bluuebunny/crossref_metadata_2025 huggingface dataset:
External Carotid Artery-to-Middle Cerebral Artery Bypass Using a Saphenous Vein Graft With 3-Vessel Anastomosis for the Treatment of a Large, Ruptured Middle Cerebral Artery Aneurysm: 2-Dimensional Operative Video
Authors: Ravina Kristine , Bakhsheshian Joshua , Carey Joseph N , Russin Jonathan J
Published: January 2021

Cerebral revascularization is the treatment of choice for select complex intracranial aneurysms unamenable to traditional approaches.
1
Complex middle cerebral artery (MCA) bifurcation aneurysms can include the origins of 1 or both M2 branches and may benefit from a revascularization strategy.
2,3
A novel 3-vessel anastomosis technique combining side-to-side and end-to-side anastomoses, allowing for bihemispheric anterior cerebral artery revascularization, was recently reported.
4

This 2-dimensional operative video presents the case of a 73-yr-old woman who presented as a Hunt-Hess grade 4 subarachnoid hemorrhage due to the rupture of a large right MCA bifurcation aneurysm. The aneurysm incorporated the origins of the frontal and temporal M2 branches and was deemed unfavorable for endovascular treatment. A strategy using a high-flow bypass from the external carotid artery to the MCA with a saphenous vein (SV) graft was planned to revascularize both M2 branches simultaneously, followed by clip-trapping of the aneurysm. Intraoperatively, the back walls of both M2 segments distal to the aneurysm were connected with a standard running suture, and the SV graft was then attached to the side-to-side construct in an end-to-side fashion. Catheter angiograms on postoperative days 1 and 6 demonstrated sustained patency of the anastomosis and good filling through the bypass. The patient's clinical course was complicated by vasospasm-related right MCA territory strokes, resulting in left-sided weakness, which significantly improved upon 3-mo follow-up with no new ischemia.

The patient consented for inclusion in a prospective Institutional Review Board (IRB)-approved database from which this IRB-approved retrospective report was created.
Placement of a Pipeline Embolization Device: 2-Dimensional Operative Video
Authors: Darwal Maureen A , Binning Mandy J , Veznedaroglu Erol
Published: January 2021

Flow diversion has been a game-changer in the treatment of wide-neck large and giant cavernous and supraclinoid internal carotid artery (ICA) aneurysms as well as large vertebral artery aneurysms. Prior to their existence, carotid sacrifice or clipping with or without external to internal carotid artery bypass was the mainstay of treatment. Prior to flow diversion, endovascular coil embolization was often not effective as a stand-alone treatment because of the fact that many of these aneurysms present with symptoms created by mass effect on the cavernous sinus cranial nerves by the aneurysm. Packing the aneurysm with coils did nothing to alleviate the mass effect and did not prevent flow from entering the aneurysm. The continued flow causes coil compaction and aneurysm enlargement. Flow diversion addressed both these issues by diverting flow from the aneurysm while allowing the aneurysm to slowly thrombose and shrink. The video is a step-by-step account of this procedure in a 72-yr-old male with a large recurrence of a previously coiled cavernous ICA aneurysm. The procedure was performed following informed consent.
Simultaneous Robotic Single-Position Surgery With Oblique Lumbar Interbody Fusion With Software Planning: 2-Dimensional Operative Video
Authors: Pham Martin H , Plonsker Jillian , Diaz-Aguilar Luis D , Osorio Joseph A , Lehman Ronald A
Published: January 2021

The use of robotic guidance for spinal instrumentation is promising for its ability to offer the advantages of precision, accuracy, and reproducibility. This has become even more important in the era of lateral interbody surgery because spinal robotics opens up the possibility of a straightforward workflow for single-position surgery in the lateral position.

We present here a case of a 72-yr-old woman who presented with an L4-5 spondylolisthesis with axial back pain and radiculopathy. She subsequently underwent an L4-5 oblique lumbar interbody fusion with L4-5 bilateral posterior instrumentation in a single lateral position (Mazor X Stealth Edition, Medtronic Sofamor Danek, Medtronic Inc, Dublin, Ireland). Due to the oblique lateral approach and posterior robotic assistance, both surgeons were able to work simultaneously for increased efficiency. To our knowledge, this is the first video demonstrating a two-surgeon simultaneous robotic single-position surgery with oblique lumbar interbody fusion using a spinal robotic platform.

There is no identifying information in this video. Patient consent was obtained for the surgical procedure and for publishing of the material included in the video.
Put some muscle behind it: Understanding movement capacity of tropical birds
Authors: Robinson W Douglas , Rourke Bryan , Stratford Jeffrey A
Published: January 2021

The capacity for flight varies widely among bird species and influences their ecology, evolution, and conservation. Variation in vagility is influenced by behavioral responses to the nature of gaps between habitat elements as well as intrinsic characteristics of the species, particularly physiological traits influencing the physical capacity for sustained flight. Here, we briefly summarize the current state of knowledge revealing the wide variety of movement capacities of Neotropical birds. We then review current knowledge of avian muscle physiology and the role that muscle characteristics may play in influencing movement behavior. We argue that fundamental shifts in our understanding of avian muscle physiology and the influence of physiology on movement behavior remain to be elucidated, in part because knowledge from other vertebrates is being inappropriately applied to birds. In particular, critical evaluation of assumptions applied to birds from detailed studies of mammals is needed. Moving away from simple binary categorizations of avian flight muscles as “red vs. white” or “fast vs. slow” to characterize the cellular mechanisms and specific isoforms active at various life stages or seasons is also needed. An increasingly large number of avian species with a wide array of flight styles from hummingbirds to soaring raptors are appearing in GenBank, facilitating detailed physiological and evolutionary comparisons among species. Properly assessing the muscle physiological characteristics of Neotropical bird species with a wide array of movement capacities may improve our abilities to predict which species are most sensitive to landscape fragmentation and other factors that influence dispersal and migration.
Radio loudness and classification for radio sources
Authors: Zhang Lixia , Fan Junhui , Zhu Jingtian
Published: January 2021

