bluuebunny/crossref_metadata_2025 huggingface dataset:
Left Ventricular Thrombus Formation in a Structurally and Functionally Normal Heart: A Case Report and Literature Review
Authors: Manasrah Nouraldeen , Abdel-Qader Anas , Al Sbihi Ali , Alqasem Sarah , Saif Lama Tareq , Chaudhary Ahmed J. , Ismail Rana , Rajagopal Ramegowda
Published: May 2022

Left ventricular (LV) thrombosis usually occurs as a complication of acute anterior myocardial infarction (MI) and dilated cardiomyopathy. It also occurs in patients with a hypercoagulable state. However, in the setting of normal systolic function, LV thrombi are extremely rare. We present a case of a healthy woman who had LV thrombus despite normal LV systolic function that presented as an acute aortoiliac embolism.
Paper 02: A Modified Lemaire Lateral Extra-Articular Tenodesis in High Risk Adolescents Undergoing Anterior Cruciate Ligament Reconstruction: Two-Year Clinical Outcomes
Authors: Cordasco Frank , Perea Sofia Hidalgo , Brusalis Christopher , Green Daniel
Published: May 2022

Objectives:

This study aimed to evaluate the safety and efficacy of performing a lateral extra-articular tenodesis (LET) with a modified Lemaire technique (MLT) in conjunction with anterior cruciate ligament reconstruction (ACLR) in children and adolescents at increased risk for failed ACLR.

Methods:

A consecutive series of patients ≤19 years who underwent simultaneous ACLR and LET with minimum two-year follow-up data were reviewed. Patients were indicated for LET when one or more of the following risk factors were present: participant in high-risk competitive sport such as football, lacrosse, soccer or basketball, grade 3 pivot shift, hyperlaxity (Beighton score > 6), recurvatum, revision ACLR, contralateral ACLR, or chronic ACL insufficiency. ACLR was performed using either full-thickness quadriceps tendon (QUAD) for skeletally immature patients or bone-patellar tendon-bone (BTB) autograft for skeletally mature patients. All-epiphyseal (AE) or complete transphyseal (CT)techniques were used depending on patients’ skeletal maturity. At a minimum two-year follow-up, patient-reported outcome measures included Single Assessment Numeric Evaluation (SANE), Pediatric International Knee Documentation Committee (Pedi-IKDC), and the HSS Functional Activity Brief Scale (HSS Pedi-FABS) scores. Return-to-sport (RTS)data and second surgeries were also obtained.

Results:

Sixty-one consecutive patients (mean age 15.17 ±1.73 years, range 11-19 years, 62% female) were analyzed (Table 1). 59 patients (97%) participated in organized sports including soccer, basketball, football and lacrosse, with soccer being the most popular one. The average grade at the time of surgery was 9th grade. Ten patients (16%) were revision ACLR procedures. Seven (11%) patients underwent AE and 54 (89%) underwent CT ACLR. Forty-two (69%) cases employed a QUAD autograft, while 19 (31%) utilized a BTB autograft. All patients underwent a LET with a MLT and 2 patients underwent simultaneous implant mediated guided growth with a plate for structural genu valgum. At two-year follow-up, mean SANE score was 95, median Pedi-IKDC score was 91, and median HSS-Pedi Fabs score was 27. RTS rate was 91.8%. Ten patients had subsequent surgical procedures, including two hardware removal procedures for hemiepiphysiodesis, three contralateral ACLR, three meniscus surgeries, one lysis of adhesions, and one revision ACLR for BTB graft re-rupture. Two patients were lost to follow-up and excluded from the study.

Conclusions:

The findings suggest that concomitant LET and ACLR in adolescent patients with risk factors for failed ACLR is associated with favorable patient-reported outcomes, high return to sports participation, and low ACL re-rupture rate at two years follow-up. [Table: see text]
Paper 05: Glenoid Labral Tears are associated with Increased Neurofilament Innervation
Authors: Beretov Julia , Marvi Salman , Lam Patrick , Murrell George , Murphy Geoffrey
Published: May 2022

Objectives:

Pain is a common presentation following glenohumeral labral injuries. However, the source of that pain is undetermined. We aimed to determine if there is a differential expression of nerve fibres around the glenoid labrum and if torn labra have increased neuronal expression compared to untorn labra.

Methods:

Labral tissue was collected at 3, 5, 9 and 12 o clock during total shoulder arthroplasty (n = 7). Samples were also collected at 3, 5 and 12 o clock during rotator cuff repair (n = 16), anterior labral repair (n = 6), type II superior labral anterior to posterior (SLAP) repair (n = 4) and capsular release for idiopathic capsulitis (n = 5). Sections were immunostained with antibodies to neurofilament, a specific neuronal marker which is used to identify central and peripheral nerve fibres, and the concentration and intensity of immunostained-positive cells assessed.

Results:

The concentration of neurofilament staining was similar in the superior, anterior, posterior and inferior glenoid labrum in untorn labra (8 neurofilament expressing cells/mm2, p > 0.05). Torn labra exhibited a 3-4-fold increase in neuronal expression which was isolated to the location of the tear in SLAP (p = 0.09) and anterior labral tears (p = 0.02). The concentration of neurofilament expressing cells in torn glenoid labrum samples were comparable to the glenoid labrum of adhesive capsulitis samples (p > 0.05). Figure 3. Mean (SD) neurofilament expressing cells per mm2 at 12 o’clock (A), 3 o’clock (B) and 5 o’clock (C) using labral tissue from patients with either a; RCT (n = 16), anterior labral tear (n = 6), SLAP tear (n = 4) or a frozen shoulder (n = 5). *p <0.05 compared using a one-way ANOVA with post-hoc analysis.

