bluuebunny/crossref_metadata_2025 huggingface dataset:
Cost-Effectiveness of Bariatric Surgery Prior to Total Knee Arthroplasty in the Morbidly Obese
Authors: McLawhorn Alexander S. , Southren Daniel , Wang Y. Claire , Marx Robert G. , Dodwell Emily R.
Published: January 2016

Background:

Obesity is associated with adverse outcomes and increased costs after total knee arthroplasty. Bariatric surgery is an effective treatment for morbid obesity, but its cost-effectiveness for weight loss prior to total knee arthroplasty is unknown. The purpose of this study was to evaluate the cost-effectiveness of bariatric surgery prior to total knee arthroplasty for patients in whom medical treatment of obesity and knee osteoarthritis had failed.

Methods:

A state-transition Markov model was constructed to compare the cost-utility of two treatment protocols for patients with morbid obesity and end-stage knee osteoarthritis: (1) immediate total knee arthroplasty and (2) bariatric surgery two years prior to the total knee arthroplasty. The probability of transition for each health state and its utility were derived from the literature. Costs, expressed in 2012 United States dollars, were estimated with use of administrative and claims data. Costs and utilities were discounted at 3% annually, and effectiveness was expressed in quality-adjusted life-years (QALYs). The principal outcome measure was the incremental cost-effectiveness ratio (ICER). One-way, two-way, and probabilistic sensitivity analyses were performed, using $100,000 per QALY as the threshold willingness to pay.

Results:

Morbidly obese patients undergoing total knee arthroplasty alone had lower QALYs gained than patients who underwent bariatric surgery two years prior to the total knee arthroplasty. The ICER between these two procedures was approximately $13,910 per QALY, well below the threshold willingness to pay. Results were stable across broad value ranges for independent variables. Probabilistic sensitivity analysis found that the median ICER was $14,023 per QALY (95% confidence interval, $4875 to $51,210 per QALY).

Conclusions:

This model supports bariatric surgery prior to total knee arthroplasty as a cost-effective option for improving outcomes in morbidly obese patients with end-stage knee osteoarthritis who are indicated for total knee arthroplasty.

Level of Evidence:

Economic and Decision Analysis Level II. See Instructions for Authors for a complete description of levels of evidence.
Quality of Life and Surgical Outcomes After Soft-Tissue Reconstruction of Complex Oncologic Defects of the Spine and Sacrum
Authors: Dolan Roisin T. , Butler Joseph S. , Wilson-MacDonald James , Reynolds Jeremy , Cogswell Lucy , Critchley Paul , Giele Henk
Published: January 2016

Background:

Tumor-related spinal surgery has been revolutionized by recent advances in spinal stabilization, modern neuroimaging, and perioperative intensive medicine. This study examines clinical outcomes and factors associated with complications following reconstruction of complex oncologic defects of the spine and sacrum, in an attempt to increase preoperative recognition of high-risk patients with diminished wound-healing capacity and to optimize clinical outcomes in this cohort.

Methods:

We performed a retrospective analysis of fifty-five consecutive patients who underwent soft-tissue reconstruction with or without osseous stabilization of defects following spinal or sacral tumor resection at a quaternary referral center over a twelve-year period. Surgical outcomes included the prevalence of postoperative complications and success of wound closure at the latest follow-up. Health-related quality-of-life outcomes were assessed using the EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer 30-Item Core Quality of Life Questionnaire) and SF-36 (Short Form-36) questionnaires.

Results:

The mean age of the cohort was 46.7 years (range, eighteen to seventy-one years), with a male preponderance (3:1). Soft-tissue reconstructions (n = 70 flaps) were performed in the fifty-five patients. Overall, 36.3% of patients had wound complications. There was a twofold higher wound complication rate after delayed (60%) compared with immediate (29%) reconstruction (p = 0.03). Patients undergoing delayed reconstruction reported significantly lower SF-36 and EORTC QLQ-C30 scores.

Conclusions:

Orthoplastic management of spinal tumors should involve a strategy for preoperative recognition of patients at risk of compromised wound-healing. Prophylactic soft-tissue reconstruction can achieve stable definitive wound closure and potentially avoid the need for secondary procedures in appropriately selected patients.

Level of Evidence:

Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
The Effect of Workers’ Compensation Status on Outcomes of Cervical Disc Arthroplasty
Authors: Gornet Matthew F. , Schranck Francine W. , Copay Anne G. , Kopjar Branko
Published: January 2016

Background:

Receiving Workers’ Compensation benefits has been associated with inferior outcomes after lumbar fusion. The purpose of our study was to compare the outcomes of cervical disc arthroplasty between patients receiving and those not receiving Workers’ Compensation.

