bluuebunny/crossref_metadata_2025 huggingface dataset:
Dynamics of Human Immunodeficiency Virus-1 Genetic Diversification During Acute Infection
Authors: Song Hongshuo , Bose Meera , Pinyakorn Suteeraporn , Sanders-Buell Eric , O’Sullivan Anne Marie , Silas Daniel , Trichavaroj Rapee , Nuntapinit Bessara , Pham Phuc T , Akapirat Siriwat , Kroon Eugène , de Souza Mark , Gramzinski Robert , Michael Nelson L , Robb Merlin L , Vasan Sandhya , Tovanabutra Sodsai , Ananworanich Jintanat
Published: September 2020

We analyzed human immunodeficiency virus envelope diversity in 98 acute infections. The within-host genetic diversity, divergence from transmitted/founder (T/F) strain, and the observed frequency of multiple T/F infections increased with Fiebig stage. These data identify rapid viral dynamics during acute infection with implications for clinical trials conducted in this setting.
Transmission of SARS-CoV-2 in Public Transportation Vehicles: A Case Study in Hunan Province, China
Authors: Luo Kaiwei , Lei Zhao , Hai Zheng , Xiao Shanliang , Rui Jia , Yang Hao , Jing Xinping , Wang Hui , Xie Zhengshen , Luo Ping , Li Wanying , Li Qiao , Tan Huilu , Xu Zicheng , Yang Yang , Hu Shixiong , Chen Tianmu
Published: September 2020

Here we report a case study of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak event during bus trips of an index patient in Hunan Province, China. This retrospective investigation suggests potential airborne transmission of SARS-CoV-2 and the possibility of superspreading events in certain close contact and closed space settings, which should be taken into account when control strategies are planned.
Measuring the Impact of Continuous Disinfection Strategies on Environmental Burden in Outpatient Settings: A Prospective Randomized Controlled Trial
Authors: Warren Bobby G , Turner Nicholas , Smith Becky , Addison Rachel , Marden Samantha , Weber David J , Rutala William A , Anderson Deverick J
Published: September 2020

Background

Our primary objective was to determine the effectiveness of 2 enhanced disinfection strategies compared with standard disinfection: “near-UV” light (Arm 1) and a persistent organosilane quaternary ammonium disinfectant (Arm 2) using a triple-blind study design. Our secondary objective was to characterize environmental contamination of outpatient clinics.

Methods

This trial was conducted at 2 clinics: the wound and pulmonary outpatient clinics at Duke University Health System in Durham, North Carolina. In Arm 1, room overhead lights were replaced with 405-nm near-UV visible light bulbs. In Arm 2, the organosilane quaternary ammonium disinfectant was applied to all room surfaces. The control arm received no intervention. All arms received routine disinfection. Room contamination was measured twice daily (before and after clinic) over 25 clinic days.

Results

The primary outcome was the change in total contamination, measured in colony forming units (CFUs), on environmental surfaces at the end of the clinic day compared with the beginning of the clinic day. Results from each intervention arm were compared against results from the control arm. The median delta total CFU for Arm 1 was 2092 CFUs (interquartile range [IQR], −1815 to 8566); the median delta for Arm 2 was 2016 CFUs (IQR, −1443 to 7430). Compared with the control arm (median delta = 1987 [IQR, −1611 to 15 857]), neither intervention led to a significant decrease in daily room contamination change (P for Arm 1 = 0.78 and P for Arm 2 = 0.71).

Conclusions

Neither near-UV lights or a persistent organosilane quaternary ammonium disinfectant reduced environmental contamination in 2 outpatient clinics compared with control rooms but did reduce the number of clinically important pathogens recovered.
Epidemiological and Clinical Findings of Short-Term Recurrence of Severe Acute Respiratory Syndrome Coronavirus 2 Ribonucleic Acid Polymerase Chain Reaction Positivity in 1282 Discharged Coronavirus Disease 2019 Cases: A Multicenter, Retrospective, Observational Study
Authors: Chen Sheng-Long , Xu Hui , Feng Hui-Ying , Sun Jiu-Feng , Li Xin , Zhou Lin , Song Wen-Liang , Huang Shan-Shan , He Jun-Lei , Deng Yi-Yu , Wang Rui-Jie , Fang Ming
Published: September 2020

Background

Short-term recurrence of positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ribonucleic acid (RNA) polymerase chain reaction (PCR) in discharged coronavirus disease 2019 (COVID-19) patients attracts the public’s concern. This study aimed to determine the clinical and epidemiological results of such patients.

Methods

This retrospective study was conducted on 32 designated hospitals for COVID-19 patients discharged from January 14 to March 10, 2020. After 28-day followed-up, patients who tested positive again for SARS-CoV-2 RNA and confirmed by reverse-transcriptase polymerase chain reaction were re-admitted to hospital for further treatments. All of the close contacts of patients who tested positive again were asked to self-segregate for 14 days. Data of epidemiology, symptoms, laboratory tests, and treatments were analyzed in those patients, and their close contacts were investigated.

