bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neoplastic and immune single-cell transcriptomics define subgroup-specific intra-tumoral heterogeneity of childhood medulloblastoma
Authors: Riemondy Kent A , Venkataraman Sujatha , Willard Nicholas , Nellan Anandani , Sanford Bridget , Griesinger Andrea M , Amani Vladimir , Mitra Siddhartha , Hankinson Todd C , Handler Michael H , Sill Martin , Ocasio Jennifer , Weir Seth J , Malawsky Daniel S , Gershon Timothy R , Garancher Alexandra , Wechsler-Reya Robert J , Hesselberth Jay R , Foreman Nicholas K , Donson Andrew M , Vibhakar Rajeev 
Published: May 2021

Abstract

Background
Medulloblastoma (MB) is a heterogeneous disease in which neoplastic cells and associated immune cells contribute to disease progression. We aimed to determine the influence of neoplastic and immune cell diversity on MB biology in patient samples and animal models.

Methods
To better characterize cellular heterogeneity in MB we used single-cell RNA sequencing, immunohistochemistry, and deconvolution of transcriptomic data to profile neoplastic and immune populations in patient samples and animal models across childhood MB subgroups.

Results
Neoplastic cells cluster primarily according to individual sample of origin which is influenced by chromosomal copy number variance. Harmony alignment reveals novel MB subgroup/subtype-associated subpopulations that recapitulate neurodevelopmental processes, including photoreceptor and glutamatergic neuron-like cells in molecular subgroups GP3 and GP4, and a specific nodule-associated neuronally differentiated subpopulation in the sonic hedgehog subgroup. We definitively chart the spectrum of MB immune cell infiltrates, which include subpopulations that recapitulate developmentally related neuron-pruning and antigen-presenting myeloid cells. MB cellular diversity matching human samples is mirrored in subgroup-specific mouse models of MB.

Conclusions
These findings provide a clearer understanding of the diverse neoplastic and immune cell subpopulations that constitute the MB microenvironment.
Occupational causes of hypersensitivity pneumonitis: a systematic review and compendium
Authors: Kongsupon N , Walters G I , Sadhra S S 
Published: May 2021

Abstract

Background
Hypersensitivity pneumonitis (HP) is caused by a variety of antigens and low-molecular-weight chemicals, often through occupational exposure. Making a diagnosis of HP and identifying a cause are challenging. Cryptogenic cases are frequently reported, and missing or incomplete exposure histories can cause misclassification.

Aims
To provide an evidence-based compendium of sources of exposure and causes of HP for the clinician, through systematic review of medical literature.

Methods
Articles related to HP causative agents and occupational exposure were searched from the databases OVID Medline (1946 to October 2020) and EMBASE (1974 to October 2020). Abstracts and full texts of articles were screened by two reviewers. Data on causative antigens, occupational source of exposure and any associated eponymous name were extracted and grouped according to source of exposure.

Results
A total of 1790 articles were identified, from which 305 articles met the inclusion criteria. An additional 22 articles were identified from citation lists of the selected review articles. Sources of exposure identified for HP were sorted into 14 categories of work (agricultural, plant matter processing, wood, animal-related, foodstuff, food processing, metal processing, polymers, other manufacturing, chemicals, aerosolized water, service, waste and sewage and wind instruments).

Conclusions
This work is a comprehensive list of occupational causative agents and exposures causing HP. Cases are grouped by source of exposure, allowing an immediately accessible compendium of causes for use during occupational exposure assessment, which could also form the basis for a clinical questionnaire.
The Thought From the Machine: Neural Basis of Thoughts With a Coherent and Diminished Sense of Authorship
Authors: Klock Leonie , Voss Martin , Weichenberger Markus , Kathmann Norbert , Kühn Simone 
Published: May 2021

