bluuebunny/crossref_metadata_2025_split huggingface dataset:
Seasonal accumulation of photoassimilated carbon relates to growth rate and use for new aboveground organs of young apple trees in following spring
Authors: Imada Shogo , Tako Yasuhiro 
Published: July 2022

Abstract
Deciduous trees accumulate carbon (C) in woody parts during the growth season which is subsequently used for the initial development and growth of newly formed organs in the following season; however, it is unclear which period during the growth season contributes to C accumulation. Three-year-old potted Malus domestica (apple) trees were grown in controlled growth chambers during the growth season and exposed to 13CO2 in an exposure chamber at seven different periods of the growth season, including vegetative and reproductive growth periods. Approximately half of the trees were harvested in late autumn, and the remaining trees were grown in a field in the following year. The 13C accumulation in the different organs in late autumn, and its concentration in the new aboveground growth during the following growth season, was determined. The concentration of the photoassimilated 13C in woody parts (shoots, trunk, rootstock and coarse roots) in the late autumn was higher in the trees labeled during the period of vigorous vegetative growth than in those labeled during other periods of growth. Furthermore, 13C concentration in the leaves, annual shoots, flower buds and flowers in the following early spring was also high in the trees labeled during this period. The concentration of 13C in the flower buds and flowers was positively correlated with that in the woody parts in the late autumn and old shoots in the following spring. Hence, the seasonal accumulation of photoassimilated C in woody parts in late autumn is related to growth rates during the growth season and its use for the initial development of newly formed organs in the following spring. These results suggest that under non-stressed conditions, C accumulated during the period of vigorous vegetative growth largely contributes to the C reserves that are used for the development of new organs in the following year.
Family and Provider Experiences With Longitudinal Care Coordination for Infants With Medical Complexity
Authors: Dallas Abbey , Ryan Alexandra , Mestan Karen , Helner Khrystyna , Foster Carolyn 
Published: July 2022

Background:
Parents in the neonatal intensive care unit (NICU) report low self-confidence managing their children's ongoing medical and social needs. While bedside nurses provide critical support for families throughout their NICU admission, there may be a role for nursing coordination throughout hospitalization, discharge, and in the transition to outpatient care.

Purpose:
This program evaluation explores parent and provider experiences of a novel longitudinal care coordination program for infants with medical complexity from the NICU through their first year of life post-discharge.

Methods:
First, a sequential exploratory mixed-methods approach was used to evaluate parental experiences (n = 5 interviewed followed by n = 23 surveyed). Provider perspectives were elicited through semi-structured interviews (n = 8) and focus groups (n = 26 in 3 groups).

Results:
Parent-reported benefits included frequent communication and personalized support that met families' and patients' evolving needs. Care coordinators, who were trained as nurses and social workers, developed longitudinal relationships with parents. This seemed to facilitate individualized support throughout the first year of life. Providers reported that smaller caseloads were central to the success of the program.

Implications for Practice and Research:
This longitudinal care coordination program can be used as a translatable model in NICUs elsewhere to address the unique needs of families of infants with medical complexity throughout the first year of life. Future implementations should consider how to expand program size while maintaining individualized supports. As the care coordinators are former NICU nurses and social workers, there may be a growing role for nursing coordination of care in the neonatal population.
Immediate Weight Bearing as Tolerated Is Safe Following Intramedullary Fixation of Extra-articular Metaphyseal Proximal Tibia Fractures (OTA/AO 41-A)
Authors: Telgheder Zachary L. , Hill Brenton , Huang Kevin , Watson David T. , Maxson Benjamin , Infante Anthony , Donohue David , Shah Anjan , Downes Katheryne , Sanders Roy W. , Mir Hassan R. 
Published: July 2022

Objectives:
To determine whether immediate weight bearing after intramedullary fixation of extra-articular proximal tibia fractures (OTA/AO 41A) results in change of alignment before union.

Design:
Retrospective Review.

Setting:
Level I and Level II Trauma Center.

Patients/Participants:
Thirty-seven patients with 37 proximal tibial fractures, all whom could bear weight as tolerated postoperatively. Eighteen fractures were OTA/AO 41-A2, and 19 were OTA/AO 41-A3.

Intervention:
Intramedullary nailing of extra-articular proximal tibia fractures.