Results

Of 1282 discharged patients, 189 (14.74%) tested positive again for SARS-CoV-2 RNA during 28-day follow-up. The median time from discharge to the next positive test was 8 days (interquartile range [IQR], 5–13). Patients in the group that tested positive again were younger (34 vs 45 years, P < .001) with a higher proportion of moderate symptoms (95.77% vs 84.35%, P < .001) in the first hospitalization than in the negative group. During the second hospitalization, all patients who tested positive again showed normal peripheral white blood cells and lymphocytes and no new symptoms of COVID-19; 78.31% further improved on chest computed tomography scan compared with the first discharge, yet 25.93% accepted antiviral therapy. The median time of re-positive to negative test was 8 days (IQR, 4–15). None of the close contacts developed COVID-19.

Conclusions

Our data suggest that the short-term recurrence of positive SARS-CoV-2 RNA in discharged patients is not a relapse of COVID-19, and the risk of onward transmission is very low. This provides important information for managing COVID-19 patients.
Prevention of Cardiac Implantable Electronic Device–Related Infection in Patients With Cancer: The Role of a Comprehensive Prophylactic Bundle Approach That Includes the Antimicrobial Mesh
Authors: Khalil Melissa , Karimzad Kaveh , Durand Jean-Bernard , Malek Alexandre E , Raad Issam I , Viola George M
Published: September 2020

Background

Oncological patients have several additional risk factors for developing a cardiac implantable electronic device (CIED)–related infection. Therefore, we evaluated the clinical impact of our comprehensive bundle approach that includes the novel minocycline and rifampin antimicrobial mesh (TYRX) for the prevention of CIED infections in patients living with cancer.

Methods

We retrospectively reviewed all consecutive patients who had a CIED placement at our institution during 2012–2017 who received preoperative vancomycin, intraoperative pocket irrigation with bacitracin and polymyxin B, plus TYRX antimicrobial mesh, followed by postoperative oral minocycline.

Results

A total of 154 patients had a CIED, with 97 permanent pacemakers (PPMs), 23 implantable cardioverter defibrillators (ICDs), and 34 cardiac resynchronization therapy (CRT) devices. An underlying solid cancer was present in 62% of patients, while 38% had a hematologic malignancy. Apart from a higher proportion of surgical interventions in the PPM group than in the ICD and CRT groups (P = .007), no other oncologic variables were statistically significantly different between groups. Despite an extensive median follow-up period (interquartile range) of 21.9 (6.7–33.8) months, 16 patients (10%) had a mechanical complication, while only 2 patients (1.3%) developed a CIED infection, requiring the device to be explanted.

Conclusions

Our comprehensive prophylactic bundle approach using TYRX antimicrobial mesh in an oncologic population at high risk for infections was revealed upon extensive follow-up to be both safe and effective in maintaining the rate of CIED infection at 1.3%, well within published averages in the broader population of CIED recipients.
Remedies, Analysed

†
Authors: Steel Sandy
Published: September 2020

While an extensive literature exists on the nature and justification of particular remedies, such as compensation or restitution, the nature and justification of remedies in general is less well explored. This article reviews Stephen Smith’s Rights, Wrongs, and Injustices: The Structure of Remedial Law, which offers an account of the nature of remedies, why courts award them, and a taxonomy of the grounds of private law remedies. The article considers the following questions addressed or raised by the book: (i) What is a remedy? (ii) Why do courts grant remedies? (iii) What are the grounds of remedies? and (iv) Should remedial law be considered an area of law? Each section sets out and analyses Smith’s answers and some alternative views are outlined. For example, I sketch a different account of the concept of a remedy which is not restricted to rulings, refine the book’s account of the distinction between substantive and remedial law, and offer reasons to doubt that the grounds of remedies are fully reducible to wrongs, injustices and Right threats.
A GPU-accelerated image reduction pipeline
Authors: Niwano Masafumi , Murata Katsuhiro L , Adachi Ryo , Wang Sili , Tachibana Yutaro , Yatsu Yoichi , Kawai Nobuyuki , Shimokawabe Takashi , Itoh Ryosuke
Published: September 2020

We developed a high-speed image reduction pipeline using Graphics Processing Units (GPUs) as hardware accelerators. Astronomers desire to detect the emission measure counterpart of gravitational-wave sources as soon as possible and to share in the systematic follow-up observation. Therefore, high-speed image processing is important. We developed a new image-reduction pipeline for our robotic telescope system, which uses a GPU via the Python package CuPy for high-speed image processing. As a result, the new pipeline has increased in processing speed by more than 40 times compared with the current one, while maintaining the same functions.
Designing Trials with Purpose: Pragmatic Clinical Trials of Nonpharmacological Approaches for Pain Management
Authors: Gordon Kirsha S , Peduzzi Peter , Kerns Robert D
Published: September 2020

Objective

Pain is one of the most significant causes of morbidity and disability worldwide. The efficacy of several nonpharmacological approaches for pain management has been established, but significant gaps exist between this evidence and their limited availability and use in routine clinical practice. Questions remain about their effectiveness and how best to integrate them in usual care to optimize patient-centered outcomes. Pragmatic clinical trials (PCTs) may help address this gap. Informed by the Pragmatic Explanatory Continuum Indicator Summary (PRECIS-2), we sought to describe the key features of optimized PCTs of nonpharmacological approaches for the management of pain and common co-occurring conditions.

Methods

To accomplish this objective, we searched the published literature on PCTs of nonpharmacological pain management approaches from 2010–2019 and applied the PRECIS-2 criteria. We discuss key PRECIS-2 domains of interest for designing and performing PCTs and cite specific examples from the published literature as potential models for future PCTs.

