bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pre-operative echocardiograms in acute fragility hip fractures
Authors: AbuSharar Shady Piedra , Bess Leah , Hennrikus Eileen 
Published: March 2021

Abstract
In 2014, the American College of Cardiology/American Heart Association (ACC/AHA) released guidelines for ordering pre-operative echocardiograms in patients undergoing non-cardiac surgery. The purpose of this study is to determine if pre-operative echocardiograms ordered prior to fragility hip fracture repair are ordered according to these guidelines, change anesthetic management or affect patient outcomes. In addition, we attempted to evaluate the efficacy of the ACC/AHA guidelines.
We conducted a 4-year retrospective chart review of acute fragility hip fractures at a single institution. Charts were reviewed to determine which patients met criteria for a pre-operative echocardiogram. Within this group we then compared patients who received a pre-operative echocardiogram to those who did not. Comparisons were made with regard to time to surgery, changes from standard anesthetic management, major adverse cardiac events, length of hospital stay, and 1-year mortality. We also examined which patients received postoperative echocardiograms and the incidence of adverse cardiac events in this group.
Of 402 patients, 87 (22%) had ACC/AHA indications for pre-operative echocardiogram, and 42 (48%) of them received one. The indication to order a pre-operative echocardiogram in stable heart failure or valve disease patients if their last echo was greater than 1 year was only followed 23% of the time. In the pre-operative echocardiogram group, anesthetic management was adjusted more frequently (P = .025), and average time to surgery was greater (P < .001). The incidence of a major adverse cardiac event was 10% in the ACC/AHA echocardiogram indicated group and 3% in the non-indicated echocardiogram group. An equal number of echocardiograms were completed postoperatively as were completed under ACC/AHA pre-operative guidelines. Sixty-seven percent of the postoperative echocardiograms did not have ACC/AHA pre-operative indications.
Our data demonstrates that pre-operative echocardiograms for “stable heart failure and valvular disease with greater than 1 year from last echocardiogram” is infrequently performed without significant adverse cardiac outcomes. Pre-operative echocardiography was associated with more anesthetic adjustments and longer time to surgery. Postoperative echocardiograms were done for cardiopulmonary complications. Studies need to examine and refine clinical parameters that would improve the selection of patients who would benefit from pre-operative echocardiograms.
Association of serum vaspin, apelin, and visfatin levels and stroke risk in a Chinese case-control study
Authors: Yu Dalin , Huang Bin , Wu Bin , Xiao Jun 
Published: March 2021

Abstract
Adipose tissue acts as an active endocrine organ secreting a number of adipokines and may be involved in biological mechanism of stroke. Vaspin, apelin, and visfatin play important roles in the regulation of vascular disorders.
Our aim was to evaluate whether the concentrations of vaspin, apelin, and visfatin were associated with stroke risk.
A total of 235 patients with stroke (156 patients with ischemic stroke and 79 patients with hemorrhagic stroke) and 235 age- and gender-matched healthy controls were included in this study. A sandwich ELISA was developed to measure the serum vaspin, apelin, and visfatin levels.
There was a statistically significant difference in the median levels of serum vaspin, apelin, and visfatin levels between stroke cases and controls (vaspin: 1.50 vs 1.07 ng/ml; apelin: 1.56 vs 1.32 pg/ml; visfatin: 23.40 vs 19.65 ng/ml; all P values <.001). Multiple logistic regression analysis showed that, serum vaspin and visfatin levels were significantly inversely associated with increased risk of stroke, and the odds ratios (ORs) in the highest tertile were 2.25 [95% confidence interval (CI) 1.38–3.67; P for trend <.001] for vaspin and 2.56 (95% CI 1.46–4.47; P for trend <.001) for visfatin, respectively, compared with the lowest tertile. Higher apelin levels were marginally associated with lower stroke risk (P for trend =.060).
Our study indicated that higher vaspin, apelin, and visfatin levels might be associated with increased stroke risk. Necessary prospective cohort studies should be conducted to confirm this association in the future.
Low‐Risk Human Leukocyte Antigen Genes and Mild Villous Atrophy Typify Celiac Disease With Immunoglobulin A Deficiency
Authors: Schirru Enrico , Jores Rita Désirée , Rossino Rossano , Corpino Mara , Cucca Francesco , Congia Mauro 
Published: March 2021