The extragalactic radio sources are divided into two subclasses (radio-loud and radio-quiet sources) in the literature using radio loudness (R), which is defined as the ratio of radio emission to optical emission, but the boundary R-value separating the two classes is different in various sources. In this work, a sample of 2419 objects from the 13th catalog of quasars and active nuclei is used to build a boundary for the two subclasses. To do so, we compiled the radio and optical data, calculated their radio and optical indexes, made K-correction, obtained the radio loudness, and adopted a Bayesian analysis method to the logarithm of radio loudness for classification. We also investigated the correlations of radio loudness with radio/optical luminosities. Our main conclusions are summarized as follows: (1) The distribution of the logarithm of radio loudness (log R) is bimodal, the sources with log R < 1.26 are classified as radio-quiet sources, and those with log R > 1.26 are classified as radio-loud ones from the Bayesian analysis method. (2) The average radio-optical effective spectral index of radio-quiet sources is 〈αRO〉 = 0.05, while that of radio-loud sources is 〈αRO〉 = 0.55. (3) There are positive correlations between radio luminosity and radio loudness for both radio-loud sources and radio-quiet sources. (4) A dividing line of separating the distribution of the clusters on the diagram of radio loudness against radio luminosity was obtained statistically to set the boundary between radio-loud sources and radio-quiet sources, with an accuracy of $99.73\%$ based on the classification result from the Bayesian analysis method.
An antisense noncoding RNA enhances translation via localized structural rearrangements of its cognate mRNA
Authors: Reis Rodrigo S , Deforges Jules , Schmidt Romy R , Schippers Jos H M , Poirier Yves
Published: January 2021

A large portion of eukaryotic genes are associated with noncoding, natural antisense transcripts (NATs). Despite sharing extensive sequence complementarity with their sense mRNAs, mRNA–NAT pairs elusively often evade dsRNA-cleavage and siRNA-triggered silencing. More surprisingly, some NATs enhance translation of their sense mRNAs by yet unknown mechanism(s). Here, we show that translation enhancement of the rice (Oryza sativa) PHOSPHATE1.2 (PHO1.2) mRNA is enabled by specific structural rearrangements guided by its noncoding antisense RNA (cis-NATpho1.2). Their interaction in vitro revealed no evidence of widespread intermolecular dsRNA formation, but rather specific local changes in nucleotide base pairing, leading to higher flexibility of PHO1.2 mRNA at a key high guanine-cytosine�(GC) regulatory region inhibiting translation, ∼350-nt downstream of the start codon. Sense–antisense RNA interaction increased formation of the 80S complex in PHO1.2, possibly by inducing structural rearrangement within this inhibitory region, thus making this mRNA more accessible to 60S. This work presents a framework for nucleotide resolution studies of functional mRNA–antisense pairs.
Analysis of intraspecies diversity reveals a subset of highly variable plant immune receptors and predicts their binding sites
Authors: Prigozhin Daniil M , Krasileva Ksenia V
Published: January 2021

The evolution of recognition specificities by the immune system depends on the generation of receptor diversity and on connecting the binding of new antigens with the initiation of downstream signaling. In plant immunity, the innate Nucleotide-Binding Leucine-Rich Repeat (NLR) receptor family enables antigen binding and immune signaling. In this study, we surveyed the NLR complements of 62 ecotypes of Arabidopsis thaliana and 54 lines of Brachypodium distachyon and identified a limited number of NLR subfamilies that show high allelic diversity. We show that the predicted specificity-determining residues cluster on the surfaces of Leucine-Rich Repeat domains, but the locations of the clusters vary among NLR subfamilies. By comparing NLR phylogeny, allelic diversity, and known functions of the Arabidopsis NLRs, we formulate a hypothesis for the emergence of direct and indirect pathogen-sensing receptors and of the autoimmune NLRs. These findings reveal the recurring patterns of evolution of innate immunity and can inform NLR engineering efforts.
Linking thermodynamics and measurements of protein stability
Authors: Lindorff-Larsen Kresten , Teilum Kaare
Published: January 2021

We review the background, theory and general equations for the analysis of equilibrium protein unfolding experiments, focusing on denaturant and heat-induced unfolding. The primary focus is on the thermodynamics of reversible folding/unfolding transitions and the experimental methods that are available for extracting thermodynamic parameters. We highlight the importance of modelling both how the folding equilibrium depends on a perturbing variable such as temperature or denaturant concentration, and the importance of modelling the baselines in the experimental observables.
Role of an Atypical Cadherin Gene, Cdh23 in Prepulse Inhibition, and Implication of CDH23 in Schizophrenia
Authors: Balan Shabeesh , Ohnishi Tetsuo , Watanabe Akiko , Ohba Hisako , Iwayama Yoshimi , Toyoshima Manabu , Hara Tomonori , Hisano Yasuko , Miyasaka Yuki , Toyota Tomoko , Shimamoto-Mitsuyama Chie , Maekawa Motoko , Numata Shusuke , Ohmori Tetsuro , Shimogori Tomomi , Kikkawa Yoshiaki , Hayashi Takeshi , Yoshikawa Takeo
Published: January 2021

