bluuebunny/crossref_metadata_2025 huggingface dataset:
Targeting thalamocortical circuits for closed-loop stimulation in Lennox–Gastaut syndrome
Authors: Warren Aaron E L , Butson Christopher R , Hook Matthew P , Dalic Linda J , Archer John S , Macdonald-Laurs Emma , Schaper Frederic L W V J , Hart Lauren A , Singh Hargunbir , Johnson Lise , Bullinger Katie L , Gross Robert E , Morrell Martha J , Rolston John D
Published: May 2024

This paper outlines the therapeutic rationale and neurosurgical targeting technique for bilateral, closed-loop, thalamocortical stimulation in Lennox–Gastaut syndrome, a severe form of childhood-onset epilepsy. Thalamic stimulation can be an effective treatment for Lennox–Gastaut syndrome, but complete seizure control is rarely achieved. Outcomes may be improved by stimulating areas beyond the thalamus, including cortex, but the optimal targets are unknown. We aimed to identify a cortical target by synthesizing prior neuroimaging studies, and to use this knowledge to advance a dual thalamic (centromedian) and cortical (frontal) approach for closed-loop stimulation. Multi-modal brain network maps from three group-level studies of Lennox–Gastaut syndrome were averaged to define the area of peak overlap: simultaneous EEG-functional MRI of generalized paroxysmal fast activity, [18F]fluorodeoxyglucose PET of cortical hypometabolism and diffusion MRI structural connectivity associated with clinical efficacy in a previous trial of thalamic deep brain stimulation. The resulting ‘hotspot’ was used as a seed in a normative functional MRI connectivity analysis to identify connected networks. Intracranial electrophysiology was reviewed in the first two trial patients undergoing bilateral implantations guided by this hotspot. Simultaneous recordings from cortex and thalamus were analysed for presence and synchrony of epileptiform activity. The peak overlap was in bilateral premotor cortex/caudal middle frontal gyrus. Functional connectivity of this hotspot revealed a distributed network of frontoparietal cortex resembling the diffuse abnormalities seen on EEG-functional MRI and PET. Intracranial electrophysiology showed characteristic epileptiform activity of Lennox–Gastaut syndrome in both the cortical hotspot and thalamus; most detected events occurred first in the cortex before appearing in the thalamus. Premotor frontal cortex shows peak involvement in Lennox–Gastaut syndrome and functional connectivity of this region resembles the wider epileptic brain network. Thus, it may be an optimal target for a range of neuromodulation therapies, including thalamocortical stimulation and emerging non-invasive treatments like focused ultrasound or transcranial magnetic stimulation. Compared to thalamus-only approaches, the addition of this cortical target may allow more rapid detections of seizures, more diverse stimulation paradigms and broader modulation of the epileptic network. A prospective, multi-centre trial of closed-loop thalamocortical stimulation for Lennox–Gastaut syndrome is currently underway.
Combined low-dose dobutamine and exercise stress echocardiography: a new hybrid protocol to detect inducible ischaemia
Authors: Vakalis Konstantinos , Berrill Max , Jimeno Majimen , Chester Ruth , Rahman-Haley Shelley , Barron Anthony , Baltabaeva Aigul
Published: May 2024

Aims

Myocardial response to stress echocardiography may be elicited physiologically, through exercise, or pharmacologically, often with dobutamine. Both have advantages but also limitations due to reduced exercise capacity or side-effects to stressor agent/lack of closeness to true pathophysiology of ischaemic cascade. We have combined low-dose dobutamine and exercise, creating a ‘hybrid’ protocol to utilize the advantages of both techniques and limit the drawbacks. The aim of the study was to evaluate its safety and feasibility.

Methods and results

In the hybrid protocol, low-dose dobutamine infusion (up to 10 µg/kg/min) is enhanced by supine bicycle exercise at 3-min increments of workload of 25 W to achieve target heart rate (THR). We analysed safety and outcome data for all the patients who underwent this protocol from 2017 to 2022. Out of 835, 727 (87.1%) patients referred for evaluation of ischaemia underwent the hybrid protocol. The median age was 61 years old and 61% (442/727) were men. The median exercise time was 11 (9–13.5) min with a median maximum workload of 100 W (75–125). Out of 727, 670 (92.2%) achieved THR. Atropine was not used. Out of 727, 192 (26.4%) of studies were positive for ischaemia. Out of 122, 102 (83.6%) with positive stress who underwent invasive angiography had significant coronary disease. The incidence of complications was low: 1/727—severe arrhythmia, 5/727 (0.7%) developed a vasovagal episode, and 14/727 (1.9%) had a hypertensive response to exercise.

Conclusion

Our findings suggest that this protocol is safe, feasible, and has a high success rate in achieving THR.
Virulence characteristics of Gram-positive bacteria isolated from diabetic foot ulcers
Authors: Keogh Rebecca A , Huyvaert Savannah , Moore Garrett D , Horswill Alexander R , Doran Kelly S
Published: May 2024