Results

We found 13 nonpharmacological PCTs. They were heterogeneous in size, recruitment, follow-up time, and location. The lessons learned from these studies led us to explicate key features of trials on the explanatory–pragmatic continuum across the PRECIS-2 domains that can be used by future investigators when designing their clinical trials of nonpharmacological approaches to pain management.

Conclusions

We encourage the increased application of PCTs to produce timely and valuable results and products that will inform the development of safe and effective integrated pain care plans that optimize important patient-centered outcomes.
Construct Validity of a Task-Oriented Bimanual and Unimanual Strength Measurement in Children With Unilateral Cerebral Palsy
Authors: Geijen Mellanie , Rameckers Eugene , Bastiaenen Caroline , Gordon Andrew , Smeets Rob
Published: September 2020

Objective

The purposes of this study were to (1) investigate aspects of construct validity of peak force measurements of crate-and-pitcher tasks using the Task-oriented Arm-hAnd Capacity (TAAC), an instrument designed to measure task-oriented arm and hand strength for cross-sectional and evaluation purposes, and (2) compare TAAC measurements with those of comparative measures using COSMIN guidelines.

Methods

In this cross-sectional validity study, participants were 105 children (mean age = 12 years 10 months; number of boys = 66) diagnosed with unilateral cerebral palsy (UCP). Ten a priori hypotheses were formulated with peak force of the TAAC as index measure and compared with measures on body functions and structure and activity level of the International Classification of Functioning, Disability and Health for Children and Youth. Strength and direction of the relationship between the TAAC and comparative measures were investigated by calculating Pearson correlation coefficients (r).

Results

On body functions and structures level, low-to-moderate positive correlations (0.493–0.687) were found. On activity level, low negative and positive correlations (−0.271 to 0.387) were found.

Conclusion

The construct of peak force measurement of the TAAC is in line with the a priori hypotheses with comparators on body function and structures and activity level, indicating a partial overlap of the construct of the TAAC with both International Classification of Functioning levels. The TAAC appears to be valuable, as it measures functional strength that differs from the constructs of the comparators. More research with a larger population and more comparators is needed.

Impact

Clinically relevant information is lacking about the use of strength and strength measurement during daily activities in children with UCP. This study shows that the TAAC provides unique information about functional strength in children with UCP.
Anonymity or Distance? Job Search and Labour Market Exclusion in a Growing African City
Authors: Abebe Girum , Caria A Stefano , Fafchamps Marcel , Falco Paolo , Franklin Simon , Quinn Simon
Published: September 2020

We show that helping young job seekers signal their skills to employers generates large and persistent improvements in their labour market outcomes. We do this by comparing an intervention that improves the ability to signal skills (the “job application workshop”) to a transport subsidy treatment designed to reduce the cost of job search. In the short run, both interventions have large positive effects on the probability of finding a formal job. The workshop also increases the probability of having a stable job with an open-ended contract. Four years later, the workshop significantly increases earnings, job satisfaction, and employment duration, but the effects of the transport subsidy have dissipated. Gains are concentrated on individuals who generally have worse labour market outcomes. Overall, our findings highlight that young people possess valuable skills that are unobservable to employers. Making these skills observable generates earnings gains that are far greater than the cost of the intervention.
Risks and Returns of Cryptocurrency
Authors: Liu Yukun , Tsyvinski Aleh
Published: September 2020

We establish that cryptocurrency returns are driven and can be predicted by factors that are specific to cryptocurrency markets. Cryptocurrency returns are exposed to cryptocurrency network factors but not cryptocurrency production factors. We construct the network factors to capture the user adoption of cryptocurrencies and the production factors to proxy for the costs of cryptocurrency production. Moreover, there is a strong time-series momentum effect, and proxies for investor attention strongly forecast future cryptocurrency returns.
National policy councils for science, technology, and innovation: A scheme for structural definition and implementation
Authors: Cevallos Rodrigo A , Merino Moreno Carlos
Published: September 2020

National policy councils for science, technology, and innovation have become a common institutional arrangement in supporting governments to overcome the problems of coordination derived from the complexity of national innovation systems. These organizations are expected to involve stakeholders with strategic capacity in defining long-term goals for science, technology, and innovation, to coordinate efforts and to monitor execution. However, governments face several options to devise the proper council for their purposes, and the absence of a common framework may induce theoretical and analytical difficulties. This exploratory and descriptive study proposes a scheme for defining the structure of such a council and a comprehensive approach that is based on the novel Organisation for Economic Co-operation and Development (OECD) database; analyzing the results obtained for thirty-one countries. The results obtained from the index confirm heterogeneity, while the clustering suggests three types of councils. The proposed scheme provides a standard tool for the study and implementation of these councils.
Can the digestibility of corn distillers dried grains with solubles fed to pigs at two stages of growth be enhanced through management of particle size using a hammermill or a roller mill?
Authors: Acosta Jesus A , Petry Amy L , Gould Stacie A , Jones Cassandra K , Stark Charles R , Fahrenholz Adam C , Patience John F
Published: September 2020