We previously identified quantitative trait loci (QTL) for prepulse inhibition (PPI), an endophenotype of schizophrenia, on mouse chromosome 10 and reported Fabp7 as a candidate gene from an analysis of F2 mice from inbred strains with high (C57BL/6N; B6) and low (C3H/HeN; C3H) PPI levels. Here, we reanalyzed the previously reported QTLs with increased marker density. The highest logarithm of odds score (26.66) peaked at a synonymous coding and splice-site variant, c.753G>A (rs257098870), in the Cdh23 gene on chromosome 10; the c.753G (C3H) allele showed a PPI-lowering effect. Bayesian multiple QTL mapping also supported the same variant with a posterior probability of 1. Thus, we engineered the c.753G (C3H) allele into the B6 genetic background, which led to dampened PPI. We also revealed an e-QTL (expression QTL) effect imparted by the c.753G>A variant for the Cdh23 expression in the brain. In a human study, a homologous variant (c.753G>A; rs769896655) in CDH23 showed a nominally significant enrichment in individuals with schizophrenia. We also identified multiple potentially deleterious CDH23 variants in individuals with schizophrenia. Collectively, the present study reveals a PPI-regulating Cdh23 variant and a possible contribution of CDH23 to schizophrenia susceptibility.
Portal vein thrombosis in patients with hepatosplenic schistosomiasis who underwent oesophagogastric devascularization combined with splenectomy
Authors: Cançado Guilherme G L , Nardelli Mateus J , Barbosa Fernanda A , Silva Catherine F , Osório Fernanda M F , Ferrari Teresa C A , Couto Claudia A , Faria Luciana C
Published: January 2021

Background

Portal vein thrombosis (PVT) has been described in nearly 50% of patients who underwent oesophagogastric devascularization combined with splenectomy (EGDS), but no previous study has compared its occurrence in surgical and non-surgical groups. This study aimed to investigate PVT in hepatosplenic schistosomiasis (HSS) and its association with EGDS and upper variceal bleeding (UVB).

Methods

Retrospectively, 104 HSS individuals were enrolled. Following EGDS, the occurrence of PVT, mesenteric vein thrombosis (MVT), hospital admissions and UVB were recorded.

Results

EGDS was performed in 27 (26%) patients. PVT and MVT were detected in 30 (33%) and 8 (9.8%) patients, respectively. Patients who underwent EGDS were at greater risk of PVT (63% vs 19.7%; odds ratio [OR] 6.12 [95% confidence interval {CI} 2.3 to 16.1], p<0.001) when compared with a non-surgical approach. There was no significant difference in UVB occurrence and β-blocker usage. PVT was associated with more hospital admissions (p=0.030) and higher alkaline phosphatase levels (p=0.008). UVB occurrence in patients with and without thrombosis was similar. In multivariate analysis, after adjustment, PVT was associated with the surgical approach (OR 4.56 [95% CI 1.55 to 13.38], p=0.006) and age at HSS diagnosis (OR 0.94 [95% CI 0.90 to 0.99], p=0.021).

Conclusions

EGDS was not associated with a decreased frequency of UVB when compared with the non-surgical approach but was an independent risk factor for PVT.
Improving turnaround time of molecular diagnosis of Middle East respiratory syndrome coronavirus in a hospital in Saudi Arabia
Authors: Rabaan Ali A , Al-Tawfiq Jaffar A
Published: January 2021

Background

There have been 2562 laboratory-confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) in 27 countries, with a case fatality rate of 34.5%. Data on the turnaround time (TAT) are lacking. We report TAT for MERS-CoV samples over time.

Methods

This is a monocentric study and the TAT for the reporting of 2664 MERS-CoV polymerase chain reaction (PCR) results were calculated in hours from the time of the receipt of respiratory samples to the reporting of the results.

Results

The mean TAT±standard deviation was significantly lower in 2018 compared with previous years (19.25±13.8). The percentage of samples processed within 24 h increased from 42.3% to 73.8% in 2015 and 2018, respectively (p<0.0001). The mean TAT was 19.2 h in 2018 and was significantly lower than previous years.

Conclusions

The TAT for the MERS-CoV results decreased during the study period. Timely reporting of MERS-CoV PCR results may aid in further enhancing infection control measures.
Impaired Wound Healing with Imatinib Mesylate Therapy
Authors: Ronicke Moritz , Erfurt-Berge Cornelia
Published: January 2021

Medication-induced ulcers are generally rare. Although the tyrosine kinase inhibitor imatinib mesylate is frequently prescribed, the occurrence of ulcers related to the medication has not been previously described. Herein, the authors report a case of a patient with impaired wound healing that was attributed to imatinib mesylate treatment. Providers should maintain suspicion for medication-induced ulcers, particularly if treatment for the presumed underlying cause of an ulcer fails.
Effectiveness of a Multimedia Patient Education Intervention on Improving Self-care Knowledge and Skills in Patients with Colorectal Cancer after Enterostomy Surgery: A Pilot Study
Authors: Wang Shou-Yu , Chang Tsai-Hsiu , Han Chiao-Yi
Published: January 2021

OBJECTIVE

Colorectal cancer is most commonly treated through surgery. Self-care knowledge and skills are instrumental for disease adaptation once the patient returns home. Therefore, this study examined the effects of a multimedia patient education intervention on improving self-care knowledge and skills in patients with colorectal cancer who underwent colostomy surgery.

