bluuebunny/crossref_metadata_2025 huggingface dataset:
Computerized Planning of Prostate Cryosurgery and Shape Considerations
Authors: Joshi Purva , Sehrawat Anjali , Rabin Yoed
Published: July 2017

The current study aims to explore possible relationships between various prostate shapes and the difficulty in creating a computer-based plan for cryosurgery. This research effort is a part of an ongoing study to develop computational means in order to improve cryosurgery training and education. This study uses a computerized planner—a key building block of a recently developed prototype for cryosurgery training. The quality of planning is measured by the overall defect volume, a proprietary concept which refers to undercooled areas internal to the target region and overcooled areas external to it. Results of this study numerically confirm that the overall defect volume decreases with an increasing number of cryoprobes, regardless of the geometry of the prostate. However, the number of cryoprobes required to achieve the smallest possible defect may be unrealistically high (<30). Results of this study also demonstrate that the optimal cryoprobe layout is associated with a smaller defect for symmetric prostate geometries and, independently, for prostate models that better resemble a sphere. Furthermore, a smaller defect is typically achieved when the urethra passes through the center of the prostate model. This study proposes to create a cryoprobe convex hull for the purpose of initial planning, which is a subdomain similar in shape to the prostate but at a reduced size. Parametric studies indicate that a cryoprobe convex hull contracted by 7 to 9 mm in all directions from the prostate capsule serves as a quasi-optimal initial condition for planning, that is, a preselected number of cryoprobes placed in the cryoprobe convex hull yields favorable results for optimization. The cryoprobe convex hull could accelerate computer-based planning, while also being adopted as a concept for traditional cryosurgery training, when computerized means are absent.
Variations in Unrealistic Optimism Between Acceptors and Decliners of Early Phase Cancer Trials
Authors: Jansen Lynn A. , Mahadevan Daruka , Appelbaum Paul S. , Klein William M. P. , Weinstein Neil D. , Mori Motomi , Degnin Catherine , Sulmasy Daniel P.
Published: July 2017

Research has found that patient-subjects in early phase cancer trials exhibit unrealistic optimism regarding the risks and possible benefits of trial participation. Unrealistic optimism is associated with therapeutic misconception and failures to appreciate research-related information. This is the first study to assess whether those who decline to participate in these trials also exhibit unrealistic optimism. It is also the first study to assess whether there are significant differences in appreciation of research-related risks/benefits and therapeutic misconception between these two groups. We approached 261 patients at two academic medical centers who were offered enrollment in a Phase I, II, or I/II cancer trial (between 2012 and 2016). Two hundred thirty-three patients agreed to enroll in an early phase cancer trial, 171 of whom agreed to be interviewed for the study. Twenty-eight patients declined the offer to enroll, 15 of whom agreed to be interviewed for the study. Subjects participated in a structured face-to-face interview with a research associate trained to administer the study questionnaires. Acceptors demonstrated a significantly higher level of unrealistic optimism than decliners ( p < .05). Decliners had significantly less therapeutic misconception than acceptors (3.37 [ SD = 0.85] vs. 3.79 [ SD = 0.77], p = .042). There was a significant difference on one of the appreciation questions between acceptors and decliners ( p = .009). Comparative assessment of acceptors and decliners to early phase cancer trials casts light on whether unrealistic optimism is consequential for the decision to participate in these trials. The different levels of unrealistic optimism exhibited by these groups suggest that it may be a factor that affects the decision to participate.
Super-selective coil embolization of a basilar perforator artery aneurysm previously treated by the stent-in-stent technique, using an extremely soft bare coil delivered through a one-marker microcatheter
Authors: Chau Yves , Sachet Marina , Sédat Jacques
Published: July 2017

Background

Aneurysms of the perforating arteries arising from the basilar artery trunk are rare and represent a therapeutic challenge.

Methods

A basilar perforator aneurysm was initially treated by the stent-in-stent technique. Enlargement of the aneurysm was seen on follow up and the sac was secondarily coiled using two extremely soft bare coils, delivered through a one-marker microcatheter.

Results

At 6 months, the patient had a modified Rankin Scale score of 0 and cerebral arteriography demonstrated complete occlusion of the lesion.

Conclusions

We describe, as far as we are aware, the first case of basilar perforator aneurysm occlusion using extremely soft bare coils, inserted through the mesh of two stents previously placed in the basilar trunk.
Comparisons of ASPECTS 5 and 6 for endovascular treatment in anterior circulation occlusive stroke
Authors: Li Wenchen , Li Shijun , Dai Meifen , Wang Shang , Xiong Yunyun
Published: July 2017

Background

Whether ASPECTS 5 and ASPECTS 6 were significantly different on clinical outcomes in acute anterior circulation ischemic stroke undergoing endovascular treatment remains unclear. We aimed to retrospectively compare the effectiveness and safety of ASPECTS 5 and ASPECTS 6 in acute anterior circulation large-artery occlusive stroke patients.

Methods

A total of 41 patients, 14 in the ASPECTS 5 group and 27 in the ASPECTS 6 group, were enrolled between January 2014 and June 2016. Modified Rankin Scale 0–2 was considered as good functional outcome. Symptomatic intracerebral hemorrhage at 72 hours and mortality at 90 days were recorded.

