bluuebunny/crossref_metadata_2025_split huggingface dataset:
Systemic sclerosis myocarditis has unique clinical, histological and prognostic features: a comparative histological analysis
Authors: De Luca Giacomo , Campochiaro Corrado , De Santis Maria , Sartorelli Silvia , Peretto Giovanni , Sala Simone , Canestrari Giovanni , De Lorenzis Enrico , Basso Cristina , Rizzo Stefania , Thiene Gaetano , Palmisano Anna , Esposito Antonio , Selmi Carlo , Gremese Elisa , Della Bella Paolo , Dagna Lorenzo , Bosello Silvia Laura 
Published: December 2019

AbstractObjectiveTo outline the clinical, histological and prognostic features of systemic sclerosis (SSc) endomyocardial biopsy-proven myocarditis with respect to those of diverse endomyocardial biopsy-proven virus-negative myocarditis (VNM).MethodsWe retrospectively analysed data from three cohorts of endomyocardial biopsy-proven myocarditis: SSc-related VNM (SSc-VNM); isolated VNM (i-VNM); and VNM related to other systemic autoimmune diseases (a-VNM). The degree of myocardial fibrosis was expressed as relative percentage and fibrotic score (0–3). Clinical data, cardiac enzymes, echocardiogram, 24 h ECG Holter and cardiac magnetic resonance were obtained at baseline and during follow-up. Non-parametric tests were used.ResultsWe enrolled 12 SSc-VNM [11 females, mean age 49.3 (14.2) years; seven diffuse-SSc, five early-SSc], 12 i-VNM [12 females, mean age 47.7 (10.8) years] and 10 a-VNM [four females, mean age 48.4 (16.3) years] patients. SSc patients had higher degrees of myocardial fibrosis as assessed by both percentage [SSc-VNM: 44.8 (18.8)%; a-VNM: 28.6 (16.5)%; i-VNM: 24.9 (10.3)%; P = 0.019] and score [SSc-VNM: 2.3 (0.8); a-VNM: 1.4 (1.1); i-VNM: 1.2 (0.7); P = 0.002]. Myocardial fibrosis directly correlated with skin score (r = 0.625, P = 0.03) and number of ventricular ectopic beats on 24 h ECG Holter in SSc patients (r = 0.756, P = 0.01). Dyspnoea class was higher at presentation in SSc-VNM patients (P = 0.041) and we found heart failure only in SSc patients (25%) (P = 0.05). At cardiac magnetic resonance, myocardial oedema was nearly undetectable in SSc-VNM patients compared with others (P = 0.02). All patients received immunosuppressive treatment. The number of patients who died during follow-up due to cardiac complications was significantly higher in SSc-VNM patients (50%), as compared with a-VNM (0%) and i-VNM (8.3%) patients (P = 0.006). Patients who died during follow-up had higher degrees of myocardial fibrosis [52.2 (11.6)% vs 27.5 (12.9)%, P = 0.024; fibrotic score: 2.83 (0.41) vs 1.4 (0.9), P &lt; 0.001].ConclusionSSc has unique clinical and histological features, as it tends to present more frequently with heart failure and a higher dyspnoea class and to show higher degrees of myocardial fibrosis. These specific features are paralleled by a worse cardiac prognosis.
Non-structural carbohydrate pools not linked to hydraulic strategies or carbon supply in tree saplings during severe drought and subsequent recovery
Authors: Kannenberg Steven A , Phillips Richard P 
Published: December 2019

