bluuebunny/crossref_metadata_2025 huggingface dataset:
Cosmic filaments in galaxy cluster outskirts: quantifying finding filaments in redshift space
Authors: Kuchner Ulrike , Aragón-Salamanca Alfonso , Rost Agustín , Pearce Frazer R , Gray Meghan E , Cui Weiguang , Knebe Alexander , Rasia Elena , Yepes Gustavo
Published: February 2021

Inferring line-of-sight distances from redshifts in and around galaxy clusters is complicated by peculiar velocities, a phenomenon known as the ‘Fingers of God’ (FoG). This presents a significant challenge for finding filaments in large observational data sets as these artificial elongations can be wrongly identified as cosmic web filaments by extraction algorithms. Upcoming targeted wide-field spectroscopic surveys of galaxy clusters and their infall regions, such as the WEAVE Wide-Field Cluster Survey, motivate our investigation of the impact of FoG on finding filaments connected to clusters. Using zoom-in resimulations of 324 massive galaxy clusters and their outskirts from the three hundred project, we test methods typically applied to large-scale spectroscopic data sets. This paper describes our investigation of whether a statistical compression of the FoG of cluster centres and galaxy groups can lead to correct filament extractions in the cluster outskirts. We find that within 5R200 (∼15 h−1 Mpc) statistically correcting for FoG elongations of virialized regions does not achieve reliable filament networks compared to reference filament networks based on true positions. This is due to the complex flowing motions of galaxies towards filaments in addition to the cluster infall, which overwhelm the signal of the filaments relative to the volume that we probe. While information from spectroscopic redshifts is still important to isolate the cluster regions, and thereby reduce background and foreground interlopers, we expect future spectroscopic surveys of galaxy cluster outskirts to rely on 2D positions of galaxies to extract cosmic filaments.
Constraining the circumbinary disc tilt in the KH 15D system
Authors: Poon Michael , Zanazzi J J , Zhu Wei
Published: February 2021

KH 15D is a system that consists of a young, eccentric binary, and a circumbinary disc that obscures the binary as the disc precesses. We develop a self-consistent model that provides a reasonable fit to the photometric variability that was observed in the KH 15D system over the past 60 yr. Our model suggests that the circumbinary disc has an inner edge rin ≲ 1 au, an outer edge rout ∼ a few au, and that the disc is misaligned relative to the stellar binary by ∼5–16°, with the inner edge more inclined than the outer edge. The difference between the inclinations (warp) and longitude of ascending nodes (twist) at the inner and outer edges of the disc are of order ∼10 and ∼15°, respectively. We also provide constraints on other properties of the disc, such as the precession period and surface density profile. Our work demonstrates the power of photometric data in constraining the physical properties of planet-forming circumbinary discs.
The obstructed jet in Mrk 231
Authors: Wang Ailing , An Tao , Jaiswal Sumit , Mohan Prashanth , Wang Yuchan , Baan Willem A , Zhang Yingkang , Yang Xiaolong
Published: February 2021

Mrk 231 is the closest radio-quiet quasar known and one of the most luminous infrared galaxies in the local Universe. It is characterized by the co-existence of a radio jet and powerful multiphase multiscale outflows, making it an ideal laboratory to study active galactic nucleus (AGN) feedback. We analyse the multi-epoch very long baseline interferometry data of Mrk 231 and estimate the jet head advance speed to be ≲0.013 c, suggesting a sub-relativistic jet flow. The jet position angle changes from −113○ in the inner parsec to −172○ at a projected distance of 25 pc. The jet structure change might result from either a jet bending following the rotation of the circum-nuclear disc or the projection of a helical jet on the plane of the sky. In the large opening angle (∼60○) cone, the curved jet interacts with the interstellar medium and creates wide-aperture-angle shocks that subsequently dissipate a large portion of the jet power through radiation and contribute to powering the large-scale outflows. The low power and bent structure of the Mrk 231 jet, as well as extensive radiation dissipation, are consistent with the obstruction of the short-length jet by the host galaxy’s environment.
Social Determinants of Health and Neurosurgical Outcomes: Current State and Future Directions
Authors: Glauser Gregory , Detchou Donald K , Dimentberg Ryan , Ramayya Ashwin G , Malhotra Neil R
Published: February 2021

The relationship between social determinants of health (SDOH) and neurosurgical outcomes has become increasingly relevant. To date, results of prior work evaluating the impact of social determinants in neurosurgery have been mixed, and the need for robust data on this subject remains. The present review evaluates how gender, race, and socioeconomic status (SES) influence outcomes following various brain tumor resection procedures. Results from a number of prior studies from the senior author's lab are summarized, with all data acquired using the EpiLog tool (Epilog Laser). Separate analyses were performed for each procedure, evaluating the unique, isolated impact of gender, race, and SES on outcomes. A comprehensive literature review identified any prior studies evaluating the influence of these SDOH on neurosurgical outcomes. The review presented herein suggests that the effect of gender and race on outcomes is largely mitigated when equal access to care is attained, and socioeconomic factors and comorbidities are controlled for. Furthermore, when patients are matched upon for a number of clinically relevant covariates, SES impacts postoperative mortality. Elucidation of this disparity empowers surgeons to initiate actionable change to equilibrate future outcomes.
A BLUS1 kinase signal and a decrease in intercellular CO2 concentration are necessary for stomatal opening in response to blue light
Authors: Hosotani Sakurako , Yamauchi Shota , Kobayashi Haruki , Fuji Saashia , Koya Shigekazu , Shimazaki Ken-ichiro , Takemiya Atsushi
Published: February 2021

