bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors of Long-Term Pain After Hip Arthroplasty in Patients With Femoral Neck Fractures: A Cohort Study
Authors: Noori Atefeh , Sprague Sheila , Bzovsky Sofia , Schemitsch Emil H. , Poolman Rudolf W. , Frihagen Frede , Axelrod Daniel , Heels-Ansdell Diane , Bhandari Mohit , Busse Jason W. ,   on behalf of the HEALTH Investigators
Published: October 2020

Objectives:
To identify factors associated with the development of prolonged pain after hip fracture surgery.

Design:
Secondary analysis of a randomized controlled trial.

Setting:
Eighty hospitals in 10 countries.

Patients/Participants:
One thousand four hundred forty-one hip fracture patients in the HEALTH trial.

Interventions:
Total hip arthroplasty or hemiarthroplasty.

Main Outcome Measures:
Moderate-to-severe pain (at least 2 activities on the Western Ontario and McMaster Universities Osteoarthritis questionnaire pain subscale with scores ≥2) at 12 and 24 months after hip arthroplasty.

Results:
Of 840 and 726 patients with complete baseline data and outcomes at 1-year and 2-year follow-up, 96 (11.4%) and 80 (11.0%) reported moderate-to-severe pain, respectively. An increased risk of pain at both 1 and 2 years after surgery was associated with reporting moderate-to-severe hip pain before fracture [absolute risk increase (ARI) 15.3%, 95% confidence interval (CI) 6.44%–24.35%; ARI 12.5%, 95% CI 2.85%–22.12%, respectively] and prefracture opioid use (ARI 15.6%, 95% CI 5.41%–25.89%; ARI 21.1%; 95% CI 8.23%–34.02%, respectively). Female sex was associated with an increased risk of persistent pain at 1 year (ARI 6.2%, 95% CI 3.53%–8.84%). A greater risk of persistent pain at 2 years was associated with younger age (≤79-year-old; ARI 6.3%; 95% CI 2.67%–9.91%) and higher prefacture functional status (ARI 10.7%; 95% CI 3.80%–17.64%).

Conclusions:
Among hip fracture patients undergoing arthroplasty, approximately one in 10 will experience moderate-to-severe pain up to 2 years after surgery. Younger age, female sex, higher functioning prefracture, living with hip pain prefracture, and use of prescription opioids were predictive of persistent pain.

Level of Evidence:
Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
What Factors Increase Revision Surgery Risk When Treating Displaced Femoral Neck Fractures With Arthroplasty: A Secondary Analysis of the HEALTH Trial
Authors: Blankstein Michael , Schemitsch Emil H. , Bzovsky Sofia , Poolman Rudolf W. , Frihagen Frede , Axelrod Daniel , Heels-Ansdell Diane , Bhandari Mohit , Sprague Sheila , Schottel Patrick C. ,   on behalf of the HEALTH Investigators
Published: October 2020

Objectives:
HEALTH was a randomized controlled trial comparing total hip arthroplasty with hemiarthroplasty in low-energy displaced femoral neck fracture patients aged ≥50 years with unplanned revision surgery within 24 months of the initial procedure being the primary outcome. No significant short-term differences between treatment arms were observed. The primary objective of this secondary HEALTH trial analysis was to determine if any patient and surgical factors were associated with increased risk of revision surgery within 24 months after hip fracture.

Methods:
We analyzed 9 potential factors chosen a priori that could be associated with revision surgery. The factors included age, body mass index, major comorbidities, independent ambulation, type of surgical approach, length of operation, use of femoral cement, femoral head size, and degree of femoral stem offset. Our statistical analysis was a multivariable Cox regression using reoperation within 24 months of index surgery as the dependent variable.

Results:
Of the 1441 patients included in this analysis, 8.1% (117/1441) experienced reoperation within 24 months. None of the studied factors were found to be predictors of revision surgery (P > 0.05).

Conclusion:
Both total and partial hip replacements are successful procedures in low-energy displaced femoral neck fracture patients. We were unable to identify any patient or surgeon-controlled factors that significantly increased the need for revision surgery in our elderly and predominately female patient population. One should not generalize our findings to an active physiologically younger femoral neck fracture population.

Level of Evidence:
Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Pediatric and Neonatal Invasive Candidiasis
Authors: Jantarabenjakul Watsamon , Yodkitudomying Chatnapa , Chindamporn Ariya , Suchartlikitwong Pintip , Anugulruengkitt Suvaporn , Pancharoen Chitsanu , Puthanakit Thanyawee 
Published: October 2020

Background:
Invasive candidiasis (IC) is a serious infection among children with underlying medical conditions. A shift from C. albicans to non-albicans Candida has been observed worldwide. This study aims to identify species of Candida and factors associated with the overall 30-day mortality rate.

