bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment options for unstable ankle fractures in older adults: A systematic review and meta-analysis
Authors: Grazette Andrew , Wigley Catrin , Metcalfe Andrew 
Published: July 2020

Background Ankle fractures are the third most common fracture in the elderly. Patients over 60 years are more severely affected by these injuries than their younger counterparts and have a higher rate of complications regardless of the management strategy. Traditional management strategies for unstable ankle fractures include plaster immobilisation and open reduction and internal fixation, with newer modalities such as intramedullary fixation becoming increasingly popular. The aim of this review is to establish the best current evidence for or against different treatment strategies. Methods A systematic review and meta-analysis of randomised controlled trials comparing treatment options for unstable ankle fractures in adults over 55 was conducted, with the primary outcome being functional assessment score at 6–12 months (Olerud and Molander Ankle Score). Secondary outcomes were adverse events including infection and re-operation. Results The search strategies identified 426 articles. After screening and full text review, four papers met the inclusion and exclusion criteria, providing data on 754 ankle fractures. Alternative treatment groups were tibio-talo-calcaneal nail, fibular nail and casting and were compared to open reduction and internal fixation. Meta-analysis of the data showed no difference in Olerud and Molander Ankle Score between treatment modalities at 6–12 months. There was, however, a significant reduction in the incidence of adverse events (OR 0.59 (0.44, 0.81)) and wound infection (0.13 (0.05, 0.31)) in the alternative treatment groups compared to open reduction and internal fixation. Conclusion The current evidence shows no significant difference between treatment modalities for ankle fractures in older adults in terms of functional outcome. Open reduction and internal fixation has a higher rate of adverse events and wound infection when compared to alternative treatments. Therefore, surgery should be carefully considered and if undertaken, in a select patient cohort other treatment modalities, such as intramedullary fixation should be considered.
Efficacy and safety of PulseRider for treatment of wide-necked intracranial aneurysm—A systematic review and meta-analysis
Authors: Pranata Raymond , Yonas Emir , Vania Rachel , Sidipratomo Prijo , July Julius 
Published: July 2020

Objective PulseRider is a novel self-expanding nickel-titanium (nitinol) stent for treatment of wide-necked aneurysms, which is commonly located at the arterial branches in the brain. This systematic review and meta-analysis aims to assess the efficacy and safety of PulseRider for treatment of wide-necked intracranial aneurysm. Method We performed a systematic literature search on articles that evaluate the efficacy and safety of PulseRider-assisted coiling of the wide-necked aneurysm from several electronic databases. The primary endpoint was adequate occlusion, defined as Raymond-Roy Class I + Raymond-Roy Class II upon immediate angiography and at six-month follow-up. Results There were a total of 157 subjects from six studies. The rate of adequate occlusion on immediate angiography was 90% (95% CI, 85%–94%) and 91% (95% CI, 85%–96%) at six-month follow-up. Of these, Raymond-Roy Class I can be observed in 48% (95% CI, 41%–56%) of aneurysms immediately after coiling, and 64% (95% CI, 55%–72%) of aneurysms on six-month follow-up. Raymond-Roy Class II was found in 30% (95% CI, 23%–37%) of aneurysms immediately after coiling, and 25% (17–33) after six-month follow-up. Complications occur in 5% (95% CI, 1%–8%) of the patients. There were three intraoperative aneurysm rupture, three thrombus formation, three procedure-related posterior cerebral artery strokes, one vessel dissection, and one delayed device thrombosis. There was no procedure/device-related death. Conclusions PulseRider-assisted coiling for treatment of patients with wide-necked aneurysm reached 90% adequate occlusion rate that rises up to 91% at sixth month with 5% complication rate.
Malnutrition in Orthopaedic Sports Medicine: A Review of the Current Literature
Authors: Choi Jihoon T. , Yoshida Brandon , Jalali Omid , Hatch George F. 
Published: July 2020

