseline. However, health outcomes declined from the OAS final assessment to the OAFS (only the SGRQ Impact scores were significantly different).

Conclusion

These findings suggest that further study with a larger population is needed to determine if the significant health outcome improvements from multifaceted home educational and environmental interventions (OAS) could be more strongly maintained by providing additional follow-up “booster” interventions to this older adult population with asthma.
A new scoring system for predicting extent of resection in medial sphenoid wing meningiomas based on three-dimensional multimodality fusion imaging
Authors: Wang Zilan , Liang Xiaolong , Yang Yanbo , Gao Bixi , Wang Ling , You Wanchun , Chen Zhouqing , Wang Zhong
Published: November 2020

Background

Three-dimensional (3D) fusion imaging has been proved to be a promising neurosurgical tool for presurgical evaluation of tumor removal. We aim to develop a scoring system based on this new tool to predict the resection grade of medial sphenoid wing meningiomas (mSWM) intuitively.

Methods

We included 46 patients treated for mSWM from 2014 to 2019 to evaluate their tumors’ location, volume, cavernous sinus involvement, vascular encasement, and bone invasion by 3D multimodality fusion imaging. A scoring system based on the significant parameters detected by statistical analysis was created and evaluated.

Results

The tumor volumes ranged from 0.8 cm3 to 171.9 cm3. A total of 39 (84.8%) patients had arterial involvement. Cavernous sinus (CS) involvement was observed in 23 patients (50.0%) and bone invasion was noted in 10 patients (21.7%). Simpson I resection was achieved in 10 patients (21.7%) and Simpson II resection was achieved in 17 patients (37.0%). Fifteen patients (32.6%) underwent Simpson III resection and 4 patients (8.7%) underwent Simpson IV resections. A scoring system was created. The score ranged from 1 to 10 and the mean score of our patients was 5.3 ± 2.8. Strong positive monotonic correlation existed between the score and resection grade (Rs = 0.772, P < 0.001). The scoring system had good predictive capacity with an accuracy of 69.60%.

Conclusions

We described a scoring system that enabled neurosurgeons to predict extent of resection and outcomes for mSWM preoperatively with 3D multimodality fusion imaging.

Trial registration

Retrospectively registered
Validity of endocan as a biomarker in systemic sclerosis: relation to pathogenesis and disease activity
Authors: Mahgoub Marwa Yahia , Fouda Ali Ibrahim , Elshambaky Ahmed Yousef , Elgazzar Walaa Bayoumie , Shalaby Sara Abdellatif
Published: November 2020

Background

Systemic sclerosis (SSc), an autoimmune disease, has endothelial dysfunction and tissue fibrosis. The lack of its specific activity markers urges the research. Endocan is an immunomodulatory protein associated with endothelial dysfunction. We aimed to measure of the endocan level in systemic sclerosis (SSc) patients’ sera to test its relation to disease activity and treatment responses. Also, to evaluate its specificity by comparing these data with Behçet’s disease (BD) and rheumatoid arthritis (RA) patients’ data.

Results

SSc and RA patients were in activity but in the BD group; eight were active and seven were inactive. The endocan level was higher in the three groups in comparison to the controls without statistically significant differences (p value RA 0.697, SSc 0.063, and BD 0.196). A statistically significant difference in endocan levels between SSc patients with and without vascular manifestations (pulmonary hypertension and finger pitting ulcers, p < 0.0001, p = 0.0097, respectively). There were no significant correlations between endocan level and the erythrocyte sedimentation rate and C-reactive protein (positive rheumatoid factor for RA) in the three groups (p > 0.05). There were no significant correlations between endocan level and activity scores in the three groups (p > 0.05). The cut-off value of endocan was 1.3 ng/ml.

Conclusion

Endocan is a non-specific marker for the vascular pathogenesis in systemic sclerosis but not a good predictor for its activity.
Validating the origin of microseismic events in target reservoir using guided waves recorded by DAS
Authors: Huff Owen , Lellouch Ariel , Luo Bin , Jin Ge , Biondi Biondo
Published: November 2020

