bluuebunny/crossref_metadata_2025_split huggingface dataset:
Agricultural Trauma Causing Open Fractures: Is Antibiotic Coverage Against Anaerobic Organisms Indicated?
Authors: Wynn Malynda , Kesler Kyle , Morellato John , Higginbotham Robert , Robertson Michael , Marsh John Lawrence , Hogue Matthew 
Published: May 2021

Objective:
To compare deep infection rate and causative organisms in open fractures of the lower extremity from agricultural trauma with similar injuries in nonagricultural trauma.

Design:
Retrospective.

Setting:
Two tertiary care institutions.

Methods:
Open lower extremity fractures sustained between 2003 and 2018 caused by agriculture-related trauma in adult patients were reviewed. A nonagriculture open fracture control group (NAG) was identified for comparison. Patient demographics and injury characteristics were assessed. Outcomes included occurrence of deep infection and causative organisms.

Results:
One hundred seventy-eight patients were identified in the agriculture (AG) (n = 89) and control (NAG) (n = 89) groups. Among patients with agricultural injury, farm machinery was the most common mechanism in 69 (77.5%) of them. Open injuries of the foot (38.2%) and tibial shaft injuries (25.8%) were the most common in the AG and NAG groups, respectively. Deep infection was seen in 21% of patients in the AG group compared with 10% in the NAG group (P < 0.05). In the AG group, anaerobic infection occurred in 44% of patients with deep infection compared with 9.1% in the NAG group (P < 0.05). The most common anaerobic organisms included enterococci, Pseudomonas aeruginosa, and Clostridium perfringens.

Conclusions:
This study supports that open fractures due to agricultural trauma have a high infection rate, with anaerobic infection occurring at higher rates than in injuries due to nonagricultural trauma. Prophylactic treatment with antibiotics directed against anaerobes is indicated in these injuries.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Incidence and Risk Factors for Postoperative Urinary Retention Following Lumbar Spine Fusion
Authors: Bowman John J. , Edwards Charles C. , Dean Clayton , Park Justin , Edwards Charles C. 
Published: May 2021

Study Design:
This was a prospective cohort study (observational—retrospective chart review).

Objective:
The objective of this study was to determine clinical rates and correlations of postoperative urinary retention (POUR) in elective spine decompression and fusion procedures.

Summary of Background Data:
POUR is a common postoperative complication that often has a major adverse impact on a patient’s recovery from elective lumbar spine surgery. The etiology of POUR in most cases is unknown. Patients undergoing lumbar spine surgery are considered to be at increased risk for POUR due to prone positioning during surgery and intraoperative cauda equina nerve root manipulation. Current studies reporting on POUR after elective spine surgery provide limited insight regarding risk factors and effective prevention strategies for this at-risk population. The purpose of this study is to identify risk factors for POUR after elective lumbar spine surgery and strategies for reducing its incidence.

Materials and Methods:
Two hundred consecutive patients aged 50 years or older undergoing combined lumbar decompression and fusion procedures over a 5-month period at a single institution were prospectively observed. Demographic and clinical data were prospectively recorded, including: medical history, surgical data, medications administered, complications, and postoperative hospital course. Factors correlating with POUR through a univariate analysis with P≤0.20 were considered for multivariate analysis.

Results:
POUR occurred in 19 of 200 patients. Those with POUR were more likely to be male (20% vs. 4%, odds ratio=6.2). Administration of scopolamine (P=0.02), neostigmine (P=0.01), and the total number of levels operated on (P=0.02) were found to be independent risk factors for the development of POUR. Length of surgery, surgical level, the performance of an interbody fusion did not have a bearing on the development of POUR (P>0.05).

Discussion:
We describe a single institution’s experience of POUR incidence in 200 consecutive patients aged 50 years or older undergoing single or multilevel lumbar spine fusion procedures by 1 of 4 surgeons. Specific demographic and clinical risk factors were identified and a codified classification for POUR in a surgical population is presented.
The results of this study will help clinicians appropriately counsel patients undergoing elective lumbar fusion about the potential development of POUR. The perioperative administration of scopolamine and neostigmine should be cautiously considered in men over 50 years of age due to the increased POUR risk.

