bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Outcomes Associated With Preoperative Opioid Use in Various Shoulder Surgical Procedures: A Systematic Review
Authors: Devano Dan Michael J. , Smith John-Rudolph , Houck Darby A. , McCarty Eric C. , Seidl Adam J. , Wolcott Michelle L. , Frank Rachel M. , Bravman Jonathan T. 
Published: April 2021

Background: The impact of preoperative opioid use on outcomes after shoulder surgery is unknown. Purpose/Hypothesis: To examine the role of preoperative opioid use on outcomes in patients after shoulder surgery. We hypothesized that preoperative opioid use in shoulder surgery will result in increased postoperative pain and functional deficits when compared with nonuse. Study Design: Systematic review; Level of evidence, 3. Methods: A systematic review was performed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included were all English-language studies comparing clinical outcomes of shoulder surgery in patients who used opioids preoperatively (opioid group) as well as patients who did not (nonopioid group) with a minimum follow-up of 1 year. Outcomes included range of motion, American Shoulder and Elbow Surgeons score, Constant-Murley score, and visual analog scale for pain. Study quality was evaluated with the Modified Coleman Methodology Score and the MINORS score (Methodological Index for Non-randomized Studies). Results: Included were 5 studies (level 2, n = 1; level 3, n = 4): Two studies were on total shoulder arthroplasty, 2 on reverse total shoulder arthroplasty, 1 on both, and 1 on arthroscopic rotator cuff repair. There were 827 patients overall: 290 in the opioid group (age, 63.2 ± 4.0 years [mean ± SD]; follow-up, 38.9 ± 7.5 months) and 537 in the nonopioid group (age, 66.0 ± 4.7 years; follow-up, 39.5 ± 8.1 months). The opioid group demonstrated significantly worse pre- and postoperative visual analog scale and Constant-Murley score pain scores as compared with the nonopioid group. Mean American Shoulder and Elbow Surgeons scores were significantly lower in the opioid group at pre- and postoperative time points as compared with the nonopioid group ( P < .05 for all). However, both groups experienced similar improvement in outcomes pre- to postoperatively. One study showed that the opioid group consumed significantly more opioids postoperatively than the nonopioid group and for a longer duration ( P < .05). The overall mean Modified Coleman Methodology Score and MINORS score were 64.2 ± 14 and 15.8 ± 1.0, respectively. Conclusion: Opioid use prior to various shoulder surgical procedures negatively affected postoperative pain and functionality. Although the opioid group showed significantly worse scores postoperatively, the groups experienced similar improvements.
Changes in the Contact Stress Distribution Pattern of the Patellofemoral Joint After Medial Open-Wedge High Tibial Osteotomy: An Evaluation Using Computed Tomography Osteoabsorptiometry
Authors: Kameda Toshiaki , Kondo Eiji , Onodera Tomohiro , Iwasaki Koji , Onodera Jun , Yasuda Kazunori , Iwasaki Norimasa 
Published: April 2021

Background: Medial open-wedge high tibial osteotomy (OWHTO) theoretically causes distalization and lateralization of the tibial tuberosity and the patella. Purpose/Hypothesis: The purpose of the study was to identify any changes in the stress distribution of subchondral bone density across the patellofemoral (PF) joint before and after OWHTO through the use of computed tomography (CT) osteoabsorptiometry. We hypothesized that OWHTO would alter the distribution of contact stress in the PF joint. Study Design: Case series; Level of evidence, 4. Methods: A total of 17 patients (17 knees) who underwent OWHTO were enrolled in this study between September 2013 and September 2015. All patients underwent radiologic examination preoperatively and at 1 year postoperatively, and the distribution patterns of subchondral bone density through the articular surface of the femoral trochlea and patella were assessed preoperatively and >1 year postoperatively using CT osteoabsorptiometry. The quantitative analysis of the obtained mapping data focused on location of the high-density area (HDA) through the articular surface of the PF joint. The percentage of HDA at each divided region of the articular surface of the femoral trochlea and the patella was calculated. Results: In the radiologic evaluation, the Blackburne-Peel ratio was significantly reduced ( P < .001) after surgery, and the tilting angle of the patella was significantly decreased ( P < .001). On CT evaluation, the percentage of HDA in the lateral notch and lateral trochlea of the femur and in the medial portion of the lateral facet of the patella increased significantly after OWHTO surgery ( P ≤ .038). Conclusion: OWHTO significantly increased the stress distribution pattern of the lateral trochlea of the femur and the medial portion of the lateral facet of the patella. The procedure significantly lowered the patellar height and significantly decreased the patellar tilting angle after surgery.
Surgical Management of Patella Alta in Patellofemoral Instability: A Systematic Review and Meta-analysis
Authors: Tan Si Heng Sharon , Ngiam Erica Hian Kim , Lim Jia Ying , Lim Andrew Kean Seng , Hui James Hoipo 
Published: April 2021