We develop a new algorithm that uses guided-wave energy in distributed acoustic sensing (DAS) records to identify microseismic events originating within or very close to a shale reservoir. Guided waves are dispersive waves that propagate in a low-velocity layer bounded by two high-velocity layers. This is a geologic structure that is seen for some shale reservoirs, most notably the Eagle Ford. Only microseismic events originating within or close to the low-velocity layer will excite significant guided-wave energy, which can be observed in DAS records. We confirm the relationship between guided-wave energy and event depth relative to the reservoir by using synthetic modeling. Given the known velocity structure, we can predict the dispersion curves for guided waves and use them to separate body and guided waves. We demonstrate a method to quantify the amplitude of guided waves in field DAS data recorded directly above the Eagle Ford Shale. Using this technique, we can separate events that originate within or close to the Eagle Ford from events that do not, thus circumventing the large depth uncertainty in a microseismic catalog derived from surface geophones. Our analysis shows that events classified as originating within or close to the Eagle Ford are horizontally closer to the stimulating well than non-Eagle Ford events. This is interpreted as representing different hydraulic fracture geometries in the Eagle Ford compared to its bounding formations, the Buda Limestone and Austin Chalk. The application of our method yields a new catalog that highlights the events relevant to stimulation and production in the target reservoir. It also provides a strong depth constraint that can improve relocation attempts using surface data, enabling a more accurate estimation of stimulated rock volume geometry.
Real-time hydraulic fracture monitoring and wellbore characterization with distributed acoustic sensing of pumping noise
Authors: Borodin Igor , Segal Arkady
Published: November 2020

The strong and regular acoustic signal provided by working pumps spreads along a well based on wellbore geometrical and physical attributes. This signal can be used to devise well properties through the interpretation of distributed acoustic data collected along a zone of interest. Any well feature that is an irregularity of the well scheme, such as tubing expansion, fluid-to-fluid interface, or an adjacent hydraulic fracture, porous reservoir, or annular compartment, can be characterized this way. Every pump generates a plurality of harmonic frequencies; thus, there are plenty of data for inversion for feature parameters. We describe a quantitative inversion workflow and give synthetic examples of hydraulic fracture monitoring and hydraulic port open/closure condition monitoring. We also stress that interference of the pump signal by the flow noise signal should be accounted for in distributed acoustic sensing interpretation.
Surface seismics with DAS: An emerging alternative to modern point-sensor acquisition
Authors: Bakulin Andrey , Silvestrov Ilya , Pevzner Roman
Published: November 2020

Land seismic acquisition is moving toward “light and dense” geometries, with point receiver systems believed to be an ultimate configuration of choice. Cableless land nodal systems enable more flexible spatial sampling at the price of eliminating even small arrays. For large surveys in a desert environment, such spacing remains insufficient to address the complex near surface, while recordings with single sensors exhibit a significant reduction in data quality. At the same time, exploration problems increasingly demand smaller uncertainty in all seismic products. While 1 m geophone sampling could have addressed these problems, it remains out of economic reach as point sensor cost plateaus. We examine an emerging alternative technology of distributed acoustic sensing (DAS) that revolutionized borehole geophysics but is still mostly unknown in the seismic world. Fully broadband DAS sensors promise massive channel count and uncompromised inline sampling down to 0.25 m. Their distributed nature offers the unique capability to conduct a continuous recording with multiscale grids of “shallow,” “deep,” and “full-waveform inversion” receivers, all implemented with a single set of fixed cables and only one round of shooting. These distinct features allow us to simultaneously pursue near-surface characterization, imaging of deeper targets, and velocity model evaluation. Specifically, in a desert environment, distributed sensors may offer superior data quality compared to point sensors, whereas DAS capability of “seismic zoom” in the near surface becomes instrumental for near-surface characterization. Finally, simultaneous acquisition of surface seismic and vertical arrays that can be achieved easily with DAS can effectively address the exploration of subtler targets such as low-relief structures. We support these findings with a field case study from a desert environment and synthetic examples. With many distinct advantages, surface seismic with DAS emerges as a compelling alternative to modern point-sensor acquisitions.
Neuromuscular Block Monitoring in Patients With Facial Rejuvenation: A Case Report
Authors: Jahromi Behdad , Knezevic Nebojsa Nick
Published: November 2020

Neuromuscular blocking agents are used during general anesthesia to optimize intubating and surgical conditions. Determining the level of neuromuscular blockade and ensuring adequate reversal are crucial to prevent anesthesia-related postoperative residual weakness and its associated complications. We present a 33-year-old woman who underwent laparoscopic appendectomy. Facial nerve stimulation failed to elicit response to neurostimulation, but subsequent ulnar nerve stimulation showed train-of-four count of 4 without fade in the adductor pollicis muscle. It was later determined that the patient recently received botulinum toxin treatment. Facial nerve stimulation is not a reliable method for neuromuscular blockade monitoring.
“Memorable Equinox”
Authors: Peters John Durham
Published: November 2020

