bluuebunny/crossref_metadata_2025_split huggingface dataset:
COVID-19 and loneliness: A rapid systematic review
Authors: Pai Nagesh , Vella Shae-Leigh 
Published: July 2021

Background: Loneliness is known to be associated with both poorer physical and mental health, being associated with increased mortality. Responses throughout the world to the current COVID-19 pandemic all incorporate varying degrees of social distancing and isolation. There is an imperative to provide a timely review and synthesis of the impact of COVID-19 on loneliness in the general population. Methods: PubMed was searched using the key terms ‘COVID-19’, ‘coronavirus’, ‘SARS-COV2’ and ‘loneliness’. Fifty-four articles were identified and screened against the inclusion criteria. The inclusion criteria stipulated that the study needed to incorporate a measure of loneliness with participants being drawn from the general adult population. Twenty-four studies met the inclusion criteria. Results: The key data extracted from the 24 reviewed studies are presented and summarised with a focus on key demographics of participants, the research designs utilised, the measures of loneliness employed and the other variables assessed in the studies. Overall, the findings indicate that loneliness has been a significant issue during the current COVID-19 pandemic and loneliness is positively associated with mental health symptoms. However, there were inconsistencies in the results evident across studies. Conclusion: To our knowledge, this is the first systematic review of research investigating loneliness during the current COVID-19 pandemic in the general adult population. Despite the inconsistencies evident in some of the results across the studies, it is clearly apparent that loneliness is having an impact on the mental health and wellbeing of the general adult population. Furthermore, it is apparent that the current COVID-19 pandemic has had an impact on loneliness in the general adult population and that loneliness is significantly positively associated with mental illness symptomatology. Thus, there is an imperative to address loneliness through public policy and interventions. The limitations of this review are noted and directions given for future research.
Sudden death due to non-traumatic rupture of splenic artery aneurysm
Authors: Anand Aditya , Khurana Sahil , Ateriya Navneet , Sunil Kumar Sharma G A 
Published: July 2021

Introduction Splenic artery aneurysm is a rare form of vascular pathology that carries a high risk of mortality once it gets ruptured. It has a prevalence of 1% and occurs due to thinning and dilatation of the arterial wall. Case We describe a case of a 35-year-old policeman who died suddenly. At medico-legal autopsy, intraperitoneal clotted blood about 1000 g and liquid blood about 3000 ml were seen. On further exploration, ruptured splenic artery aneurysm about 2.0 cm in diameter became visible near the hilum. Conclusion Rare cases typically present as sudden and unexpected death with intraperitoneal bleed and may be confused with blunt trauma abdomen. Therefore, splenic artery aneurysm is an appropriate differential diagnosis for sudden deaths and intraperitoneal bleeding, respectively.
The Beneficial Effect of an Intra-articular Injection of Losartan on Microfracture-Mediated Cartilage Repair Is Dose Dependent
Authors: Logan Catherine A. , Gao Xueqin , Utsunomiya Hajime , Scibetta Alex C. , Talwar Mika , Ravuri Sudheer K. , Ruzbarsky Joseph J. , Arner Justin W. , Zhu Dandan , Lowe Walter R. , Philippon Marc J. , Huard Johnny 
Published: July 2021