Light-induced stomatal opening stimulates CO2 uptake and transpiration in plants. Weak blue light under strong red light effectively induces stomatal opening. Blue light-dependent stomatal opening initiates light perception by phototropins, and the signal is transmitted to a plasma membrane H+-ATPase in guard cells via BLUE LIGHT SIGNALING 1 (BLUS1) kinase. However, it is unclear how BLUS1 transmits the signal to H+-ATPase. Here, we characterized BLUS1 signaling in Arabidopsis thaliana, and showed that the BLUS1 C-terminus acts as an auto-inhibitory domain and that phototropin-mediated Ser-348 phosphorylation within the domain removes auto-inhibition. C-Terminal truncation and phospho-mimic Ser-348 mutation caused H+-ATPase activation in the dark, but did not elicit stomatal opening. Unexpectedly, the plants exhibited stomatal opening under strong red light and stomatal closure under weak blue light. A decrease in intercellular CO2 concentration via red light-driven photosynthesis together with H+-ATPase activation caused stomatal opening. Furthermore, phototropins caused H+-ATPase dephosphorylation in guard cells expressing constitutive signaling variants of BLUS1 in response to blue light, possibly for fine-tuning stomatal opening. Overall, our findings provide mechanistic insights into the blue light regulation of stomatal opening.
Linking AM-PAC Mobility and Daily Activity to the PROMIS Physical Function Metric
Authors: Thackeray Anne , Hanmer Janel , Yu Lan , McCracken Polly , Marcus Robin
Published: February 2021

Objective

The purpose of this study was to link Activity Measure for Post-Acute Care (AM-PAC) Mobility and Daily Activity scales to the PROMIS Physical Function (PF) allowing for a common metric across scales.

Methods

Cross-sectional study of patients 18 years and older presenting to 1 of 8 outpatient rehabilitation clinics in southwestern Pennsylvania. Patients completed one survey with questions from the AM-PAC Daily Activity and Mobility short forms, and the PROMIS PF item bank. Using item response theory, 2 rounds of fixed-parameter calibration were performed. In the first, the AM-PAC Daily Activity and Mobility items were calibrated with 27 fixed item parameters from the PROMIS PF. Second, the AM-PAC Daily Activity items were calibrated with 11 PROMIS Upper Extremity fixed item parameters. This process uses the construct of physical function and equates AM-PAC items on the same underlying measurement scale for the PROMIS PF.

Results

Both scales measured a wide range of functioning and demonstrated good calibration. Data were appropriate for a fixed-parameter item response theory-based crosswalk. AM-PAC Daily Activity and Mobility raw scores were mapped onto the PROMIS PF metric. AM-PAC Daily Activity scores were also mapped onto the PROMIS PF Upper Extremity metric.

Conclusion

Question items from the AM-PAC Daily Activity, AM-PAC Mobility, and PROMIS PF similarly measure the construct of physical function. This consistency allows for a crosswalk of AM-PAC scores onto the PROMIS PF metric.

Impact

Crosswalk tables developed in this study allow for converting scores from the AM-PAC Daily Activity and Mobility scales to the PROMIS PF metric. This will facilitate monitoring of longitudinal change in function over time and across settings.
The potential toxicity of food-added sodium benzoate in mice is concentration-dependent
Authors: Olofinnade Anthony Tope , Onaolapo Adejoke Yetunde , Onaolapo Olakunle James , Olowe Olugbenga Adekunle
Published: February 2021

Sodium benzoate (NaB) is a versatile food preservative that has also found some applications in the treatment of medical disorders. However, till date, its possible widespread effects on the body are not well studied. We examined the likely effect of diet-added NaB on weight/food intake, haematological parameters, neurobehaviour, antioxidant status, lipid profile and anti-inflammatory/apoptotic markers in mice. Animals were assigned randomly into 4 groups of 10 mice each. Groups included normal control (fed rodent chow) and three groups fed NaB at 125 (0.0125%), 250 (0.025% and 500 (0.05%) mg/kg of feed added to diet, respectively, for eight weeks. Body weight and food intake were assessed. At the end of the experimental period animals were euthanized, blood was then taken for the assessment of haematological, biochemical and inflammatory/apoptotic markers. At the lowest concentration, NaB diet increased body weight and food intake. Decrease in haematological cell counts and total antioxidant capacity were observed, whereas serum malondialdehyde levels and superoxide dismutase activity were increased across the three concentrations. Serum tumour necrosis factor-alpha and interleukin-10 decreased, whereas caspase-3 levels showed no significant difference. Lipid profile and biochemical indices of kidney and liver function were also affected by NaB diet. In conclusion, our findings suggest that NaB may be harmful if regulations regarding its limit of consumption are mistakenly or deliberately ignored. Therefore, it is advisable that regulations on quantities to be added to food be enforced.
The Shieh Score as a Risk Assessment Tool for Hospital-Acquired Pressure Injuries: A Retrospective Cohort Study
Authors: Shieh David , Li Qiaowu , Shi Jiaxiao M. , Tovar Stephanie
Published: February 2021

OBJECTIVE

To design a new risk assessment tool to identify patients at high risk for hospital-acquired pressure injuries.

METHODS

The researchers developed the Shieh Score using retrospective data of 406,032 hospital admissions from January 2014 to December 2016 with 1,299 pressure injury cases from the pressure injury registry. A decision tree and best subset logistic regression were used to select predictors from demographic and clinical candidate variables, which were then used to construct the Shieh Score.