Diabetic wound infections including diabetic foot ulcers (DFUs) are a major global health concern and a leading cause of non-traumatic amputations. Numerous bacterial species establish infection in DFUs, and treatment with antibiotics often fails due to widespread antibiotic resistance and biofilm formation. Determination of bacterial species that reside in DFU and their virulence potential is critical to inform treatment options. Here, we isolate bacteria from debridement tissues from patients with diabetes at the University of Colorado Anschutz Medical Center. The most frequent species were Gram-positive including Enterococcus faecalis, Staphylococcus aureus, and Streptococcus agalactiae, also known as Group B Streptococcus (GBS). Most tissues had more than one species isolated with E. faecalis and GBS frequently occurring in polymicrobial infection with S. aureus. S. aureus was the best biofilm producing species with E. faecalis and GBS isolates exhibiting little to no biofilm formation. Antibiotic susceptibility varied amongst strains with high levels of penicillin resistance amongst S. aureus, clindamycin resistance amongst GBS and intermediate vancomycin resistance amongst E. faecalis. Finally, we utilized a murine model of diabetic wound infection and found that the presence of S. aureus led to significantly higher recovery of GBS and E. faecalis compared to mice challenged in mono-infection.
The Evolution and Characterization of the RNA Interference Pathways in Lophotrochozoa
Authors: Formaggioni Alessandro , Cavalli Gianmarco , Hamada Mayuko , Sakamoto Tatsuya , Plazzi Federico , Passamonti Marco
Published: May 2024

In animals, three main RNA interference mechanisms have been described so far, which respectively maturate three types of small noncoding RNAs (sncRNAs): miRNAs, piRNAs, and endo-siRNAs. The diversification of these mechanisms is deeply linked with the evolution of the Argonaute gene superfamily since each type of sncRNA is typically loaded by a specific Argonaute homolog. Moreover, other protein families play pivotal roles in the maturation of sncRNAs, like the DICER ribonuclease family, whose DICER1 and DICER2 paralogs maturate respectively miRNAs and endo-siRNAs. Within Metazoa, the distribution of these families has been only studied in major groups, and there are very few data for clades like Lophotrochozoa. Thus, we here inferred the evolutionary history of the animal Argonaute and DICER families including 43 lophotrochozoan species. Phylogenetic analyses along with newly sequenced sncRNA libraries suggested that in all Trochozoa, the proteins related to the endo-siRNA pathway have been lost, a part of them in some phyla (i.e. Nemertea, Bryozoa, Entoprocta), while all of them in all the others. On the contrary, early diverging phyla, Platyhelminthes and Syndermata, showed a complete endo-siRNA pathway. On the other hand, miRNAs were revealed the most conserved and ubiquitous mechanism of the metazoan RNA interference machinery, confirming their pivotal role in animal cell regulation.
Hospital-Based Health Professionals’ Perceptions of Frailty in Older People
Authors: Manuel Kisani , Crotty Maria , Kurrle Susan E , Cameron Ian D , Lane Rachel , Lockwood Keri , Block Heather , Sherrington Catherine , Pond Dimity , Nguyen Tuan A , Laver Kate
Published: May 2024

Background and Objectives

There is a high prevalence of frailty amongst older patients in hospital settings. Frailty guidelines exist but implementation to date has been challenging. Understanding health professional attitudes, knowledge, and beliefs about frailty is critical in understanding barriers and enablers to guideline implementation, and the aim of this study was to understand these in rehabilitation multidisciplinary teams in hospital settings.

Research Design and Methods

Twenty-three semistructured interviews were conducted with health professionals working in multidisciplinary teams on geriatric and rehabilitation wards in Adelaide and Sydney, Australia. Interviews were audio recorded, transcribed, and coded by 2 researchers. A codebook was created and interviews were recoded and applied to the Framework Method of thematic analysis.

Results

Three domains were developed: diagnosing frailty, communicating about frailty, and managing frailty. Within these domains, 8 themes were identified: (1) diagnosing frailty has questionable benefits, (2) clinicians don’t use frailty screening tools, (3) frailty can be diagnosed on appearance and history, (4) frailty has a stigma, (5) clinicians don’t use the word “frail” with patients, (6) frailty isn’t always reversible, (7) there is a lack of continuity of care after acute admission, and (8) the community setting lacks resources.

Discussion and Implications

Implementation of frailty guidelines will remain challenging while staff avoid using the term “frail,” don’t perceive benefit of using screening tools, and focus on the individual aspects of frailty rather than the syndrome holistically. Clinical champions and education about frailty identification, reversibility, management, and communication techniques may improve the implementation of frailty guidelines in hospitals.
Improvement in quality of life after asfotase alfa treatment in adults with pediatric-onset hypophosphatasia: data from 5 patient-reported outcome measures
Authors: Dahir Kathryn M , Ing Steven W , Deal Chad , Messali Andrew , Bates Toby , Rush Eric T
Published: May 2024

Hypophosphatasia (HPP) is a rare, inherited metabolic disorder caused by deficient tissue-nonspecific alkaline phosphatase activity. This study assessed the impact of treatment with asfotase alfa on patient-reported outcomes (PROs) in adults with pediatric-onset HPP. A longitudinal, telephone-based survey was administered to eligible individuals enrolled in a patient support program. Interviews were conducted at study entry (prior to asfotase alfa initiation) and after 3, 6, and 12 mo. PROs—Patient Health Questionnaire-9 [PHQ-9], Work Productivity and Activity Impairment Questionnaire: Specific Health Problem [WPAI:SHP], Patient-Reported Outcomes Measurement Information System 29 [PROMIS-29], and Routine Assessment of Patient Index Data 3 [RAPID3]—were assessed at each time point. Appropriate statistical tests were performed to assess score changes. Among 50 enrolled patients (mean age: 46 yr [SD: 15.4]; 80% female; 94% White), 49 were evaluable at 3 mo, 44 at 6 mo, and 29 at 12 mo. By month 3, statistically significant improvements from baseline were detected in PHQ-9 scores (10.6 vs 5.8 [P < .0001]), PROMIS-29 domain scores (overall physical function: 38.0 vs 43.0 [P = .001]; anxiety: 57.5 vs 51.5 [P = .0011]; fatigue: 63.3 vs 55.3 [P < .0001]; sleep disturbances: 58.8 vs 54.3 [P = .0099]; ability to participate in social roles and activities: 42.6 vs 47.7 [P = .0012]; and pain interference: 63.8 vs 58.4 [P = .001]), and RAPID3 domain scores (functional status: 2.7 vs 1.1 [P < .0001]; pain tolerance: 6.0 vs 3.2 [P < .0001]; and global health estimate: 5.1 vs 2.7 [P < .0001]). Improvements persisted at month 12. Patients also showed improvements in WPAI:SHP domain scores at month 6 (presenteeism: 39.6% vs 14.1% [P < .0001] and work productivity loss: 41.9% vs 14.1% [P < .0001]). Treatment with asfotase alfa was associated with improved quality of life across several domains.
Integration of eye-tracking and object detection in a deep learning system for quality inspection analysis
Authors: Cho Seung-Wan , Lim Yeong-Hyun , Seo Kyung-Min , Kim Jungin
Published: May 2024

