bluuebunny/crossref_metadata_2025_split huggingface dataset:
Genetic analysis of plasmid-encoded mcr-1 resistance in Enterobacteriaceae derived from poultry meat in the Netherlands
Authors: Jamin Casper , Sanders Bazante K , Zhou Miaomiao , Costessi Adalberto , Duijsings Danny , Kluytmans Jan A J W , van Alphen Lieke B , Schrauwen Eefje J A 
Published: September 2021

Abstract

Background
Colistin is classified as the highest priority and critically important antimicrobial for human medicine by WHO as it is the last resort agent for treatment of carbapenem-resistant Enterobacteriaceae in humans. Additional research is necessary to elucidate the genetic structure of mcr-1 resistance genes, commonly found on plasmids, using WGS.

Objectives
To map and compare the genetic characteristics of 35 mcr-1-mediated colistin-resistant Enterobacteriaceae isolated from chicken meat to highlight the genetic variation of the mcr-1-containing plasmids.

Methods
Sequencing was performed using Illumina HiSeq2500, Novaseq6000 and ONT’s GridION. GridION data was locally basecalled and demultiplexed using ONT’s Albacore 2.3.4 followed by Porechop 2.3. Quality filtering was performed using Filtlong 2.0. Hybrid Assembly was performed using Unicycler 4.7. Plasmids were compared with reference sequences in plasmid-RefSeq and pATLAS.

Results
A total of 35 mcr-1 positive Enterobacteriaceae were investigated, which resulted in 34 qualitatively robust hybrid assemblies of 2 Klebsiella pneumoniae and 32 Escherichia coli. mcr-1.1 was present in 33/34 isolates. One isolate contained an mcr-1.1-like resistance gene, due to a deletion of one codon. Two mcr-1.1 genes were located on the chromosome, while the majority of the mcr-1 genes were found on IncX4 type plasmids (n = 19). Almost all plasmids identified in this study were highly similar to plasmids found in human-derived strains.

Conclusions
The mcr-1.1-containing plasmids from retail chicken show high sequence similarity to human mcr-1.1 plasmids, suggesting that this may be a contributor to the presence of colistin resistance in humans.
Theoretical analysis of stress intensity factor for two unequal collinear cracks subjected to internal pressure and compressive stress
Authors: Zhang Xianshang , Long Qingming , Zheng Tao , Zhu Zheming , Wang Meng , Hou Peng 
Published: September 2021

Abstract
In this paper, a new solution of the stress intensity factors (SIFs) for two unequal collinear cracks is developed considering internal pressure, friction and compressive stress. The complex stress function and elliptic integral function are used to obtain the analytical solution of the SIFs, and it shows a good agreement with the previous researchers’ solutions and numerical results. The theoretical results show that the difference and interaction of the SIFs at cracks’ tips are caused by crack geometry parameters, and they also indicate that the internal pressure leads to the SIFs of a mode I crack and affects the SIFs of a mode II crack because of friction.
Post-vaccination COVID Toes (Chilblains) Exacerbated by Rituximab Infusion Suggests Interferon Activation as Mechanism
Authors: Qiao Jana W , Dan Yongwook , Wolf Michael E , Zoccoli Christina M , Demetriou Theodore J , Lennon Robert P 
Published: September 2021

ABSTRACT
Coronavirus disease (COVID) toes are pernio-like skin lesions associated with severe acute respiratory syndrome coronavirus 2. We observed pernio-like skin findings presenting after a Pfizer BioNTech vaccine, which significantly worsened after an infusion of rituximab. This suggests that the mechanism for COVID toes is interferon activation. Military providers may avoid unnecessary referrals for this self-limiting condition by anticipating this adverse effect.
Compounding Effects of Traumatic Brain Injury, Military Status, and Other Factors on Pittsburgh Sleep Quality Index: A Meta-analysis
Authors: Babu Henry Samuel Immanuel , Breneman Charity B , Chun Timothy , Hamedi Arghavan , Murphy Rayelynn , Barrett John P 
Published: September 2021

ABSTRACT

Introduction
Traumatic brain injury (TBI) or concussion is a known risk factor for multiple adverse health outcomes, including disturbed sleep. Although prior studies show adverse effects of TBI on sleep quality, its compounding effect with other factors on sleep is unknown. This meta-analysis aimed to quantify the effects of TBI on subjective sleep quality in the context of military status and other demographic factors.

