bluuebunny/crossref_metadata_2025_split huggingface dataset:
Optimal Anchor at the Uppermost Instrumented Vertebra in Long Fusion From the Pelvis to the Lower Thoracic Spine in Elderly Patients With Degenerative Spinal Deformity
Authors: Tsutsui Shunji , Hashizume Hiroshi , Yukawa Yasutsugu , Minamide Akihito , Nakagawa Yukihiro , Iwasaki Hiroshi , Takami Masanari , Yamada Hiroshi 
Published: May 2021

Study Design:
This was a retrospective cohort study.

Objective:
The objective of this study was to compare pedicle screws (PSs) and transverse process hooks (TPHs) as anchors at the uppermost instrumented vertebra (UIV) in the lower thoracic spine in elderly patients with adult spinal deformity.

Summary of Background Data:
Less-rigid fixation using hooks at the UIV are thought to best prevent proximal junctional kyphosis (PJK) in long spinal fusion surgery. Although adult spinal deformity is commonly treated via spinal fusion from the pelvis to the lower thoracic spine, few studies have focused on UIV anchors in the lower thoracic spine.

Materials and Methods:
We retrospectively reviewed 53 patients aged 65 years and above who underwent spinal fusion from the pelvis to T9 or T10, with a minimum follow-up of 1 year. Radiographic outcomes including the incidence of PJK and implant failure were compared between 28 patients with TPHs and 25 patients PSs at the UIV.

Results:
The TPH and PS groups had similar radiographic values for pelvic incidence-lumbar lordosis (preoperative: 42.8 vs. 49.0 degrees, postoperative: 9.9 vs. 7.3 degrees) and the sagittal vertical axis (preoperative: 109.3 vs. 106.8 mm; postoperative: 21.9 vs. 11.2 mm). However, the incidence of PJK was significantly higher in the TPH group (35.7%) than that in the PS group (8.0%) at the 1-year follow-up (P=0.012). PJK in the TPH group was associated with UIV or UIV±1 fracture accompanied by posterior dislodgement of the TPH.

Conclusion:
Rigid fixation using PSs at the UIV in the lower thoracic spine produced better radiographic outcomes than did TPHs in elderly patients undergoing spinopelvic fusion.

Level of Evidence:
Level III.
Eliminating HIV reservoirs for a cure: the issue is in the tissue
Authors: Busman-Sahay Kathleen , Starke Carly E. , Nekorchuk Michael D. , Estes Jacob D. 
Published: May 2021

Purpose of review
Advances in antiretroviral therapy have saved numerous lives, converting a diagnosis with human immunodeficiency virus 1 (HIV-1) from a death sentence into the possibility for a (nearly) normal life in many instances. However, the obligation for lifelong adherence, increased risk of accumulated co-morbidities, and continued lack of uniform availability around the globe underscores the need for an HIV cure. Safe and scalable HIV cure strategies remain elusive, in large part due to the presence of viral reservoirs in which caches of infected cells remain hidden from immune elimination, primarily within tissues. Herein, we summarize some of the most exciting recent advances focused on understanding, quantifying, and ultimately targeting HIV tissue viral reservoirs.

Recent findings
Current studies have underscored the differences between viral reservoirs in tissue compartments as compared to peripheral blood, in particular, the gastrointestinal (GI) tract. Additionally, several novel or modified techniques are showing promise in targeting the latent viral reservoir, including modifications in drug delivery platforms and techniques such as CRISPR.

Summary
Elimination of tissue viral reservoirs is likely the key to generation of an effective HIV cure. Exciting studies have come out recently that reveal crucial insights into topics ranging from the basic biology of reservoir seeding to effective drug targeting. However, there are still many outstanding questions in the field about the relative importance of specific reservoirs, such as the GI tract, that may alter the final strategy pursued.
Visualization of HIV-1 reservoir: an imaging perspective
Authors: Chapon Catherine , Moysi Eirini , Naninck Thibaut , Mayet Celine , Petrovas Constantinos 
Published: May 2021

Purpose of review
The persistence of HIV-1-infected cells, despite the introduction of the combinatorial antiretroviral therapy, is a major obstacle to HIV-1 eradication. Understanding the nature of HIV reservoir will lead to novel therapeutic approaches for the functional cure or eradication of the virus. In this review, we will update the recent development in imaging applications toward HIV-1/simian immunodeficiency virus (SIV) viral reservoirs research and highlight some of their limitations.

