bluuebunny/crossref_metadata_2025_split huggingface dataset:
Argonaute binding within 3′-untranslated regions poorly predicts gene repression
Authors: Chu Yongjun , Kilikevicius Audrius , Liu Jing , Johnson Krystal C , Yokota Shinnichi , Corey David R 
Published: May 2020

Abstract
Despite two decades of study, the full scope of RNAi in mammalian cells has remained obscure. Here we combine: (i) Knockout of argonaute (AGO) variants; (ii) RNA sequencing analysis of gene expression changes and (iii) Enhanced Crosslinking Immunoprecipitation Sequencing (eCLIP-seq) using anti-AGO2 antibody to identify potential microRNA (miRNA) binding sites. We find that knocking out AGO1, AGO2 and AGO3 together are necessary to achieve full impact on steady state levels of mRNA. eCLIP-seq located AGO2 protein associations within 3′-untranslated regions. The standard mechanism of miRNA action would suggest that these associations should repress gene expression. Contrary to this expectation, associations between AGO and RNA are poorly correlated with gene repression in wild-type versus knockout cells. Many clusters are associated with increased steady state levels of mRNA in wild-type versus knock out cells, including the strongest cluster within the MYC 3′-UTR. Our results suggest that assumptions about miRNA action should be re-examined.
Conservative Management of Type II Odontoid Fractures in Older People: A Retrospective Observational Comparison of Osseous Union Versus Nonunion
Authors: McIlroy Suzanne , Lam Jordan , Khan Muhammad Faheem , Mirza Asfand Baig , Philip Jerry Ajayi , Grahovac Gordan , Bell David 
Published: May 2020

Abstract

BACKGROUND
Type II odontoid fractures are a common cervical fracture in older people. Lower osseous-union rates are reported in those treated conservatively compared to surgically; however, the clinical relevance of a nonunion is unknown.

OBJECTIVE
To compare pain, disability, and quality of life in older people following conservative management of type II odontoid fractures demonstrating osseous-union and nonunion.

METHODS
Electronic records were searched from 2008 to 2018 for adults ≥65 yr with type II odontoid fracture, managed in a semi-rigid collar. Clinical and demographic data were retrieved from electronic patient notes. Surviving patients were invited to complete questionnaires to assess pain, disability, and quality of life. Ethical approval was granted.

RESULTS
A total of 125 patients were identified: 36 (29%) demonstrated osseous-union, 89 (71%) had nonunion, of which 33 (40%) had radiological instability. Mean age at fracture was 84 yr (osseous-union 83 yr; nonunion 84 yr). A total of 53 had deceased (41 nonunion). Median length of survival was 77 mo for osseous-union vs 50 mo for nonunion; P = .02. No patient developed myelopathy during the follow-up period. Questionnaire response rate was 39 (58%). There were no statistically significant differences between the groups in terms of pain, disability, or quality of life (P > .05). Both groups reported mild disability and pain but low quality of life.

CONCLUSION
Management with a semi-rigid collar in older people with type II odontoid fracture is associated with low levels of pain and disability without statistically significant differences between those demonstrating osseous-union or stable or unstable nonunions. Conservative management appears to be a safe treatment for older people with type II fractures.
Outcomes of Operative Vaginal Delivery Managed by Residents Under Supervision and Attending Obstetricians: A Prospective Cross-sectional Study
Authors: Sentilhes L. , Madar H. , Ducarme G. , Hamel J. , Mattuizzi A. , Hanf M. 
Published: May 2020

(Am J Obstet Gynecol. 2019;221:59.e1–59.e15)
Operative vaginal delivery is intended to expedite vaginal delivery during a prolonged second stage of delivery or for suspected fetal compromise. While every resident should be proficient with delivery requiring forceps and/or vacuum extractors by the end of their training, these procedures are associated with greater maternal and neonatal morbidity than spontaneous vaginal delivery in the short-term. Obstetricians are at greater litigation risk if neonatal trauma or brachial plexus injury occurs. Therefore, there has been a decrease in operative vaginal deliveries in different parts of the world during the last 2 decades. The United States has seen a decrease from 10% of all births in 1994 to 3% in 2014 for both vacuum and forceps assisted deliveries. This decrease is despite the American College of Obstetricians (ACOG) and the Society for Maternal-Fetal Medicine advocating the use of operative vaginal delivery as a means of reducing cesarean section rates. The aim of this study was to determine the maternal morbidity and neonatal morbidity in a large French observational study of attempted operative vaginal deliveries.
Association of Early Postnatal Transfer and Birth Outside a Tertiary Hospital With Mortality and Severe Brain Injury in Extremely Preterm Infants: Observational Cohort Study With Propensity Score Matching
Authors: Helenius K. , Longford N. , Lehtonen L. , Modi N. , Gale C. 
Published: May 2020

