bluuebunny/crossref_metadata_2025_split huggingface dataset:
Timing of Surgery for Thoracolumbar Spine Trauma
Authors: Ruddell Jack H. , DePasse J. Mason , Tang Oliver Y. , Daniels Alan H. 
Published: October 2020

Study Design:
Large multicenter retrospective cohort study.

Objective:
The objective of this study was to analyze the effect of fusion timing on inpatient outcomes in a nationally representative population with thoracolumbar fracture and concurrent neurological injury.

Summary of Background Data:
Among thoracolumbar trauma admissions, concurrent neurological injury is associated with greater long-term morbidity. There is little consensus on optimal surgical timing for these patients; previous investigations fail to differentiate thoracolumbar fracture with and without neurological injury.

Materials and Methods:
We analyzed 19,136 nonelective National Inpatient Sample cases (2004–2014) containing International Classifications of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes for closed thoracic/lumbar fracture with neurological injury and procedure codes for primary thoracolumbar/lumbosacral fusion, excluding open/cervical fracture. Timing classification from admission to fusion was same-day, 1–2-, 3–6-, and ≥7-day delay. Primary outcomes included in-hospital mortality, complications, and infection; secondary outcomes included total and postoperative length of stay and charges. Logistic regressions and generalized linear models with gamma distribution and log-link evaluated the effect of surgical timing on primary and secondary outcomes, respectively, controlling for age, sex, fracture location, fusion approach, multiorgan system injury severity score, and medical comorbidities.

Results:
Patients undergoing surgery ≤72 hours (n=12,845) had the lowest odds of in-hospital cardiac [odds ratio (OR)=0.595; 95% confidence interval (CI), 0.357–0.991] and respiratory complications (OR=0.495; 95% CI, 0.313–0.784) and infection (OR=0.615; 95% CI, 0.390–0.969). No differences were observed between same-day (n=4724) and 1–2-day delay (n=8121) (P>0.05). Lowest odds of hemorrhage or hematoma was observed following 3–6-day delay (OR=0.467; 95% CI, 0.236–0.922). A ≥7-day delay to fusion (n=2,002) was associated with greatest odds of hemorrhage/hematoma (OR=2.019; 1.107–3.683), respiratory complications (OR=1.850; 95% CI, 1.076–3.180), and infection (OR=3.155; 95% CI, 1.891–5.263) and greatest increases in mean postoperative length of stay (4.26% or 35.3% additional days) and charges (163,562 or 71.7% additional US dollars) (P<0.001).

Conclusions:
Patients with thoracolumbar fracture and associated neurological injury who underwent surgery within 3 days of admission experienced fewer in-hospital complications. These benefits may be due to secondary injury mechanism avoidance and earlier mobilization.

Level of Evidence:
Level III.
Socioeconomic Factors Account for Variability in Language Skills in Preschoolers with Autism Spectrum Disorders
Authors: Olson Lindsay , Kinnear Mikaela , Chen Bosi , Reynolds Sarah , Ibarra Cynthia , Wang Tiffany , Linke Annika , Fishman Inna 
Published: October 2020

ABSTRACT:

Objective:
Although no longer required for a diagnosis, language delays are extremely common in children diagnosed with autism spectrum disorders (ASD). Factors associated with socioeconomic status (SES) have broad-reaching impact on language development in early childhood. Despite recent advances in characterizing autism in early childhood, the relationship between SES and language development in ASD has not received much attention.

The objective of this study was
to examine whether toddlers and preschoolers with ASD from low-resource families are more likely to experience language delays above and beyond those associated with autism itself.

Methods:
Developmental and diagnostic assessments including the Mullen Scales of Early Learning, the Autism Diagnostic Observation Schedule, Second Edition, and the Vineland Adaptive Behavior Scales were obtained from 62 young children with ASD and 45 typically developing children aged 15 to 64 months. Sociodemographic information including household income, maternal education, and racial/ethnic identity was obtained from caregivers. Multiple regression models were used to test for associations between socioeconomic indices and language scores.

Results:
Maternal education accounted for variability in expressive language (EL) and receptive language (RL), with lower SES indices associated with lower language skills, and more so in children with ASD.

