bluuebunny/crossref_metadata_2025_split huggingface dataset:
Integrated physiological, proteome and gene expression analyses provide new insights into nitrogen remobilization in citrus trees
Authors: Xiong Huaye , Ma Haotian , Zhao Huanyu , Yang Linsheng , Hu Bin , Wang Jie , Shi Xiaojun , Zhang Yueqiang , Rennenberg Heinz 
Published: February 2022

Abstract
Nitrogen (N) remobilization is an important physiological process that supports the growth and development of trees. However, in evergreen broad-leaved tree species, such as citrus, the mechanisms of N remobilization are not completely understood. Therefore, we quantified the potential of N remobilization from senescing leaves of spring shoots to mature leaves of autumn shoots of citrus trees under different soil N availabilities and further explored the underlying N metabolism characteristics by physiological, proteome and gene expression analyses. Citrus exposed to low N had an approximately 38% N remobilization efficiency (NRE), whereas citrus exposed to high N had an NRE efficiency of only 4.8%. Integrated physiological, proteomic and gene expression analyses showed that photosynthesis, N and carbohydrate metabolism interact with N remobilization. The improvement of N metabolism and photosynthesis, the accumulation of proline and arginine, and delayed degradation of storage protein in senescing leaves are the result of sufficient N supply and low N remobilization. Proteome further showed that energy generation proteins and glutamate synthase were hub proteins affecting N remobilization. In addition, N requirement of mature leaves is likely met by soil supply at high N nutrition, thereby resulting in low N remobilization. These results provide insight into N remobilization mechanisms of citrus that are of significance for N fertilizer management in orchards.
Association of Gestational Age With Postpartum Hemorrhage: An International Cohort Study
Authors: Butwick A.J. , Liu C. , Guo N. , Bentley J. , Main E.K. , Mayo J.A. , Shaw G.M. , Stephansson O. 
Published: March 2022

(Anesthesiology. 2021:874–886. doi: 10.1097/ALN:0000000000003730)
Although postpartum hemorrhage is a leading cause of preventable maternal death and morbidity in developed countries, 39% of women in the United States with severe postpartum hemorrhage do not have identified risk factors. All pregnant women are given risk assessment for common reasons of postpartum hemorrhage including preeclampsia, multiple gestations, labor induction, cesarean delivery, and chorioamnionitis. A factor not commonly used on risk assessments is gestational age at delivery. Data collected from previous in vitro studies showed inconsistent and conflicting associations between gestational age and postpartum hemorrhage. Some studies indicated there was a greater risk in women who delivered preterm, while others indicated postterm delivery posed the greatest risk. Differences in reporting methods between countries may also contribute to a lack of consistent data to show a strong relationship between gestational age and postpartum hemorrhage. The aim of this study was to assess and compare the association of gestational age and postpartum hemorrhage in the United States and Sweden.
General Anesthetic and Airway Management Practice for Obstetric Surgery in England: A Prospective, Multicenter Observational Study
Authors: Odor P.M. , Bampoe S. , Moonesinghe S.R. , Andrade J. , Pandit J.J. , Lucas D.N. ,   Pan-London Perioperative Audit and Research Network (PLAN), for the DREAMY Investigators Group
Published: March 2022

(Anaesthesia. 2021;76:460–471)
The use of general anesthesia (GA) in obstetrics is typically avoided due to concerns of increased risks, but is sometimes unavoidable. Accidental awareness during GA (AAGA) has been previously investigated by the Royal College of Anaesthetists and the Association of Anaesthetists in 2013. This study, the direct reporting of awareness in maternity patients (DREAMY) study aimed to determine the incidence, risk factors, and sequelae of AAGA. A secondary study within DREAMY sought to describe the provision of GA, including drugs and management techniques used in the United Kingdom.
Validation of a Bioabsorbable Device that Seals Perforations After Tuohy Needle Dural Puncture in an Ovine Model
Authors: García-Vitoria C. , García-Roselló M. , Reina M.A. , De Andres J. , Gutiérrez-Bautista Á.J. , Esteve V. , Boezaart A. , Redondo J.I. 
Published: March 2022