Background: A previous publication demonstrated that the oral intake of losartan promoted microfracture-mediated hyaline-like cartilage repair in osteochondral defects of a rabbit knee model. However, an intra-articular (IA) injection of losartan may have direct beneficial effects on cartilage repair and has not been studied. Purpose: To determine the dosage and beneficial effects of an IA injection of losartan on microfracture-mediated cartilage repair and normal cartilage homeostasis. Study Design: Controlled laboratory study. Methods: Rabbits were divided into 5 groups (n = 6 each): a microfracture group (MFX group) and 4 different losartan treatment groups that received varying doses of IA losartan (0.1, 1, 10, and 100 mg per knee). An osteochondral defect (5 mm) was created in the trochlear groove cartilage of 1 limb in each rabbit, and 5 microfracture perforations were made in the osteochondral defect. Both the injured and the contralateral knee joints were injected with IA losartan immediately after microfracture and at 2 and 4 weeks after surgery. Rabbits were sacrificed at 6 weeks after surgery for analysis including gross observation, micro–computed tomography, histology, and reverse transcription quantitative polymerase chain reaction. Results: Micro–computed tomography and gross observation demonstrated comparable subchondral bone healing and hyaline-like cartilage morphology in the 0.1-, 1-, and 10-mg losartan groups relative to the MFX group. Conversely, the 100-mg losartan group showed neither bony defect healing nor cartilage repair. Histology revealed higher O’Driscoll scores and hyaline-like cartilage regeneration in the 1-mg losartan group compared with the MFX group. In contrast, the 100-mg losartan group showed the lowest histology score and no cartilage repair. An IA injection of losartan at the doses of 0.1, 1, and 10 mg did not cause adverse effects on uninjured cartilage, while the 100-mg dose induced cartilage damage. Quantitative polymerase chain reaction results showed downregulation of the transforming growth factor β (TGF-β) signaling pathway after IA losartan injection. Conclusion: An IA injection of losartan at the dose of 1 mg was most effective for the enhancement of microfracture-mediated cartilage repair without adversely affecting uninjured cartilage. Conversely, a high dose (100 mg) IA injection of losartan inhibited cartilage repair in the osteochondral defect and was chondrotoxic to normal articular cartilage. Clinical Relevance: An IA injection of losartan at an optimal dosage represents a novel microfracture enhancement therapy and warrants a clinical trial for future clinical applications.
Greater Palatal Cleft Width Predicts an Increased Risk for Unfavorable Outcomes in Cleft Palate Repair
Authors: Okhiria Åsa C. , Jabbari Fatemeh , Hakelius Malin M. , Johansson Monica M. Blom , Nowinski Daniel J. 
Published: July 2021

Objective: To investigate the impact of cleft width and cleft type on the need for secondary surgery and velopharyngeal competence from a longitudinal perspective. Design: Retrospective, longitudinal study. Setting: A single multidisciplinary craniofacial team at a university hospital. Patients: Consecutive patients with unilateral or bilateral cleft lip and palate and cleft palate only (n = 313) born from 1984 to 2002, treated with 2-stage palatal surgery, were reviewed. A total of 213 patients were included. Main Outcome Measures: The impact of initial cleft width and cleft type on secondary surgery. Assessment of hypernasality, audible nasal emission, and glottal articulation from routine follow-ups from 3 to 16 years of age. The assessments were compared with reassessments of 10% of the recordings. Results: Cleft width, but not cleft type, predicted the need for secondary surgery, either due to palatal dehiscence or velopharyngeal insufficiency. The distribution of cleft width between the scale steps on a 4-point scale for hypernasality and audible nasal emission differed significantly at 5 years of age but not at any other age. Presence of glottal articulation differed significantly at 3 and 5 years of age. No differences between cleft types were seen at any age for any speech variable. Conclusions: Cleft width emerged as a predictor of the need for secondary surgery as well as more deviance in speech variables related to velopharyngeal competence during the preschool years. Cleft type was not related to the need for secondary surgery nor speech outcome at any age.
Artificial double inversion recovery images for (juxta)cortical lesion visualization in multiple sclerosis
Authors: Bouman Piet M , Strijbis Victor IJ , Jonkman Laura E , Hulst Hanneke E , Geurts Jeroen JG , Steenwijk Martijn D 
Published: July 2021