Abstract
Patients with schizophrenia who experience inserted thoughts report a diminished sense of thought authorship. Based on its elusive neural basis, this functional neuroimaging study used a novel setup to convince healthy participants that a technical device triggers thoughts in their stream of consciousness. Self-reports indicate that participants experienced their thoughts as self-generated when they believed the (fake) device was deactivated, and attributed their thoughts externally when they believed the device was activated—an experience usually only reported by patients diagnosed with schizophrenia. Distinct activations in the medial prefrontal cortex (mPFC) were observed: ventral mPFC activation was linked to a sense of thought authorship and dorsal mPFC activation to a diminished sense of thought authorship. This functional differentiation corresponds to research on self- and other-oriented reflection processes and on patients with schizophrenia who show abnormal mPFC activation. Results thus support the notion that the mPFC might be involved in thought authorship as well as anomalous self-experiences.
Cell salvage in trauma
Authors: Waters Jonathan H. 
Published: June 2021

Purpose of review
The collection of shed blood and its reinfusion has been termed ‘cell salvage’ or ‘autotransfusion’. This review will summarize the historical foundation of cell salvage and summarize recent literature associated with cell salvage use in trauma.

Recent findings
There have been no publications on cell salvage in trauma during the last 2 years. This is based on a PubMed search using the key words, ‘cell salvage’, ‘autologous blood transfusion’ and ‘operative blood salvage’. Although the wars in Iraq and Afghanistan were ongoing, publications focused upon autotranfusion of unwashed blood from the hemothorax and on the resuscitation of the injured in remote settings.

Summary
Autotransfusion or cell salvage is markedly under utilized in trauma. Opportunities exist for significant blood savings if it is used more frequently. More research is clearly needed to assess the safety of autotransfusion in the traumatized patient.
National trends in nonoperating room anesthesia: procedures, facilities, and patient characteristics
Authors: Du Austin L. , Robbins Kimberly , Waterman Ruth S. , Urman Richard D. , Gabriel Rodney A. 
Published: June 2021

Purpose of review
Nonoperating room anesthesia (NORA) continues to increase in popularity and scope. This article reviews current and new trends in NORA, trends in anesthesia management in nonoperating room settings, and the evolving debates surrounding these trends.

Recent findings
National data suggests that NORA cases will continue to rise relative to operating room (OR) anesthesia and there will continue to be a shift towards performing more interventional procedures outside of the OR. These trends have important implications for the safety of interventional procedures as they become increasingly more complex and patients continue to be older and more frail. In order for anesthesia providers and proceduralists to be prepared for this future, rigorous standards must be set for safe anesthetic care outside of the OR.
Although the overall association between NORA and patient morbidity and mortality remains unclear, focused studies point toward trends specific to each non-OR procedure type. Given increasing patient and procedure complexity, anesthesiology teams may see a larger role in the interventional suite. However, the ideal setting and placement of anesthesia staff for interventional procedures remain controversial. Also, the impact of COVID-19 on the growth and utilization of non-OR anesthesia remains unclear, and it remains to be seen how the pandemic will influence the delivery of NORA procedures in postpandemic settings.

Summary
NORA is a rapidly growing field of anesthesia. Continuing discussions of complication rates and mortality in different subspecialty areas will determine the need for anesthesia care and quality improvement efforts in each setting. As new noninvasive procedures are developed, new data will continue to shape debates surrounding anesthesia care outside of the operating room.
Flouroscopic Control of Tibial Torsion After Intramedullary Nailing: A Technical Trick
Authors: Eckardt Henrik , Morgenstern Mario , Cadosch Dieter , Stoffel Karl 
Published: May 2021

