bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dose-Dependent Early Postoperative Opioid Use Is Associated with Periprosthetic Joint Infection and Other Complications in Primary TJA
Authors: Chung Brian C. , Bouz Gabriel J. , Mayfield Cory K. , Nakata Haley , Christ Alexander B. , Oakes Daniel A. , Lieberman Jay R. , Heckmann Nathanael D. 
Published: May 2021

Background:
Opioids are commonly prescribed for postoperative pain following total joint arthroplasty. Despite widespread use, few studies have examined the dose-dependent effect of perioperative opioid use on postoperative complications following total hip arthroplasty (THA) and total knee arthroplasty (TKA). Therefore, we examined the dose-dependent relationship between opioid use and postoperative complications following primary THA and TKA.

Methods:
We queried the Premier Healthcare Database to identify adult patients who underwent primary elective THA or TKA from 2004 to 2014, and quantified opioid consumption within the first 3 postoperative days. Opioid consumption was standardized to morphine milligram equivalents (MMEs). Patients were divided into quintiles on the basis of MME exposure: <54, 54 to 82, 83 to 116, 117 to 172, and >172 MMEs. Primary outcomes included postoperative periprosthetic joint infection, pulmonary embolism, deep venous thrombosis, and pulmonary complications. Secondary outcomes included wound infection, wound dehiscence, and readmission within 30 and 90 days postoperatively. Univariate and multivariate analyses were performed to compare differences between groups and to account for confounders.

Results:
A total of 1,525,985 patients were identified. The mean age was 65.7 ± 10.8 years, 598,320 patients (39.2%) were male, and 1,174,314 patients (77.0%) were Caucasian. On multiple logistic regression analysis, increasing MME exposure was associated with a dose-dependent increased risk of postoperative complications. Compared with patients receiving <54 MMEs, exposure to >172 MMEs was associated with greater odds of periprosthetic joint infection (adjusted odds ratio [aOR], 1.37; 95% confidence interval [CI], 1.33 to 1.42), deep venous thromboembolism (aOR, 1.34; 95% CI, 1.30 to 1.38), pulmonary embolism (aOR, 1.29; 95% CI, 1.25 to 1.34), and pulmonary complications (aOR, 1.06; 95% CI, 1.05 to 1.08). Exposure to >172 MMEs was associated with increased risk of wound infection (aOR, 1.37; 95% CI, 1.33 to 1.41), wound dehiscence (aOR, 1.24; 95% CI, 1.19 to 1.31), and readmission within 30 (aOR, 1.21; 95% CI, 1.20 to 1.22) and 90 days (aOR, 1.20; 95% CI, 1.19 to 1.21).

Conclusions:
Increasing opioid use within the early postoperative period following THA or TKA was associated with a dose-dependent increased risk of periprosthetic joint infection and venous thromboembolic events.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Septic Dislocation of Hip After Cephalomedullary Nail Fixation of Intertrochanteric Fractures of Femur
Authors: Sridhar Michael S. , Pichiotino Erin R. 
Published: May 2021

Case:
We describe 3 cases of septic hip arthritis with a dislocation after failed, cephalomedullary nail (CMN) fixation following fragility intertrochanteric (IT) hip fractures that were treated with antibiotic spacer placement.

Conclusion:
Septic hip arthritis and compromised hip abductors can contribute to dislocation of the hip after CMN for IT fractures. This case report presents a treatment plan to address this rare complication, not yet reported after CMN for IT fractures in the literature, to control infection and optimize function.
When Total Joint Arthroplasty After Septic Arthritis Can Be Safely Performed
Authors: Tan Timothy L. , Xu Chi , Kuo Feng-Chih , Ghanem Elie , George Jaiben , Shohat Noam , Chen Ji-Ying , Lee Mel S. , Higuera Carlos , Parvizi Javad 
Published: May 2021

Background:
Patients undergoing total joint arthroplasty (TJA) following septic arthritis are at higher risk for developing periprosthetic joint infection (PJI). Minimal literature is available to guide surgeons on the optimal timing of TJA after completing treatment for prior native joint septic arthritis. This multicenter study aimed to determine the optimal timing of TJA after prior septic arthritis and to examine the role of preoperative serology in predicting patients at risk for developing PJI.