METHODS

A quasi-experimental design was adopted to measure the self-care knowledge and skills of patients with colorectal cancer before and after surgery. The experimental group (n = 33) received a multimedia patient education intervention, whereas the control group (n = 30) was provided conventional instructions. Results were evaluated using analysis of covariance.

RESULTS

On the day prior to discharge from hospital, the experimental group exhibited significantly greater improvement in self-care knowledge than did the control group. The experimental group also exhibited significantly greater improvement in self-care skills than did the control group on the day of gas passage, the day prior to discharge from hospital, and during the first clinic visit after discharge from the hospital.

CONCLUSIONS

Multimedia patient education intervention yielded greater improvement in self-care knowledge and skills than did conventional instruction. Therefore, multimedia patient education is an adequate educational tool for patients with colorectal cancer who have undergone colostomy surgery.
Severe Maternal Morbidity and Risk of Mortality Beyond the Postpartum Period
Authors: Ukah U. Vivian , Dayan Natalie , Potter Brian J. , Ayoub Aimina , Auger Nathalie
Published: January 2021

OBJECTIVE:

To examine long-term risks of mortality after a pregnancy complicated by severe maternal morbidity.

METHODS:

We analyzed a longitudinal cohort of 1,229,306 women who delivered in the province of Quebec, Canada from 1989 through 2016. Severe maternal morbidity included conditions such as cerebrovascular accidents, acute renal failure, severe preeclampsia, and other life-threatening complications. The outcome was in-hospital mortality after the last pregnancy, categorized as postpartum (42 days or fewer after delivery) and long-term (43 days to 29 years after delivery). We estimated hazard ratios (HRs) ofr mortality with 95% CI for severe maternal morbidity compared with no severe morbidity, using Cox regression models adjusted for maternal characteristics.

RESULTS:

Severe maternal morbidity occurred in 2.9% of women. The mortality rate associated with severe maternal morbidity was 0.86 per 1,000 person-years compared with 0.41 per 1,000 person-years for no morbidity. Compared with no morbidity, severe maternal morbidity was associated with two times the rate of death any time after delivery (95% CI 1.81–2.20). Severe cardiac complications (HR 7.00, 85% CI 4.94–9.91), acute renal failure (HR 4.35, 95% CI 2.66–7.10), and cerebrovascular accidents (HR 4.03, 95% CI 2.17–7.48) were the leading morbidities associated with mortality after 42 days.

CONCLUSION:

Women who experience severe maternal morbidity have an accelerated risk of mortality beyond the postpartum period compared with women who do not experience severe morbidity. More intensive clinical follow-up may be merited for women with serious pregnancy complications.
Racial and Ethnic Disparities in Reproductive Health Services and Outcomes, 2020
Authors: Sutton Madeline Y. , Anachebe Ngozi F. , Lee Regina , Skanes Heather
Published: January 2021

Racial and ethnic disparities in women's health have existed for decades, despite efforts to strengthen women's reproductive health access and utilization. Recent guidance by the American College of Obstetricians and Gynecologists (ACOG) underscores the often unacknowledged and unmeasured role of racial bias and systemic racial injustice in reproductive health disparities and highlights a renewed commitment to eliminating them. Reaching health equity requires an understanding of current racial–ethnic gaps in reproductive health and a concerted effort to develop and implement strategies to close gaps. We summarized national data for several reproductive health measures, such as contraceptive use, Pap tests, mammograms, maternal mortality, and unintended pregnancies, by race–ethnicity to inform health-equity strategies. Studies were retrieved by systematically searching the PubMed (2010–2020) electronic database to identify most recently published national estimates by race–ethnicity (non-Hispanic Black or African American, Hispanic or Latinx, and non-Hispanic White women). Disparities were found in each reproductive health category. We describe relevant components of the Affordable Care Act (ACA) and the Preventing Maternal Deaths Act, which can help to further strengthen reproductive health care, close gaps in services and outcomes, and decrease racial–ethnic reproductive health disparities. Owing to continued diminishment of certain components of the ACA, to optimally reach reproductive health equity, comprehensive health insurance coverage is vital. Strengthening policy-level strategies, along with ACOG's heightened commitment to eliminating racial disparities in women's health by confronting bias and racism, can strengthen actions toward reproductive health equity.
The Contrast of Color
Authors: Gillispie-Bell Veronica
Published: January 2021

The evidence of racial health disparities is profound. Much attention has been given to the disparity in maternal morbidity and mortality experienced by Black mothers. The disparity in Black lives lost from coronavirus disease 2019 (COVID-19) has further highlighted the disparity in health outcomes for Black people. Although COVID-19 is a new disease, the reason for the health disparity is the same as in maternal morbidity and mortality: implicit bias and structural racism. Implicit bias among health care professionals leads to disparities in how health care is delivered. Generations of structural racism perpetuated through racial residential segregation, economic suppression, and health care inequality have normalized the poorer health outcomes for Black Americans. It is easy to dismiss these issues as someone else's problem, because health care professionals often fail to acknowledge the effect of implicit bias in their own practices. We all need to be highly critical of our own practices and look introspectively for implicit bias to find the cure. Health care organizations must invest time and resources into investigating the structural racism that exists within our own walls.
Twelve Live Births After Uterus Transplantation in the Dallas UtErus Transplant Study
Authors: Johannesson Liza , Testa Giuliano , Putman J. Michael , McKenna Gregory J. , Koon E. Colin , York Jackie R. , Bayer Johanna , Zhang Lilly , Rubeo Zachary S. , Gunby Robert T. , Gregg Anthony R.
Published: January 2021

OBJECTIVE:

To describe aggregated pregnancy outcomes after uterus transplantation from a single, experienced center.

