bluuebunny/crossref_metadata_2025_split huggingface dataset:
The evolution of anteriorly directed molar occlusion in mammals
Authors: Grossnickle David M , Weaver Lucas N , Jäger Kai R K , Schultz Julia A 
Published: May 2021

AbstractIn non-mammalian synapsids and early mammals, evolutionary transformations in the feeding and hearing apparatuses are posited to have been prerequisites for the radiation of extant mammals. Unlike most vertebrates, including many early synapsids, mammals have precise dental occlusion, a lower jaw composed of one bone, and middle ear ossicles derived from ancestral jaw bones. We illuminate a related functional transition: therian mammals (eutherians and metatherians) evolved anteriorly directed chewing strokes, which are absent in other synapsid lineages. Anteriorly directed jaw movement during occlusion necessitates anteriorly directed muscle force vectors, and we posit that a shift in muscle orientation is reflected in the fossil record by the evolutionary appearance of a posteriorly positioned angular process in cladotherians (therians and their close kin). Anteriorly directed occlusion might have been absent in earlier synapsids because of the presence of attached middle ear elements in the posterior region of the jaw that prohibited the posterior insertion of jaw musculature. These changes to the masticatory apparatus in cladotherians are likely to have permitted the evolution of novel masticatory movements, including grinding in both the anterior and medial directions (e.g. rodents and ungulates, respectively). Thus, this evolutionary transition might have been a crucial prerequisite for the dietary diversification of therians.
ATP-Dependent Protease ClpP and Its Subunits ClpA, ClpB, and ClpX Involved in the Field Bismerthiazol Resistance in Xanthomonas oryzae pv. oryzae
Authors: Ni Yuan , Hou Yiping , Kang Jinbo , Zhou Mingguo 
Published: May 2021

Resistance of Xanthomonas oryzae pv. oryzae, which causes rice bacterial leaf blight, to bismerthiazol has been detected in China since the 1990s. The strains resistant to bismerthiazol on rice plants were more sensitive to bismerthiazol than wild-type (WT) strains in vitro. Here, quantitative PCR was applied to detect the fold expression of adenosine triphosphate–dependent proteases, ClpP and its subunits, which withstand stresses including bactericides in bismerthiazol-resistant strains and their parental susceptible WT strain (ZJ173). Results showed that the expression of ClpP and its subunits was higher in bismerthiazol-resistant strains than in ZJ173. They were upregulated during the early growth phase and downregulated during the middle growth phase in ZJ173 treated with bismerthiazol but did not change in the resistant strains. ClpP and its subunits were overexpressed in X. oryzae pv. oryzae in this study; the higher expression of these genes increased sensitivity in vitro and increased resistance in vivo to bismerthiazol. Bismerthiazol inhibition of exopolysaccharide (EPS) production, biofilm production, and motility was also lower in ClpP and its subunits’ overexpression mutants of X. oryzae pv. oryzae. The deletion mutants of ClpP and its subunits in ZJ173 decreased pathogenicity, biofilm production, swimming ability, EPS production, and growth in low-nutrient environments. Moreover, ClpP and its subunits may act downstream of the histidine utilization pathway, which could be inhibited by bismerthiazol in X. oryzae pv. oryzae. Taken together, our results indicated that ClpP and its subunits of X. oryzae pv. oryzae influenced resistance to bismerthiazol.
Power-assisted Pedicle Screw Technique Protects Against Risk of Surgeon Overuse Injury
Authors: Claeson Amy A. , Schwab Frank J. , Gandhi Anup A. , Skaggs David L. 
Published: May 2021

Study Design.
Cadaveric.

Objective.
The aim of this study was to quantify the amplitude and duration of surgeons’ muscle exertion from pedicle cannulation to screw placement using both manual and power-assisted tools in a simulated surgical environment using surface electromyography (EMG).

Summary of Background Data.
A survey of Scoliosis Research Society members reported rates of neck pain, rotator cuff disease, lateral epicondylitis, and cervical radiculopathy at 3 ×, 5 ×, 10 ×, and 100 × greater than the general population. The use of power-assisted tools in spine surgery to facilitate pedicle cannulation through screw placement during open posterior fixation surgery may reduce torque on the upper limb and risk of overuse injury.