During quality inspection in manufacturing, the gaze of a worker provides pivotal information for identifying surface defects of a product. However, it is challenging to digitize the gaze information of workers in a dynamic environment where the positions and postures of the products and workers are not fixed. A robust, deep learning-based system, ISGOD (Integrated System with worker’s Gaze and Object Detection), is proposed, which analyzes data to determine which part of the object is observed by integrating object detection and eye-tracking information in dynamic environments. The ISGOD employs a six-dimensional pose estimation algorithm for object detection, considering the location, orientation, and rotation of the object. Eye-tracking data were obtained from Tobii Glasses, which enable real-time video transmission and eye-movement tracking. A latency reduction method is proposed to overcome the time delays between object detection and eye-tracking information. Three evaluation indices, namely, gaze score, accuracy score, and concentration index are suggested for comprehensive analysis. Two experiments were conducted: a robustness test to confirm the suitability for real-time object detection and eye-tracking, and a trend test to analyze the difference in gaze movement between experts and novices. In the future, the proposed method and system can transfer the expertise of experts to enhance defect detection efficiency significantly.
Social interactions generate complex selection patterns in virtual worlds
Authors: Santostefano Francesca , Fraser Franco Maxime , Montiglio Pierre-Olivier
Published: May 2024

Understanding the influence of social interactions on individual fitness is key to improving our predictions of phenotypic evolution. However, we often overlook the different components of selection regimes arising from interactions among organisms, including social, correlational, and indirect selection. This is due to the challenging sampling efforts required in natural populations to measure phenotypes expressed during interactions and individual fitness. Furthermore, behaviours are crucial in mediating social interactions, yet few studies have explicitly quantified these selection components on behavioural traits. In this study, we capitalize on an online multiplayer video game as a source of extensive data recording direct social interactions among prey, where prey collaborate to escape a predator in realistic ecological settings. We estimate natural and social selection and their contribution to total selection on behavioural traits mediating competition, cooperation, and predator–prey interactions. Behaviours of other prey in a group impact an individual’s survival, and thus are under social selection. Depending on whether selection pressures on behaviours are synergistic or conflicting, social interactions enhance or mitigate the strength of natural selection, although natural selection remains the main driving force. Indirect selection through correlations among traits also contributed to the total selection. Thus, failing to account for the effects of social interactions and indirect selection would lead to a misestimation of the total selection acting on traits. Dissecting the contribution of each component to the total selection differential allowed us to investigate the causal mechanisms relating behaviour to fitness and quantify the importance of the behaviours of conspecifics as agents of selection. Our study emphasizes that social interactions generate complex selective regimes even in a relatively simple ecological environment.
Take me to the River: Sophie Anderson and Elaine of Astolat
Authors: McLoughlin John
Published: May 2024

Sophie Gengembre Anderson (1823–1903) is not a painter of considerable critical acclaim; her work has been largely disregarded by art history and criticism, charged on the often-fatal count of sentimentality and lumped in with the kinds of ‘kitsch’ art rejected by modernism and its descendants. Despite this, her work continues to sell – at multi-million-dollar auctions and printed on cheap paraphernalia. Anderson’s appeal at these very different cultural echelons is testament to her technical effectiveness and to the enduring quality of her particular brand of Victorian mawkishness, and though her many paintings of children may never quite find purchase amidst the innovations and revelations of art in the recent century, these qualities do lend themselves to a deeply sympathetic mode of historical and literary painting. Anderson’s large, Tennyson-inspired literary depiction of Elaine of Astolat signalled her desire to enter the aggressively male-dominated space of historical and literary art and offers a valuable new perspective on a story and a character which has been so often – even obsessively – depicted by men. Elaine, which sits high above the entryway to Liverpool’s Walker Art Gallery, was one of the first such paintings by a woman to be purchased with public funds, and it represents a valuable entry-point for critique – both of the Victorian art establishment and of Tennyson’s Idylls of the King. Anderson’s artistic choices betray a profound sympathy for Elaine of Astolat and serve to highlight the pathos of a character who has seen her story and her character distorted from its inception.
Improving plastic degrading enzymes via directed evolution
Authors: Joho Yvonne , Vongsouthi Vanessa , Gomez Chloe , Larsen Joachim S , Ardevol Albert , Jackson Colin J
Published: May 2024