Conclusions:
Perioperative scopolamine and neostigmine administration in men over 50 should be avoided when possible to minimize the risk of POUR.

Level of Evidence:
Level III.
Impact of Obesity Severity on Achieving a Minimum Clinically Important Difference Following Minimally Invasive Transforaminal Lumbar Interbody Fusion
Authors: Cha Elliot D.K. , Lynch Conor P. , Mohan Shruthi , Geoghegan Cara E. , Jadczak Caroline N. , Singh Kern 
Published: May 2021

Study Design:
This was a retrospective cohort study.

Objective:
The objective of this study was to determine the impact of obesity on postoperative outcomes and minimum clinically important difference (MCID) achievement following minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).

Summary of Background Data:
Obesity is a proven risk factor for poorer outcomes in MIS TLIF patients. However, few studies have investigated the impact of body mass index (BMI) on achievement of a MCID for Patient-Reported Outcome Measurement Information System Physical Function (PROMIS PF).

Methods:
A prospective surgical database was retrospectively reviewed for primary, elective, single level MIS TLIF patients. Patients were categorized into BMI groups: nonobese (<30 kg/m2); obese I (≥30 and <35 kg/m2); severe (≥35 and <40 kg/m2); and morbid (≥40 kg/m2). Demographic, perioperative information, and complication rates were compared between groups. Visual Analog Scale (VAS) back and leg, Oswestry Disability Index (ODI), 12-Item Short Form-12 Physical Composite Score (SF-12 PCS), and PROMIS PF were collected preoperatively and up to 2-year postoperatively. Impact of BMI on outcome measures and MCID achievement at all timepoints was evaluated.

Results:
A total of 162 patients were included with 88 patients categorized as normal weight, 37 obese I, 25 severe, and 12 morbid. SF-12 PCS, and PROMIS PF significantly differed by BMI at all timepoints, but only at 6- and 12-week for VAS back, preoperatively and 12 weeks for VAS leg, and preoperatively to 1-year for ODI. MCID achievement only differed for PROMIS PF and VAS back at 2 years, but did not for overall MCID achievement.

Conclusions:
BMI is a significant predictor of ODI, SF-12 PCS, and PROMIS PF preoperatively to 1-year postoperatively, but only through 12-week for VAS scores. MCID achievement varied for PROMIS PF and VAS back, suggesting that though BMI may affect postoperative outcome values, obesity may impact a patient’s perception of meaningful improvements in pain and physical function.
A Primer on the Use of Artificial Intelligence in Spine Surgery
Authors: Katsuura Yoshihiro , Colón Luis F. , Perez Alberto A. , Albert Todd J. , Qureshi Sheeraz A. 
Published: May 2021

Design:
This was a narrative review.

Purpose:
Summarize artificial intelligence (AI) fundamentals as well as current and potential future uses in spine surgery.

Summary of Background Data:
Although considered futuristic, the field of AI has already had a profound impact on many industries, including health care. Its ability to recognize patterns and self-correct to improve over time mimics human cognitive function, but on a much larger scale.

Methods:
Review of literature on AI fundamentals and uses in spine pathology.

Results:
Machine learning (ML), a subset of AI, increases in hierarchy of complexity from classic ML to unsupervised ML to deep leaning, where Language Processing and Computer Vision are possible. AI-based tools have been developed to segment spinal structures, acquire basic spinal measurements, and even identify pathology such as tumor or degeneration. AI algorithms could have use in guiding clinical management through treatment selection, patient-specific prognostication, and even has the potential to power neuroprosthetic devices after spinal cord injury.

Conclusion:
While the use of AI has pitfalls and should be adopted with caution, future use is promising in the field of spine surgery and medicine as a whole.