Results

Good functional outcome at 90 days in the ASPECTS 5 group (0% (0/14)) was significantly lower than that in the ASPECTS 6 group (25.9% (7/27)) ( p = 0.04). Rates of symptomatic intracranial hemorrhage (21.4 (3/14) vs 18.5% (5/27), p = 0.83) and mortality (64.3% (9/14) vs 44.4% (12/27), p = 0.23) within 90 days were not significantly different. There is a trend for a lower rate of successful reperfusion in the ASPECTS 5 group (71.4% (10/14) for ASPECTS 5 vs 92.6% (25/27) for ASPECTS 6, p = 0.07).

Conclusions

ASPECTS 5 has very little chance to reach good functional outcome in Chinese patients with anterior circulation large-artery occlusive stroke. Future studies with large sample sizes are needed.
Optimal lane change motion of intelligent vehicles based on extended adaptive pseudo-spectral method under uncertain vehicle mass
Authors: Zeping Fang , Jianmin Duan
Published: July 2017

Lane change operation is widely used in numerous traffic scenarios; to minimize lane change time and avoid collisions with other vehicles required by intelligent vehicles, an optimal lane change motion is proposed for the shortest time free lane change and emergency obstacle avoidance lane change. First, two optimal lane change motion models are constructed based on a 3-degree-of-freedom dynamical vehicle model. Because of uncertain parameters in the vehicle model, the optimal lane change motion problem is an uncertain optimal control problem. Subsequently, targeted at nonlinearity and uncertain parameters, an extended adaptive pseudo-spectral method is also presented on the basis of approximate and numerical integration of parameter space. Finally, solving the optimal lane change motion problem, optimization results, control results based on the nonlinear model predictive control algorithm, and experimental results are shown under circumstances of certain vehicle mass and uncertain vehicle mass. As for uncertain parameters, optimization results are featured with robustness. Thus, uncertain parameters need not be measured, and optimization calculation need not be carried out in real time. The algorithm put forward here could be adopted to solve an uncertain optimal control problem. The optimal lane change motion can be extended to apply in more complex operations like merging, double-lane change, entering/exiting highways, or overtaking another vehicle.
A similarity method for predicting the residual velocity and deceleration of projectiles during impact with dissimilar materials
Authors: Song Qing , Dong Yongxiang , Cui Miao , Yu Bin
Published: July 2017

A method for predicting the residual velocity and deceleration of a projectile during normal low-velocity impact on a 2024-O thin aluminium plate is developed based on the similarity theory. Geometric scaling, the dissimilar materials of the projectile and different target thicknesses are considered. By a similitude analysis, the simulation criteria between the modelling and prototype experiments are obtained. The dimensionless velocity and deceleration of a projectile can be predicted by the relationship equations with the dimensionless dynamic pressure, projectile density and target thickness. On the basis of experimental data, the dimensionless residual velocity relationship is obtained and verified. In the range of normalised target thicknesses of [Formula: see text] (where H is target thickness and [Formula: see text] is projectile diameter), the deceleration–time data during penetration is simplified as a triangular wave. Moreover, it can be characterised using the maximum deceleration, the time to the maximum deceleration and the period of the triangular wave. Through a simulation analysis, three dimensionless deceleration characteristics of the projectile are developed to replicate a prototype-like deceleration–time process in a scaled model.
Free vibration of functionally graded carbon nanotube-reinforced conical panels integrated with piezoelectric layers subjected to elastically restrained boundary conditions
Authors: Fan Jianyu , Huang Jin , Ding Junbo , Zhang Jie
Published: July 2017

This article presents the free vibration of piezoelectric functionally graded carbon nanotube-reinforced composite conical panels with elastically restrained boundary conditions. The material properties of carbon nanotube-reinforced composites are assumed to be temperature-dependent and are obtained using the extended rule of mixture. First-order shear deformation theory is adopted to obtain the kinematics of the hybrid panels, and the boundary spring technique is used to implement arbitrary boundary conditions. Meanwhile, two types of electrical boundary conditions, closed circuit and open circuit, are considered for the free surfaces of the piezoelectric layers. The complete sets of electro-mechanically coupled governing equations are obtained using the Rayleigh–Ritz procedure with the Chebyshev polynomial basis functions. The resultant eigenvalue problem is solved to obtain natural frequencies and mode shapes of the hybrid panels. Convergence and comparison studies have been conducted to verify the stability and accuracy of the proposed method. Several numerical examples are examined to reveal the influences of the carbon nanotube volume fractions, carbon nanotube distribution types, boundary conditions, geometrical parameters, and temperatures on the natural frequencies of the hybrid panel. Moreover, the mode shapes of the hybrid panels under various boundary conditions are also presented.
Effect of novice driver’s car-following characteristic on roadway segment capacity
Authors: Yang Haifei , Wu Zhong
Published: July 2017

