bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Impact of Surgical Approaches for Isolated Acetabulum Fracture on Sexual Functions: A Prospective Study
Authors: Yavuz Ibrahim Alper , Aykanat Can , Senel Cagdas , Inci Fatih , Ceyhan Erman , Aslan Yılmaz , Tuncel Altug , Yildirim Ahmet Ozgur 
Published: August 2021

Objectives:
To investigate the effects of surgical modalities for isolated acetabular fractures on the sexual functions of patients and their partners.

Design:
Prospective.

Setting:
Level I trauma centre.

Patients/Participants:
Sixty-five patients who had undergone open reduction and internal fixation because of isolated acetabular fractures who were sexually active before, together with their partners.

Intervention:
Patients operated on for isolated acetabular fractures were divided into 3 groups according to surgical approaches: the Kocher–Langenbeck approach (n = 36), ilioinguinal approach (n = 16), and modified Stoppa approach (n = 13).

Main Outcome Measurements:
Sexual functions of patients and their partners were evaluated with the 5-item version of the International Index of Erectile Function score and Female Sexual Function Index score preoperatively and at the postoperative first year after the rehabilitation period.

Results:
The mean age of the patients was 41.8 ± 13.0 (18–69) years. In male patients, the mean 5-item version of the International Index of Erectile Function score had changed from 24.3 to 20.0 at the postoperative first year and the decrease in sexual function scores was less with the Kocher–Langenbeck approach. In female patients, the Female Sexual Function Index scores had decreased statistically significantly from 24.9 to 18.3 at the postoperative first year, but there was no statistically significant difference between surgical groups. Both male and female patients' partners' sexual function scores were also decreased at the postoperative first year.

Conclusions:
As a result of our study, it was observed that the posterior approach is more advantageous than anterior approaches in preserving the sexual functions of male patients in acetabular fracture surgery. However, the surgical approach did not affect the sexual functions of female patients.

Level of Evidence:
Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
Pediatric and Adolescent Fractures of the Acetabulum Treated With ORIF: What Are Their Functional Outcomes?
Authors: Southam Brendan R. , Schumaier Adam , Ramalingam Wendy , Avilucea Frank , Rice Denning Jaime , Whitlock Patrick W. , Archdeacon Michael T. 
Published: August 2021

Objectives:
To evaluate the functional outcomes of pediatric and adolescent patients (<18 year old) who sustained acetabulum fractures that were treated with open reduction internal fixation (ORIF).

Design:
Retrospective cohort.

Setting:
Level 1 trauma center.

Patients:
Thirty-four pediatric and adolescent patients underwent acetabulum fracture ORIF between 2001 and 2018. Of the operatively treated patients, 21 patients had sufficient follow-up (>6 months), one died after fixation secondary to other traumatic injuries, and 12 patients were lost to follow-up.

Intervention:
Acetabulum fracture ORIF.

Main Outcome Measurement:
The SF-36 Health Survey and Short Musculoskeletal Functional Assessment (SMFA) were compared with population norms. The modified Merle d'Aubigné clinical hip score, Matta radiologic outcome, and postoperative complications were also documented.

Results:
Functional outcome data were available at a mean of 5 years 2 months. Mean SF-36 scores were 44.8 and 50.1 for the physical component score and mental component scores, respectively, which did not differ significantly from US population norms (physical component score mean: 50, P = 0.061 and mental component score mean: 50, P = 0.973). Furthermore, the mean SMFA Bother Index score was 18.6, which is not significantly different from the population norm mean of 13.8 (P = 0.268). However, the function index mean was 31.9, which was significantly worse than the population norm mean of 12.7 (P = 0.001). Two patients with a delayed reduction (>6 hours) of an acetabulum fracture dislocation had poor outcomes related to the development of avascular necrosis and post-traumatic osteoarthritis.

Conclusion:
In this small cohort, 86% (18/21) of these patients had a favorable functional outcome with the exception of the SMFA Functional Index that was significantly less than population norms. Although long-term follow-up is needed, we advocate for operative management of pediatric and adolescent acetabulum fractures when adult displacement and instability criteria are present.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Tibial Shaft and Pilon Fractures With Associated Syndesmotic Injury: A Matched Cohort Assessment
Authors: Purcell Kevin F. , Bergin Patrick F. , Russell George V. , Graves Matt L. , Jones LaRita C. , Spitler Clay A. 
Published: August 2021

Objective:
To determine the outcomes of pilon and tibial shaft fractures with syndesmotic injuries compared with similar fractures without syndesmotic injury.