Background: Proximal, distal, and combined proximal and distal procedures have been performed for patellofemoral instability in the presence of patella alta. No consensus exists regarding the accepted surgical management for this condition. Purpose: To pool the outcomes of surgical management for patellofemoral instability in the presence of patella alta and to determine whether the outcomes differ for different surgical techniques. Study Design: Systematic review; Level of evidence, 4. Methods: This systematic review was conducted using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. All studies that reported surgical outcomes for patellofemoral instability in the presence of patella alta were included. The random-effects model was used to analyze pooled estimates of preoperative and postoperative differences for outcomes that were reported in ≥3 studies. If heterogeneity existed among the studies, further analysis was performed using random-effects meta-regression analysis, which allowed for the identification of moderators. Results: A total of 11 studies with 546 knees were included. The pooled relative risk (RR) of having no patellofemoral dislocation and no patellofemoral apprehension or subjective instability postoperatively was 51.80 (95% CI, 20.75-129.31) and 48.70 (95% CI, 17.22-137.71), respectively. The pooled weighted mean improvement (WMI) for the Kujala and Lysholm scores postoperatively was 31.98 (95% CI, 28.66-35.30) and 35.93 (95% CI, 30.12-41.74), respectively. The pooled WMI for patellar tilt angles postoperatively was 10.94 (95% CI, 7.87-14.01). These outcomes were homogeneous across all studies. The pooled WMI for Insall-Salvati ratio, Caton-Deschamps index, and tibial tubercle–trochlear groove distance postoperatively was 0.31 (95% CI, 0.17-0.45), 0.24 (95% CI, 0.12-0.36), and 6.77 (95% CI, 1.96-11.58), respectively. These outcomes were heterogeneous across the studies, with the presence of distal procedures being a significant moderator. The presence of distal procedures had a significantly higher unweighted RR of 38.07 (95% CI, 2.37-613.09) for major complications compared with proximal procedures alone, although the incidence of minor complications was comparable (unweighted RR, 1.25; 95% CI, 0.35-4.48). Conclusion: Surgical management for patellofemoral instability in the presence of patella alta consistently led to improvement in clinical and functional outcomes, regardless of the type of procedure performed. Distal procedures were better able to correct the patellar height and tibial tubercle–trochlear groove distance, although these procedures also posed a higher RR of subsequent surgery compared with proximal procedures alone.
What Motivates People to Start a Graduate Entry Nursing Programme: An Interpretive Multi-Centred Case Study
Authors: Macdiarmid Rachel , McClunie-Trust Patricia , Shannon Kay , Winnnington Rhona , E. Donaldson Andrea , Jarden Rebecca J. , Lamdin-Hunter Rachel , Merrick Eamon , Turner Rosemary , Jones Virginia 
Published: April 2021

