bluuebunny/crossref_metadata_2025 huggingface dataset:
Application of a Z-Shaped Umbilical Incision and a Saline-Cooled Radiofrequency Device to Single-Incision Laparoscopic Surgery for a Huge Liver Cyst: Report of a Case
Authors: Igami Tsuyoshi , Tsuchiya Tomonori , Ebata Tomoki , Yokoyama Yukihiro , Sugawara Gen , Mizuno Takashi , Nagino Masato
Published: September 2015

When compared with other diseases, few authors have reported on single-incision laparoscopic surgery (SILS) for liver cysts. We herein describe our experience with SILS for a huge liver cyst with the application of an umbilical Z-shaped incision using a gel port and a high-density monopolar saline-cooled radiofrequency device with a successful outcome. An 80-old-year woman was diagnosed with a huge liver cyst with abdominal pain. She underwent percutaneous drainage of the liver cyst and injection of both absolute ethanol and an antimicrobial agent into the liver cyst at the previous hospital. Because of re-expansion of the liver cyst and symptom recurrence, we performed SILS for the liver cyst. An umbilical Z-shaped incision was made for gel port placement. After aspiration of the cystic fluid and dissection of the thin cystic wall by laparoscopic coagulating shears, the thick cystic wall was divided using an endoscopic linear stapler to avoid bleeding and bile leakage. After wide fenestration, a high-density monopolar saline-cooled radiofrequency device was applied for the ablation of the remnant membrane of the cystic wall. All maneuvers could be performed only through the gel port. The patient was discharged 4 days after surgery and was satisfied with the cosmetic results. This case shows that the application of an umbilical Z-shaped incision using a gel port and a high-density monopolar saline-cooled radiofrequency device is useful for the accomplishment of SILS for a huge liver cyst.
Skeletonization and Isolation of the Glissonean and Venous Branches in Liver Surgery With an Ultrasonic Scalpel Technology
Authors: Aoki Takeshi , Murakami Masahiko , Koizumi Tomotake , Enami Yuta , Koike Reiko , Fujimori Akira , Kusano Tomokazu , Matsuda Kazuhiro , Yamada Kosuke , Nogaki Koji , Watanabe Makoto , Otsuka Koji , Gareer Haytham , Kato Takashi
Published: September 2015

This study describes a novel technique for skeletonization and isolation of Glissonean and venous branches during liver surgery using a harmonic scalpel (HS). Hepatic resections with HS were performed with the skeletonization and isolation technique in 50 patients (HS group). Variables evaluated were blood loss, operative time, biliary leak, and morbidity. The results were compared with 50 hepatic resections that were performed using a previously established technique: Cavitron ultrasonic surgical aspirator with electric cautery, ligatures, and hemoclips (NHS group). The HS group had shorter total operative times (285 versus 358 minutes; P = 0.01), less blood loss (389 versus 871 mL; P = 0.034), and less crystalloid infusion (2744 versus 3299 mL; P = 0.027) compared with the NHS group. Postoperative liver function and complication rates were similar when comparing the two groups. These data demonstrate that HS is a simple, easy, and effective instrument for the skeletonization and isolation of vessels during liver transection.
Palliation With Endoscopic Metal Stents May Be Preferable to Surgical Intervention for Patients With Obstructive Pancreatic Head Adenocarcinoma
Authors: Kofokotsios Alexandros , Papazisis Konstantinos , Andronikidis Ioannis , Ntinas Achilleas , Kardassis Dimitrios , Vrochides Dionisios
Published: September 2015

The aim of this study was to evaluate the efficacy of endoscopically placed metal stents in comparison with operative procedures, in patients with obstructive pancreatic head cancer. Endoscopic stenting techniques and materials for gastrointestinal malignancies are constantly improving. Despite this evolution, many still consider operative procedures to be the gold standard for palliation in patients with unresectable obstructive pancreatic head cancer. This is a retrospective study of 52 patients who were diagnosed with obstructive (biliary, duodenal, or both) adenocarcinoma of the pancreatic head. Twenty-nine patients (endoscopy group) underwent endoscopic stenting. Eleven patients (bypass group) underwent biliodigestive bypass. Twelve patients (Whipple group) underwent Whipple operation with curative intent; however, histopathology revealed R1 resection (palliative Whipple). T4 disease was identified in 13 (44.8%), 7 (63.6%), and 3 (25%) patients in the endoscopy, bypass, and Whipple groups, respectively. Metastatic disease was present only in the endoscopy group (n = 12; 41.3%). There was no intervention-related mortality. Median survival was 280 days [95% confidence interval (95% CI), 103, 456 days], 157 days (95% CI, 0, 411 days), and 647 days (95% CI, 300, 993 days) for the endoscopy, bypass, and Whipple groups, respectively (P = 0.111). In patients with obstructive pancreatic head cancer, endoscopic stenting may offer equally good palliation compared with surgical double bypass. The numerically (not statistically) better survival after palliative Whipple might be explained by the smaller tumor burden in this subgroup of patients and not by the superior efficacy of this operation.
Three-Dimensional Laparoscopic Sleeve Gastrectomy: Improved Patient Safety and Surgeon Convenience
Authors: Martínez-Ubieto Fernando , Jiménez-Bernadó Teresa , Martínez-Ubieto Javier , Cabrerizo Antonio , Pascual-Bellosta Ana , Muñoz-Rodriguez Luis , Jiménez-Bernadó Alfredo
Published: September 2015