Recent findings
CD4 T cells are the primary target of HIV-1/SIV and the predominant site for productive and latent reservoirs. This viral reservoir preferentially resides in lymphoid compartments that are difficult to access, which renders sampling and measurements problematical and a hurdle for understanding HIV-1 pathogenicity. Novel noninvasive technologies are needed to circumvent this and urgently help to find a cure for HIV-1. Recent technological advancements have had a significant impact on the development of imaging methodologies allowing the visualization of relevant biomarkers with high resolution and analytical capacity. Such methodologies have provided insights into our understanding of cellular and molecular interactions in health and disease.

Summary
Imaging of the HIV-1 reservoir can provide significant insights for the nature (cell types), spatial distribution, and the role of the tissue microenvironment for its in vivo dynamics and potentially lead to novel targets for the virus elimination.
Environmental impact on reproductive health and risk mitigating strategies
Authors: Giudice Linda C. 
Published: May 2021

Purpose of review
The purpose of this review is to increase awareness among reproductive health professionals and trainees about the impact of environmental toxicants and climate change on women's health and mitigation strategies at the individual, professional and governmental levels.

Recent findings
Global health indicators reveal a meteoric rise of noncommunicable diseases over the past 50 years, which threaten reproductive health directly and indirectly. Evolutionary genetic mutations as contributors are unlikely in this timeframe, and environmental causes have been invoked. Notably, the past 75 years have witnessed marked increases in industrial chemical production, and global warming has rendered a ‘climate crisis’ with extreme temperatures and compromised food, water, and air quality. There is now strong experimental and epidemiologic evidence for endocrine disrupting chemicals and particulate matter and chemical components of air pollution in the pathophysiology of human reproductive disorders during development and across the lifespan, especially among vulnerable populations.

Summary
Environmental impacts on fertility, pregnancy outcomes, childhood neurodevelopment, and reproductive tract development are significant, not widely appreciated, and may be preventable. In light of the evidence, education and advocating economical mitigations of toxic environmental chemicals and alternative energy strategies are imperatives to assure quality reproductive health for this and future generations.
Aldosterone contributes to hypertension in male mice inducibly overexpressing human endothelin-1 in endothelium
Authors: Berillo Olga , Coelho Suellen C. , Mahjoub Nada , Offermanns Stefan , Paradis Pierre , Schiffrin Ernesto L. 
Published: May 2021

Objective:
Mechanisms of blood pressure (BP) regulation by endothelin (ET)-1 produced by endothelial cells are complex and remain unclear. Long-term exposure to human ET-1 (hET-1) in mice inducibly overexpressing hET-1 in the endothelium (ieET-1) caused sustained BP elevation. ET-1 has been shown to stimulate the release of aldosterone. Whether aldosterone plays a role in hET-1 overexpression-induced BP elevation and vessel injury is unknown.

Method:
Nine- to 12-week-old male ieET-1 mice and control mice expressing a tamoxifen-inducible Cre recombinase (CreERT2) in the endothelial cells (ieCre) were treated with tamoxifen for 5 days and studied 3 months later.

Results:
Endothelial hET-1 overexpression increased plasma aldosterone levels, which was reversed by 2-week treatment with atrasentan, an endothelin type A receptors blocker. Aldosterone synthase and cryptochrome 2 adrenal cortex mRNA expression was decreased in ieET-1 mice. Two-week treatment with eplerenone, a mineralocorticoid receptor antagonist, reduced systolic BP by 10 mmHg in ieET-1 mice during rest time. Saline challenge-induced sodium excretion and renal cortex thiazide-sensitive sodium-chloride cotransporter mRNA expression were decreased in ieET-1 mice. The sensitivity of mesenteric arteries to contraction by norepinephrine was increased in ieET-1 mice, and was abrogated by eplerenone treatment, whereas sensitivity of endothelium-independent relaxation responses to sodium nitroprusside was enhanced. Resistance artery remodeling was reduced in eplerenone-treated ieET-1 vs. ieET-1 and ieCre mice.