In the later 1950s and 1960s, the American neurologist John Cunningham Lilly (1915–2001) undertook an unorthodox set of experiments on bottlenose dolphins (tursiops truncatus). The centerpiece of this research was their bioacoustic practices, including hearing and phonation. Lilly’s work sits at the crossroads of many vectors in postwar American culture: the birth of the counterculture from the spirit of Cold War militarized science; the cybernetic dream of flattening the differences between animal, human, machine, and alien intelligence; the exploration of otherness through drugs and madness; and the rise to cultural prominence of dolphins as archetypes of intelligent liberated beings. Sound technologies, especially tape, were the conditio sine qua non of Lilly’s cetacean research. He used tape obsessively in his efforts to decrypt dolphin communications and later to liberate human consciousness from its tendency to get stuck in repeating loops. Remarkably, he failed to reflect on the media a priori of his interspecies imagination.
Hormone mediated dispersal and sexual maturation in males of the social paper wasp Polistes lanio
Authors: Southon Robin J. , Radford Andrew N. , Sumner Seirian
Published: November 2020

Sex-biased dispersal is common in social species, though the dispersing sex may delay emigration if associated benefits are not immediately attainable. In the social Hymenoptera (ants, some bees and wasps), newly emerged males typically disperse from the natal nest whilst most females remain as philopatric helpers. The mechanisms regulating male dispersal, whether male dispersal is directly linked to sexual maturation and if such mechanisms are conserved across the Hymenoptera is relatively unknown. Through field observations and mark–recapture, we observed that males of the social paper wasp Polistes lanio emerge from pupation sexually immature, and delay dispersal from their natal nest for up to seven days whilst undergoing sexual maturation. Delayed dispersal may benefit males by allowing them to mature in the safety of the nest and thus be more competitive in mating. We also demonstrate that both male dispersal and maturation are associated with juvenile hormone (JH), a key regulator of insect reproductive physiology and behaviour, which also has derived functions regulating social organisation in female Hymenoptera. Males treated with methoprene (a JH analogue) dispersed earlier and possessed significantly larger accessory glands than their age-matched controls. These results highlight the wide role of JH in social hymenopteran behaviour, with parallel ancestral functions in males and females, and raise new questions on the nature of selection for sex-biased dispersal.
Phylogenetic analysis of maximal oxygen consumption during exercise (V̇O2max) and ecological correlates among lizard species
Authors: Albuquerque Ralph L. , Garland Theodore
Published: November 2020

The maximum amount of oxygen consumed during forced exercise (V̇O2max) sets the upper limit to the effort that can be sustained over relatively long periods and can limit activity levels in nature. Among ectotherms, V̇O2max is primarily affected by body size and body temperature, but it should also coadapt with behavior, ecology, and life history aspects. We compiled published data from 11 different families of lizards, including 58 species and 7 populations (total 65 data points) and tested whether V̇O2max was related to diet (herbivore, insectivore, insectivore/carnivore, carnivore, and omnivore), climate (tropical, temperate, and arid), nocturnality, viviparity, or family. We fitted models that included body mass and measurement temperature as covariates, and all possible combinations of other independent variables using ordinary least-squares (OLS) and phylogenetic regressions assuming an Ornstein-Uhlenbeck model of residual trait evolution (RegOU). The sum of Akaike weights for each independent variable revealed viviparity (∑wi=0.996) and the combined set of dummy variables coding for helodermatids, varanids, and skinks (∑wi=0.996) as the most important predictors. These three families had relatively high V̇O2max. They are composed mainly of active foragers that probably benefit from higher V̇O2max. Viviparity had a negative effect on V̇O2max. Ecological or behavioral factors associated with viviparity (e.g., activity levels), but not included here, may explain this effect. The average allometric slope of V̇O2max from the top eight models (which accounted for 99% of the cumulative evidence) was 0.803, which is similar to that reported previously for lizards and for mammals in general.
Preparation of Cu@Ag Core-Shell Nanoparticles by NaBH4 Combined with NaH2PO2 as Reductants
Authors: Ma Yuling , Wang Lin , Ye Qin , Qin Haihang , Fu Qiubo
Published: November 2020

In this work, sodium borohydride (NaBH4) and sodium hypophosphite (NaH2PO2) were simultaneously used as reductants to prepare Cu@Ag core-shell nanoparticles with a particle size of 300–500 nm. Results proved that Cu@Ag particles with different particle sizes could be obtained by changing the molar ratio of NaBH4 to NaH2PO2 and reaction temperature. The characterization of prepared samples demonstrated that the decoupling effect of NaBH4 and NaH2PO2 could be a promising method for modifying the core-shell particle size.
Williams–Campbell syndrome: an unusual presentation in an adult patient
Authors: Rohilla Mili , Previgliano Carlos , Geimadi Atefeh , Sangster Guillermo
Published: November 2020