Materials and Methods
A programmatic search of PubMed database from inception to June 2020 was conducted to identify studies that compared subjective sleep quality measured using Pittsburgh Sleep Quality Index (PSQI) in individuals with TBI relative to a control group. The meta-analysis included group-wise standard mean difference (SMD) and 95% CI. Pooled means and SDs were obtained for TBI and non-TBI groups with and without military service, and meta-regression was conducted to test for group effects. Exploratory analysis was performed to test for the effect of TBI, non-head injury, military status, sex, and age on sleep quality across studies.

Results
Twenty-six articles were included, resulting in a combined total of 5,366 individuals (2,387 TBI and 2,979 controls). Overall, individuals with TBI self-reported poorer sleep quality compared to controls (SMD = 0.63, 95% CI: 0.45 to 0.80). Subgroup analysis revealed differences in the overall effect of TBI on PSQI, with a large effect observed in the civilian subgroup (SMD: 0.80, 95% CI: 0.57 to 1.03) and a medium effect in the civilian subgroup with orthopedic injuries (SMD: 0.40, 95% CI: 0.13 to 0.65) and military/veteran subgroup (SMD: 0.43, 95% CI: 0.14 to 0.71). Exploratory analysis revealed that age and history of military service significantly impacted global PSQI scores.

Conclusions
Poor sleep quality in TBI cohorts may be due to the influence of multiple factors. Military/veteran samples had poorer sleep quality compared to civilians even in the absence of TBI, possibly reflecting unique stressors associated with prior military experiences and the sequelae of these stressors or other physical and/or psychological traumas that combine to heightened vulnerability. These findings suggest that military service members and veterans with TBI are particularly at a higher risk of poor sleep and its associated adverse health outcomes. Additional research is needed to identify potential exposures that may further heighten vulnerability toward poorer sleep quality in those with TBI across both civilian and military/veteran populations.
HHV-6 Encephalitis After Chimeric Antigen Receptor T-cell Therapy (CAR-T): 2 Case Reports and a Brief Review of the Literature
Authors: Rebechi Melanie T , Bork Jacqueline T , Riedel David J 
Published: September 2021

AbstractHuman herpesvirus 6 (HHV-6) reactivation can occur in patients who are highly immunosuppressed, including those who have undergone hematopoietic stem cell transplantation (HSCT). HHV-6 encephalitis is a severe manifestation that is well described in the HSCT population. Chimeric antigen receptor T-cell (CAR-T) therapy is a novel cancer-directed immunotherapy that results in severe immunosuppression. Patients undergoing CAR-T therapy may be at risk for HHV-6 encephalitis, which can be difficult to distinguish from a common adverse effect of CAR-T therapy, neurotoxicity. Herein, we describe 2 patients diagnosed with HHV-6 encephalitis after CAR-T therapy and discuss the diagnostic approach and differential diagnosis for altered mental status after CAR-T therapy. Diagnosing HHV-6 encephalitis can be difficult in this patient population as altered mental status is common after CAR-T therapy and may be attributed to CAR-T-associated neurotoxicity.
Normalization of Peri-Arteriovenous Malformation Hemodynamics Prior to Direct Microsurgery: 2-Dimensional Operative Video
Authors: Rahme Rudy J , Turcotte Evelyn L , Patra Devi P , Welz Matthew E , Batjer H Hunt , Bendok Bernard R 
Published: September 2021

Abstract
Arteriovenous malformations (AVMs) are highly complex vascular lesions characterized by abnormal connections between arteries and an intervening nidus. Definitive and safe treatment of AVMs may require the combination of multiple treatment modalities to address the various complex features of the AVM.
1
Endovascular embolization can be used as an adjuvant to surgery in order to control deep feeders, reduce flow, and address high-risk features such as aneurysms. In addition, by progressively reducing the AVM flow, staged embolization can lead to normalization of peri-AVM hemodynamics and therefore may decrease the risk of postresection hemorrhage.
2,3
In this operative video, we present a case of a 41-yr-old female who presented with progressively worsening left-sided hemiparesis. Magnetic resonance imaging (MRI) and angiography revealed a complex right fronto-parietal AVM with significant associated edema, likely due to the vascular steal phenomenon. The area of edema, which included the motor cortex, was thought to be at high risk for postoperative hemorrhage from normal perfusion pressure breakthrough. We therefore decided to proceed with staged presurgical embolization to gradually normalize the perilesional hemodynamics, and therefore possibly reduce the risk of postoperative morbidity. The patient underwent 3 embolization sessions at 6-wk intervals. An MRI after the last embolization showed near-complete resolution of the fluid-attenuated inversion-recovery (FLAIR) signal around the AVM. Microsurgical resection was performed on the day after the last embolization. The patient tolerated the procedure well and was discharged at her neurological baseline with mild contralateral hemiparesis, which has continued to improve at follow-up. Postoperative angiography showed complete resection of the AVM. The patient consented to the procedure as shown in this operative video and gave informed written consent for use of her images in publication.
Biomechanical Evaluation of Semi-rigid Junctional Fixation Using a Novel Cable Anchor System to Prevent Proximal Junctional Failure in Adult Spinal Deformity Surgery
Authors: Doodkorte Remco J.P. , Roth Alex K. , Jacobs Eva , Arts Jacobus J.C. , Willems Paul C. 
Published: September 2021