(Reg Anesth Pain Med. 2021;46:389–396. doi: 10.1136/rapm-2020-102225. Epub January 27, 2021)
Cerebrospinal fluid (CSF) leak can lead to postdural puncture headaches (PDPH) and other adverse outcomes following an accidental dural puncture (ADP). The current “gold standard” treatment is an epidural blood patch, optimally performed at least 48 hours following ADP. No current therapy has yet been shown to prevent the onset of PDPH when applied prophylactically, immediately following an ADP. To address this, the authors designed a bioabsorbable device, in the form of a physical patch, which is inserted via the Tuohy needle immediately following an ADP, to seal the dural hole preventing further CSF leakage. The device consists of a patch which unfolds inside the subarachnoid space. A thread passes from the device, through the dural hole, ligamentum flavum, interspinous and supraspinous ligaments and into the subcutaneous tissues. By means of unidirectional barbs along the thread, traction is provided to hold the patch against the dura. The device is contained inside a flexometallic cannula, which is advanced through the Tuohy needle via an applicator, and introduces the device into the subarachnoid space. After placement, the flexometallic cannula, applicator, and epidural needle are removed in order, leaving only the patch and barbed thread in situ. The aim of this study was to determine the efficacy of the new device.
The Society for Obstetric Anesthesia and Perinatology Coronavirus Disease 2019 Registry: An Analysis of Outcomes Among Pregnant Women Delivering During the Initial Severe Acute Respiratory Syndrome Coronavirus-2 Outbreak in the United States
Authors: Katz D. , Bateman B.T. , Kjaer K. , Turner D.P. , Spence N.Z. , Habib A.S. , George R.B. , Toledano R.D. , Grant G. , Madden H.E. , Butwick A.J. , Lynde G. , Minehart R.D. , Beilin Y. , Houle T.T. , Sharpe E.E. , Kodali B. , Bharadwaj S. , Farber M.K. , Palanisamy A. , Prabhu M. , Gonzales N.Y. , Landau R. , Leffert L. 
Published: March 2022

(Anesth Analg. 2021;133:462–473. doi: 10.1213/ANE.0000000000005592)
From the beginning of the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) outbreak to January 17, 2021, there was an interest concerning and growing research on pregnancy and SARS-CoV-2, but little data had been gathered and analyzed comparing obstetric patients with and without the virus with regards to anesthetic management. The Society for Obstetric Anesthesia and Perinatology (SOAP) coronavirus disease 2019 (COVID-19) registry was made primarily to better understand anesthetic management and obstetric outcomes in women with and without SARS-CoV-2 during hospital delivery at widespread-testing institutions.
Quality of Life After Maternal Near Miss: A Systematic Review
Authors: von Rosen I.E.W. , Shiekh R.M. , Mchome B. , Chunsen W. , Khan K.S. , Rasch V , Linde D.S. 
Published: March 2022

(Acta Obstet Gynecol Scand. 2021;100:704–714)
Annually, ~7 million women worldwide experience a maternal near miss (MNM), defined by the World Health Organization as nearly dying but surviving a complication in pregnancy, childbirth or within 42 days postpartum. A MNM can affect a patient’s health in a number of ways, but the extent of the impact on a woman’s quality of life is unclear. Previous systematic reviews on MNM and quality of life have not addressed the entire definition of QoL, but rather individual components. This systematic review aims to explore the association between MNM and overall QoL.
Predicting Vaginal Birth After Previous Cesarean: Using Machine-learning Models and a Population-based Cohort in Sweden
Authors: Lindblad Wollmann C. , Hart K.D. , Liu C. , Caughey A.B. , Stephansson O. , Snowden J.M. 
Published: March 2022

(Acta Obstet Gynecol Scand. 2021;100:513–520. doi: 10.1111/aogs.14020. Epub October 31, 2020)
There are risks and benefits to choosing a trial of labor after cesarean (TOLAC) or a repeat cesarean delivery (CD). When TOLAC is successful (international success rate is 40% to 80%) and the patient has a vaginal birth (VD) after cesarean (VBAC), a benefit is decreased epidemic CD rate and decreased risk for repeat CD maternal morbidity. However risks of TOLAC include unplanned repeat CD, uterine rupture, and greater likelihood of maternal and neonatal adverse outcomes. Due to these tradeoffs, it is important to make accurate predictions regarding potential TOLAC success, thus leading to improved clinical counseling, and outcomes for women. This study aims to evaluate individualized predictions using machine-learning models for TOLAC for women with no previous VD and only one previous CD. It also aims to compare machine-learning methods with established regression prediction models.
Association of Peripartum Management and High Maternal Blood Loss at Cesarean Delivery for Placenta Accreta Spectrum (PAS): A Multinational Database Study
Authors: Schwickert A. , van Beekhuizen H.J. , Bertholdt C. , Fox K.A. , Kayem G. , Morel O. , Rijken M.J. , Stefanovic V. , Strindfors G. , Weichert A. , Weizsaecker K. , Braun T. ,   International Society for Placenta Accreta Spectrum (IS-PAS)
Published: March 2022