The presence of significant proportion of novice drivers greatly affects traffic flow performance due to their poor driving skills. The primary objective of this study was to develop adjustment factors to evaluate the impacts of novice driver’s car-following characteristic on roadway segment capacity. On-road experiments were conducted for measuring the car-following behavioral data associated with novice and experienced drivers. Comparative analyses were conducted. It was found that novice drivers preferred keeping significantly larger spacing and headways than experienced drivers did. Linear regression analyses were conducted to relate travel speeds to spacing and headways. Adjustment factors were developed to quantitatively evaluate the effects of novice drivers’ car-following behaviors on roadway segment capacity. It was found that as the proportion of novice drivers in the traffic stream increased, the reduction rate of capacity had the same trend of increasing. The presence of novice drivers may result in up to 13% of capacity reduction when traffic flow composed entirely of novice drivers traveling with an average speed of 90 km/h. The validity of implementing the novice driver adjustment factor was tested against measured data. The results of validation determined that the proposed adjustment factors improve the estimation accuracy of roadway segment capacity.
A high-precision dynamic model of a sounding rocket and rapid wind compensation method research
Authors: Peng Wuyu , Zhang Qingbin , Yang Tao , Feng Zhiwei
Published: July 2017

Sounding rockets are the only direct detection method for near-space and are utilized for different kinds of scientific research. Dynamic models are the foundation of research on sounding rockets. However, no dynamic models have included all the working processes of a sounding rocket. A high-precision dynamic model of a sounding rocket is proposed in this article; the model includes motion on the launch rail, the free flight phase, parachute deployment, the inflation process, and steady descent. Through the model, the entirety of the dynamic process can be understood in detail to help improve performance. A combination wind compensation method was investigated to rapidly and accurately obtain launch parameters; the method was derived from a wind weighting and pattern search method. Based on the simulation results, the proposed approaches are proven to be effective.
Design method of a vertical screw conveyor based on Taylor–Couette–Poiseuille stable helical vortex
Authors: Xiaoxia Sun , Wenjun Meng , yuan Yuan
Published: July 2017

This article investigates gas–solid two-phase flow in a vertical screw conveyor and analyzes the distribution function of the circumferential velocity of particles in the radial direction. Theoretical analysis combined with EDEM+FLUENT simulation analysis is performed to determine the best fill rate, the best screw speed, and critical Reynolds number when Taylor–Couette–Poiseuille flow stable helical vortex forms in the vertical screw conveyor. The formula for the critical Reynolds number and the best throughput is determined under different friction coefficients to establish an efficient design method based on Taylor–Couette–Poiseuille stable helical vortex flow. The method greatly benefits the design of vertical screw conveyors.
Chattering-free sliding mode synchronization control for a hybrid mechanism
Authors: Cao Yuanyuan , Gao Guoqin , Wu Xintong
Published: July 2017

For a hybrid mechanism used for automobile electro-coating conveying, a chattering-free sliding mode synchronization controller is proposed to improve the synchronization performance during motion process. The Jacobi matrix of the mechanism is calculated according to kinematic analysis, and the dynamic model is established by Lagrange method. Since the mechanism consists of two sets of hybrid mechanisms bilaterally, a novel synchronization error including the synchronization error between two ends of the end-effector is designed. By combining cross-coupling control with chattering-free sliding mode control, a novel chattering-free sliding mode synchronization controller is proposed. The stability of the proposed algorithm is proved by Lyapunov stability theorem. The simulation and experimental results show that the proposed controller can effectively reduce the chattering of driving forces and further improve the synchronization performance and tracking accuracy of the system.
Dynamical analysis of a single degree-of-freedom impact oscillator with impulse excitation
Authors: Wang Jun , Shen Yongjun , Yang Shaopu
Published: July 2017

In this article, the dynamical behavior of a single degree-of-freedom impact oscillator with impulse excitation is studied, where the mass impacts at one stop and is shocked with impulse excitation at the other stop. The existing and stability conditions for periodic motion of the oscillator are established. The effects of system parameters on dynamical response are discussed under different initial velocities. It is found that smaller shock gap than impact gap could make the periodic motion more stable. The decrease in natural frequency would consume less impact energy, make the vibration frequency smaller, and reduce the vibration efficiency. Finally, the dynamical properties are further analyzed under a special case, that is, the shock gap approaches zero. It could be seen that the larger shock coefficient and impact restitution coefficient would make vibration period smaller. Based on the stability condition, there are an upper limit for the product of shock coefficient and impact restitution coefficient, so that a lower limit of corresponding vibration period exists.
Task-priority redundancy resolution on acceleration level for underwater vehicle-manipulator system
Authors: Tang Qirong , Liang Le , Xie Jianhua , Li Yinghao , Deng Zhenqiang
Published: July 2017

A task-priority redundancy resolution with restoring moments optimized on acceleration level for the underwater vehicle-manipulator system is investigated in this article. Redundant resolution is a key and difficult problem in underwater vehicle-manipulator system’s trajectory planning. Firstly, kinematic modeling and dynamic modeling based on Lagrange method are studied. To overcome acceleration’s sudden change in traditional task-priority method, a new redundancy resolution method on the acceleration level is proposed. In this approach, a scalar potential function is established and used for reducing the effect of restoring moments by applying gradient projection. Finally, simulation is performed to verify the effectiveness of the proposed approach by comparing with traditional approaches.
Interactive leadership in turbulent school climates. An exploratory study of high school principals from the City of Buenos Aires
Authors: Romero Claudia , Krichesky Gabriela
Published: July 2017