Conclusion:
These results demonstrate that aldosterone contributes to BP elevation and vascular norepinephrine sensitivity and remodeling caused by hET-1 overexpression in endothelium in mice.
Nutrients and micronutrients at risk during renal replacement therapy: a scoping review
Authors: Berger Mette M. , Broman Marcus , Forni Lui , Ostermann Marlies , De Waele Elisabeth , Wischmeyer Paul E. 
Published: May 2021

Purpose of review
Malnutrition is frequent in patients with acute kidney injury. Nutrient clearance during renal replacement therapy (RRT) potentially contributes to this complication. Although losses of amino acid, trace elements and vitamins have been described, there is no clear guidance regarding the role of micronutrient supplementation.

Recent findings
A scoping review was conducted with the aim to review the existing literature on micronutrients status during RRT: 35 publications including data on effluent losses and blood concentrations were considered relevant and analysed. For completeness, we also included data on amino acids. Among trace elements, negative balances have been shown for copper and selenium: low blood levels seem to indicate potential deficiency. Smaller size water soluble vitamins were found in the effluent, but not larger size liposoluble vitamins. Low blood values were frequently reported for thiamine, folate and vitamin C, as well as for carnitine. All amino acids were detectable in effluent fluid. Duration of RRT was associated with decreasing blood values.

Summary
Losses of several micronutrients and amino acids associated with low blood levels represent a real risk of deficiency for vitamins B1 and C, copper and selenium: they should be monitored in prolonged RRT. Further Research is urgently required as the data are insufficient to generate strong conclusions and prescription recommendations for clinical practice.
Best case/worst case for the trauma ICU: Development and pilot testing of a communication tool for older adults with traumatic injury
Authors: Zimmermann Christopher J. , Zelenski Amy B. , Buffington Anne , Baggett Nathan D. , Tucholka Jennifer L. , Weis Holly B. , Marka Nicholas , Schoultz Thomas , Kalbfell Elle , Campbell Toby C. , Lin Vivian , Lape Diane , Brasel Karen J. , Phelan Herbert A. , Schwarze Margaret L. 
Published: May 2021

BACKGROUND
“Best Case/Worst Case” (BC/WC) is a communication tool to support shared decision making in older adults with surgical illness. We aimed to adapt and test BC/WC for use with critically ill older adult trauma patients.

METHODS
We conducted focus groups with 48 trauma clinicians in Wisconsin, Texas, and Oregon. We used qualitative content analysis to characterize feedback and adapted the tool to fit this setting. Using rapid sequence iterative design, we developed an implementation tool kit. We pilot tested this intervention at two trauma centers using a pre-post study design with older trauma patients in the intensive care unit (ICU). Main outcome measures included study feasibility, intervention acceptability, quality of communication, and clinician moral distress.

RESULTS
BC/WC for trauma patients uses a graphic aid to document major events over time, illustrate plausible scenarios, and convey uncertainty. We enrolled 86 of 116 eligible patients and their surrogates (48 pre/38 postintervention). The median patient age was 72 years (51–95 years) and mean Geriatric Trauma Outcome Score was 126.1 (±30.6). We trained 43 trauma attendings and trauma fellows to use the intervention. Ninety-four percent could perform essential tool elements after training. The median end-of-life communication score (scale 0–10) improved from 4.5 to 6.6 (p = 0.006) after intervention as reported by family and from 4.1 to 6.0 (p = 0.03) as reported by nurses. Moral distress did not change. However, there was improvement (less distress) reported by physicians regarding “witnessing providers giving false hope” from 7.34 to 5.03 (p = 0.022). Surgeons reported the tool put multiple clinicians on the same page and was useful for families, but tedious to incorporate into rounds.

CONCLUSION
BC/WC trauma ICU is acceptable to clinicians and may support improved communication in the ICU. Future efficacy testing is threatened by enrollment challenges for severely injured older adults and their family members.

LEVEL OF EVIDENCE
Therapeutic, level III.
The timing of amputation of mangled lower extremities does not predict post-injury outcomes and mortality: A retrospective analysis from the ACS TQIP database
Authors: Tillmann Bourke W. , Guttman Matthew P. , Nathens Avery B. , de Mestral Charles , Kayssi Ahmed , Haas Barbara 
Published: May 2021

BACKGROUND
While limb salvage does not result in improved functional outcomes among patients with a mangled lower extremity, the impact of attempted limb salvage on mortality and complications is poorly understood. The objective of this study was to evaluate the relationship between attempted limb salvage and in-hospital outcomes among patients with a mangled lower extremity.