RESULTS

The final Shieh Score included the following measures: sex, age, diabetes, glomerular filtration rate, albumin level, level of function, use of IV norepinephrine, mechanical ventilation, and level of consciousness. The Shieh Score had a higher Youden Index, specificity, and positive predictive value than the Braden Scale. However, the Braden Scale had a higher sensitivity compared with the Shieh Score.

CONCLUSIONS

The Shieh Score is an alternative risk assessment tool that may effectively identify a smaller number of patients at high risk for hospital-acquired pressure injuries with a higher specificity and positive predictive value than the Braden Scale.
Investigating the Psychometric Properties of the Pieper-Zulkowski Pressure Ulcer Knowledge Test among Nurses in Iran
Authors: Moharramzadeh Habibeh , Heidarzadeh Mehdi , Aghamohammadi-Kalkhoran Masoomeh
Published: February 2021

OBJECTIVE

To evaluate the psychometric properties of the Pieper-Zulkowski Pressure Ulcer Knowledge Test (PZ-PUKT) in Iranian nurses.

METHODS

A convenience sample of 323 nurses and 161 nursing students from the Ardabil University of Medical Sciences in Iran agreed to participate in the study. To determine the psychometric properties of the PZ-PUKT content and differential validity, item analysis (difficulty and discriminative indices), internal consistency, and test-retest were performed.

RESULTS

Because the total PZ-PUKT score for critical care nurses (39.84 ± 7.10) was higher compared with general nurses (37.01 ± 8.47) and nursing students (24.59 ± 12.95), the differential validity of the tool was confirmed. The mean difficulty indices of questions with and without considering the “I don’t know” option were 0.53 and 0.65, respectively, and 0.27 and 0.13 for discriminative index. Cronbach α coefficient was .92 for the 72-item test. The correlation coefficient between test and retest for 30 nurses was 0.81.

CONCLUSIONS

This study showed that the Persian version of the PZ-PUKT is valid and reliable for use in Iran. It can be used in education and research to assess nurses’ knowledge as well as to evaluate the effectiveness of training programs on prevention and care of pressure injuries.
The wage gap in the PA profession
Authors: Marvel Susan Shiland
Published: February 2021

The wage gap between men and women in the physician assistant (PA) profession has followed the evolution of trends and cultural shifts in both medicine and the broader US workforce. Although the gap has narrowed both nationally and, more specifically, within the PA profession, female PAs make on average $11,000 (or 6%) less than their male counterparts. The rate at which the wage gap is closing in the United States has slowed indicating that the remaining causes of the problem are subtle and difficult to address. This article discusses contributing factors such as implicit bias, workplace culture, modern family structure in the context of outdated expectations, female PA self-undervaluing, and weak consequences for violation of existing labor laws. Solutions may include legislation to further protect and empower women in the workplace, campaigns from PA professional organizations that can influence the profession's cultural landscape and empower PAs to know their worth, PA educators including contract negotiation as part of the curriculum, and employers addressing systemic hiring processes that undervalue female PAs.
Effect of Prophylactic Negative Pressure Wound Therapy vs Standard Wound Dressing on Surgical-Site Infection in Obese Women After Cesarean Delivery: A Randomized Clinical Trial
Authors: Tuuli Methodius G. , Liu Jingxia , Tita Alan T. N. , Longo Sherri , Trudell Amanda , Carter Ebony B. , Shanks Anthony , Woolfolk Candice , Caughey Aaron B. , Warren David K. , Odibo Anthony O. , Colditz Graham , Macones George A. , Harper Lorie
Published: February 2021

(Abstracted from JAMA 2020;324:1180–1189)

Surgical-site infection is a significant cause of morbidity, lengthening hospital stays and contributing to health care costs. Cesarean delivery increases the risk of surgical site infection, and obesity contributes to this risk because obese pregnant women are more likely to have cesarean deliveries.
Ovulation Inhibition With A New Vaginal Ring Containing Trimegestone
Authors: Duijkers Ingrid J. M. , Klipping Christine , Draeger Corinna , Schug Barbara S. , Dax Annika , Friedrich Maika , Nickisch Klaus
Published: February 2021

(Abstracted from Contraception 2020;102:237–242)

Women receiving combined hormonal contraceptives (CHCs) are at increased risk of stroke, myocardial infarction, or venous thromboembolism, whereas those receiving progestogen-only preparations for contraception have little or no increased risk of these complications. However, the progestogen-only pills (POPs) currently marketed in the United States all have drawbacks.
Forebrain Acetylcholine Modulates Isoflurane and Ketamine Anesthesia in Adult Mice
Authors: Leung L. Stan , Chu Liangwei , Prado Marco A. M. , Prado Vania F.
Published: February 2021

Background

Cholinergic drugs are known to modulate general anesthesia, but anesthesia responses in acetylcholine-deficient mice have not been studied. It was hypothesized that mice with genetic deficiency of forebrain acetylcholine show increased anesthetic sensitivity to isoflurane and ketamine and decreased gamma-frequency brain activity.

Methods

Male adult mice with heterozygous knockdown of vesicular acetylcholine transporter in the brain or homozygous knockout of the transporter in the basal forebrain were compared with wild-type mice. Hippocampal and frontal cortical electrographic activity and righting reflex were studied in response to isoflurane and ketamine doses.