Conclusions:

This study supports the hypothesis that following a traumatic tear of the anterior or superior labrum, the labrum in that region becomes populated with new nerves fibres and that these fibres are likely to be responsible for many of the symptoms noted by patients with superior (SLAP) and/or anterior labral (Bankart) tears.
Paper 07: Predictors of Return to Sport in High-Level Athletes Following Hip Arthroscopy for Femoroacetabular Impingement
Authors: Monahan Peter , Jimenez Andrew , Owens Jade , Maldonado David , Saks Benjamin , Sabetian Payam , Ankem Hari , Lall Ajay , Domb Benjamin
Published: May 2022

Objectives:

The purpose of this study is to identify clinical and radiographic factors that predict return to sport in high-level athletes and to determine thresholds for significant predictors.

Methods:

Data were reviewed on all patients who underwent primary hip arthroscopy between November 2008 and August 2018. Patients were included if they played professional, college, or high school sports within 1 year before surgery and had preoperative, 3-month, 1-year, and 2-year postoperative patient reported outcome (PRO) scores for modified Harris Hip Score (mHHS), Hip Outcome Score-Sport Specific-Subscale (HOS-SSS), and Non-Arthritic Hip Score (NAHS). Patients were divided into groups based on whether they returned to sport (RTS). Multivariate logistic regression and receiver operator characteristic (ROC) analysis were used to evaluate the correlation between significant variables and RTS.

Results:

A total of 136 patients with a mean age of 20.8 ± 7.07 years were included. Competition level, postoperative alpha angle, change in alpha angle, and postoperative PROs were significantly different between groups. The multivariate logistic regression model identified postoperative alpha angle as a statistically significant predictor of return to sport [P < .001, S > 9.97 (OR 0.85, CI 0.79-0.91)]. The ROC curve for postoperative alpha angle demonstrated acceptable discrimination between patients returning to sport and patients not returning to sport with an area under the curve of 0.71 and a threshold value of 46˚. Athletes with a postoperative alpha angle ≤ 46˚ returned to sport at a rate of 71.2%, while those with a postoperative alpha angle > 46˚ returned to sport at a rate of 28.1% [(P < .001, S > 9.97 (OR 6.3, CI 2.6-15.2)]

Conclusions:

Postoperative alpha angle was identified as a predictor of return to sport in high-level athletes. The odds of returning to sport were 6.3 times greater in athletes with postoperative alpha angles ≤ 46˚ compared to athletes with angles > 46˚.
Paper 12: Biomechanical Comparison of Anatomic Restoration of the Ulnar Footprint Versus Traditional Ulnar Tunnels in Ulnar Collateral Ligament Reconstruction
Authors: Chang Edward , Looney Austin , Roach William , Clark DesRaj , Nagda Sameer , Colantonio Anthony Le Donald
Published: May 2022

Objectives:

Current techniques for ulnar collateral ligament (UCL) do not reproduce the anatomic ulnar footprint of the UCL. The purpose of this study was to describe a novel UCL reconstruction technique that utilizes proximal-to-distal ulnar bone tunnels to better recreate the anatomy of the UCL and compare the biomechanical profile at time zero between this technique, the native UCL, and the traditional docking technique. Our hypothesis was that the biomechanical profile of the anatomic technique is similar to the native UCL and traditional docking technique.

Methods:

Ten matched cadaveric elbows were potted with the forearm in neutral rotation. The palmaris longus tendon graft was harvested, and bones were sectioned 14 cm proximal and distal to the elbow joint. Specimen testing included: (1) native UCL testing performed at 90° flexion with 0.5 Nm valgus moment preload, (2) cyclic loading from 0.5-to-5 Nm valgus moment for 1000 cycles at 1 Hz, and (3) load to failure at 0.2 mm/s. Elbows then underwent UCL reconstruction with one elbow of each pair receiving the classic docking technique using either anatomic (proximal-to-distal) or traditional (anterior-to-posterior) tunnel locations. Specimen testing was then repeated, as described above.

Results:

There was no difference between maximum load at failure or valgus angle between the anatomic or traditional tunnel location techniques (34.90 ± 10.65 Nm vs. 37.28 ± 14.26 Nm, P = 0.644) or the native UCL (45.83 ± 17.03 Nm, P = 0.099). Additionally, there was no difference in valgus angle after 1000 cycles across the anatomic (4.58 ± 1.47°), traditional (4.08 ± 1.28°), or native UCL (4.07 ± 1.99°). Anatomic group and the native UCL had similar valgus angles at failure (24.13 ± 5.86° vs. 20.13 ± 5.70°, P = 0.083), while the traditional group had a higher valgus angle at failure compared to the native UCL (24.88 ± 6.18° vs. 19.44 ± 5.86°, P = 0.015).

Conclusions:

UCL reconstruction with the docking technique utilizing proximal-to-distal ulnar tunnels to restore the anatomic ulnar footprint better recreates the anatomy of the UCL while providing valgus stability comparable to reconstruction with docking technique using traditional anterior-to-posterior ulnar tunnel locations. These results suggest that utilization of the anatomic tunnel location in UCL reconstruction has similar biomechanical properties compared to the traditional method at the time of initial fixation (i.e., not accounting for healing following reconstruction in vivo) while keeping the ulnar tunnels further from the ulnar nerve. Further studies are warranted to determine if an anatomically based UCL reconstruction results in differing outcomes compared to traditional reconstruction techniques.
PAPER 14: Excision of Hook of Hamate Fractures in Elite Baseball Players: Surgical Technique and Return to Play
Authors: Leibman Matthew , Engler Ian
Published: May 2022

Objectives:

Hook of hamate fractures are relatively common in baseball players, but diagnosis and surgical technique can be challenging. Outcomes following surgical excision, as well as optimal surgical technique, in elite baseball players have not been clearly established. Our hypothesis was that excision of hook of hamate fractures in elite professional and collegiate baseball players with a tailored technique would lead to high rates of return to play within a short time.