Plastic degrading enzymes have immense potential for use in industrial applications. Protein engineering efforts over the last decade have resulted in considerable enhancement of many properties of these enzymes. Directed evolution, a protein engineering approach that mimics the natural process of evolution in a laboratory, has been particularly useful in overcoming some of the challenges of structure-based protein engineering. For example, directed evolution has been used to improve the catalytic activity and thermostability of polyethylene terephthalate (PET)-degrading enzymes, although its use for the improvement of other desirable properties, such as solvent tolerance, has been less studied. In this review, we aim to identify some of the knowledge gaps and current challenges, and highlight recent studies related to the directed evolution of plastic-degrading enzymes.
Inclusion as a science, technology, and innovation policy objective in high-income countries: the decoupling dilemma
Authors: Kalliomäki Helka , Kalliokoski Johanna , Woodson Thomas , Kunttu Leena , Kuusisto Jari
Published: May 2024

This paper scrutinizes the objective of inclusion in contemporary science, technology, and innovation (STI) policies by analyzing its manifestations within the broad STI policy language promoting a closer interaction between science and society. We contribute to the STI policy literature by revisiting current conceptualizations that primarily center on marginalized groups. By analyzing the Broader Impacts Criterion and Responsible Research and Innovation frameworks in the USA and the European Union, we show that inclusion in the context of high-income countries is partially decoupling from marginalization and increasingly being instrumentalized to serve impact agendas. Our conceptual framework synthesizing the dimensions of goal setting and agency illustrates the broadening scope of inclusive policies and the emergent decoupling dilemma that has been neglected in the literature. Future research must account for the growing ambiguity of policy language that is facing new legitimacy questions and the blurring of objectives focused on supporting marginalized groups.
Lupine-induced crooked calf syndrome: mitigation through intermittent grazing management of cattle
Authors: Welch Kevin D , Lee Stephen T , Panter Kip E , Stegelmeier Bryan S , Stonecipher Clint A , Cook Daniel
Published: May 2024

Lupines are responsible for a condition in cattle referred to as “crooked calf syndrome” (CCS) that occurs when pregnant cattle graze teratogenic lupines. A proposed management strategy to limit these types of birth defects includes utilizing an intermittent grazing schedule to allow short durations of grazing lupine-infested areas interrupted by movement to a lupine-free pasture. The objective of this study was to determine if an intermittent schedule of ten continuous days of lupine treatment followed by 5 d off treatment would be sufficient to decrease, or prevent, the incidence of lupine-induced malformations. Continuous dosing of the teratogenic lupine (Lupinus leucophyllus) to pregnant cows for 30 d during the most susceptible stage of pregnancy (gestation days 40 to 70) resulted in severe skeletal birth defects in their calves. However, intermittent dosing of the teratogenic lupine demonstrated that interrupted intake of lupine reduced the severity, or eliminated, permanent skeletal malformations in calves born to cows dosed lupine. Toxicokinetic and ultrasound data demonstrated a clear inverse correlation between serum anagyrine (the primary teratogenic alkaloid in some lupines) concentrations in the dam and fetal movement. In the intermittent group, fetal movement quickly returned to normal after lupine feeding stopped and remained normal until lupine treatment resumed. Therefore, interrupting lupine intake for at least 5 d through an intermittent grazing program could reduce the severity of the CCS. Furthermore, this method would allow ranchers to move cattle back into lupine pastures after a brief interruption, which would allow for more efficient utilization of forage resources.
Effects of feeding α-amylase-expressed corn silage and grain on performance, enteric methane production, and carcass characteristics in beef steers
Authors: Rebelo Lucas R , Clark Kirsten L , Relling Alejandro E , Lee Chanhee
Published: May 2024

An experiment was conducted to evaluate the effects of feeding Enogen feed corn (EFC) silage or EFC grain with different grain processing (dry-rolled corn vs. whole-shelled corn) in feedlot cattle diets. Total 68 Angus cross-bred steers were blocked by body weight and the treatments (diets) were randomly assigned to steers in each block: a basal diet with isoline corn silage and isoline dry-rolled corn grain (IIR); the basal diet with EFC silage and isoline dry-rolled corn grain (EIR); the basal diet with EFC silage and EFC dry-rolled grain (EER); and the basal diet with EFC silage and EFC whole-shelled grain (EEW). Isoline refers to the isogenic counterpart of Enogen corn silage or grain. Steers received the assigned treatment over 32 wk of the entire experiment (backgrounding and finishing) until harvested. Part of the steers (eight blocks) in each treatment were used to measure CH4 production (g/d) using the GreenFeed and CH4 production per unit of DMI. All data were analyzed using a mixed procedure of SAS in a randomized complete block design, considering diet as a fixed effect and block as a random effect. Steers fed the EIR diet increased (P = 0.03) DMI compared to IIR during the backgrounding phase. However, feeding EFC silage or grain did not affect body weight, average daily gain, and feed efficiency during backgrounding and finishing phases. Feeding EEW decreased (P ≤ 0.05) body weight, average daily gain, feed efficiency, and tended to decrease (P = 0.06) hot carcass weight compared to EER during the finishing phase. Methane production per unit of DMI decreased (P = 0.02) for steers fed EIR compared with steers fed IIR only during the backgrounding phase. Feeding EFC grain had no effect on CH4 production (g/d) in both phases. In conclusion, feeding EFC silage or grain did not improve the performance of beef steers during the backgrounding and finishing phases in the current experiment condition. Methane production per unit of DMI was reduced for steers fed EFC silage compared with isoline corn silage only during the backgrounding phase.
Ancient mitogenomes reveal evidence for the Late Miocene dispersal of mergansers to the Southern Hemisphere
Authors: Rawlence Nicolas J , Verry Alexander J F , Cole Theresa L , Shepherd Lara D , Tennyson Alan J D , Williams Murray , Wood Jamie R , Mitchell Kieren J
Published: May 2024