Results

The loss-of-righting-reflex dose for isoflurane was lower in knockout (mean ± SD, 0.76 ± 0.08%, n = 18, P = 0.005) but not knockdown (0.78 ± 0.07%, n = 24, P = 0.021), as compared to wild-type mice (0.83 ± 0.07%, n = 23), using a significance criterion of P = 0.017 for three planned comparisons. Loss-of-righting-reflex dose for ketamine was lower in knockout (144 ± 39 mg/kg, n = 14, P = 0.006) but not knockdown (162 ± 32 mg/kg, n = 20, P = 0.602) as compared to wild-type mice (168 ± 24 mg/kg, n = 21). Hippocampal high-gamma (63 to 100 Hz) power after isoflurane was significantly lower in knockout and knockdown mice compared to wild-type mice (isoflurane-dose and mouse-group interaction effect, F[8,56] = 2.87, P = 0.010; n = 5 to 6 mice per group). Hippocampal high-gamma power after ketamine was significantly lower in both knockout and knockdown mice when compared to wild-type mice (interaction effect F[2,13] = 6.06, P = 0.014). The change in frontal cortical gamma power with isoflurane or ketamine was not statistically different among knockout, knockdown, and wild-type mice.

Conclusions

These findings suggest that forebrain cholinergic neurons modulate behavioral sensitivity and hippocampal gamma activity during isoflurane and ketamine anesthesia.

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Understanding Rising Electronic Cigarette Use
Authors: Wylie Blair J. , Hauptman Marissa , Hacker Michele R. , Hawkins Summer S.
Published: February 2021

Vaping is the act of inhaling an aerosol generated by an electronic cigarette (e-cigarette), a battery-powered device that heats a reservoir of liquid, typically nicotine-containing, to deliver contents to the user. E-cigarettes were initially introduced as a means of smoking cessation, although evidence of their effectiveness is limited. There is a widespread perception that these products are a safer alternative to conventional cigarettes, driven in large part by marketing efforts by e-cigarette manufacturers. Yet to achieve vaporization, temperatures are so high that components of the device hardware, such as metals, plastics, rubber and foam, are aerosolized and inhaled along with the vaporized e-liquid containing nicotine, flavoring and solvents. We do not fully understand the health consequences of such aerosol exposure, particularly long-term effects, but short-term negative cardiovascular and respiratory effects have been demonstrated. Very few studies have evaluated the reproductive effect of e-cigarette use. We do not know whether vaping during pregnancy affects birth outcomes or the lifelong health of the fetus. There has been an exponential rise in the use of e-cigarettes in the United States since their introduction, particularly among youths, while concurrently there has been a laudable reduction in conventional cigarette use. It is imperative that obstetrician–gynecologists have a basic understanding of e-cigarettes, screen all patients as is consistently done for conventional smoking, and provide resources to patients about potential negative consequences of use.
Cervical Vestibular Evoked Myogenic Potentials That Are Absent at 500 Hz But Present at 1000 Hz Are Characteristic of Endolymphatic Hydrops-Related Disease
Authors: Fujimoto Chisato , Kinoshita Makoto , Ichijo Kentaro , Oka Mineko , Kamogashira Teru , Sugasawa Keiko , Kawahara Takuya , Yamasoba Tatsuya , Iwasaki Shinichi
Published: February 2021

Objectives:

It remains unclear whether the dominance of 1000 Hz responses over responses at 500 Hz in cervical vestibular evoked myogenic potentials (cVEMPs) are characteristic of endolymphatic hydrops (EH), due to the presence of patients with absent responses at both frequencies. The purpose of the present study is to examine whether the dominant cVEMP responses at 1000 Hz over 500 Hz are characteristic findings of EH-related diseases among patients who show various cVEMP findings.

Design:

We retrospectively reviewed the medical records of 470 consecutive patients who underwent cVEMP testing with short-tone bursts at both 500 Hz and 1000 Hz. We categorized the cVEMP responses of these 470 patients into the following five groups: (group 1) present responses at both frequencies bilaterally, (group 2) present responses at 500 Hz but absent at 1000 Hz on at least one side, (group 3) absent responses at 500 Hz but present at 1000 Hz on at least one side, (group 4) absent responses at both frequencies on one side and present at both frequencies on the other side, and (group 5) absent responses at both frequencies bilaterally. We compared the proportion of EH-related diseases between each group and the other four groups and then investigated any increased or decreased disease incidence in each group.

Results:

In group 3, the proportion of EH-related disease was significantly higher (p < 0.01), and the incidence of an EH-related disease was greatly increased (standard residual value > 3).

Conclusions:

cVEMPs that are absent at 500 Hz and present at 1000 Hz may be characteristic of EH-related disease.
Cost-effectiveness of Corrective Fusion Surgeries for Adult Spinal Deformities
Authors: Arima Hideyuki , Hasegawa Tomohiko , Yamato Yu , Kato Masashi , Yoshida Go , Banno Tomohiro , Oe Shin , Mihara Yuki , Ushirozako Hiroki , Yamada Tomohiro , Watanabe Yuh , Ide Koichiro , Nakai Keiichi , Kurosu Kenta , Matsuyama Yukihiro
Published: February 2021

Study Design.

Retrospective cohort study.

Objective.

The aim of this study was to summarize the cost-effectiveness of surgical treatment for adult spinal deformity (ASD) according to the operative method over 2 years postoperatively.

Summary of Background Data.

Extensive corrective fusion surgery for ASD requires numerous expensive implants, greatly contributing toward the national medical expenses. Previous national studies reported high complication rates in spinal surgeries using instrumentation. However, the cost-effectiveness of such procedures has not been scrutinized.

Methods.

In total, 173 ASD patients (151 women; mean age 69.1 years) who underwent corrective fusion between 2010 and 2017 were included. Cost-effectiveness was evaluated according to the cost of obtaining 1 quality-adjusted life year (QALY). Patients were divided into three groups: the “corrective fusion surgery using multiple Grade 2 osteotomy” (Grade-2) group, three-column osteotomy group (three-column), and lateral lumbar interbody fusion (LLIF) group.