AbstractNon-structural carbohydrate (NSC) pools fluctuate based on the interplay between photosynthesis, demand from various carbon (C) sinks and tree hydraulic status. Thus, it has been hypothesized that tree species with isohydric stomatal control (i.e., trees that close stomata rapidly in response to drought) rely heavily on NSC pools to sustain metabolism, which can lead to negative physiological consequences such as C depletion. Here, we seek to use a species’ degree of isohydry or anisohydry as a conceptual framework for understanding the interrelations between photosynthetic C supply, hydraulic damage and fluctuations in NSC pools. We conducted a 6-week experimental drought, followed by a 6-week recovery period, in a greenhouse on seven tree species that span the spectrum from isohydric to anisohydric. Throughout the experiment, we measured photosynthesis, hydraulic damage and NSC pools. Non-structural carbohydrate pools were remarkably stable across species and tissues—even highly isohydric species that drastically reduced C assimilation were able to maintain stored C. Despite these static NSC pools, we still inferred an important role for stored C during drought, as most species converted starches into sugars during water stress (and back again post-drought). Finally, we did not observe any linkages between C supply, hydraulic damage and NSC pools, indicating that NSC was maintained independent of variation in photosynthesis and hydraulic function. Our results advance the idea that C depletion is a rare phenomenon due to either active maintenance of NSC pools or sink limitation, and thus question the hypothesis that reductions in C assimilation necessarily lead to C depletion.
Time to Surgery and Patient Mortality in Geriatric Acetabular Fractures
Authors: Glogovac Georgina , Le Theodore Toan , Archdeacon Michael T. 
Published: December 2019

Objectives:
To determine whether surgical intervention within 48 hours of injury results in decreased mortality in geriatric patients who have sustained acetabular fractures.

Design:
Retrospective case series.

Setting:
University Level 1 Trauma Center.

Patients/Participants:
One hundred eighty-three patients 65 years of age and older who were operatively treated for acetabular fractures between 2002 and 2017. The average age was 76 years.

Intervention:
Operative fixation of acetabular fracture.

Main Outcome Measurements:
Chi square tests were used to compare 30-day, 6-month, and 1-year mortality after operative intervention between patients treated within 48 hours and after 48 hours. A Cox proportional hazard model was used to determine predictors of mortality.

Results:
The overall 1-year morality was 15%. When patients were grouped by time to surgery (fracture fixation within 48 hours or after 48 hours), there were no statistically significant differences in 30-day, 6-month, or 1-year mortality between groups. In addition, there were no statistically significant differences in age, sex, mechanism of injury, fracture pattern, Charlson comorbidity index, length of hospital stay, presence of deep vein thrombosis, or quality of reduction. In the final multivariate Cox regression model of survival, increasing age was associated with a significantly increased hazard of death with a hazard ratio (HR) of 1.09 (95% confidence interval, 1.05–1.13) per year of age (P < 0.001). Patient sex, mechanism of injury, fracture pattern, estimated blood loss, and Charlson comorbidity index were not significant predictors of mortality.

Conclusion:
In contrast to the clear mortality benefits of early surgical intervention in geriatric patients with proximal femur fractures, the results of our study suggest that surgical intervention after 48 hours of injury is not associated with increased mortality rates in geriatric patients with acetabular fractures. Increased mortality was independently associated with advancing age. Sex, mechanism of injury, and facture pattern were not associated with mortality. Time to surgery in geriatric patients with acetabular fractures should be determined on an individual basis.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Functional Elbow Range of Motion in Children and Adolescents
Authors: Valone Lindsey C. , Waites Cameron , Tartarilla Ashley B. , Whited Amy , Sugimoto Dai , Bae Donald S. , Bauer Andrea S. 
Published: December 2019

Background:
The functional elbow range of motion in children and adolescents has not been previously reported. In adults, a functional motion arc of 30 to 130 degrees of elbow flexion and 50 degrees of pronation to 50 degrees of supination is well established. Contemporary tasks such as cellular phone use and keyboarding require greater elbow flexion and pronation than the functional motion arc. Whether or not this is true in children has yet to be established. We hypothesize that to perform functional and contemporary tasks, children and adolescents use a greater range of elbow motion and forearm rotation as compared with adults.

Methods:
Twenty-eight subjects performed 8 functional tasks and 4 contemporary tasks. Kinematic data were captured using a 3-dimensional motion analysis system as previously described. Mean and SD was collected for elbow flexion, extension, pronation, and supination. Unpaired t tests were performed to compare elbow kinematics of children 6- to 11-year-old (n=14) to that of adolescents 12- to 17-year-old (n=14), with a significance criterion of P-value <0.05.