The objective of this study was to determine the impact of reducing the mean particle size (PS) of corn distillers dried grains with solubles (DDGS) with a hammermill (HM) or with a roller mill (RM) on the apparent total tract digestibility (ATTD) of dry matter (DM), gross energy (GE), N, acid hydrolyzed ether extract (AEE), and fiber components in growing and finishing pigs. Twenty-four growing barrows were housed in individual pens and were randomly assigned to a 3 × 2 factorial design (n = 8): three grinding methods [either corn DDGS ground with an HM to a PS of 450 μm; corn DDGS ground with an RM to a PS of 450 μm; and corn DDGS with a PS of 670 μm (not further ground)] and two body weight (BW) periods (growing pigs with an average initial BW of 54.7 ± 0.9 kg, and finishing pigs with an average initial BW of 107.8 ± 1.5 kg BW). Fecal samples were collected for each BW period in the last 3 d of an 11-d feeding period. Titanium dioxide was used as an indigestible marker. Digestibility data were analyzed using the MIXED procedure of SAS. Results showed that finishing pigs tended to have better ATTD of DM than growing pigs (P = 0.09) and had increased ATTD of GE and N than growing pigs (P = 0.03 and P < 0.01, respectively). On the other hand, growing pigs had better ATTD of AEE than finishing pigs (P = 0.01). Pig BW period did not affect the ATTD of neutral detergent fiber (NDF), acid detergent fiber (ADF), and hemicellulose. Reducing the mean PS of corn DDGS with either HM or RM (from 670 to 450 µm) improved the ATTD of DM and GE (P < 0.01 and P < 0.01), tended to improve the ATTD of N (P = 0.08), and improved the ATTD of AEE (P < 0.01). No effect of reducing PS was observed for the ATTD of NDF, ADF, or hemicellulose. There were no differences between HM and RM in any of the ATTD variables tested. In conclusion, reducing PS of corn DDGS from 670 to 450 μm either with an HM or with an RM improved the digestibility of DM, GE, and AEE and modestly improved the digestibility of N in growing and finishing pigs. However, reducing the PS of corn DDGS did not affect the digestibility of fiber components.
Posttraumatic Stress Disorder After a Psychedelic Experience, a Case Report
Authors: Rubin-Kahana Dafna Sara , Hassan Ahmed Nabeel , Le Foll Bernard
Published: September 2020

In the last 2 decades, there is a renaissance in the scientific investigation of the therapeutic potential of psychedelic compounds. It is studied for the treatment of many psychiatric disorders, including posttraumatic stress disorder. The treatment is always done in the setting of psychedelic-assisted psychotherapy. A little is known about the potential effects, outside of the setting of psychedelic-assisted psychotherapy, on people diagnosed with a mental disorder or have a significant trauma history. In this case report, we present a young man who developed posttraumatic stress disorder after a psychedelic experience, induced by both Lysergic Acid Diethylamide (LSD) and N, N Dimethyltryptamine (DMT). In the psychedelic experience, a repressed memory of childhood sexual abuse was recovered. To our knowledge, this is the first report on posttraumatic stress disorder onset after a psychedelic experience. We believe that this case report is important since the history of trauma is prevalent among individuals with substance use disorder. Medical staff that treat people with either substance use disorder or trauma should be familiar with irregular presentations, such as the one described in this case.
Using Extended Release Buprenorphine Injection to Discontinue Sublingual Buprenorphine: A Case Series
Authors: Ritvo Alexis D. , Calcaterra Susan L. , Ritvo Jonathan I.
Published: September 2020

Buprenorphine is highly effective for the treatment of opioid use disorder and is increasingly being used in the treatment of chronic pain. For various reasons, patients on buprenorphine may request discontinuation of this medication. Tapering off buprenorphine can be challenging due to intolerable withdrawal symptoms, including nausea, malaise, anxiety, and dysphoria. A single dose of extended-release buprenorphine may facilitate discontinuation of buprenorphine by mitigating prolonged, debilitating opioid withdrawal symptoms. We report on three cases of successful transition from low dose sublingual buprenorphine to a single injection of 100 mg extended-release buprenorphine to opioid cessation in patients who had previously been unable to taper fully off buprenorphine. This novel use of extended-release buprenorphine provides a viable alternative to fully transition patients off buprenorphine when they are medically and emotionally ready.
Loss-adjusting
Authors: Jones Abigail , Caes Line , Eccleston Christopher , Noel Melanie , Rugg Tessa , Jordan Abbie
Published: September 2020

Objectives:

Complex Regional Pain Syndrome (CRPS) is a chronic pain condition that can present specific difficulties when occurring in adolescence. There is limited work exploring future narratives of healthy adolescents, and how these may differ for those who have chronic health conditions, but there is no research on the future narratives of adolescents who have CRPS.

Materials and Methods:

In this study, 50 adolescents (44 females, 5 males, 1 preferred not to say) aged 14 to 25 years (mean=19.8, SD=3.68), completed an online story completion task, with a further sample of 10 completing a follow-up telephone interview.

Results:

Story completion data were initially analyzed deductively based on the work of Morley and colleagues using hoped-for and feared-for future codes, revealing higher instances of hope (291 over 48 stories) than fear (99 over 27 stories). These codes were subsequently analyzed alongside the in-depth interview data using inductive thematic analysis, generating 2 themes that represent distinct, yet related, approaches of how adolescents incorporate CRPS into their future narratives: (1) the centrality of loss theme identifies the ways some adolescents described how CRPS brings loss, with narratives focused on how these adolescents imagine such losses continuing into the future, and (2) the adjusting to loss theme illustrates the ways other adolescents were able to imagine a future in which they were able to adjust to the losses which CRPS may bring.