Level of Evidence:
Level IV.
Knockdown of circ_0004104 Alleviates Oxidized Low-Density Lipoprotein-Induced Vascular Endothelial Cell Injury by Regulating miR-100/TNFAIP8 Axis
Authors: Ji Pan , Song Xuyang , Lv Zhiping 
Published: May 2021

Abstract:
Coronary artery disease (CAD) is a common cardiovascular disease, mainly due to vascular endothelial cell (VEC) injury caused by atherosclerosis. Circular RNA has been shown to be involved in the regulation of various diseases. However, the role and mechanism of circ_0004104 in CAD are still unclear. Oxidized low-density lipoprotein (ox-LDL) was used to construct the VEC injury model in vitro. The expression levels of circ_0004104 and miR-100 were measured by quantitative real-time polymerase chain reaction. The proliferation of VECs was determined using 3-(45)-dimethylthiahiazo (-z-y1)-35-di-phenytetrazoliumromide assay and 5-ethynyl-2′-deoxyuridine staining assay. VEC apoptosis rate was assessed using flow cytometry, and caspase-3 activity was measured using a Caspase-3 Assay Kit. The protein expression levels of Ki-67, cleaved-caspase3, and tumor necrosis factor-α-induced protein 8 (TNFAIP8) were detected by western blot analysis. Furthermore, enzyme-linked immunosorbent assay was performed to assess the concentrations of inflammatory cytokines. In addition, the relationship between miR-100 and circ_0004104 or TNFAIP8 was confirmed by dual-luciferase reporter assay and biotin-labeled RNA pull-down assay. Our results revealed that circ_0004104 was upregulated and miR-100 was downregulated in patients with CAD and ox-LDL–induced VECs. Ox-LDL could inhibit the proliferation and promote the apoptosis and inflammation of VECs to induce VEC injury. However, silenced circ_0004104 could alleviate VEC injury induced by ox-LDL. Moreover, we found that circ_0004104 could sponge miR-100 and a miR-100 inhibitor could reverse the inhibition effect of circ_0004104 knockdown on ox-LDL–induced VEC injury. In addition, TNFAIP8 was a target of miR-100, and miR-100 alleviated ox-LDL–induced VEC injury by targeting TNFAIP8. Our data suggested that circ_0004104 promoted ox-LDL–induced VEC injury by the miR-100/TNFAIP8 axis, indicating that circ_0004104 might be a potential biomarker for CAD treatment.
Carbon Monoxide Releasing Molecule A1 Reduces Myocardial Damage After Acute Myocardial Infarction in a Porcine Model
Authors: Iqbal Javaid , Chamberlain Janet , Alfaidi Mabruka , Hughes Matthew , Alizadeh Tooba , Casbolt Helen , Evans Paul , Mann Brian , Motterlini Roberto , Francis Sheila , Gunn Julian 
Published: May 2021

Abstract:
Infarct size is a major determinant of outcomes after acute myocardial infarction (AMI). Carbon monoxide–releasing molecules (CORMs), which deliver nanomolar concentrations of carbon monoxide to tissues, have been shown to reduce infarct size in rodents. We evaluated efficacy and safety of CORM-A1 to reduce infarct size in a clinically relevant porcine model of AMI. We induced AMI in Yorkshire White pigs by inflating a coronary angioplasty balloon to completely occlude the left anterior descending artery for 60 minutes, followed by deflation of the balloon to mimic reperfusion. Fifteen minutes after balloon occlusion, animals were given an infusion of 4.27 mM CORM-A1 (n = 7) or sodium borate control (n = 6) over 60 minutes. Infarct size, cardiac biomarkers, ejection fraction, and hepatic and renal function were compared amongst the groups. Immunohistochemical analyses were performed to compare inflammation, cell proliferation, and apoptosis between the groups. CORM-A1–treated animals had significant reduction in absolute infarct area (158 ± 16 vs. 510 ± 91 mm2, P < 0.001) and infarct area corrected for area at risk (24.8% ± 2.6% vs. 45.2% ± 4.0%, P < 0.0001). Biochemical markers of myocardial injury also tended to be lower and left ventricular function tended to recover better in the CORM-A1 treated group. There was no evidence of hepatic or renal toxicity with the doses used. The cardioprotective effects of CORM-A1 were associated with a significant reduction in cell proliferation and inflammation. CORM-A1 reduces infarct size and improves left ventricular remodeling and function in a porcine model of reperfused MI by a reduction in inflammation. These potential cardioprotective effects of CORMs warrant further translational investigations.
Gene Therapy: Targeting Cardiomyocyte Proliferation to Repopulate the Ischemic Heart
Authors: López Ayelén Emilce , Bauzá María del Rosario , Cuniberti Luis , Crottogini Alberto José , Olea Fernanda Daniela , Locatelli Paola 
Published: May 2021