Methods:
A retrospective chart review was conducted among children with culture-confirmed IC from birth to 15 years of age at King Chulalongkorn Memorial Hospital, Thailand. Multivariate Cox regression analysis was performed to determine associated factors with 30-day mortality.

Results:
From 2003 to 2019, 102 episodes of IC in pediatric group with a median age of 16 months (interquartile range 4–65) and 12 episodes of IC in neonatal group with a median age of 18 days (interquartile range 12–22). The species distribution were Candida albicans (35%), Candida parapsilosis (26%), Candida tropicalis (22%), Candida glabrata (6%) and other/unspecified species (11%). Antifungal treatment was given in 88% (67% Amphotericin B deoxycholate, 28% Fluconazole). Overall 30-day mortality rates were 28.5% [95% confidence interval (CI) 20.8%–38.4%] and 8.3% (95% CI 1.2%–46.1%) in pediatrics and neonates, respectively. Mortality rate among the neutropenic group was significantly higher than non-neutropenic group (46.4% vs. 20.6%, P = 0.005). Factors associated with 30-day mortality in pediatric IC were shock [adjusted hazard ratio (aHR) 4.2; 95% CI 1.8–9.4], thrombocytopenia (aHR 7.7; 95% CI 1.8–33.9) and no antifungal treatment (aHR 4.6; 95% CI 1.7–12.1).

Conclusions:
Two-third of children with IC were diagnosed with non-albicans Candida. Children with high mortality rate included those with neutropenia, presented with shock or thrombocytopenia, such that the proper empiric antifungal treatment is recommended.
Relationship Between Job Satisfaction and Burnout Based on a Structural Equation Model
Authors: Song Xiaohua , Xiang Minrong , Liu Yan , Yu Chuanhua 
Published: October 2020

Objectives:
To understand the relationship between job burnout and job satisfaction for medical workers and analyse the influencing factors.

Methods:
We used two scales to examine medical workers in Hengyang mental hospitals. Multivariate logistic regression and structural equation model were used to evaluate the relevant factors of job satisfaction, and the relationship between job satisfaction and job burnout.

Results:
The total job satisfaction was at the moderate level. For job burnout was in the middle burnout level. Job satisfaction can have a negative prediction function for job burnout (direct effect −0.684). The relevant factors of job burnout and job satisfaction was as follows: nature of the work, pay, benefits and communication impacted job satisfaction and job burnout.

Conclusions:
The current level of job satisfaction is relatively low, job satisfaction has a negative effect on job burnout.
Clinical Feature and Prognosis of Sudden Sensorineural Hearing Loss With Rheumatoid Arthritis
Authors: Li Hui , Zhang Mingjie , Wang Mengjun , Zhang Shuhan , Ma Shiyin , Wang Xiaomin 
Published: October 2020

Objectives:
Recent publications reported that patients with rheumatoid arthritis (RA) experience an increased risk of suffering sudden sensorineural hearing loss (SSNHL), however, these cases are poorly understood. This study aims to explore the clinical presentations and hearing recovery of SSNHL patients with RA.

Study Design:
Retrospective study.

Setting:
Tertiary medical center.

Patients:
Forty-seven SSNHL patients with RA (RA group) and 431 SSNHL patients without RA (non-RA group) were recruited between April 2015 and June 2019.

Interventions:
In the non-RA group, all patients were administrated with oral steroids. In the RA group, 21 patients were treated with oral steroid (OS group) and 26 patients were administrated with intratympanic steroids plus oral steroids (IS+OS group).

Main Outcome Measures:
We explored the clinical features and hearing recovery of SSNHL patients with RA in comparison with patients without RA, we also evaluated the therapeutic effect of combined steroids in SSNHL patients with RA.

Results:
RA group had higher initial hearing loss level (mean 68.5 dB), final hearing threshold (mean 52.3 dB), the rates of profound hearing loss (48.9%), and no recovery (48.9%) than non-RA group (mean 55.1 dB, mean 34.8 dB, 32.9 and 27.6%, all p < 0.05), however, had lower hearing gains (mean 16.1 dB) and the rate of partial recovery (12.8%) than non-RA group (mean 20.3 dB and 28.8%, all p < 0.05). Furthermore, IS+OS group had higher hearing gains (mean 21.1 dB) and lower rate of no recovery (30.8%) than in the OS group (mean 10.0 dB and 71.4%, all p < 0.05).