Context: Malnutrition is well-studied in various aspects of the orthopaedic literature, most commonly in relation to arthroplasty, spine surgery, and trauma. However, the management of nutritional deficiencies is commonly overlooked among orthopaedic sports medicine providers. The purpose of this article is to analyze the available sports medicine literature to review the associations between malnutrition and the management of orthopaedic sports medicine patients from a treatment and performance standpoint. Evidence Acquisition: PubMed was searched for relevant articles published from 1979 to 2019. Study Design: Clinical review. Level of Evidence: Level 4. Results: Few studies exist on the implications of macronutrient deficiencies specific to orthopaedic sports medicine procedures. Interestingly, micronutrient disorders—namely, hypovitaminosis D and iron deficiency—have been well studied and may lead to worse postoperative outcomes, injury rates, and athletic performance. Nutritional supplementation to correct such deficiencies has been shown to mitigate these effects, though further study is required. Conclusion: Nutritional deficiencies are highly prevalent in orthopaedic sports medicine patients, and practitioners should be aware of their potential effects on treatment and performance outcomes. Management of such deficiencies and their effect on surgical patients remain an area of potential future research. Future studies are warranted in order to explore the potential therapeutic role of nutritional supplementation to prevent complications after common orthopaedic sports medicine procedures, improve athletic performance, and reduce injury rates.
Increased cryptococcal meningitis mortality among HIV negative, non-transplant patients: a single US center cohort study
Authors: Motoa Gabriel , Pate Amy , Chastain Daniel , Mann Sarah , Canfield Gregory S. , Franco-Paredes Carlos , Henao-Martínez Andrés F. 
Published: July 2020

Cryptococcal meningitis (CM) is an opportunistic fungal infection associated with human immunodeficiency virus (HIV) and other forms of immunosuppression. We lack a clear understanding of CM associated mortality among HIV-negative, non-transplant patients in the United States (US). This article compares clinical features and outcomes across HIV status in patients with laboratory-confirmed CM. Methods: A retrospective cohort study was performed that included adult patients with laboratory-confirmed CM treated at an academic tertiary hospital between January 2000 and September 2018. Those with a history of organ transplant or non-meningeal infections were excluded. Data were gathered on demographics, HIV status, clinical presentation, cerebrospinal fluid (CSF) profiles, neurological outcomes, hospital course, and mortality. Results: A total of 70 patients with cryptococcal disease were identified. Our final sample included 36 CM patients, mean age was 48.8 ± 13.2 years; of this group, 66.7% ( n = 24) had HIV. Median [interquartile range (IQR)] absolute CD4 count for the HIV group was 35 cells/μl (10–80 cells/μl). Non-HIV/non-transplant patients were significantly older ( p < 0.001) and had higher rates of altered mental status (AMS) on presentation (58.3% versus 25%, p = 0.05). Non-HIV patients/non-transplant patients had significantly higher CSF white blood cell (WBC) count ( p = 0.02), lower CSF glucose ( p = 0.005), and higher CSF protein ( p < 0.001) compared with HIV patients. There was no significant variation in temperature, blood pressure, WBC count, serum sodium, CSF opening pressure, length of stay, intensive care unit admission, or neurological outcomes. Overall, 90-day all-cause mortality was 19.4%: mortality rates were significantly higher in non-HIV/non-transplant patients at both 90 days (41.7% versus 8.3%, p = 0.017) and 1 year (41.7% versus 12.5%, p = 0.047). Conclusion: Compared with HIV-infected individuals, non-HIV/non-transplant CM patients have a higher CSF WBC count at the time of diagnosis, higher rates of AMS on presentation, and higher rates of 90-day and 1-year all-cause mortality. Further prospective research is needed to identify the hallmarks of CM in non-HIV/non-transplant patients to facilitate early identification and intervention.
The Paradoxes of Student Well-being in Singapore
Authors: Ng Pak Tee 
Published: July 2020

Purpose: Singapore’s education system is known for its robust curriculum and excellent results. It is also a system of keen competitiveness and high pressure. This article addresses how such an education system responds to the issue of student well-being. Design/Approach/Methods: This article analyses the recent initiatives and shift in education philosophy in Singapore’s education system, which have a bearing on the issue of student well-being. Findings: This article argues that while there are direct efforts to address student well-being, the direction Singapore is taking is to pursue a holistic education paradigm, in which education is engaging, joyful, meaningful, and values-based. This article also argues that such a paradigm goes beyond the current well-being agenda and is aligned with a view that education should be about wholeness and purpose. While there are challenges associated with these changes, the Singapore experience suggests that the more we focus on holistic education, rather than interpret student well-being narrowly, the more wellness the students may actually and eventually experience. Originality/Value: This article brings to readers learning points from Singapore regarding student well-being, as the country grapples with change to develop a generation of young people, whose beings are and will continue to be well.
Is Use of Topical Vancomycin in Pediatric Spine Surgeries a Safe Option in the Prevention of Surgical Site Infections? A Meta-analysis and Systematic Review of the Literature
Authors: Sathish Muthu , Girinivasan Chellamuthu 
Published: July 2020