Discussion:

CRPS may damage the future plans of adolescents. However, being or learning how to be flexible about these goals, may help them to build more positive future narratives.
Comparisons of the Sensitivity and Reliability of Multiple Measures of Listening Effort
Authors: Giuliani Nicholas P. , Brown Carolyn J. , Wu Yu-Hsiang
Published: September 2020

Objectives:

The objective of this study was to evaluate the sensitivity and reliability of one subjective (rating scale) and three objective (dual-task paradigm, pupillometry, and skin conductance response amplitude) measures of listening effort across multiple signal to noise ratios (SNRs).

Design:

Twenty adults with normal hearing attended two sessions and listened to sentences presented in quiet and in stationary noise at three different SNRs: 0, –3, and –5 dB. Listening effort was assessed by examining change in reaction time (dual-task paradigm), change in peak to peak pupil diameter (pupillometry), and change in mean skin conductance response amplitude; self-reported listening effort on a scale from 0 to 100 was also evaluated. Responses were averaged within each SNR and based on three word recognition ability categories (≤50%, 51% to 71%, and >71%) across all SNRs. Measures were considered reliable if there were no significant changes between sessions, and intraclass correlation coefficients were a minimum of 0.40. Effect sizes were calculated to compare the sensitivity of the measures.

Results:

Intraclass correlation coefficient values indicated fair-to-moderate reliability for all measures while individual measurement sensitivity was variable. Self-reports were sensitive to listening effort but were less reliable, given that subjective effort was greater during the dual task than either of the physiologic measures. The dual task was sensitive to a narrow range of word recognition abilities but was less reliable as it exhibited a global decrease in reaction time across sessions. Pupillometry was consistently sensitive and reliable to changes in listening effort. Skin conductance response amplitude was not sensitive or reliable while the participants listened to the sentences. Skin conductance response amplitude during the verbal response was sensitive to poor (≤50%) speech recognition abilities; however, it was less reliable as there was a significant change in amplitude across sessions.

Conclusions:

In this study, pupillometry was the most sensitive and reliable objective measure of listening effort. Intersession variability significantly influenced the other objective measures of listening effort, which suggests challenges for cross-study comparability. Therefore, intraclass correlation coefficients combined with other statistical tests more fully describe the reliability of measures of listening effort across multiple difficulties. Minimizing intersession variability will increase measurement sensitivity. Further work toward standardized methods and analysis will strengthen our understanding of the reliability and sensitivity of measures of listening effort and better facilitate cross-modal and cross-study comparisons.
Stability-Based Classification of Ankle Fractures—The Long-Term Outcome After 11–13 Years of Follow-up
Authors: Karkkola Sini , Kortekangas Tero , Pakarinen Harri , Flinkkilä Tapio , Niinimäki Jaakko , Leskelä Hannu-Ville
Published: September 2020

Objectives:

To assess the long-term functional and radiological outcome, as well as complications and reoperations of ankle fracture patients treated based on stability classification.

Design:

Retrospective.

Setting:

Main Trauma Center, University Hospital.

Patients and Interventions:

One hundred sixty patients were treated based on stability classification. After a mean follow-up of 12 years, 102 patients were assessed; 67 visited the outpatient clinic, and standard standing ankle radiographs were taken; osteoarthritis (OA) was graded according to Kellgren–Lawrence classification. The remaining patients (n = 35) were followed up via mail or telephone. The complications and reoperations of all 160 patients were collected from electronic patient records.

Main Outcome Measures:

Olerud–Molander ankle score, foot and ankle outcome score, visual analog scale, RAND-36 item health survey, range-of-motion measurements, and Kellgren–Lawrence OA classification.

Results:

Very good to excellent ankle functional outcome was reported by 96% of the stable fracture group [mean Olerud–Molander ankle score (OMAS), 92; range, 20–100] and 82% of the unstable group (mean OMAS, 86; range, 30–100). For patients with an unstable fracture, OMAS and VAS pain scores significantly improved from 2 to 12 years, even though higher grades of radiologic OA were found. No patients with fractures deemed stable needed operative intervention even in the long-term follow-up. Instead, 30% of the operatively treated patients underwent reoperation during the long follow-up.

Conclusions:

The treatment of ankle fractures based on stability-based classification led to predictable, functionally good outcomes even during long-term follow-up. Ankle fractures can reliably be deemed stable based on this classification and treated without failures in the long term.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Rod-Screw Constructs Composed of Dissimilar Metals Do Not Affect Complication Rates in Posterior Fusion Surgery Performed for Adult Spinal Deformity
Authors: Denduluri Sahitya K. , Koltsov Jayme C.B. , Ziino Chason , Segovia Nicole , McMains Craig , Falakassa Jonathan , Ratliff John , Wood Kirkham B. , Alamin Todd , Cheng Ivan , Hu Serena S.
Published: September 2020

Study Design:

This was a retrospective cohort study.

Objective:

The objective of this study was to compare implant-related complications between mixed-metal and same-metal rod-screw constructs in patients who underwent posterior fusion for adult spinal deformity.

Summary of Background Data:

Contact between dissimilar metals is discouraged due to potential for galvanic corrosion, increasing the risk for metal toxicity, infection, and implant failure. In spine surgery, titanium (Ti) screws are most commonly used, but Ti rods are notch sensitive and likely more susceptible to fracture after contouring for deformity constructs. Cobalt chrome (CC) and stainless steel (SS) rods may be suitable alternatives. No studies have yet evaluated implant-related complications among mixed-metal constructs (SS or CC rods with Ti screws).