METHODS:

This prospective study reports on live births among 20 women who received a uterus transplant from 2016 to 2019 at Baylor University Medical Center at Dallas. These live births occurred between November 2017 and September 2020. The main measures were live birth, maternal complications, and fetal and newborn outcomes.

RESULTS:

There were six graft failures (four surgical complications and two with poor perfusion postoperatively). Of the 14 technically successful transplants, at least one live birth occurred in 11 patients. Thus far, the live birth rate per attempted transplant is 55%, and the live-birth rate per technically successful transplant is 79%. Ten uteri were from nondirected living donors and one uterus was from a deceased donor. In vitro fertilization was performed to achieve pregnancy. Ten recipients delivered one neonate, and one recipient delivered two neonates. One organ rejection episode was detected during pregnancy and was resolved with steroids. The median birth weight was 2,890 g (range 1,770–3,140 g [median 68th percentile]). Maternal weight gain was higher than Institute of Medicine recommendations. Maternal medical complications were observed in five recipients (elevated creatinine level, gestational diabetes, gestational hypertension [n=2], and preeclampsia). In five recipients, maternal medical or obstetric complications led to an unplanned preterm delivery (elevated creatinine level, preeclampsia; preterm labor [n=3]). The median gestational age at delivery was 36 6/7 weeks (range 30 6/7–38 weeks). All neonates were liveborn, with Apgar scores of 8 or higher at 5 minutes.

CONCLUSION:

Over the first 3 years, our program experienced a live-birth rate per attempted transplant of 55% and a live-birth rate per technically successful transplant of 79%. In our experience, uterus transplantation resulted in a third-trimester live birth in all cases in which pregnancies reached 20 weeks of gestation. Maternal medical and obstetric complications can occur; however, these were manageable by applying principles of generally accepted obstetric practice.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT02656550.
Is There Value in Venous Thromboembolism Chemoprophylaxis After Pediatric Scoliosis Surgery? A 28-Year Single Center Study
Authors: Erkilinc Mehmet , Clarke Amelia , Poe-Kochert Connie , Thompson George H. , Hardesty Christina K. , O’Malley Natasha , Mistovich R. Justin
Published: January 2021

Background:

With a recognized increase in the incidence of venous thromboembolism (VTE) in children, especially in those with complex, chronic conditions, it is important for patient safety and risk management to identify subgroups that would benefit from prophylactic treatment. The aim of our study was to assess whether scoliosis surgery in children was associated with an increased incidence of VTE, including deep venous thrombosis (DVT) and pulmonary embolism, and if chemoprophylaxis is warranted.

Methods:

We reviewed our institution’s Pediatric Orthopaedic Spine Database (1992-2019) to identify patients who had a symptomatic VTE postoperatively.

Results:

There were 1471 patients (1035 female, 436 male) with a mean age at surgery of 12.1±3.2 years (range, 1 to 18 y) underwent posterior spinal fusion and instrumentation (2131 procedures). No patients were given pharmacological VTE prophylaxis, and no routine screening for VTE was performed. Two patients had a lower extremity DVT (0.13%) within 6 months following surgery, (range, 55 to 161 d). Neither patient had a subsequent pulmonary embolism. They were 9 and 17 years of age with a diagnosis of neuromuscular scoliosis (1 each postpolio and myelodysplasia). One affected patient had a central venous line inserted perioperatively, a known risk factor for thromboembolism. All DVTs were treated with appropriately dosed anticoagulants. None had a family history of hypercoagulation.

Conclusions:

The risk of symptomatic VTE is extraordinarily low after pediatric spinal deformity surgery. Mechanical prophylaxis is sufficient in most cases. Further multi-center studies may help identify patient specific risk factors.
Management and Complications in Nonoperative Fractures of the Tibial Spine: A Systematic Review
Authors: Zhang Kailai , Catapano Michael , Carsen Sasha , Peterson Devin , de SA Darren
Published: January 2021

Effective options exist for acute nonoperative management of anterior tibial spine fractures, yet there exists a paucity of literature describing long-term outcomes for these patients. This systematic review thus aims to consolidate management strategies and complications for patients with nonoperative anterior tibial spine fractures. In accordance with PRISMA guidelines, 5 databases (CINAHL, MEDLINE, EMBASE, Cochrane, and Pubmed) were searched and screened in duplicate. Quality assessment was performed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. Of 485 studies identified in the initial search, a total of 18 studies involving 369 patients were eligible for this review. These were stratified into 173 type I, 124 type II, and 72 type III injuries as described by Meyers and McKeever. All patients were treated with knee immobilization in either full extension or slight flexion, with possible closed reduction and/or aspiration of hemarthrosis. Complications at final follow-up comprised 33.9% of patients with persistent stiffness, 19.4% persistent instability, 11.1% mechanical symptoms, 6.37 delayed anterior cruciate ligament reconstruction, 4.9% delayed operative intervention for other complications, and 1.9% extension impingement. Given the lack of comparative studies in this review, definitive conclusions for nonoperative management are difficult to establish on the basis of the current body of literature alone. A modestly higher rate of arthrofibrosis and persistent laxity are seen in higher-grade injuries, however, only a minority of studies stratified complications by Meyers and McKeever classification in this review. A better understanding of variables in treatment decision making require further prospective study focused on the collection of functional and patient-reported outcome measures, whereas also further delineating complications by injury severity.
Crawford Type IV Congenital Pseudarthrosis of the Tibia: Treatment With Vascularized Fibular Grafting and Outcome at Skeletal Maturity
Authors: El-Gammal Tarek A. , El-Sayed Amr , Kotb Mohamed M. , Saleh Waleed R. , Ragheb Yasser F. , Refai Omar A. , Morsy Mohamed M. , El-Gammal Yousif T.
Published: January 2021

