bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preoperative opioid use is a risk factor for complication following revision total hip arthroplasty
Authors: Wilson Jacob M , Farley Kevin X , Erens Greg A , Bradbury Thomas L , Guild George N 
Published: August 2020

Background: The demand for revision total hip arthroplasty (THA) procedures continues to increase. A growing body of evidence in primary THA suggests that preoperative opioid use confers increased risk for complication. However, it is unknown whether the same is true for patients undergoing revision procedures. The purpose of this study was to investigate whether or not there was a relationship between preoperative opioid use and surgical complications, medical complications, and healthcare utilisation following revision THA. Methods: This is a retrospective cohort study using the Truven Marketscan database. Patients undergoing revision THA were identified. Preoperative opioid prescriptions were queried for 1 year preoperatively and were used to divide patients into cohorts based on temporality and quantity of opioid use. This included an opioid naïve group as well as an “opioid holiday” group (6 months opioid naïve period after chronic use). Demographic and complication data were collected and both univariate and multivariate analysis was then performed. Results: 62.5% of patients had received an opioid prescription in the year preceding surgery. Patients with continuous preoperative opioid use had higher odds of the following: infection (superficial or deep surgical site infection; OR 1.29; 95% CI, 1.03–1.62, p  = 0.029), wound complication (OR 1.36; 95% CI, 1.02–1.82, p = 0.037), sepsis (OR 1.90; 95% CI 1.08–3.34, p = 0.026), and revision surgery (OR 1.54, 95% CI, 1.28–1.85, p < 0.001). This group also had higher care utilisation including extended length of stay, non-home discharge, 90-day readmission, and emergency room visits ( p < 0.001). An opioid holiday mitigated some of this increased risk as this cohort has baseline (i.e. same as opioid naïve) risk ( p > 0.05 for all comparison). Conclusions: Opioid use prior to revision THA is common and is associated with increased risk of postoperative complication. Given that risk was reduced by a preoperative opioid holiday, this represents a modifiable risk factor which should be discussed and addressed preoperatively to optimise outcomes.
Diagnostic Accuracy of Magnetic Resonance Images and Weight-Bearing Radiographs in Patients With Arthroscopic-Proven Medial Osteoarthritis of the Knee
Authors: Muñoz-García Nuria , Cordero-Ampuero José , Madero-Jarabo Rosario 
Published: August 2020

Aims: The aim of this study is to analyze the diagnostic value of weight-bearing radiographs, magnetic resonance images (MRI), and the combination of both in osteoarthritic knees when using arthroscopic findings as the “gold standard” to compare with. Methods: A total of 59 patients were studied because of chronic pain in 1 of their knees. Radiographs were classified according to Kellgren-Lawrence scale. Magnetic resonance images were classified according to Vallotton, and arthroscopic findings according to Outerbridge criteria. Results: Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were, respectively, 75.0%, 60.0%, 56.2%, 77.8%, and 66.1% for weight-bearing radiographs, and 70.8%, 88.6%, 81.0%, 81.6%, and 81.4% for MRI. Logistic regression analysis showed that a weight-bearing radiograph added to MRI offered no additional diagnostic value compared with MRI alone ( P < .001). Conclusions: Magnetic resonance images presented higher specificity, positive and negative predictive values, and accuracy than weight-bearing radiographs for knee osteoarthritis. The combination of radiographs and MRI did not improve the diagnostic accuracy, compared with MRI alone.
Evaluating an Algorithm and Clinical Prediction Rule for Diagnosis of Bone Stress Injuries
Authors: Nye Nathaniel S. , Covey Carlton J. , Pawlak Mary , Olsen Cara , Boden Barry P. , Beutler Anthony I. 
Published: August 2020