Mergansers are riverine and coastal piscivorous ducks that are widespread throughout North America and Eurasia but uncommon in the Southern Hemisphere. One species occurs in South America and at least two extinct species are known from New Zealand. It has been proposed that these Southern Hemisphere merganser lineages were founded by at least two independent dispersal events from the Northern Hemisphere. However, some morphological and behavioural evidence suggests that Southern Hemisphere mergansers may form a monophyletic clade that descended from only a single dispersal event from the Northern Hemisphere. For example, Southern Hemisphere mergansers share several characteristics that differ from Northern Hemisphere mergansers (e.g. non-migratory vs. migratory, sexual monochromatism vs. sexual dichromatism, long vs. short pair bonds). We sequenced complete mitogenomes from the Brazilian merganser and an extinct merganser from New Zealand—the Auckland Island merganser. Our results show that the Brazilian and Auckland Island mergansers are not sister-taxa, and probably descend from two separate colonization events from the Northern Hemisphere at least 7 Mya. Nuclear (palaeo)genomic data may help to further resolve the relationship between living and extinct mergansers, including merganser fossils from New Zealand that have not been subjected to palaeogenetic analysis.
Disease modification in axial spondyloarthritis – still a controversy?
Authors: de Hooge Manouk , van der Heijde Désirée
Published: May 2024

Purpose of review

This review evaluates recent advancements in disease-modifying therapies for axial spondyloarthritis (axSpA).

Recent findings

A recent study could not demonstrate an additional effect of NSAID therapy on golimumab [Tumor Necrosis Factor-α inhibitor (TNFi)] on structural progression; however, this might be due to the fact that the study was underpowered. While DMARDs have shown promise in suppressing inflammation, their impact on structural progression remains uncertain. A well powered trial showed no difference in spinal progression between secukinumab [Interleukin17A inhibitor (IL17Ai)] and adalimumab-biosimilar (TNFi). Preliminary data on Janus kinase inhibitors (JAKi) focus on MRI findings but lack evidence on radiographic spinal progression. While some studies suggest promising outcomes, others reveal limitations and inconclusive findings.

Recent studies explore the effectiveness of NSAIDs, biological disease-modifying antirheumatic drugs like TNFi and IL-17i, as well as JAK inhibitors in axSpA. Conflicting evidence surrounds these therapies’ ability to impede structural progression, with challenges in study design and interpretation. Moreover, changes in demographics and treatment methods underscore the importance of examining trends over time when assessing disease outcomes. Ultimately, ongoing research could benefit from new imaging tools when evaluating therapeutic strategies for modifying disease progression in axSpA.
Optimal Fixation Strategies for Displaced Femoral Neck Fractures in Patients 18–59 Years of Age: An Analysis of 565 Cases Treated at 26 Level 1 Trauma Centers
Authors: Roser Tom , Collinge Cory A. , Giga Kashmeera , Lebus George F. , Beltran Michael J. , Crist Brett , Sems Stephen A. , Gardner Michael J. , Sagi H. Claude , Archdeacon Michael T. , Mir Hassan R. , Rodriguez-Buitrago Andres , Mitchell Phillip , Tornetta Paul ,   the Young Femoral Neck Fracture Working Group
Published: May 2024

OBJECTIVES:

The objective of this study was to determine the difference in failure rates of surgical repair for displaced femoral neck fractures in patients younger than 60 years of age according to fixation strategy.

METHODS:

Design:

This is a retrospective, comparative cohort study.

Setting:

Twenty-six Level 1 North American trauma centers.

Patient Selection Criteria:

Patients younger than 60 years of age with a displaced femoral neck fracture (OTA 31-B2, B3) undergoing surgical repair from 2005 to 2017.

Outcome Measures and Comparisons:

Patient demographics, injury characteristics, repair methods used, and treatment failure (nonunion/failed fixation, avascular necrosis, and need for secondary surgery) were compared according to fixation strategy.

RESULTS:

Five hundred and sixty-five patients met inclusion criteria and were studied. The mean age was 42 years, 36% were female, and the average Pauwels' angle of fractures was 55 degrees. There were 305 patients treated with multiple cannulated screws (MCS) and 260 treated with a fixed-angle (FA) construct. Treatment failures were 46% overall, but was more likely to occur in MCS constructs versus FA devices (55% vs. 36%, P < 0.001). When FA constructs were substratified, the use of a sliding hip screw with addition of a medial femoral neck buttress plate (FNBP) and “antirotation” (AR) screw demonstrated better results than either FNBP or AR screw alone or neither with the lowest overall construct failure rate of 11% (P < 0.036).

CONCLUSIONS:

Historically used fixation constructs for femoral neck fractures (eg, multiple cannulated screws and sliding hip screw) in young and middle-aged adults performed poorly compared with more recently proposed constructs, including those using a medial femoral neck buttress plate and an antirotation screw. Fixed-angle constructs outperformed multiple cannulated screws overall, and augmentation of fixed-angle constructs with a medial femoral neck buttress plate and antirotation screw improved the likelihood of successful treatment. Surgeons should prioritize fixation decisions when repairing displaced femoral neck fractures in patients.