Main Outcome Measurements:
Change in fracture alignment or loss of reduction.

Results:
The average change in coronal alignment at the final follow-up was 1.22 ± 1.28 degrees of valgus and 1.03 ± 1.05 degrees of extension in the sagittal plane. Twenty-five patients demonstrated excellent initial alignment, 10 patients demonstrated acceptable initial alignment, and 2 patients demonstrated poor initial alignment. Five patients demonstrated a change in alignment from excellent to acceptable at the final follow-up. No patient went from excellent or acceptable initial alignment to poor final alignment. Five patients required unplanned secondary surgical procedures. Two patients required return to the operating room for soft-tissue coverage procedures, 2 patients required surgical debridement of a postoperative infection, and 1 patient underwent debridement and exchange nailing of an infected nonunion. No patient underwent revision for implant failure or loss of reduction.

Conclusion:
Immediate weight bearing after intramedullary fixation of extra-articular proximal tibia fractures (OTA/AO 41A) led to minimal change in alignment at final postoperative radiographs.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Convergent and Discriminative Validity of the PROMIS Physical Function 4 Questionnaire for Assessing Pain-related Disability in Low Back Pain Patients Seeking Chiropractic Care
Authors: Sandal Louise F. , Young James J. , Søgaard Karen , Hartvigsen Jan 
Published: July 2022

Study Design.
A prospective cohort study.

Objective.
To investigate construct validity by examining the convergent and discriminative validity of the Patient-Reported Outcomes Measurement Information System Physical Function 4a (PROMIS-PF4) questionnaire in low back pain (LBP) patients seeking care from Danish chiropractors.

Summary of Background Data.
The Roland-Morris Disability Questionnaire (RMDQ) is often used to assess physical functioning in LBP. However, it consists of 24 items, which is time consuming to complete in clinical practice. The PROMIS-PF4 questionnaire has only four items and may be more applicable for clinical use.

Materials and Methods.
Patients with LBP seeking care from chiropractors in Denmark completed the PROMIS-PF4, RMDQ, Subgroups for Targeted Treatment (STarT) Back screening tool, and Numeric Pain Rating Scale (NPRS) in advance of their first appointment with the chiropractor. Convergent validity was assessed using Spearman correlation coefficients between the PROMIS-PF4 and RMDQ and NPRS, respectively. Discriminative validity of the PROMIS-PF4 was assessed by calculating the area under the receiver operating characteristic curve (AUC) when plotting the PROMIS-PF4 t score against a reference case for RMDQ; NPRS; and high and low risk groups using the STarT Back screening tool.

Results.
Among 356 patients the PROMIS-PF4 questionnaire had strong convergent validity with the RMDQ (r=−0.76) and moderate convergent validity with the NPRS (r=−0.42). The PROMIS-PF4 had good and acceptable discriminative validity for disability (AUC=0.88) and high risk of persisting disability (AUC=0.72), and poor or no discriminative validity for pain intensity (AUC=0.66) and low-risk of persisting disability (AUC=0.26), respectively.

Conclusion.
As hypothesized, for convergent validity the PROMIS-PF4 has stronger correlation with the RMDQ than the NPRS and good discriminative validity for identifying patients with pain-related disability and at high risk of persisting disability but not for identifying pain intensity or low-risk of persisting disability. Consequently, the PROMIS-PF4 has adequate construct validity for measuring pain-related disability in an LBP population in chiropractic care.
Validation of Adult Spinal Deformity Surgical Outcome Prediction Tools in Adult Symptomatic Lumbar Scoliosis
Authors: Wondra James P. , Kelly Michael P. , Greenberg Jacob , Yanik Elizabeth L. , Ames Christopher P. , Pellise Ferran , Vila-Casademunt Alba , Smith Justin S. , Bess Shay , Shaffrey Christopher I. , Lenke Lawrence G. , Serra-Burriel Miquel , Bridwell Keith H. 
Published: July 2022

Study Design.
A post hoc analysis.

Objective.
Advances in machine learning (ML) have led to tools offering individualized outcome predictions for adult spinal deformity (ASD). Our objective is to examine the properties of these ASD models in a cohort of adult symptomatic lumbar scoliosis (ASLS) patients.