One of the aims of laparoscopic surgery is to improve upon the results obtained by open surgery. This clearly appears to have been achieved in bariatric surgery. Two-dimensional (2-D) systems have been used to date, though new 3-dimensional (3-D) technologies have been introduced in an attempt to improve surgeon vision and thus increase the safety of the surgical techniques. Sixty obese patients underwent sleeve gastrectomy using a device equipped with 3-D optics allowing surgery to be viewed by the surgeon in 3 dimensions by using a specific monitor and wearing appropriate glasses. The mean patient age was 48.1 years. The mean weight was 114 kg (range, 92–172), with a mean body mass index (BMI) of 44 ± 5.21 kg/m2. All surgeries were performed using the 3-D system, with a mean surgical time of 71 ± 49.6 minutes and a mean hospital stay of 3.0 ± 1.2 days. Only 1 intraoperative complication was recorded: retroperitoneal bleeding on insertion of the optical trocar. Over a mean follow-up period of 12 months, the mean body weight of the patients was 88 kg (range, 71–121), with a BMI of 30.56 ± 3.98 kg/m2 and a percentage excess weight loss of 68.14% ± 7.89%. There was clear improvement of both the blood pressure and glucose levels. Three-dimensional sleeve gastrectomy is safe, viable, and fully reproducible compared with 2-D surgery, improving visualization of the surgical field, safety, and surgeon convenience. Randomized studies involving larger patient samples are needed for the comparison of results.
Effect of Intraoperative Valsalva Maneuver Application on Bleeding Point Detection and Postoperative Drainage After Thyroidectomy Surgeries
Authors: Tokaç Mehmet , Dumlu Ersin Gürkan , Bozkurt Birkan , Öcal Haydar , Aydın Cevdet , Yalçın Abdussamed , Çakır Bekir , Kılıç Mehmet
Published: September 2015

The purpose of this paper was to analyze the effect of Valsalva maneuver application before finalizing thyroidectomy operations on the identification of bleeding points and postoperational drainage. One hundred patients (age range, 24–76 years) with multinodular goiter, recurrent multinodular goiter, toxic diffuse multinodular goiter, or papillary thyroid cancer were included in the study and were divided into 2 groups of 50 randomly. Both groups underwent thyroidectomy operation, only 1 group received intraoperative Valsalva maneuver application (twice, 30 seconds of 30-cm PEEP). The size of the thyroid gland, the duration of operation, hospital stay, and drain usage were reported. Postoperational occurrences of drainage, hematoma, reoperation, and additional complications were compared between the groups. Valsalva maneuver application helped to identify minor bleeding points in 32% of the cases. There was no significant difference between the study groups regarding the thyroid gland size, operation duration, hospital stay, and the duration of drain usage (P > 0.05 for all). The amount of drainage as well as the frequencies of hematoma, reoperation, and further complications was not significantly different between the study groups (P > 0.05 for all). Intraoperative application of Valsalva maneuver is only useful to detect minor bleeding points in some patients during thyroidectomy operations, but it had no effect on the duration of postoperative drain usage, the amount of drainage, and risk of hematoma. Therefore, intraoperative application of Valsalva maneuver has no beneficial effect on postoperative hemorrhagic complication after thyroidectomy operations.
Correlation between Poynting flux and soft electron precipitation in the dayside polar cap boundary regions
Authors: Deng Yue , Sheng Cheng , Su Yi‐Jiun , Hairston Marc R. , Knipp Delores , Huang Cheryl Y. , Ober Daniel , Redmon Rob J. , Coley Robin
Published: September 2015

Observations have revealed large Poynting flux and soft electron precipitation around the cusp region, which have strong impacts on the polar ionosphere/thermosphere. Simulations also confirmed that Poynting flux and soft electron precipitation significantly change the neutral density and dynamics around the dayside polar cap boundary regions. However, no detailed study has been conducted to show if they should coincide with each other or not. Our analysis of Defense Meteorological Satellite Program (DMSP) satellite data reveals a complex correlation between them. Poynting flux and soft particle precipitation are coincident in some cases (match cases), but a clear displacement between them can also be identified in others (nonmatch cases). In the 29 cusp crossings from F13 we investigated, the ratio between nonmatch and match cases is close to 1:4. In nonmatch cases, the displacement between the Poynting flux enhancement and soft particle precipitation enhancement can be as large as 1° in geomagnetic latitude.
Study of equatorial E region irregularities using rare daytime VHF scintillation observations
Authors: Yadav V. , Kakad B. , Pant T. K. , Bhattacharyya A. , Prasad D. S. V. V. D.
Published: September 2015

Scintillations on VHF radio signal are sparsely observed during daytime due to unavailability of strong electron density irregularities in equatorial E or F region. Type I/II irregularities observed at E region altitudes during the daytime are linked with either two‐stream or gradient drift instability. The occurrence of these irregularities in presence of strong blanketing Es (Esb) can produce weak‐moderate scintillations on VHF signal during daytime. Such sparse daytime VHF scintillations are used in the present study to retrieve information about E region irregularities, which are generally examined with radar observations. We use spaced receiver scintillation observations on 251 MHz signal transmitted from geostationary satellite UFO2 (71.2°E) and recorded at Tirunelveli (8.5°N, 77.8°E, dip latitude 0.6°N). Ionosonde data from Trivandrum (8.5°N, 76.6°E, dip latitude 0.5°N) during 2003–2005 is used to confirm the association of daytime scintillations with Esb. The daytime scintillations last for 15–45 min during postnoon hours. Their occurrence closely matches the peak occurrence time of Esb. For the first time, spatial scale lengths of E region irregularities are obtained using the technique introduced by Bhattacharyya et al. (2003). The observed spatial scales are validated using theoretical model. The theoretical model manifests 6–19% density fluctuations in the E region to produce weak scintillations (0.15 ≤S4≤ 0.4) on 251 MHz. The study reveals that scale lengths of E region irregularities are smaller on counter equatorial electrojet (CEEJ) days than non‐CEEJ days, which could be resulting from lower electron temperatures in E region on CEEJ days.
Auroral spirals at Saturn
Authors: Radioti A. , Grodent D. , Gérard J.‐C. , Roussos E. , Mitchell D. , Bonfond B. , Pryor W.
Published: September 2015