Results.

The average medical cost for the initial surgery was USD 72,240, and that during the 2 years after the initial surgery was USD 76,294. The medical expenses for the initial surgery and those over the 2 years were higher in the LLIF group. The cumulative improvement in QALY over the 2 years did not significantly differ among the groups (0.13, 0.15, and 0.18 in the Grade-2, three-column, and LLIF groups, respectively). Cost/QALY 2 years after the surgery was USD 509,370, 518,406, and 463,798 in the Grade-2, three-column, and LLIF groups, respectively.

Conclusion.

We summarized the medical costs and cost-effectiveness of three different surgical methods for ASD in patients with different backgrounds over 2 years postoperatively. The medical expense for the initial surgery was highest in the LLIF group, and the cumulative improvement in QALY over the 2 years tended to be higher in the LLIF group, but the difference was not significant; the overall cost-effectiveness was lowest in the LLIF group.

Level of Evidence: 3
Measuring the Appropriateness of Spinal Manipulation for Chronic Low Back and Chronic Neck Pain in Chiropractic Patients
Authors: Coulter Ian D. , Herman Patricia M. , Kommareddi Mallika , Hurwitz Eric L. , Shekelle Paul G.
Published: February 2021

Study Design.

RAND/UCLA Appropriateness Method (RUAM) applied to chiropractic manipulation for patients with chronic low-back pain (CLBP) and chronic neck pain (CNP).

Objective.

Determine the rate of appropriate care provided by US chiropractors.

Summary of Background Data.

Spinal manipulation has been shown effective for CLBP and CNP but may not be appropriate for all patients with these conditions.

Methods.

Ratings of the appropriateness of spinal and cervical manipulation previously developed by two RUAM expert panels were applied to data abstracted from random samples of patient charts from chiropractors in six US regions to determine the appropriateness of manipulation for each patient.

Results.

Of 125 chiropractors sampled, 89 provided charts that could be abstracted. Of the 2128 charts received, 1054 were abstracted. Charts received but not abstracted included 460 that were unusable (e.g., illegible), and 555 did not have CLBP or CNP. Across the abstracted charts 72% had CLBP, 57% had CNP, and 29% had both; 84% of patients with CLBP and 86% with CNP received manipulation. Patients with CLBP who had minor neurologic findings, sciatic nerve irritation, or no joint dysfunction were significantly less likely to receive manipulation. Patients with CNP who had substantial trauma etiology, no joint dysfunction, or no radiographs were significantly less likely to receive manipulation. Most manipulation for CLBP (64%) was appropriate and most manipulation for CNP (93%) was for patients where appropriateness was uncertain or equivocal. The proportions of patients receiving inappropriate manipulation for either condition were low (1%–3%) as were the numbers of patients presenting to these chiropractors for which manipulation was inappropriate.

Conclusion.

Chiropractors in this US sample tend to provide manipulation to very few patients with CLBP or CNP for which it is inappropriate. However, more research is needed to determine which patients with CNP benefit from manipulation.

Level of Evidence: 4
The Rare Occurrence of Reoperation After Cervical Laminoplasty
Authors: Barkley Ariana S. , Eaton Jessica , Carroll Kate , Sullivan Liam T. , Zhang Fangyi , Ravanpay Ali
Published: February 2021

Study Design:

Retrospective cohort study.

Objective:

To determine the rate of recurrent or adjacent-level stenosis requiring reoperation after single-door cervical laminoplasty for spondylotic myelopathy at our institution.

Summary of Background Data:

Adjacent-level stenosis requiring reoperation is a commonly evaluated condition for anterior or posterior arthrodesis, however, there are few studies that evaluate adjacent-level stenosis in the case of cervical laminoplasty.

Methods:

Retrospective review of adults undergoing cervical laminoplasty for spondylotic myelopathy between January 2005 and May 2018 at our institution. Demographics, symptom duration, stenotic levels, preoperative and postoperative Medical Research Council motor, American Spinal Injury Association, modified Japanese Orthopaedic Association scores, and Nurick grade were obtained. Postoperative data included presence of C5 palsy, infection rate, alleviation or persistence of symptoms, and rate of recurrent or adjacent-level stenosis.

Results:

A total of 102 patients underwent cervical laminoplasty; mean age was 56.7 years (±12.96). Most were men (n=76, 74.5%), with myelopathy (n=64, 63.4%), C4 (n=94, 93.1%), and C5 (n=92, 91.1%) cervical stenosis; mean symptom duration was 55 days (7 d to 2.8 y). Average follow-up was 6.4 months (±3.4). After surgery, there was statistically significant improvement in Nurick grade (3.1±2.2 vs. 2.7±2.4, P=0.002) and modified Japanese Orthopaedic Association score (11.4±3.7 vs. 13.9±3.6, P<0.001); American Spinal Injury Association scores also improved (P<0.001). Rate of postoperative C5 palsy was 7.8% (n=8); postoperative infection rate was 1.96% (n=2). Reoperation rate was 4.9% (n=5); reoperation for recurrent or adjacent-level stenosis was 1.96% (n=2).

Conclusions:

Recurrent or adjacent-level stenosis requiring reoperation after cervical laminoplasty is rare. Longitudinal studies are needed to verify correlation between motion preservation and incidence of adjacent or recurrent stenosis.