Study Design.
A porcine cadaveric biomechanical study.

Objective.
To biomechanically evaluate a novel Cable Anchor System as semi-rigid junctional fixation technique for the prevention of proximal junctional failure after adult spinal deformity surgery and to make a comparison to alternative promising prophylactic techniques.

Summary of Background Data.
The abrupt change of stiffness at the proximal end of a pedicle screw construct is a major risk factor for the development of proximal junctional failure after adult spinal deformity surgery. A number of techniques that aim to provide a gradual transition zone in range of motion (ROM) at the proximal junction have previously been studied. In this study, the design of a novel Cable Anchor System, which comprises a polyethylene cable for rod fixation, is assessed.

Methods.
Ten T6–T13 porcine spine segments were subjected to cyclic 4 Nm pure-moment loading. The following conditions were tested: uninstrumented, 3 level pedicle screw fixation (PSF), and PSF with supplementary Cable Anchors applied proximally at 1-level (Anchor1) or 2-levels (Anchor2), transverse process hooks (TPH), and 2-level sublaminar tapes (Tape2). The normalized segmental range of motion in the junctional zone was compared using one-way analysis of variance and linear regression.

Results.
Statistical comparison at the level proximal to PSF showed significantly lower ROMs for all techniques compared to PSF fixation alone in all movement directions. Linear regression demonstrated a higher linearity for Anchor1 (0.820) and Anchor2 (0.923) in the junctional zone in comparison to PSF (1-level: 0.529 and 2-level: 0.421). This linearity was similar to the compared techniques (TPH and Tape2).

Conclusion.
The Cable Anchor System presented in this study demonstrated a gradual ROM transition zone at the proximal end of a rigid pedicle screw construct similar to TPH and 2-level sublaminar tape semi-rigid junctional fixation constructs, while providing the benefit of preserving the posterior ligament complex.

Level of Evidence: 5
Shoulder Balance in Adult Spinal Deformity Patients Undergoing Selective Lumbar Fusion
Authors: Alluri Ram Kiran , Sheikh Basel , Elysee Jonathan Charles , Lovecchio Francis , Shah Sachiin , Punyala Ananth , Ang Bryan , Lafage Renaud , Lafage Virginie , Schwab Frank , Kim Han Jo 
Published: September 2021

Study Design.
Retrospective review.

Objective.
To analyze if shoulder balance continues to change in the postoperative period in patients undergoing selective lumbar fusion for adult spinal deformity (ASD), and secondarily, analyze if shoulder balance correlates with health-related quality of life (HRQOL) outcomes.

Summary of Background Data.
Shoulder balance in patients with ASD is poorly understood and has largely been extrapolated from adolescent scoliosis literature.

Materials and Methods.
Adult patients who underwent selective lumbar fusion (upper instrumented vertebra: Τ9–Τ12, lower instrumented vertebra: L4-Pelvis) for thoracolumbar or lumbar scoliosis (cobb angle > 30°) or sagittal plane deformity with thoracic compensatory curves (cobb angle > 10°) were identified. The clavicular angle (CA) was used to quantify shoulder balance. Shoulder balance was categorized into three groups postoperatively (balanced: CA <2°, mild imbalance: CA 2°–4°, severe imbalance: CA >4°). The average CA and proportion of patients in each shoulder balance group were compared at each postoperative period. Patients with 1-year postoperative HRQOL scores were identified.