Methods:

eview of a single academic hand surgery practice from 2006-2020 found 42 elite athletes competing at professional (20) or varsity collegiate (22) baseball levels who underwent surgical excision of 42 hook of hamate fractures with a standardized technique. The clinical history, timing of surgery, complications, and time to return to play were recorded for each patient.

Results:

All patients underwent an excision of their hook of hamate fracture at an average of 7.2 weeks (range 0.5 – 52 weeks) from the onset of symptoms. All patients but one were able to return to full pre-injury level of baseball participation within 6 weeks from the date of surgery, with a mean return to sport of 5.4 weeks (range 3-8 weeks). Two patients returned to the operating room – one for scar tissue formation causing ulnar nerve compression and one for residual bone fragment causing pain and ulnar nerve compression.

Conclusions:

Surgical excision of hook of hamate fractures in elite baseball players showed a very high rate of return to play within six weeks. Meticulous adherence to the described surgical technique tailored to athletes optimizes clinical outcomes and avoids complications.
Paper 15: Return to Play after Biceps Tenodesis for Isolated SLAP Tears in Overhead Athletes
Authors: Lorentz Nathan , Colasanti Christopher , Markus Danielle , Alaia Michael , Campbell Kirk , Strauss Eric , Jazrawi Laith , Hurley Eoghan
Published: May 2022

Objectives:

The purpose of the current study was to investigate clinical outcomes in overhead athletes undergoing biceps tenodesis for the treatment of symptomatic, isolated SLAP tears involving the biceps-labral complex.

Methods:

A retrospective review of overhead athletes who underwent biceps tenodesis for a SLAP tear was performed. The American Shoulder & Elbow Surgeons (ASES) score, Visual Analogue Scale (VAS), Subjective Shoulder Value (SSV), patient satisfaction, willingness to undergo surgery again, revisions, and return to play (RTP) were evaluated. Psychological readiness to return to sport was evaluated using the SLAP-Return to Sport after Injury (SLAP-RSI) score. A p value of <0.05 was considered to be statistically significant.

Results:

The current study included 44 overhead athletes. The mean age was 34.9 (16-46), 79.5% were males, and the mean follow-up was 49 months (18-107). Overall, we found that 81.8% of patients returned to play their overhead sport following biceps tenodesis, and 59.1% of patients returned to the same or higher level of play. It took patients on average 8.7 months to return to play following biceps tenodesis. The mean SLAP-RSI score was 69.3, and 70.5 % of patients passed the SLAP-RSI threshold of 56. The mean scores for ASES, VAS, SSV, and satisfaction were 92, 0.8, 80.5, and 87.9%, respectively. No patients in our cohort required a revision surgery.

Conclusions:

This study found that athletes undergoing biceps tenodesis as the treatment for a symptomatic, isolated SLAP tear had a high rate of return to play, good functional outcomes, and a low rate of revision surgery.
Paper 21: Blood Flow Restriction Therapy Improves Early Patient Reported Outcomes Following ACL Reconstruction
Authors: Khalil Lafi , Jildeh Toufic , Abbas Muhammad , Buckley Patrick , Moutzouros Vasilios , Okoroha Kelechi , Tramer Joseph
Published: May 2022

Objectives:

To evaluate the affect of blood flow restriction (BFR) therapy conducted both before and after anterior cruciate ligament (ACL) reconstruction on early quadriceps strength and patient reported outcomes.

Methods:

A total of 43 patients (24 male, 19 female; age 27.6 ± 11.88 years) presenting with an ACL tear were randomized into two groups, BFR (N=22) and Control (N=21) at their initial clinic visit (ICV). Quadriceps strength was measured utilizing a handheld dynamometer in order to calculate peak force, average force and time to peak force during seated leg extension at the ICV. All patients were provided education on preoperative exercises to be performed 4-5 days per week for two weeks between the ICV and date of surgery. The BFR group was instructed to perform these exercises with a pneumatic cuff set to 80% of limb occlusion pressure placed over the proximal thigh. Following surgery, patients underwent physical therapy utilizing standard post-ACL reconstruction therapy protocols, with exercises performed with and without the use of BFR in each respective group. Patient Reported Outcome Measurement System Physical Function (PROMIS-PF), International Knee Documentation Committee (IKDC) scores, knee range of motion and quadriceps circumference were gathered at the ICV, the day of surgery, 2 weeks and 6 weeks after surgery. Quadriceps strength measurements were repeated the day of surgery and six weeks following ACL reconstruction.

Results:

No significant differences were noted between the BFR and control groups in peak quadriceps force generation (Figure 1), time to peak force or average force at any timepoints (P>0.05). At six weeks post-surgery, the BFR group had significantly higher PROMIS-PF (43.16 ± 5.29 versus 38.39 ± 5.39, p=0.02) and IKDC (58.22 ± 7.64 versus 47.05 ± 13.50, p=0.01, Figure 2) scores compared to the control group.

Conclusions:

Blood flow restriction therapy before and after ACL reconstruction results in improved patient reported outcomes scores without objective improvements in strength at six week follow up. Long term follow up is needed to determine if differences arise in quadriceps strength between groups. [Figure: see text][Figure: see text]
Paper 22: Increased Lower Extremity Injury Associated with Player Load and Distance in Collegiate Women’s Soccer
Authors: Nguyen Jessica , Hwang Calvin , Abrams Geoffrey , Xiao Michelle
Published: May 2022

Objectives:

High cumulative workloads and spikes in player workloads have been associated with an increased risk of injury in soccer and other sports. These studies, however, have all been conducted with data from male soccer players or male athletes in other sports, with few studies investigating female athletes. Using metrics collected from GPS units to monitor cumulative load and distance may be valuable for injury prevention. The purpose of this study was to examine the relationship between injury risk and workload as collected from wearable GPS units in NCAA Division I women’s soccer players.