School leadership has been identified as a key function to assuring quality in education. Principals’ leadership can have a direct effect on students’ learning by improving teaching, or an indirect effect by creating conditions that foster learning. This exploratory study aims to understand how school principals exercise their leadership and its relation with the learning climate of their schools. We analyzed two dimensions: principals’ agendas and school climate perception, using the questionnaire provided by the TALIS examination, in a sample of 82 principals from secondary schools in the City of Buenos Aires. Administrative and leadership tasks and meetings occupy first place in the agenda of the principals from our sample. However, principals devote almost half of their time to interactions with non-teacher members of the school community. This suggests the preponderance of an “ interactive leadership”, which appears as a response towards “turbulent school climates”. Nevertheless, it is precisely the instructional role of principals that can effectively improve learning conditions by operating on the academic dimension of school climate. This requires training policies and professional development opportunities that improve the instructional role of school leaders so that they can develop a more proactive leadership.
The UK Justice and Security Bill 2012–2013: Using secrecy to legitimize the securitization of the law
Authors: Pope Mark
Published: July 2017

The Justice and Security Act of 2013 provides for closed hearings in civil cases involving security sensitive information. The author argues that the UK Government successfully created and reinforced the authority of secretive sources to ensure the Bill was passed. Such authoritative sources promoted imaginaries of a future attack but also the need to respect legal principles that protected members of ‘our’ community. The dynamics between these imaginaries and principles led to the passing of the Bill in its final form – approving closed procedures in court, but removing inquests and issues of the ‘public interest’ from the Bill. Moreover, deliberation of the Bill was represented as negotiated and rational, thereby providing the final Act with legitimacy in elite fields. This research outlines how secrecy may not only be an end-goal of securitization moves, but reference to secret intelligence can also be integral to the justification of these moves.
Neoadjuvant chemotherapy by bronchial arterial infusion in patients with unresectable stage III squamous cell lung cancer
Authors: Zhu Jun , Zhang Hai-ping , Jiang Sen , Ni Jian
Published: July 2017

Background:

We investigated the effects of neoadjuvant chemotherapy administered via bronchial arterial infusion (BAI) on unresectable stage III lung squamous cell carcinoma (SCC).

Methods:

This was a single-arm retrospective study of chemotherapy with gemcitabine plus cisplatin (GP) administered via BAI to patients with unresectable lung SCC. Data regarding the post-treatment response rate, downstage rate, and surgery rate, as well as progression-free survival (PFS), overall survival (OS), quality of life, and post-BAI side effects were collected.

Results:

A total of 36 patients were enrolled in this study between August 2010 and May 2014. The response rate was 72.2%, and the downstage rate was 22.2%. Among the patients who were downstaged, 16 (44.4%) patients were because of their T stage, and 5 (13.9%) patients were downstaged due to to their N stage. The surgery rate was 52.8%, the 1-year survival rate was 75.4%, and the 2-year survival rate was 52.1%. The median PFS was 14.0 months [95% confidence interval (CI): 8.6–19.4], and the median OS was 25.0 months (95% CI: 19.1–30.9). The quality of life was significantly improved, and the chemotherapy was well tolerated.

Conclusions:

Compared with intravenous neoadjuvant chemotherapy, BAI chemotherapy significantly improved the surgery rate, prolonged PFS and OS, and improved the quality of life in patients with unresectable stage III lung SCC.
A perspective on diuretic resistance in chronic congestive heart failure
Authors: Shah Niel , Madanieh Raef , Alkan Mehmet , Dogar Muhammad U. , Kosmas Constantine E. , Vittorio Timothy J.
Published: July 2017

Chronic congestive heart failure (CHF) is a complex disorder characterized by inability of the heart to keep up the demands on it, followed by the progressive pump failure and fluid accumulation. Although the loop diuretics are widely used in heart failure (HF) patients, both pharmacodynamic and pharmacokinetic alterations are thought to be responsible for diuretic resistance in these patients. Strategies to overcome diuretic resistance include sodium intake restriction, changes in diuretic dose and route of administration and sequential nephron diuretic therapy. In this review, we discuss the definition, prevalence, mechanism of development and management strategies of diuretic resistance in HF patients.
Endometriosis
Authors: Kukstas Charlotte
Published: July 2017

Endometriosis is a common condition that is characterised by the presence of functional endometrial tissue outside the uterus. Presentation can vary, with some women experiencing painful symptoms whereas others have no symptoms at all. As endometriosis can present with a variety of symptoms, many of which are non-specific, there is often a delay between the onset of symptoms and diagnosis. The diagnosis of endometriosis begins with clinical history and physical examination, leading to further investigation and imaging techniques. The gold standard investigation remains laparoscopy. Medical treatment and surgery offer therapeutic options. It is commonly associated with subfertility, which also requires assessment and management.
Inguinal Hernia in Athletes: Role of Dynamic Ultrasound
Authors: Vasileff William Kelton , Nekhline Mikhail , Kolowich Patricia A. , Talpos Gary B. , Eyler Willam R. , van Holsbeeck Marnix
Published: July 2017

Background:

Inguinal hernia is a commonly encountered cause of pain in athletes. Because of the anatomic complexity, lack of standard imaging, and the dynamic condition, there is no unified opinion explaining its underlying pathology.

Hypothesis:

Athletes with persistent groin pain would have a high prevalence of inguinal hernia with dynamic ultrasound, and herniorrhaphy would successfully return athletes to activity.

Study Design:

Case-control study.

Level of Evidence:

Level 3.