ABSTRACTObjectives:We aimed to establish if in celiac disease (CD) with immunoglobulin A deficiency (IgAD) duodenal histopathology is influenced by human leukocyte antigen (HLA)‐DQB1*02 alleles dosage. Clinical differences between patients with CD and patients with CD and IgAD (CD‐IgAD) were also evaluated.Methods:Five hundred and sixteen CD and 16 patients with CD‐IgAD, enrolled over the time of 8 years, took part in this study. The severity of duodenal histopathology and frequency of CD at‐risk HLA class II genes were compared in patients with CD versus patients with CD‐IgAD. HLA class II genotypes were subdivided into two categories of genetic risk: high: HLA‐DR3/DR7, ‐DR3/DR3, ‐DR4/DR4 ‐DR3/DR4 and low: HLA‐DR5/DR7, ‐DR3/X, ‐DR4/X and X/X, where X means neither ‐DR3 nor ‐DR4. Then, they were compared with two types of duodenal histopathology: 0, 1, 2 and 3a of mild villous atrophy (MVA) and 3b and 3c of severe villous atrophy (SVA) according to the Marsh‐Oberhuber classification. Clinical data concerning gender, number of esophagogastroduodenoscopies (EGDs) and association with other autoimmune diseases were obtained from medical records.Results:In comparison with CD, CD‐IgAD showed an increased frequency of MVA (P < 0.0001). Furthermore, CD‐IgAD with MVA showed an increase of HLA low‐risk genotypes (P = 0.036) and half HLA‐DQ2 heterodimers (P = 0.0443). Interestingly, CD‐IgAD demanded an increased number of EGDs to reach the diagnosis of CD (P = 0.0104) and autoimmune liver diseases were more frequent compared to CD (P = 0.0049).Conclusions:CD‐IgAD is associated with MVA, low‐risk HLA class II genes, an increased number of EGDs and autoimmune liver diseases.
Peritoneovenous Shunt for Intractable Ascites in Children
Authors: Defert Coralie , Marret Jean‐Baptiste , Lacaille Florence , Sissaoui Samira , Dupic Laurent , Lardy Hubert , Capito Carmen , Chardot Christophe 
Published: March 2021

ABSTRACTIntractable ascites is a rare condition in children mainly caused by cirrhosis or lymphatic disorders. Internal drainage may be considered as rescue therapy. In our department, 4 patients ages from 2 months to 15 years old underwent a peritoneovenous shunt (PVS) placement between 2010 and 2020. The surgically inserted device was a pumping device that enabled to drain ascites from the peritoneum into the venous system via the internal jugular vein (Denver shunt, BD Company, NJ). Immediate efficient drainage was achieved in all cases and lasted up to 9 years. Two major complications occurred: a postoperative fat embolism requiring urgent temporary ligation of the shunt and endocarditis shortly after inguinal hernia repair performed 16 months after placement of the shunt. Implementation of a PVS may be a useful procedure in patients with refractory ascites. Chylous ascites should be drained and washed totally before activating the device to avoid fat embolism. Antibiotic prophylaxis is required when abdominal surgery is planned while the device is in place.
The Versatility of the Pedicled Medial Sural Artery Perforator Flap: From Simple to Its Chimeric Pattern and Clinical Experience with 37 Cases
Authors: Scaglioni Mario F. , Rodi Timo , Fritsche Elmar 
Published: March 2021

Background:
Defects in the knee area, popliteal fossa region, and upper third of the lower extremity can pose a challenge for reconstructive plastic surgeons. The purpose of this article is to report the authors’ experience with the use of the pedicled medial sural artery perforator flap in its simple and chimeric form for reconstruction of defects in three different regions: knee, popliteal fossa, and proximal lower leg.

Methods:
From April of 2018 to April of 2019, 37 patients (29 men and eight women) with a mean age of 51 years (range, 18 to 78 years) underwent reconstruction with 37 pedicled medial sural artery perforator flaps. All flaps were harvested as pedicled perforator flaps in conventional or chimeric fashion and were based on one or two perforators. The defect locations included the knee (18 cases), popliteal fossa (seven cases), and proximal lower leg (12 cases). The cause of reconstruction was trauma in 22 patients (59 percent), tumor in 10 patients (27 percent), and donor-site closure of free medial sural artery perforator in five patients (14 percent).

Results:
The flap sizes varied from 3.5 × 5 cm to 5 × 10 cm. All but one flap, which showed distal tip necrosis, survived completely after surgery. The donor sites were all closed primarily. Minor complications included flap dehiscence (two cases) and minor wound infection delaying the healing process (four cases). All complications were treated conservatively. Follow-up observations were conducted for 3 to 12 months, and all patients had good functional recovery with satisfactory cosmetic results.