Methods:

Lower extremity injury incidence and GPS workload data (player load, total distance, and high-speed distance) of 65 NCAA Division I women’s soccer players were collected over 3 seasons. Accumulated 1-, 2-, 3- and 4-weekly loads and acute: chronic workload ratios (ACWR) were classified into discrete ranges by z-scores. ACWR was calculated using rolling averages and exponentially weighted moving averages (EWMA) models. Binary logistic regression models were used to compare the 7:28 rolling average and EWMA ACWRs between injured and non-injured players for all GPS/accelerometer variables. The prior 1-, 2-, 3-, and 4-weekly accumulated loads for all GPS/accelerometer variables were compared between the injured and uninjured cohorts using two-sample t-tests with an alpha level of 0.05 set as significant.

Results:

There were a total of 53 lower extremity injuries that resulted in lost time recorded (5.76/1000 hours ‘on-field’ exposure time; 34 non-contact and 19 contact injuries). The prior 2-week (7,242 vs 6,613; p=0.02), 3-week (10,533 vs 9,718; p=0.02), and 4-week (13,819 vs 12,892; p=0.04) accumulated player loads and 2-week (62.40 vs 57.25 km; p=0.04), 3-week (90.97 vs 84.10 km; p=0.03), and 4-week (119.31 vs 111.38 km; p=0.05) accumulated total distances were significantly higher for injured players compared to non-injured players during the same timeframes. There were no significant differences in player load, total distance, or high-speed distance ACWR between injured and non-injured players for both the rolling averages and EWMA calculations.

Conclusions:

Higher accumulated player load and total distance, but not ACWR, are associated with injury in women’s soccer players.
Paper 25: The Effect of Osteochondroplasty on Time to Reoperation after Arthroscopic Management of Femoroacetabular impingement
Authors: Simunovic Nicole ,   FIRST Investigators, Kay Jeffrey , Ayeni Olufemi
Published: May 2022

Objectives:

The purpose of this study was to assess and compare the effect of 1) arthroscopic osteochondroplasty with or without labral repair versus 2) arthroscopic lavage with or without labral repair on the time to reoperation in adults aged 18 to 50 with femoroacetabular impingement (FAI) over the 27-months post-operative using a time-to-event analysis.

Methods:

Using the comprehensive dataset from the multinational Femoroacetabular Impingement Randomized Controlled Trial (FIRST), all reoperations were identified until 27-months post-operative. Subjects were randomized to a treatment of arthroscopic osteochondroplasty or arthroscopic lavage with or without labral repair. The analysis was conducted using a Cox proportional-hazards model, with the percentage of patients with a reoperation analyzed in a time-to-event analysis as the outcome. The independent variable was the procedure, with age and impingement subtype explored as potential covariates. The effects from the Cox model were expressed as the hazard ratio (HR), corresponding 95% confidence interval (CI) and the associated p-value. All tests were two-sided with an alpha level of 0.05.

Results:

A total of 108 patients in the osteochondroplasty group and 106 in the lavage group were included. The mean age of the patients included in the study was 36.0 (SD=8.5) years. Overall, a total of 27 incident reoperations were identified within 27 months of follow-up for an incidence rate of 6.0 per 100 person years. Within the osteochondroplasty group a total of 8 incident reoperations were identified for incidence rate of 3.4 per 100 person years while within the lavage group, a total of 19 incident reoperations were identified for an incidence rate of 8.7 per 100 person years. The hazard of reoperation for patients undergoing osteochondroplasty is 40% that of patients undergoing lavage (HR=0.40,95% CI=0.17-0.91,p=0.029).

Conclusions:

This, time-to-event analysis with 27-months follow-up demonstrates that for adults between the ages of 18 and 50 with FAI, arthroscopic osteochondroplasty is associated with a 2.5-fold decrease in the hazard of reoperation at any point in time compared to arthroscopic lavage.
Social Class and Emotional Well-Being: Lessons From a Daily Diary Study of Families Engaged in Virtual Elementary School During COVID-19
Authors: Cohen Shana R. , Wishard Guerra Alison , Molgaard Monica R. , Miguel Jessica
Published: May 2022

To understand how parents adapted to virtual learning expectations during the initial COVID-19 school closures in spring 2020, this study investigated families’ daily activities, including parents’ emotions and their appraisals of the value of daily activities across two timepoints. Thirty-two parent–child dyads (Mean child age = 78 months, 50% male; 47% Latinx/Hispanic; 28% Spanish speaking) from a Southern California school district serving a diverse population completed a daily diary texting protocol (experience sampling method; ESM) five times per day over five days. Families spent most of their time together engaging in mealtime activities (preparing meals and eating). Families from low socioeconomic backgrounds reported appraising academic activities, social skills, and life skills more highly than families from high socioeconomic backgrounds. Parents reported more positive emotions than negative emotions. Findings provide opportunities for educators to mitigate learning loss by building on children’s learning experiences and family adaptations to daily routines during COVID-19.
Impact on functional outcome of an adaptive Stroke Unit based system of care for patients undergoing endovascular treatment during pandemic times
Authors: Equiza Jon , de la Riva Patricia , Angel Larrea José , Marta-Enguita Juan , Albájar Inés , Lüttich Alex , Garmendia Eñaut , Alonso Maitane , de Arce Ana , Díez Noemí , Gonzalez Félix , Iruzubieta Pablo , Sulibarria Naroa , Puig Josep , Martínez-Zabaleta Maite
Published: May 2022

Introduction:

The COVID19 pandemic collapsed intensive care units (ICUs) all around the world, conditioning systems of care (SOC) for other critical conditions such as severe ischemic stroke requiring endovascular treatment (EVT). Our aim was to evaluate the impact of an adaptive Stroke Unit (SU) based SOC on functional outcomes, with the goal of avoiding both general anesthesia (GA) and ICU admission in stroke patients treated with EVT.