METHODS
We performed a retrospective cohort study of adults, 16 years or older, with a mangled lower extremity. Data were derived from the American College of Surgeons’ Trauma Quality Improvement Program (2012–2017). We compared mortality, complications (severe sepsis, acute kidney injury [AKI], decubitus ulcers) and length of stay between patients managed with the intention of limb salvage (amputation beyond 24 hours or no amputation) and those who underwent early amputation (within 24 hours of presentation). Instrumental variable analysis was used to evaluate the relationship between management strategy and outcomes.

RESULTS
We identified 5,527 patients with a mangled lower extremity, of which 901 (16.3%) underwent early amputation. Among those managed with attempted limb salvage, 42.5% underwent amputation prior to discharge. After adjusting for patient and hospital characteristics, there was no association between initial management strategy and mortality (odds ratio, 1.20; 95% confidence interval [CI], 0.83–1.74 early amputation vs. attempted limb salvage). Early amputation was associated with lower odds of AKI (OR, 0.59; 95% CI, 0.39–0.88) and a trend toward shorter length of stay (relative risk, 0.77; 95% CI, 0.52–1.14).

CONCLUSION
Over half of patients who sustain a mangled lower extremity undergo amputation during their initial hospital course. While a limb salvage strategy is associated with an elevated risk of AKI, there is no association between attempted limb preservation and mortality. These findings suggest that in patients in which there is no clear indication for early amputation, attempts at limb salvage do not come at the cost of increased mortality.

LEVEL OF EVIDENCE
Therapeutic study, level IV.
The Electrophysiological Findings in Spinocerebellar Ataxia Type 6: Evidence From 24 Patients
Authors: Zhang WenWen , Jasinarachchi Mahi , Seiderer Linda , Szmulewicz David J. , Roberts Leslie J. 
Published: May 2021

Purpose:
Peripheral neuropathy has been reported commonly in several spinocerebellar ataxia (SCA) types. To date, there is a lack of robust evidence for neuropathy or neuronopathy in SCA type 6 (SCA6). Here, we aim to evaluate the presence of neuropathy or neuronopathy in a cohort of SCA6 patients.

Methods:
Twenty-four individuals with genetically confirmed SCA6 underwent detailed neurophysiological assessment. This included nerve conduction studies, and in some, cutaneous silent periods, blink reflexes, tilt table tests, quantitative sudomotor axon reflex tests, and somatosensory (median and tibial) evoked potentials.

Results:
Mean age was 56.1 years (range, 22–94 years) at the time of testing. Four patients were presymptomatic of SCA6 at recruitment. The mean disease duration of symptomatic patients was 11.9 years (range, 1–40 years). Most patients (79.2%, 19/24) had no neurophysiological evidence of a peripheral neuropathy. One with impaired glucose tolerance had mild, large, and small fiber sensorimotor polyneuropathy. One elderly patient had length-dependent axonal sensorimotor polyneuropathy. Two had minor sensory abnormalities (one had type II diabetes and previous chemotherapy). One other had minor small fiber abnormalities. Ten patients (41.7%) had median neuropathies at the wrist. All somatosensory evoked potential (15/15), and most autonomic function tests (13/14) were normal.

Conclusions:
A large proportion of subjects (79.2%) in our cohort had no evidence of large or small fiber neuropathy. This study does not support the presence of neuropathy or neuronopathy as a common finding in SCA6 and confirms the importance of considering comorbidities as the cause of neurophysiological abnormalities.
Frailty variation models for susceptibility and exposure to SARS-CoV-2
Authors: Gomes M. Gabriela M. , Ferreira Marcelo U. , Chikina Maria , Pegden Wesley , Aguas Ricardo 
Published: May 2021

SummaryIndividual variation in susceptibility and exposure is subject to selection by force of infection, accelerating the natural acquisition of immunity, and reducing herd immunity thresholds and epidemic final sizes. This is a manifestation of a wider population phenomenon known as “frailty variation” in demography. Despite this theoretical understanding, public health policies continue to be guided by mathematical models that leave out most of the relevant variation and as a result inflate projected infection burdens. Here we focus on the trajectories of the coronavirus disease (COVID-19) pandemic in England and Scotland. We fit models to series of daily deaths and estimate relevant epidemiological parameters, including coefficients of variation which we find in agreement with direct measurements based on published contact surveys. Our estimates are robust to whether the data series encompass one or two pandemic waves. We conclude that herd immunity thresholds are being reached with a larger contribution of vaccination in Scotland than in England, where naturally acquired immunity is higher. These results are relevant to global vaccination policies.
Assessment of N95 respirator for reuse after sterilization: filtration efficacy, breathing resistance, quality factor, chemical structure and surface charge density
Authors: Kumar Amit , Subramanian V. , Shailesh J. , Venkatraman B. 
Published: May 2021