(BMJ. 2019;367:1–11)
The occurrence of infants born <28 weeks gestation is rare in both the United Kingdom and the United States, but such incidents carry a very high risk of death, neonatal morbidity, and long-term disability. Previous research has indicated that the best outcomes for these infants are achieved when care is given in specialized tertiary hospitals. At-risk pregnant women who present at nontertiary hospitals are often transferred to more specialized facilities either before or after delivery; a number of recent studies have focused on the outcomes of infants who were transferred postnatally, with inconclusive results. These investigators conducted their research to determine if transferred infants had a higher incidence of mortality and severe brain injury compared with nontransferred infants born in tertiary hospitals.
Remifentanil Patient-controlled Analgesia in Labour: 6-Year Audit of Outcome Data of the RemiPCA SAFE Network (2010-2015)
Authors: Melber A.A. , Jelting Y. , Huber M. , Keller D. , Dullenkopf A. , Girard T. , Kranke P. 
Published: May 2020

(Int J Obstet Anesth. 2019;39:12–21)
Remifentanil patient-controlled analgesia (PCA) has been used for ∼20 years during labor as an alternative analgesic approach. While many units utilize this analgesic option in patients who cannot receive neuraxial analgesia, some offer it routinely to their laboring patients. There are some potentially serious side effects of remifentanil PCA, such as respiratory depression and hypoxemia. Swiss researchers developed the RemiPCA SAFE Network in 2009 when the analgesic technique became available in their country. The purpose of the network was to monitor PCA use and assess maternal and neonatal outcomes. While initially developed for Swiss facilities, the network later allowed obstetric units from other countries to participate and provide their data. Data collected by the network helps individual facilities to evaluate their performance and allows the network committee to assess the overall outcomes of remifentanil PCA for labor. The goal of the current audit study was to accurately outline the quality assurance system used by the network and analyze outcomes on remifentanil PCA effectiveness and safety based on the data collected.
Dose-Response Study of 4 Weight-Based Phenylephrine Infusion Regimens for Preventing Hypotension During Cesarean Delivery Under Combined Spinal-Epidural Anesthesia
Authors: Xiao F. , Shen B , Xu W.P. , Feng Y. , Ngan Kee W.D. , Chen X.Z. 
Published: May 2020

(Anesth Analg. 2020;130:187–193)
When performing a cesarean delivery, anesthesiologists are most likely to use spinal anesthesia or combined spinal-epidural anesthesia, although these methods are associated with high rates of hypotension. Phenylephrine is considered to be an acceptable vasopressor for hypotension prevention, but not much research has been done to determine the optimal dose for prophylactic phenylephrine infusions. The few studies that have examined phenylephrine infusions did not use infusion rates that had been properly adjusted for patient body weight, so more research is warranted. These investigators conducted their study to examine the dose-response relationship for a fixed-rate, weight-based phenylephrine infusion under combined spinal-epidural anesthesia during cesarean delivery. In addition, the authors aimed to determine the infusion dose that would adequately prevent hypotension for 50% (ED50) and 90% (ED90) of patients.
Ultrasound-guided Transmuscular Quadratus Lumborum Block for Elective Cesarean Section Significantly Reduces Postoperative Opioid Consumption and Prolongs Time to First Opioid Request: A Double-blind Randomized Trial
Authors: Hansen C.K. , Dam M. , Steingrimsdottir G.E. , Laier G.H. , Lebech M. , Poulsen T.D. , Chan V.W.S. , Wolmarans M. , Bendtsen T.F. , Børglum J. 
Published: May 2020