Conclusion:
The pedicled medial sural artery perforator flap can be considered an optimal method of reconstruction for covering defects not only in the knee area but also in the popliteal fossa and upper lower leg.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
The burden of readmission after discharge from necrotizing soft tissue infection
Authors: Toraih Eman , Hussein Mohammad , Tatum Danielle , Reisner Adin , Kandil Emad , Killackey Mary , Duchesne Juan , Taghavi Sharven 
Published: March 2021

BACKGROUND
The need for extensive surgical debridement with necrotizing soft tissue infections (NSTIs) may put patients at high risk for unplanned readmission. However, there is a paucity of data on the burden of readmission in patients afflicted with NSTI. We hypothesized that unplanned readmission would significantly contribute to the burden of disease after discharge from initial hospitalization.

METHODS
The Nationwide Readmission Database was used to identify adults undergoing debridement for NSTI hospitalizations from 2010 to 2017. Risk factors for 90-day readmission were assessed by Cox proportional hazards regression.

RESULTS
There were a total of 82,738 NSTI admissions during the study period, of which 25,076 (30.3%) underwent 90-day readmissions. Median time to readmission was 25 days (interquartile range, 9–49 days). Fragmentation of care, longer length of index stay (>2 weeks), and Medicaid status were independent risk factors for readmission. Median cost of a readmission was US $10,543. Readmission added 174,640 hospital days to episodes of care over the study period, resulting in an estimated financial burden of US $1.4 billion.

CONCLUSION
Unplanned readmission caused by NSTIs is common and costly. Interventions that target patients at risk for readmission may help decrease the burden of disease.

LEVEL OF EVIDENCE
Economic/Epidemiological, level IV.
Deep immune profiling of whole blood to identify early immune signatures that correlate to patient outcome after major trauma
Authors: Mendoza April E. , Raju Paul Susan , El Hechi Majed , Naar Leon , Nederpelt Charlie , Mikdad Sarah , van Erp Inge , Hess Joshua M. , Velmahos George C. , Poznansky Mark , Reeves Patrick 
Published: March 2021

BACKGROUND
Major injury results in an early cascade of immunologic responses that increase susceptibility to infection and multiorgan dysfunction. Detailed immune profiling by mass cytometry has the potential to identify immune signatures that correspond to patient outcomes. Our objective was to determine the prognostic value of immune signatures early after major trauma injury.

METHODS
Trauma patients (n = 17) were prospectively enrolled between September 2018 and December 2019. Serial whole blood samples were obtained from trauma patients (mean Injury Severity Score, 26.2; standard error of the mean, 3.7) at Days 1 and 3 after injury, and from age- and sex-matched uninjured controls using a standardized protocol for fixation, storage, and labeling. Computational analyses including K-nearest neighbor automated clustering of immune cells and Spearman’s correlation analysis were used to identify correlations between cell populations, clinical measures, and patient outcomes.

RESULTS
Analysis revealed nine immune cell clusters that correlated with one or more clinical outcomes. On Days 1 and 3 postinjury, the abundance of immature neutrophil and classical monocytes exhibited a strong positive correlation with increased intensive care unit and hospital length of stay. Conversely, the abundance of CD4 T-cell subsets, namely Th17 cells, is associated with improved patient outcomes including decreased ventilator days (r = −0.76), hospital-acquired pneumonia (r = −0.69), and acute kidney injury (r = −0.73).

CONCLUSION
Here, we provide a comprehensive multitime point immunophenotyping analysis of whole blood from patients soon after traumatic injury to determine immune correlates of adverse outcomes. Our findings indicate that alterations in myeloid-origin cell types may contribute to immune dysfunction after injury. Conversely, the presence of effector T cell populations corresponds with decreased hospital length of stay and organ dysfunction. Overall, these data identify novel immune signatures following traumatic injury that support the view that monitoring of immune (sub)-populations may provide clinical decision-making support for at-risk patients early in their hospital course.