We report observations of auroral spirals at Saturn propagating from midnight to noon via dawn, based on Cassini/UVIS measurements. The aurora during that sequence is observed for the first time to consist of detached features swirling as they propagate from dawn to early afternoon. The features have a diameter of ∼6000 km in the ionosphere, which would correspond to 12 to 15 RS wide plasma regions in the magnetosphere. Simultaneous ENA enhancements are observed; however, they do not show a clear spiral form. We estimate the velocity of the UV auroral features to decrease from 85% of rigid corotation (28°/h) near the equatorward edge to 68% of rigid corotation (22°/h) in the poleward edge. We discuss two possible scenarios which could explain the generation of the auroral spirals. First, we suggest that the auroral spirals could be related to large dynamic hot populations which create regions with strong velocity gradients. Alternatively, a less possible theory could be that the auroral spirals are related to field line deformation from the magnetosphere to the ionosphere, similar to the scenario proposed to explain auroral spirals at Earth. Such field line twist can happen for a configuration where the magnetospheric source region is located between a pair of plasma flow vortices.
Statistical characterization of the growth and spatial scales of the substorm onset arc
Authors: Kalmoni N. M. E. , Rae I. J. , Watt C. E. J. , Murphy K. R. , Forsyth C. , Owen C. J.
Published: September 2015

We present the first multievent study of the spatial and temporal structuring of the aurora to provide statistical evidence of the near‐Earth plasma instability which causes the substorm onset arc. Using data from ground‐based auroral imagers, we study repeatable signatures of along‐arc auroral beads, which are thought to represent the ionospheric projection of magnetospheric instability in the near‐Earth plasma sheet. We show that the growth and spatial scales of these wave‐like fluctuations are similar across multiple events, indicating that each sudden auroral brightening has a common explanation. We find statistically that growth rates for auroral beads peak at low wave number with the most unstable spatial scales mapping to an azimuthal wavelength λ≈ 1700–2500 km in the equatorial magnetosphere at around 9–12 RE. We compare growth rates and spatial scales with a range of theoretical predictions of magnetotail instabilities, including the Cross‐Field Current Instability and the Shear Flow Ballooning Instability. We conclude that, although the Cross‐Field Current instability can generate similar magnitude of growth rates, the range of unstable wave numbers indicates that the Shear Flow Ballooning Instability is the most likely explanation for our observations.
Dust storm and electron density in the equatorial D region ionosphere of Mars: Comparison with Earth's ionosphere from rocket measurements in Brazil
Authors: Haider S. A. , Batista I. S. , Abdu M. A. , Muralikrishna P. , Shah Siddhi Y. , Kuroda T.
Published: September 2015

We report the first model result for the dust densities and electron densities in the D region ionosphere of Mars for aerosol particles of different sizes during a major dust storm that occurred in Martian Year (MY) 25 at low latitude. These calculations are made at latitude 10°S and solar longitudes (Ls) = 200°, 220°, 250°, and 280° for high, medium, low, and absence of dust storms, respectively. Four corresponding dust layers were found at 50 km, 50 km, 38 km, and 25 km during these events. During high dust storm period, the optical depth and dust density increased by a factor of ~20 from its normal condition. The electron densities estimated for the D region ionosphere of Mars for submicron sized dust particles are largest as compared to that estimated for larger particles. The electron density reduced by ~2 orders of magnitude during high dust storm. The estimated electron density in the clear atmosphere of Mars is compared with measurements of Earth's ionosphere at nearly the same geophysical condition.
Thermal electron acceleration by electric field spikes in the outer radiation belt: Generation of field‐aligned pitch angle distributions
Authors: Vasko I. Y. , Agapitov O. V. , Mozer F. S. , Artemyev A. V.
Published: September 2015

Van Allen Probes observations in the outer radiation belt have demonstrated an abundance of electrostatic electron‐acoustic double layers (DL). DLs are frequently accompanied by field‐aligned (bidirectional) pitch angle distributions (PAD) of electrons with energies from hundred eVs up to several keV. We perform numerical simulations of the DL interaction with thermal electrons making use of the test particle approach. DL parameters assumed in the simulations are adopted from observations. We show that DLs accelerate thermal electrons parallel to the magnetic field via the electrostatic Fermi mechanism, i.e., due to reflections from DL potential humps. The electron energy gain is larger for larger DL scalar potential amplitudes and higher propagation velocities. In addition to the Fermi mechanism, electrons can be trapped by DLs in their generation region and accelerated due to transport to higher latitudes. Both mechanisms result in formation of field‐aligned PADs for electrons with energies comparable to those found in observations. The Fermi mechanism provides field‐aligned PADs for <1 keV electrons, while the trapping mechanism extends field‐aligned PADs to higher‐energy electrons. It is shown that the Fermi mechanism can result in scattering into the loss cone of up to several tenths of percent of electrons with flux peaking at energies up to several hundred eVs.
Plasma sheet Pi2 pulsations associated with bursty bulk flows
Authors: Xing Xiaoyan , Wang Chih‐Ping , Liang Jun , Lyons Larry R.
Published: September 2015