Methods:
A total of 207 TJAs were performed after prior septic arthritis from 2000 to 2017 at 5 institutions. Laboratory values, prior treatment, time from the initial infection, and other variables were recorded. Bivariate analyses were performed to identify the association between the time from septic arthritis to TJA and the risk of developing subsequent PJI. A subanalysis was performed between patients who underwent TJA in 1 setting (n = 97) compared with those who underwent 2-stage arthroplasties (n = 110). Receiver operating characteristic (ROC) curve analysis was performed for serum markers prior to TJA in predicting the risk of a subsequent PJI.

Results:
The overall PJI rate was 12.1%. Increasing time from septic arthritis treatment to TJA was not associated with a reduction of PJI, whether considering time as a continuous or categorical variable, for both surgical treatment cohorts (all p > 0.05). Although the ROC curve analysis found that the optimal threshold for timing of TJA from the initial treatment was 5.9 months, there was no difference in the PJI rate when the overall cohort was dichotomized by this threshold and when stratified by 1-stage compared with 2-stage TJA. There was no significant difference in erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level prior to conversion TJA between patients who subsequently developed PJI and those who did not.

Conclusions:
Serum markers have limited value in predicting subsequent PJI in patients who undergo TJA after prior septic arthritis. There was no optimal interim period between septic arthritis treatment and subsequent TJA; thus, delaying a surgical procedure does not appear to reduce the risk of PJI.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
RNA-Binding Protein IMP3 is a Novel Regulator of MEK1/ERK Signaling Pathway in the Progression of Colorectal Cancer through the Stabilization of MEKK1 mRNA
Authors: Zhang Meng , Zhao Senlin , Tan Cong , Gu Yanzi , He Xuefeng , Du Xiang , Li Dawei , Wei Ping 
Published: May 2021

Abstract
Background

MEK1/ERK signaling pathway plays an important role in most tumor progression, including colorectal cancer (CRC), however, MEK1-targeting therapy has little effective in treating CRC patients, indicating there may be a complex mechanism to activate MEK1/ERK signaling pathway except RAS activated mechanism.
Methods

To investigate the clinical significance of IMP3, we analyzed its expression levels in publicly available dataset and samples from Fudan University Shanghai Cancer Center. The effects of IMP3 on proliferation, migration, and invasion were determined by in vitro and in vivo experiments. To investigate the role of IMP3 in colon carcinogenesis, conditional IMP3 knockout C57BL/6 mice was generated. The IMP3/MEKK1/MEK/ERK signaling axis in CRC was screened and validated by RNA-sequencing, RNA immunoprecipitation, luciferase reporter and western blot assays.
Results

We find RNA binding protein IMP3 directly bind to MEKK1 mRNA 3’-UTR, which regulates its stability, promote MEKK1 expression and sequentially activates MEK1/ERK signaling. Functionally, IMP3 promote the malignant biological process of CRC cells via MEKK1/MEK1/ERK signaling pathway both in vitro and in vivo, Moreover, IMP3−/− mice show decreased the expression of MEKK1 as well as colorectal tumors compared with wild-type mice after treatment with azoxymethane/dextran sodium sulfate. Clinically, the expression of IMP3 and MEKK1 are positive correlated, and concomitant IMP3 and MEKK1 protein levels negatively correlate with metastasis in CRC patients. In addition, MEK1 inhibitor in combination with shRNA-IMP3 have a synergistic effect both in vitro and in vivo.
Conclusion

Our study demonstrates that IMP3 regulates MEKK1 in CRC, thus activating the MEK1/ERK signaling in the progression of colorectal cancer, Furthermore, these results provide new insights into potential applications for combining MEK1 inhibitors with other target therapy such as IMP3 in preclinical trials for CRC patients.
Impact of Perioperative Chemotherapy on Survival Outcomes Among Patients with Metastatic Colorectal Cancer to the Liver
Authors: Baidoun Firas , Merjaneh Zahi , Nanah Rama , Saad Anas M. , Abdel-Rahman Omar 
Published: May 2021