(Reg Anesth Pain Med. 2019;44:896–900)
Reducing pain and opioid consumption after scheduled cesarean delivery is important for maternal comfort and bonding with her newborn. The quadratus lumborum block has been found to reduce pain after cesarean delivery. This study aimed to evaluate the analgesic effect of an ultrasound-guided transmuscular quadratus lumborum (TQL) block in reducing opioid consumption in the first 24 hours following cesarean delivery. The authors hypothesized a TQL block with ropivacaine would result in a minimum relevant difference of 50% reduction in opioid consumption during the first 24 hours compared with a TQL block with saline placebo.
Maternal Respiratory Distress and Successful Reversal With Sugammadex During Intrauterine Transfusion With Fetal Paralysis
Authors: Munro A. , McKeen D. , Coolen J. 
Published: May 2020

(Int J Obstet Anesth. 2019;39:129–140)
Intrauterine transfusion (IUT) is a treatment for fetal anemia resulting from Rh(D) alloimmunization. Fetal paralysis is often utilized during an IUT procedure to improve its safety. Fetal bradycardia is one of the most common complications of the procedure, and use of paralysis has been found to significantly decrease the risk of fetal heart rate changes during IUT. There are several neuromuscular blocking agents (NMBA) available for inducing fetal paralysis, and a possible complication during IUT is inadvertent maternal administration of an NMBA. This case report involved maternal respiratory distress secondary to unintended neuromuscular blockade during IUT, which was treated with sugammadex administration.
Driving high-functioning clinical teams
Authors: Brooks Paula B. , Fulton Megan E. 
Published: May 2020

ABSTRACT

Background:
Rapid changes in the healthcare marketplace are driving healthcare systems to modify operations by which advanced practice registered nurses (APRNs) and physician assistants (PAs) serve patients. By identifying more effective and efficient utilization workflows, organizations can meet these demands, resulting in high-functioning clinical teams.

Local problem:
With the growing number of APRNs and PAs in a large academic medical center, there was a recognized need to establish effective and efficient utilization practices for these healthcare providers.

Methods:
Directors of the APP Best Practice Center developed an internal NP/certified nurse midwife (CNM)/clinical nurse specialist (CNS)/PA assessment service which conducted evaluations to optimize APRN and PA practice at the clinical/department level. This assessment excluded certified registered nurse anesthetists.

Interventions:
Thirty-two clinical areas were evaluated between September 2016 and May 2019. This included an NP/CNM/CNS/PA survey and more than 200 individual NP/CNM/CNS/PA interviews. Assessments addressed utilization, billing practices, professional development, and communication among team members.

Results:
Qualitative and quantitative reports were compiled. Many common themes were identified. These were broken down into three major categories: productivity, clinical operations, and professional development/support.

Conclusions:
Several recommendations were presented to department leaders about NP/CNM/CNS/PA practice. Departments that implemented several of the recommendations showed positive outcomes. This was evidenced by increased financial gain (increased relative value units, increase in revenue generated), increased patient access (increased clinic densities), and overall NP/CNM/CNS/PA satisfaction.
Factors Affecting Changes of Cluster of Differentiation 4 Cell Counts Among Human Immunodeficiency Virus-positive People Who Inject Heroin and Receive Methadone Maintenance Treatment
Authors: Wu Kuen-Hong , Juan Shao-Chiu , Chan Chia-Hsiang , Chou Sun-Yuan , Chan Hung-Yu 
Published: May 2020

Aims:
Opioids have been hypothesized to suppress the immune function and worsen outcomes among people living with human immunodeficiency virus (HIV). The study aimed to identify key factors associated with the increased cluster of differentiation 4 (CD4) cell counts among HIV-positive people who inject heroin and receive methadone maintenance treatment (MMT).

Methods:
This longitudinal study was conducted at a psychiatric hospital in Northern Taiwan. Participants were recruited from 2006 through 2011, and received CD4 cell counts and HIV viral load monitoring once every 4 to 6 months. Trend in CD4 cell counts, defined as change in CD4 cell count over time, was used as the outcome measure. Independent variables included MMT-related factors and baseline characteristics. Baseline characteristics included age, gender, CD4 cell count, HIV viral load, tests for other infections, liver function tests, and urine drug screens.

Results:
Three hundred and fifty one participants were recruited during the study period. The multivariate linear mixed model analysis revealed a higher MMT attendance rate, a higher baseline CD4 cell count, and a shorter duration of MMT were associated with an increase in CD4 cell count over time.