Results.
Eighty-six patients were included. The preoperative CA was 2.7 ± 2.3° and did not significantly change at discharge (2.9 ± 2.4°), 6-weeks (2.5 ± 2.1°), 6-months (2.4 ± 2.2°), 1-year (2.4 ± 2.5°), or 2-years (2.3 ± 1.5°) postoperatively. The proportion of patients in each shoulder balance group did not significantly change from discharge to 6-weeks, 6-months, 1-year or 2-years postoperatively (P > 0.1). At 1-year follow-up, the CA demonstrated no significant correlation with Oswestry Disability Index, Scoliosis Research Society (SRS)-22 score, or SRS-22 subscores. There was no significant association between shoulder balance group and Oswestry Disability Index, SRS-22 score, or SRS-22 subscores.

Conclusions.
In patients with ASD undergoing selective lumbar fusion, shoulder balance did not change over the postoperative period. From a functional standpoint, shoulder balance demonstrated no correlation with HRQOL scores. In patients undergoing selective lumbar fusion for ASD, shoulder balance may not spontaneously correct over the postoperative period, but this may not be of functional consequence.

Level of Evidence: 4
Analysis of MNS16A VNTR polymorphic sequence variations of the TERT gene and associated risk for development of bladder cancer
Authors: Anwar Iqra , Pandith Arshad A. , Wani Mohammad S. , Mir Hyder , Godha Meena , Koul Aabid , Shah Zafar A. , Manzoor Usma , Amin Ina , Qasim Iqbal 
Published: September 2021

Abstract

Background:
The MNS16A variable number tandem repeat (VNTR) polymorphism of the human telomerase reverse transcriptase (hTERT) gene acts as a regulator of hTERT promoter activity and has been shown to have a role in the predisposition toward various cancers. The current study aimed to investigate the association between MNS16A VNTR alleles and genetic predisposition to bladder cancer in the Kashmir region of northern India.

Materials and methods:
A total of 130 patients with bladder cancer and 170 age- and gender-matched healthy controls were included in this study. Primer-specific polymerase chain reaction was used to genotype the different variants of VNTR alleles of the MNS16A VNTR polymorphism.

Results:
Short allele VNTR-243 (SS) genotype frequency significantly differed between cases (9.23%) and controls (3.52%) (OR = 3.08 [95% CI = 1.10–8.61], p = 0.042). The VNTR-243 short allele (S) was found significantly more frequent in bladder cancer cases (28.46%) than controls (20.88%) (OR = 1.50 [95% CI = 1.03–2.19], p = 0.034). Likewise, the long allele (LL) hTERT MNS16A genotype was distributed more frequently in low stage disease versus high stage disease (60.29% vs. 39.70%) (OR = 0.79 [95% CI = 0.39–1.60], p = 0.595).

Conclusion:
The MNS16A VNTR short allele (S) was associated with a higher risk for bladder cancer in our population as compared to long alleles.
Simultaneous laparoscopic nephroureterectomy and robot-assisted radical cystectomy: Lessons learned from our initial experience
Authors: Yajima Shugo , Nakanishi Yasukazu , Matsumoto Shunya , Tanabe Kenji , Masuda Hitoshi 
Published: September 2021

Abstract

Background:
In patients with high-risk bladder cancer and concomitant upper urinary tract malignancies, simultaneous cystectomy and nephroureterectomy is the principle oncological procedure of choice. Nevertheless, there are still not many reports of simultaneous robot-assisted radical cystectomy (RARC) and nephroureterectomy. Therefore, the aim of this study was to evaluate outcomes and complications of simultaneous RARC and laparoscopic nephroureterectomy in our institution.

Materials and methods:
This case series evaluated our initial clinical results of 3 patients who underwent simultaneous laparoscopic unilateral nephroureterectomy and RARC with the da Vinci Xi system between 2019 and 2020 at our hospital. Demographic data, preoperative parameters, and postoperative parameters were retrospectively analyzed.

Results:
All 3 patients were men whose median age was 75 years (range 73–89 years). The median total operative time was 435 minutes (range 429–484 minutes), median estimated blood loss was 377 mL (range 125–410 mL), and median hospital stay was 26 days (range 21–36 days). In all 3 cases, each trocar was used in 7 ports. The postoperative complications were stratified according to the Clavien-Dindo Classification system, and a grade 3B complication developed in 1 patient: trocar site herniation of the small bowel.