Methods.
Pedicle preparation and screw placement was performed from T4-L5 in four cadavers by two board-certified spine surgeons using both manual and power-assisted techniques. EMG recorded muscle activity from the flexor carpi radialis, extensor carpi radialis, biceps, triceps, deltoid, upper trapezius, and neck extensors. Muscle activity was reported as a percentage of the maximum voluntary exertion of each muscle group (%MVE) and muscle exertion was linked to low- (0–20% MVE), moderate- (20%–45% MVE), high- (45%–70% MVE) and highest- (70%–100% MVE) risk of overuse injury based on literature.

Results.
Use of power-assisted tools for pedicle cannulation through screw placement maintains average muscle exertion at low risk for overuse injury for every muscle group. Conversely with manual technique, the extensor carpi radialis, biceps, upper trapezius and neck extensors operate at levels of exertion that risk overuse injury for 50% to 92% of procedure time. Powerassisted tools reduce average muscle exertion of the biceps, triceps, and deltoid by upwards of 80%.

Conclusion.
Power-assisted technique protects against risk of overuse injury. Elevated muscle exertion of the extensor carpi radialis, biceps, upper trapezius, and neck extensors during manual technique directly correlate with surgeons’ self-reported diagnoses of lateral epicondylitis, rotator cuff disease, and cervical myelopathy.

Level of Evidence: N/A
Multifidus Muscle Fiber Type Distribution is Changed in Mouse Models of Chronic Intervertebral Disc Degeneration, but is not Attenuated by Whole Body Physical Activity
Authors: James Gregory , Millecamps Magali , Stone Laura S. , Hodges Paul W. 
Published: May 2021

Study Design.
Case-controlled animal study.

Objective.
The aim of this study was to investigate whether multifidus muscle fiber type distribution changes in models of interverbal disc (IVD) degeneration and whether this is resolved by physical activity (PA).

Summary of Background Data.
The loss of slow type I muscle fibers in the multifidus muscle in people with low back pain is contentious. Data from animal models of IVD degeneration suggest some discrepancies in human studies might be explained by the dependence of slow muscle fiber changes and their underlying mechanisms, on the time since injury and progression of IVD degeneration. It is not yet resolved what changes are apparent once the chronic phase is established. It is also not known whether muscle fiber changes can be resolved by whole body PA. This study aimed to examine slow fiber distribution in the multifidus muscle in models of IVD injury or spontaneous degeneration in animals with or without exposure to PA.

Methods.
Two models of IVD degeneration were used. The first model used a genetically modified mouse (SPARC-null) that spontaneously develops IVD degeneration. The second model involved a surgically induced IVD lesion to induce degeneration. Mice in each study were allocated to housing with or without a running wheel for PA. At 12 months of age, the multifidus muscle was harvested. Slow muscle fiber distribution and the mRNA expression of genes associated with muscle fiber type transformation were examined.

Results.
The proportion and cross-sectional area of slow muscle fibers were reduced in both models of IVD degeneration compared to controls, without evidence of ongoing fiber transformation. Whole-body PA did not attenuate these alterations.

Conclusion.
Results confirmed slow muscle fiber loss in the multifidus in the chronic phase of IVD degeneration induced spontaneously and by injury. Whole-body PA did not attenuate changes to muscle fiber distribution. More specific approaches to muscle activation might be required to achieve more complete reversal of muscle fiber changes, with potential implications for therapy in humans.

Level of Evidence: N/A
Perioperative care capacity in East Africa: results of an Ethiopian national cross-sectional survey
Authors: Kifle Fitsum , Belihu Kokeb D. , Beljege Bezaye Z. , Dhufera Hailu T. , Keno Frezer B. , Taye Desalegn B. , Teklehaimanot Masresha G. , Weldesenbet Ermiyas B. , Gemechu Tirunesh B. , Moore Jolene 
Published: May 2021

Background:
Provision of safe surgery has gained focus recently. In 2015, the World Health Organization (WHO) called for the strengthening of surgical and anesthesia services as a universal health coverage component. The same year, the Ethiopian Ministry of Health (MOH) launched the “Saving Lives through Safe Surgery” initiative to prioritize and scale-up surgical services. This study provides an updated overview of perioperative facilities’ status to facilitate the identification of future focus areas.