Conclusions:
SSNHL patients with RA experienced severe hearing loss and had poor hearing prognosis. IS+OS provide better hearing recovery than OS for this population.
Single-Cell RNA-seq of Human Myeloid-Derived Suppressor Cells in Late Sepsis Reveals Multiple Subsets With Unique Transcriptional Responses: A Pilot Study
Authors: Darden Dijoia B. , Bacher Rhonda , Brusko Maigan A. , Knight Parker , Hawkins Russell B. , Cox Michael C. , Dirain Marvin L. , Ungaro Ricardo , Nacionales Dina C. , Rincon Jaimar C. , Gauthier Marie-Pierre L. , Kladde Michael , Bihorac Azra , Brusko Todd M. , Moore Frederick A. , Brakenridge Scott C. , Mohr Alicia M. , Moldawer Lyle L. , Efron Philip A. 
Published: October 2020

ABSTRACT

Background:
Increased circulating myeloid-derived suppressor cells (MDSCs) are independently associated with poor long-term clinical outcomes in sepsis. Studies implicate subsets of MDSCs having unique roles in lymphocyte suppression; however, characterization of these cells after sepsis remains incomplete. We performed a pilot study to determine the transcriptomic landscape in MDSC subsets in sepsis using single-cell RNAseq (scRNA-seq).

Methods:
A mixture of whole blood myeloid-enriched and Ficoll-enriched PBMCs from two late septic patients on post-sepsis day 21 and two control subjects underwent Cellular Indexing of Transcriptomes and Epitopes by Sequencing (CITE-seq).

Results:
We successfully identified the three MDSC subset clusters—granulocytic (G-), monocytic (M-), and early (E-) MDSCs. Sepsis was associated with a greater relative expansion of G-MDSCs versus M-MDSCs at 21 days as compared to control subjects. Genomic analysis between septic patients and control subjects revealed cell-specific and common differential expression of genes in both G-MDSC and M-MDSC subsets. Many of the common genes have previously been associated with MDSC proliferation and immunosuppressive function. Interestingly, there was no differential expression of several genes demonstrated in the literature to be vital to immunosuppression in cancer-induced MDSC.

Conclusion:
This pilot study successfully demonstrated that MDSCs maintain a transcriptomic profile that is immunosuppressive in late sepsis. Interestingly, the landscape in chronic critical illness is partially dependent on the original septic insult. Preliminary data would also indicate immunosuppressive MDSCs from late sepsis patients appear to have a somewhat unique transcriptome from cancer and/or other inflammatory diseases.
Monocyte exocytosis of mitochondrial danger-associated molecular patterns in sepsis suppresses neutrophil chemotaxis
Authors: Konecna Barbora , Park Jinbong , Kwon Woon-Yong , Vlkova Barbora , Zhang Quanzhi , Huang Wei , Kim Hyo In , Yaffe Michael B. , Otterbein Leo E. , Itagaki Kiyoshi , Hauser Carl J. 
Published: October 2020

BACKGROUND
Trauma and sepsis both increase the risk for secondary infections. Injury mobilizes mitochondrial (MT) danger-associated molecular patterns (mtDAMPs) directly from cellular necrosis. It is unknown, however, whether sepsis can cause active MT release and whether mtDAMPs released by sepsis might affect innate immunity.

METHODS
Mitochondrial release from human monocytes (Mo) was studied after LPS stimulation using electron microscopy and using fluorescent video-microscopy of adherent Mo using Mito-Tracker Green (MTG) dye. Release of MTG+ microparticles was studied using flow cytometry after bacterial stimulation by size exclusion chromatography of supernatants with polymerase chain reaction (PCR) for mitochondrial DNA (mtDNA). Human neutrophil (PMN), chemotaxis, and respiratory burst were studied after PMN incubation with mtDNA.

RESULTS
LPS caused Mo to release mtDAMPs. Electron microscopy showed microparticles containing MT. mtDNA was present both in microvesicles and exosomes as shown by PCR of the relevant size exclusion chromatography bands. In functional studies, PMN incubation with mtDNA suppressed chemotaxis in a dose-dependent manner, which was reversed by chloroquine, suggesting an endosomal, toll-like receptor-9–dependent mechanism. In contrast, PMN respiratory burst was unaffected by mtDNA.