LEVEL OF EVIDENCE
Prognostic/Epidemiologic, Level IV.
Complete loss of CASK causes severe ataxia through cerebellar degeneration in human and mouse
Authors: Patel Paras A , Hegert Julia , Cristian Ingrid , Kerr Alicia , LaConte Leslie EW , Fox Michael A , Srivastava Sarika , Mukherjee Konark 
Published: March 2021

AbstractHeterozygous loss of X-linked genes like CASK and MeCP2 (Rett syndrome) causes neurodevelopmental disorders (NDD) in girls, while in boys such loss leads to profound encephalopathy. The cellular basis for these disorders remains unknown. CASK is presumed to work through the Tbr1-reelin pathway in neuronal migration during brain development. Here we report our clinical and histopathological analysis of a deceased 2-month-old boy with a CASK-null mutation. We demonstrate that although smaller in size, the CASK-null human brain exhibits normal lamination without defective neuronal differentiation, migration, or axonal guidance, excluding the role of reelin in CASK-linked pathology. The disproportionately hypoplastic cerebellum in humans without CASK expression is associated with cerebellar astrogliosis, a marker for neuronal loss. Cerebellum-specific deletion in mouse confirms a post-developmental degeneration of cerebellar granular neurons that results in a small cerebellum. Mechanistically, cerebellar hypoplasia in CASK mutation thus results from neurodegeneration rather that developmental defects. Zygosity-pathology correlation suggests that NDDs like CASK mutation and Rett syndrome are pathologically neurodegenerative; however, random X-chromosome inactivation in the typical heterozygous mutant girls results in 50% of cells expressing the functional gene, resulting in a non-progressive pathology, whereas complete loss of the only allele in boys leads to unconstrained degeneration and encephalopathy.One sentence summary of studyCASK loss causes cerebellar degeneration. The authors have declared that no conflict of interest exists.
The late endosome-resident lipid bis(monoacylglycero)phosphate is a cofactor for Lassa virus fusion
Authors: Markosyan Ruben M. , Marin Mariana , Zhang You , Cohen Fredric S. , Melikyan Gregory B. 
Published: March 2021

AbstractArenavirus entry into host cells occurs through a low pH-dependent fusion with late endosomes that is mediated by the viral glycoprotein complex (GPC). The mechanisms of GPC-mediated membrane fusion and of virus targeting to late endosomes are not well understood. To gain insights into arenavirus fusion, we examined cell-cell fusion induced by the Old World Lassa virus (LASV) GPC complex. LASV GPC-mediated cell fusion is more efficient and occurs at higher pH in cells expressing human LAMP1 compared to cells lacking this cognate receptor, but this receptor is not absolutely required for virus entry. GPC-induced fusion progresses through the same lipid intermediates as fusion mediated by other viral glycoproteins – a lipid curvature-sensitive intermediate upstream of hemifusion and a hemifusion intermediate downstream of acid-dependent steps that can be arrested in the cold. Importantly, GPC-mediated fusion is specifically augmented by an anionic lipid, bis(monoacylglycero)phosphate (BMP), which is highly enriched in late endosomes. We show that BMP promotes late steps of LASV fusion downstream of hemifusion – the formation and enlargement of fusion pores. This lipid also specifically promotes cell fusion mediated by GPC of the unrelated New World Junin arenavirus. The BMP-dependence of post-hemifusion stages of arenavirus fusion suggests that these viruses evolved to use this lipid as a cofactor to direct virus entry to late endosomes.Author SummaryPathogenic arenaviruses pose a serious health threat. The viral envelope glycoprotein GPC mediates attachment to host cells and drives virus entryviaendocytosis and low pH-dependent fusion within late endosomes. Understanding the host factors and processes that are essential for arenavirus fusion may identify novel therapeutic targets. To delineate the mechanism of arenavirus entry, we examined cell-cell fusion induced by the Old World Lassa virus GPC proteins at low pH. Lassa virus fusion was augmented by the LAMP1 receptor and progressed through lipid curvature-sensitive intermediates, such as hemifusion (merger of contacting leaflets of viral and cell membrane without the formation of a fusion pore). We found that most GPC-mediated fusion events were off-path hemifusion structures and that the transition from hemifusion to full fusion and fusion pore enlargement were specifically promoted by an anionic lipid, bis(monoacylglycero)phosphate, which is highly enriched in late endosomes. This lipid also specifically promotes fusion of unrelated New World Junin arenavirus. Our results imply that arenaviruses evolved to use bis(monoacylglycero)phosphate to enter cells from late endosomes.
Native proline-rich motifs exploit sequence context to target actin-remodeling Ena/VASP proteins
Authors: Hwang Theresa , Grant Robert A. , Ilunga Meucci W. , Sivaraman Venkatesh , Keating Amy E. 
Published: March 2021