Methods:
An online national cross-sectional survey was conducted in September–November 2020, incorporating elements from recognized surgical and anesthesia facility assessment tools to assess infrastructure, workforce, and availability of resources across Ethiopian government facilities.

Results:
Responses were received from 81/289 (28%) facilities, conducting a mean of 6.9 (range: 1–37) surgeries per day. All regions were represented. There were shortages in specialty surgical, obstetric, and anesthesiology workforce, functioning anesthesia machines, airway equipment, recommended monitoring devices, and capnography. Shortages of analgesia, anesthesia, and emergency medications were reported. Sixty-eight (84%) facilities had a postanesthetic care unit with a mean of 3.1 (range: 1–15) beds. The presence of trained nurses, oxygen, monitoring devices, equipment, medications, and postoperative care guidelines was minimal.

Conclusions:
This study provides an updated overview of surgical capacity in Ethiopia. Despite the expansion of surgical access, there are ongoing resource deficits. Expansion of surgical capacity should be accompanied by a similar expansion in the provision of adequately equipped and staffed postanesthetic care units and a focus on postoperative care.
Women's knowledge and awareness on menopause symptoms and its treatment options remains inadequate: a report from the United Arab Emirates
Authors: Shahzad Dania , Thakur Asiya Aqeel , Kidwai Samreen , Shaikh Habiba Omer , AlSuwaidi Alia Obaid , AlOtaibi Afra Fahad , Carrick Frederick Robert , Abdulrahman Mahera 
Published: May 2021

Abstract

Objectives:
We aimed to evaluate the awareness, knowledge, and perception of middle-aged women regarding menopause and hormone therapy (HT).

Methods:
This observational study was conducted on pre-, peri-, post-, and surgically menopausal women (n = 591) from January 2020 until June 2020 in Dubai. A structured questionnaire was developed based on previous literature to assess participants’ knowledge and awareness of menopause and HT. The questionnaire was implemented by face-to-face interview. Factors associated with the degree of menopausal knowledge were identified.

Results:
Majority (498, 82%) of participant women had fair to poor overall knowledge on menopause, did not know whom HT is used for (404, 48%), and for whom it is contradicted (455, 77%). Knowledge on menopause and HT was highly associated with better attitudes (P < 0.001 and P < 0.001, respectively).
Furthermore, the greater the knowledge on menopause, the better the knowledge of HT (P < 0.001). Education was the primary factor that played a significant role in having better knowledge or attitudes. Nationality showed an association with better attitudes on menopause, with non-Arabs having better attitudes than Arabs and UAE nationals.

Conclusions:
Community medicine educators and primary healthcare providers need to prepare tailored premenopausal and postmenopausal educational interventional programs for further educating women and preparing them for this phase of their lives.
PURTSCHER-LIKE RETINOPATHY IN A PATIENT WITH MILK-ALKALI SYNDROME AND PANCREATITIS
Authors: Alsberge Joseph B. , Chen Judy J. , McDonald H. Richard 
Published: May 2021

Purpose:
To report a case of Purtscher-like retinopathy in a patient with milk-alkali syndrome and pancreatitis.

Methods:
Case report and review of the literature.

Results:
A 46-year-old woman presented with decreased vision following discharge from the intensive care unit, where she had been admitted for milk-alkali syndrome secondary to long-term calcium supplementation and over-the-counter antacid use, and pancreatitis. Dilated examination showed ischemic retinal whitening and retinal hemorrhages in the posterior pole bilaterally consistent with Purtscher-like retinopathy. Over three months, the retinopathy resolved and her vision improved.

Conclusion:
Milk-alkali syndrome is the clinical triad of hypercalcemia, renal failure, and metabolic alkalosis and occurs secondary to the consumption of large amounts of calcium and alkali. The hypercalcemia associated with milk-alkali syndrome may cause pancreatitis, which can lead to Purtscher-like retinopathy.
Work and Non-Work Sickness Presenteeism
Authors: Probst Tahira M. , Lee Hyun Jung , Bazzoli Andrea , Jenkins Melissa R. , Bettac Erica L. 
Published: May 2021

Objective:
To test the role of workplace coronavirus disease (COVID-19) climate in shaping employee attitudes toward the CDC prevention guidelines and subsequent levels of work and non-work sickness presenteeism.