Design:
Retrospective case–control study.

Setting:
Level 1 trauma center.

Patients/Participants:
All patients over a 5-year period (2012–2017) with tibial shaft or pilon fractures with a concomitant syndesmotic injury and a control group without a syndesmotic injury matched for age, OTA/AO fracture classification, and Gustilo–Anderson open fracture classification.

Intervention:
Preoperative or intraoperative diagnosis of syndesmotic injury with reduction and fixation of both fracture and syndesmosis.

Main Outcome Measurement:
Rates of deep infection, nonunion, unplanned reoperation, and amputation in patients with a combined syndesmotic injury and tibial shaft or pilon fracture versus those without a syndesmotic injury.

Results:
A total of 30 patients, including 15 tibial shaft and 15 pilon fractures, were found to have associated syndesmotic injuries. The matched control group comprised 60 patients. The incidence of syndesmotic injury in all tibial shaft fractures was 2.3% and in all pilon fractures was 3.4%. The syndesmotic injury group had more neurologic injuries (23.3% vs. 8.3% P = 0.02), more vascular injuries not requiring repair (30% vs. 15%, P = 0.13), and a higher rate compartment syndrome (6.7% vs. 0%, P = 0.063). Segmental fibula fracture was significantly more common in patients with a syndesmotic injury (36.7% vs. 13.3%, P = 0.04). Fifty percent of the syndesmotic injury group underwent an unplanned reoperation with significantly more unplanned reoperations (50% vs. 27.5%, P = 0.04). The syndesmotic group had a significantly higher deep infection rate (26.7% vs. 8.3% P = 0.047) and higher rate of amputation (26.7% vs. 3.3% P = 0.002) while the nonunion rate was similar (17.4% vs. 16.7% P = 0.85).

Conclusions:
Although syndesmotic injuries with tibial shaft or pilon fractures are rare, they are a marker of a potentially limb-threatening injury. Limbs with this combined injury are at increased risk of deep infection, unplanned reoperation, and amputation. The presence of a segmental fibula fracture should raise clinical suspicion to evaluate for syndesmotic injury.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
The intersection of drug interactions and adverse reactions in contemporary antiretroviral therapy
Authors: Nhean Salin , Tseng Alice , Back David 
Published: August 2021

Purpose of review
Advances in antiretroviral therapy (ART) have transformed HIV infection into a chronic and manageable condition. The introduction of potent and more tolerable antiretrovirals (ARVs) with favorable pharmacokinetic profiles has changed the prevalence and nature of drug–drug interactions (DDIs). Here, we review the relevance of DDIs in the era of contemporary ART.

Recent findings
Management of DDIs remains an important challenge with modern ART, primarily due to increased polypharmacy in older persons living with HIV. Significant DDIs exist between boosted ARVs or older nonnucleoside reverse transcriptase inhibitors and comedications for chronic comorbidities (e.g., anticoagulants, antiplatelets, statins) or complex conditions (e.g., anticancer agents, immunosuppressants). Newer ARVs such as unboosted integrase inhibitors, doravirine, and fostemsavir have reduced DDI potential, but there are clinically relevant DDIs that warrant consideration. Potential consequences of DDIs include increased toxicity and/or reduced efficacy of ARVs and/or comedications. Management approaches include switching to an ARV with less DDI potential, changing comedications, or altering medication dosage or dosing frequency. Deprescribing strategies can reduce DDIs and polypharmacy, improve adherence, minimize unnecessary adverse effects, and prevent medication-related errors.