Abstract:
Adult mammalian cardiomyocytes show scarce division ability, which makes the heart ineffective in replacing lost contractile cells after ischemic cardiomyopathy. In the past decades, there have been increasing efforts in the search for novel strategies to regenerate the injured myocardium. Among them, gene therapy is one of the most promising ones, based on recent and emerging studies that support the fact that functional cardiomyocyte regeneration can be accomplished by the stimulation and enhancement of the endogenous ability of these cells to achieve cell division. This capacity can be targeted by stimulating several molecules, such as cell cycle regulators, noncoding RNAs, transcription, and metabolic factors. Therefore, the proposed target, together with the selection of the vector used, administration route, and the experimental animal model used in the development of the therapy would determine the success in the clinical field.
Pediatric Microbial Keratitis With Overnight Orthokeratology in Russia
Authors: Bullimore Mark A. , Mirsayafov Dmitry S. , Khurai Aslan R. , Kononov Leonid B. , Asatrian Suzanna P. , Shmakov Andrei N. , Richdale Kathryn , Gorev Valery V. 
Published: May 2021

Objectives:
To estimate the incidence of microbial keratitis in children wearing overnight orthokeratology lenses in Moscow, Russia.

Methods:
To estimate the number of children wearing overnight orthokeratology lenses in 2018, 1,368 patient records from 13 Doctors Lens clinics were selected at random and extrapolated to the entire patient base. To identify cases of microbial keratitis, all episodes of infiltrative keratitis from Morozovskaya City Children's Clinical Hospital in 2018 were recorded and adjudicated by three experienced ophthalmologists. Incidence was calculated as the number of cases divided by the estimated number of wearers.

Results:
There were 23,049 overnight orthokeratology fits between 2010 and 2018. Among the 1,368 records surveyed, 1,078 (79%) were younger than 18 years at initial fitting. Based on a 7% or 10% annual discontinuation rate, the estimated number of children wearing lenses in 2018 was 10,307 or 9,422, respectively. During 2018, there were 139 cases of corneal infiltrative keratitis in children and 45 were adjudicated as microbial keratitis (32%). Of these, 20 cases were associated with contact lens wear (44%): 15 soft lens wearers (33%) and 5 overnight orthokeratology wearers (11%). Based on the 5 cases and assuming a 7% or 10% discontinuation rate, the annual incidence is 4.9 (95% confidence interval[CI]: 2.1–11.4) or 5.3 (95% CI: 2.3–12.4) per 10,000 patient years.

Conclusion:
The incidence of microbial keratitis in children wearing overnight orthokeratology is lower than a previous United States study and similar to rates associated with use of daily wear soft contact lenses.
Effective Cannula Vacuuming Maneuver to Unfold the Descemet Membrane Graft
Authors: Koçluk Yusuf , Kasım Burcu 
Published: May 2021

Objectives:
To present the cannula vacuuming maneuver (CVM) in the Descemet membrane endothelial keratoplasty (DMEK) and to investigate the efficacy of CVM in reducing the unfolding time (UT) of the graft in cases with an unstable anterior chamber (AC).

Subjects/methods:
Forty-four eyes of 44 patients, who underwent DMEK at the ophthalmology clinic of a training and research hospital, were included in this retrospective study. Surgical videos and patient charts were examined retrospectively. In 21 cases, only no-touch technique maneuvers were used (group 1), and in 23 cases, CVM was used in addition to the no-touch technique (group 2). Demographic data, the status of AC, graft diameter, width, and formation of graft rolls and UT were recorded and compared between the groups. The causes of increased UT and the reason for using CVM were investigated in group 2.

Results:
Although an unstable AC was observed more frequently in group 2, the difference between the groups was not statistically significant (P=0.054). Unfolding time of rolls in group 2 was significantly shorter than group 1 (P=0.040).

Conclusion:
Cannula vacuuming maneuver shortens the UT of the graft roll in the AC and facilitates the graft unfolding maneuvers in complicated cases.
The Magnitude of Interferon Gamma Release Assay Responses in Children With Household Tuberculosis Contact Is Associated With Tuberculosis Exposure and Disease Status
Authors: Ronge Lena , Sloot Rosa , Du Preez Karen , Kay Alexander W. , Kirchner H. Lester , Grewal Harleen M. S. , Mandalakas Anna M. , Hesseling Anneke C. 
Published: May 2021

Background:
The clinical utility of the magnitude of interferon gamma (IFNγ) in response to mycobacterial antigens is unknown. We assessed the association between quantitative IFNγ response and degree of Mycobacterium tuberculosis exposure, infection and tuberculosis (TB) disease status in children.