Background:

Vascularized fibular grafting (VFG) is currently accepted as one of the best treatments for congenital tibial pseudoarthrosis (CPT). However, with longer follow-up, functional results deteriorate, and some problems become evident.

Methods:

Thirty-nine patients with CPT were treated with VFG. Their age at surgery averaged 5.2 years. Twenty-one cases aged 3 years or less at the time of surgery. All cases were Crawford type IV affected by neurofibromatosis-1. Fourteen patients had 1 to 7 previous surgeries with an average of 4.2 procedures. The length of the fibula used averaged 9.9 cm, and the fibula was fixed by intramedullary wires in 26 cases, and transfixion screws in 11 cases.

Results:

Follow-up averaged 8.1 years. Seventeen cases (43.6%) reached skeletal maturity before the final follow-up. Primary bone union was achieved in 37 cases (96%) after an average of 3.2 months. Stress fracture occurred in 21 cases (51.3%) and was recurrent in 11 cases. Twenty-one cases (53.8%) developed tibial shaft deformities with an average valgus angle of 13.8 degrees and procurvatum angle of 18.8 degrees. The overall final limb length discrepancy (LLD) averaged 2.2 cm. Ipsilateral ankle valgus deformity occurred in 21 cases (53.8%) and averaged 10 degrees. A total of 17 cases required an average of 2 secondary procedures. The tibial deformity did not appear to remodel with age, but the LLD and the angle of ipsilateral ankle valgus deformity continued to significantly increase until skeletal maturity.

Conclusion:

This study reports the largest single center experience of CPT cases treated with VFG. Free VFG is an excellent treatment option for CPT. Best results are achieved when the procedure is performed at or before the age of 3 years, in the absence of previous surgeries, and with the use of intramedullary fixation. The resulting LLD and the degree of ipsilateral ankle valgus increase with age until skeletal maturity, however, tibial deformity does not remodel and should be corrected at any age if it is excessive. Donor side mild ankle valgus may occur despite sound tibiofibular synostosis.

Level of Evidence:

Level IV.
Patient-reported Outcomes Measurement Information System (PROMIS) Scores for Children With Brachial Plexus Birth Injury
Authors: Manske M. Claire , Abarca Nancy E. , Letzelter Joseph P. , James Michelle A.
Published: January 2021

Background:

Patient-reported Outcomes Measurement Information System (PROMIS) for pediatrics is a validated patient-reported or parent-proxy–reported outcomes assessment tool used to evaluate health-related quality of life in children and adolescents with chronic medical conditions. The health-related quality of life of children with brachial plexus birth injury (BPBI) as measured by PROMIS is not well understood. We hypothesized that children with BPBI would report impaired upper extremity (UE) function but normal mobility, pain interference, and peer relationships compared with a reference pediatric population, and that UE function PROMIS scores would be associated with BPBI severity and patient age.

Methods:

This is a retrospective cohort study of 180 children with BPBI ages 5 to 17 years old who responded to 4 pediatric PROMIS domains (mobility, pain interference, peer relationships, and UE function) between April 2017 and April 2019. Responses were converted to a T score, which allows comparison with a reference pediatric population (mean reference score=50). Multivariable linear regression was used to quantify the association between PROMIS scores and age, sex, Narakas type, and composite Mallet score.

Results:

Children with BPBI had normal PROMIS mobility (49.6±8.5), pain interference (44.6±9.7), and peer relationships (52.4±10.6) scores, but reported mild impairment in UE function (40.8±12.1). Age (P<0.0001) and Narakas type (P=0.02) were associated with PROMIS UE function scores, but sex and composite Mallet scores were not. There were no significant associations between the other PROMIS domains and age, sex, Narakas Type, or composite Mallet scores.

Conclusions:

Children with BPBI reported PROMIS scores for mobility, pain interference, and peer relationships similar to the reference population but impairment in UE function. Reported UE function decreased with increasing disease severity and increased with age. These PROMIS domains seem to be useful tools for the clinician to evaluate children with BPBI and better understand the challenges they face. Further study is needed to assess their utility in measuring the effects of treatment interventions.