Objective:

Williams–Campbell syndrome (WCS) is a rare congenital disorder, which leads to bronchiectasis affecting fourth to sixth order of bronchial divisions. Symptoms include cough, sputum, wheeze and recurrent pulmonary infections, classically seen in the paediatric age group with selective bronchiectasis of the mid-order bronchioles. The literature describing diagnosis of Williams–Campbell syndrome in adult population is very sparse.

Methods:

This report presents a 62-year-old female with cough, fever, dyspnea and generalized body ache. She has had multiple admissions to the hospital since her childhood due to recurrent lower respiratory tract infections. Imaging findings demonstrated multiple cystic thin walled airways, compatible with bronchiectatic changes in the upper, middle and lower lobes bilaterally, bronchial wall thickening with air-fluid levels prominent in the fifth and sixth generation bronchial divisions, with normal calibre trachea and central bronchi. These radiological findings are consistent with diagnosis of Williams–Campbell syndrome, which was diagnosed after ruling out the other common causes of bronchiectasis.

Conclusion:

Williams–Campbell syndrome is a rare congenital cystic lung disease, the diagnosis of which is made by exclusion of common causes of bronchiectasis such as cystic fibrosis, allergic bronchopulmonary aspergillosis, tuberculosis, dyskinetic cilia syndrome and alpha-1 antitrypsin deficiency. Whenever the clinical picture is consistent with bronchiectasis, especially involving the mid-order bronchioles and recurrent pulmonary infections, it is wise to include WCS in the list of differential diagnoses, even in the adult population.
An Augmented Lagrangian Decomposition Method for Chance-Constrained Optimization Problems
Authors: Bai Xiaodi , Sun Jie , Zheng Xiaojin
Published: November 2020

Joint chance-constrained optimization problems under discrete distributions arise frequently in financial management and business operations. These problems can be reformulated as mixed-integer programs. The size of reformulated integer programs is usually very large even though the original problem is of medium size. This paper studies an augmented Lagrangian decomposition method for finding high-quality feasible solutions of complex optimization problems, including nonconvex chance-constrained problems. Different from the current augmented Lagrangian approaches, the proposed method allows randomness to appear in both the left-hand-side matrix and the right-hand-side vector of the chance constraint. In addition, the proposed method only requires solving a convex subproblem and a 0-1 knapsack subproblem at each iteration. Based on the special structure of the chance constraint, the 0-1 knapsack problem can be computed in quasi-linear time, which keeps the computation for discrete optimization subproblems at a relatively low level. The convergence of the method to a first-order stationary point is established under certain mild conditions. Numerical results are presented in comparison with a set of existing methods in the literature for various real-world models. It is observed that the proposed method compares favorably in terms of the quality of the best feasible solution obtained within a certain time for large-size problems, particularly when the objective function of the problem is nonconvex or the left-hand-side matrix of the constraints is random.
Factors associated with underutilisation of antenatal care services in Limpopo, South Africa
Authors: Mulondo Seani Adrinah
Published: November 2020

Background

The aim of this study was to explore and describe factors associated with underutilisation of antenatal care services. In South Africa, maternal and child healthcare services are provided free of charge. Despite this, utilisation of antenatal care services remains a major public health challenge. Literature affirms that 96% of pregnant women present at antenatal care services only after 12 weeks of pregnancy, and this is influenced by several factors. Women's attitude plays an integral role.

Methods

This study used a qualitative, exploratory, descriptive design. Purposive and convenient sampling methods were used to select 10 hospitals and 83 pregnant women, respectively. Ten focus group discussions were conducted to collect data. Trustworthiness was ensured by means of Guba's model and data were analysed, qualitatively, using Tesch's eight steps.

Results

The majority of the pregnant women (83%) were from rural areas, had unplanned pregnancies, had five pregnancies/children or more, factors that are associated with underutilisation of antenatal care services. Cultural practices and beliefs regarding early presentation to antenatal care services and its effect on pregnancies were also found to be associated with underutilisation.