Background: Cortical lesions are highly inconspicuous on magnetic resonance imaging (MRI). Double inversion recovery (DIR) has a higher sensitivity than conventional clinical sequences (i.e. T1, T2, FLAIR) but is difficult to acquire, leading to overseen cortical lesions in clinical care and clinical trials. Objective: To evaluate the usability of artificially generated DIR (aDIR) images for cortical lesion detection compared to conventionally acquired DIR (cDIR). Methods: The dataset consisted of 3D-T1 and 2D-proton density (PD) T2 images of 73 patients (49RR, 20SP, 4PP) at 1.5 T. Using a 4:1 train:test-ratio, a fully convolutional neural network was trained to predict 3D-aDIR from 3D-T1 and 2D-PD/T2 images. Randomized blind scoring of the test set was used to determine detection reliability, precision and recall. Results: A total of 626 vs 696 cortical lesions were detected on 15 aDIR vs cDIR images (intraclass correlation coefficient (ICC) = 0.92). Compared to cDIR, precision and recall were 0.84 ± 0.06 and 0.76 ± 0.09, respectively. The frontal and temporal lobes showed the largest differences in discernibility. Conclusion: Cortical lesions can be detected with good reliability on artificial DIR. The technique has potential to broaden the availability of DIR in clinical care and provides the opportunity of ex post facto implementation of cortical lesions imaging in existing clinical trial data.
Pronated Grip View With Wrist Deviation: A Pilot Study on the Effect on Ulnocarpal Relationships
Authors: Logli Anthony L. , Schueler Beth A. , Littrell Laurel A. , Kakar Sanjeev 
Published: July 2021

Background We hypothesize that different positions of the wrist in the coronal plane makes the carpus susceptible to ulnar impaction. Methods We prospectively enrolled 10 adult volunteers and obtained fluoroscopic images of each wrist in 12 different positions using a standardized protocol. Distances from the ulna to the lunate (UL) and ulna to the triquetrum (UT) were digitally measured as was the portion of the lunate surface area that was uncovered (LUR) with wrist deviation. Results A wrist position of Pronation, Neutral Deviation, and Grip (P-ND-G) significantly shortened the ulnocarpal distance when compared to a position of Neutral Rotation, Neutral Deviation, and No Grip (NR-ND-NG). Radial deviation during pronation and gripping (Pronated, Radial Deviation, Gripping [P-RD-G]) resulted in the lowest mean UL distance (1.2 mm). UT distance was minimized by a position of ulnar deviation during a pronated grip (Pronated, Ulnar Deviation, Gripping [P-UD-G]) (3.1 mm). The lunate becomes more uncovered with radial deviation. Conclusion Radial deviation minimizes the UL distance while ulnar deviation minimizes the UT distance during a wrist position of pronation and gripping. Further, there is more proximal lunate surface area uncoverage during all positions of radial deviation compared to ulnar deviation.
Hyperselective neurectomy for the treatment of upper limb spasticity in adults and children: a prospective study
Authors: Leclercq Caroline , Perruisseau-Carrier Anne , Gras Mathilde , Panciera Paolo , Fulchignoni Camillo , Fulchignoni Marcello 
Published: July 2021

Hyperselective neurectomy (HSN) procedures in the spastic upper limb aim to reduce tone by excising some branches of the involved peripheral motor nerves, at the point of entry of each motor ramus into the target muscle. In this prospective study, 42 patients with upper limb spasticity were treated by HSN for the muscles of elbow flexion, forearm pronation and wrist flexion and evaluated for their short-term results (average 6 months) and long-term outcomes (average 31 months). Results at both time points showed an effective reduction of the spastic tone, with no decrease of muscle strength in the operated spastic muscles. Comparison of results between the two time points showed durability of the improvement, which remained statistically significant despite a slight relapse in spasticity. The results of HSN compare favourably with the other techniques of partial neurectomy; however, the technique requires a detailed knowledge of upper limb motor anatomy. Level of evidence: II
Characterization of circulating tumor cells in early breast cancer patients receiving neoadjuvant chemotherapy
Authors: Jakabova Anna , Bielcikova Zuzana , Pospisilova Eliska , Petruzelka Lubos , Blasiak Piotr , Bobek Vladimir , Kolostova Katarina 
Published: July 2021