Abstract
IntroductionWhile surgical resection for primary tumor and distant metastases is recommended among individuals with resectable colorectal liver metastases, the role and timing of perioperative systemic therapy is not yet defined.Materials and MethodsThe National Cancer Database was queried for patients diagnosed with metastatic colorectal adenocarcinoma with isolated liver metastases between 2004 and 2016. We evaluated the overall survival (OS) based on the perioperative chemotherapy status using Kaplan-Meier estimates and multivariable cox regression analyses.ResultsA total of 6,883 patients with metastatic CRC and liver metastases were included, within which 6,042 (87.8%) were treated with surgery and chemotherapy, and 841(12.2%) were treated with surgery only. We found that patients who were treated with surgery and chemotherapy had better OS compared to patients who were treated with surgery only (median OS 42.9 months vs 6.4 months, P<0.001). On multivariable analysis, chemotherapy was associated with better OS (HR 0.30; 95% CI: 0.275 - 0.328; P<0.001).We also found that patients who received multiagent chemotherapy had better OS compared to patients who received single-agent chemotherapy (median OS 43.7 months vs 36.1 months, P<0.001), patients who received neoadjuvant chemotherapy had better OS compared to patients who received adjuvant chemotherapy (median OS 48.6 months vs 38.6 months, P<0.001).ConclusionPatients with CRC with isolated liver metastases who were treated with perioperative chemotherapy had significant improvement in OS compared to patients who didn’t receive chemotherapy. Also, neoadjuvant chemotherapy had better OS compared to adjuvant chemotherapy, and multiagent chemotherapy had better OS compared to single-agent chemotherapy.
Is the ABO Blood Group Associated With Increased Intraoperative Blood Loss in Cervical Surgery? A Cohort Study
Authors: Cao Jun-Xiong , Lin Lu , Ke Zhen-Yong , Jia Xiao-Jiong , Cheng Si 
Published: May 2021

Abstract
ObjectiveTo find out if the ABO blood group is associated with increased intraoperative blood loss in cervical surgery.MethodsA total of 126 patients who underwent cervical surgery under general anesthesia were included in this comparative study. Types of cervical surgery included anterior cervical corpectomy decompression and fusion (ACCF) and anterior cervical discectomy and fusion (ACDF). According to ABO blood group differences, the patients were divided into O and non-O blood groups. Intraoperative blood loss was assessed by external blood loss (EBL), Drop-Hct (hematocrit), and Drop-Hb (hemoglobin). This study collected indicators such as ABO blood group, preop Hct, preop Hb, postop Hct, postop Hb, history of hypertension, and etiology.ResultsThere were 22 patients in the O blood group and 104 in the non-O group. There were no significant differences in age between the two groups. Patients of blood group O showed a significantly higher Drop-Hb than in the non-O group (15(11.9-20.2) g/L and 8.5(6.5-11.0) g/L, p=0.001). Drop-Hct also showed a significant difference between the two groups (4.8 (3.3-6.9) (%) vs. 2.2 (1.6-2.8) (%), p=0.001). There was no association between group O and EBL (p=0.263). The ACCF subgroup included 54 patients. Patients with O blood had significantly higher Drop-Hct and Drop-Hb (p<0.05). In the ACDF subgroup (n=72), Drop-Hct and Drop-Hb of O blood patients increased significantly (p<0.05). ConclusionThe ABO blood group was associated with Drop-Hct and Drop-Hb. Consequently, blood group O may be a risk factor for increased intraoperative blood loss during anterior cervical surgery.
A Nomogram for Predicting the Risk of Tuberculosis Infection
Authors: Liu Huanqing , Li Tingting , Lyn Jun 
Published: May 2021