There is a debate as to whether magnetic Pi2 pulsations (0.006–0.025 Hz) observed in the plasma sheet and on the ground are triggered by the earthward moving bursty bulk flows (BBFs) from midtail or distant tail or are caused by the substorm plasma instabilities initiated in the near‐Earth plasma sheet. To resolve this debate, we conducted case and statistical studies of enhanced plasma sheet Pi2 pulsations using Time History of Events and Macroscale Interactions during Substorms (THEMIS) observations from X~−30 RE to X~−8 RE. The case studies show that for both substorm‐related and quiet time BBFs, enhanced Pi2 oscillations are observed in front of BBFs from midtail to the near‐Earth plasma sheet. The oscillations intensify 1–4 min prior to the substantial flow enhancement, and usually initiate within several narrow discrete frequency bands, with lower frequencies intensifying earlier. We further examined the wave properties using low‐frequency MHD fitting method and found that one or more discrete waves for each event are magnetosonic waves. Our statistical study of 364 BBFs shows that Pi2 pulsations are commonly associated with BBFs throughout the plasma sheet. The lowest‐frequency oscillations usually appear below 0.01 Hz, and the strongest power oscillations appear at ~0.01 Hz or higher frequencies. We found that over 75% of the discrete oscillations are magnetosonic waves, and that 70%–75% of them are slow mode. These suggest that plasma sheet Pi2 pulsations are likely triggered by BBFs in the entire plasma sheet regardless of substorm onsets.
Power line harmonic radiation observed by the DEMETER spacecraft at 50/60 Hz and low harmonics
Authors: Němec F. , Parrot M. , Santolík O.
Published: September 2015

We present a low‐altitude satellite survey of Power Line Harmonic Radiation (PLHR), i.e., electromagnetic waves radiated by electric power systems on the ground. We focus on frequencies corresponding to the first few harmonics of the base power system frequencies (50 Hz or 60 Hz, depending on the region). It is shown that the intensities of electromagnetic waves detected at these frequencies at an altitude of about 700 km are significantly enhanced above industrialized areas. The frequencies at which the wave intensities are increased are in excellent agreement with base power system frequencies just below the satellite location. We also investigate a possible presence of the weekend effect, i.e., if the situation is different during the weekends when the power consumption is lower than during the weekdays. Such an effect might be possibly present in the European region, but it is very weak. PLHR effects are less often detected in the summer, as the ionospheric absorption increases, and also, the radiation is obscured by lightning generated emissions. This difference is smaller in the U.S. region, in agreement with the monthly variations of the power consumption. The analysis of the measured frequency spectra reveals that although intensity increases at low odd harmonics of base power system frequencies are routinely detected, low even harmonics are generally absent. Finally, we verify the relation of PLHR intensities to the geomagnetically induced currents (GICs) proxy. It is shown that the PLHR intensity is increased at the times of higher GIC proxy values during the night.
Association of Lupus Anticoagulant With Long‐Term Damage Accrual in Antineutrophil Cytoplasmic Antibody–Associated Vasculitis
Authors: Jordan Natasha , D'cruz David P.
Published: September 2015

Objective

Antiphospholipid antibodies (aPL) are frequently present in antineutrophil cytoplasmic antibody–associated vasculitis (AAV) patients; however, the prognostic impact of aPL in such patients has not been elucidated. The objective of this study was to determine whether persistent aPL positivity in AAV patients was associated with increased long‐term damage accrual.

Methods

Clinical data were retrospectively collected on all AAV patients who attended the vasculitis clinic at our center over a 4‐year period. Data collection included presence of lupus anticoagulant (LAC) and IgG and IgM anticardiolipin (aCL) antibody titers, along with concurrent diagnosis of antiphospholipid syndrome (APS). Accumulation of long‐term damage was quantified using the Vasculitis Damage Index (VDI).

Results

Data from 116 AAV patients were analyzed. A total of 34% (n = 40) had persistently positive aCL or LAC or a concurrent diagnosis of APS and were classified as AAV/aPL. A total of 76 patients (66%) were classified as AAV alone. LAC was present in a statistically higher proportion of AAV/aPL patients than those in the AAV‐alone group (P < 0.0001). Mean VDI score was significantly higher in the AAV/aPL group at mean ± SD 3.54 ± 1.36 as compared to 1.96 ± 1.42 in the AAV‐alone group (P < 0.0001). Major vascular damage scores were significantly higher in the AAV/aPL group, with mean ± SD 0.32 ± 0.59 as compared to 0.07 ± 0.26 in the AAV‐alone group (P < 0.007).

Conclusion

Persistently positive occurrence of aPL, in particular LAC, is present in a significant proportion of AAV patients and is associated with a higher VDI score. Clinicians should consider screening AAV patients for aPL.
Choosing Wisely in Daily Practice: An Intervention Study on Antinuclear Antibody Testing by Rheumatologists
Authors: Lesuis Nienke , Hulscher Marlies E. J. L. , Piek Ester , Demirel Hatice , van der Laan‐Baalbergen Nicole , Meek Inger , van Vollenhoven Ronald F. , den Broeder Alfons A.
Published: September 2015

Objective

To assess the effect of a simple intervention on antinuclear antibody (ANA) test overuse by rheumatologists.