Results:
The mean arc of motion to achieve functional tasks was 28 to 146 degrees of elbow extension/flexion and 54 degrees of supination to 65 degrees of pronation. Contemporary tasks utilized 40 to 148 degrees of elbow extension/flexion and 49 degrees of supination to 65 degrees of pronation. A greater supination/pronation arc (107 degrees) and greater elbow flexion (148 degrees) were used to bring a cellular phone to the ear, whereas greater pronation (65 degrees) was used to type on a keyboard. Statistically significant differences were observed between children and adolescents in each of the 12 tasks, with the exception of using a fork.

Conclusions:
A motion arc of 30 to 130 degrees of elbow flexion and 50 to 50 degrees of pronation/supination is sufficient to achieve most positional and functional tasks in children and adolescents. However, specific contemporary tasks such as the use of a cellular phone and typing on a keyboard utilize more elbow flexion and pronation. Awareness of greater use of flexion and pronation to achieve contemporary tasks may help guide surgeons in the care of patients with posttraumatic elbow and forearm deformities and contractures.

Level of Evidence:
Level II—investigation of a diagnostic test.
Normative Values for Capital Femoral Epiphyseal Extension of the Developing Hip Based on Age, Sex, and Oxford Bone Age
Authors: Marshall Danielle C. , Morris William Z. , Liu Raymond W. 
Published: December 2019

Background:
Recent evidence suggests that increasing capital femoral epiphyseal extension may be an adaptive response that underlies the development of most cam morphology, whereas slipped capital femoral epiphysis is associated with its deficiency. However, there is an absence of rigorous data on the normal development of epiphyseal extension in the hip joint in modern adolescents. The aim of this study was to establish normative values for anterior and superior epiphyseal extension in a normal adolescent control population.

Methods:
A total of 210 pediatric subjects (420 hips) between the ages of 8 and 17 years old at the time of presentation who received pelvic radiographs were retrospectively reviewed. Basic demographic data were collected. All subjects with underlying hip pathology were excluded. Epiphyseal extension ratio (EER) was measured, defined as the ratio of extension of the capital femoral epiphysis down the femoral neck relative to the diameter of the femoral head. Superior EER was measured on the anterioposterior view and anterior EER on the frog-leg lateral view bilaterally. Skeletal maturity was graded based on Oxford bone age (OBA) at the proximal femur.

Results:
The superior EER increased from 0.63±0.05 at age 8 to 0.80±0.05 at age 17. The anterior EER similarly increased from 0.56±0.06 at age 8 to 0.74±0.05 at age 17. The superior and anterior EERs increased with age in a linear fashion for males (r=0.80 and 0.75, respectively) and females (r=0.67 and 0.65) through physeal closure. When subjects were standardized by the OBA stage of the femoral head, females and males showed no statistical difference at OBA stages 6, 7 or 8.

Conclusions:
Superior and anterior EER increased throughout adolescent development until physeal closure. When controlling for skeletal maturity, there were no significant differences between sexes. This normative data may help guide future management and research of slipped capital femoral epiphysis and cam morphology.

Level of Evidence:
Level II, Diagnostic.
Association of Knee Pain and Crouch Gait in Individuals With Cerebral Palsy
Authors: Pelrine Eliza , Novacheck Tom , Boyer Elizabeth 
Published: December 2019

Background:
Crouch gait (ie, excessive knee flexion) is commonly seen in patients with cerebral palsy (CP) and has been inconsistently linked with knee pain. The definitive cause of knee pain is unknown, but may result from increased joint forces due to crouch gait kinematics. Our purpose was to determine whether knee pain is positively associated with knee flexion in gait among a large sample of ambulatory individuals with CP. We hypothesized that knee pain prevalence would increase as knee flexion increased.

Methods:
In this retrospective study, pain questionnaire and 3-dimensional gait analysis data from 2015 to 2018 were extracted from the medical records of individuals with CP who had a clinical gait analysis. The pain questionnaire asked caregivers/patients to indicate the location of pain and when it occurs. A multivariate logistic regression was performed with minimum knee flexion in stance, patella alta, age, and sex as predictors of knee pain.

Results:
Among the 729 participants included in the analysis, 147 reported knee pain (20.1%). The odds of knee pain were not associated with minimum knee flexion in stance or sex. However, the odds of knee pain increased 73.2% when patella alta was present (P=0.008) and tended to increase 2.2% as age increased (P=0.059).