Level of Evidence:

Level III—treatment benefits: nonrandomized controlled cohort/follow-up study.
Complete testicular remission after chemotherapy in a patient with advanced seminoma: is the testicle a real ‘sanctuary’? A case report and review of the literature
Authors: Caspani Francesca , Nigro Olga , Ogliari Francesca Rita , Proserpio Ilaria , Dehò Federico , Capogrosso Paolo , Valdatta Luigi , De Palma Diego , Garutti Leonardo , Tamborini Federico , Chini Claudio
Published: February 2021

Testicular cancer is relatively uncommon, but at the same time, it is the most common solid tumor in men between the ages of 20 and 34 years. Seminoma represents the most frequently encountered germ cell tumors. Because orchiectomy is usually performed before chemotherapy, little is known about the effect of systemic chemotherapy on primary testicular tumors. Furthermore, the testis has always been considered a sanctuary site, an immune-privileged site in which inadequate exposure of the tumor to chemotherapy may occur. We report the case of a young patient with advanced seminoma with a complete testicular response after four cycles of cisplatin-based chemotherapy. Then, we performed a systematic review of the literature reporting the studies published to date on the topic.
Bioinformatics analysis of microarray data reveals epithelial-mesenchymal-transition in pediatric ependymoma
Authors: Ma Quanfeng , Shu Chang , Wang Jinhuan
Published: February 2021

The objectives of this study were to explore the possible mechanisms of pediatric ependymoma using bioinformatics methods and provide potential genes and signaling pathways for pediatric ependymoma study. The data of GES74195 from Gene Expression Ominibus was analyzed by R language for pediatric ependymoma study. The differentially expressed genes were explored using gene set enrichment analysis, search tool for the retrieval of interacting genes, Cytoscape as well as other mainstream bioinformatics methods. Extracellular matrix–receptors interaction pathways and focal adhesion pathway were demonstrated as the key signaling pathway for pediatric ependymoma. The potential hub genes enriched in the two signaling pathways were regarded as final hub genes for this microarray analysis. The development and progression of pediatric ependymoma were associated with epithelial-mesenchymal-transition. Various potential hub genes and potential key signaling pathways in order to further explore their values in the diagnosis and treatment of this disease in the future.
Exaggerated Microvascular Vasodilating Responses in Cirrhotic Patients With Septic Shock*
Authors: Hariri Geoffroy , Urbina Tomas , Lavillegrand Jean-Rémi , Gasperment Maxime , Mazerand Sandie , Abdelmalek Abdelkrim , Bigé Naïke , Baudel Jean-Luc , Guidet Bertrand , Maury Eric , Ait-Oufella Hafid
Published: February 2021

OBJECTIVES:

Cirrhosis is associated with hemodynamic and vascular disorders. However, microvascular reactivity of cirrhotic patients in the context of sepsis has poorly been investigated.

DESIGN:

Prospective observational study.

SETTING:

Medical ICU in a tertiary teaching hospital.

PATIENTS:

We prospectively included adult patients admitted in the ICU for septic shock with and without cirrhosis. After initial resuscitation, global hemodynamic parameters were recorded and skin microvascular reactivity to local acetylcholine iontophoresis was measured.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Thirty patients with septic shock were included (60% male), 10 with cirrhosis and 20 without, with a median age of 61 years (54–74 yr). Cirrhotic patients were mainly classed as Child-Pugh C (80%) and all of them had ascites. Sequential Organ Failure Assessment score and ICU mortality of cirrhotic patients were higher than the noncirrhotic patients, respectively (6.5 [5.0–8.3] vs 11.5 [9.0–14.0]; p < 0.01; 15% vs 70%; p < 0.01). Peripheral tissue perfusion and global hemodynamic parameters were not different between the cirrhotic and noncirrhotic patients but arterial lactate level was three times higher in patients with cirrhosis (6.0 mmol/L [3.9–8.0 mmol/L] vs 2.0 mmol/L [0.9–3.5 mmol/L]; p < 0.01). Basal skin microvascular blood flow was not statistically different between the groups (4.94 perfusion units [3.45–8.73 perfusion units] vs 6.95 perfusion units [5.24–8.38 perfusion units]; p = 0.29). After acetylcholine simulation, skin microvascular blood flow increased more in cirrhotic patients than in noncirrhotic patients (644% [217–966%] vs 169% [73–505%], p = 0.03). Global microvascular reactivity was seven times higher in cirrhotic patients (area under the curve, 16,412 perfusion units [13,898–19,041 perfusion units] vs 2,664 perfusion units [969–4,604 perfusion units]; p < 0.001).

CONCLUSIONS:

We identified an exaggerated vasodilating microvascular response in cirrhotic patients with septic shock. Such a result may explain vasopressor resistance and paves the way for future therapeutic trials, targeting nitric oxide pathway specifically in this population.
Safety and Efficacy of Human Chorionic Gonadotropin Hormone-Derivative EA-230 in Cardiac Surgery Patients: A Randomized Double-Blind Placebo-Controlled Study
Authors: van Groenendael Roger , Beunders Remi , Hemelaar Pleun , Hofland Jan , Morshuis Wim J. , van der Hoeven Johannes G. , Gerretsen Jelle , Wensvoort Gert , Kooistra Emma J. , Claassen Wout J. , Waanders Denise , Lamberts Maud G. A. , Buijsse Leonie S. E. , Kox Matthijs , van Eijk Lucas T. , Pickkers Peter
Published: February 2021

OBJECTIVES:

To determine the safety and efficacy of human chorionic gonadotropin hormone-derivative EA-230 in cardiac surgery patients. Cardiac surgery induces systemic inflammation and may impair renal function, affecting patient outcome. EA-230 exerted immunomodulatory and renoprotective effects in preclinical models and was safe and showed efficacy in phase I and II human studies.