AbstractThe human proteome is replete with short linear motifs (SLiMs) of 4-6 residues that are critical for protein-protein interactions, yet the importance of the sequence surrounding such motifs is underexplored. We devised a proteomic screen to systematically examine the influence of SLiM sequence context on protein-protein interactions. Focusing on the EVH1 domain of ENAH, an actin regulator that is upregulated in invasive cancers, we screened 36-residue proteome-derived peptides for binding. We discovered a pocket on the ENAH EVH1 domain that diverged from its orthologs to recognize extended SLiMs, and we found that proteins with two EVH1-binding SLiMs can wrap around a single domain. We also found that the ciliary protein PCARE uses an extended 23-residue region to obtain higher affinity than any known ENAH EVH1-binding motif. Our screen provides a way to uncover the effects of broader proteomic context on motif-mediated interactions, revealing diverse mechanisms of contextual control over EVH1 interactions and establishing that SLiMs can’t be fully understood outside of their native context.
Polaris Battery Labs: Startup Risk Management
Authors: Walker Russell , Dilts Andrew 
Published: March 2021

Polaris Battery Labs was an Oregon-based startup that provided innovation services to companies in the lithium ion battery industry. Its operating philosophy and expertise in this fast-growing industry enabled it to provide great value to its clients, but as a startup that was seeking growth the company was subject to multiple risks.
For Polaris, taking clients, developing new manufacturing capabilities to meet unproven battery technologies, and even extending credit to its clients posed real risk. Many of its clients were startups themselves and had a significant probability of failure. Others were established firms testing new and unproven battery technologies, many of which were unlikely to gain traction in the market.
The case examines how a technology-driven firm managed the risk of working with startups, claiming appropriate intellectual property, and developing a sustainable portfolio of clients.
Statin use and the reoperation rates in glaucoma filtration surgery – population‐based cohort study
Authors: Virtanen Aapo , Haukka Jari , Harju Mika , Loukovaara Sirpa 
Published: March 2021

AbstractPurposeTo examine the association of systemic statin therapy and reoperation rate after glaucoma filtration surgery (GFS).MethodsThis is a population‐based, historic cohort study of 2705 eyes undergoing GFS in Finland between July 2009 and December 2016. GFSs were identified from national administrative healthcare registers. Baseline sociodemographic and health characteristics were documented. Reoperation rates of GFS subgroups were analysed, with statin users compared to non‐users. The outcomes were modelled using a Poisson regression model adjusted for age, sex, education, statin use, chronic comorbidities, and cataract surgery with incident rate ratios (IRR) as the main outcome measure.ResultsThe cohort contained 2263 subjects with open‐angle glaucoma (OAG), 823 men and 1440 women. Surgery was performed on 2705 eyes. First documented procedures: deep sclerectomy (DS) (n = 1601), trabeculectomy (TRE) (799) and glaucoma drainage device (GDD) implantation (305) respectively. In total, 438 secondary operations were performed during the 7.5‐year (median 2.25 years) follow‐up period. The reoperation rates were 19% after DS, 12% after TRE, and 13% after GDD. Of the surgical procedures, 32% were performed on eyes of patients receiving statin therapy. Statin users showed no difference in reoperation rates (IRR 1.06, CI 0.82–1.37). In subgroups, no difference was observed in the reoperation rates adjusted with statin use after filtration surgery (DS, TRE) (IRR 1.06, CI 0.8–1.40) or GDD implantation (0.57, CI 0.20–1.63).ConclusionSystemic statin therapy among surgically treated OAG patients had no impact on secondary surgery rates following DS, TRE or GDD implantation.
Social and economic value creation by Bendigo Bank and Stockland Property Group: Application of Shared Value Business Model
Authors: Mehera Asoke , Ordonez‐Ponce Eduardo 
Published: March 2021

AbstractThis case study explores how two Australian businesses—Bendigo Bank and Stockland Property—have adopted thematic components of the shared value business model to create social and economic value for their stakeholders. Information about organizational business models was collected from their annual reports and by interviewing company representatives. The study finds that Bendigo and Stockland have emphasized a new thematic component of stakeholder engagement—namely, customers and regional communities—in addition to three thematic components of shared value business model—reconceiving products, redefining the value chain, and using clustered collaboration—to create value. Additionally, both companies have increased their return on equity considerably in the period 2014–2019 while enhancing social value based on strategic initiatives. The study concludes by recommending an extended version of the shared value business model to enhance social and economic value creation based on stakeholder engagement.