LEVEL OF EVIDENCE:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
The Effects of Unitizing Nail–Plate Constructs in Distal Femur Fractures: A Biomechanical Study
Authors: Mayer Erik , Lendhey Matin , Kelley Benjamin , Shi Brendan , Upfill-Brown Alexander , Devana Sai K. , Brodke Dane , Shah Akash , Sekimura Troy , Gudapati Varun , Zukotynski Brian , Park Jeannie , Witt Amber R. , Marciante Mara , Mahoney Jonathan M. , Bucklen Brandon S. , Lee Christopher
Published: May 2024

OBJECTIVES:

To assess the biomechanical differences between linked and unlinked constructs in young and osteoporotic cadavers in addition to osteoporotic sawbones.

METHODS:

Intraarticular distal femur fractures with comminuted metaphyseal regions were created in three young matched pair cadavers, three osteoporotic matched pair cadavers, and six osteoporotic sawbones. Precontoured distal femur locking plates were placed in addition to a standardized retrograde nail, with unitized constructs having one 4.5 mm locking screw placed distally through the nail. Nonunitized constructs had seven 4.5 mm locking screws placed through the plate around the nail, with one 5 mm distal interlock placed through the nail alone. Cadaveric specimens were subjected to axial fatigue loads between 150 and 1500 N (R Ratio = 10) with 1 Hx frequency for 10,000 cycles. Sawbones were axially loaded at 50% of the ultimate load for fatigue testing to achieve runout, with testing performed with 30 and 300 N (R Ratio = 10) loads with 1 Hz frequency for 10,000 cycles.

RESULTS:

In young cadavers, there was no difference in the mean cyclic displacement of the unitized constructs (1.51 ± 0.62mm) compared to the non-unitized constructs (1.34 ± 0.47mm) (Figure 4A), (p = 0.722). In osteoporotic cadavers, there was no difference in the mean cyclic displacement of the unitized constructs (2.46 ± 0.47mm) compared to the non-unitized constructs (2.91 ± 1.49mm) (p =0.639). There was statistically no significant difference in cyclic displacement between the unitized and non-unitized groups in osteoporotic sawbones(p = 0.181).

CONCLUSIONS:

Linked constructs did not demonstrate increased axial stiffness or decreased cyclical displacement in comparison to unlinked constructs in young cadaveric specimens, osteoporotic cadaveric specimens, or osteoporotic sawbones.
Treatment Failure After Repair of Displaced Femoral Neck Fractures in Patients Compared by “Decade of Life”: An Analysis of 565 Cases in Adults Less Than 60 years of Age
Authors: Collinge Cory A. , Giga Kashmeera , Roser Thomas , Lebus George F. , Beltran Michael J. , Crist Brett , Sems Stephen A. , Gardner Michael J. , Sagi H. Claude , Archdeacon Michael T. , Mir Hassan R. , Rodriguez-Buitrago Andres , Mitchell Phillip , Tornetta Paul ,   the Young Femoral Neck Fracture Working Group
Published: May 2024

OBJECTIVES:

To study the results of displaced femoral neck fractures (FNFs) in adults less than 60 years of age by comparing patients, injury, treatment, and the characteristics of treatment failure specifically according to patients' age at injury, that is, by their “decade of life” [ie, “under 30” (29 years and younger), “the 30s” (30–39 years), “the 40s” (40–49 years), and “the 50s” (50–59 years)].

METHODS:

Design:

Multicenter retrospective comparative cohort series.

Setting:

Twenty-six North American Level 1 Trauma Centers.

Patient Selection Criteria:

Skeletally mature patients aged 18–59 years with operative repair of displaced FNFs.

Outcome Measures and Comparisons:

Main outcome measures were treatment failures (fixation failure and/or nonunion, osteonecrosis, malunion, and the need for subsequent major reconstructive surgery (arthroplasty or proximal femoral osteotomy). These were compared across decades of adult life through middle age (<30 years, 30–39 years, 40–49 years, and 50–59 years).

RESULTS:

Overall, treatment failure was observed in 264 of 565 (47%) of all hips. The mean age was 42.2 years, 35.8% of patients were women, and the mean Pauwels angle was 53.8 degrees. Complications and the need for major secondary surgeries increased with each increasing decade of life assessed: 36% of failure occurred in patients <30 years of age, 40% in their 30s, 48% in their 40s, and 57% in their 50s (P < 0.001). Rates of osteonecrosis increased with decades of life (under 30s and 30s vs. 40s vs. 50s developed osteonecrosis in 10%, 10%, 20%, and 27% of hips, P < 0.001), while fixation failure and/or nonunion only increased by decade of life to a level of trend (P = 0.06). Reparative methods varied widely between decade-long age groups, including reduction type (open vs. closed, P < 0.001), reduction quality (P = 0.030), and construct type (cannulated screws vs. fixed angle devices, P = 0.024), while some variables evaluated did not change with age group.

CONCLUSIONS:

Displaced FNFs in young and middle-aged adults are a challenging clinical problem with a high rate of treatment failure. Major complications and the need for complex reconstructive surgery increased greatly by decade of life with the patients in their sixth decade experiencing osteonecrosis at the highest rate seen among patients in the decades studied. Interestingly, treatments provided to patients in their 50s were notably different than those provided to younger patient groups.