Methods

This was an explorative, pragmatic, before‐and‐after, controlled implementation study among rheumatologists working at 3 rheumatology departments in secondary and tertiary care centers in The Netherlands. The intervention was given in all study centers separately and combined education with feedback. Six outcome measures describe the intervention effects: the ANA/new patient ratio (APR), difference with the target APR, percentage of positive ANA tests, percentage of repeated ANA testing, percentage of ANA‐associated diseases, and APR variation between rheumatologists. Outcomes were compared between the pre‐ and postintervention period (both 12 months) using (multilevel) logistic regression or F testing. Results are reported together for centers 1 and 2, and separately for center 3, because ANA tests could not be linked to an individual rheumatologist in center 3.

Results

The APR decreased from 0.37 to 0.11 after the intervention in centers 1 and 2 (odds ratio [OR] 0.19, 95% confidence interval [95% CI] 0.17–0.22, P < 0.001) and from 0.45 to 0.30 in center 3 (OR 0.53, 95% CI 0.45–0.62, P < 0.001). The percentage of repeated ANA requests in all centers and the APR variation for centers 1 and 2 decreased significantly. Only in center 3 did the percentage of ANA‐associated diseases increase significantly.

Conclusion

A simple intervention resulted in a relevant and significant decrease in the numbers of ANA tests requested by rheumatologists, together with an improvement on 3 other outcome measures.
Asymptomatic Versus Symptomatic Ankle Joints in Rheumatoid Arthritis: A High‐Resolution B‐Mode and Power Doppler Ultrasound Study
Authors: Alsuwaidi Mohammed , Ehrenstein Boris , Fleck Martin , Hartung Wolfgang
Published: September 2015

Objective

Ankle joints are frequently neglected in activity scoring systems, including the Disease Activity Score in 28 joints (DAS28). Only a few studies have assessed pathologies detected by ultrasonography of the ankles in symptomatic rheumatoid arthritis (RA) patients. We evaluated ankle joints in RA patients regardless of symptomatology, using musculoskeletal ultrasound (MSUS) as well as power Doppler ultrasound (PDUS).

Methods

A total of 160 ankle joints of 80 RA patients were examined using MSUS and PDUS, according to the European League Against Rheumatism MSUS guidelines. Additionally, the talonavicular joints (TNJs) and the medial and the lateral tendon compartments were examined. The visual analog scale (VAS) score was recorded for each patient.

Results

A total of 80 RA patients with a median age of 60 years and disease duration of 5 years were enrolled in our study. The median DAS28 score was 5. A total of 97 ankles were painful (VAS 1–10), whereas 63 ankles were asymptomatic (VAS 0). Overall, the predominant pathology was arthritis of the tibiotalar joint (TTJ) and/or TNJ in 124 ankles (77%), followed by tenosynovitis of the medial compartment tendons in 44 ankles (28%). Arthritis of the TTJ was present in 59% and synovitis of the TNJ in 35% of the symptomatic ankles. In asymptomatic ankles, TTJ synovitis was detected in 35%, whereas TNJ arthritis was observed in 18%. PDUS activity was higher in the subgroup of symptomatic ankles.

Conclusion

The most frequent pathologies detected by MSUS were arthritis of the TTJ and TNJ, followed by tenosynovitis of the medial compartment tendons. Pathologic findings were more frequent in symptomatic but also common in asymptomatic patients, whereas PDUS activity was generally low and mainly observed in symptomatic patients.
Work Outcome in Patients With Ankylosing Spondylitis: Results From a 12‐Year Followup of an International Study
Authors: Castillo‐Ortiz J. D. , Ramiro S. , Landewé R. , van der Heijde D. , Dougados M. , van den Bosch F. , Boonen A.
Published: September 2015

Objective

To understand the impact of ankylosing spondylitis (AS) on work disability (WD) over 12 years compared with the general population, and explore factors predicting adverse work outcome, defined as new partial WD or reduction in working hours.

Methods

Source of data was the Outcome Assessments in Ankylosing Spondylitis International Study, which includes patients from The Netherlands, France, and Belgium. Standardized WD rates over time compared to the general population were calculated using indirect standardization (Dutch patients only). Cox survival analyses identified baseline predictors as well as time‐varying factors influencing adverse work outcome over 12 years.

Results

Of 215 patients, 55 (26%) were full WD at baseline and 139 (65%) were at risk for adverse work outcome during followup. When compared to the general population, WD over 12 years continued to be increased in Dutch men (incidence rate [IR] 2.9 [95% confidence interval (95% CI) 1.2, 4.6]), but less clearly for women (IR 1.2 [95% CI −0.4, 2.9]). Within the entire sample, baseline predictors of adverse work outcome over 12 years were residence in The Netherlands (versus France or Belgium) (hazard ratio [HR] 3.4 [95% CI 1.4, 8.4]) and worse Bath Ankylosing Spondylitis Functional Index (BASFI) (HR 1.2 [95% CI 1.0, 1.4]). Time‐varying predictors over 12 years were residence in The Netherlands, uveitis, and either BASFI or Bath Ankylosing Spondylitis Disease Activity Index with age and inflammatory bowel disease.

Conclusion

Although WD was already prevalent at inclusion in the cohort, a substantial proportion of patients incurred further adverse work outcome over 12 years. In addition to country of residence, uveitis, age, and self‐reported physical function or disease activity predicted long‐term adverse work outcome.
Clinical Characteristics of Sarcoid Arthropathy: A Population‐Based Study
Authors: Ungprasert Patompong , Crowson Cynthia S. , Matteson Eric L.
Published: September 2015

Objective

The epidemiology and clinical characteristics of sarcoid arthropathy are not well described, as only referral‐based studies have been reported. This study aimed to use the data from a geographically well‐defined population to characterize the clinical characteristics of sarcoid arthropathy.