Study Design: Systematic review and meta-analysis. Objective: To systematically review the available articles on topical vancomycin powder (TVP) use in pediatric spine surgeries exploring the usefulness and safety of such practice. Methods: We conducted an independent and duplicate electronic database search in PubMed, EMBASE, and Cochrane Library till March 2020 to identify all relevant literature on the use of TVP for pediatric spine surgeries. Surgical site infection (SSI) rate, specific reported complications, reoperation rate, microbial flora pattern in reported SSIs, and safety profile were the outcomes analyzed. Analysis was performed with the R platform using OpenMeta[Analyst] software. Results: No prospective studies were available to evaluate the use of TVP in pediatric spine surgeries for the prevention of SSIs. Neither standardized protocol, nor drug dosage, nor safety profile was established for pediatric use. Three retrospective cohort studies including 824 patients (TVP/control: 400/424) were included in the meta-analysis. There was low-quality evidence suggesting no significant difference between the 2 groups in SSI rate (RR = 0.474; 95% CI = [0.106,2.112]; P = .327) with significant heterogeneity ( I2 = 70.14; P = .035). The TVP group showed a significant benefit on cost analysis in one of the included studies. However, TVP did not prevent gram-negative coinfection on SSI in the TVP group. Conclusion: From the literature available at present, TVP does not qualify to be recommended as a safe and useful option to prevent SSI following pediatric spine surgeries. High-quality prospective interventional studies are needed to arrive at a consensus on its use along with appropriate dosage and method of application.
Antihyperalgesic effect of exercise is augmented by the oral pretreatment with extract of Casearia sylvestris in an animal model of osteoarthritis
Authors: Pascoalino Shayany Dalbem , Lüdtke Daniela Dero , Heymanns Ana Caroline , Salm Daiana , Costa Déborah M , Martins Daniel Fernandes , Horewicz Verônica V , Bobinski Franciane , Piovezan Anna Paula 
Published: July 2020

Background/Purpose: Osteoarthritis (OA) is the main orthopedic disease to cause pain and edema in humans. This study evaluated the influence of complementary medicine on the hyperalgesia and edema induced by exercise in an animal model of OA as well as possible role for interleukin (IL)-1β to these outcomes. Methods: Mice (25–35 g) were subjected to intraplantar injection of Freund’s complete adjuvant and were subjected to exercise and oral treatment with ethanolic crude extract of Casearia sylvestris (ECE-CS) or vehicle (alone or in combination) and evaluated through behavioral and biochemical tests. Results: At day 5, exercise and ECE-CS alone did not reduce hyperalgesia, while the combination of both enhanced this effect. In muscle and skin tissues from the treated paw of mice, both treatments alone or in combination reduced in similar extent the levels of IL-1β in relation to the control group. Conclusion: Association of both complementary therapies may bring benefits on pain associated with OA in humans.
Characterization of Geriatric Dysphagia Diagnoses in Age‐Based Cohorts
Authors: Applebaum Jeremy , Lee Emerson , Harun Aisha , Davis Ashley , Hillel Alexander T. , Best Simon R. , Akst Lee M. 
Published: July 2020

ObjectiveAn aging population requires increased focus on geriatric otolaryngology. Patients aged ≥65 years are not a homogenous population, and important physiologic differences have been documented among the young‐old (65‐74 years), middle‐old (75‐84), and old‐old (≥85). We aim to analyze differences in dysphagia diagnoses and swallowing‐related quality‐of‐life among these age subgroups.Study DesignRetrospective chart review.SettingTertiary care laryngology clinic.Subjects and MethodsWe identified chief complaint, diagnosis, and self‐reported swallowing handicap (Eating Assessment Tool [EAT‐10] score) of all new patients aged ≥65 years presenting to the Johns Hopkins Voice Center between April 2015 and March 2017. Dysphagia diagnoses were classified by physiologic etiology and anatomic source. Diagnostic categories and EAT‐10 score were evaluated as functions of patient age and sex.ResultsOf 839 new patients aged ≥65 years, 109 (13.0%) reported a chief complaint of dysphagia and were included in this study. The most common dysphagia etiologies were neurologic and esophageal. Most common diagnoses were diverticula (15.6%), reflux (13.8%), and radiation induced (8.3%). Diverticula, cricopharyngeal hypertonicity, and radiation‐induced changes were associated with higher EAT‐10 score (P <. 001). Significant differences by sex were found in anatomic source of dysphagia, as men and women were more likely to present with oropharyngeal and esophageal disease, respectively (P =. 023). Dysphagia etiology and EAT‐10 score were similar across age subgroups.ConclusionImportant differences among dysphagia diagnosis and EAT‐10 score exist among patients aged ≥65 years. Knowledge of these differences may inform diagnostic workup, management, and further investigations in geriatric otolaryngology.
Dividual identity in grief theories, palliative and bereavement care
Authors: Davies Douglas J. 
Published: July 2020