LEVEL OF EVIDENCE:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Early megakaryocyte lineage-committed progenitors in adult mouse bone marrow
Authors: Liu Zixian , Wang Jinhong , Ma Yao , Xie Miner , Wu Peng , Zhang Sen , Wang Xiaofang , Dong Fang , Cheng Hui , Zhu Ping , Han Mingzhe , Ema Hideo
Published: May 2024

Hematopoietic stem cells (HSCs) have been considered to progressively lose their self-renewal and differentiation potentials prior to the commitment to each blood lineage. However, recent studies have suggested that megakaryocyte progenitors (MkPs) are generated at the level of HSCs. In this study, we newly identified early megakaryocyte lineage-committed progenitors (MgPs) mainly in CD201−CD48− cells and CD48+ cells separated from the CD150+CD34−Kit+Sca-1+Lin− HSC population of the bone marrow in adult mice. Single-cell colony assay and single-cell transplantation showed that MgPs, unlike platelet-biased HSCs, had little repopulating potential in vivo, but formed larger megakaryocyte colonies in vitro (on average 8 megakaryocytes per colony) than did previously reported MkPs. Single-cell RNA sequencing supported that HSCs give rise to MkPs through MgPs along a Mk differentiation pathway. Single-cell reverse transcription polymerase chain reaction (RT-PCR) analysis showed that MgPs expressed Mk-related genes, but were transcriptionally heterogenous. Clonal culture of HSCs suggested that MgPs are not direct progeny of HSCs. We propose a differentiation model in which HSCs give rise to MgPs which then give rise to MkPs, supporting a classic model in which Mk-lineage commitment takes place at a late stage of differentiation.
Analysis of vascular anatomy in deep inferior epigastric perforator flap
Authors: Tsai Hsu-Yun , Fang Chien-Liang , Hsu Chin-Hao , Tu Chin-Wen , Wu Yueh-Lin , Yang Hsin-Yi
Published: May 2024

Objectives

The deep inferior epigastric artery perforator (DIEP) flap is considered the gold standard in autologous breast reconstruction. One of the existing challenges of the procedure is maintaining a pedicle of suitable length and diameter for flap survival. In this study, we analyzed the vascular anatomy of bipedicle DIEP flap cases in terms of the vessel diameter, the rate of secondary venae comitantes, and pedicle length to determine the efficacy of microvascular anastomosis and venous drainage.

Materials and Methods

We retrospectively evaluated 108 patients who underwent immediate breast reconstruction using free bipedicle DIEP flaps between 2012 and 2019. The patient characteristics, diameters of the deep inferior epigastric artery (DIEA) and accompanying veins (DIEVs), DIEA pedicle length, vessel re-anastomosis rate, flap failure rate, and fat necrosis were recorded.

Results

Comparison of the right-side and left-side diameters and pedicle lengths obtained showed no significant differences (P > 0.05). A total of 148 sides (68.52%) of flaps had double venous drainage, whereas 68 sides (31.48%) of flaps had one. Vein congestion occurred in 5 cases, and all involved with just one DIEV anastomosis. No arterial occlusions were observed.

Conclusions

This is an analysis of extensive clinical data in terms of DIEA, DIEV, and pedicle length. The low vein congestion rate observed reveals that adequate venous drainage was achieved in the DIEV system for DIEP reconstruction. Adequate deep inferior epigastric vessel pedicle length and vessel size, as well as greater than 60% of flaps with secondary DIEV, may allow comfortable microsurgery with reduced complications.
POSTINTRAVITREAL INJECTION AND POSTCATARACT EXTRACTION ENDOPHTHALMITIS VISUAL OUTCOMES BY ORGANISM
Authors: Cioana Milena , Naidu Sumana , Far Parsa M. , Yeung Shanna C. , You Yuyi , Yan Peng
Published: May 2024

Purpose:

To compare visual outcomes of endophthalmitis following intravitreal injections (IVIs) and cataract extraction by causative organism.

Methods:

Searches in Cochrane Central Register of Controlled Trials, MEDLINE, and Embase identified articles reporting visual outcomes by causative organisms in post-IVI and cataract extraction endophthalmitis cases from January 2010 to February 2022. A random-effects meta-analysis compared visual improvement among endophthalmitis cases caused by causative organisms.

Results:

Eighty-five out of 3,317 retrieved studies were included. The highest degree of visual acuity improvement in both post-IVI and postcataract extraction endophthalmitis was seen in cases caused by coagulase-negative staphylococci, followed by gram-negative organisms and other gram-positive organisms such as streptococci and enterococci. Culture-negative cases showed more visual acuity improvement than culture-positive cases in post-IVI endophthalmitis. These results remained consistent when accounting for endophthalmitis treatment, IVI type, condition requiring IVI treatment, follow-up period, and initial preprocedural visual acuity.

Conclusion:

Coagulase-negative staphylococci and gram-negative organisms show the most visual acuity improvement in both post-IVI and postcataract extraction endophthalmitis. Other gram-positive organisms such as streptococci and enterococci are associated with less visual improvement. This updated systematic review and meta-analysis revealed that the results of the Endophthalmitis Vitrectomy Study are consistent decades later despite advancements in surgical practices and the evolution of microorganisms over time.
SURGICAL OUTCOMES OF RETINAL DETACHMENT ASSOCIATED WITH PROLIFERATIVE SICKLE CELL RETINOPATHY
Authors: Ahmed Ishrat , Wakabayashi Taku , Gonzales Anthony F. , Ong Sally S. , Light Jacob G. , Handa James T. , Yonekawa Yoshihiro , Scott Adrienne W.
Published: May 2024

Purpose:

To evaluate the long-term anatomic and visual outcomes in eyes with sickle cell retinopathy–related retinal detachments (RDs).

Methods:

Patients who underwent surgery for sickle cell retinopathy–related RDs at the Wilmer Eye Institute or Wills Eye Hospital between 2008 and 2020 and followed for at least 6 months postoperatively were retrospectively reviewed. The primary outcome was the rate of single-surgery anatomic success and final reattachment.