DESIGN:

Double-blinded, placebo-controlled, randomized study.

SETTING:

Collaboration of the Cardiothoracic Surgery, Anesthesiology, and the Intensive Care departments of a tertiary hospital in the Netherlands.

PATIENTS:

One hundred eighty patients undergoing an on-pump coronary artery bypass procedure with or without concomitant valve surgery.

INTERVENTIONS:

Ninety mg/kg/hr EA-230 or placebo administered during surgery.

MEASUREMENTS AND MAIN RESULTS:

During the study, no safety concerns emerged. EA-230 did not modulate interleukin-6 plasma concentrations (area under the curve 2,730 pg/mL × hr [1,968–3,760] vs 2,680 pg/mL × hr [2,090–3,570] for EA-230 and placebo group, respectively; p = 0.80). Glomerular filtration rate increased following surgery (mean ± sem increase in the EA-230 vs placebo groups: glomerular filtration rateiohexol measured using iohexol plasma clearance: 19 ± 2 vs 16 ± 2 mL/min/1.73 m2; p = 0.13 and estimated glomerular filtration rate with the Modification of Diet in Renal Disease equation using creatinine: 6 ± 1 vs 2 ± 1 mL/min/1.73 m2; p = 0.01). The “injury” stage of the Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease criteria for acute kidney injury was 7% in the EA-230 group versus 18% in the placebo group (p = 0.07). In addition, EA-230-treated patients had a less positive fluid balance compared with placebo-treated patients (217 ± 108 vs 605 ± 103 mL; p = 0.01), while the use of vasoactive agents was similar in both groups (p = 0.39). Finally, hospital length of stay was shorter in EA-230 treated patients (8 d [7–11] vs 10 d [8–12]; p = 0.001). Efficacy results were more pronounced in patients that had longer duration of surgery and thus longer duration of study drug infusion.

CONCLUSIONS:

EA-230 was safe in patients undergoing on-pump cardiac surgery. It did not modulate interleukin-6 plasma concentrations but appeared to exert beneficial renal and cardiovascular effects and shortened in-hospital length of stay.
Effects of Prone Positioning on Venous Return in Patients With Acute Respiratory Distress Syndrome*
Authors: Lai Christopher , Adda Imane , Teboul Jean-Louis , Persichini Romain , Gavelli Francesco , Guérin Laurent , Monnet Xavier
Published: February 2021

OBJECTIVES:

To examine the effects of prone positioning on venous return and its determinants such as mean systemic pressure and venous return resistance in patients with acute respiratory distress syndrome.

DESIGN:

Prospective monocentric study.

SETTINGS:

A 25-bed medical ICU.

PATIENTS:

About 22 patients with mild-to-severe acute respiratory distress syndrome in whom prone positioning was decided.

INTERVENTIONS:

We obtained cardiac index, mean systemic pressure, and venous return resistance (the latter two estimated through the heart-lung interactions method) before and during prone positioning. Preload responsiveness was assessed at baseline using an end-expiratory occlusion test.

MEASUREMENTS AND MAIN RESULTS:

Prone positioning significantly increased mean systemic pressure (from 24 mm Hg [19–34 mm Hg] to 35 mm Hg [32–46 mm Hg]). This was partly due to the trunk lowering performed before prone positioning. In seven patients, prone positioning increased cardiac index greater than or equal to 15%. All were preload responsive. In these patients, prone positioning increased mean systemic pressure by 82% (76–95%), central venous pressure by 33% (21–59%), (mean systemic pressure – central venous pressure) gradient by 144% (83–215)%, while it increased venous return resistance by 71% (60–154%). In 15 patients, prone positioning did not increase cardiac index greater than or equal to 15%. In these patients, prone positioning increased mean systemic pressure by 28% (18–56%) (p < 0.05 vs. patients with significant increase in cardiac index), central venous pressure by 21% (7–54%), (mean systemic pressure – central venous pressure) gradient by 28% (23–86%), and venous return resistance by 37% (17–77%). Eleven of these 15 patients were preload unresponsive.

CONCLUSIONS:

Prone positioning increased mean systemic pressure in all patients. The resulting change in cardiac index depended on the extent of increase in (mean systemic pressure – central venous pressure) gradient, of preload responsiveness, and of the increase in venous return resistance. Cardiac index increased only in preload-responsive patients if the increase in venous return resistance was lower than the increase in the (mean systemic pressure –central venous pressure) gradient.
Long-Term Implications of Abnormal Left Ventricular Strain During Sepsis
Authors: Beesley Sarah J. , Sorensen Jeff , Walkey Allan J. , Tonna Joseph E. , Lanspa Michael J. , Hirshberg Ellie , Grissom Colin K. , Horne Benjamin D. , Burk Rebecca , Abraham Theodore P. , Paine Robert , Brown Samuel M.
Published: February 2021

Objectives:

Septic cardiomyopathy develops frequently in patients with sepsis and likely increases short-term mortality. However, whether septic cardiomyopathy is associated with long-term outcomes after sepsis is unknown. We investigated whether septic patients with septic cardiomyopathy have worse long-term outcomes than septic patients without septic cardiomyopathy.

Design:

Retrospective cohort study.

SETTING:

Adult ICU.