Methods:
We completed cross-sectional analysis of children (≤15 years) exposed to an adult with bacteriologically confirmed TB, 2007–2012 in Cape Town, South Africa. IFNγ values were reported as concentrations and spot forming units for the QuantiFERON-TB Gold In-Tube (QFT-GIT) and T-SPOT.TB, respectively. Random-effects linear regression was used to investigate the relation between the M. tuberculosis contact score, clinical phenotype (TB diseased, infected, uninfected) and IFNγ▪response as outcome, adjusted for relevant covariates.

Results:
We analyzed data from 669 children (median age, 63 months; interquartile range, 33–108 months). A 1-unit increase in M. tuberculosis contact score was associated with an increase of IFNγ 0.60 international unit/mL (95% confidence interval [CI], 0.44–0.76 international unit/mL), and IFNγ spot forming unit 2 counts (95% CI, 1–3). IFNγ response was significantly lower among children with M. tuberculosis infection compared with children with TB disease (β = –1.42; 95% CI, –2.80 to –0.03) for the QFT-GIT, but not for the T-SPOT.TB. This association was strongest among children 2–5 years (β = –2.35 years; 95% CI, –4.28 to –0.42 years) and absent if <2 years.

Conclusions:
The magnitude of IFNγ response correlated with the degree of recent M. tuberculosis exposure, measured by QFT-GIT and T-SPOT.TB, and was correlated with clinically relevant TB phenotypes using the QFT-GIT. IFNγ values are not only useful in estimating the risk of M. tuberculosis infection but may also support the diagnosis of TB disease in children.

Discussion:
The magnitude of IFNγ response correlated with the degree of recent M. tuberculosis exposure, measured by QFT-GIT and T-SPOT.TB, and was correlated with clinically relevant TB phenotypes using the QFT-GIT. IFNγ values are not only useful in estimating the risk of M. tuberculosis infection but may also support the diagnosis of TB disease in children.
Rapid Evidence and Gap Map of virtual care solutions across a stepped care continuum for youth with chronic pain and their families in response to the COVID-19 pandemic
Authors: Birnie Kathryn A. , Pavlova Maria , Neville Alexandra , Noel Melanie , Jordan Isabel , Jordan Evie , Marianayagam Justina , Stinson Jennifer , Lorenzetti Diane L. , Faulkner Violeta , Killackey Tieghan , Campbell Fiona , Lalloo Chitra 
Published: May 2021

AbstractPoor access to pediatric chronic pain care is a longstanding concern. The COVID-19 pandemic has necessitated virtual care delivery at an unprecedented pace and scale. We conducted a scoping review to create an interactive Evidence and Gap Map of virtual care solutions across a stepped care continuum (ie, from self-directed to specialist care) for youth with chronic pain and their families. Review methodology was codesigned with 8 youth with chronic pain and 7 parents/caregivers. Data sources included peer-reviewed scientific literature, gray literature (app stores and web sites), and a call for innovations. Records were independently coded and assessed for quality. Overall, 185 records were included (105 scientific records, 56 apps, 16 web sites, and 8 innovations). Most virtual care solutions were applicable across pediatric chronic pain diagnoses, with the greatest proportion at lower levels of stepped care (ie, >100 self-guided apps and web sites). Virtual delivery of psychological strategies was common. Evidence gaps were noted at higher levels of stepped care (ie, requiring more resource and health professional involvement), integration with health records, communication with health professionals, web accessibility, and content addressing social/family support, medications, school, substance use, sleep, diet, and acute pain flares or crises. Evidence and Gap Maps are a novel visual knowledge synthesis tool, which enable rapid evidence-informed decision-making by patients and families, health professionals, and policymakers. This evidence and gap map identified high-quality virtual care solutions for immediate scale and spread and areas with no evidence in need of prioritization. Virtual care should address priorities identified by youth with chronic pain and their families.