Conclusions

Some pregnant women do not consider antenatal care services as essential and choose to present late, despite the knowledge that monitoring of maternal health during pregnancy by midwives could prevent maternal and neonatal morbidity, while improving maternal and neonatal health and wellness. Recommendations include the provision of information and education materials to women, as well as health education, to sensitise and increase women's awareness of the urgency in utilising antenatal care services.
Midwives in low-resource settings
Authors: Shahid Shahnaz
Published: November 2020

Pakistan is a low-resource country where midwives are often not supported in their role as skilled birth attendants. Changes are needed to support midwives in providing safe and effective care.
How useful are virtual fracture clinics?
Authors: Khan Shehzaad A. , Asokan Ajay , Handford Charles , Logan Peter , Moores Thomas
Published: November 2020

Background

Due to the overwhelming demand for trauma services, resulting from increasing emergency department attendances over the past decade, virtual fracture clinics (VFCs) have become the fashion to keep up with the demand and help comply with the BOA Standards for Trauma and Orthopaedics (BOAST) guidelines. In this article, we perform a systematic review asking, “How useful are VFCs?”, and what injuries and conditions can be treated safely and effectively, to help decrease patient face to face consultations. Our primary outcomes were patient satisfaction, clinical efficiency and cost analysis, and clinical outcomes.

Methods

We performed a systematic literature search of all papers pertaining to VFCs, using the search engines PubMed, MEDLINE, and the Cochrane Database, according to the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) checklist. Searches were carried out and screened by two authors, with final study eligibility confirmed by the senior author.

Results

In total, 21 records were relevant to our research question. Six orthopaedic injuries were identified as suitable for VFC review, with a further four discussed in detail. A reduction of face to face appointments of up to 50% was reported with greater compliance to BOAST guidelines (46.4%) and cost saving (up to £212,000).

Conclusions

This systematic review demonstrates that the VFC model can help deliver a safe, more cost-effective, and more efficient arm of the trauma service to patients. Cite this article: Bone Joint Open 2020;1-11:683–690.
The impact of COVID-19 on morbidity and mortality in neck of femur fracture patients
Authors: Ward Alex E. , Tadross Daniel , Wells Fiona , Majkowski Lawrence , Naveed Umna , Jeyapalan Rathan , Partridge David G. , Madan Suvira , Blundell Chris M.
Published: November 2020

Aims

Within the UK, around 70,000 patients suffer neck of femur (NOF) fractures annually. Patients presenting with this injury are often frail, leading to increased morbidity and a 30-day mortality rate of 6.1%. COVID-19 infection has a broad spectrum of clinical presentations with the elderly, and those with pre-existing comorbidities are at a higher risk of severe respiratory compromise and death. Further increased risk has been observed in the postoperative period. The aim of this study was to assess the impact of COVID-19 infection on the complication and mortality rates of NOF fracture patients.

Methods

All NOF fracture patients presenting between March 2020 and May 2020 were included. Patients were divided into two subgroup: those with or without clinical and/or laboratory diagnosis of COVID-19. Data were collected on patient demographics, pattern of injury, complications, length of stay, and mortality.

Results

Overall, 132 patients were included. Of these, 34.8% (n = 46) were diagnosed with COVID-19. Bacterial pneumonia was observed at a significantly higher rate in those patients with COVID-19 (56.5% vs 15.1%; p =< 0.000). Non respiratory complications such as acute kidney injury (30.4% vs 9.3%; p =0.002) and urinary tract infection (10.9% vs 3.5%; p =0.126) were also more common in those patients with COVID-19. Length of stay was increased by a median of 21.5 days in patients diagnosed with COVID-19 (p < 0.000). 30-day mortality was significantly higher in patients with COVID-19 (37.0%) when compared to those without (10.5%; p <0.000).

Conclusion

This study has shown that patients with a neck of femur fracture have a high rate of mortality and complications such as bacterial pneumonia and acute kidney injury when diagnosed with COVID-19 within the perioperative period. We have demonstrated the high risk of in hospital transmission of COVID-19 and the association between the infection and an increased length of stay for the patients affected. Cite this article: Bone Joint Open 2020;1-11:669–675.
The impact of COVID-19 on elective and trauma spine service in a district general hospital
Authors: Zahra Wajiha , Karia Monil , Rolton Daniel
Published: November 2020

Aims

The aim of this paper is to describe the impact of COVID-19 on spine surgery services in a district general hospital in England in order to understand the spinal service provisions that may be required during a pandemic.

Methods

A prospective cohort study was undertaken between 17 March 2020 and 30 April 2020 and compared with retrospective data from same time period in 2019. We compared the number of patients requiring acute hospital admission or orthopaedic referrals and indications of referrals from our admission sheets and obtained operative data from our theatre software.