Material and methods:

We performed an observational study comparing data from our traditional ICU-GA based SOC and the adaptive SU-Conscious Sedation (CS) based SOC (consecutive patients undergoing EVT 1 year prior and after onset of the pandemic). Primary outcome was 90-days modified Rankin Scale (mRS), and secondary outcomes included, among others, in-hospital complications, and hospital length of stay (LOS).

Results:

A total of 210 EVT were performed during the study period (107 under the traditional-SOC and 103 under the adaptive-SOC). A significantly greater proportion of patient was treated under CS (15.9% vs 57.3%; p < 0.001) and admitted for post-procedural care at SU (15% vs 66%; p < 0.001) in the adaptive SOC. Rates of in-hospital complications were similar in both periods, with reduced hospital LOS in the adaptive SOC (10 (7–15) vs 8 (6–12); p = 0.005). The adaptive SOC was associated with higher odds for 90 days favorable outcome (mRS 0–2) (aOR 3.15 (1.34–7.39); p = 0.008).

Conclusion:

In our case, an adaptive SOC that combined both preference for CS and postprocedural care in SU was associated with better functional outcomes and reduced healthcare resource use for patients undergoing EVT.
The Impact of Contingencies on Entrepreneurship Education Outcomes
Authors: Vuorio Anna , Zichella Giulio , Sawyerr Olukemi
Published: May 2022

The results of Entrepreneurship Education (EE) impact research have been equivocal, and one suggested explanation is the influence of contingencies such as the types of learning experiences, gender, and field of study. In this paper we aim to answer the question of which contingencies shape the outcome of EE by examining the outcome variables of entrepreneurial intentions (EI) and creative self-efficacy (CSE). Utilizing a quasi-experimental pre-post survey design, we surveyed 209 students from three universities who were exposed to three different learning experiences: writing a business plan, achieving proof-of-concept, and achieving proof-of-business. Through multi-value qualitative comparative analysis, we found six unique combinations associated with high levels of EI and CSE, respectively, after a learning experience. High EI and CSE are both associated with developing proof-of-concept and proof-of-business, but not with writing a business plan. Also, students’ fields of study play a role in high levels of EI regardless of the learning experience, while students’ prior work experience seems to play a role in EI and CSE.
Confronting Power Asymmetries in Partnerships to Address Grand Challenges
Authors: Gray Barbara , Purdy Jill , Ansari Shahzad
Published: May 2022

Much of the literature on multistakeholder partnerships that addresses grand challenges has extolled the virtues of such partnerships as a means of reducing uncertainty, acquiring resources, and solving local and global wicked problems. These virtues include opening up “access and agendas to wider participation” (Gray, 1989, p. 120), coordinating across jurisdictional boundaries, mobilizing diverse and heterogeneous actors, and generating novel solutions to address these complex problems. Yet partnerships are not panaceas, and the reasons they fall short of their stated aspirations remain underexplored. We argue that attention to the political landscape, and particularly who has power and who does not, can account for the shortfalls of many partnerships. Theory and practice can improve by considering power dynamics in the institutional field that shapes the context in which partnerships unfold and influences the problems partnerships are designed to affect. We consider four field conditions that differ with respect to the degree of power and alignment of goals among actors in the field. We discuss four trajectories of change originating from each of these field conditions that describe shifts in field-level power or alignment of goals: collaboration, contention, consciousness raising, and compliance. We explore the dynamics associated with each trajectory to show how fields may shift toward or away from conditions conducive to building and sustaining collaborative partnerships around grand challenges.
The odyssey of pacritinib in myelofibrosis
Authors: Venugopal Sangeetha , Mascarenhas John
Published: May 2022

Myelofibrosis (MF) can present with symptomatic splenomegaly and/or cytopenias including thrombocytopenia. Disease-related thrombocytopenia is a poor prognostic factor with a median overall survival of less than 2 years. Currently approved JAK1/2 inhibitors have not been evaluated in patients with platelets ≤ 50 × 109/L and in fact could potentiate thrombocytopenia because of their combined JAK1/2 inhibitory activity. Pacritinib (PAC), a selective JAK2, fms-like tyrosine kinase 3, interleukin-1 receptor-associated kinase 1 multikinase inhibitor was developed to meet this unmet need. PAC was evaluated in 2 randomized phase 3 trials in the frontline setting (PERSIST-1, PAC 400 mg daily vs best available therapy) and second-line setting in patients with MF with platelets ≤ 100 × 109/L (PERSIST-2, PAC 400 mg daily or 200 mg twice daily vs best available therapy). PERSIST-1 met its primary end point; however, the development of PAC hit a brief pause because of a US Food and Drug Administration–mandated clinical hold for excess of bleeding and cardiac events in the PAC 400 mg daily arm in the PERSIST-1 study. Although the PERSIST-2 study was terminated abruptly because of this clinical hold, it met its splenic response end point and demonstrated a trend toward symptom improvement. Subsequent, diligent review of the PERSIST-1 and PERSIST-2 studies did not confirm an excess of severe bleeding or cardiac events on the PAC arm. Additionally, the dose finding PAC203 study endorsed the safety and efficacy of 200 mg twice daily, leading to the approval of PAC for the treatment of patients with MF with platelets ≤ 50 × 109/L.
Comparative genomics highlight the importance of lineage-specific gene families in evolutionary divergence of the coral genus, Montipora
Authors: Yoshioka Yuki , Suzuki Go , Zayasu Yuna , Yamashita Hiroshi , Shinzato Chuya
Published: May 2022

Background

Scleractinian corals of the genus Montipora (Anthozoa, Cnidaria) possess some unusual biological traits, such as vertical transmission of algal symbionts; however, the genetic bases for those traits remain unknown. We performed extensive comparative genomic analyses among members of the family Acroporidae (Montipora, Acropora, and Astreopora) to explore genomic novelties that might explain unique biological traits of Montipora using improved genome assemblies and gene predictions for M. cactus, M. efflorescens and Astreopora myriophthalma.