Summary of Background Data.
ML algorithms produce patient-specific probabilities of outcomes, including major complication (MC), reoperation (RO), and readmission (RA) in ASD. External validation of these models is needed.

Methods.
Thirty-nine predictive factors (12 demographic, 9 radiographic, 4 health-related quality of life, 14 surgical) were retrieved and entered into web-based prediction models for MC, unplanned RO, and hospital RA. Calculated probabilities were compared with actual event rates. Discrimination and calibration were analyzed using receiver operative characteristic area under the curve (where 0.5=chance, 1=perfect) and calibration curves (Brier scores, where 0.25=chance, 0=perfect). Ninety-five percent confidence intervals are reported.

Results.
A total of 169 of 187 (90%) surgical patients completed 2-year follow up. The observed rate of MCs was 41.4% with model predictions ranging from 13% to 68% (mean: 38.7%). RO was 20.7% with model predictions ranging from 9% to 54% (mean: 30.1%). Hospital RA was 17.2% with model predictions ranging from 13% to 50% (mean: 28.5%). Model classification for all three outcome measures was better than chance for all [area under the curve=MC 0.6 (0.5–0.7), RA 0.6 (0.5–0.7), RO 0.6 (0.5–0.7)]. Calibration was better than chance for all, though best for RA and RO (Brier Score=MC 0.22, RA 0.16, RO 0.17).

Conclusions.
ASD prediction models for MC, RA, and RO performed better than chance in a cohort of adult lumbar scoliosis patients, though the homogeneity of ASLS affected calibration and accuracy. Optimization of models require samples with the breadth of outcomes (0%–100%), supporting the need for continued data collection as personalized prediction models may improve decision-making for the patient and surgeon alike.
SARS-CoV-2 Infections in Icelandic Children: Close Follow-up of All Confirmed Cases in a Nationwide Study
Authors: Thors Valtyr , Bjornsdottir Kristin L. , Love Thorvardur , Haraldsson Asgeir 
Published: July 2022

Introduction:
Children are less likely to acquire SARS-CoV-2 infections than adults and when infected, usually have milder disease. True infection and complication rates are, however, difficult to ascertain. In Iceland, a strict test, trace and isolate policy was maintained from the start of the pandemic and offers more accurate information of the number of truly infected children in a nationwide study.

Material and methods:
All children with positive PCR for SARS-CoV-2 infections from February 28, 2020 to August 31, 2021 were followed up through telephone consultations for at least 14 days and their symptoms were registered. Symptom severity and duration were categorized based on age groups and the source of infection was registered.

Results:
A total of 1749 children were infected with SARS-CoV-2 in 3 waves of infections. All waves had similar disease severity whereas the incidence was 5-fold higher in the third wave (3.5 vs. 0.73/1000 children/month). No children had severe symptoms, 81 (4.6%) had moderate symptoms, 1287 (73.9%) had mild and 374 (21.5%) were asymptomatic. Symptoms from upper (n = 839, 48%) and lower respiratory tract (n = 744, 43%) were most common. Median duration of symptoms was 5 days and adolescents had a higher risk of prolonged duration [OR:1.84 (1.39–2.43)]. Nineteen (1.1%) children needed medical attention, but no child was hospitalized. The source of infection was a household member in 65% of cases.

Discussion:
During the first 3 waves of the pandemic, SARS-CoV-2 infections in Icelandic children were mild and none were hospitalized. The most common symptoms were respiratory symptoms followed by fever, headache and tiredness. This study helps shed light on true complication rates of children with confirmed SARS-CoV-2 infection.
Pronociceptive autoantibodies in the spinal cord mediate nociceptive sensitization, loss of function, and spontaneous pain in the lumbar disk puncture model of chronic back pain
Authors: Guo Tian-Zhi , Shi Xiaoyou , Li Wen-wu , Wei Tzuping , Sahbaie Peyman , Clark J. David , Kingery Wade S. 
Published: July 2022