Background and Aims: The aim of this study was to characterize circulating tumor cells (CTCs) during neoadjuvant chemotherapy (NACT) in early and locally advanced breast cancer (LABC) patients. Using ultrasound, tumor volume measurement was compared with the presence and the molecular nature of CTCs over multiple time intervals corresponding to treatment periods. Methods: A total of 20 patients diagnosed with breast cancer (BC) of different histotypes were monitored during the NACT period and in the follow-up period (~5 years). Peripheral blood for CTCs ( n = 115) was taken prior to NACT, after two to three chemotherapy cycles, after the completion of NACT (before surgery) and at some time points during adjuvant therapy. CTCs were enriched using a size-based filtration method (MetaCell®) capturing viable cells, which enabled vital fluorescence microscopy. A set of tumor-associated (TA) genes and chemoresistance-associated (CA) genes was analyzed by qPCR in the enriched CTC fractions. Results: The analysis of tumor volume reduction after administration of anthracyclines (AC) and taxanes (TAX) during NACT showed that AC therapy was responsive in 60% (12/20) of tumors, whereas TAX therapy was responsive in 30% (6/20; n.s.). After NACT, CTCs were still present in 70.5% (12/17) of patients (responders versus non-responders, 61.5% versus 100%; not significant). In triple-negative BC (TNBC) patients ( n = 8), tumor volume reduction was observed in 75% cases. CTCs were significantly reduced in 42.9% of all HER2-negative BC patients. In HER2+ tumors, CTC reduction was reported in 16.6% only. Relapses were also more prevalent in the HER2-positive patient group (28.5 versus 66.6%). During NACT, the presence of CTCs (three tests for each patient) identified patients with relapses and indicated significantly shorter progression-free survival (PFS) rates ( p = 0.03). Differentiation between progressive disease and non-progressive disease was obtained when the occurrence of excessive expression for CA genes in CTCs was compared ( p = 0.024). Absence of tumor volume reduction was also significantly indicative for progressive disease ( p = 0.0224). Disseminated CTCs in HER2-negative tumors expressed HER2 in 29% of samples collected during the overall follow-up period (16/55), and in 32% of samples during the follow-up of NACT (10/31). The change accounted for 78.5% of HER2-negative patients (11/14) in total, and 63.6% of the conversion cases occurred during NACT (7/11). For the remaining four patients (36.3%), conversion to HER2+ CTCs occurred later during adjuvant therapy. We believe there is the possibility of preventing further progression by identifying less responsive tumors during NACT using CTC monitoring, which could also be used effectively during adjuvant therapy.
Obesity and Work-Related Injuries Among Farmers in Kentucky, Tennessee, and West Virginia
Authors: Hunsucker Sharon , Reed Deborah B. 
Published: July 2021

Background Obesity is a recognized risk factor for work-related injuries (WRI). Despite the inherent safety hazards associated with farm work, research on obesity among farmers is limited giving little guidance to occupational health providers on obesity as a risk factor in farm WRI. This study evaluated the association between obesity and farm WRI. Methods Cross-sectional data were collected from farmers ( n = 100) in Kentucky, Tennessee, and West Virginia. Data included a survey (demographic data, farm factors, health indicators, occurrences of work-related injuries consistent with the definition of Occupational Safety and Health Administration [OSHA] recordable injuries) and direct anthropometric measures (height, weight, and waist circumference). Logistic regression was used to model any work-related injury, injuries consistent with the definition of OSHA recordables (herein called OSHA-recordable injuries), and recurrent injuries occurring during farm work performance on body mass index (BMI) and waist circumference. Findings Twenty-five percent of the participants reported any injuries, and 18% reported OSHA-recordable injuries. Farmers with a BMI ≥30 kg/m2 had 3 times the risk for OSHA-recordable injuries and 5 times the risk for recurrent injuries. No significant relationship was identified between waist circumference and farm WRI. Conclusion This study provides evidence that increased BMI is a safety risk for farmers. Prospective studies with a larger sample are needed. Occupational health nurses and providers should educate farmers on the potential safety risk of obesity and implement weight management programs addressing obesity in farmers.
Can We Extrapolate SINS Score to Evaluate Instability in Spinal Tuberculosis?
Authors: Pithwa Yogesh Kishorkant , Sinha Roy Vikrant 
Published: July 2021