(Acta Obstet Gynecol Scand. 2021;100(suppl 1):29–40. doi: 10.1111/aogs.14103. Epub February 21, 2020)
Though there has been a global decline in maternal mortality rates, the cesarean delivery (CD) rate continues to rise, resulting in an increase of placenta accreta spectrum (PAS). PAS is associated with postpartum hemorrhage (PPH) and cesarean hysterectomy, severely impacting maternal morbidity and mortality. PAS pregnancy and delivery management vary greatly between institutions. This study investigates which management and epidemiologic factors correspond with maternal outcomes, specifically high and extraordinarily high maternal blood loss during CD when PAS is present.
REGIONAL ANESTHESIA Ultrasound Increases the Success Rate of Spinal Needle Placement through the Epidural Needle During Combined Spinal-epidural Anesthesia
Authors: Tao B. , Liu K. , Ding M. , Xue H. , Li X. , Zhao P. 
Published: March 2022

(Eur J Anaesthesiol. 2021;38:251–258. doi: 10.1097/EJA.0000000000001380)
Successful combined spinal-epidural anesthesia (CSEA) during cesarean section is important, and ultrasound-assisted placement may improve patient safety and satisfaction compared with placement using anatomic landmark palpation. This study specifically investigates whether ultrasound imaging before CSEA increases the first-pass success rate for spinal needle placement through the epidural needle.
Preferred Instructional Methods of Millennial Nursing Students
Authors: McAtee Brooke 
Published: March 2022

Abstract
The continuing nursing shortage requires nurse educators to understand how students best learn to maximize student success and retention. Millennial generation students in a midwestern community college associate degree in nursing program were interviewed to determine which instructional methods they identified as aiding learning and which were possible barriers to their education. It was found that lectures and interactive questions enhanced student learning, and group work was the least effective learning strategy. This study concluded that millennial students learn best when mixed instructional methods use active and passive strategies.
Regular Kratom (Mitragyna speciosa Korth.) Use and Its Association With Endoplasmic Reticulum Stress Response
Authors: Fauzi Nurul Atiqahd Muhamad , Tan Mei Lan , Hamid Shahrul Bariyah Sahul , Singh Darshan , Abdullah Mohammad Farris Iman Leong Bin 
Published: February 2022

Objectives
This study determined the association between expression of the endoplasmic reticulum (ER) stress sensor mRNA in the peripheral leukocytes and the patterns of kratom use and evaluated the correlations between the levels of the ER stress sensor mRNA and the severity of kratom dependence and kratom induced depressive symptoms among people who use kratom (PWUK).

Methods
A total of 20 PWUK and 20 age matched non-kratom using healthy controls were recruited. Data collected from PWUK included patterns of kratom use, severity of kratom dependence, and severity of depressive symptoms during abstinence from kratom. The mRNA expression of binding immunoglobulin protein (BiP), X-box binding protein 1, activating transcription factor 4, and C/-EBP homologous protein (CHOP) (major indicators of ER stress response) were analyzed using quantitative reverse transcription polymerase chain reaction in leucocyte-derived total RNA sample of the participants.

Results
PWUK regardless of their pattern of kratom use recorded significantly higher expression of BiP mRNA compared with controls. Expression of CHOP mRNA was only significantly higher in those who first consumed kratom at the age of 18 years and above and those who have been using kratom for longer than 6 years, compared with controls. Higher expression of BiP, ATF4, and CHOP mRNA were significantly positive correlated with greater severity of kratom dependence. Although only higher expression of BiP and CHOP mRNA were significantly positively correlated with greater severity of depressive symptoms.

Conclusions
Regular kratom consumption may activate the ER stress pathway and there may be a link between altered ER stress response and kratom dependence and kratom induced depressive symptoms.
Prevalence of Somatosensory Tinnitus in Veterans With Tinnitus
Authors: Theodoroff Sarah M. , McMillan Garnett P. , Frederick Melissa T. , Random Chan , Thielman Emily , Vergis Shiny , Cherian Kay , Cherian Neil 
Published: March 2022

Objectives:
The primary objective was to estimate the prevalence of somatosensory tinnitus (ST) among Veterans with tinnitus.