AbstractIn the present ongoing pandemic, the N95 respirator is an essential protective barrier to suppress the spread of the SARS-Cov-2 virus and protect the frontline worker from exposure. The N95 respirators are meant for single usage; however, they can be used after decontamination in-light of the economy and shortfall in availability. At this juncture, the respirators performance after various types of sterilization and usage condition is required to be analyzed in detail. With this motto, this work has proceeded. The filtration efficiency, pressure drop, and quality factor of the respirator are evaluated for two face velocities (5.8 and 26.4 cm/s) following different sterilization methods. Sterilization techniques used here are dry air oven heating, gamma irradiation, and immersing in a 10% concentration of liquid hydrogen peroxide. The particle filtration performance and electrostatic surface charge density measurement are used to determine the facemasks efficacy after sterilization. The methods recommended to sterilize N95 masks without affecting their performance are (i) using dry air heat at 80°C and (ii) H2O2soaking. The highest reduction in filtration efficiency is observed to be 30-35% after gamma irradiation due to a change in the electrostatic properties of the respirator layers. However, the filtration efficiency does not change significantly for other sterilization methods despite a change in charge density, but there is no direct correlation with filtration efficiency. Electrostatic charge measurement of the filtration layer is a crucial indicator of filtration efficiency degradation. Policymakers can use these data during potential future N95 shortage to assess the viability of sterilization methods.
Comparative Transcriptomics Identifies Potential Stemness-Related Markers for Mesenchymal Stromal/Stem Cells
Authors: Ghabriel Myret , El Hosseiny Ahmed , Moustafa Ahmed , Amleh Asma 
Published: May 2021

AbstractMesenchymal stromal/stem cells (MSCs) are multipotent cells residing in multiple tissues with the capacity for self-renewal and differentiation into various cell types. These properties make them promising candidates for regenerative therapies. MSC identification is critical in yielding pure populations for successful therapeutic applications; however, the criteria for MSC identification proposed by the International Society for Cellular Therapy (ISCT) is inconsistent across different tissue sources. In this study, we aimed to identify potential markers to be used together with the ISCT’s criteria to provide a more accurate means of MSC identification. Thus, we carried out a comparative analysis of the expression of human and mouse MSCs derived from multiple tissues to identify the common differentially expressed genes. We show that six members of the proteasome degradation system are similarly expressed across MSCs derived from bone marrow, adipose tissue, amnion, and umbilical cord. Also, with the help of predictive models, we found that these genes successfully identified MSCs across all the tissue sources tested. Moreover, using genetic interaction networks, we showed a possible link between these genes and antioxidant enzymes in the MSC antioxidant defense system, thereby pointing to their potential role in prolonging the life span of MSCs. Our results suggest that these genes can be used as stemness-related markers.
Short single-stranded DNA with putative non-canonical structures comprises a novel class of plasma cell-free DNA
Authors: Hisano Osamu , Ito Takashi , Miura Fumihito 
Published: May 2021

ABSTRACTCell-free DNA (cfDNA) in human blood is currently investigated as a minimally invasive, highly informative biomarker. Here, we aimed to investigate the existence of the shorter cfDNA fragments in the blood. Using an improved cfDNA purification protocol and a 3′-end-labeling method, we found DNA fragments of approximately 50 nucleotides in human plasma, present at a molar concentration comparable to that of the nucleosome-sized fragments. These short fragments cannot be recovered by widely used cfDNA isolation methods, and are composed of single-stranded DNA (ssDNA), thus escaping detection in previous studies. We established a library-preparation protocol based on our unique ssDNA ligation technique and applied it to the isolated cfDNA. Deep sequencing of these libraries revealed that the short fragments are derived from hundreds of thousands of genomic sites in open chromatin regions and enriched with transcription factor-binding sites. Remarkably, antisense strands of putative G-quadruplex motifs occupy as much as one-third of peaks called with these short fragments. Hence, we propose a novel class of plasma cfDNA composed of short single-stranded fragments that potentially form non-canonical DNA structures.