Methods: As in life at large, ideas of ‘self’ underlie a great deal of theory and practice in palliative care and in bereavement care, they are frequently implicit, being part of shared cultural assumptions, but may assume a degree of theoretical abstraction when fostered by professionals. This article considers the latter, arguing for an interpretation of ‘self’ influenced by the anthropological notion of dividual or composite personhood and not for that of the autonomous, relatively insular individual typified in much postmodern culture. Results: After depicting both types of personhood, the article explores Western theories of grief typified in the approaches of attachment and loss, continuing bonds with the dead and narrative approaches to identity. Discussion: The dividual approach to personhood then drives a theoretical critique of those grief theories as a means of reflecting upon palliative and bereavement care. Conclusion This alignment of palliative and bereavement care is seen as an entailment of the dividual approach to personhood, while further consequences are raised for analysing memory, dreams and visitations of the dead, as well as providing a potential perspective upon memory loss and the dissonance experienced by relatives of someone who no longer recognizes them.
Crystal chemistry of the variscite and metavariscite groups: Crystal structures of synthetic CrAsO4⋅2H2O, TlPO4⋅2H2O, MnSeO4⋅2H2O, CdSeO4⋅2H2O and natural bonacinaite, ScAsO4⋅2H2O
Authors: Kolitsch Uwe , Weil Matthias , Kovrugin Vadim M. , Krivovichev Sergey V. 
Published: July 2020

AbstractWe report the crystal structures of four synthetic members of the variscite group (space group typePbca) and of bonacinaite, the first naturally occurring scandium arsenate member of the metavariscite group. All structures were determined using single-crystal X-ray intensity data. The following members were all synthesised under either mild hydrothermal conditions or by wet-chemical methods (<90°C). CrAsO4⋅2H2O (deep green):a= 8.894(2),b= 9.946(2),c= 10.206(2) Å andV= 902.8(3) Å3;R1= 2.14%. Tl3+PO4⋅2H2O (colourless):a= 10.2848(7),b= 8.8578(6),c= 10.3637(7) Å andV= 944.14(11) Å3(data at –173°C);R1= 2.56%. MnSeO4⋅2H2O (pale pink):a= 10.441(2),b= 9.2410(18),c= 10.552(2) Å andV= 1018.1(3) Å3;R1= 2.19%. A different method of preparation of MnSeO4⋅2H2O yielded crystals with very similar unit-cell parameters,a= 10.4353(5),b= 9.2420(5) andc= 10.5349(6) Å;R1= 2.25%. CdSeO4⋅2H2O (colourless) hasa= 10.481(1),b= 9.416(1),c= 10.755(1) Å andV= 1061.4(2) Å3;R1= 1.53%. The thermal behaviour of the two selenate members was studied by a combination of DSC and TG, supplemented by PXRD. Bonacinaite (IMA2018-056), metavariscite-type natural (Sc,Al)(As,P)O4⋅2H2O (ideally ScAsO4⋅2H2O), crystallises in the space groupP21/n, witha= 5.533(1),b= 10.409(2),c= 9.036(2) Å, β = 91.94(3)° andV= 520.11(18) Å3;R1= 3.66%. The structural formula, supported by chemical analysis, is (Sc0.807(1)Al0.193)(As0.767(7)P0.233)O4⋅2H2O. All structures are based on frameworks built by corner-sharing of TO4tetrahedra (T = P5+, As5+or Se6+) with MO4(H2O)2(M = Mn2+, Cd2+, Cr3+, Sc3+or Tl3+) octahedra. The flexible frameworks are reinforced by partly bifurcated, strong to weak hydrogen bonds.The crystal chemistry of all known synthetic and natural members of the variscite and metavariscite groups is discussed and compared, and the relative stabilities are evaluated. With the aid of theCOMPSTRUprogram (Bilbao Crystallographic Server), a quantitative comparison of the crystal structures in both groups is given. Calculations of the structural and topological complexity reveal that the metavariscite structure type is structurally and topologically simpler than that of variscite. It is suggested that metavariscite and phosphosiderite are metastable kinetically stabilised phases, in contrast to thermodynamically stable variscite and strengite, respectively. The 3D frameworks of the members of both groups have been shown to be potential electrode materials for rechargeable Li ion batteries.
Phosphoproteomic quantitation and causal analysis reveal pathways in GPVI/ITAM-mediated platelet activation programs
Authors: Babur Özgün , Melrose Alexander R. , Cunliffe Jennifer M. , Klimek John , Pang Jiaqing , Sepp Anna-Liisa I. , Zilberman-Rudenko Jevgenia , Tassi Yunga Samuel , Zheng Tony , Parra-Izquierdo Iván , Minnier Jessica , McCarty Owen J. T. , Demir Emek , Reddy Ashok P. , Wilmarth Phillip A. , David Larry L. , Aslan Joseph E. 
Published: July 2020