Abstract
Previously, we observed that B cells and autoantibodies mediated chronic nociceptive sensitization in the mouse tibia fracture model of complex regional pain syndrome and that complex regional pain syndrome patient antibodies were pronociceptive in fracture mice lacking mature B cells and antibodies (muMT). The current study used a lumbar spinal disk puncture (DP) model of low back pain in wild-type (WT) and muMT mice to evaluate pronociceptive adaptive immune responses. Spinal disks and cords were collected 3 weeks after DP for polymerase chain reaction and immunohistochemistry analyses. Wild-type DP mice developed 24 weeks of hindpaw mechanical allodynia and hyperalgesia, grip weakness, and a conditioned place preference response indicative of spontaneous pain, but pain responses were attenuated or absent in muMT DP mice. Spinal cord expression of inflammatory cytokines, immune cell markers, and complement components were increased in WT DP mice and in muMT DP mice. Dorsal horn immunostaining in WT DP mice demonstrated glial activation and increased complement 5a receptor expressionin spinal neurons. Serum collected from WT DP mice and injected into muMT DP mice caused nociceptive sensitization, as did intrathecal injection of IgM collected from WT DP mice, and IgM immune complexes were observed in lumbar spinal disks and cord of WT DP mice. Serum from WT tibia fracture mice was not pronociceptive in muMT DP mice and vice versa, evidence that each type of tissue trauma chronically generates its own unique antibodies and targeted antigens. These data further support the pronociceptive autoimmunity hypothesis for the transition from tissue injury to chronic musculoskeletal pain state.
18F-FDG Brain PET Findings in Narcolepsy Type 2
Authors: Varughese Robin T. , Kothare Sanjeev V. , Franceschi Ana Marija 
Published: July 2022

Abstract
A 16-year-old adolescent boy with extensive travel throughout West Africa presented with a 6-year history of social withdrawal, anhedonia, and daytime sleepiness. The patient’s electroencephalography was normal. Initial MRI revealed small pituitary gland and left temporal developmental venous anomaly. Subsequently obtained 18F-FDG brain PET was notable for markedly severe hypometabolism in the brainstem. Further workup revealed a normal orexin, autoimmune encephalitis panel, and negative titers for Trypanosoma brucei and cruzi in the CSF. Outpatient sleep study showed mild obstructive sleep apnea, and multiple sleep latency test revealed reduced mean sleep latency at 7 minutes with sleep-onset REM in 3/5 naps, findings consistent with narcolepsy type 2.
Necessity of Routine Chest Radiograph Following Chest Tube Removal in Pediatric Patients After Cardiovascular Surgery
Authors: Slak Peter , Winant Abbey J. , Lee Edward Y. , Plut Domen 
Published: July 2022

Purpose:
Chest tube placement and subsequent removal is a routine step in patient management after cardiovascular surgery. The purpose of this retrospective study is to determine the necessity of routine chest radiography following chest tube removal in order to detect potential complications in pediatric patients after cardiovascular surgery.

Materials and Methods:
We retrospectively reviewed the hospital records of all consecutive children up to 5 years of age who had cardiovascular surgery at our hospital between January 2015 and December 2020. Two radiologists independently evaluated routine chest radiographs performed 4 hours following chest tube removal for the presence of potential complications. In all post chest tube removal chest radiographs that demonstrated a complication, the patient’s medical record was investigated in order to determine if there was an associated clinical or laboratory test abnormality, and if the radiographically detected complication led to a change in patient management. Inter-rater agreement between the 2 reviewers was evaluated with κ statistics.

Results:
We identified 147 children (73 [49.7%] male and 74 [50.3%] female; mean age=13.8 mo old; range 0 to 60 mo) who met the inclusion criteria. Complications were detected on routine chest radiograph after chest tube removal in 10 patients (6.8%) including pneumothorax (n=5, 3.4%), pleural effusion (n=3, 2%), pneumomediastinum (n=1, 0.7%), and pneumopericardium (n=1, 0.7%). No clinical or laboratory abnormalities were present in all children affected with radiographically detected complications on routine chest radiograph 4 hours after chest tube removal, and there was no need for intervention in any affected patients. There was high inter-rater κ agreement between the 2 independent reviewers for detecting complications on chest radiographs after chest tube removal (κ=0.94).