Methods:

Forty-seven amateur and professional athletes with sports-related groin pain who underwent ultrasound were selected based on history and examination. Patients with prior groin surgery or hip pathology were excluded. Clinical and surgical documentation were correlated with imaging. The study group was compared with 41 age-matched asymptomatic athletes.

Results:

Ultrasound was positive for hernia with movement of bowel, bladder, or omental tissue anterior to the inferior epigastric vessels during Valsalva maneuver. The 47-patient symptomatic study group included 41 patients with direct inguinal hernias, 1 with indirect inguinal hernia, and 5 with negative ultrasound. Of 42 patients with hernia, 39 significantly improved with herniorrhaphy, 2 failed to improve after surgery and were diagnosed with adductor longus tears, and 1 improved with physical therapy. Five patients with negative ultrasound underwent magnetic resonance imaging and were diagnosed with hip labral tear or osteitis pubis. The 41-patient asymptomatic control group included 3 patients with direct inguinal hernias, 2 with indirect inguinal hernias, and 3 with femoral hernias.

Conclusion:

Inguinal hernias are a major component of groin pain in athletes. Prevalence of direct inguinal hernia in symptomatic athletes was greater than that for controls ( P < 0.001). Surgery was successful in returning these athletes to sport: 39 of 42 (93%) athletes with groin pain and inguinal hernia became asymptomatic.

Clinical Relevance:

Persistent groin pain in the athlete may relate to inguinal hernia, which can be diagnosed with dynamic ultrasound imaging. Herniorrhaphy is successful at returning athletes to sports activity.
Factors associated with global longitudinal strain decline in hypertensive patients with normal left ventricular ejection fraction
Authors: Soufi Taleb Bendiab Nabila , Meziane-Tani Abderrahim , Ouabdesselam Souhila , Methia Nadera , Latreche Samia , Henaoui Latefa , Monsuez Jean-Jacques , Benkhedda Salim
Published: July 2017

Background

Early detection of risk factors for left ventricular (LV) dysfunction may be useful in patients with high blood pressure (HBP).

Methods

Patient from an outpatient HBP clinic underwent a two-dimensional Doppler-coupled echocardiography with determination of LV global longitudinal strain (GLS) by speckle-tracking.

Results

Among 200 patients (mean age 61.7 ± 9.7 years), 155 were overweight, 93 had diabetes, 83 had dyslipidemia, and 109 had uncontrolled HBP. LV hypertrophy (LVH) was found in 136 patients (68%), including concentric (n = 106) and eccentric (n = 30) LVH. Diastolic dysfunction patterns were observed in 178 patients (89%), and increased filling pressures were observed in 37 patients (18.5%). GLS ranged from –25% to –11.6% (mean –16.9 ± 3.2%). Low GLS values (>–17%) were found in 91 patients (45.5%), 68 with and 23 without LVH. In univariate analysis, a reduced GLS was associated with HBP lasting for >10 years (odds ratio (OR) = 3.51, 95% confidence interval (CI) 1.73–7.09; p = 0.002), uncontrolled HBP (OR = 3.55, 95% CI 1.96–6.43; p < 0.0001), overweight (OR = 2.01, 95% CI 0.93–4.31; p = 0.0028), diabetes (OR = 2.21, 95% CI 1.25–3.90; p = 0.006), dyslipidemia (OR = 2.16, 95% CI 1.22–3.84; p = 0.008), renal failure (OR = 4.27, 95% CI 1.80–10.10; p = 0.001), an increased Cornell index (OR = 3.70, 95% CI 1.98–6.90; p < 0.0001), concentric LVH (OR = 9.26, 95% CI 2.62–32.73; p = 0.001), remodeling (OR = 8.51, 95% CI 2.18–33.23; p = 0.002), and filling pressures (OR = 7.1, 95% CI 2.9–17.3; p < 0.0001). In multivariable analysis, duration of HBP (p = 0.038), uncontrolled BP (p = 0.006), diabetes (p = 0.023), LVH (p = 0.001), and increased filling pressures (p = 0.003) remained associated with GLS decline.

Conclusion

Early impairment of LV function, detected by a reduced GLS, is associated with long-lasting, uncontrolled HBP, overweight, related metabolic changes, and is more pronounced in patients with LVH.
Comparison of distinctive clinical and cardiac magnetic resonance features between ST elevation myocardial infarction patients with incomplete myocardial rupture and those with moderate to severe pericardial effusion
Authors: Pineda Víctor , Figueras Jaume , Moral Sergio , Bañeras Jordi , Rodríguez-Palomares José , Evangelista Artur , García-Dorado David
Published: July 2017

Background:

Whether patients with incomplete myocardial rupture (IMR) present distinctive clinical and cardiac magnetic resonance features from those with moderate–severe pericardial effusion (⩾10 mm (PE)) remains unknown

Methods:

We compared the clinical, angiographic and cardiac magnetic resonance characteristics of nine patients with IMR (diagnosed angiographically and/or by cardiac magnetic resonance) with 29 with PE, and also with 38 without IMR or PE with evidence of transmural necrosis (reference group) matched for age, gender and year of admission.