Background: A novel algorithm and clinical prediction rule (CPR), with 18 variables, was created in 2014. The CPR generated a bone stress injury (BSI) score, which was used to determine the necessity of imaging in suspected BSI. To date, there are no validated algorithms for imaging selection in patients with suspected BSI. Hypothesis: A simplified CPR will assist clinicians with diagnosis and decision making in patients with suspected BSI. Study Design: Prospective cohort study. Level of Evidence: Level 3. Methods: A total of 778 military trainees with lower extremity pain were enrolled. All trainees were evaluated for 18 clinical variables suggesting BSI. Participants were monitored via electronic medical record review. Then, a prediction model was developed using logistic regression to identify clinical variables with the greatest predictive value and assigned appropriate weight. Test characteristics for various BSI score thresholds were calculated. Results: Of the enrolled trainees, 204 had imaging-confirmed BSI in or distal to the femoral condyles. The optimized CPR selected 4 clinical variables (weighted score): bony tenderness (3), prior history of BSI (2), pes cavus (2), and increased walking/running volume (1). The optimized CPR with a score ≥3 yielded 97.5% sensitivity, 54.2% specificity, and 98.2% negative predictive value. An isolated measure, bony tenderness, demonstrated similar statistical performance. Conclusion: The optimized CPR, which uses bony tenderness, prior history of BSI, pes cavus, and increased walking/running volume, is valid for detecting BSI in or distal to the femoral condyles. However, bony tenderness alone provides a simpler criterion with an equally strong negative predictive value for BSI decision making. Clinical Relevance: For suspected BSI in or distal to the femoral condyles, imaging can be deferred when there is no bony tenderness. When bony tenderness is present in the setting of 1 or more proven risk factors and no clinical evidence of high-risk bone involvement, presumptive treatment for BSI and serial radiographs may be appropriate.
Perioperative Complications of Minimally Invasive Transforaminal Lumbar Interbody Fusion (MI-TLIF): 10 Years of Experience With MI-TLIF
Authors: Patel Jwalant , Kundnani Vishal , Raut Saijyot , Meena Mohit , Ruparel Sameer 
Published: August 2020

Study Design: A prospective study. Objectives: We present a largest study until date performed over a period of 10 years assessing the perioperative complications. The primary aim of this study was to review the incidence of perioperative complications of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) in single-level lumbar degenerative diseases. Methods: A prospective study performed over a period of 10 years involving 560 patients who underwent single-level lumbar MI-TLIF. Perioperative clinical and radiological parameters, postoperative complications, and satisfactory outcomes in the form of Wang’s criteria were evaluated. All patients were scrutinized into 5 different categories based on the descriptive classification for perioperative complications suggested by the authors. Results: The mean age was 61.8 ± 12.7 years and male to female ratio was 0.8:1. The overall incidence of the perioperative complication was 25.5%. In all, 19.64% patients developed single complication, 4.64% patients were with 2 complications, and 1.25% patients developed 3 complications from the described categories. A total of 16.78% patients developed early (<6 months postsurgery) and 8.75% patients developed late (>6 months postsurgery) complications. Conclusion: This study showed 25.5% incidence of perioperative complications in MI-TLIF for degenerative lumbar disease over a period of 10 years with a higher incidence rate during the initial 3 years of practice. The described classification for perioperative complications is helpful to record, to evaluate and to understand the etiology based on its duration of occurrence in the perioperative period. MI-TLIF is an effective procedure with substantial clinical benefits in the form of excellent to good clinical-radiological outcomes.
Fears, Depression, and Anxieties of Patients With Diabetic Retinopathy and Implications for Education and Treatment
Authors: Bloom Jeffrey M. , Mason John O. , Mason Lauren , Swain Thomas A. 
Published: August 2020

Objective: This study investigates undiagnosed depression and anxiety related to diabetes in patients with diabetic retinopathy and identifies commonly feared complications that these patients experience. Methods: The 74 consecutive individuals with diabetes were recruited for this investigation from the office of a retina specialist, and data were obtained from the participants through a self-report survey given to the patients before their appointment. Results: The most feared complication reported by patients surveyed was blindness (38.36%). When asked about depression and anxiety related to their diabetes, 20.27% of patients stated they have depression related to their diabetes, whereas 18.92% had anxiety related to their diabetes. Only 17.57% of the patients said they were being treated for their depression and/or anxiety at the time of the survey. Conclusions: This study demonstrates that many patients with diabetic retinopathy have coexisting fears and mental health concerns. Because most retina specialists treat a high number of patients with diabetes, it is crucial to understand the barriers and comorbidities related to this patient population. Retina specialists may play a role in identifying the hidden and underlying fears, depression, and anxieties in patients with diabetes so that these patients can get the necessary help and counseling they need.
Emicizumab for the treatment of acquired hemophilia A
Authors: Knoebl Paul , Thaler Johannes , Jilma Petra , Quehenberger Peter , Gleixner Karoline , Sperr Wolfgang R. 
Published: August 2020