Methods:
Three waves of anonymous survey data were collected in October and December 2020 and February 2021. Participants were 304 employed adults in the U.S., of whom half were working onsite.

Results:
Time 1 workplace COVID-19 climate was positively associated with Time 2 employee attitudes toward the CDC prevention guidelines, which in turn predicted Time 3 levels of non-work and work sickness presenteeism.

Conclusions:
The workplace can shape employee attitudes toward the CDC COVID-19 prevention guidelines and their work and non-work sickness presenteeism, thus highlighting the important role companies have in reducing community spread of the novel coronavirus in work and non-work settings.
Clinical Features and Management of Drop Attacks in Menière's Disease. Special Emphasis on the Possible Occurrence of Vertigo After the Drop Attacks
Authors: Lelonge Yann , Karkas Alexandre , Peyron Roland , Reynard Pierre , Convers Philippe , Bertholon Pierre 
Published: May 2021

Introduction:
Tumarkin first described drop attacks (DA) in patients with a peripheral vestibular syndrome and speculated the role of a mechanical deformation of the otolith organs. We emphasized on the possible occurrence of vertigo/dizziness after a DA. In the light of the oculomotor examination of one patient right after the DA, we discussed on the mechanisms. We also described the management of DA.

Material and Method:
This study included patients with definite Meni�re's disease (MD) and at least one DA without associated neurological symptoms. Patients with vertigo/dizziness after the fall were not excluded.

Results:
Fifteen patients with MD complained of DA that was complicated either by severe head trauma (n = 1) or various fractures (n = 4). Seven patients complained of vertigo/dizziness after the DA. In one patient, DA occurred in the waiting room with a vertical illusion of movement immediately after the fall and a predominant down beating nystagmus that later changed direction. Follow up was favorable in all patients after oral medication alone (n = 7), chemical labyrinthectomy (n = 7) or vestibular neurotomy (n = 1).

Conclusions:
We suggest that a subset of patients with MD can complain of vertigo after a DA. We conclude on the possible occurrence of a vertical mainly down beating nystagmus in MD. Since this latter nystagmus is likely related to a semicircular canal rather than an otolith dysfunction, we discuss on the mechanisms of DA followed by vertigo/dizziness. Due to the risk of trauma in DA, chemical labyrinthectomy is a reasonable and effective option although spontaneous remission is possible.
Proteomic Imaging of Vestibular Schwannomas and Normal Nerves. Histopathologic Correlations
Authors: Karkas Alexandre , Berger François , Péoc’h Jean-Michel , Cosmo Philippe , Bouamrani Ali , Dumollard Jean-Marc 
Published: May 2021

Objectives:
Proteomic analysis of vestibular schwannoma (VS), non-vestibular schwannoma (NVS), and normal nerve (NN) using mass spectrometry and imaging of matrix assisted laser desorption ionization-time of flight (MALDI-TOF).

Methods:
Retrospective, qualitative, and descriptive study on VS, NVS, and NN. Samples were provided by our Tumor Bank. They were analyzed histologically then sprayed by acid matrix. The laser beam of MALDI performed desorption-ionization of the sample. A mass spectrogram (MS) was drawn depending on time of flight of ionized peptides, and MALDI-imaging was obtained which is a summation color spectrum depending on sample's peptide content. The slice was reexamined histologically and results compared with MALDI-imaging.

Results:
Fifty schwannomas were sampled, of which 27 exploitable: 22 VS (17 Antoni type A and five type B) and five NVS (all Antoni type B). Eleven NN were analyzed. Among the 22 VS, near-total correlation between MALDI-imaging and pathology was found in two cases (9.1%), partial correlation in four (18.2%), and no correlation in 16 (72.7%); correlations were more frequent in VS of the Antoni type B. MS showed a peptide spike at 2,000 m/z in 7 (31.8%) and 5,000 m/z in 21 (95.5%). Among the five NVS, near-total correlation was found in three cases (60%), partial correlation in one (20%), and no correlation in one (20%). MS showed a peptide spike at 2,000 m/z in two (40%) and 5,000 m/z in all (100%). Among the 11 NN, near-total correlation was found in nine cases (81.8%), partial correlation in one (9.1%), and no correlation in one (9.1%). MS showed no peptide spike at 2,000 or 5,000 m/z. Behind homogeneous areas on histology, there was great heterogeneity on MALDI-imaging and MS, regarding VS and NVS, but not NN.