Conclusions:
The study showed better adherence to MMT was associated with better preserved immune functions. The negative impact of duration of MMT on CD4 cell counts may be ameliorated by improving the attendance rate, initiation of MMT earlier when the baseline CD4 cell count is still relatively high and by the other beneficial effects of MMT, such as healthier lifestyles with reduced use of short-acting opioids.
Relationship Between Corrective Saccades and Measures of Physical Function in Unilateral and Bilateral Vestibular Loss
Authors: Riska Kristal M. , Bellucci Jordan , Garrison Doug , Hall Courtney 
Published: May 2020

Objectives:
Following the loss of vestibular function, some patients functionally improve and are minimally bothered by their loss of peripheral function while others remain more symptomatic and are unable to return to their activities of daily living. To date, the mechanisms for functional improvement remain poorly understood. The purpose of the present study was to examine the association between corrective saccades and measures of handicap, dynamic visual acuity, gait, and falls.

Design:
A retrospective chart review was performed to identify patients who were diagnosed with unilateral or bilateral vestibular hypofunction and who also completed a baseline vestibular rehabilitation evaluation. A total of 82 patients with unilateral vestibular hypofunction and 17 patients with bilateral vestibular hypofunction were identified. The video head impulse test results for each patient were grouped based on the type of presenting saccades. Specifically, the saccade grouping included the following: (1) covert, (2) overt, or (3) a combination of both types of saccades.

Results:
The results show that covert saccades are associated with better performance on measures of dynamic visual acuity, gait, and balance in patients with unilateral vestibular hypofunction. Patients exhibiting overt saccades or combination of both covert and overt saccades were more often found to have an abnormal gait speed and be characterized as being at risk for falls using the Dynamic Gait Index. We observed no differences in physical function for those patients with bilateral vestibular hypofunction as a function of saccade grouping.

Conclusions:
When comparing saccade groups (covert, overt, or combination of both), patients with unilateral vestibular hypofunction and covert saccades demonstrated better performance on standard baseline physical therapy measures of dynamic visual acuity and gait and balance. We did not observe any significant associations between saccade group and physical function in patients with bilateral vestibular hypofunction; however, additional studies are needed with adequate sample sizes. Our findings may suggest that corrective saccade latency in patients with unilateral vestibular hypofunction is related to measures of physical function. The extent to which saccade latency has the potential to be a useful target for vestibular rehabilitation is still to be determined and may be promising target to improve functional outcomes.
Management of nonarthritic meniscal tears: a qualitative, patient-centered assessment of decision making
Authors: Nelson Patrick , Bhatt Surabhi , Terry Michael , Tjong Vehniah 
Published: May 2020

Background:
Meniscal lesions are the most common intraarticular knee injury. Treatment involves a decision for conservative management or surgery. Recent literature has demonstrated similar outcomes between these two methods in patients with meniscal tears and minimal arthritis. This study explores factors influencing a patient’s decision to choose operative versus nonoperative management in the treatment of nonarthritic meniscal lesions.

Methods:
Semistructured interviews were conducted with patients ages 18 to 50 yr old, with MRI confirmed diagnosis of meniscal tear and minimum of 2-year follow-up. Patients with Kellen-Lawrence Grade 2 or greater, with prior knee injuries, or knee surgeries were excluded. Qualitative analysis was performed to derive codes, categories, and themes. An assessment of patient-reported outcomes including the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Marx activity score was also conducted.

Results:
Twenty-four patients with meniscal tears were interviewed. Those who chose surgical management with arthroscopic partial meniscectomy (n=12) cited significant pain, desire for definitive treatment, and aggressive personality traits. The nonoperative group (n=12) frequently had social constraints precluding surgery, more conservative personalities, and symptoms that did not affect their daily lives. The nonoperative group had significantly lower KOOS scores in symptoms (90.2 vs. 76.5, P=0.05), sports and recreation (84.2 vs. 64.2, P=0.05), and quality of life (QOL) (85.4 vs. 62.0, P=0.01).

Conclusions:
Psychological and social factors such as pain perception, personality, and time commitments affected patients’ decisions to undergo surgical or conservative management for meniscal tears. This study may help surgeons and other health care professionals better understand and educate patients contemplating surgery.