PATIENTS:

Adult ICU patients with sepsis.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Left ventricular global longitudinal systolic strain was our primary measure of septic cardiomyopathy. We employed a suite of multivariable survival analyses to explore linear and nonlinear associations between left ventricular global longitudinal systolic strain and major adverse cardiovascular events, which included death, stroke, and myocardial infarction. Our primary outcome was major adverse cardiovascular event through 24 months after ICU discharge. Among 290 study patients, median left ventricular global longitudinal systolic strain was –16.8% (interquartile range, –20.4% to –12.6%), and 38.3% of patients (n = 111) experienced a major adverse cardiovascular event within 24 months after discharge. On our primary, linear analysis, there was a trend (p = 0.08) toward association between left ventricular global longitudinal systolic strain and major adverse cardiovascular event (odds ratio, 1.03; CI, < 1 to 1.07). On our nonlinear analysis, the association was highly significant (p < 0.001) with both high and low left ventricular global longitudinal systolic strain associated with major adverse cardiovascular event among patients with pre-existing cardiac disease. This association was pronounced among patients who were younger (age < 65 yr) and had Charlson Comorbidity Index greater than 5.

Conclusions:

Among patients with sepsis and pre-existing cardiac disease who survived to ICU discharge, left ventricular global longitudinal systolic strain demonstrated a U-shaped association with cardiovascular outcomes through 24 months. The relationship was especially strong among younger patients with more comorbidities. These observations are likely of use to design of future trials.
Assessment of Electrical Impedance Tomography to Set Optimal Positive End-Expiratory Pressure for Venoarterial Extracorporeal Membrane Oxygenation-Treated Patients*
Authors: Soulé Christelle , Crognier Laure , Puel Floriane , Ruiz Stéphanie , Seguin Thierry , Fourcade Olivier , Georges Bernard , Conil Jean-Marie , Minville Vincent , Vardon-Bounes Fanny
Published: February 2021

OBJECTIVES:

Patients on venoarterial extracorporeal membrane oxygenation have many risk factors for pulmonary complications in addition to their heart failure. Optimal positive end-expiratory pressure is unknown in these patients. The aim was to evaluate the ability of electrical impedance tomography to help the physician to select the optimal positive end-expiratory pressure in venoarterial extracorporeal membrane oxygenation treated and mechanically ventilated patients during a positive end-expiratory pressure trial.

DESIGN:

Observational prospective monocentric.

SETTING:

University hospital.

PATIENTS:

Patients (n = 23) older than 18 years old, on mechanical ventilation and venoarterial extracorporeal membrane oxygenation.

INTERVENTIONS:

A decreasing positive end-expiratory pressure trial (20–5 cm H2O) in increments of 5 cm H2O was performed and monitored by a collection of clinical parameters, ventilatory and ultrasonographic (cardiac and pulmonary) to define an optimal positive end-expiratory pressure according to respiratory criteria (optimal positive end-expiratory pressure selected by physician with respiratory parameters), and then adjusted according to hemodynamic and cardiac tolerances (optimal positive end-expiratory pressure selected by physician with respiratory, hemodynamic, and echocardiographic parameters). At the same time, electrical impedance tomography data (regional distribution of ventilation, compliance, and overdistension collapse) were recorded and analyzed retrospectively to define the optimal positive end-expiratory pressure.

MEASUREMENTS AND MAIN RESULTS:

The median of this optimal positive end-expiratory pressure was 10 cm H2O in our population. Electrical impedance tomography showed that increasing positive end-expiratory pressure promoted overdistention of ventral lung, maximum at positive end-expiratory pressure 20 cm H20 (34% [interquartile range, 24.5–40]). Decreasing positive end-expiratory pressure resulted in collapse of dorsal lung (29% [interquartile range, 21–45.8]). The optimal positive end-expiratory pressure selected by physician with respiratory parameters was not different from the positive end-expiratory pressure chosen by the electrical impedance tomography. However, there is a negative impact of a high level of intrathoracic pressure on hemodynamic and cardiac tolerances.

CONCLUSIONS:

Our results support that electrical impedance tomography appears predictive to define optimal positive end-expiratory pressure on venoarterial extracorporeal membrane oxygenation, aided by echocardiography to optimize hemodynamic assessment and management.
De-stressing From Distress
Authors: Holbert Elizabeth , Dellasega Cheryl
Published: February 2021

In critical care units, distressing events related to patient and family-centered care can influence job dissatisfaction and emotional distress.1–8 Strategies for processing difficult incidents are limited, creating a need for standardized real-time debriefing tools. This study evaluated an innovative nurse-led program that was developed and piloted in one acute care unit of a large academic medical center. An evidence-based practice nurse-led debriefing process provided a sequential process for facilitation of an interdisciplinary group after the occurrence of a distressing event. Throughout a 2-year period, 104 real-time debriefings (>380 staff participation) took place. Emergent situations precipitated the most debriefings followed by disruptive patient/family behavior. Over 80% of the participants affirmed the debriefing process was beneficial, assisted them in coping with the traumatic event, and recommended this type of debriefing to others. These results show that members of an interdisciplinary team will engage in a brief (∼10 minute) nurse-led debriefing program when offered the opportunity to do so, and that this intervention was successful beyond the acute care unit where it originated.
Palliative Care Consult Among Older Adult Patients in Intensive Care Units
Authors: Grabda Marina , Lim Fidelindo A.
Published: February 2021

A review of the literature indicates that there are many benefits of palliative care consultations for patients in the intensive care unit (ICU). Patients who received palliative care treatment were found to have a better emotional state, received less invasive procedures, and had a shorter ICU length of stay. It is noted that patients who could benefit from palliative care treatments may not be identified due to failures to meet the criteria for palliative care consultations. A culture change is needed to improve palliative services, and to standardize when and how it is used.