Summary
Management of DDIs requires close interdisciplinary collaboration from multiple healthcare disciplines (medicine, nursing, pharmacy) across a spectrum of care (community, outpatient, inpatient).
Improvements of Frontotemporal Cerebral Blood Flow and Cognitive Functioning in Patients With First Episode of Schizophrenia Treated With Long-Acting Aripiprazole
Authors: Peitl Vjekoslav , Badžim Vivian A. , Šiško Markoš Ines , Rendulić Ana , Matešić Krunoslav , Karlović Dalibor 
Published: August 2021

Abstract

Purpose/Background
Frontal and temporal cerebral blood flow (CBF) changes are the most common impairments of CBF described in patients with schizophrenia. Those impairments have also been associated with cognitive deficits, a hallmark of schizophrenia. In light of that fact, treatment interventions should target cognitive deficits to prevent chronic disability. However, specific therapies targeting cognitive symptoms are very few and far between. One of the treatment possibilities is aripiprazole, because several studies reported its potential procognitive effects. The objective of this study was to investigate whether use of aripiprazole in its long-acting injectable formulation (ALAI), during a 3-month treatment, has beneficial effects on CBF and cognitive functioning in patients with first episode of schizophrenia.

Methods/Procedures
Single-photon emission computed tomography with technetium-99m hexamethylpropylene amine oxime was performed at 2 time points. Cognitive functions were assessed with a standardized test for cognitive functions, 5-KOG test, whereas severity of clinical symptoms was assessed with the Positive and Negative Syndrome Scale, both at the same 2 time points as single-photon emission computed tomography. Three-month treatment with ALAI was associated with improvement of several cognition indices and improvements of right-sided frontal and temporal CBF, as well as of clinical symptoms.

Findings/Results
Multivariate tests were used to test for the effects of ALAI treatment on cognitive functions, clinical presentation, and brain perfusion in a 3-month period. Multivariate model revealed statistical significance (F = 11.958, P < 0.001). Of 10 separate 5-KOG parameters, 3-month treatment with ALAI significantly influenced 4: undelayed recall, delayed recall, attention, and working memory—digit span forward. Finally, 3-month ALAI treatment significantly improved regional CBF in 2 of 4 investigated areas, both on the right side of the brain (frontally and temporally).

Implications/Conclusions
Results of this research showed that treatment with ALAI in patients with first episode of schizophrenia is associated with improved right-sided frontal and temporal CBF, as well as with improved symptoms, including cognition indices. Although we cannot confirm it directly, it is possible that improved frontotemporal CBF led to the improvement in cognition indices.
Longitudinal Changes in Spirometry in Deployed Air Force Firefighters
Authors: Berglund Andrew J. , Kim John , Walter Robert J. , McCann Edward T. , Morris Michael J. 
Published: August 2021

Introduction:
Inhalational exposures are common among service members who deploy to southwest Asia. The objective of this study is to determine if deployed Air Force firefighters have any decline in spirometry related to deployment.

Methods:
This study is a retrospective chart review.

Results:
The database search identified 302 firefighters with documentation of two separate spirometry examinations. For deployed firefighters, mean change in forced expiratory volume at 1 second (FEV1) percent predicted was –1.01 ± 7.86, forced vital capacity (FVC) was –0.46 ± 10.26 predicted, and mid-expiratory flow (FEF25–75) was –0.13 ± 12.97. For firefighters who had never deployed, mean change in FEV1 percent predicted was +0.08 ± 7.09, FVC was +0.72 ± 7.75, and FEF25–75 was –0.66 ± 16.17.

Conclusion:
There does not appear to be evidence that deployment causes a significant change in lung function as measured by spirometry.
18F-FDG PET and PET/CT for the evaluation of gastric signet ring cell carcinoma: a systematic review
Authors: Dondi Francesco , Albano Domenico , Giubbini Raffaele , Bertagna Francesco 
Published: August 2021

Background
In the last years, 18F-fluorodeoxyglucose PET/computed tomography (18F-FDG PET/CT) has demonstrated its utility for the evaluation of gastric cancer; however, considering some histotypes such as gastric signet ring cell carcinoma (GSRCC) the results are limited. The aim of this review is to analyze the diagnostic performance of 18F-FDG PET and PET/CT for the assessment of GSRCC.

Methods
A wide literature search of the PubMed/MEDLINE, Scopus, Embase and Cochrane library databases was made to find relevant published articles about the diagnostic performance of 18F-FDG PET or PET/CT for the evaluation of GSRCC.

Results
The comprehensive computer literature search revealed 179 articles. On reviewing the titles and abstracts, 162 articles were excluded because the reported data were not within the field of interest. Nine studies were included in the review and references were also screened for additional articles. Finally, 26 articles were selected and retrieved in full-text version.