Introduction While graduate entry nursing programmes are well established in the United Kingdom and the United States of America (USA), they are relatively new to New Zealand and Australia. These programmes have been developed to meet the demands of the health workforce and provide graduates an alternative pathway to becoming a RN. Nursing is viewed as an attractive career option for this growing market of graduate entry students. Objective This study explored the motivations underpinning students choosing a graduate entry MNSc degree over a traditional undergraduate nursing programme. Methods A qualitative, longitudinal single case study design, informed by Yin was used. The first phase of the study is reported here. All students commencing a MNSc degree at the beginning of 2020 across four education providers (3 in New Zealand & 1 in Australia) were eligible to take part in the study. Ten students agreed to take part and undertake an interview. Braun and Clarke’s approach to thematic analysis was used to analyse the interview data. Results Three key themes of motivation were identified from the data: the attraction of nursing; the clarity nursing offers in terms of career progression; and the design of the intensive programme. Conclusions The motivations to choose a MNSc degree were deeply considered, multifaceted, and influenced by nursing role models. Students wanting to engage with a graduate entry MNSc programme did so through a reflective process of assessing their current career status and future career values. Participants in this study believed nursing would provide a secure and sustainable career path, potentially creating new horizons or possibilities beyond their previous work and life experiences. Having insight into what motivates individuals to enrol in such programmes may assist both education providers and the health sector with RN graduate recruitment and graduate entry programme enrolment.
Inhibiting autophagy targets human leukemic stem cells and hypoxic AML blasts by disrupting mitochondrial homeostasis
Authors: Dykstra Kaitlyn M. , Fay Hannah R. S. , Massey Ashish C. , Yang Neng , Johnson Matthew , Portwood Scott , Guzman Monica L. , Wang Eunice S. 
Published: April 2021

Abstract
Leukemia stem cells (LSCs) and therapy-resistant acute myeloid leukemia (AML) blasts contribute to the reinitiation of leukemia after remission, necessitating therapeutic interventions that target these populations. Autophagy is a prosurvival process that allows for cells to adapt to a variety of stressors. Blocking autophagy pharmacologically by using mechanistically distinct inhibitors induced apoptosis and prevented colony formation in primary human AML cells. The most effective inhibitor, bafilomycin A1 (Baf A1), also prevented the in vivo maintenance of AML LSCs in NSG mice. To understand why Baf A1 exerted the most dramatic effects on LSC survival, we evaluated mitochondrial function. Baf A1 reduced mitochondrial respiration and stabilized PTEN-induced kinase-1 (PINK-1), which initiates autophagy of mitochondria (mitophagy). Interestingly, with the autophagy inhibitor chloroquine, levels of enhanced cell death and reduced mitochondrial respiration phenocopied the effects of Baf A1 only when cultured in hypoxic conditions that mimic the marrow microenvironment (1% O2). This indicates that increased efficacy of autophagy inhibitors in inducing AML cell death can be achieved by concurrently inducing mitochondrial damage and mitophagy (pharmacologically or by hypoxic induction) and blocking mitochondrial degradation. In addition, prolonged exposure of AML cells to hypoxia induced autophagic flux and reduced chemosensitivity to cytarabine (Ara-C), which was reversed by autophagy inhibition. The combination of Ara-C with Baf A1 also decreased tumor burden in vivo. These findings demonstrate that autophagy is critical for mitochondrial homeostasis and survival of AML cells in hypoxia and support the development of autophagy inhibitors as novel therapeutic agents for AML.
Prevalence, predictors, and outcomes of clonal hematopoiesis in individuals aged ≥80 years
Authors: van Zeventer Isabelle A. , Salzbrunn Jonas B. , de Graaf Aniek O. , van der Reijden Bert A. , Boezen H. Marike , Vonk Judith M. , van der Harst Pim , Schuringa Jan Jacob , Jansen Joop H. , Huls Gerwin 
Published: April 2021