Abstract
Acquired hemophilia A (AHA) is a severe bleeding disorder caused by inhibiting autoantibodies to coagulation factor VIII (FVIII). For hemostatic treatment, bypassing agents and human or porcine FVIII are currently standard of care. Emicizumab is a bispecific, FVIII-mimetic therapeutic antibody that reduced the annualized bleeding rates in congenital hemophiliacs. Here, we report on 6 male and 6 female patients with AHA treated with emicizumab (all data medians and interquartile range), age 74 (64-80) years, initial FVIII &lt;1%; inhibitor titer 22.3 Bethesda units (BU)/mL (range, 3-2000). Eight patients had severe bleeding. Emicizumab was started, 3 mg/kg subcutaneously, weekly for 2 to 3 doses, followed by 1.5 mg/kg every 3 weeks to keep the lowest effective FVIII levels. For FVIII monitoring, chromogenic assays with human and bovine reagents were used. All patients received immunosuppression with steroids and/or rituximab. After the first dose of emicizumab, activated partial thromboplastin time normalized in 1 to 3 days, FVIII (human reagents) exceeded 10% after 11 (7.5-12) days. Hemostatic efficacy was obtained and bypassing therapy stopped after 1.5 (1-4) days. FVIII (bovine reagents) exceeded 50%, indicating complete remission after 115 (67-185) days, and emicizumab was stopped after 31 (15-79) days. A median of 5 injections (range, 3-9) were given. No patient died of bleeding or thromboembolism, and no breakthrough bleeding was observed after the first dose of emicizumab. In conclusion, emicizumab seems to be an effective hemostatic therapy for AHA, with the advantages of subcutaneous therapy, good hemostatic efficacy, early discharge, and reduction of immunosuppression and adverse events.
Postdischarge thrombosis and hemorrhage in patients with COVID-19
Authors: Patell Rushad , Bogue Thomas , Koshy Anita , Bindal Poorva , Merrill Mwanasha , Aird William C. , Bauer Kenneth A. , Zwicker Jeffrey I. 
Published: August 2020

Abstract
Coronavirus disease 2019 (COVID-19) is associated with a prothrombotic state with a high incidence of thrombotic events during hospitalization; however, data examining rates of thrombosis after discharge are limited. We conducted a retrospective observational cohort study of discharged patients with confirmed COVID-19 not receiving anticoagulation. The cohort included 163 patients with median time from discharge to last recorded follow-up of 30 days (interquartile range [IQR], 17-46 days). The median duration of index hospitalization was 6 days (IQR, 3-12 days) and 26% required intensive care. The cumulative incidence of thrombosis (including arterial and venous events) at day 30 following discharge was 2.5% (95% confidence interval [CI], 0.8-7.6); the cumulative incidence of venous thromboembolism alone at day 30 postdischarge was 0.6% (95% CI, 0.1-4.6). The 30-day cumulative incidence of major hemorrhage was 0.7% (95% CI, 0.1-5.1) and of clinically relevant nonmajor bleeds was 2.9% (95% CI, 1.0-9.1). We conclude that the rates of thrombosis and hemorrhage appear to be similar following hospital discharge for COVID-19, emphasizing the need for randomized data to inform recommendations for universal postdischarge thromboprophylaxis.
Institutionalized data quality assessments: a critical pathway to improving the accuracy of integrated disease surveillance data in Sierra Leone
Authors: Njuguna Charles , Vandi Mohamed , Mugagga Malimbo , Kanu Joseph , Liyosi Evans , Chimbaru Alexander , Gachari Wilson , Caulker Victor , Sesay Stephen , Githuku Jane , Yoti Zabulon , Yahaya Ali Ahmed , Talisuna Ambrose , Fall Ibrahima Socé 
Published: August 2020

Abstract
Background
Public health agencies require valid, timely and complete health information for early detection of outbreaks. Towards the end of the Ebola Virus Disease (EVD) outbreak in 2015, the Ministry of Health and Sanitation (MoHS), Sierra Leone revitalized the Integrated Disease Surveillance and Response System (IDSR). Data quality assessments were conducted to monitor accuracy of IDSR data.