Abstract
Background: Tuberculosis (TB) has become one of the main causes of deaths worldwide. Because of certain conditions prevent the early TB diagnosis and treatment to some extent. This study aimed to develop a tuberculosis (TB) infection risk model and validate the ability of nomogram to predict risk for TB infection in a Chinese population.﻿Methods: A prediction model based on the training dataset of 272 patients was established. Minimum absolute shrinkage and selection operator regression model were adopted to optimize the feature selection of the TB infection risk model. Using multivariate logistic regression analysis, a predictive model combining the features selected in the minimum absolute shrinkage and the selected operator regression model was constructed. The ability of this predictive model to discriminate and calibrate TB infection risk and its utility in clinical settings were assessed via concordance index (C-index), calibration plot, area under time-dependent receiver operating characteristic curve (AUC), and decision curve analysis (DCA). The clinical practicality of nomogram was evaluated via net reclassification index (NRI) and integrated discrimination improvement (IDI). Bootstrapping validation allowed internal validation.Results: According to this predictive nomogram, the main predictors of TB infection risk were gender, age, smoking history, fever, hemoptysis, fatigue, emaciation, CD8, CD4/CD8, ESR, CRP, and abnormal liver function. The model exhibited superior risk calibration and discrimination with a C-index of 0.737 (95% CI: 0.685–0.789). The internal validation reached a C-index value of 0.688. The predictive model was able to produce an AUC of 0.729 (95% CI: 0.677–0.781). Analysis of the decision curve revealed the TB infection probability nomogram manifested its clinical usefulness on the condition that intervention was decided at the TB probability threshold of 13%. Moreover, results demonstrated that nomogram could be utilized as an effective prognostic tool according to NRI and IDI.Conclusion: The new TB probability nomogram for predicting TB infection risk developed herein that combines various factors, such gender, age, smoking history, fever, hemoptysis, fatigue, emaciation, CD8, CD4/CD8, ESR, CRP, and abnormal liver function is convenient and useful in predicting individual TB risks among patients.
Early Efficacy of Type I Collagen Based Matrix-Assisted Autologous Chondrocyte Transplantation to Treat Articular Cartilage Lesions
Authors: Li Xiang , Qian Jiatian , Li Shiao , Fu Peiliang , Chen Chengyan 
Published: May 2021

Abstract
Purpose: To investigate the clinical, radiological, and histological results of type I collagen-based matrix-assisted autologous chondrocyte transplantation (MACT) in the treatment of chondral lesions of the knee.Methods: The study prospectively enrolled 20 patients with symptomatic knee chondral defects (mean size defect was 2.41±0.43 cm2, range 2.0 to 3.4 cm2) in the lateral femoral condyle and femoral groove who underwent type I collagen-based MACT between July 2017 and July 2019. KOOS was assessed preoperatively, with periodic clinical follow-up performed preoperatively and then every 3 months for up to 12 months postoperative period, and thereafter at 1-year intervals. During this follow-up, serial magnetic resonance imaging T2 mapping of repair cartilage was used to reflect the quantitative analysis quality of the regenerative cartilage. In one patient, second-look arthroscopy was performed at 12 months after implantation to assess the characteristics of cartilage regeneration.Results: Compared with preoperation, the score of the pain, symptoms, activities of daily living, sports and recreation, and quality of life showed statistically significant improvement with a significant difference at 3, 6, 12, and 24 months after operation(P<0.05). The difference in KOOS subscales scores between every two-time point was statistically significant (P<0.001). HE stains showed the newly formed cartilage was naive chondrocytes. Safranin O-fast green stain manifested in the regenerated tissue comprising predominantly fibroblast-like cells surrounded by glycosaminoglycans. Immunohistochemistry analysis showed that the expression of collagen type II was more clearly and evenly distributed than collagen type I.Conclusion: Type I collagen-based MACT was a clinically effective treatment for functional and pain level improvement, and this method presented histologic evidence of inducing hyaline‐like cartilage in cartilage lesions by biopsy in one case. The quantitative MRI T2-mapping test showed that there was a difference between the transplanted cartilage and the surrounding hyaline cartilage.
Prevalence and Factors Associated With Stunting Among Children Aged 6-59 Months in Kabale District, Uganda
Authors: Kasajja Musa , Nabiwemba Elizabeth , Wamani Henry , Kamukama Saul 
Published: May 2021