Summary:
After intramedullary nailing of tibia shaft fractures, torsional malalignment greater than 10 degrees occur in up to 41% of operated legs. The reason is the difficult clinical assessment of rotation intraoperatively, the large variation in absolute torsion of the tibia, and the absence of established reliable methods to fluoroscopically evaluate tibial rotation and compare with the contralateral side. We present here a fast and low-tech intraoperative method on how to achieve identical tibial torsion of the operated and noninjured side. The method can be used for tibia shaft and metaphyseal fractures and only requires a normal C-arm fluoroscope with 2 monitors. First, a true lateral image of the knee on the noninjured side with the femoral condyles aligned is obtained. Second, with the leg and the C-arm rotation and tilt fixed, the fluoroscope is moved parallel to the patient axis and a lateral ankle image is obtained and saved. The fibula position relative to the tibia at the level of the Volkmann tubercle on the lateral view defines the torsion of the tibia. The sequence described above is repeated on the operated side after implantation of the nail before proximal locking. On the operated side, the fibula position relative to the tibia should be identical to the noninjured side before proximal locking takes place. Otherwise, a rotational malalignment is present and must be corrected. The comparison between operated and noninjured side is easy on a fluoroscope with 2 monitors. The complete examination takes a few minutes and has minor additional radiation exposure. We performed the intraoperative torsion control in 10 patients and performed a postoperative low-dose Computer Tomography-control of the torsion of both legs and found the rotational deformity to be less than 10 degrees in all patients.
Definitive Fixation Outcomes of Open Tibial Shaft Fractures: Systematic Review and Network Meta-analysis
Authors: Al-Hourani Khalid , Donovan Richard , Stoddart Michael T. , Foote Clary J. , Kelly Michael B. , Tornetta Paul 
Published: May 2021

Objectives:
To delineate if there were differences in outcomes between definitive fixation strategies in open tibial shaft fractures.

Data Sources:
MEDLINE, EMBASE, CENTRAL, and OpenGrey.

Study Selection:
Randomized and Quasi-randomized studies analyzing adult patients (>18 years) with open tibial shaft fractures (AO-42), undergoing definitive fixation treatment of any type.

Data Extraction:
Data regarding patient demographics, definitive bony/soft-tissue management, irrigation, type of antibiotics, and follow-up. Definitive intervention choices included unreamed intramedullary nailing (UN), reamed intramedullary nailing, plate fixation, multiplanar, and uniplanar external fixation (EF). The primary outcome was unplanned reoperation rate. Cochrane risk of bias tool and Grading of Recommendation Assessment, Development and Evaluation systems were used for quality analysis.

Data Synthesis:
A random-effects meta-analysis of head-to-head evidence, followed by a network analysis that modeled direct and indirect data was conducted to provide precise estimates [relative risk (RR) and associated 95% confidence interval (95% CI)].

Results:
In open tibial shaft fractures, direct comparison UN showed a lower risk of unplanned reoperation versus EF (RR 0.67, 95% CI 0.43–1.05, P = 0.08, moderate confidence). In Gustilo type III open fractures, the risk reduction with nailing compared with EF was larger (RR 0.61, 95% CI 0.37–1.01, P = 0.05, moderate confidence). UN had a lower reoperation risk compared with reamed intramedullary nailing (RR 0.91, 95% CI 0.58–1.4, P = 0.68, low confidence); however, this was not significant and did not demonstrate a clear advantage.

Conclusions:
Intramedullary nailing reduces the risk of unplanned reoperation by a third compared with EF, with a slightly larger reduction in type III open fractures. Future trials should focus on major complication rates and health-related quality of life in high-grade tibial shaft fractures.

Level of Evidence:
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
The Effect of Hospital and Surgeon Volumes on Complication Rates After Fixation of Peritrochanteric Hip Fractures
Authors: Testa Edward J. , Brodeur Peter , Kahan Lindsey G. , Modest Jacob M. , Cruz Aristides I. , Gil Joseph A. 
Published: May 2021

Objective:
This study evaluates the relationship between hospital and surgeon volumes of peritrochanteric hip fracture fixation and complication rates.

Methods:
Adults (60 years of age or older) who underwent surgical fixation for closed peritrochanteric fractures from 2009 to 2015 were identified using International Classification of Diseases 9 and 10 Clinical Modification and Procedural codes in the New York Statewide Planning and Research Cooperative System database. Readmission, reoperations, in-hospital mortality, and other adverse events were compared across surgeon and facility volumes. Statistical significance was set at P < 0.05.