Results:

Patients with IMR were younger than those with PE ( p<0.001) but the two groups shared a higher rate of admission delay (78% and 41%) than those without IMR/PE (5%, p<0.001) and lower frequency of reperfusion therapy (44%, 55% and 100%, respectively, p<0.001). Thirteen patients with PE (45%) but only one IMR (11%) presented recurrent chest pain. IMR patients tended to present smaller infarct size at cardiac magnetic resonance ( p=0.153 and 0.036) and number of segments with ⩾75% necrosis than PE patients and those without IMR/PE ( p=0.098 and 0.029, respectively). Ten PE patients presented cardiac tamponade (35%). A control 2D-echocardiogram performed within two years in 71 patients (93%) documented a pseudoaneurysm in one PE and in one IMR patient.

Conclusions:

IMR is generally silent and occurs in younger patients with smaller infarct size than those with PE although both present late and are often untreated with reperfusion therapy. These findings may warrant imaging assessment in ST elevation myocardial infarction patients with delayed admission, particularly in absence of reperfusion, to rule out an IMR.
Better safe than sorry? Frequent attendance in a hospital emergency department: an exploratory study
Authors: Daniels Jo , Osborn Mike , Davis Cara
Published: July 2017

Introduction:

Pain accounts for the majority of attendances to the Emergency Department (ED), with insufficient alleviation of symptoms resulting in repeated attendance. People who frequently attend the ED are typically considered to be psychologically and socially vulnerable in addition to experiencing health difficulties. This service development study was commissioned to identify the defining characteristics and unmet needs of frequent attenders (FAs) in a UK acute district general hospital ED, with a view to developing strategies to meet the needs of this group.

Methods:

A mixed-methods multi-pronged exploratory approach was used, involving staff interviews, focus groups, business data and case note analysis.

Results:

Findings reflect an absence of a coherent approach to meeting the needs of FAs in the ED, especially those experiencing pain. FAs to this ED tend to be vulnerable, complex and report significant worry and anxiety. Elevated anxiety on the part of the patient may be contributing to a ‘better safe than sorry’ culture within the ED and is reported to bear some influence on the clinical decision-making process.

Discussion:

It is recommended that a systemic approach is taken to improve the quality and accessibility of individualised care plans, provision of patient education, psychological care and implementation of policies and procedures. Change on an organisational level is likely to improve working culture, staff satisfaction and staff relationships with this vulnerable group of patients. A structured care pathway and supportive changes are likely to lead to economic benefits. Further research should build on findings to implement and test the efficacy of these interventions.
‘Why me?’ The problem of chronic pain after surgery
Authors: Lavand’homme Patricia
Published: July 2017

Chronic postsurgical pain (CPSP) has become a health priority and is scheduled to be included in the upcoming version of the International Classification of Diseases, 11th Revision (ICD-11). Recent studies on CPSP show unchanged prevalence despite progress made in fundamental research about underlying pathophysiological mechanisms. Nevertheless, clinical research has allowed better understanding of some CPSP aspects such as the development of neuropathic CPSP. Actually, some improvements are ongoing such as a refined definition and the assessment of CPSP in vulnerable populations, for example, paediatric patients. Pain after surgery, its resolution or its transition to CPSP is a dynamic process that reinforces the necessity of longitudinal assessment and management. In other words, CPSP can be called ‘perioperative medicine’.
Journalistic expertise: A communicative approach
Authors: Carpenter Serena , Kanver Duygu
Published: July 2017

Journalists’ privileges and the perceived value of their contributions are being affected by the increasing belief that journalistic work is a product that can be produced by anyone. This perspective should prompt questions related to the conceptualization of journalistic expertise and the functions of educational institutions that assert they teach it. This research contributes to scientific knowledge by introducing an alternative scholarly approach toward defining journalistic expertise—a communication perspective. Prestige in the digital landscape is increasingly associated with the ability of communicators to package information conveying their expertise to various publics. We proposed a set of variables to assess expertise: journalism-related degree, previous professional journalism experience, affiliation, journalism awards, specialization, technical skills, journalism skills, and public service through a content analysis of public Facebook fan pages. The results revealed that journalists communicated their expertise by highlighting their affiliation, previous experience, and specialization(s).
Chondromyxoid fibroma of the distal fibula treated by percutaneous radiofrequency ablation
Authors: Berenstein-Weyel Tamar , Lebel Ehud , Katz Daniela , Applbaum Yaakov , Peyser Amos
Published: July 2017

Background:

Percutaneous radiofrequency ablation (RFA) has been shown to be an effective treatment for soft tissue lesions and also benign bone tumors, especially osteoid osteoma. There are limited data regarding this technique in other bone tumors, specifically larger and more aggressive ones.

Purposes:

To describe the use of RFA as a definitive treatment and an alternative to traditional open surgery for the treatment of chondromyxoid fibroma (CMF), a benign but locally aggressive bone tumor.

Case presentation:

An 11.5-year-old girl was diagnosed with a 4-cm lytic bone lesion of the distal fibula. Evaluation, including biopsy, revealed CMF. It was managed by fluoroscopy-guided RFA only. Six-year follow-up demonstrated complete healing without damage to the adjacent distal fibular growth plate.