Abstract
Background: Despite of the global efforts undertaken to improve nutrition, malnutrition still continues to be a serious public health concern. Malnutrition in its various forms has been closely associated to major causes of illness, disability and death. Malnutrition in the form of childhood stunting has therefore been identified as a significant hindrance to human development. The aim of this study was to assess the nutritional status of children aged 6–59 months and determine factors associated with stunting among children in Kabale district. Methodology: A cross sectional study was conducted among 640 children, aged 6–59 months selected using both simple random and systematic random sampling techniques. Interview administered questionnaires were used to collect household data whereas anthropometric data was collected using a height board, digital weighing scales and Mid Upper Arm Circumference (MUAC) Tapes. Data was analyzed using STATA version 12.0 and ENA for SMART, 2011. Results: The overall prevalence of stunting among children 6-59 months was 41.1%. Factors independently associated with stunting included; age of the child (children in the age category of 36-47months APOR=0.38; 95% CI 0.18-0.79 and those in the age category of 24-35months APOR=0.42; 95% CI 0.19-0.88), major source of food for the household that is children from households in which mothers indicated market as the major source of food (APOR=0.67; 95% CI 0.48-0.94) and disposal of child stool that is children whose stool was put/ rinsed in a latrine (APOR=0.41; 95% CI: 0.23-0.74) as well as those that whose stool was thrown in garbage (APOR= 0.29; 95% CI: 0.12-0.72). Conclusion: The prevalence of stunting among children aged 6-59 months in Kabale district was high. Practices/ factors independently associated with stunting among children aged 6-59months included; age of the child, major source of food for the household and disposal of child stool. Addressing these factors requires a proper mix of both community and health based interventions. There is also need to strengthen on strategies for reducing stunting like; sanitation and hygiene as well as food and nutrition security within rural households.
A Study on the Soundscape Satisfaction Degree of Urban Landscape Garden Parks
Authors: Di Guoqing , Xiang Junli , Yao Yao , Chen Cong , Lin Qinhao 
Published: May 2021

Abstract
Establishing a public response model of soundscape in parks can provide a basis for the optimization of soundscape design. Three representative urban landscape garden parks were selected in Hangzhou, in which a number of evaluation points were chosen along soundwalk paths. Binaural sounds at each evaluation point were sampled by an artificial head and the landscapes of horizontal view and vertical view were obtained by panoramic photos and satellite images, respectively. An evaluation on soundscape of each point was conducted in laboratory based on virtual reality technology, and the correlations between 17 acoustic indicators, 35 landscape indicators and soundscape satisfaction degree were analyzed. The public response model of soundscape satisfaction degree in parks was established. Final indicators entering the model were the loudness level of sound, the aggregation index of water, the largest patch index of water and the landscape shape index of roads, and their standard regression coefficients were -0.666, - 0.561, 0.523 and -0.310, respectively. The impact weights of acoustics and landscape factors on the satisfaction were 32.3% and 67.7%. When the percentage of vegetation area in park exceeds 15%, its contribution to satisfaction degree will be close to a fixed value (reflected in the constant term of the model). The soundscape satisfaction can be effectively improved by reducing the loudness level of sound in parks, increasing the area of the largest water patch with scattered water patches around it, and reducing the shape complexity of road patches.
Impact of Cavotricuspid Isthmus Anatomy on the Ablation Index For Successful First-Pass Typical Atrial Flutter Ablation
Authors: Kashiwagi Manabu , Kuroi Akio , Katayama Yosuke , Terada Kosei , Fujita Suwako , Hozumi Takeshi , Shimamura Kunihiro , Shiono Yasutsugu , Tanimoto Takashi , Kubo Takashi , Tanaka Atsushi , Akasaka Takashi 
Published: May 2021

Abstract
Cavotricuspid isthmus (CTI) linear ablation has been established as the treatment for typical atrial flutter. Recently, ablation index (AI) has emerged as a novel marker for estimating ablation lesions. We investigated the relationship between CTI anatomy and ablation parameters. In addition, we focused on the influence of AI on the procedural results of typical atrial flutter ablation. A total of 107 patients who underwent CTI ablation were retrospectively enrolled in this study. All patients underwent computed tomography before catheter ablation. From the receiver-operating curve, the best cut-off value of CTI depth was < 4.1 mm to predict first-pass success. The patients were divided into two groups according to the CTI depth: the concave group (CG) and straight group (SG). Although the average AI was not different between both groups, the CG required a longer ablation time and showed a lower first-pass success rate (p < 0.01). In addition, the catheter inversion technique was more frequently required in the CG (p < 0.01). The best cut-off values of the weakest AIs at the anterior and posterior lesions for predicting first-pass success were >420 and >386, respectively. Among patients with these cut-off values, the first-pass success rate was 88% in the SG and 50% in the CG (p < 0.01). Although ablation parameters were not significantly different, the first-pass success rate was lower in the CG than in the SG. AI-guided CTI may be useful in straight CTIs, but a modified approach might be required for concave CTIs.