Methods:

Adults with spinal deformity who underwent at least 5-level thoracic and/or lumbar posterior fusion or 3-column osteotomy between January 2013 and May 2015 were reviewed, excluding neuromuscular deformity, tumor, acute trauma or infection. Implant-related complications included pseudarthrosis, proximal junctional kyphosis, hardware failure (rod fracture, screw pullout or haloing), symptomatic hardware, and infection.

Results:

A total of 61 cases met inclusion criteria: 24 patients received Ti rods with Ti screws (Ti-Ti, 39%), 31 SS rods (SS-Ti, 51%), and 6 CC rods (CC-Ti, 9.8%). Median follow-up was 37–42 months for all groups. Because of the limited number of cases, the CC-Ti group was not included in statistical analyses. There were no differences between Ti-Ti and SS-Ti groups with regard to age, body mass index, or smokers. Implant-related complications did not differ between the Ti-Ti and SS-Ti groups (P=0.080). Among the Ti-Ti group, there were 15 implant-related complications (63%). In the SS-Ti group, there were 12 implant-related complications (39%). There were 3 implant-related complications in the CC-Ti group (50%).

Conclusion:

We found no evidence that combining Ti screws with SS rods increases the risk for implant-related complications.
Comparison of Early Surgical Treatment With Conservative Treatment of Incomplete Cervical Spinal Cord Injury Without Major Fracture or Dislocation in Patients With Pre-existing Cervical Spinal Stenosis
Authors: Lee Subum , Kim Chunghwan , Ha Jung-Ki , Jung Sang Ku , Park Jin Hoon
Published: September 2020

Study Design:

This was a retrospective comparative study.

Objective:

The objective of this study was to evaluate the clinical outcomes of early surgical treatment (<24 h) and conservative treatment of incomplete cervical spinal cord injury (CSCI) without major fracture or dislocation in patients with pre-existing cervical spinal canal stenosis (CSCS).

Summary of Background Data:

The relative benefits of surgery, especially early surgical treatment, and conservative treatment for CSCI without major fracture or dislocation in patients with pre-existing CSCS remain unclear. Animal models of CSCI have demonstrated that early surgical decompression immediately after the initial insult may prevent or reverse secondary injury. However, the clinical outcomes of early surgery for incomplete CSCI in patients with pre-existing CSCS are still unclear.

Materials and Methods:

The medical records and radiographic data of 54 patients admitted to our facility between 2005 and 2015 with American Spinal Injury Association (ASIA) impairment scale grade B or C and pre-existing CSCS without major fracture or dislocation were retrospectively reviewed. Thirty-three patients (mean age, 57.4±14.0 y) underwent early surgical treatment within 24 hours after initial trauma (S group), and 21 patients (mean age, 56.9±13.6 y) underwent conservative treatment (C group) performed by 2 spinal surgeons in accordance with their policies. The primary outcome was the degree of improvement in ASIA grade after 2 years.

Results:

During the 2-year follow-up period, higher percentages of patients in the S group than in the C group showed ≥1 grade (90.9% vs. 57.1%, P=0.0051) and 2 grade (30.3% vs. 9.5%) improvements in ASIA grade. Multivariate analysis showed that treatment type, specifically early surgical treatment, was the only factor significantly associated with ASIA grade improvement after 2 years (P=0.0044).

Conclusions:

Early surgery yielded better neurological outcomes than conservative treatment in patients with incomplete CSCI without major fracture or dislocation and pre-existing CSCS.

Level of Evidence:

Level III.
Pulley Release and Reconstruction With Acellular Dermal Matrix After Zone 2 Flexor Tendon Injury
Authors: Kurlander David E. , Swanson Marco , Tu Leigh-Anne , Kumar Anand R. , Long Tobias C. , Lineberry Kyle D. , Khouri Joseph S.
Published: September 2020

Zone 2 flexor tendon repair has been historically associated with poor outcomes, mainly due to stiffness. In an effort to minimize adhesions, accommodate flexor digitorum profundus and flexor digitorum superficialis bulk, and prevent bowstringing, we have developed a novel approach to flexor tendon repair that relies on aggressive flexor tendon pulley release and pulley reconstruction with acellular dermal matrix. This technique leverages the antiadhesive properties and high tensile strength of acellular dermal matrix to maximize gliding and prevent bowstringing. Here we describe the details of our technique and illustrate a case where this technique was employed.
Association of weight change in young adulthood with subsequent risk of hepatocellular carcinoma: a national cohort study
Authors: Kim Kyuwoong , Choi Seulggie , Lee Gyeongsil , Son Joung Sik , Kim Kyae Hyung , Park Sang Min
Published: September 2020