Conclusions:
There was a lack of correlation between MALDI-imaging and pathology in VS (except Antoni type B) as compared with NVS and NN. The lack of correlation in VS of the type A as compared with type B VS and NVS could be attributed to the overexpression of degeneration-associated proteins/peptides in VS of the type B as well as NVS that are better correlated with histologic findings. The two peptide spikes detected in schwannoma and not in NN opens up the prospect of tumor biomarkers identifiable by sequencing. The proteomic polymorphism found in VS and NVS was absent on histology which is a new morphologic characteristic of schwannoma. Further studies should be performed in the future to confirm the benefit and usefulness of the MALDI in the analysis of VS and NVS.
Management of surgery, menorrhagia and child-birth for patients with unclassified bleeding disorders: a systematic review of cohort studies
Authors: Desborough Michael J.R. , Obaji Samya , Lowe Gillian C. , Doree Carolyn , Thomas Will 
Published: May 2021

Unclassified bleeding disorders account for 2.6% of all new bleeding disorder registrations in the UK. The management of the bleeding phenotype associated with these disorders is poorly described. Systematic review and meta-analysis to determine the bleeding rates associated with tranexamic acid, desmopressin, platelet transfusion, plasma transfusion and recombinant activated factor VII, for patients with unclassified bleeding disorders undergoing surgery, childbirth or with menorrhagia. We searched for randomized controlled trials in MEDLINE, Embase, The Cochrane Central Register of Controlled Trials, PubMed, ISI Web of Science and the Transfusion Evidence Library from inception to 24 February 2020. Wherever appropriate, data were pooled using the metaprop function of STATA. Two studies with 157 participants with unclassified bleeding disorders were identified. The pooled risk of minor bleeding for patients undergoing surgery treated with peri-operative tranexamic acid was 11% (95% confidence interval 3--20%; n = 52; I
2 = 0%); the risk for desmopressin and tranexamic acid in combination was 3% (95% confidence interval 0--7%; n = 71; I
2 = 0%). There were no instances of major bleeding. In one procedure, 1 of 71 (1.4%), treated with a combination of desmopressin and tranexamic acid, the patient had a line-related deep vein thrombosis. There were too few patients treated to prevent postpartum haemorrhage or for menorrhagia to draw conclusions. The GRADE quality of evidence was very low suggesting considerable uncertainty over the results. However, both tranexamic acid, and the combination of tranexamic and desmopressin have high rates of haemostatic efficacy and have few adverse events.

Protocol registration
PROSPERO CRD42020169727.
Objective assessment of metabolism and guidance of ICU rehabilitation with cardiopulmonary exercise testing
Authors: Whittle John , San-Millán Iñigo 
Published: May 2021

Purpose of review
Addressing the reduced quality of life that affects ICU survivors is the most pressing challenge in critical care medicine. In order to meet this challenge, we must translate lessons learnt from assessing and training athletes to the clinical population, utilizing measurable and targeted parameters obtained during cardiopulmonary exercise testing (CPET).

Recent findings
Critical illness survivors demonstrate a persistent reduction in their physical and metabolic function. This manifests in reduced aerobic exercise capacity and metabolic inflexibility. CPET-guided targeted metabolic conditioning has proved beneficial in several clinical populations, including those undergoing high-risk surgery, and could be successfully applied to the rehabilitation of ICU survivors.

Summary
CPET shows great promise in the guidance of rehabilitation in functionally limited ICU survivors. Parallels in the physiological response to exercise in athletes and clinical populations with the stress and consequences of critical illness must be investigated and ultimately applied to the burgeoning population of ICU survivors in order to treat the consequences of survival from critical illness.