Level of Evidence:

Level III.
An Analysis of the Application of the Harmony Search Algorithm to Solving the Nurse Rostering Problem
Authors: Lartey Kelvin , Akowuah Emmanuel Kofi
Published: January 2021

The nurse rostering problem describes the task of distributing nurses over working time slots, called shifts, in such a way that the workforce demand for each shift in a scheduling period is met, while ensuring that each nurse is not overttasked or undertasked. This problem is a major issue in Ghana, which this research aims to tackle. To that end, the performance of a heuristic algorithm that showed promise, called the Harmony Search algorithm, is examined. The algorithm, as applied to solving the nurse rostering problem in a hospital in Ghana, was implemented and evaluated with the Python programming language. The results suggest that the algorithm performs well in generating 1-week duty rosters but falters for extended periods, indicating that it may not on its own be potent enough to handle optimization problems. Finally, we outline some recommendations future researchers may want to note.
Deep learning applied to two-dimensional color Doppler flow imaging ultrasound images significantly improves diagnostic performance in the classification of breast masses: a multicenter study
Authors: Yu Teng-Fei , He Wen , Gan Cong-Gui , Zhao Ming-Chang , Zhu Qiang , Zhang Wei , Wang Hui , Luo Yu-Kun , Nie Fang , Yuan Li-Jun , Wang Yong , Guo Yan-Li , Yuan Jian-Jun , Ruan Li-Tao , Wang Yi-Cheng , Zhang Rui-Fang , Zhang Hong-Xia , Ning Bin , Song Hai-Man , Zheng Shuai , Li Yi , Guang Yang
Published: January 2021

Background

The current deep learning diagnosis of breast masses is mainly reflected by the diagnosis of benign and malignant lesions. In China, breast masses are divided into four categories according to the treatment method: inflammatory masses, adenosis, benign tumors, and malignant tumors. These categorizations are important for guiding clinical treatment. In this study, we aimed to develop a convolutional neural network (CNN) for classification of these four breast mass types using ultrasound (US) images.

Methods

Taking breast biopsy or pathological examinations as the reference standard, CNNs were used to establish models for the four-way classification of 3623 breast cancer patients from 13 centers. The patients were randomly divided into training and test groups (n = 1810 vs. n = 1813). Separate models were created for two-dimensional (2D) images only, 2D and color Doppler flow imaging (2D-CDFI), and 2D-CDFI and pulsed wave Doppler (2D-CDFI-PW) images. The performance of these three models was compared using sensitivity, specificity, area under receiver operating characteristic curve (AUC), positive (PPV) and negative predictive values (NPV), positive (LR+) and negative likelihood ratios (LR−), and the performance of the 2D model was further compared between masses of different sizes with above statistical indicators, between images from different hospitals with AUC, and with the performance of 37 radiologists.

Results

The accuracies of the 2D, 2D-CDFI, and 2D-CDFI-PW models on the test set were 87.9%, 89.2%, and 88.7%, respectively. The AUCs for classification of benign tumors, malignant tumors, inflammatory masses, and adenosis were 0.90, 0.91, 0.90, and 0.89, respectively (95% confidence intervals [CIs], 0.87–0.91, 0.89–0.92, 0.87–0.91, and 0.86–0.90). The 2D-CDFI model showed better accuracy (89.2%) on the test set than the 2D (87.9%) and 2D-CDFI-PW (88.7%) models. The 2D model showed accuracy of 81.7% on breast masses ≤1 cm and 82.3% on breast masses >1 cm; there was a significant difference between the two groups (P < 0.001). The accuracy of the CNN classifications for the test set (89.2%) was significantly higher than that of all the radiologists (30%).

Conclusions

The CNN may have high accuracy for classification of US images of breast masses and perform significantly better than human radiologists.

Trial registration

Chictr.org, ChiCTR1900021375; http://www.chictr.org.cn/showproj.aspx?proj=33139.
Frequency of hepatitis B and C in patients attending oral and maxillofacial surgery department for dental extraction at Sandeman Provincial Hospital Quetta
Authors: Khan Changaiz , Khan Shahbaz , Ul Mulk Nizam , Khan Tareen Mirza , Hammad Jahangir , Zaman Kasi Mir
Published: January 2021

Introduction:

The aim of this study is to evaluate the frequency of hepatitis B and C (HBV & HCV) in patients attending oral and maxillofacial surgery unit for dental extraction. These are blood borne viral infections which may transmit due to used dental needles, blood transfusions, used syringes, drug abuse, homosexuality, and prostitution. Dentists are considered as one of the most highly vulnerable professionals at risk. This study also highlights the importance of routine screening for these viral infections before dental surgery.

Objective:

The objective of this study was to evaluate the frequency of HBV and HCV among patients who visited for dental extraction.

Rationale:

To highlight the importance of routine screening before any dental procedure, specially before any oral surgical procedure such as tooth extraction.

Materials and Methods:

This study was conducted in exodontia section of oral and maxillofacial surgery unit, Sandeman Provincial Hospital Quetta. The total study period was 1 year, commencing from November, 2018 to November, 2019. A total of 3431 patients were screened before dental extraction.

Results:

Of 3431 patients, 149 were found to be positive for HBV and HCV collectively. Among them 95 (2.7%) were HBV positive and 54 (1.5%) were diagnosed with HCV.

Conclusion:

This study clearly emphasizes the importance of preoperative routine screening for HBV and HCV before any dental procedure.
Brain functional changes in perimenopausal women: an amplitude of low-frequency fluctuation study
Authors: Liu Ningning , Zhang Yue , Liu Shuang , Zhang Xuening , Liu Huijun
Published: January 2021

Objective:

To evaluate the effects of sex hormones on amplitude of low-frequency fluctuation (ALFF) in brain regions related to cognition in perimenopausal women.