CONCLUSION
In addition to passive release of mtDAMPs by traumatic cellular disruption, inflammatory and infectious stimuli cause active mtDAMP release via microparticles. mtDNA thus released can have effects on PMN that may suppress antimicrobial function. mtDAMP-mediated “feed-forward” mechanisms may modulate immune responses and potentially be generalizable to other forms of inflammation. Where they cause immune dysfunction the effects can be mitigated if the pathways by which the mtDAMPs act are defined. In this case, the endosomal inhibitor chloroquine is benign and well tolerated. Thus, it may warrant study as a prophylactic antiinfective after injury or prior sepsis.
Traumatic brain injury induced temperature dysregulation: What is the role of β blockers?
Authors: Asmar Samer , Bible Letitia , Chehab Mohamad , Tang Andrew , Khurrum Muhammad , Castanon Lourdes , Ditillo Michael , Douglas Molly , Joseph Bellal 
Published: October 2020

BACKGROUND
Traumatic brain injury (TBI) is associated with sympathetic discharge that leads to posttraumatic hyperthermia (PTH). Beta blockers (ββ) are known to counteract overactive sympathetic discharge. The aim of our study was to evaluate the effect of ββ on PTH in critically-ill TBI patients.

METHODS
We performed retrospective cohort analysis of the Medical Information Mart for Intensive Care database. We included all critically ill TBI patients with head Abbreviated Injury Scale (AIS) score of 3 or greater and other body region AIS score less than 2 who developed PTH (at least one febrile episode [T > 38.3°C] with negative microbiological cultures (blood, urine, and bronchoalveolar lavage). Patients on preinjury ββ were excluded. Patients were stratified into (ββ+) and (ββ−) groups. Propensity score matching was performed (1:1 ratio) controlling for patient demographics, injury parameters and other medications that influence temperature. Outcomes were the number of febrile episodes, maximum temperature, and the time interval between febrile episodes. Multivariate linear regression was performed.

RESULTS
We analyzed 4,286 critically ill TBI patients. A matched cohort of 1,544 patients was obtained: 772 ββ + (metoprolol, 60%; propranolol, 25%; and atenolol, 15%) and 772 ββ−. Mean age was 63.4 ± 15.4 years, median head AIS score of 3 (3–4), and median Injury Severity Score of 10 (9–16). Patients in the ββ+ group had a lower number of febrile episodes (8 episodes vs. 12 episodes; p = 0.003), lower median maximum temperature (38.0°C vs. 38.5°C; p = 0.025), and a longer median time between febrile episodes (3 hours vs. 1 hour; p = 0.013). On linear regression, propranolol was found to be superior in terms of reducing the number of febrile episodes and the maximum temperature. However, there was no significant difference between the three ββ in terms of reducing the time interval between febrile episodes (p = 0.582).

CONCLUSION
Beta blockers attenuate PTH by decreasing the frequency of febrile episodes, increasing the time interval between febrile episodes, and reducing the maximum rise in temperature. ββ may be a potential therapeutic modality in PTH.

LEVEL OF EVIDENCE
Therapeutic, level IV.
Prior cocaine exposure increases firing to immediate reward while attenuating cue and context signals related to reward value in anterior insula
Authors: Pribut Heather J. , Vázquez Daniela , Brockett Adam T. , Wei Alice D. , Tennyson Stephen S. , Roesch Matthew R. 
Published: October 2020

ABSTRACTThe insula contributes to behavioral control and is disrupted by substance abuse, yet we know little about the neural signals underlying these functions or how they are disrupted after chronic drug self-administration. Here, rats self-administered either cocaine (experimental group) or sucrose (control) for twelve consecutive days. After a one-month withdrawal period, we recorded from anterior insula while rats performed a previously learned reward-guided decision-making task. Cocaine-exposed rats were more sensitive to value manipulations and were faster to respond. These behavioral changes were accompanied by elevated counts of neurons in the insula that increased firing to reward. These neurons also fired more strongly at the start of long delay trials-when a more immediate reward would be expected, and fired less strongly in anticipation of the actual delivery of delayed rewards. Although reward-related firing to immediate reward was enhanced after cocaine self-administration, reward-predicting cue and context signals were attenuated.Significance StatementThe insula plays a clear role in drug-addiction and drug-induced impairments of decision-making, yet there is little understanding of its underlying neural signals. We found that chronic cocaine self-administration reduces cue and context-encoding in insula, while enhancing signals related to immediate reward. These changes in neural activity likely contribute to impaired decision-making and impulsivity observed after drug use.
Design Of A Rapid And Reversible Fluorescence Assay To Detect Covid-19 And Other Pathogens
Authors: Yerramilli V. Siddartha , Scarlata Suzanne 
Published: October 2020