Results:
A total of 29,656 patients were included in the study. Low-volume (LV) facilities had higher rates of readmission [hazard ratio (HR) 1.07, 95% confidence interval (CI), 1.05–1.17], pneumonia (HR 1.36, 95% CI, 1.22–1.51), wound complications (HR 1.24, 95% CI, 1.03–1.49), and mortality (HR 1.15, 95% CI, 1.04–1.27) but lower rates of acute renal failure (HR 0.90, 95% CI, 0.83–0.98), deep vein thrombosis (HR 0.66, 95% CI, 0.55–0.78), and acute respiratory failure (HR 0.77, 95% CI, 0.62–0.95) than high-volume (HV) facilities. Patients treated by LV surgeons had lower rates of readmission (HR 0.92, 95% CI, 0.87–0.97) and deep vein thrombosis (HR 0.78, 95% CI, 0.66–0.94) but higher rates of acute renal failure (HR 1.13, 95% CI, 1.04–1.22) than those treated by HV surgeons.

Conclusions:
There are increased rates of mortality, readmission, and certain complications when peritrochanteric femur fractures are surgically managed at LV hospitals compared with those managed at HV hospitals. Thus, the benefit of a high-volume surgical facility is apparent in mortality and readmissions but not all complications. There was no significant decrease in complications if fixation was performed by HV surgeons relative to LV surgeons.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Treatment of Recalcitrant Femoral Shaft Nonunion With Medial Femoral Condyle Pedicled Autograft: Technical Trick
Authors: DeKeyser Graham J. , Bailey Travis L. , Higgins Thomas F. , Tyser Andrew R. 
Published: May 2021

Summary:
Nonunited fractures of the femoral shaft and distal femur are usually successfully addressed with stabilization with or without autogenous bone grafting. For the small subset of these problems that prove recalcitrant to front-line treatment, a pedicled medial femoral condyle (MFC) bone flap can provide a source of vascularized autograft with minimal donor site morbidity. The MFC has gained recent widespread adoption as a free vascularized bone transfer, and here, we present a surgical technique and retrospective analysis of patients treated with a pedicled MFC technique. This serves as a useful treatment option for these difficult problems and may be especially helpful in low resource environments or where microsurgical anastomosis is not feasible.
Nonoperative Treatment of Select Lateral Compression Type II Pelvic Ring Injuries (OTA/AO 61B2.2) Results in a Low Rate of Radiographic Displacement
Authors: Gibbs Stephen , Colcord Madison , Curtin Patrick , Roomian Tamar , Seymour Rachel , Phelps Kevin , Kempton Laurence , Hsu Joseph , Sims Stephen , Bosse Michael , Swart Eric , Karunakar Madhav 
Published: May 2021

Objectives:
To quantify radiographic outcomes and to identify predictors of late displacement in the nonoperative treatment of lateral compression type II (LC-2) pelvic ring injuries.

Design:
Retrospective review.

Setting:
Two Level 1 trauma centers.

Patients/Participants:
Thirty eight patients 18 years of age or older with LC-2 pelvic ring injuries were included in the study.

Intervention:
Nonoperative treatment.

Main Outcome Measurements:
Crescent fracture displacement (CFD) was measured on initial axial computed tomography scan. Change in pelvic ring alignment was measured by the deformity index, simple ratio, and inlet and outlet ratios on successive plain radiographs.

Results:
Patients in this study had minimally displaced LC-2 pelvic ring injuries, with median initial CFD of 2 mm and median initial deformity index of 2%. No patients had a change of more than or equal to 10 percentage points in deformity index over the treatment period, but small amounts of displacement were seen on the other ratios. No patients initially selected for nonoperative treatment converted to operative treatment. No radiographic predictors of late displacement were identified. Bilateral pubic rami fractures and the presence of a complete sacral fracture ipsilateral to the crescent fracture were not associated with late displacement.