Results

Between 17 March to 30 April 2020, there were 48 acute spine referrals as compared to 68 acute referrals during the same time period last year. In the 2019 period, 69% (47/68) of cases referred to the on-call team presented with back pain, radiculopathy or myelopathy compared to 43% (21/48) in the 2020 period. Almost 20% (14/68) of spine referrals consisted of spine trauma as compared to 35% (17/48) this year. There were no confirmed cases of cauda equine last year during this time. Overall, 150 spine cases were carried out during this time period last year, and 261 spine elective cases were cancelled since 17 March 2020.

Recommendations

We recommend following steps can be helpful to deal with similar situations or new pandemics in future: 24 hours on-call spine service during the pandemic. Clinical criteria in place to prioritize urgent spinal cases. Pre-screening spine patients before elective operating. Start of separate specialist trauma list for patients needing urgent surgeries.

Conclusion

This paper highlights the impact of COVID-19 pandemic in a district general hospital of England. We demonstrate a decrease in hospital attendances of spine pathologies, despite an increase in emergency spine operations. Cite this article: Bone Joint Open 2020;1-6:281–286.
Providing a paediatric trauma and orthopaedics service during the peak of the COVID-19 pandemic
Authors: Iliadis Alexis D , Eastwood Deborah M , Bayliss Lee , Cooper Michael , Gibson Alexander , Hargunani Rikin , Calder Peter ,   Royal National Orthopaedic Hospital Paediatric COVID-19 Collaborative
Published: November 2020

Introduction

In response to the COVID-19 pandemic, there was a rapidly implemented restructuring of UK healthcare services. The The Royal National Orthopaedic Hospital, Stanmore, became a central hub for the provision of trauma services for North Central/East London (NCEL) while providing a musculoskeletal tumour service for the south of England, the Midlands, and Wales and an urgent spinal service for London. This study reviews our paediatric practice over this period in order to share our experience and lessons learned. Our hospital admission pathways are described and the safety of surgical and interventional radiological procedures performed under general anaesthesia (GA) with regards to COVID-19 in a paediatric population are evaluated.

Methods

All paediatric patients (≤ 16 years) treated in our institution during the six-week peak period of the pandemic were included. Prospective data for all paediatric trauma and urgent elective admissions and retrospective data for all sarcoma admissions were collected. Telephone interviews were conducted with all patients and families to assess COVID-19 related morbidity at 14 days post-discharge.

Results

Overall, 100 children underwent surgery or interventional radiological procedures under GA between 20 March and 8 May 2020. There were 35 trauma cases, 20 urgent elective orthopaedic cases, two spinal emergency cases, 25 admissions for interventional radiology procedures, and 18 tumour cases. 78% of trauma cases were performed within 24 hours of referral. In the 97% who responded at two weeks following discharge, there were no cases of symptomatic COVID-19 in any patient or member of their households.

Conclusion

Despite the extensive restructuring of services and the widespread concerns over the surgical and anaesthetic management of paediatric patients during this period, we treated 100 asymptomatic patients across different orthopaedic subspecialties without apparent COVID-19 or unexpected respiratory complications in the early postoperative period. The data provides assurance for health care professionals and families and informs the consenting process. Cite this article: Bone Joint Open 2020;1-6:287–292.
Dealing with the COVID-19 pandemic in orthopaedics: experiences and procedure in Germany
Authors: Mueller Michael , Boettner Friedrich , Karczewski Daniel , Janz Viktor , Felix Stephan , Kramer Axel , Wassilew Georgi I
Published: November 2020

Aims

The worldwide COVID-19 pandemic is directly impacting the field of orthopaedic surgery and traumatology with postponed operations, changed status of planned elective surgeries and acute emergencies in patients with unknown infection status. To this point, Germany's COVID-19 infection numbers and death rate have been lower than those of many other nations.

Methods

This article summarizes the current regimen used in the field of orthopaedics in Germany during the COVID-19 pandemic. Internal university clinic guidelines, latest research results, expert consensus, and clinical experiences were combined in this article guideline.

Results

Every patient, with and without symptoms, should be screened for COVID-19 before hospital admission. Patients should be assigned to three groups (infection status unknown, confirmed, or negative). Patients with unknown infection status should be considered as infectious. Dependent of the infection status and acuity of the symptoms, patients are assigned to a COVID-19-free or affected zone of the hospital. Isolation, hand hygiene, and personal protective equipment is essential. Hospital personnel directly involved in the care of COVID-19 patients should be tested on a weekly basis independently of the presence of clinical symptoms, staff in the COVID-19-free zone on a biweekly basis. Class 1a operation rooms with laminar air flow and negative pressure are preferred for surgery in COVID-19 patients. Electrocautery should only be utilized with a smoke suction system. In cases of unavoidable elective surgery, a self-imposed quarantine of 14 days is recommended prior to hospital admission.