Results

We obtained genomic data for the three species of comparable high quality to other published coral genomes. Comparative genomic analyses revealed that the gene families restricted to Montipora are significantly more numerous than those of Acropora and Astreopora, but their functions are largely unknown. The number of gene families specifically expanded in Montipora was much lower than the number specifically expanded in Acropora. In addition, we found that evolutionary rates of the Montipora-specific gene families were significantly higher than other gene families shared with Acropora and/or Astreopora. Of 40 gene families under positive selection (Ka/Ks ratio > 1) in Montipora, 30 were specifically detected in Montipora-specific gene families. Comparative transcriptomic analysis of early life stages of Montipora, which possesses maternally inherited symbionts, and Acropora, which lacks them, revealed that most gene families continuously expressed in Montipora, but not expressed in Acropora do not have orthologs in Acropora. Among the 30 Montipora-specific gene families under positive selection, 27 are expressed in early life stages.

Conclusions

Lineage-specific gene families were important to establish the genus Montipora, particularly genes expressed throughout early life stages, which under positive selection, gave rise to biological traits unique to Montipora. Our findings highlight evolutionarily acquired genomic bases that may support symbiosis in these stony corals and provide novel insights into mechanisms of coral-algal symbiosis, the physiological foundation of coral reefs.
Increased serum IL-2, IL-4, IL-5 and IL-12p70 levels in AChR subtype generalized myasthenia gravis
Authors: Huan Xiao , Zhao Rui , Song Jie , Zhong Huahua , Su Manqiqige , Yan Chong , Wang Ying , Chen Sheng , Zhou Zhirui , Lu Jiahong , Xi Jianying , Luo Sushan , Zhao Chongbo
Published: May 2022

Background

Myasthenia gravis (MG) is an autoimmune disorder affecting neuromuscular junctions. Cytokines play important roles in facilitating the immune response and augmenting the pathogenic antibody production. The current study aims to sensitively characterize the serum levels of cytokines with very low concentration in generalized MG (gMG).

Methods

Using ultrasensitive single-molecule arrays (SIMOA), we measured serum IL-2, IL-4, IL-5 and IL-12p70 in 228 participants including 152 immunotherapy-naïve anti-acetylcholine receptor (AChR) subtype gMG from Huashan MG registry and 76 age-matched healthy controls. Subgroup analysis was then performed by stratifying patients according to the onset ages, MGFA classification, disease duration at baseline.

Results

Serum IL-2, IL-4, IL-5 and IL-12p70 levels were significantly elevated in gMG compared to controls (0.179 pg/mL versus 0.011 pg/mL,P < 0.0001; 0.029 pg/mL versus 0.018 pg/mL,P = 0.0259; 0.215 pg/mL versus 0.143 pg/mL,P = 0.0007; 0.132 pg/mL versus 0.118 pg/mL,P = 0.0401). Subgroup analysis revealed that IL-2 levels were slightly elevated in gMG with MGFA II compared to MGFA III/IV (0.195 pg/mL versus 0.160 pg/mL,P = 0.022), as well as elevated levels of IL-2 (0.220 pg/mL versus 0.159 pg/mL,P = 0.0002) and IL-5 (0.251 pg/mL versus 0.181 pg/mL,P = 0.004) in late-onset gMG compared with the early-onset gMG. gMG patients with a long duration had a significant increased serum IL-12p70 than those with a short duration (0.163 pg/mL versus 0.120 pg/mL,P = 0.011).

Conclusion

Serum IL-2, IL-4, IL-5 and IL-12p70 levels were increased in AChR subtype gMG using ultrasensitive measurement. Serum cytokines with very low concentrations may provide as potential biomarkers in stratifying gMG patients in future prospective cohort studies.
Predictors for successful weight reduction during treatment with Dapagliflozin among patients with type 2 diabetes mellitus in primary care
Authors: Huh Youn , Kim Young Sik
Published: May 2022

Aims

Studies on factors affecting weight loss effect after start of dapagliflozin in type 2 diabetes mellitus (T2DM) patients are few. The aim of this study was to identify if there were any patient characteristics that could predict weight loss after starting treatment with dapagliflozin.

Methods

The study included 200 Korean patients with T2DM who were prescribed dapagliflozin in a family medicine clinic during 2014–2019. We studied patients for 1 year after starting dapagliflozin treatment. Data were collected from medical records. Clinically meaningful weight reduction was defined as ≥3% decrease in body weight and odds ratios (ORs) and 95% confidence intervals (CIs) for succeeding this weight reduction was calculated for different baseline characteristics.

Results

In total, 113 (56.5%) patients were male. Weight loss of ≥3% in 1 year treatment with dapagliflozin was achieved in 122 (61%) patients. The likelihood of this level of weight loss was significantly increased with regular exercise (OR 2.13, 95% CI 1.07–4.25), with concomitant metformin treatment (OR 2.90, 95% CI 1.23–6.80), and in patients with normal renal function (OR 13.84, 95% CI 1.33–144.26). Patients receiving sulfonylurea treatment were less likely to achieve ≥3% weight reduction (OR 0.39, 95 CI 0.19–0.79).