Conclusions:
A spectrum of injury severity and stability exists in the LC-2 pattern. Nonoperative treatment of LC-2 injuries with low initial deformity and CFD results in minimal subsequent displacement.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Resuscitative Endovascular Balloon Occlusion of the Aorta in Hemodynamically Unstable Patients With Pelvic Ring Injuries
Authors: Marchand Lucas S. , Sepehri Aresh , Hannan Zachary D. , Zaidi Raza , DuBose Joseph J. , Morrison Jonathan J. , O'Toole Robert V. , Slobogean Gerard M. 
Published: May 2021

Objective:
To evaluate the outcomes of patients with pelvic ring injuries managed with resuscitative endovascular balloon occlusion of the aorta (REBOA).

Design:
Retrospective case series.

Setting:
Academic, Level 1 trauma center in North America.

Patients:
Twenty-five patients with disruption of the pelvic ring and hemodynamic instability.

Intervention:
Placement of a REBOA device as an adjuvant treatment to trauma resuscitation.

Main Outcome Measure:
Death and ischemic-related complications.

Results:
The average age of patients was 43 years (range: 17–85). Patients presented with a median lactate of 6.3 mmol/L, systolic blood pressure of 116 mm Hg, heart rate of 121 beats/minute, and injury severity score of 34. The median unit of packed red blood cells received through transfusion in the first 24 hours of hospital admission was 13 (interquartile range: 8–28). Young–Burgess injury patterns included fractures of the following types: 5 lateral compression (LC)-1, 1 LC-2, 8 LC-3, 4 anteroposterior compression-2, and 7 anteroposterior compression-3. Angiography and embolization were performed in 24 (96%) patients. Selective embolization occurred in 18 (72%) patients, with nonselective angiography of the iliac system occurring in 7 (24%) patients. There were 12 (48%) deaths, 7 (28%) patients requiring lower extremity fasciotomy, and 5 (20%) patients requiring lower extremity amputations, and there was 1 (4%) patient requiring thrombectomy.

Conclusions:
REBOA use in pelvic ring injuries is rare and most frequently used in critically ill patients with polytrauma. Successful pelvic embolization can occur in concert with REBOA use; however, the severity of injury is associated with a high complication profile. In this series of 25 patients, in-hospital mortality was 48%. For those patients who survived, 54% experienced a major complication (fasciotomy, amputation, and deep infection). Further investigation is required to evaluate the role REBOA may play in managing these patients.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Application and Evaluation of an Independent Robotic Arm System in K-wire Placement for Lumbar Fusion
Authors: Li Junyu , Wang Zizhen , Zeng Lin , Liu Zhongjun , Hu Wanheng , Yu Miao 
Published: May 2021

Study Design:
A single-center randomized controlled study.

Objective:
The objective of this study was to introduce a novel robotic system with an independent arm (“Orthbot Intelligent Orthopedic Minimally Invasive System”; Xin Junte Surgical Technologies) that has been developed and tested as a surgical assistant for autoplacement of the Kirschner wire (K-wire) in lumbar fusion, and to evaluate its accuracy by comparing it with the conventional free-hand instrumentation.

Summary of Background Data:
Robotic technology has performed excellently in spine surgeries and has demonstrated high clinical value and potential. Robot-assisted spinal surgery is now being promoted as a paradigm for technology-led advancement.

Materials and Methods:
A total of 24 patients were recruited and assigned randomly to the robotic arm group (RG) or the free-hand group (FG). Deviation distance and deviation angle (DA) of K-wire placement were measured and compared between the RG and the FG.

Results:
The average deviation distance was 0.88±0.08 mm in the RG and 5.13±1.68 mm in the FG (P<0.001). In both coronal and sagittal radiographs, the average DA of K-wire placement was smaller in the RG (P<0.05), and in both axial and sagittal computed tomography scans, the average DA of pedicle screw placement was also lower in the RG (P<0.05), which indicated higher accuracy of the robotic system.

Conclusions:
The novel robotic system in this study has shown certain advantages over the conventional free-hand approach in K-wire placement for lumbar fusion, including being more accurate in K-wire placement, fully automatic, and more adaptive to preoperative plans. Although the robotic arm proves to be promising in our results, the small sample size in this clinical study necessitates further multicenter, large sample follow-up studies to verify its advantages.