Risk of hepatocellular carcinoma (HCC) in young adults might be clinically overlooked for future HCC risk. Thus, we examined the association between weight change and future risk of developing HCC in young adults. We collected a nationwide and population-based cohort data of more than 2.2 million men and women aged between 20 and 39 who were without previous cancer diagnosis and underwent two consecutive biennial national health screening between 2002 and 2005 from the National Health Insurance Service database. The individuals were categorized as weight loss (≥5.0 kg and 2.0–4.9 kg), stable weight (weight gain or loss <2.0 kg), and weight gain (2.0–4.9 kg and ≥5.0 kg) and were followed-up for incident HCC from 1 January 2006 to 31 December 2018. During 12 years of follow-up, there were 2694 HCCs in men and 306 HCCs in women. In the multivariable Cox proportional hazards model adjusted for socioeconomic, health behavior, medical characteristics, and family history, weight gain of more than 5.0 kg and between 2.0 and 4.9 kg were associated with significantly increased risk in young men [hazard ratio (HR) 1.16, 95% confidence intervals (95% CI) 1.01–1.32] and young women (HR 1.34, 95% CI 1.01–1.77), respectively. Protective association of weight loss with HCC was not observed. The association of weight gain and HCC risk was stronger in young adults with underlying liver diseases compared to those without any liver disease (P
heterogeneity < 0.001). Weight gain during young adulthood should not be clinically overlooked for future HCC risk, especially among those with underlying liver diseases.
Adult height and risk of gastric cancer: a pooled analysis within the Stomach cancer Pooling Project
Authors: Giraldi Luca , Stojanovic Jovana , Arzani Dario , Persiani Roberto , Hu Jinfu , Johnson Kenneth C. , Zhang Zuo-Feng , Ferraroni Monica , Palli Domenico , Yu Guo-Pei , La Vecchia Carlo , Pelucchi Claudio , Lunet Nuno , Ferro Ana , Malekzadeh Reza , Muscat Joshua , Zaridze David , Maximovich Dmitry , Aragones Nuria , Martin Vicente , Vioque Jesùs , Navarrete-Munoz Eva M. , Pakseresht Mohammadreza , Negri Eva , Rota Matteo , Pourfarzi Farhad , Mu Lina , Kurtz Robert C. , Lagiou Areti , Lagiou Pagona , Pastorino Roberta , Boccia Stefania
Published: September 2020

Background

The association between height and risk of gastric cancer has been studied in several epidemiological studies with contrasting results. The aim of this study is to examine the association between adult height and gastric cancer within a large pooled analysis of case-control studies members of the Stomach cancer Pooling (StoP) Project consortium.

Methods

Data from 18 studies members of the StoP consortium were collected and analyzed. A multivariable logistic regression model was used to estimate the study-specific odds ratios (ORs) and 95% confidence intervals (CIs) for the association between 10-cm increase in height and risk of gastric cancer. Age, sex, tobacco smoking, alcohol consumption, social class, geographical area and Helicobacter pylori (H. pylori) status were included in the regression model. Resulting estimates were then pooled with random-effect model. Analyses were conducted overall and in strata of selected variables.

Results

A total of 7562 cases and 19 033 controls were included in the analysis. The pooled OR was 0.96 (95% CI 0.87–1.05). A sensitivity analysis was performed restricting the results to the studies with information on H. pylori status, resulting in an OR of 0.97 (95% CI 0.79–1.20).

Conclusion

Our study does not support a strong and consistent association between adult height and gastric cancer.
Survival patterns of childhood neuroblastoma: an analysis of clinical data from Southern-Eastern European countries
Authors: Karalexi Maria A. , Servitzoglou Marina , Papadakis Vassilios , Kachanov Denis , Česen Mazič Maja , Baka Margaret , Moschovi Maria , Kourti Maria , Polychronopoulou Sofia , Stiakaki Eftichia , Hatzipantelis Emmanuel , Dana Helen , Stefanaki Kalliopi , Malama Astero , Themistocleous Marios S. , Strantzia Katerina , Shamanskaya Tatyana , Bouka Panagiota , Panagopoulou Paraskevi , Kantzanou Maria , Ntzani Evangelia , Dessypris Nick , Petridou Eleni Th.
Published: September 2020

The prognosis of children with neuroblastoma (NBL) can be dismal with significant variations depending on the stage and biology of the tumor. We assessed the event-free (EFS) and overall (OS) survival using harmonized data from three Southern-Eastern European (SEE) countries. Data for 520 incident NBL cases (2009–2018) were collected from Greece, Slovenia and Russia. Kaplan–Meier curves were fitted, and EFS/OS were derived from Cox proportional models by study variables including the protocol-based risk-group (low/observation, intermediate, high). Over one-third of cases were coded in the high-risk group, of which 23 children (4.4%) received treatment with anti-ganglioside 2 (GD2) mAb. Survival rates were inferior in older (OS 5-year; 1.5–4.9 years: 61%; EFS 5-year; 1.5–4.9 years: 48%) compared to children younger than 1.5 years (OS 5-year; <1.5 years: 91%; EFS 5-year; <1.5 years: 78%). Predictors of poor OS included stage 4 (hazard ratio, HROS: 18.12, 95% confidence intervals, CI: 3.47–94.54), N-myc amplification (HROS: 2.16, 95% CI: 1.40–3.34), no surgical excision (HROS: 3.27, 95% CI: 1.91–5.61) and relapse/progression (HROS: 5.46, 95% CI: 3.23–9.24). Similar unfavorable EFS was found for the same subsets of patients. By contrast, treatment with anti-GD2 antibody in high-risk patients was associated with decreased risk of death or unfavorable events (HROS: 0.11, 95% CI: 0.02–0.79; HREFS: 0.19, 95% CI: 0.07–0.52). Our results confirm the outstanding prognosis of the early NBL stages, especially in children <1.5 years, and the improved outcomes of the anti-GD2 treatment in high-risk patients. Ongoing high-quality clinical cancer registration is needed to ensure comparability of survival across Europe and refine our understanding of the NBL biology.
A validated tool of combining risk factors with fecal immunochemical test for selecting colonoscopy in asymptomatic Chinese population
Authors: Liao Yi , Li Senmao , Chen Hao , Chen Chunyu , Huang Jintuan , Lin Feng , Wang Jianping , Yang Zuli
Published: September 2020