Conclusions:
The data suggest that there is not a meaningful association between crouch gait and knee pain. Having patella alta was associated with pain. Further studies that use validated pain questionnaires are needed to understand the multifactorial etiology of knee pain within ambulatory individuals with CP.

Level of Evidence:
Level III—case-control study.
The Impact of Temporal Artery Biopsy at a UK Tertiary Plastic Surgery Unit
Authors: Chew Bryan J. W. , Khajuria Ankur , Ibanez Javier 
Published: December 2019

Background:
Guidelines recommend temporal artery biopsy (TAB) for patients suspected of having giant cell arteritis (GCA). We evaluated the impact of TAB on the diagnosis and management of patients with suspected GCA at a tertiary plastic surgery unit.

Methods:
A retrospective review of all TAB procedures performed at our centre over 7 years was performed. One hundred and one patients were included in the study. Patients were classified into 3 diagnostic groups: confirmed (positive TAB), presumed (negative TAB with high clinical suspicion) and unlikely (negative TAB with low clinical suspicion). The clinical presentation and management for each group were compared.

Results:
The average American College of Rheumatology (ACR) score was 3.07. The number of patients with an ACR score of ≥3 before TAB was 72 (71.3%) and remained the same after TAB. The number of patients who remained on steroid therapy was lower in the group with an unlikely diagnosis of GCA compared to the group with a confirmed diagnosis (p<0.05). Conversely, there was no significant difference in steroid therapy between those with a presumed and confirmed diagnosis (p>0.05).

Conclusions:
This study found a significant difference in steroid treatment between those with confirmed GCA and those where the diagnosis was unlikely showing that TAB may support decisions regarding steroid therapy. However, TAB was inappropriately requested for patients whose pre-TAB ACR score was ≥3 as this score is sufficient for the diagnosis of GCA. Therefore, the use of TAB should be limited to cases of diagnostic uncertainty.
Neodymium Laser Treatment of IOP Rise Following Ex-Press Glaucoma Device Implantation: A Retrospective Review From 4 Institutions
Authors: Mustafa Majd , Shoham-Hazon Nir , Reiss George R. , Samuelson Thomas W. , Condon Gary , Ahmed Iqbal Ike K. 
Published: December 2019

Précis:
Our retrospective study examined the use of neodymium laser in 53 eyes with high intraocular pressure (IOP) following Ex-Press filtration device implantation. We found a statistically significant immediate IOP-lowering effect in all eyes, with a mean IOP reduction of 13.34±8.99 mm Hg, and a posttreatment IOP of 14.30±8.57 mm Hg (P<0.0001). Of a subset of 43 eyes on which 6 months follow-up IOP data was available, 28 eyes achieved treatment success (IOP<18 without further surgical interventions) with a mean IOP of 11.39±4.03 mm Hg at 6 months.

Purpose:
The purpose of this study was to report on the use of neodymium laser for treatment of eyes with IOP rise following Ex-Press glaucoma filtration device implantation.

Methods:
We retrospectively examined the medical records of 73 patients who underwent Ex-Press device implantation at 4 medical institutions between 2007 and 2015 and subsequently developed an IOP rise. Enrollment criteria included patients with POAG on whom posttreatment IOP data is available. Indications for treatment with neodymium laser were an IOP above target and a flat bleb. To disrupt the presumed microblockage, the neodymium laser was aimed at the axial and relief ports of the Ex-Press device. Applanation tonometry measurements were followed up after neodymium treatment for variable time intervals. Success was defined as an IOP <18 mm Hg at 6 months without further surgical or laser-based glaucoma interventions.

Results:
A total of 73 charts were reviewed. Twenty patients were excluded due to insufficient data or a diagnosis other than POAG. Data from 53 eyes of the remaining 53 patients was analyzed. The mean duration between Ex-Press implantation and rise in IOP requiring neodymium intervention was 34.2 months (range, 1.1 to 67.2). We found a statistically significant immediate IOP-lowering effect in all eyes, with a mean IOP drop of 13.34±8.99 mm Hg, and a mean posttreatment IOP of 14.30±8.57 mm Hg (P<0.0001). Of a subset of 43 eyes on which 6 months follow-up IOP data was available, 11 eyes required further glaucoma intervention (surgery or laser-based); 4 eyes had an IOP of ≥18 at 6 months. In the remaining 28 successful eyes, a sustained IOP<18 mm Hg was observed at 6 months, with a mean pressure of 11.39±4.03 mm Hg (P<0.0001). Hypotony (IOP<5) occurred in 3 eyes immediately following treatment and self-resolved by 1 week.