Conclusion

During the current COVID-19 pandemic, orthopaedic patients admitted to the hospital should be treated based on an interdisciplinary algorithm, strictly separating infectious and non-infectious cases. Cite this article: Bone Joint Open 2020;1-6:309–315.
Dynamic deformation of the femoral head occurs on weightbearing in Legg-Calves-Perthes disease
Authors: Aarvold Alexander , Lohre Ryan , Chhina Harpreet , Mulpuri Kishore , Cooper Anthony
Published: November 2020

Aims

Though the pathogenesis of Legg-Calve-Perthes disease (LCPD) is unknown, repetitive microtrauma resulting in deformity has been postulated. The purpose of this study is to trial a novel upright MRI scanner, to determine whether any deformation occurs in femoral heads affected by LCPD with weightbearing.

Methods

Children affected by LCPD were recruited for analysis. Children received both standing weightbearing and supine scans in the MROpen upright MRI scanner, for coronal T1 GFE sequences, both hips in field of view. Parameters of femoral head height, width, and lateral extrusion of affected and unaffected hips were assessed by two independent raters, repeated at a one month interval. Inter- and intraclass correlation coefficients were determined. Standing and supine measurements were compared for each femoral head.

Results

Following rigorous protocol development in healthy age-matched volunteers, successful scanning was performed in 11 LCPD-affected hips in nine children, with seven unaffected hips therefore available for comparison. Five hips were in early stage (1 and 2) and six were in late stage (3 and 4). The mean age was 5.3 years. All hips in early-stage LCPD demonstrated dynamic deformity on weightbearing. Femoral head height decreased (mean 1.2 mm, 12.4% decrease), width increased (mean 2.5 mm, 7.2% increase), and lateral extrusion increased (median 2.5 mm, 23% increase) on standing weightbearing MRI compared to supine scans. Negligible deformation was observed in contra-lateral unaffected hips, with less deformation observed in late-stage hips. Inter- and intraclass reliability for all measured parameters was good to excellent.

Conclusion

This pilot study has described an effective novel research investigation for children with LCPD. Femoral heads in early-stage LCPD demonstrated dynamic deformity on weightbearing not previously seen, while unaffected hips did not. Expansion of this protocol will allow further translational study into the effects of loading hips with LCPD. Cite this article: Bone Joint Open 2020;1-7:364–369.
Foot function during gait and parental perceived outcome in older children with symptomatic club foot deformity
Authors: McCahill Jennifer Leigh , Stebbins Julie , Harlaar Jaap , Prescott Robin , Theologis Tim , Lavy Christopher
Published: November 2020

Aims

To assess if older symptomatic children with club foot deformity differ in perceived disability and foot function during gait, depending on initial treatment with Ponseti or surgery, compared to a control group. Second aim was to investigate correlations between foot function during gait and perceived disability in this population.

Methods

In all, 73 children with idiopathic club foot were included: 31 children treated with the Ponseti method (mean age 8.3 years; 24 male; 20 bilaterally affected, 13 left and 18 right sides analyzed), and 42 treated with primary surgical correction (mean age 11.6 years; 28 male; 23 bilaterally affected, 18 left and 24 right sides analyzed). Foot function data was collected during walking gait and included Oxford Foot Model kinematics (Foot Profile Score and the range of movement and average position of each part of the foot) and plantar pressure (peak pressure in five areas of the foot). Oxford Ankle Foot Questionnaire, Disease Specific Index for club foot, Paediatric Quality of Life Inventory 4.0 were also collected. The gait data were compared between the two club foot groups and compared to control data. The gait data were also correlated with the data extracted from the questionnaires.

Results

Our findings suggest that symptomatic children with club foot deformity present with similar degrees of gait deviations and perceived disability regardless of whether they had previously been treated with the Ponseti Method or surgery. The presence of sagittal and coronal plane hindfoot deformity and coronal plane forefoot deformity were associated with higher levels of perceived disability, regardless of their initial treatment.