Conclusion:
These results demonstrate that variability in EL and RL skills in young children with autism can be accounted for by socioeconomic variables. These findings highlight the necessity for targeted intervention and effective implementation strategies for children with ASD from low-resource households and communities and for policies designed to improve learning opportunities and access to services for these young children and their families.
Understanding the Relationship Between Nursing Home Experience With Human Immunodeficiency Virus and Patient Outcomes
Authors: Meyers David J. , Wilson Ira B. , Lee Yoojin , Rahman Momotazur 
Published: October 2020

Background:
As the population with human immunodeficiency virus (HIV) continues to age, the need for nursing home (NH) care is increasing.

Objectives:
To assess whether NH’s experience in treating HIV is related to outcomes.

Research Design:
We used claims and assessment data to identify individuals with and without HIV who were admitted to NHs in 9 high HIV prevalent states. We classified NHs into HIV experience categories and estimate the effects of NH HIV experience on patient’s outcomes. We applied an instrumental variable using distances between each individual’s residence and NHs with different HIV experience.

Subjects:
In all, 5,929,376 admissions for those without HIV and 53,476 admissions for residents with HIV.

Measures:
Our primary outcomes were 30-day hospital readmissions, likelihood of becoming a long stay resident, and 180-day mortality posthospital discharge.

Results:
Residents with HIV tended to have poorer outcomes than residents without HIV, regardless of the NH they were admitted to. Residents with HIV admitted to high HIV experience NHs were more likely to be readmitted to the hospital than those admitted to NHs with lower HIV experience (19.6% in 0% HIV NHs, 18.7% in 05% HIV NHs and 22.9% in 5%–50% HIV NHs).

Conclusions:
Residents with HIV experience worse outcomes in NHs than residents without HIV. Increased HIV experience was not related to improved outcomes.
Prospective Evaluation of the Safety and Efficacy of THRIVE for Children Undergoing Airway Evaluation
Authors: Okland Tyler S. , Liu George S. , Caruso Thomas J. , Sidell Douglas R. 
Published: October 2020

Background:
Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) is a humidified high-flow nasal cannula capable of extending apneic time. Although THRIVE is assumed to stent upper airway soft tissues, this has not been objectively evaluated. Also, there are no prior studies providing safety and efficacy data for those patients undergoing upper airway evaluation using THRIVE.

Methods:
This report is a prospective study of the safety and efficacy of THRIVE in pediatric patients younger than 18 years old undergoing drug-induced sleep endoscopy. We positioned a flexible laryngoscope to view the larynx, and photographs were taken with no THRIVE flow (control) and with THRIVE flow at 10 and 20 liters per minute (LPM). Upper airway patency was measured using epiglottis to posterior pharynx distance, laryngeal inlet area, and modified Cormack–Lehane score at the trialed parameters. Vomiting and aspiration were our primary safety endpoints.

Results:
Eleven patients (6 women) with a mean age of 5.3 ± 2.1 years (2–8 years; SD, 2.05) were enrolled. Measurements of upper airway patency showed a significant THRIVE flow–associated increase in epiglottis to posterior pharynx distance (105 ± 54 at 10 L/min and 199 ± 67 at 20 L/min; P = 0.007) and nonsignificant increase of laryngeal inlet area (206 ± 148 at 10 L/min and 361 ± 190 at 20 L/min; P = 0.07). Cormack–Lehane score improved significantly at higher THRIVE volumes (P = 0.006).

Conclusions:
THRIVE appears to safely improve upper airway patency during sleep endoscopy in the pediatric patient. In this study, we objectively document the flow-dependent increase in laryngeal patency associated with THRIVE.
Perioperative Temperature Management in Children: What Matters?
Authors: Lee Shu Ying , Wan Sharon Yuan Kwan , Tay Chin Lin , Tan Zi Hui , Wong Irene , Chua Maureen , Allen John C. 
Published: October 2020

Introduction:
Inadvertent perioperative hypothermia is common and associated with increased risk of perioperative complications. Adult data drives most guidelines for pediatric perioperative temperature management and does not consistently demonstrate effectiveness in children. This study aims to identify risk factors for hypothermia and determine the effectiveness of current interventions in the pediatric population.