Methods
Starting 2016, data quality assessments (DQA) were conducted in randomly selected health facilities. Structured electronic checklist was used to interview district health management teams (DHMT) and health facility staff. We used malaria data, to assess data accuracy, as malaria was endemic in Sierra Leone. Verification factors (VF) calculated as the ratio of confirmed malaria cases recorded in health facility registers to the number of malaria cases in the national health information database, were used to assess data accuracy. Allowing a 5% margin of error, VF < 95% were considered over reporting while VF > 105 was underreporting. Differences in the proportion of accurate reports at baseline and subsequent assessments were compared using Z-test for two proportions.

Results
Between 2016 and 2018, four DQA were conducted in 444 health facilities where 1729 IDSR reports were reviewed. Registers and IDSR technical guidelines were available in health facilities and health care workers were conversant with reporting requirements. Overall data accuracy improved from over- reporting of 4.7% (VF 95.3%) in 2016 to under-reporting of 0.2% (VF 100.2%) in 2018. Compared to 2016, proportion of accurate IDSR reports increased by 14.8% (95% CI 7.2, 22.3%) in May 2017 and 19.5% (95% CI 12.5–26.5%) by 2018. Over reporting was more common in private clinics and not- for profit facilities while under-reporting was more common in lower level government health facilities. Leading reasons for data discrepancies included counting errors in 358 (80.6%) health facilities and missing source documents in 47 (10.6%) health facilities.

Conclusion
This is the first attempt to institutionalize routine monitoring of IDSR data quality in Sierra Leone. Regular data quality assessments may have contributed to improved data accuracy over time. Data compilation errors accounted for most discrepancies and should be minimized to improve accuracy of IDSR data.
TgROP18 targets IL20RB for host-defense-related-STAT3 activation during Toxoplasma gondii infection
Authors: Kong Ling , Jiang Dan , He Cheng , Xia Jing , Wei Haixia , Zhou Lijuan , Peng Hongjuan 
Published: August 2020

AbstractBackgroundToxoplasma gondiiis an opportunistic protozoan infecting almost one-third of the world’s population.Toxoplasma gondiirhoptry protein 18 (TgROP18) is a key virulence factor determining the parasite’s acute virulence and is secreted into host cells during infection. We previously identified the interaction ofTgROP18 and host cell immune-related receptor protein IL20RB, and observed the activation of STAT3 in human keratinocytes (HaCaT) cells infected by therop16knockout RH strain, thoughTgROP16 is regarded as being responsible for host STAT3 activation duringT. gondiiinvasion. Therefore, we hypothesizeTgROP18 can activate host STAT3 through binding to IL20RB.MethodsCRISPR-CAS9 technology was used to generate the ROP16 and ROP18 double knockout RH strain, RH-∆rop16∆rop18. SDS-PAGE and western blot were used to detect STAT3 activation in different HaCaT cells with high endogenous IL20RB expression treated withT. gondiitachyzoites infection, recombinant ROP18, or IL-20. FRET and co-immunoprecipitation (Co-IP) was used to detect the protein-protein interaction.ResultsWe observed thatTgROP18 was involved in a synergic activation of the host JAK/STAT3 pathway together withTgROP16 in human HaCaT cells infected withT. gondiior treated with recombinantTgROP18 protein, stimulating host proinflammatory immune responses such as expression of TNF-α. The effect of recombinant ROP18 on STAT3 phosphorylation was presented in a dose-dependent manner. Additionally,TgROP18 was identified to target IL20RB on its extracellular domain. When we treated different cell lines with the recombinant ROP18, STAT3 phosphorylation could only be observed in the cells with endogenous IL20RB expression, such as HaCaT cells.ConclusionsThese findings indicate thatTgROP18-IL20RB interaction uponT. gondiiinvasion was involved in STAT3 activation, which is associated with host cell defense.
Aggressive behavioural interactions between swans (Cygnus spp.) and other waterbirds during winter: a webcam-based study
Authors: Wood Kevin A. , Ham Phoebe , Scales Jake , Wyeth Eleanor , Rose Paul E. 
Published: August 2020

Abstract
Background
Our understanding of any impacts of swans on other waterbirds (including other swans), and potential effects on waterbird community structure, remain limited by a paucity of fundamental behavioural and ecological data, including which species swans interact aggressively with and how frequently such interactions occur.