Methods:

This cross-sectional study involved 25 perimenopausal women and 25 premenopausal women who underwent behavioral evaluations, sex hormone level measurements, and functional magnetic resonance imaging (fMRI). All data and ALFF analyses were preprocessed using the Data Processing Assistant for Resting-State fMRI. Statistical analyses were performed using the Resting-State fMRI Data Analysis Toolkit to explore the differences in ALFF between perimenopausal and premenopausal women. The gray matter volume (GMV) values extracted from brain regions (regions of interest) with significantly different ALFF values between the perimenopausal and premenopausal groups were compared. We analyzed the correlations of the ALFF and GMV values of these regions of interest with the results of behavioral evaluations and sex hormone levels in the two groups.

Results:

Compared with the premenopausal group, the perimenopausal group showed significant ALFF increase in the left gyrus rectus. Regions with decreased ALFF in the perimenopausal group included the left superior temporal gyrus, left inferior frontal gyrus, and left insula. The GMV values of the left gyrus rectus and left superior temporal gyrus were reduced in perimenopausal women. Furthermore, the estradiol level was negatively correlated with the ALFF value of the left gyrus rectus in perimenopausal women.

Conclusions:

The ALFF and GMV values of certain brain regions related to cognitive function were changed in perimenopausal women. Such functional brain alterations may provide more information regarding the mechanism of cognitive dysfunction in perimenopausal women.
Associations between sleep duration, midday napping, depression, and falls among postmenopausal women in China: a population-based nationwide study
Authors: Zhou Zonglei , Yu Yu , Zhou Ruzhen , Luan Rongsheng , Li Kunpeng
Published: January 2021

Objective:

To explore the independent and joint associations of sleep duration, midday napping, and depression with fall accidents in Chinese postmenopausal women.

Methods:

A total of 2,378 postmenopausal women aged ≥ 45 years from the baseline survey of the China Health and Retirement Longitudinal Study were enrolled in the study. Each participant provided data on falls, sleep duration, midday napping by a self-reporting approach. We employed the Chinese version of the Center for Epidemiologic Studies Depression Scale to assess depression. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were calculated to estimate the associations of predictor variables with falls using multivariate logistic regression.

Results:

Of the 2,378 postmenopausal women, 478 (20.10%) reported falls in the preceding 2 years. Compared with sleep duration of 7 to 8 h/night, sleep duration of 5 to 6 h/night (OR, 1.49; 95% CI, 1.03-2.15) and of ≤ 5 h/night (OR, 1.63; 95% CI, 1.18-2.25) were associated with a higher fall prevalence. However, no significant correlation was found between sleep duration of > 8 h/night and falls. Furthermore, participants with depression were more likely to report falls (OR, 1.78; 95% CI, 1.41-2.25) than their depression-free counterparts. The duration of midday napping was not independently associated with falls, but significant joint associations of sleeping ≤ 6 h/night and no napping (OR, 1.72; 95% CI, 1.07-2.76) or napping > 60 minutes (OR, 2.14; 95% CI, 1.18-3.89) with more falls were found. Similarly, a combined status of sleeping ≤ 6 h/night and depression was related to more falls (OR, 2.97; 95% CI, 1.86-4.74).

Conclusion:

The present study demonstrates that short sleep duration and depression are independently associated with more falls among postmenopausal women in China. Moreover, short sleep duration combined with no or long napping, short sleep duration combined with depression are jointly correlated with more falls. Future longitudinal studies are warranted to confirm these findings.
Sodium--glucose co-transporter-2 inhibitors for patients with diabetic and nondiabetic chronic kidney disease: a new era has already begun
Authors: Sarafidis Pantelis , Ortiz Alberto , Ferro Charles J. , Halimi Jean-Michel , Kreutz Reinhold , Mallamaci Francesca , Mancia Giuseppe , Wanner Christoph
Published: January 2021

Chronic kidney disease (CKD) is a major issue of public health. Hypertension control and use of renin--angiotensin system (RAS) blockers are the cornerstones of treatment for CKD of any cause. However, even under optimal RAS blockade, many individuals will progress towards more advanced CKD. Within the past few years, evidence from cardiovascular outcome trials with sodium--glucose co-transporter-2 (SGLT-2) inhibitors clearly suggested that these agents substantially delay CKD progression in patients with diabetes mellitus on top of standard-of-care treatment. The Canagliflozin-and-Renal-Events-in-Diabetes-with-Established-Nephropathy-Clinical-Evaluation (CREDENCE) study, showed that canagliflozin substantially reduced the risk of doubling of SCr, end-stage kidney disease (ESKD), or death from renal or cardiovascular causes in 4401 patients with diabetic CKD compared with placebo (hazard ratio 0.70; 95% CI 0.59–0.82). Recently, the Study-to-Evaluate-the-Effect-of-Dapagliflozin-on-Renal-Outcomes-and-Cardiovascular-Mortality-in-Patients-With-Chronic-Kidney-Disease (DAPA-CKD), including 2510 patients with diabetic and 1803 with nondiabetic CKD, also showed an impressive reduction in the risk of ≥50% decline in eGFR, ESKD, or death from renal or cardiovascular causes (HR 0.61; 95% CI 0.51–0.72). The benefit was similar for patients with diabetic and nondiabetic CKD, including patients with glomerulonephritides. Following this conclusive evidence, relevant guidelines should accommodate their recommendations to implement treatment with SGLT-2 inhibitors for patients with diabetic and nondiabetic CKD.