Methods

An inception cohort of patients with incident sarcoidosis in the years 1976–2013 in a geographically well‐defined population was identified based on comprehensive individual medical records review. Inclusion required physician diagnosis supported by histopathology and radiologic features of intrathoracic sarcoidosis, compatible clinical presentation, and exclusion of other granulomatous diseases. Patients with joint pain were then identified from this cohort.

Results

In 1976–2013, all 345 incident cases of sarcoidosis were identified. Symptoms of joint pain occurred in 42 patients (mean age 41.2 years, 57.1% female, and 95% white), and 35 patients had swollen joint(s) on physical examination. Most patients had arthralgia prior to the diagnosis of sarcoidosis, with an average time to diagnosis of 21 days. Of the 35 cases, oligoarthritis (2 to 4 joints) was the most common pattern (88% of cases), followed by monoarthritis (6%) and polyarthritis (6%). Ankles were involved in 91% of cases. In the majority of patients (88%), the arthritis resolved within 6 weeks. Classic Lofgren's syndrome was observed in 11 patients (26%).

Conclusion

Inflammatory arthritis occurs in a minority of patients with sarcoidosis. Acute oligoarthritis with bilateral ankle involvement was the most common pattern of sarcoid arthropathy. It should be noted that the generalizability of the results may be limited, as the cohort was predominantly white.
Relation of Step Length to Magnetic Resonance Imaging–Detected Structural Damage in the Patellofemoral Joint: The Multicenter Osteoarthritis Study
Authors: Stefanik Joshua J. , Gross K. Douglas , Guermazi Ali , Felson David T. , Roemer Frank W. , Niu Jingbo , Lynch John A. , Segal Neil A. , Lewis Cora E. , Lewis Cara L.
Published: September 2015

Objective

To investigate the relationship of step length to the sex‐specific prevalence and worsening of magnetic resonance imaging (MRI)–detected structural damage in the patellofemoral (PF) joint among a cohort of older women and men with or at risk of knee osteoarthritis (OA).

Methods

The Multicenter Osteoarthritis Study is a cohort study of persons ages 50–79 years with or at risk of knee OA. Step length was assessed using the GAITRite walkway (CIR Systems) at the 60‐month visit, and cartilage damage and bone marrow lesions (BMLs) were graded on MRI at the 60‐ and 84‐month visits. Step length was divided into sex‐specific quintiles, and the relationship of step length to the prevalence and worsening of cartilage damage and BMLs in the PF joint was examined using logistic regression, adjusting for age, body mass index (BMI), leg length, and tibiofemoral joint structural damage.

Results

In 1,053 knees, 4,094 and 4,083 PF joint subregions were studied for the cartilage and BML analyses, respectively. Mean ± SD age was 65.6 ± 8.1 years and mean ± SD BMI was 29.1 ± 4.7 kg/m2; 62% of participants were female. In women, compared to those with the shortest step length, those with the longest step length had 0.62 (95% confidence interval [95% CI] 0.43–0.88) and 0.59 (95% CI 0.40–0.87) times the odds of cartilage damage and BMLs, respectively. There was no cross‐sectional association in men, and no longitudinal association in either sex.

Conclusion

Women with PF joint structural damage may adapt their gait by shortening their step length, but this may not be sufficient to reduce the risk of worsening damage over time.
Computational Lexical Analysis of the Language Commonly Used to Describe Gout
Authors: Lawrence Edwards N. , Malouf Robert , Perez‐Ruiz Fernando , Richette Pascal , Southam Siobhan , DiChiara Matthew
Published: September 2015

Objective

To characterize the current language that is used in describing and defining gout, its symptoms, and its treatment by reviewing recent publications in rheumatology and determining how word choice may, or may not, be reflective of recent scientific developments in gout specifically.

Methods

This was a computational linguistics study, using collocations analyses and concordance analyses on a database of scientific literature related to gout. The final data set for analysis included 2,590 articles, all relating to gout and published between May 2003 and May 2013 and amounting to 12,101,036 tokens (sentence segments). Analysis was conducted by a team of linguists and social scientists.

Results

Our primary finding is that current disease language in gout is marked by ambiguity and imprecision, as evidenced by numerous terms that have similar but distinct meanings, but are nevertheless used interchangeably, therefore blending the slight but significant distinctions between these words. Whereas treatment language is characterized by a multitude of terms to describe a therapeutic mechanism of action, there is a relative void of terms and phrases used to describe success (treating to target) in gout.

Conclusion

The data suggest that the language used to describe gout could be improved and updated. A transformation from an antiquated and insufficiently descript terminological set to one that reflects the recent scientific and clinical advancements made in the category would maximize opportunities for patient and physician understanding.
Can Creatine Supplementation Improve Body Composition and Objective Physical Function in Rheumatoid Arthritis Patients? A Randomized Controlled Trial
Authors: Wilkinson Thomas J. , Lemmey Andrew B. , Jones Jeremy G. , Sheikh Fazal , Ahmad Yasmeen A. , Chitale Sarang , Maddison Peter J. , O'brien Thomas D.
Published: September 2015

Objective

Rheumatoid cachexia (muscle wasting) in rheumatoid arthritis (RA) patients contributes to substantial reductions in strength and impaired physical function. The objective of this randomized controlled trial was to investigate the effectiveness of oral creatine (Cr) supplementation in increasing lean mass and improving strength and physical function in RA patients.