Methods:
We carried out a prospective observational study in children undergoing anesthesia in our tertiary pediatric unit. We included 869 patients (<16 y) undergoing emergency/elective surgeries over 2 months. Our team recorded the incidence of hypothermia (tympanic core temperature < 36°C) within 15 minutes of arrival to the postanesthetic care unit. We collected data such as patient demographic, surgical, anesthetic (including monitoring and warming measures used), and operating theater (OT) temperature. We performed statistical analysis to identify risk factors associated with hypothermia.

Results:
Postoperative hypothermia incidence was 12.3% (107/869). The mean core temperature on arrival to the postanesthetic care unit was 36.6°C (+SD 0.45) in normothermic patients versus 35.6°C (+SD 0.34) in hypothermic patients. Multivariable analysis identified starting ambient OT temperature [odds ratio (OR) = 0.83, confidence interval (CI): 0.71–0.96; P = 0.010], intraoperative temperature monitoring (OR = 0.49, CI: 0.28–085; P = 0.011), use of occlusive dressing (OR = 0.35, CI: 0.15–0.85; P = 0.020), and active forced-air warming (OR = 0.42, CI: 0.25–0.70; P = 0.001) as factors independently protective of postoperative hypothermia. Hypothermia occurred less frequently with emergency vs. elective procedures (OR 0.43, CI: 0.21–0.91; P = 0.026).

Conclusions:
Routine core temperature monitoring and active forced-air warming are useful measures to prevent hypothermia. Additionally, occlusive covers and controlling ambient OT temperature are cost-effective and safe methods to reduce inadvertent hypothermia.
Behavioral Interventions can Mitigate Adverse Pregnancy Outcomes Among Women Conceiving on ART and Those Initiated on ART During Pregnancy: Findings From the MOTIVATE Trial in Southwestern Kenya
Authors: Onono Maricianah , Odwar Tobias , Wahome Samuel , Helova Anna , Bukusi Elizabeth Anne , Hampanda Karen , Turan Janet , Abuogi Lisa 
Published: October 2020

Background:
Antiretroviral therapy (ART) is essential for the elimination of mother-to-child transmission and improved health outcomes for women living with HIV (WLWH). However, adverse pregnancy outcomes (APOs) among pregnant women on ART are a growing concern.

Methods:
We investigated the associations between timing of ART initiation and APOs among pregnant WLWH receiving behavioral interventions (community mentor mothers and text messaging) in the Mother-Infant Visit Adherence and Treatment Engagement (MOTIVATE) study in southwestern Kenya. Log binomial models were used for estimation of relative risks (RRs) (adjusted for the clustered nature of data) evaluating APOs with 3 exposure comparisons: (1) preconception ART initiation vs. postconception initiation; (2) among postconception ART initiating women, comparisons across gestational ages at cART initiation (first versus second and third trimester exposure), and (3) intervention allocation.

Results:
Of the 1275 women included in this analysis, 388 (30%) had an APO: 306 preterm births, 38 low birth weight infants, 33 stillbirths, and 11 miscarriages. In multivariable analysis, viral load ≥1000 copies/mL, moderate and severe anemia at baseline increased risk of APOs. Among women initiating ART before and after conception, no difference was observed in the composite APO. Women who received community mentor mother visits alone (aRR 0.74: 95% CI: 0.71 to 0.76) or text messages alone (aRR 0.79: 95% CI: 0.70 to 0.89) had lower risks of experiencing any APOs.

Conclusions:
Receiving supportive behavioral interventions may mitigate the risk of experiencing an APO among WLWH on ART. Further studies are needed to investigate the underlying mechanisms and optimize the benefits of these interventions.
Epicanthoplasty With Rotated-advanced-back Cut Flap
Authors: Yang Liya , Huang Yuanliang , Li HaiDong 
Published: October 2020

Background:
Epicanthoplasty is one of the most popular cosmetic surgeries in Asia. The aim of this study was to present a rotated, advanced, back cut flap (R-A-B flap) that leads to correct the congenital epicanthus effectively with satisfactory results.