Abstract
Platelets engage cues of pending vascular injury through coordinated adhesion, secretion, and aggregation responses. These rapid, progressive changes in platelet form and function are orchestrated downstream of specific receptors on the platelet surface and through intracellular signaling mechanisms that remain systematically undefined. This study brings together cell physiological and phosphoproteomics methods to profile signaling mechanisms downstream of the immunotyrosine activation motif (ITAM) platelet collagen receptor GPVI. Peptide tandem mass tag (TMT) labeling, sample multiplexing, synchronous precursor selection (SPS), and triple stage tandem mass spectrometry (MS3) detected &gt;3000 significant (false discovery rate &lt; 0.05) phosphorylation events on &gt;1300 proteins over conditions initiating and progressing GPVI-mediated platelet activation. With literature-guided causal inference tools, &gt;300 site-specific signaling relations were mapped from phosphoproteomics data among key and emerging GPVI effectors (ie, FcRγ, Syk, PLCγ2, PKCδ, DAPP1). Through signaling validation studies and functional screening, other less-characterized targets were also considered within the context of GPVI/ITAM pathways, including Ras/MAPK axis proteins (ie, KSR1, SOS1, STAT1, Hsp27). Highly regulated GPVI/ITAM targets out of context of curated knowledge were also illuminated, including a system of &gt;40 Rab GTPases and associated regulatory proteins, where GPVI-mediated Rab7 S72 phosphorylation and endolysosomal maturation were blocked by TAK1 inhibition. In addition to serving as a model for generating and testing hypotheses from omics datasets, this study puts forth a means to identify hemostatic effectors, biomarkers, and therapeutic targets relevant to thrombosis, vascular inflammation, and other platelet-associated disease states.
Pulmonary alveolar proteinosis in children
Authors: Bush Andrew , Pabary Rishi 
Published: July 2020

Pulmonary alveolar proteinosis (PAP) is an umbrella term for a wide spectrum of conditions that have a very characteristic appearance on computed tomography. There is outlining of the secondary pulmonary lobules on the background of ground-glass shadowing and pathologically, filling of the alveolar spaces with normal or abnormal surfactant. PAP is rare and the common causes in children are very different from those seen in adults; autoimmune PAP is rare and macrophage blockade not described in children. There are many genetic causes of PAP, the best known of which are mutations in the genes encoding surfactant protein (SP)-B, SP-C, thyroid transcription factor 1, ATP-binding cassette protein 3, and the granulocyte–macrophage colony-stimulating factor (GM-CSF) receptor α- and β- chains. PAP may also be a manifestation of rheumatological and metabolic disease, congenital immunodeficiency, and haematological malignancy. Precise diagnosis of the underlying cause is essential in planning treatment, as well as for genetic counselling. The evidence base for treatment is poor. Some forms of PAP respond well to whole-lung lavage, and autoimmune PAP, which is much commoner in adults, responds to inhaled or subcutaneous GM-CSF. Emerging therapies based on studies in murine models of PAP include stem-cell transplantation for GM-CSF receptor mutations.Educational aimsTo understand when to suspect that a child has pulmonary alveolar proteinosis (PAP) and how to confirm that this is the cause of the presentation.To show that PAP is an umbrella term for conditions characterised by alveolar filling by normal or abnormal surfactant, and that this term is the start, not the end, of the diagnostic journey.To review the developmental differences in the spectrum of conditions that may cause PAP, and specifically to understand the differences between causes in adults and children.To discuss when to treat PAP with whole-lung lavage and/or granulocyte–macrophage colony-stimulating factor, and review potential promising new therapies.