Conclusion
Despite some limitations affect our review, GSRCC seems to have low 18F-FDG uptake, and therefore 18F-FDG PET or PET/CT reveals impaired sensitivity for its evaluation. However, a correlation between 18F-FDG uptake and some clinico-pathologic features (such as stage, depth of invasion, size and presence of nodal metastasis) has been demonstrated. Besides, a possible prognostic role of PET/CT features is starting to emerge.
Short-Term Resorption of Grafted Bone After Split Calvarial Bone Grafting for an Occipital Skull Defect in a Patient With Multisystem Langerhans Cell Histiocytosis
Authors: Mizokami Masataka , Imanishi Masaya , Asato Hirotaka 
Published: August 2021

Abstract
Langerhans cell histiocytosis (LCH) is a rare disease in which LCH cells derived from myeloid dendritic cells proliferate and invade single or multiple systems. We have encountered a case of short-term resorption of the grafted bone after split calvarial bone grafting for an occipital skull defect in a 6-year-old girl with multisystem LCH in remission who was referred to our department for reconstructive surgery. We performed cranioplasty using a split calvarial bone graft. Two months after surgery, computed tomography scans revealed that most of the grafted bone had been resorbed. To our knowledge, there have been no such reports previously. There are 2 possible explanations for the resorption of an autologous bone graft in this patient. The first possibility is that the recipient site contained an active lesion and the second is that the bone resorption occurred because the bone graft was placed on the periosteum.
Biomarkers for the Early Diagnosis of Sepsis in Burns
Authors: Li Andrew T. , Moussa Anthony , Gus Eduardo , Paul Eldho , Yii Erwin , Romero Lorena , Lin Zhiliang Caleb , Padiglione Alexander , Lo Cheng Hean , Cleland Heather , Cheng Allen C. 
Published: August 2021

Objective:
The aim of this study was to evaluate the diagnostic performance of all biomarkers studied to date for the early diagnosis of sepsis in hospitalized patients with burns.

Background:
Early clinical diagnosis of sepsis in burns patients is notoriously difficult due to the hypermetabolic nature of thermal injury. A considerable variety of biomarkers have been proposed as potentially useful adjuncts to assist with making a timely and accurate diagnosis.

Methods:
We searched Medline, Embase, Cochrane CENTRAL, Biosis Previews, Web of Science, and Medline In-Process to February 2020. We included diagnostic studies involving burns patients that assessed biomarkers against a reference sepsis definition of positive blood cultures or a combination of microbiologically proven infection with systemic inflammation and/or organ dysfunction. Pooled measures of diagnostic accuracy were derived for each biomarker using bivariate random-effects meta-analysis.

Results:
We included 28 studies evaluating 57 different biomarkers and incorporating 1517 participants. Procalcitonin was moderately sensitive (73%) and specific (75%) for sepsis in patients with burns. C-reactive protein was highly sensitive (86%) but poorly specific (54%). White blood cell count had poor sensitivity (47%) and moderate specificity (65%). All other biomarkers had insufficient studies to include in a meta-analysis, however brain natriuretic peptide, stroke volume index, tumor necrosis factor (TNF)-alpha, and cell-free DNA (on day 14 post-injury) showed the most promise in single studies. There was moderate to significant heterogeneity reflecting different study populations, sepsis definitions and test thresholds.

Conclusions:
The most widely studied biomarkers are poorly predictive for sepsis in burns patients. Brain natriuretic peptide, stroke volume index, TNF-alpha, and cell-free DNA showed promise in single studies and should be further evaluated. A standardized approach to the evaluation of diagnostic markers (including time of sampling, cut-offs, and outcomes) would be useful.
Assessing sustainability factors for rural sanitation coverage in Kenya, Zambia, Nepal, and Bhutan: A qualitative case study analysis
Authors: Sakas Zoe , Uwah Eberechukwu A. , Snyder Jedidiah S. , Garn Joshua V. , Freeman Matthew C. 
Published: August 2021