Methods:
From January of 2017 to December of 2018, we performed the modified cut back flap epicanthoplasty to correct epicanthus. The esthetic results were evaluated with patients’ feedback: perfect, good, dissatisfied, or failed.

Results:
A total of 118 patients were involved. Postoperative evaluation using a grading scale indicated “perfect" results for 86 patients (73%) and “good" results for 32 patients (27%). No patients rated the results as “dissatisfied" or “failed." There were no significant postoperative complications.

Conclusion:
The R-A-B flap for epicanthoplasty is a reliable and simple method, resulting in good cosmetic outcome with minimal scar formation.
Persistence with oral bisphosphonates and denosumab among older adults in primary care in Ireland
Authors: Walsh Mary E. , Fahey Tom , Moriarty Frank 
Published: October 2020

ABSTRACTPurposeGaps in pharmacological treatment for osteoporosis can reduce effectiveness. This study aimed to estimate persistence rates for oral bisphosphonates and denosumab in older primary care patients and identify factors associated with discontinuation.MethodsOlder patients newly prescribed oral bisphosphonates or denosumab between 2012 and 2017 were identified from 44 general practices (GP) in Ireland. Persistence without a coverage gap of >90 days was calculated for both medications from therapy initiation. Factors associated with time to discontinuation were explored using Cox regression analysis. Exposures included age-group, osteoporosis diagnosis, fracture history, calcium/vitamin D prescription, number of other medications, health cover, dosing frequency (bisphosphonates) and previous bone-health medication (denosumab).ResultsOf 41,901 patients, n=1,569 newly initiated on oral bisphosphonates and n=1,615 on denosumab. Two-year persistence was 49.4% for oral bisphosphonates and 53.8% for denosumab and <10% were switched to other medication. Having state-funded health cover was associated with a lower hazard of discontinuation for both oral bisphosphonates (HR=0.49, 95%CI=0.36-0.66, p<0.01) and denosumab (HR=0.71, 95%CI=0.57-0.89, p<0.01). Older age-group, number of medications and calcium/vitamin D prescription were also associated with better bisphosphonate persistence while having osteoporosis diagnosed was associated with better denosumab persistence.ConclusionPersistence for osteoporosis medications is sub-optimal. Of concern, few patients are switched to other bone-health treatments when denosumab is stopped which could increase fracture risk. Free access to GP services and medications may have resulted in better medication persistence in this cohort. Future research should explore prescribing choices in primary-care osteoporosis management and evaluate cost-effectiveness of interventions for improving persistence.SUMMARYGaps in pharmacological treatment for osteoporosis can reduce its effectiveness. This study found approximately half of older adults in primary care newly initiated on bisphosphonates or denosumab were still taking these after 2 years. Abrupt discontinuation of denosumab without switching to an alternative is concerning due to increased fracture risk.
Spatial distribution of neuropathology and neuroinflammation elucidate the biomechanics of fluid percussion injury
Authors: Beitchman Joshua A. , Lifshitz Jonathan , Harris Neil G. , Thomas Theresa C. , Lafrenaye Audrey D. , Hånell Anders , Dixon C. Edward , Povlishock John T. , Rowe Rachel K. 
Published: October 2020