Abstract
Clonal hematopoiesis (CH), characterized by a fraction of peripheral blood cells carrying an acquired genetic variant, emerges with age. Although in general CH is associated with increased mortality and morbidity, no higher risk of death was observed for individuals ≥80 years. Here, we investigated CH in 621 individuals aged ≥80 years from the population-based LifeLines cohort. Sensitive error-corrected sequencing of 27 driver genes at a variant allele frequency ≥1% revealed CH in the majority (62%) of individuals, independent of gender. The observed mutational spectrum was dominated by DNMT3A and TET2 variants, which frequently (29%) displayed multiple mutations per gene. In line with previous results in individuals ≥80 years, the overall presence of CH did not associate with a higher risk of death (hazard ratio, 0.91; 95% confidence interval, 0.70-1.18; P = .48). Being able to assess the causes of death, we observed no difference between individuals with or without CH, except for deaths related to hematological malignancies. Interestingly, comparison of mutational spectra confined to DNMT3A and TET2 vs spectra containing other mutated genes, showed a higher risk of death when mutations other than DNMT3A or TET2 were present (hazard ratio, 1.48; 95% confidence interval, 1.06-2.08; P = .025). Surprisingly, no association of CH with cardiovascular morbidity was found, irrespective of clone size. Further, CH associated with chronic obstructive pulmonary disease. Data on estimated exposure to DNA damaging toxicities (ie, smoking, a history of cancer [as a proxy for previous genotoxic therapy], and job-related pesticide exposure) showed an association with spliceosome and ASXL1 variants, but not with DNMT3A and TET2 variants.
Functional ecological convergence between the thylacine and small prey-focused canids
Authors: Rovinsky Douglass S. , Evans Alistair R. , Adams Justin W. 
Published: April 2021

AbstractBackgroundMorphological convergence is a fundamental aspect of evolution, allowing for inference of the biology and ecology of extinct species by comparison with the form and function of living species as analogues. The thylacine (Thylacinus cynocephalus), the iconic recently extinct marsupial, is considered a classic example of convergent evolution with the distantly related placental wolf or dog, though almost nothing is actually known regarding its ecology. This lack of data leads to questions regarding the degree of convergence with, and the similarity of, the functional ecology of the thylacine and the wolf/dog. Here, we examined the cranium of the thylacine using 3D geometric morphometrics and two quantitative tests of convergence to more precisely determine convergent analogues, within a phylogenetically informed dataset of 56 comparative species across 12 families of marsupial and placental faunivorous mammals. Using this dataset, we investigated patterns of correlation between cranial shape and diet, phylogeny, and relative prey size across these terrestrial faunivores.ResultsWe find a correlation between cranial, facial, and neurocranial shape and the ratio of prey-to-predator body mass, though neurocranial shape may not correlate with prey size within marsupials. The thylacine was found to group with predators that routinely take prey smaller than 45% of their own body mass, not with predators that take subequal-sized or larger prey. Both convergence tests find significant levels of convergence between the thylacine and the African jackals and South American ‘foxes’, with lesser support for the coyote and red fox. We find little support for convergence between the thylacine and the wolf or dog.ConclusionsOur study finds little support for a wolf/dog-like functional ecology in the thylacine, with it instead being most similar to mid-sized canids such as African jackals and South American ‘foxes’ that mainly take prey less than half their size. This work suggests that concepts of convergence should extend beyond superficial similarity, and broader comparisons can lead to false interpretations of functional ecology. The thylacine was a predator of small to mid-sized prey, not a big-game specialist like the placental wolf.
Characterization of a haplotype-reference panel for genotyping by low-pass sequencing in Swiss Large White pigs
Authors: Nosková Adéla , Bhati Meenu , Kadri Naveen Kumar , Crysnanto Danang , Neuenschwander Stefan , Hofer Andreas , Pausch Hubert 
Published: April 2021