Methods

In a double‐blind design, 40 RA patients were randomized to either 12 weeks’ supplementation of Cr or placebo. Body composition (dual x‐ray absorptiometry and bioelectrical impedance spectroscopy [BIS]), strength, and objectively assessed physical function were measured at baseline, day 6, week 12, and week 24. Data analysis was performed by analysis of covariance.

Results

Cr supplementation increased appendicular lean mass (ALM; a surrogate measure of muscle mass) by mean ± SE 0.52 ± 0.13 kg (P = 0.004 versus placebo), and total LM by 0.60 ± 0.37 kg (P = 0.158). The change in LM concurred with the gain in intracellular water (0.64 ± 0.22 liters; P = 0.035) measured by BIS. Despite increasing ALM, Cr supplementation, relative to placebo, failed to improve isometric knee extensor strength (P = 0.408), handgrip strength (P = 0.833), or objectively assessed physical function (P = 0.335–0.764).

Conclusion

In patients with RA, Cr supplementation increased muscle mass, but not strength or objective physical function. No treatment‐related adverse effects were reported, suggesting that Cr supplementation may offer a safe and acceptable adjunct treatment for attenuating muscle loss; this treatment may be beneficial for patients experiencing severe rheumatoid cachexia.
Lupus Means Sacrifices: Perspectives of Adolescents and Young Adults With Systemic Lupus Erythematosus
Authors: Tunnicliffe David J. , Singh‐Grewal Davinder , Chaitow Jeffrey , Mackie Fiona , Manolios Nicholas , Lin Ming‐Wei , O'neill Sean G. , Ralph Angelique F. , Craig Jonathan C. , Tong Allison
Published: September 2015

Objective

Disease activity, organ damage, and treatment burden are often substantial in children and adolescents with systemic lupus erythematous (SLE), and the complex interplay among the developing child, parents, and peers makes effective management difficult. We aimed to describe the experiences and perspectives of adolescents and young adults diagnosed with juvenile‐onset SLE to inform strategies for improving treatment and health outcomes.

Methods

Focus groups and face‐to‐face semistructured interviews were conducted with 26 patients ages 14–26 years, from 5 Australian hospitals in 2013–2014. Focus groups and interview transcripts were thematically analyzed.

Results

Five themes were identified: marring identity (misrepresented self, heightened self‐consciousness, sense of isolation), restricting major life decisions (narrowed career options, threat to parenthood), multifaceted confusion and uncertainty (frustration at delayed diagnosis or misdiagnosis, needing age and culturally appropriate information, ambiguity about cause of symptoms, prognostic uncertainty, confronting transition to adult care), resentment of long‐term treatment (restricting ambition, animosity toward medication use), and gaining resilience and coping capacities (desire for independence, developing self‐reliance, recalibrating perceived disease severity, depending on family and friends, trusting physicians).

Conclusion

Young patients with SLE perceive they have substantially limited physical and social capacities and restricted personal and career goals. Psychosocial and educational interventions targeted at improving confidence, self‐efficacy, disease‐related knowledge, and social support, and at resolving insecurities regarding patients’ capacity for self‐management may alleviate psychosocial distress and improve adherence, and thus optimize health outcomes of adolescents and young adults with SLE.
Atomic Disorders Induced by Silver and Magnesium Ion Migrations Favor High Thermoelectric Performance in α‐MgAgSb‐Based Materials
Authors: Li Dandan , Zhao Huaizhou , Li Shanming , Wei Beipei , Shuai Jing , Shi Chenglong , Xi Xuekui , Sun Peijie , Meng Sheng , Gu Lin , Ren Zhifeng , Chen Xiaolong
Published: September 2015

Thermoelectric devices can directly convert thermal energy to electricity or vice versa with the efficiency being determined by the materials’ dimensionless figure of merit (ZT). Since the revival of interests in the last decades, substantial achievements have been reached in search of high‐performance thermoelectric materials, especially in the high temperature regime. In the near‐room‐temperature regime, MgAgSb‐based materials are recently obtained with ZT ≈ 0.9 at 300 K and ≈1.4 at 525 K, as well as a record high energy conversion efficiency of 8.5%. However, the underlying mechanism responsible for the performance in this family of materials has been poorly understood. Here, based on structure refinements, scanning transmission electron microscopy (STEM), NMR experiments, and density function theory (DFT) calculations, unique silver and magnesium ion migrations in α‐MgAg0.97Sb0.99 are disclosed. It is revealed that the local atomic disorders induced by concurrent ion migrations are the major origin of the low thermal conductivity and play an important role in the good ZT in MgAgSb‐based materials.
Conducting Polymers for Neural Prosthetic and Neural Interface Applications
Authors: Green Rylie , Abidian Mohammad Reza
Published: September 2015

Neural‐interfacing devices are an artificial mechanism for restoring or supplementing the function of the nervous system, lost as a result of injury or disease. Conducting polymers (CPs) are gaining significant attention due to their capacity to meet the performance criteria of a number of neuronal therapies including recording and stimulating neural activity, the regeneration of neural tissue and the delivery of bioactive molecules for mediating device–tissue interactions. CPs form a flexible platform technology that enables the development of tailored materials for a range of neuronal diagnostic and treatment therapies. In this review, the application of CPs for neural prostheses and other neural interfacing devices is discussed, with a specific focus on neural recording, neural stimulation, neural regeneration, and therapeutic drug delivery.
3D Graphene Hollow Nanospheres@Palladium‐Networks as an Efficient Electrocatalyst for Formic Acid Oxidation
Authors: Qiu Xiaoyu , Wu Ping , Xu Lin , Tang Yawen , Lee Jong‐Min
Published: September 2015