AbstractDiffuse brain injury is better described as multi-focal, where pathology can be found adjacent to seemingly uninjured neural tissue. In experimental diffuse brain injury, pathology and pathophysiology have been reported far more lateral than predicted by the impact site. Finite element biomechanical models of diffuse brain injury predict regions of maximum stress and strain. However, the application of a skull with uniform thickness may mask the pathophysiology due to varying thickness of human and animal skulls. Force applied to the intact skull would diffuse the forces, whereas forces applied through an open skull are distributed along paths of least resistance within and then exiting the skull. We hypothesized that the local thickening of the rodent skull at the temporal ridges serves to focus the intracranial mechanical forces experienced during brain injury and generate predictable pathology in underlying cortical tissue. We demonstrated local thickening of the skull at the temporal ridges using contour analysis of coronal skull sections and oblique sectioning on MRI. After diffuse brain injury induced by midline fluid percussion injury (mFPI), pathological foci along the anterior-posterior length of cortex under the temporal ridges were evident acutely (1, 2, 7 days) and chronically (28 days) post-injury by deposition of argyophilic reaction product. Area CA3 of the hippocampus and lateral nuclei of the thalamus showed pathological change, suggesting that mechanical forces to or from the temporal ridges shear subcortical regions. A proposed model of mFPI biomechanics suggests that injury force vectors reflect off the skull base and radiate toward the temporal ridge due to the material properties of the skull based on thickness, thereby injuring ventral thalamus, dorsolateral hippocampus, and sensorimotor cortex. Surgically thinning the temporal ridge prior to injury reduced the injury-induced inflammation in sensorimotor cortex. These data build evidence for the temporal ridges of the rodent skull to contribute to the observed pathology, whether by focusing extracranial forces to enter the cranium or intracranial forces to escape the cranium. Pre-clinical investigations can take advantage of the predicted pathology to explore injury mechanisms and treatment efficacy.HighlightsThe temporal ridge is 75% thicker than the adjacent skull of the rodentExperimental diffuse TBI neuropathology occurs beneath the length of the temporal ridgeNeuropathology encompasses sensorimotor cortex, somatosensory thalamus, and dorsolateral hippocampusProposed mechanism of biomechanical injury forces include the temporal ridge
Waves out of the Korean Peninsula and inter- and intra-species replacements in freshwater fishes in Japan
Authors: Taniguchi Shoji , Bertl Johanna , Futschik Andreas , Kishino Hirohisa , Okazaki Toshio 
Published: October 2020

AbstractThe Japanese archipelago is located at the periphery of the continent of Asia. Rivers in the Japanese archipelago, separated from the continent of Asia about 17 Ma, have experienced an intermittent exchange of freshwater fish taxa through a narrow land bridge generated by lowered sea level. As the Korean Peninsula and Japanese archipelago were not covered by an ice sheet during glacial periods, phylogeographical analyses in this region can trace the history of biota for a long time beyond the last glacial maximum. In this study, we analyzed the phylogeography of four freshwater fish taxa,Hemibarbus longirostris, dark chubNipponocypris temminckii, Tanakiassp. andCarassiusssp., whose distributions include both the Korean Peninsula and western Japan. We found for each taxon that a small component of diverse Korean clades of freshwater fishes migrated in waves into the Japanese archipelago to form the current phylogeographic structure of biota. Indigenous populations were replaced by succeeding migrants. We refer to this phenomenon as “waves out of the Korean Peninsula,” with parallels to “out of Africa” in humans.
Tyramine receptor drives olfactory response to (E)-2-decenal in the stink bugHalyomorpha halys
Authors: Finetti Luca , Pezzi Marco , Civolani Stefano , Calò Girolamo , Scapoli Chiara , Bernacchia Giovanni 
Published: October 2020

AbstractIn insects, the tyramine receptor 1 (TAR1) has been shown to control several physiological functions, including olfaction. We investigated the molecular and functional profile of theHalyomorpha halystype 1 tyramine receptor gene (HhTAR1) and its role in olfactory functions of this pest. Molecular and pharmacological analyses confirmed that theHhTAR1gene codes for a true TAR1. The RT-qPCR analysis revealed thatHhTAR1is expressed mostly in adult brain and antennae as well as in early development stages (eggs, 1stand 2ndinstar nymphs). In particular, among the antennomeres that compose a typicalH. halysantenna,HhTAR1was more expressed in flagellomeres. Scanning electron microscopy (SEM) investigation revealed the type and distribution of sensilla on adultH. halysantennae: both flagellomeres appear rich in trichoid and grooved sensilla, known to be associated with olfactory functions. Through a RNAi approach, topically deliveredHhTAR1dsRNA induced a 50 % gene downregulation after 24 h inH. halys2ndinstar nymphs. An innovative behavioral assay revealed thatHhTAR1RNAi-silenced 2ndinstar nymphs were less susceptible to the alarm pheromone component (E)-2 decenal as compared to control. These results provide critical information concerning the TAR1 role in olfaction regulation, especially alarm pheromone reception, inH. halys. Furthermore, considering the emerging role of TAR1 as target of biopesticides, this work paves the way for further investigation on innovative methods for controllingH. halys.