Design:
Three hundred four Veterans with tinnitus were phone screened for ST by performing and reporting on a series of head/neck/jaw maneuvers. A random sample of 12 individuals who screened positive and five who screened negative attended an in-person visit to confirm the presence/absence of ST.

Results:
Of the 304 Veterans, 12 could not complete the screening maneuvers, 205 screened positive, and 87 screened negative. A Bayesian estimator that combines phone screening and in-person exam results establishes the prevalence of ST among Veterans with tinnitus at 56% with a 90% Bayesian confidence interval of 45% to 65%.

Conclusions:
At least half of Veterans with tinnitus have ST, suggesting that a sizable at-need population exists. Treatment addressing the biomechanical component has the potential to improve tinnitus symptoms.
Efficacy of automated electronic medical records (EMR) notification to promote provider intervention for severe depression: a retrospective record review
Authors: McKelvey Karma , Lindsey Caryn , Castro Marco , Vrahas Mark 
Published: February 2022

Background:
Depressive symptoms as measured by the Patient-Reported Outcomes Measurement Information System (PROMIS) Depression (D; PROMIS-D) score is a patient-specific independent predictor of decreased improvement after orthopaedic surgery. Despite evidence that depression predicts worse surgical outcomes, data show orthopaedic surgeons rarely address mental health with their patients.

Methods:
The authors conducted a retrospective chart review of all patient visit data from October 1, 2018 through December 31, 2020, at Cedars-Sinai Orthopaedic Center outpatient clinics to determine if a best practices alert built into the electronic medical record (EMR) notifying surgeons of their patients who had PROMIS-D scores of 70+ (severe depression) would be impetus enough for providers to intervene. Records with PROMIS-D scores of 70+ (N=361) were selected and reviewed; the authors examined how often the surgeons documented an action in the record in response to the depression notification.

Results:
Surgeons were found to take action in only 28.5% (N=103) of the visits with qualifying scores.

Conclusions:
Notification of patient depression status alone was insufficient to persuade most surgeons to discuss mental health with their severely depressed patients. To empower surgeons to have these important conversations, extant barriers need to be identified and addressed. The association with rates of intervention and individual-level factors of both patients and providers could be explored.

Level of Evidence:
Level IV.
Short-term radiographic outcome of varus osteotomy in the treatment of Legg-Calvé-Perthes disease: a retrospective case series study
Authors: Ghaznavi Alireza , Motaghi Paniz , Ghaderi Mohammad Taher , Sileymani Naseh , Saberi Saba , Mohammadpour Mehdi 
Published: February 2022

Background:
Varus osteotomy is a popular method for the operative treatment of Legg-Calvé-Perthes disease (LCPD). In this study, the authors aimed to evaluate the radiographic outcomes of varus osteotomy and its association with the extent of hip involvement.

Methods:
Twenty-one patients in early stages of disease (stage I and II of LCPD, according to the modified Elizabethtown classification) who were treated with varus osteotomy were studied. The radiographic outcome measures were Caput Index and epiphyseal quotient (EQ) that were assessed before the surgery and 2 yr postoperatively. The level of hip involvement was determined by the modified lateral pillar classification.

Results:
The mean Caput index of the patients improved from 55.5±12.7 to 74±13.4 (P<0.001). The mean EQ of the patients improved from 47.2±12.9% to 67.8±17.1% (P<0.001). According to the EQs, the radiographic outcomes were found to be good, fair, and poor in 16 (76.1%) patients, 4 (19.1%) patients, and 1 (4.8%) patient, respectively. The mean change of Caput Index and EQ was significantly more in the B/C lateral pillar group than C lateral pillar group (P=0.04 and P=0.02, respectively).

Conclusions:
Varus osteotomy could be recommended as an effective surgical treatment for LCPD. The level of hip involvement at presentation could be used as independent factors of surgical prognosis.

Level of Evidence:
Level III.
Outpatient Opioid Prescribing Habits in Pediatric Patients With Bone Sarcomas After Undergoing Primary Tumor Resection
Authors: Ramos Omar , Mierke Alex , Filler Ryan , Williams Nadine L. , Femino Joseph D. , Zuckerman Lee M. 
Published: February 2022

Background:
The majority of children with bone sarcomas experience pain. Opioids remain the mainstay treatment of cancer-related pain in children. The patterns of outpatient opioid prescription after surgery for primary bone sarcomas remains unknown. The purpose of this study is to evaluate the patterns of outpatient opioid prescription in patients with bone sarcomas after resection of the primary tumor, and to assess for factors that may lead to increased opioid dosing in these patients.