Discussion and conclusions:

RFA induces local heat in the ablation field and causes tissue necrosis. The depth of heat penetration and the size of heated sphere are accurately controlled by modern types of ablation probes and accurate positioning. The current report demonstrates the ability to use this percutaneous technique for larger and more aggressive bone tumors than has been indicated previously.
Intraoperative Radiation Exposure During Hip Arthroscopy
Authors: Salvo John P. , Zarah Jake , Chaudhry Zaira S. , Poehling-Monaghan Kirsten L.
Published: July 2017

Background:

The frequency of hip arthroscopy for the treatment of acute and chronic chondrolabral pathology and femoroacetabular impingement (FAI) has increased exponentially over the past decade. While surgeon and patient radiation exposure has been well documented in other areas of the orthopaedic literature, little is known about the procedure-specific and cumulative doses affecting the hip arthroscopist.

Purpose:

To determine the mean annual radiation exposure to the hip arthroscopist and the mean surgeon exposure per case.

Study Design:

Case series; Level of evidence, 4.

Methods:

A total of 210 consecutive hip arthroscopies performed in 209 patients by a single surgeon at a single ambulatory surgical center in a cohort consisting of approximately 50% bony (cam and pincer) pathology were prospectively reviewed, documenting the specific procedures performed in each case and the readings from a radiation dosimeter worn by the surgeon during positioning and while performing the procedures. Radiation readings for deep dose–equivalent (DDE), lens dose–equivalent (LDE), and shallow dose–equivalent (SDE) were measured. These readings were compared with the annual radiation dose limit recommendations established by the International Commission on Radiological Protection (ICRP).

Results:

The total radiation doses for the operative surgeon during all 210 cases were 183 mrem (1.83 mSv) DDE, 183 mrem (1.83 mSv) LDE, and 176 mrem (1.76 mSv) SDE. The mean exposure per case was 0.871 mrem (0.00871 mSv) DDE, 0.871 mrem (0.00871 mSv) LDE, and 0.838 mrem (0.00838 mSv) SDE. The operative surgeon’s mean annual exposure, performing 70 hip arthroscopies per year with 55% involving bony work, was 61.0 mrem (0.610 mSv) DDE, 61.0 mrem (0.610 mSv) LDE, and 58.7 mrem (0.587 mSv) SDE. These results are well below the ICRP annual limits of 50,000 mrem (500 mSv) DDE, 2000 mrem (20 mSv) LDE, and 50,000 mrem (500 mSv) SDE.

Conclusion:

For an experienced hip arthroscopist utilizing fluoroscopy during setup and bony resection, the annual and per-patient exposure to radiation remains well below the recommended ICRP limits.

Clinical Relevance:

Considering the increasing annual frequency of hip arthroscopies being performed, information regarding procedure-specific and cumulative doses of radiation exposure affecting the hip arthroscopist may provide valuable safety information for the orthopaedic community.
In Vivo Biodegradation of bisGMA and Urethane-Modified bisGMA-Based Resin Composite Materials
Authors: MacAulay M. , Tam L.E. , Santerre J.P. , Finer Y.
Published: July 2017

The aim of this study was to compare the levels of in vivo chemical degradation sustained by bisphenyl-glycidyl-dimethacrylate (bisGMA)–based and urethane-modified bisGMA-based resin composites. A cohort of 58 patients was recruited for the study. Human salivary esterase activity (HSDE) was measured for each patient prior to restoration placement. Class V or III composite restorations without occlusal contacts were placed in adult patients using a 3-step adhesive (Scotchbond MP, 3M) and 1 of 2 resin composites: a traditional bisGMA-based (Z250; 3M) ( n = 28) or a urethane-modified bisGMA-based composite (TPH Spectra, Dentsply) ( n = 30). Patients followed a 2-min rinse (saline containing 20% ethanol) protocol before, immediately after, and 7 days after restoration placement. The rinse samples were analyzed for the presence of bisphenol A (BPA) and bishydroxypropoxyphenylpropane (bisHPPP), a bisGMA breakdown product, using high-performance liquid chromatography in combination with mass spectrometry. The overall mean ± standard error (SE) HSDE activity was 23.4 ± 1.9 U/mL, with no statistical difference between the Z250 (22.6 ± 2.8 U/mL) and TPH (24.1 ± 2.1 U/mL) groups ( P = 0.69). BPA was not detected from any rinse samples. BisHPPP was detected from both composites only in rinse samples immediately after resin composite placement (0.59 µg/mm2 ± 0.16 and 0.68 µg/mm2 ± 0.16 for Z250 and TPH, respectively, P = 0.767). There was no statistically significant correlation between HSDE and amount of bisHPPP obtained from the saliva for the Z250 group ( r = 0.071, P = 0.723), TPH group ( r = 0.266, P = 0.155), and both groups combined ( r = 0.080, P = 0.549). Conventional commercial resin composite materials used in the current study did not release any detectable amount of BPA and only showed detectable levels of bisHPPP for a short term after placement, suggesting that hydrolytic consumption of any available resin substrate is fast and the generated products are rapidly diluted below the detection level limit (<20 ppb) in the oral cavity. This short-term release of bisHPPP was not significantly affected by material type or esterase level in the saliva.