Graphene has served widely as a support material for noble metal nanoparticle electrocatalysts in fuel cells. During the synthesis of electrocatalysts, however, the intense stacking and folding of graphene nanosheets decreases the utilization and activity of electrocatalysts, owing to the following aspects: i) the noble metal wrapped by the winding graphene cannot be fully utilized; ii) the structural destruction of graphene decreases the specific surface area and increases electrical resistance; and iii) the hydrophobicity and wrinkles of graphene greatly increase the mass transfer resistance of fuel molecules and electrolytes. In this work, 3D graphene oxide hollow nanospheres are designed to minimize wrinkles, maximize specific surface area, and realize the regular clipping of 2D graphene oxide. The 3D‐reduced graphene oxide hollow nanosphere supported Pd‐network nanohybrids (3D‐RGO/Pd‐NWs) are then obtained using 3D graphene oxide hollow nanospheres as a reaction precursor. The skeleton of 3D‐RGO not only acts as an exclusive inner conducting shell to promote electron and ion kinetics but is also crucial for enhancing the permeation of fuel molecules and electrolytes. Therefore, 3D‐RGO/Pd‐NWs exhibit enhanced electrocatalytic activity and durability for the formic oxidation reaction in an acidic medium compared to 2D graphene supported Pd nanoparticles and commercial Pd/C electrocatalysts.
Expedient Iodocyclization Approach Toward Polysubstituted 3H‐Benzo[e]indoles
Authors: Martins Guilherme M. , Zeni Gilson , Back Davi F. , Kaufman Teodoro S. , Silveira Claudio C.
Published: September 2015

A facile and expedient iodocyclization of 4‐(2‐prop‐1‐ynylphenyl)‐1H‐pyrroles towards the synthesis of polysubstituted 3H‐benzo[e]indoles is reported. The transformation was optimized and the best results were obtained by using iodine (1.2 equiv,) in dichloromethane, and potassium carbonate as base. The starting 1,2,3,4‐tetrasubstituted pyrroles were efficiently obtained by means of a nickel(II) chloride‐promoted four‐component (nitromethane, amine, 2‐alkynylbenzaldehyde and ethyl acetoacetate) reaction. Further functionalization of the resulting 5‐iodoheterocycles was also explored.

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On the Localized Nature of the Structural Transformations of Li2MnO3 Following Electrochemical Cycling
Authors: Phillips Patrick J. , Bareño Javier , Li Yan , Abraham Daniel P. , Klie Robert F.
Published: September 2015

Although the Li‐excess layered‐oxide Li2MnO3 has a high theoretical capacity, structural transformations within the oxide during electrochemical cycling lead to relatively low experimental capacities, hindering its use in practical applications. Here, aberration‐corrected scanning transmission electron microscopy/electron energy loss spectroscopy and high‐resolution X‐ray diffraction are used to characterize the oxide following electrochemical cycling. Microscopy reveals the coexistence of regions with local monoclinic, spinel, and rock‐salt symmetries, indicating localized and inhomogeneous structural evolutions. Crystal structure transformations are observed both at the particle surface and in the bulk. At the surface, these transformed regions resemble spinel Mn3O4 or rock‐salt MnO, consistent with oxygen loss. In the bulk, the regions resemble defect spinels, such as the layered‐spinel LixMn4/3O4, which suggest a partial phase transformation consistent with oxygen retention. Both microscopy and diffraction data of the cycled sample indicate areas of pristine Li2MnO3; the presence of such areas, in close proximity to LixMn4/3O4 areas, suggests that the layered to spinel structure transformation is partially reversible. Spinel, disordered rock salt, and pristine areas are also observed in Li2MnO3 samples intentionally damaged by electron beam irradiation. This observation indicates that the dynamic processes resulting in phase transformations can be studied for a variety of oxide systems by a judicious selection of irradiation conditions.
Radical Cation–Anion Coupling‐Induced Work Function Tunability in Anionic Conjugated Polyelectrolytes
Authors: Lee Jong‐Hoon , Lee Byoung Hoon , Jeong Song Yi , Park Sae Byeol , Kim Geunjin , Lee Seoung Ho , Lee Kwanghee
Published: September 2015

By coating conjugated polyelectrolytes (CPEs) on metals, the work function (WF) of metals can be tuned by electric dipoles formed through the self‐assembly of cation–anion pairs on the side chains of CPEs. Recently, it has been reported that a pertinent oxidative doping of anionic CPEs results in a reversed direction in the net electric dipoles, thereby yielding opposite WF tunability compared with pristine CPEs. However, the fundamental mechanism of this reversed WF tunability is not clearly understood. Here, through a systematic study of the relationship between the chemical structure of anionic CPEs (n‐type) and the corresponding oxidation‐processed CPEs (p‐type), it is clearly demonstrated that radical cations are generated on the π‐conjugated backbone of the n‐type CPEs and strongly paired with anions on the side chains of the n‐type CPEs, thereby reversing the direction of the total net electric dipoles. Furthermore, it is found that the degree of radical cation–anion coupling in the CPEs is a key factor in determining their WF tunability. It is envisioned that the results will provide a fundamental understanding of CPEs for versatile interface engineering in organic electronics.