Conclusions

T2DM patients that performed regular exercise, had normal renal function and were receiving metformin were more likely to have clinically meaningful body weight reduction after one year treatment with dapagliflozin.
Population-specific cut-off points of fatty liver index: a study based on the National Health and Nutrition Examination Survey data
Authors: Wu Juan , Tian Shen , Li Hao , Xu Zhou , Li Shu , Chen Yu-ling , Liang Xin-yu , Xiao Jun , Song Jing-yu , She Rui-ling , Ma Chen-yu , Feng Jun-han , Li Zhao-xing , Jiang Zhi-yu , Zhang Zi-wei , Wu Kai-nan , Kong Ling-quan
Published: May 2022

Background

Fatty liver index (FLI) is the most recognized blood biomarker for diagnosis of hepatic steatosis (HS), but lacks the reliable specific cut-off points (COPs). Therefore, we aim to investigate the population-specific COPs of FLI based on the results of liver ultrasound transient elastography (LUTE) and conventional ultrasonography in the National Health and Nutrition Examination Survey (NHANES).

Methods

5948 participants who underwent LUTE from the NHANES 2017–2018 and 14,797 participants who underwent conventional ultrasonography from the Third NHANES (NHANES III) were recruited. FLI was calculated by using body mass index (BMI), waist circumference (WC), triglyceride, and gamma-glutamyl transferase, and its optimal COPs in a specific population (stratified by sex, BMI, and WC) were obtained from receiver operator characteristics (ROC) curve with ultrasonic-diagnosed HS as the reference standard.

Results

Based on LUTE in NHANES 2017–2018, the prevalence of HS and metabolic dysfunction-associated fatty liver disease (MAFLD) were 58.7% and 56.2%, respectively, and the optimal COP of FLI for HS diagnosis in the overall population was 45.60, with an area under ROC curve (AUROC) of 0.833 (0.822–0.844). Based on conventional ultrasonography in NHANES III, the prevalence of HS and MAFLD were 34.4% and 27. 9%, respectively, and the optimal COP of FLI for HS was 59.5, with an AUROC of 0.681 (0.671–0.691). With the increase of BMI and WC, the COPs increased gradually with significant differences between different groups. Compared with conventional ultrasonography, the COPs of FLI based on LUTE were much more precise, with higher diagnostic ability. The population-specific COPs of FLI stratified by gender, WC, and BMI were tabulated.

Conclusion

In the United States, the incidences of HS and MAFLD were high, especially when assessed by LUTE. The FLI based on LUTE is well capable of predicting HS when stratified by gender, WC, and BMI.
Association of two geriatric treatment systems on care home admission and mortality in patients with hip fracture
Authors: Rapp Kilian , Becker Clemens , Todd Chris , Rehm Martin , Rothenbacher Dietrich , Konnopka Claudia , König Hans-Helmut , Friess Thomas , Büchele Gisela
Published: May 2022

Background

In Germany, geriatricians deliver acute geriatric care during an acute hospital stay and subacute rehabilitation after transfer to a rehabilitation clinic. However, the proportion of patients who receive acute geriatric care (AGC) or are transferred to subacute rehabilitation (TSR) differs considerably between hospitals. The aim of this study was to analyse the association between the two geriatric treatment systems and care home admission or mortality in patients following hip fracture.

Methods

Health insurance claims data were used to identify the rate of AGC per hospital and the rate of TSR per hospital following hip fracture surgery in patients aged ≥ 80 years. Outcomes were cumulative admission to a care home and cumulative mortality within 6 months after hospital admission.

Results

Data from 23,046 hip fracture patients from 561 hospitals were analysed. The rate of AGC was not associated with care home admission. However, compared to high rates of AGC medium rates or no AGC were associated with increased death rates by 12% or 20%, respectively. Treatment in hospitals with low rates of TSR was associated with a 8% higher risk of care home admission and a 10% increased risk of death compared to treatment in hospitals with high rates of TSR.

Conclusions

Our study suggests potential effects of geriatric treatment: reduction of mortality in hospitals with high rates of AGC or reduction of care home admission and mortality in hospitals with high rates of TSR.
Factors affecting perforation of the esophagus in patients with deep neck infection
Authors: Chen Shih-Lung , Ho Chia-Ying , Chin Shy-Chyi , Wang Yu-Chien
Published: May 2022

Background

Deep neck infection (DNI) is a serious disease that can lead to severe morbidity, including esophageal perforation, and mortality. However, no previous study has explored the risk factors associated with esophageal perforation in patients with DNI. This study investigated these factors.

Methods

Between September 2015 and September 2021, 521 patients with DNI were studied. Relevant clinical variables and deep neck spaces were assessed.

Results

In a multivariate analysis, involvement of the retropharyngeal space (OR 5.449, 95% CI 1.603–18.51, p = 0.006) and the presence of mediastinitis (OR 218.8, 95% CI 55.98–855.3, p < 0.001) were independent risk factors associated with esophageal perforation in patients with DNI.

There were no differences in pathogens between 32 patients with and 489 patients without esophageal perforation (all p > 0.05).