Methods:
A retrospective chart review of 28 patients with bone sarcomas undergoing primary tumor resection was performed. Demographic, medical, surgical, and pharmacological data was collected from all patients. The total morphine milligram equivalents (MMEs) prescribed after patient discharge were compared at 30-day intervals. The MMEs were then stratified by tumor location, presence of metastasis at time of surgery, and preoperative opioid use. Independent predictors of increased 30-day and total 120-day opioid utilization were evaluated.

Results:
Patients with preoperative opioid use were prescribed significantly more opioids in every 30-day postoperative interval and for the 120-day total. When stratified by tumor location, patients with primary tumors in the pelvis had significantly greater postoperative opioid utilization when compared with patients with tumors located in the lower and upper extremities during postoperative days 61 to 90 (5970 vs. 1060.4 and 0 MMEs, respectively, P=0.048) and during postoperative days 91 to 120 (6450 vs. 829.6 and 0 MMEs, respectively, P=0.015). Older age, diagnosis of osteosarcoma, increased length of stay postoperatively and presence of metastases were associated with a higher 30-day postoperative opioid utilization.

Conclusion:
Multiple factors were associated with increased opioid use including preoperative opioid use, longer postoperative stay in the hospital, metastatic disease, and primary sarcomas in the pelvis. The patient’s sex, body mass index, race, type of insurance, type of surgery performed, reoperation during the same admission and use of nonopioid adjuvants had no effect on opioid use. The results of this study can be used to stratify the average opioid requirement of pediatric patients undergoing primary bone sarcoma resection.

Level of Evidence:
Level IV.
Validation of a Novel Magnetic Resonance Imaging Classification for Osteochondritis Dissecans of the Knee
Authors: Feroe Aliya G. , Flaugh Rachel A. , Majumdar Aditi , Baxter Tara A. , Miller Patricia E. , Kocher Mininder S. 
Published: February 2022

Background:
The novel Kocher classification is a 3-group magnetic resonance imaging (MRI) classification system for osteochondritis dissecans (OCD) of the knee that was shown to have comparable reliability to that of the established 5-group Hefti classification. The purpose of this study was to evaluate the validity and clinical utility of this simplified system as an alternative to the Hefti classification.

Methods:
Demographic data and arthroscopic findings were retrospectively collected from medical and surgical records of 144 consecutive knees in children with arthroscopically diagnosed knee OCD. OCD lesions on preoperative MRIs and surgical reports (serving as the reference standard) were assessed by independent raters and assigned both a Kocher and Hefti classification. Agreement between MRI classification and arthroscopic findings for both systems was assessed using weighted kappa (k

w
) coefficients. Validation, accuracy, sensitivity, and specificity were measured by comparing a dichotomized Kocher classification for MRI and arthroscopy, and by estimating Cohen kappa (k

c
) coefficients. Agreement between arthroscopic findings and treatment type was measured using the Spearman correlation coefficient.

Results:
Inter-rater reliability between the 2 MRI raters was substantial for the Kocher classification [k

a
=0.66; 95% confidence interval (CI)=0.56-0.75] and moderate for the Hefti classification (k

a
=0.57; 95% CI=0.47-0.67). There was no difference detected in the agreement statistics for Kocher versus Hefti classifications (P=0.89). Binary agreement using dichotomized Kocher classifications was worse than the 3-group category classification. When dichotomized, combining Kocher grades 1 and 2 demonstrated moderate agreement (k

c
=0.41; 95% CI=0.25-0.58), and combining grades 2 and 3 demonstrated fair agreement (k

c
=0.34; 95% CI=0.21-0.48). There was a strong correlation between arthroscopy-based finding and treatment category for both the Kocher classification (r=0.85; 95% CI=0.80-0.89) and the Hefti classification (r=0.82; 95% CI=0.75-0.86).

Conclusion:
The validity and clinical utility of the newer 3-group Kocher classification for knee OCD is comparable to that of the well-established 5-group Hefti classification. Both systems help determine lesion stability and characteristics on MRI, which correlate closely to arthroscopic findings. This simplified classification system, with less uncertainty, provides a foundation for further outcomes research to develop an evidence-based algorithm for effective surgical management of OCD lesions of the knee.

Level of Evidence:
Level II—diagnostic study.