Fecal immunochemical test (FIT) is often used for preselection for colonoscopy, but FIT has nonoptimal sensitivity. Selection of study participant for colonoscopy based on the result of combining FIT with risk factors could improve the sensitivity of a screening program. We aimed to develop a risk prediction system of colorectal neoplasia among asymptomatic Chinese subjects. A total of 6265 asymptomatic participants with age between 50 and 70 years were invited to undergo colonoscopy screening. They were also asked to take FIT and complete a questionnaire for collecting information on risk factors. Independent risk factors were identified by binary logistic regression for colorectal neoplasia. A risk score model was developed by using the odds ratios of significant risk factors. The scoring system was divided into two groups of risk: negative risk and positive risk. The performance of the risk score model in terms of predicting colorectal neoplasia was evaluated. Of the 1786 colonoscopy screening participants, 1546 completed FIT and questionnaires. A total of 462 cases of neoplasia were detected. Based on the scoring stratification, 966 (62.5%) participants were in negative risk tier and 580 (37.5%) were in positive risk tier. The incidence of colorectal neoplasia in negative risk and positive risk groups was 18.4 and 49.0%, respectively. Risk stratification model has better ability to discriminate those with or without colorectal neoplasia than FIT-only model. Classification improved significantly with risk stratification-based screening (net reclassification improvement = 0.064, P = 0.032). Risk stratification system increases the predictive value of FIT-based screening and is useful for preselection for colonoscopy in colorectal cancer screening program.
Building on Evidence to Improve eHealth Literacy in Older Adults
Authors: Chang Sun Ju , Jang Sun Joo , Lee Haeyoung , Kim Hyunjung
Published: September 2020

This review aimed to provide information on ways to improve eHealth literacy in older adults by assessing current studies examining eHealth literacy. To achieve the aim, this review focused on what theories or theoretical frameworks were used in the studies, what factors were related to eHealth literacy, and what outcome variables were used in eHealth literacy interventions for older adults. Five electronic databases were searched to identify eligible studies. The Cochrane Handbook for Systematic Reviews of Interventions was followed to select relevant studies, and narrative synthesis was performed. Among a total of 27 studies, 13 described theories or theoretical frameworks. Credibility in Internet health information, knowledge, and experience were identified as modifiable factors related to eHealth literacy. The most frequently used outcome variable was eHealth literacy efficacy. Nurses who are interested in improving eHealth literacy in older adults should consider appropriate theoretical frameworks and multiple factors influencing eHealth literacy.
A Phase I, Open-label, Dose-escalation, and Cohort Expansion Study to Evaluate the Safety and Immune Response to Autologous Dendritic Cells Transduced With AdGMCA9 (DC-AdGMCAIX) in Patients With Metastatic Renal Cell Carcinoma
Authors: Faiena Izak , Comin-Anduix Begoña , Berent-Maoz Beata , Bot Adrian , Zomorodian Nazy , Sachdeva Ankush , Said Jonathan , Cheung-Lau Gardenia , Pang Jia , Macabali Mignonette , Chodon Thinle , Wang Xiaoyan , Cabrera Paula , Kaplan-Lefko Paula , Chamie Karim , Belldegrun Arie S. , Pantuck Allan J. , Drakaki Alexandra
Published: September 2020

Expression of carbonic-anhydrase IX (CAIX) in clear cell renal cell carcinoma (RCC) makes it an attractive vaccine target. We developed a fusion-gene construct, granulocyte-macrophage (GM) colony-stimulating factor+CAIX, delivered by an adenoviral vector (Ad) into autologous dendritic cells (DCs) in this phase 1 study. The injected immature DCs were expected to stimulate an antigen-specific immune response against CAIX expressing RCC. Three dose-escalation cohorts (5, 15, and 50×106 cells/administration) were injected intradermally q2wk×3 doses based on a 3+3 design. The primary objective was the safety of the injections. Secondary objectives were immune responses using enzyme-linked immunosorbent spot, a serum biomarker panel, and clinical response. Fifteen patients with metastatic RCC were enrolled, and 9 patients received all 3 doses. No serious adverse events were seen. There were 3 (33%) patients with grade 1 fatigue, 1 of whom subsequently experienced grade 2 fatigue. One patient (11%) experienced grade 1–2 leukopenia. Only 1 patient (11%) experienced grade 2 flu-like symptoms. Of the 9 patients who received treatment, 1 expired of progressive disease, 2 patients were lost to follow-up and 6 patients are alive. Of the 6 patients, 5 have progressive disease, and 1 has completed treatment with stable disease at 27 months follow-up. Immune response measurements appeared more robust in higher dose cohorts, which appeared to be related to patients with stable disease at 3 months. These early data show that autologous immature DC-AdGMCAIX can be safely given to metastatic RCC patients without any serious adverse events with CAIX-specific immune response elicited by the treatment. These preliminary data support further study of Ad-GMCAIX, particularly with combination therapies that may enhance clinical activity.