Conclusion

Involvement of the retropharyngeal space and the presence of mediastinitis were independent risk factors associated with esophageal perforation in patients with DNI. There were no differences in pathogens between the groups with and without esophageal perforation in DNI.
Compressed sensing based dynamic MR image reconstruction by using 3D-total generalized variation and tensor decomposition: k-t TGV-TD
Authors: Zhang Jucheng , Han Lulu , Sun Jianzhong , Wang Zhikang , Xu Wenlong , Chu Yonghua , Xia Ling , Jiang Mingfeng
Published: May 2022

Purpose

Compressed Sensing Magnetic Resonance Imaging (CS-MRI) is a promising technique to accelerate dynamic cardiac MR imaging (DCMRI). For DCMRI, the CS-MRI usually exploits image signal sparsity and low-rank property to reconstruct dynamic images from the undersampled k-space data. In this paper, a novel CS algorithm is investigated to improve dynamic cardiac MR image reconstruction quality under the condition of minimizing the k-space recording.

Methods

The sparse representation of 3D cardiac magnetic resonance data is implemented by synergistically integrating 3D total generalized variation (3D-TGV) algorithm and high order singular value decomposition (HOSVD) based Tensor Decomposition, termed k-t TGV-TD method. In the proposed method, the low rank structure of the 3D dynamic cardiac MR data is performed with the HOSVD method, and the localized image sparsity is achieved by the 3D-TGV method. Moreover, the Fast Composite Splitting Algorithm (FCSA) method, combining the variable splitting with operator splitting techniques, is employed to solve the low-rank and sparse problem. Two different cardiac MR datasets (cardiac perfusion and cine MR datasets) are used to evaluate the performance of the proposed method.

Results

Compared with the state-of-art methods, such as k-t SLR, 3D-TGV, HOSVD based tensor decomposition and low-rank plus sparse method, the proposed k-t TGV-TD method can offer improved reconstruction accuracy in terms of higher peak SNR (PSNR) and structural similarity index (SSIM). The proposed k-t TGV-TD method can achieve significantly better and stable reconstruction results than state-of-the-art methods in terms of both PSNR and SSIM, especially for cardiac perfusion MR dataset.

Conclusions

This work proved that the k-t TGV-TD method was an effective sparse representation way for DCMRI, which was capable of significantly improving the reconstruction accuracy with different acceleration factors.
Changes of biochemical biomarkers in the serum of children with convulsion status epilepticus: a prospective study
Authors: Wang Manli , Yu Jian , Xiao Xiao , Zhang Bingbing , Tang Jihong
Published: May 2022

Background

Convulsive status epilepticus (CSE) is a common neurologic emergency with high morbidity and mortality. This single center study is aimed to assess changes of serum biochemical biomarkers after seizure, and their associations with the development of CSE.

Methods

From January 2015 to October 2016, a total of 57 CSE patients, and 30 healthy controls without central nervous system diseases were enrolled in Children’s Hospital of Soochow University. CSE patients were further divided into viral encephalitis (VEN, 13 cases), primary generalized epilepsy (PGE, 30 cases), and complex febrile seizures (CFS, 14 cases). The levels of serum biochemical biomarkers were measured using the corresponding commercial ELISA kits. Logistic regression analysis was performed to identify the associations between these biomarkers and diseases.

Results

At the 1st and 4th day of CSE, neuron-specific enolase (NSE; 1st day: 20.553 ± 5.360, 4th day: 10.094 ± 3.426) and vascular endothelial growth factor (VEGF; 1st day: 153.504 ± 31.246, 4th day: 138.536 ± 25.221) in the CSE group were increased compared to the control (NSE: 6.138 ± 1.941; VEGF: 119.210 ± 31.681). Both the levels of S-100 calcium binding protein B (S-100B; 1st day: 0.738 ± 0.391) and C-reactive protein (CRP; 1st day: 11.128 ± 12.066) were elevated at 1st day of CSE (S-100B: 0.387 ± 0.040; CRP: 3.915 ± 2.064). For glial fibrillary acidic protein (GFAP), it was remarkably upregulated at 4th day of CSE (3.998 ± 1.211). NSE (P = 0.000), S-100B (P = 0.000), CRP (P = 0.011), and VEGF (P = 0.000) at 1st day of CSE, and NSE (P = 0.000), VEGF (P = 0.005), and GFAP (P = 0.000) at 4th day of CSE were significantly associated with the occurrence of CSE. Besides, NSE (P = 0.002), S-100B (P = 0.001), and VEGF (P = 0.002) at 4th day of CSE were significantly associated with VEN.

Conclusions

The levels of serum NSE, S-100B, CRP, VEGF, and GFAP are associated with CSE.
Correlation between the progression of diabetic retinopathy and inflammasome biomarkers in vitreous and serum – a systematic review
Authors: Kuo Charisse Y. J. , Murphy Rinki , Rupenthal Ilva D. , Mugisho Odunayo O.
Published: May 2022

Activation of the NOD-like receptor protein 3 (NLRP3) inflammasome pathway has been implicated in Diabetic retinopathy (DR) pathogenesis, but its impact on DR development and progression remains unclear. Therefore, the primary aim of this systematic literature review was to determine the role of the inflammasome in DR development. Furthermore, the secondary aim was to determine whether systemic inflammasome activity can be used to predict DR progression. Studies measuring vitreous and/or serum inflammasome biomarkers in DR patients with Type 2 Diabetes Mellitus (T2DM) were searched systematically using online databases EMBASE, PubMed and Web of Science with the last search conducted on 29thof September 2021. The risk of bias was assessed using the Newcastle Ottawa Scale and 20 studies were eligible for narrative analysis. Limitations included the heterogeneity in detection assays used, the small and uneven sample size, a lack of vitreous data in earlier disease stages, and not accounting for patients with other systemic co-morbidities. Analysis showed that inflammasome biomarkers IL-1β and IL-18 increased significantly from non-proliferative DR to proliferative DR in both vitreous and serum, suggesting the inflammasome pathway is activated as DR progresses and that serum inflammasome levels could be explored as potential biomarkers for DR progression.