AbstractWe describe a rapid and reusable biophysical method to assay COVID-19 and other pathogens. The method uses fluorescent sensors (i.e. molecular beacons) designed to detect COVID-19 RNA or any RNA of interest, concurrent with an internal control without the need for amplification. The molecular beacons are stem-loop structures in which a ∼10 nucleotide loop region has the complementary sequence of a region of the target RNA, and a fluorophore and quencher are placed on the 5’ and 3’ ends of the stem. The energy of hybridization of the loop with its target is designed to be greater than the hybridization energy of the energy of the stem so that when the beacon encounters its target RNA, the structure opens resulting in dequenching of the fluorophore. Here, we designed a COVID-19 beacon that is completely quenched in its native form and undergoes a 50-fold increase in fluorescence when exposed to nanomolar amounts of synthetic viral oligonucleotide. No changes in intensity are seen when control RNA is added. A control beacon to a human GAPDH RNA, chosen for its high levels in saliva, behaved similar to the COVID-19 beacon. This increase in fluorescence with beacon opening can be completely reversed upon addition of single stranded DNA complementary to COVID-19 beacon loop region. Beacons can be attached to an insert matrix allowing their use in concentrated form and can be made from morphilino oligonucleotides that are resistant to RNases. We present an analysis of the parameters that will allow the development of test strips to detect virus in aerosol, body fluids and community waste.Statement of significanceA platform for reusable and rapid detection of COVID-19 RNA and other pathogenic RNAs without the need for amplification or sophisticated instrumentation in a complex environment is described.
Extremely preterm infant admissions within the SafeBoosC-III consortium during the COVID-19 lockdown
Authors: Rasmussen Marie Isabel , Lühr Hansen Mathias , Pichler Gerhard , Dempsey Eugene , Pellicer Adelina , EL-Khuffash Afif , Shashidhar A , Piris-Borregas Salvador , Alsina Miguel , Cetinkaya Merih , Chalak Lina , Ozkan Hilal , Baserga Mariana , Sirc Jan , Fuchs Hans , Ergenekon Ebru , Arruza Luis , Mathur Amit , Stocker Martin , Vaccarello Olalla Otero , Szczapa Tomasz , Sarafidis Kosmas , Krolak-Olejnik Barbara , Memisoglu Asli , Reigstad Hallvard , Rafińska-Ważny Elżbieta , Hatzidaki Eleftheria , Peng Zhang , Gkentzi Despoina , Viellevoye Renaud , De Buyst Julie , Mastretta Emmanuele , Wang Ping , Hahn Gitte Holst , Bender Lars , Cornette Luc , Tkaczyk Jakub , Rio Ruth del , Fumagalli Monica , Papathoma Evangelina , Wilinska Maria , Naulers Gunnar , Sadowska-Krawczenko Iwona , Lecart Chantal , Couce María Luz , Fredly Siv , Heuchan Anne Marie , Karen Tanja , Greisen Gorm 
Published: October 2020

AbstractObjectiveTo evaluate if the number of admitted extremely preterm (EP) infants (born before 28 weeks of gestational age) has changed in the neonatal intensive care units (NICUs) of the SafeBoosC-III consortium during the global lockdown when compared to the corresponding time period in 2019.DesignThis is a retrospective, observational study. Forty-six out of 79 NICUs (58%) from 17 countries participated. Principal investigators were asked to report the following information: 1) Total number of EP infant admissions to their NICU in the three months where the lockdown restrictions were most rigorous during the first phase of the COVID-19 pandemic, 2) Similar EP infant admissions in the corresponding three months of 2019, 3) the level of local restrictions during the lockdown period and 4) the local impact of the COVID-19 lockdown on the everyday life of a pregnant woman.ResultsThere was no significant difference between the number of EP infant admissions during the three most rigorous lockdown months of the COVID-19 pandemic compared to the corresponding three months in 2019 (n=428 versus n=457 respectively, p=0.33). There were no significant changes within individual geographic regions and no significant association between the level of lockdown restrictions and change in the number of EP infant admissions (p=0.334).ConclusionThis largerad hocstudy did not confirm previous studies’ report of a major reduction in the number of extremely preterm births during the first phase of the COVID-19 pandemic.