AbstractBACKGROUNDFew countries are likely to achieve universal sanitation within the next decade as sustaining sanitation coverage remains a critical challenge. The purpose of this study is to investigate factors that may have supported or hindered sustainability of sanitation coverage 1-2 years after the completion of an integrated, area-wide sanitation program in four countries.METHODSBetween 2014 and 2018, the SSH4A approach was implemented in 15 countries in Africa and Asia, four of which are included in this qualitative study. We conducted focus group discussions and interviews with beneficiaries, implementors, and decision-makers to identify sustainability factors and used household survey data to characterize sub-national sanitation coverage throughout implementation, and 1-2 years after.RESULTSOur data revealed behavioral, contextual, and service delivery factors that were related to the sustainability of sanitation improvements. Service delivery factors included follow-up hygiene promotion, access to materials (e.g., plastic, cement), local government commitment post-implementation, functioning monitoring systems, uptake of the supply chain by private sector, capacity for innovation. Contextual and behavioral factors included poverty, soil type, road networks, social cohesion, desire for improved latrines, maintenance and cleaning, and knowledge of sanitation benefits.DISCUSSIONThe presence or absence of sustainability factors identified through this research may have implications on where certain programmatic approaches will work, and where adaptations may be required. Through comparing sustainability factors with sub-national slippage rates, we were able to illustrate how local service delivery systems may respond to barriers (e.g., poverty, lack of affordable sanitation options, changes in population density) and enablers (e.g., sufficient resource allocation, passionate leadership, social cohesion). Understanding the programmatic and contextual factors that either drive or hinder long-term sanitation coverage may allow for greater program impact through adapting implementation based on existing challenges in service delivery and context.
Rethinking symbiotic metabolism: trophic strategies in the microbiomes of different sponge species
Authors: Burgsdorf I , Sizikov S , Squatrito V , Britstein M , Slaby BM , Cerrano C , Handley KM , Steindler L 
Published: August 2021

AbstractIn this study we describe the major lithoheterotrophic and autotrophic processes in 21 microbial sponge-associated phyla using novel and existing genomic and transcriptomic datasets. We show that a single gene family, molybdenum-binding subunit of dehydrogenase (coxL), likely evolved to benefit both lithoheterotrophic and organoheterotrophic symbionts, through adaptation to different inorganic and organic substrates. We show the main microbial carbon fixation pathways in sponges are restricted to specialized symbiotic lineages within five phyla. We also propose that sponge symbionts, in particular Acidobacteria, are capable of assimilating carbon through anaplerotic processes. However, the presence of symbionts genomically capable of autotrophy does not inform on their actual contribution to light and dark carbon fixation. Using radioisotope assays we identified variability in the relative contributions of chemosynthesis to total carbon fixation in different sponge species. Furthermore, the symbiosis of sponges with two closely related Cyanobacteria results in outcomes that are not predictable by analysis of -omicsdata alone:CandidatusSynechococcus spongiarum contributes to the holobiont carbon budget by transfer of photosynthates, whileCandidatusSynechococcus feldmannii does not. Our results highlight the importance of combining sequencing data with physiology to gain a broader understanding of carbon metabolism within holobionts characterized by highly diverse microbiomes.
HIV-1 Mutants that Escape the Cytotoxic T-Lymphocytes are Defective in Viral DNA Integration
Authors: Balasubramaniam Muthukumar , Thapa Santosh , Davids Benem-Orom , Bryer Alex , Xu Chaoyi , Shi Jiong , Aiken Christopher , Pandhare Jui , Perilla Juan R. , Dash Chandravanu 
Published: August 2021

ABSTRACTHIV-1 replication is durably controlled in certain untreated HIV-1-infected individuals expressing particular human leukocyte antigens (HLA). These HLAs tag infected cells for elimination by presenting specific viral epitopes to CD8+ cytotoxic T-lymphocytes (CTL). In individuals expressing HLA-B27, CTLs primarily target the capsid protein (CA)-derived KK10 epitope. Selection of CA mutation R264K helps HIV-1 escape the CTL response but severely diminishes virus infectivity. Here we report that the R264K mutation-associated infectivity defect arises primarily from impaired viral DNA integration. Strikingly, selection of the compensatory CA mutation S173A or depletion of host cyclophilin A largely rescues the R264K-associated integration and infectivity defects. Collectively, our study reveals novel mechanistic insights into the fitness defect incurred by an HIV-1 variant escaping a CA-directed CTL response.