AbstractBackgroundThe key-ancestor approach has been frequently applied to prioritize individuals for whole-genome sequencing based on their marginal genetic contribution to current populations. Using this approach, we selected 70 key ancestors from two lines of the Swiss Large White breed that have been selected divergently for fertility and fattening traits and sequenced their genomes with short paired-end reads.ResultsUsing pedigree records, we estimated the effective population size of the dam and sire line to 72 and 44, respectively. In order to assess sequence variation in both lines, we sequenced the genomes of 70 boars at an average coverage of 16.69-fold. The boars explained 87.95 and 95.35% of the genetic diversity of the breeding populations of the dam and sire line, respectively. Reference-guided variant discovery using the GATK revealed 26,862,369 polymorphic sites. Principal component, admixture and fixation index (FST) analyses indicated considerable genetic differentiation between the lines. Genomic inbreeding quantified using runs of homozygosity was higher in the sire than dam line (0.28 vs 0.26). Using two complementary approaches, we detected 51 signatures of selection. However, only six signatures of selection overlapped between both lines. We used the sequenced haplotypes of the 70 key ancestors as a reference panel to call 22,618,811 genotypes in 175 pigs that had been sequenced at very low coverage (1.11-fold) using the GLIMPSE software. The genotype concordance, non-reference sensitivity and non-reference discrepancy between thus inferred and Illumina PorcineSNP60 BeadChip-called genotypes was 97.60, 98.73 and 3.24%, respectively. The low-pass sequencing-derived genomic relationship coefficients were highly correlated (r > 0.99) with those obtained from microarray genotyping.ConclusionsWe assessed genetic diversity within and between two lines of the Swiss Large White pig breed. Our analyses revealed considerable differentiation, even though the split into two populations occurred only few generations ago. The sequenced haplotypes of the key ancestor animals enabled us to implement genotyping by low-pass sequencing which offers an intriguing cost-effective approach to increase the variant density over current array-based genotyping by more than 350-fold.
Risk factors for pediatric surgical site infection following neurosurgical procedures for hydrocephalus: a retrospective single-center cohort study
Authors: Shibamura-Fujiogi Miho , Ormsby Jennifer , Breibart Mark , Warf Benjamin , Priebe Gregory P. , Soriano Sulpicio G. , Sandora Thomas J. , Yuki Koichi 
Published: April 2021

Abstract
Background
Infection is a major complication following cerebral spinal fluid (CSF) diversion procedures for hydrocephalus. However, pediatric risk factors for surgical site infection (SSI) are currently not well defined. Because a SSI prevention bundle is increasingly introduced, the purpose of this study was to evaluate risk factors associated with SSIs following CSF diversion surgeries following a SSI bundle at a single quaternary care pediatric hospital.

Methods
We performed a retrospective cohort study of patients undergoing CSF diversion procedures from 2017 to 2019. SSIs were identified prospectively through continuous surveillance. We performed unadjusted logistic regression analyses and univariate analyses to determine an association between SSIs and patient demographics, comorbidities and perioperative factors to identify independent risk factors for SSI.

Results
We identified a total of 558 CSF diversion procedures with an overall SSI rate of 3.4%. The SSI rates for shunt, external ventricular drain (EVD) placement, and endoscopic third ventriculostomy (ETV) were 4.3, 6.9 and 0%, respectively. Among 323 shunt operations, receipt of clindamycin as perioperative prophylaxis and presence of cardiac disease were significantly associated with SSI (O.R. 4.99, 95% C.I. 1.27–19.70, p = 0.02 for the former, and O.R. 7.19, 95% C.I. 1.35–38.35, p = 0.02 for the latter). No risk factors for SSI were identified among 72 EVD procedures.

Conclusion
We identified receipt of clindamycin as perioperative prophylaxis and the presence of cardiac disease as risk factors for SSI in shunt procedures. Cefazolin is recommended as a standard antibiotic for perioperative prophylaxis. Knowing that unsubstantiated beta-lactam allergy label is a significant medical problem, efforts should be made to clarify beta-lactam allergy status to maximize the number of patients who can receive cefazolin for prophylaxis before shunt placement. Further research is needed to elucidate the mechanism by which cardiac disease may increase SSI risk after shunt procedures.