Conclusion:
Our study shows that routine chest radiograph performed shortly after chest tube removal may not be necessary for the safe management of asymptomatic children after cardiovascular surgery because complications are rare and do not require intervention. In addition, obviating performance of this routine chest radiograph following chest tube removal will lead to a substantial decrease in exposure to unnecessary ionizing radiation in children who undergo frequent radiographs and lower medical costs.
A Randomized Controlled Clinical Trial of Transanal Irrigation Versus Conservative Treatment in Patients With Low Anterior Resection Syndrome After Rectal Cancer Surgery
Authors: Pieniowski Emil H.A. , Bergström Charlotta M. , Nordenvall Caroline A.M. , Westberg Karin S. , Johar Asif M. , Tumlin Ekelund Susanne F. , Larsson Kristina R. , Pekkari Klas J. , Jansson Palmer Gabriella C. , Lagergren Pernilla , Abraham-Nordling Mirna 
Published: July 2022

Objective:
The aim of the study was to evaluate transanal irrigation (TAI) as a treatment for low anterior resection syndrome (LARS).

Background:
LARS is a bowel disorder that is common after sphincter preserving rectal cancer surgery. Despite symptomatic medical treatment of LARS many patients still experience bowel symptoms that may have a negative impact on quality of life (QoL). TAI is a treatment strategy, of which the clinical experience is promising but scientific evidence is limited.

Materials and Methods:
A multicenter randomized trial comparing TAI (intervention) with conservative treatment (control) was performed. Inclusion criteria were major LARS, age above 18 years, low anterior resection with anastomosis and a defunctioning stoma as primary surgery, >6 months since stoma reversal, anastomosis without signs of leakage or stricture, and no signs of recurrence at 1-year follow-up. The primary endpoint was differences in bowel function at 12-month follow-up measured by LARS score, Cleveland Clinic Florida Fecal Incontinence Score, and 4 study-specific questions. The secondary outcome was QoL.

Results:
A total of 45 patients were included, 22 in the TAI group and 23 in the control group. Follow-up was available for 16 and 22 patients, respectively. At 12 months, patients in the TAI group reported significantly lower LARS scores (22.9 vs 32.4; P=0.002) and Cleveland Clinic Florida Fecal Incontinence Score (6.4 vs 9.2; P=0.050). In addition, patients in the TAI group also scored significantly higher QoL [8 of 16 European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) QoL aspects] compared with the control group.

Conclusions:
The results confirm our clinical experience that TAI reduces symptoms included in LARS and improves QoL.
Assessing the use of Extended Venous Thromboembolism Prophylaxis on the Rates of Venous Thromboembolism and Postpancreatectomy Hemorrhage Following Pancreatectomy for Malignancy
Authors: Stitzel Henry J. , Hue Jonathan J. , Elshami Mohamedraed , McCaulley Lauren , Hoehn Richard S. , Rothermel Luke D. , Ammori John B. , Hardacre Jeffrey M. , Winter Jordan M. , Ocuin Lee M. 
Published: July 2022

Objective:
To compare rates of venous thromboembolism (VTE) and postpancreatectomy hemorrhage (PPH) in patients with pancreatic or periampullary malignancy preimplementation and postimplementation of routine extended VTE prophylaxis.

Background:
Guidelines recommend up to 28 days of VTE prophylaxis following major abdominal cancer operations. There is a paucity of data examining rates of VTE and PPH in patients who receive extended VTE prophylaxis following pancreatectomy.

Methods:
Single-institution analysis of patients who underwent pancreatectomy for malignancy (2004–2021). VTE and PPH rates within 90 days of discharge were compared based on receipt of extended VTE prophylaxis with enoxaparin.

Results:
A total of 478 patients were included. Twenty-two (4.6%) patients developed a postoperative VTE, 12 (2.5%) of which occurred postdischarge. Twenty-five (5.2%) patients experienced PPH, 13 (2.7%) of which occurred postdischarge. There was no associated difference in the development of postdischarge VTE between patients who received extended VTE prophylaxis and those who did not (2.3% vs 2.8%, P=0.99). There was no associated difference in the rate of postdischarge PPH between patients who received extended VTE prophylaxis and those who did not (3.4% vs 1.9%, P=0.43). In the subset of patients on antiplatelet agents, the addition of enoxaparin did not appear to be associated with higher VTE (3.9 vs. 0%, P=0.31) or PPH (3.0 vs. 4.5%, P=0.64) rates.

Conclusions:
Extended VTE prophylaxis following pancreatectomy for malignancy was not associated with differences in postdischarge VTE and PPH rates. These data suggest extended VTE prophylaxis is safe but may not be necessary for all patients following pancreatectomy.