Conclusion

This is the first paper to compare outcomes between Ponseti and surgery in a symptomatic older club foot population seeking further treatment. It is also the first paper to correlate foot function during gait and perceived disability to establish a link between deformity and subjective outcomes Cite this article: Bone Joint Open 2020;1-7:384–391.
Partial resection of the posterior wall for hip dislocation in severe acetabular protrusio
Authors: Rodriguez Hugo A. , Viña Felipe , Muskus Meilyn A.
Published: November 2020

Aims

In elderly patients with osteoarthritis and protrusio who require arthroplasty, dislocation of the hip is difficult due to migration of the femoral head. Traditionally, neck osteotomy is performed in situ, so this is not always achieved. Therefore, the purpose of this study is to describe a partial resection of the posterior wall in severe protrusio.

Methods

This is a descriptive observational study, which describes the surgical technique of the partial resection of the posterior wall during hip arthroplasty in patients with severe acetabular protrusio operated on between January 2007 and February 2017.

Results

In all, 49 hip arthroplasties were performed. The average age of patients was 60 years, and idiopathic was the most frequent aetiology of protrusio. All patients were treated with femoral head autograft and no intra- or postoperative complications were reported. No patients required revision surgery.

Conclusion

Partial resection of the posterior wall demonstrated to be a safe surgical technique with 100% survival in a follow-up to ten years in total hip arthroplasty due to severe acetabular protrusio. Cite this article: Bone Joint Open 2020;1-7:431–437.
40 days and 40 nights: Clinical characteristics of major trauma and orthopaedic injury comparing the incubation and lockdown phases of COVID-19 infection
Authors: Ajayi Bisola , Trompeter Alex , Arnander Magnus , Sedgwick Philip , Lui Darren F.
Published: November 2020

Aims

The first death in the UK caused by COVID-19 occurred on 5 March 2020. We aim to describe the clinical characteristics and outcomes of major trauma and orthopaedic patients admitted in the early COVID-19 era.

Methods

A prospective trauma registry was reviewed at a Level 1 Major Trauma Centre. We divided patients into Group A, 40 days prior to 5 March 2020, and into Group B, 40 days after.

Results

A total of 657 consecutive trauma and orthopaedic patients were identified with a mean age of 55 years (8 to 98; standard deviation (SD) 22.52) and 393 (59.8%) were males. In all, 344 (approximately 50%) of admissions were major trauma. Group A had 421 patients, decreasing to 236 patients in Group B (36%). Mechanism of injury (MOI) was commonly a fall in 351 (52.4%) patients, but road traffic accidents (RTAs) increased from 56 (13.3%) in group A to 51 (21.6%) in group B (p = 0.030). ICU admissions decreased from 26 (6.2%) in group A to 5 (2.1%) in group B. Overall, 39 patients tested positive for COVID-19 with mean age of 73 years (28 to 98; SD 17.99) and 22 (56.4%) males. Common symptoms were dyspnoea, dry cough, and pyrexia. Of these patients, 27 (69.2%) were nosocomial infections and two (5.1%) of these patients required intensive care unit (ICU) admission with 8/39 mortality (20.5%). Of the patients who died, 50% were older and had underlying comorbidities (hypertension and cardiovascular disease, dementia, arthritis).

Conclusion

Trauma admissions decreased in the lockdown phase with an increased incidence of RTAs. Nosocomial infection was common in 27 (69.2%) of those with COVID-19. Symptoms and comorbidities were consistent with previous reports with noted inclusion of dementia and arthritis. The mortality rate of trauma and COVID-19 was 20.5%, mainly in octogenarians, and COVID-19 surgical mortality was 15.4%. Cite this article: Bone Joint Open 2020;1-7:330–338.
The impact of COVID-19 on trauma and orthopaedic surgery in the United Kingdom
Authors: Wallace Charles N. , Kontoghiorghe Christina , Kayani Barbar , Chang Justin S. , Haddad Fares S.
Published: November 2020

The coronavirus 2019 (COVID-19) global pandemic has had a significant impact on trauma and orthopaedic (T&O) departments worldwide. To manage the peak of the epidemic, orthopaedic staff were redeployed to frontline medical care; these roles included managing minor injury units, forming a “proning” team, and assisting in the intensive care unit (ICU). In addition, outpatient clinics were restructured to facilitate virtual consultations, elective procedures were cancelled, and inpatient hospital admissions minimized to reduce nosocomial COVID-19 infections. Urgent operations for fractures, infection and tumours went ahead but required strict planning to ensure patient safety. Orthopaedic training has also been significantly impacted during this period. This article discusses the impact of COVID-19 on T&O in the UK and highlights key lessons learned that may help to proactively prepare for the next global pandemic.

Cite this article: Bone Joint Open 2020;1-7:420–423.