Conclusions:
We reported our initial experience of simultaneous laparoscopic nephroureterectomy and RARC. A large-scale prospective, randomized, controlled trial will be required to prove the feasibility and safety of simultaneous laparoscopic nephroureterectomy and RARC.
Sociodemographic and Biomedical Correlates of Developmental Delay in 2- and 4-Year-Olds with Sickle Cell Disease
Authors: Schatz Jeffrey , Reinman Laura , Bills Sarah E. , Johnston Julia D. 
Published: September 2021

Abstract:

Background:
Developmental delay occurs frequently in sickle cell disease (SCD). Psychosocial and biomedical factors contribute to delays, but most studies have not examined the timing of risk factors and developmental delay. We examined sociodemographic and biomedical factors to evaluate whether risks of developmental delay differed across 2 developmental periods.

Methods:
We examined Ages and Stages Questionnaire, second edition (ASQ-2), outcomes in 2-year-olds (n = 100) and 4-year-olds (n = 101) with SCD. ASQ-2 data were obtained from routine developmental screenings administered as part of health care between 2009 and 2016 at a single hematology clinic. Medical record reviews were used to identify sociodemographic and biomedical factors associated with positive screenings for developmental delay.

Results:
Two-year-olds with positive ASQ-2 screenings (n = 32; 32%) were less likely to have private health insurance or to have been in formal daycare and more likely to have a severe SCD genotype. Four-year-olds with positive screenings (n = 40; 40%) were more likely to have a severe SCD genotype or an abnormal transcranial Doppler ultrasound (TCD) examination indicating high stroke risk. The strength of the association between positive screenings and insurance status, severe genotypes, and TCD examinations differed across the 2 age groups. Domain-level outcomes on the ASQ-2 also differed across the 2 age groups.

Conclusion:
The cross-sectional data indicate biomedical and psychosocial risks are related to developmental delay, but the association with specific risk factors differs across age.
Second and Third Trimester Fetal Death in the Setting of COVID-19: A California 2020 Case Series
Authors: Plotzker Rosalyn E. , Sowunmi Similoluwa , Eckert Valorie , Barnes Emily , Ngo Van , Stockman Lauren J. , LeMarchand Chloe , Halai Umme-Aiman 
Published: September 2021

Abstract
Maternal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the second and third trimesters of pregnancy may impact fetal development via vertical transmission, complications of coronavirus disease 2019 (COVID-19), or placental injury. However, potential associations between prenatal SARS-CoV-2 infection and fetal loss are not well understood. This case series of thirteen second and third trimester fetal losses reported by local public health departments to California's state public health surveillance included maternal clinical and demographic characteristics as well as placental pathology, fetal autopsy reports, and coroner report. There was no evidence that maternal COVID-19 disease severity, placental injury, or SARS-CoV-2 vertical transmission contributed to pregnancy loss. However, this case series is a limited sample; more research is needed to identify factors of prenatal SARS-CoV-2 that may contribute to fetal death in the second and third trimesters.
Anesthesia providers as stakeholders to adoption of pharmacogenomic information in perioperative care
Authors: Truong Tien M. , Apfelbaum Jeffrey L. , Schierer Emily , Danahey Keith , Borden Brittany A. , Karrison Theodore , Shahul Sajid , Anitescu Magdalena , Gerlach Rebecca , Knoebel Randall W. , Meltzer David O. , Ratain Mark J. , O’Donnell Peter H. 
Published: September 2021

Objectives
Integration of pharmacogenomics into clinical care is being studied in multiple disciplines. We hypothesized that understanding attitudes and perceptions of anesthesiologists, critical care and pain medicine providers would uncover unique considerations for future implementation within perioperative care.

Methods
A survey (multiple choice and Likert-scale) was administered to providers within our Department of Anesthesia and Critical Care prior to initiation of a department-wide prospective pharmacogenomics implementation program. The survey addressed knowledge, perceptions, experiences, resources and barriers.

Results
Of 153 providers contacted, 149 (97%) completed the survey. Almost all providers (92%) said that genetic results influence drug therapy, and few (22%) were skeptical about the usefulness of pharmacogenomics. Despite this enthusiasm, 87% said their awareness about pharmacogenomic information is lacking. Feeling well-informed about pharmacogenomics was directly related to years in practice/experience: only 38% of trainees reported being well-informed, compared to 46% of those with 1–10 years of experience, and nearly two-thirds with 11+ years (P < 0.05). Regarding barriers, providers reported uncertainty about availability of testing, turnaround time and whether testing is worth financial costs.

Conclusions
Anesthesiology, critical care and pain medicine providers are optimistic about the potential clinical utility of pharmacogenomics, but are uncertain about practical aspects of testing and desire clear guidelines on the use of results. These findings may inform future institutional efforts toward greater integration of genomic results to improve medication-related outcomes.