Level of Evidence:
Level IV.
Patient Reported Outcomes in Patients Who Stop Following Up
Authors: Chen Darren A. , Vaishnav Avani S. , Louie Philip K. , Gang Catherine Himo , McAnany Steven J. , Iyer Sravisht , Albert Todd J. , Qureshi Sheeraz A. 
Published: May 2020

Study Design.
Follow-up study.

Objective.
To determine whether minimally invasive lumbar spine surgery outcomes are different between those who are lost to follow-up and those who are not.

Summary of Background Data.
Lost to follow-up patients are a common source of selection bias for clinical outcomes research. Currently, there are no US based studies that evaluate the differences in outcomes of lost to follow-up patients after spine surgeries.

Methods.
A retrospective review of prospectively collected data of 289 patients who underwent minimally invasive lumbar surgery and were at least 1 year postsurgery was performed. Patients were divided into two groups: (1) lost to follow-up (LTF), defined as patients who had missed more than two consecutive follow-up visits and had not attended their 1-year follow-up appointment; and (2) not lost to follow-up. For the not-LTF cohort, patient response outcome measures (PROMs) (oswestry disability index (ODI), visual analog scale (VAS) back/leg, Short Form-12 (SF-12) Physical/Mental, PROMIS) and return to activities data were collected prospectively at each follow-up. For LTF patients, data were collected through emailed surveys or telephone interviews. PROMs and return to activities data of the two groups were compared. Sub-group analysis by type of surgery (decompression or fusion) was also performed.

Results.
For the entire cohort, independent t test analysis showed LTF patients had greater improvement in PROMIS Physical Function scores than those who were not-LTF (15.08 vs. 10.38, P = 0.026). For fusion surgeries, LTF patients showed a greater improvement in ODI (–30.94 vs. –16.23, P = 0.003) VAS back (–4.92 vs. –2.99, P = 0.044), and PROMIS-PF (16.09 vs. 10.38, P = 0.049). There were no significant differences in complication rates between LTF and not LTF patients.

Conclusion.
Patients undergoing minimally invasive lumbar surgery—in particular lumbar fusions—who are lost to follow-up and responded to subsequent email and phone interviews showed greater improvements in self-reported outcomes than those who continued to follow-up. Thus, our results suggest that a substantial subset of patients who are lost to follow-up do not fare worse than those who do follow-up. However, an opposite response cannot be excluded in those who did not respond to email and phone interviews.

Level of Evidence: 3
A New Surgical Strategy for Infective Spondylodiscitis
Authors: Choi Sung Hoon , Koo Ja Wook , Hur Jeong Min , Kang Chang-Nam 
Published: May 2020

Study Design.
Retrospective comparative study.

Objective.
To investigate the radiographic and clinical effectiveness of surgical treatment using a posterior-only approach, as compared with a combined antero-posterior approach, in patients with infective spondylodiscitis.

Summary of Background Data.
Spondylodiscitis is the most common infectious disease of the spine. There is currently no consensus over the surgical approach, use of bone graft, and type of instrumentation for optimal treatment of infective spondylodiscitis.

Methods.
Seventy-nine patients who received surgical treatment for infective spondylodiscitis were divided into a combined antero-posterior (AP) group and a posterior-only (P) group. Significant differences in pre- and postoperative radiographic and clinical characteristics between the two groups were identified, and univariate and stepwise multivariate logistic regression analyses were used to determine the factors that affected the decision for treatment approach between the two groups.

Results.
Preoperatively, initial height loss, wedge angle, and kyphotic angle were significantly higher in the AP group. However, estimated blood loss, operation time, and last visual analogue scale score for back pain were significantly lower in the P group. There was no difference in postoperative time to reach solid fusion. Postoperative corrected kyphotic angle was 12.8° in the AP group and 5.3° in the P group. The regional wedge angle was identified as a factor that influenced use of the combined antero-posterior approach, with a sensitivity of 60%, and specificity of 89.8% at the optimal cut-off value of 8.2°.

Conclusion.
Interbody fusion with long-level pedicle screws fixation through a posterior-only approach was shown to be as effective as a combined antero-posterior approach for the surgical treatment of infective spondylodiscitis. A posterior-only approach is recommended when the regional wedge angle of the collapsed vertebra is less than 8.2°.

Level of Evidence: 4