Results:

This study included 30 eyes from 28 patients (16 women and 12 men) with tractional RD (n = 13), rhegmatogenous RD (n = 1), and combined tractional RD/rhegmatogenous RD (n = 16). Mean age was 42.1 ± 15.1 years. The mean follow-up duration was 47.8 ± 34.1 months. Twenty-five (83.3%) eyes underwent pars plana vitrectomy and five (16.7%) eyes underwent pars plana vitrectomy with scleral buckling. Single-surgery anatomic success was achieved in 21 (70.0%) eyes at 6 months. Final reattachment was achieved in 28 (93.3%) eyes (22 eyes [73.3%] without tamponade). Recurrence of RDs was significantly associated with male gender (P = 0.041), absence of previous laser (P = 0.032), iatrogenic breaks (P = 0.035), retinectomy (P = 0.034), and silicone oil tamponade (P = 0.024). Overall, the logarithm of the minimum angle of resolution visual acuity improved from 1.53 ± 0.57 (Snellen equivalent, 20/678) to 1.15 ± 1.01 (20/283) at the final visit (P = 0.03); however, eyes with recurrent RD did not achieve significant visual improvement.

Conclusion:

Pars plana vitrectomy to repair sickle cell retinopathy–related RDs was effective in achieving anatomic success and improving vision in most eyes. Single-surgery anatomic success is critical for optimizing visual outcomes.
ANATOMIC OUTCOMES OF LENS-SPARING VITRECTOMY FOR STAGE 3 OR 4 FAMILIAL EXUDATIVE VITREORETINOPATHY
Authors: Liu Huanyu , Peng Jie , Zhang Wenting , Zhang Xuerui , Gu Victoria Y. , Yang Yuan , Xiao Haodong , Yin Jiawei , Jiao Dian , Tian Tian , Zhao Peiquan
Published: May 2024

Purpose:

To report the anatomic outcomes and retinal structure changes from lens-sparing vitrectomy (LSV) for eyes with Stage 3 or 4 familial exudative vitreoretinopathy (FEVR).

Methods:

Overall, 133 consecutive eyes of 119 patients with Stage 3 (51 eyes) or 4 (82 eyes) FEVR who underwent LSV between January 2012 and May 2023 were retrospectively reviewed.

Results:

One hundred twenty-nine eyes (97.0%) achieved traction relief through one LSV operation. The extent of retinal detachment improved in 98 eyes (73.7%), remained stable in 32 eyes (24.1%), and progressed in three eyes (2.3%). At long-term follow-up, 39 (29.3%) and 60 (45.1%) eyes had completely or partially reattached retina, respectively. The median change of venular angle was 3.6° (95% CI, 3.5–10.5; P < 0.001) and −9.9° (95% CI, −15.8 to −4.6; P < 0.001) for temporal and nasal vessels, respectively. The mean disk–fovea distance was 0.3 papillary diameter shorter (95% CI, −0.4 to −0.2; P < 0.001), and the mean temporal venular arcade distance was 0.02 papillary diameter larger (95% CI, −0.16 to 0.21; P = 0.361).

Conclusion:

These results suggest that LSV can relieve vitreoretinal traction and reattach the retina in late-stage FEVR eyes. Improvements in temporal and nasal venular angle and disk–fovea distance reflect positive retinal structure changes for patients.
VISION AND METAMORPHOPSIA OUTCOMES OF MACULAR BUCKLING FOR FOVEOSCHISIS-ASSOCIATED MACULAR DETACHMENT IN HIGHLY MYOPIC EYES
Authors: Zhang Qi , Zhao Xiujuan , Liu Bingqian , Chen Shida , Huang Xia , Wu Qingxiu , Zhan Jinlian , Lu Lin
Published: May 2024

Purpose:

To assess the functional outcomes in visual acuity, metamorphopsia, and vision-related quality of life (VR-QOL) and to evaluate prognostic factors after macular buckling (MB) surgery in eyes with high myopia and foveoschisis (FS)-associated macular detachment (MD).

Methods:

Thirty-nine eyes of 39 patients with FS-associated MD who underwent MB surgery were enrolled. Measured outcomes comprised best-corrected visual acuity (BCVA), metamorphopsia, VR-QOL, axial length (AL), macular reattachment, and resolution of foveoschisis. In addition, factors affecting final BCVA and metamorphopsia were analyzed.

Results:

At 12 months postoperatively, 36 eyes (92.31%) achieved macular reattachment, 37 eyes (94.87%) achieved complete resolution of foveoschisis, and metamorphopsia diminished in 31 eyes (79.49%). LogMAR BCVAs at baseline and months 1, 3, 6, and 12 postoperatively were 0.62 ± 0.35 (20/83), 0.65 ± 0.3 (20/89), 0.59 ± 0.31 (20/77), 0.54 ± 0.31 (20/69), and 0.46 ± 0.27 (20/57) (P < 0.001), respectively. Metamorphopsia scores by M-CHARTS were 1.36° ± 0.51°, 1.04° ± 0.51°, 0.74° ± 0.47°, 0.59° ± 0.47°, and 0.13° ± 0.29° (P < 0.001). All Visual Function Questionnaire-25 subscales demonstrated significant improvement postoperatively, with the exception of “general health” (P = 0.08) and “driving” (P = 0.111). Preoperative BCVA was an independent risk factor for postoperative BCVA at month 12 (r = 0.638, P < 0.001), and the preoperative M-score was an independent risk factor for postoperative M-score at month 12 (r = 0.187, P = 0.045).

Conclusion:

MB surgery significantly improved BCVA, metamorphopsia, and VR-QOL in patients with FS-associated MD. Preoperative BCVA and metamorphopsia score were prognostic factors for postoperative BCVA and metamorphopsia score at month 12.