Study Design: Prospective Observational Study. Objectives: To assess the feasibility of utilizing SINS score, originally suggested for neoplastic conditions, to assess structural instability in spinal tuberculosis. Methods: Patients with an established diagnosis of spinal tuberculosis were included in the study. Based on SINS scoring, patients classified as those with “indeterminate stability” were managed with or without surgery based on other parameters including neurological status, severity of pain, medical comorbidities, etc. Results: Eighty [39 males, 41 females] patients prospectively evaluated with mean age 46.74 ± 17.3 years. Classification done into stable [n = 7], indeterminate [n = 45] and unstable [n = 28] groups based on SINS scoring. All the patients in unstable group were treated with surgical stabilization whereas none in the stable group required surgical stabilization. In the indeterminate group, 26 patients underwent surgical stabilization, while 19 treated non-operatively. Major determinants predisposing to surgical intervention in “indeterminate group” were pain [14 of 26 patients] and neurological status [11 of 26 patients]. Mean follow-up 38.5 ± 22.61 months with minimum follow-up being 24 months. Preoperative VAS score for pain improved from median of 9/10 to 1/10 following surgery [ P < .0001]. In the non-operative group, the improvement was from median score of 6/10 to 1/10 [ P < .0001]. Preoperative ODI improved in non-operative and operative group from median of 42% and 70%, respectively to 10% and 12%, respectively in the postoperative period [ P < .0001 for both groups]. Conclusions: SINS scoring can be a helpful tool in surgical decision-making even in spinal tuberculosis. Further refinement of the score can be done with a larger, multicenter study.
LCL IN A SINGLE CORONAL SLICE – A NOVEL SIGN FOR IDENTIFYING ACL DEFICIENT PATIENTS AND PREDICTING RISK OF FUTURE GRAFT FAILURE
Authors: Mitchell Brendon C. , Siow Matthew Y. , Chambers Henry G. , Pennock Andrew T. , Parvaresh Kevin , Edmonds Eric W. 
Published: July 2021

Background: The ACL deficient knee is predisposed to anterior translation and internal rotation of the tibia. Hypothesis/Purpose: To show that knee deformity in an ACL deficient knee will produce a more vertical orientation of the lateral collateral ligament (LCL), allowing for the entire length of the LCL to be visualized on a single coronal slice (coronal LCL sign) on MRI, and that this sign is indicative of a greater risk for graft failure after ACL reconstruction. Methods: Charts were retrospectively reviewed to create 3 separate cohorts: normal ACL and no pathology involving the collateral ligaments (control cohort), ACL reconstruction without evidence for graft rupture, and ACL reconstruction with graft failure. Tibial translation and femorotibial rotation were measured on MRI, and posterior tibial slope was measured on lateral knee radiographs. Imaging was reviewed for the presence of the coronal LCL sign. Results: Deficient ACL (n=153) compared with intact ACL (n=70) was associated with significantly greater displacement regarding anterior translation (5.8mm internal rotation vs 0.3mm external rotation, p<0.001, respectively) and internal rotation (5.2 degrees vs. -2.4 degrees, p<0.001, respectively). The coronal LCL sign was present in a greater percentage of ACL deficient patients than intact ACL controls (68.6% vs. 18.6%, p<0.001, respectively) and associated with greater anterior tibial translation (7.2mm vs. 0.2mm vs., p<0.001) and internal tibial rotation (7.5 degrees vs 2.4 degrees, p=0.074). Multivariate analysis revealed the coronal LCL sign was significantly associated with an ACL tear (OR 12.8, p<0.001). Of the 153 ACL deficient cohort, 114 had no graft failure patients and 39 experienced graft failure. Mean follow-up time was 3.5 years (2 – 9.4 years). Coronal LCL sign was associated with graft failure (p=0.013), with an odds ratio of 4.3 for graft failure (p=0.003). Comparison of pre- and post-ACL reconstruction MRI in the graft failure cohort demonstrated reduced internal rotation, p= 0.00, but no change in coronal LCL sign (p=0.922). Conclusion: Our study shows that the coronal LCL sign correlates with the presence of an ACL tear and functions as a surrogate for the extent of axial and sagittal deformity. Further, we show that tibia internal rotation and posterior slope are independent predictors of ACL graft failure in adolescents. Whereas, the value of internal rotation could be improved with ACL reconstruction, the presence of the coronal LCL sign persisted over time and was predictive of graft rupture (without the need to make measurements or memorize values of significant risk). [Table: see text][Figure: see text]