Methods
Behavioural observations of aggression by swans and other waterbirds in winters 2018/2019 and 2019/2020, were carried out via live-streaming webcams at two wintering sites in the UK. All occurrence sampling was used to identify all aggressive interactions between conspecific or heterospecifics individuals, whilst focal observations were used to record the total time spent by swans on aggressive interactions with other swans. Binomial tests were then used to assess whether the proportion of intraspecific aggressive interactions of each species differed from 0.5 (which would indicate equal numbers of intraspecific and interspecific interactions). Zero-inflated generalized linear mixed effects models (ZIGLMMs) were used to assess between-individual variation in the total time spent by swans on aggressive interactions with other swans.

Results
All three swan species were most frequently aggressive towards, and received most aggression from, their conspecifics. Our 10-min focal observations showed that Whooper (Cygnus cygnus) and Bewick’s Swans (C. columbianus bewickii) spent 13.8 ± 4.7 s (means ± 95% CI) and 1.4 ± 0.3 s, respectively, on aggression with other swans. These durations were equivalent to 2.3% and 0.2% of the Whooper and Bewick’s Swan time-activity budgets, respectively. Model selection indicated that the time spent in aggressive interactions with other swans was best-explained by the number of other swans present for Whooper Swans, and an interactive effect of time of day and winter of observation for Bewick’s Swans. However, the relationship between swan numbers and Whooper Swan aggression times was not strong (R2 = 19.3%).

Conclusions
Whilst swans do exhibit some aggression towards smaller waterbirds, the majority of aggression by swans is directed towards other swans. Aggression focused on conspecifics likely reflects greater overlap in resource use, and hence higher potential for competition, between individuals of the same species. Our study provides an example of how questions relating to avian behaviour can be addressed using methods of remote data collection such as live-streaming webcams.
Immediate implant placement in molar extraction sockets: a systematic review and meta-analysis
Authors: Ragucci Gian Maria , Elnayef Basel , Criado-Cámara Elena , Del Amo Fernando Suárez-López , Hernández-Alfaro Federico 
Published: August 2020

Abstract
Background
Immediate implants are frequently employed in the anterior maxillary area. However, the installation of dental implants simultaneously with tooth extraction can also provide with benefits in the posterior areas with a reduction in time prior the recovery of the masticatory function. Results previously reported in the literature show high-survival and success rates for implants placed in extraction sockets in molar areas; however, this topic has received limited systematic analysis.

Material and methods
Electronic and manual literature searches were performed by two independent reviewers in several data-bases, including MEDLINE, EMBASE, and Cochrane Oral Health Group Trials Register, for articles up to January 2019 reporting outcomes of immediate implants placed in molar areas. Primary outcomes included survival and success rates, as well as marginal bone loss. Secondary outcomes included the influence of implant position, type of implant connection, grafting protocol, flap or flapless approach, implant diameter, surgical phase, presence of buccal plate, and loading protocol.

Results
Twenty studies provided information on the survival rate, with a total sample of 1.106 implants. The weighted mean survival rate of immediate implants after 1 year of follow-up was 96.6%, and the success rate was 93.3%. On the other hand, marginal bone loss was 1.29 ± 0.24 mm. Secondary outcomes demonstrated that grafting the gap and the loading protocol have an effect on survival and success rates. Similarly, the presence or absence of the buccal bone affect crestal bone levels. Meta-analysis of 4 investigations showed a weighted mean difference of 0.31 mm ± 0.8 IC 95% (0.15–0.46) more marginal bone loss at immediate implant placement versus implants in healed sites (p < 0.001) I2 = 15.2%.

Conclusion
In selected scenarios, immediate implant placement in molar extraction socket might be considered a predictable technique as demonstrated by a high survival and success rates, with minimal marginal bone loss.