Knowledge Transfer Statement: This clinical study demonstrated that the duration and degree of biodegradation of 2 representative formulations of resin composites was limited in both duration and amounts of detectable matrix derived degradation products. No significant level of potential biohazards was released following the application of the resin composites. The results of this study can help oral care professionals address concerns from their patients about possible health issues regarding the application of resin composite restorative materials.
Interactive Journal Club: Teaching an Old Dog New Tricks
Authors: Rosenthal Judith , Rosenthal Ken S
Published: July 2017

The interactive journal club incorporates basic principles of active and adult learning in a traditional education tool to maximize opportunity to develop critical thinking, communication skills, active reflection, and personal confidence in these skills. Following the choice of an appropriate article, the Designated Leader (DL) directs the discussion by presenting the title and data from the article with instructions for their analysis but without the author’s text. The participants, except the DL, are viewing the article for the first time and are prompted in their review of the raw data to provide their own interpretation, discovery, and critique. Participants are challenged to become more adept at study design, data analysis, and presentation and have indicated by informal verbal feedback that they look forward to the interactive journal club as it is enjoyable, relevant, and beneficial. Implementation of the interactive journal club does not require significant training in the approach or extensive revision or preparation of course materials.
European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis – Endorsed by the European Academy of Neurology
Authors: Ferro José M , Bousser Marie-Germaine , Canhão Patrícia , Coutinho Jonathan M , Crassard Isabelle , Dentali Francesco , di Minno Matteo , Maino Alberto , Martinelli Ida , Masuhr Florian , de Sousa Diana Aguiar , Stam Jan ,   for the European Stroke Organization
Published: July 2017

The current proposal for cerebral venous thrombosis guideline followed the Grading of Recommendations, Assessment, Development, and Evaluation system, formulating relevant diagnostic and treatment questions, performing systematic reviews of all available evidence and writing recommendations and deciding on their strength on an explicit and transparent manner, based on the quality of available scientific evidence. The guideline addresses both diagnostic and therapeutic topics. We suggest using magnetic resonance or computed tomography angiography for confirming the diagnosis of cerebral venous thrombosis and not screening patients with cerebral venous thrombosis routinely for thrombophilia or cancer. We recommend parenteral anticoagulation in acute cerebral venous thrombosis and decompressive surgery to prevent death due to brain herniation. We suggest to use preferentially low-molecular weight heparin in the acute phase and not using direct oral anticoagulants. We suggest not using steroids and acetazolamide to reduce death or dependency. We suggest using antiepileptics in patients with an early seizure and supratentorial lesions to prevent further early seizures. We could not make recommendations due to very poor quality of evidence concerning duration of anticoagulation after the acute phase, thrombolysis and/or thrombectomy, therapeutic lumbar puncture, and prevention of remote seizures with antiepileptic drugs. We suggest that in women who suffered a previous cerebral venous thrombosis, contraceptives containing oestrogens should be avoided. We suggest that subsequent pregnancies are safe, but use of prophylactic low-molecular weight heparin should be considered throughout pregnancy and puerperium. Multicentre observational and experimental studies are needed to increase the level of evidence supporting recommendations on the diagnosis and management of cerebral venous thrombosis.
A proposal for the analysis of price escalation within water tariffs: The impact of the Water Framework Directive in Spain
Authors: Suárez-Varela Marta , Martínez-Espiñeira Roberto
Published: July 2017

During the last few decades, numerous international organizations have emphasized the role of pricing policy as a tool to achieve objectives of efficiency, environmental sustainability, and cost-recovery in the management of water resources. Incorporating a certain level of price escalation within water tariffs by adopting increasing block rates is commonly advocated as a key element for controlling water demand and fulfilling these objectives. However, despite its widespread use, there exists no established procedure to measure the levels of price escalation embodied in water tariffs. We propose a measure of price escalation within water tariffs at the level of the water supply management unit (the municipality, in our study). In order to illustrate the usefulness of our measure, we analyse the evolution of price escalation in residential water tariffs between 2000 and 2014 in a sample of 952 Spanish municipalities and examine the factors influencing this evolution.
Detection and monitoring of lung inflammation in cystic fibrosis during respiratory tract exacerbation using diffusion-weighted magnetic resonance imaging
Authors: Ciet Pierluigi , Bertolo Silvia , Ros Mirco , Andrinopoulou Eleni Rosalina , Tavano Valentina , Lucca Francesca , Feiweier Thorsten , Krestin Gabriel P. , Tiddens Harm A.W.M. , Morana Giovanni
Published: July 2017

The aim was to investigate whether diffusion-weighted magnetic resonance imaging (DWI) detects and monitors inflammatory and lung function changes during respiratory tract exacerbations (RTE) treatment in patients with cystic fibrosis (CF).

29 patients with RTE underwent DWI pre- and post-antibiotic treatment. A control group of 27 stable patients, matched for age and sex, underwent DWI with the same time gap as those undergoing RTE treatment. Clinical status and lung function were assessed at each DWI time point. The CF-MRI scoring system was used to assess structural lung changes in both CF groups.

Significant reduction in the DWI score over the course of antibiotic treatment (p<0.0001) was observed in patients with RTE, but not in the control group. DWI score had a strong inverse correlation with clinical status (r=−0.504, p<0.0001) and lung function (r=−0.635, p<0.0001) in patients with RTE. Interestingly, there were persistent significant differences in the CF-MRI score between the RTE and control group at both baseline and follow-up (p<0.001), while the differences in DWI score were only observed at baseline (p<0.001).

DWI is a promising imaging method for noninvasive detection of pulmonary inflammation during RTE, and may be used to monitor treatment efficacy of anti-inflammatory treatment.