Conclusion:
Our retrospective case series suggests that neodymium laser is a potential consideration in eyes with sustained IOP rise after Ex-Press device implantation.
The Distribution and Prevalence of Macrophages in the Cochlea Following Cochlear Implantation in the Human: An Immunohistochemical Study Using Anti-Iba1 Antibody
Authors: Okayasu Tadao , Quesnel Alicia M. , O’Malley Jennifer T. , Kamakura Takefumi , Nadol Joseph B. 
Published: December 2019

Hypothesis:
Cochlear implantation may cause an increase in the number of macrophages in the human cochlea similar to previous findings in the vestibular endorgans.

Background:
Macrophages play a key role in both an inflammatory response and homeostatic maintenance. Recently, an increase in the prevalence of macrophages was demonstrated in the human vestibular endorgans after implantation. However, the prevalence of macrophages in the cochlea after implantation is unclear. The aim of this study was to compare the distribution and prevalence of macrophages in implanted human cochleae and the contralateral unimplanted ears.

Methods:
The prevalence of macrophages in the cochlea in 10 human subjects who had undergone unilateral cochlear implantation was studied by light microscopy using anti-Iba1 immunostaining. The densities of macrophages in the osseous spiral lamina (OSL) and Rosenthal's canal (RC) in implanted cochleae were compared with the contralateral unimplanted ears. The distribution of macrophage morphology (amoeboid, transitional, and ramified) was also compared.

Results:
There were activated and phagocytosing macrophages within the fibrotic sheath surrounding the electrode track and within fibrous tissue with lymphocytic infiltration in implanted ears. The densities of macrophages in OSL and RC in implanted ears were significantly greater than in unimplanted ears in some areas. There was also a difference in the prevalence of macrophage phenotype between the OSL and RC.

Conclusion:
An increase in the density of macrophages in the cochlea after cochlear implantation was demonstrated. Both phagocytosis and anti-inflammatory activity of macrophages were suggested by the distribution and prevalence of macrophages in the implanted cochlea.
Temporal Bone Anatomy in Superior Semicircular Canal Dehiscence: A Case Control Study on Bone Pneumatization and the Level of Middle Cranial Fossa
Authors: Tikka Theofano , Kontorinis Georgios 
Published: December 2019

Objectives:
To assess for any association between the presence of superior semicircular canal dehiscence (SSCD) and temporal bone pneumatization and the height of middle fossa in symptomatic patients.

Study Design:
Retrospective case-control study.

Setting:
Tertiary, university referral center.

Patients:
Symptomatic patients with SSCD and a matched group of non-SSCD patients.

Intervention:
High-resolution computed tomography of the temporal bones.

Main Outcome Measures:
We graded the temporal bone pneumatization using the Virapongse classification and measured the distance between the middle fossa and the lateral semicircular canal on coronal plane at the most anterior aspect of the lateral and superior semicircular canals. We statistically compared all parameters (level of significance 0.05).

Results:
We enrolled 30 patients with SSCD, (males = 13, females = 17) with mean age of 47 years (SD: 26). The matched control group had similar baseline characteristics (p > 0.05). Grade 4 pneumatization was noted in 83.3% (n = 25) of SSCD patients with the remainder having grade 3. In the control group, 46.6% (n = 14) had a grade 4 pneumatization, 36.6% (n = 11) grade 3 and 16.6 5 (n = 5) grade 2. This difference was statistically significant (p = 0.003). The difference in the height of the middle cranial fossa between the two groups was also statistically significant (mean 3.80 [SD: 0.84] in SSCD group and 4.68 mm [SD: 0.85] in the control group; p < 0.0001).

Conclusions:
We found better-pneumatized mastoids in patients with SSCD, indicative of a direct association between temporal bone pneumatization and SSCD. Additionally, the middle fossa dura is lying significantly lower in patients with SSCD, factor of surgical importance.