Methods:

Patient-reported outcomes, reoperations, complications, and return-to-work status were analyzed at one year after surgery in an observational cohort of consecutive patients who underwent single-level or multilevel cervical disc arthroplasty for symptomatic cervical disc conditions, including radiculopathy or discogenic pain with or without radiculopathy, exclusive of myelopathy.

Results:

Of the 189 patients who underwent cervical disc arthroplasty, 144 received Workers’ Compensation and forty-five did not. The mean scores on all patient-reported measures improved significantly from preoperative baseline to one year after surgery (p < 0.001), and the improvement in patient-reported outcomes did not differ significantly between the Workers’ Compensation and the non-Workers’ Compensation group (respectively, 22.7 compared with 25.0 for the Neck Disability Index; 8.3 compared with 9.6 for the Short Form (SF)-36 physical component summary; 7.9 compared with 9.6 for the SF-36 mental component summary; 3.5 compared with 3.7 for neck pain; and 2.6 compared with 2.8 for arm pain). The two groups also did not differ significantly in the rate of reoperations (7.6% for those receiving Workers’ Compensation compared with 13.3% for those not receiving Workers’ Compensation) and complications (2.8% compared with 4.4%, respectively). At one year after surgery, the proportion of patients who had returned to work was comparable (77.7% in the Workers’ Compensation group and 79.4% in the non-Workers’ Compensation group); however, the patients receiving Workers’ Compensation had significantly more days off before returning to work (a mean of 145.2 compared with 61.9 days; p = 0.001).

Conclusions:

After cervical disc arthroplasty, patients receiving Workers’ Compensation had outcomes that were similar to those of patients not receiving Workers’ Compensation in terms of patient-reported outcomes, surgery-related complications, reoperations, and return-to-work status. Patients receiving Workers’ Compensation remained off work for a longer interval than did patients not receiving Workers’ Compensation.

Level of Evidence:

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Passive Hip Range of Motion Predicts Femoral Torsion and Acetabular Version
Authors: Chadayammuri Vivek , Garabekyan Tigran , Bedi Asheesh , Pascual-Garrido Cecilia , Rhodes Jason , O’Hara John , Mei-Dan Omer
Published: January 2016

Background:

Orientation abnormalities of the acetabulum and femur have been implicated in early-onset coxarthrosis. The purpose of this study was to identify clinical examination findings predictive of such hip morphologies.

Methods:

A consecutive cohort of 221 patients (442 hips) undergoing hip arthroscopy was included. Demographic characteristics including age, diagnosis, sex, height, weight, body mass index (BMI), and physical activity level were recorded. Passive range of motion was measured for all hips. Preoperative computed tomography scans were utilized to measure femoral torsion and central acetabular version, and a combined femoral torsion-acetabular version (COTAV) index was defined as their sum.

Results:

The study cohort comprised 221 patients (sixty-four males, 157 females) with a mean age of 32.5 years and mean BMI of 24.2 kg/m2. Overall, hips with femoral antetorsion and acetabular anteversion exhibited the greatest internal rotation range of motion at a neutral hip position (mean, 44.2°), whereas hips with femoral retrotorsion and acetabular retroversion demonstrated the lowest corresponding value (20.1°; p < 0.001). Femoral torsion was significantly associated with female sex (p < 0.001), BMI (p < 0.001), and presence of pathology corresponding to cam-type femoroacetabular impingement (FAI) (p = 0.044). Central acetabular version was significantly associated with age (p = 0.021), female sex (p < 0.001), and absence of mixed-type FAI pathology (p = 0.025). Increasing age and internal rotation range of motion at a neutral hip position were the most significant predictors of an increased COTAV index.

Conclusions:

This study confirmed that passive hip range of motion significantly predicts combined femoral torsion and central acetabular version. Accurate clinical assessment of the COTAV index may inform surgical decision-making in hip preservation surgery.
Inflammation and Degeneration in Cartilage Samples from Patients with Femoroacetabular Impingement
Authors: Chinzei Nobuaki , Hashimoto Shingo , Fujishiro Takaaki , Hayashi Shinya , Kanzaki Noriyuki , Uchida Soshi , Kuroda Ryosuke , Kurosaka Masahiro
Published: January 2016

Background:

Femoroacetabular impingement (FAI) has been reported as a cause of hip pain in young patients and is suggested as the trigger for hip osteoarthritis (OA). The goal of this study was to quantify the metabolic profiles of articular tissues (cartilage, synovium, and labrum) harvested from patients with FAI and with end-stage OA. In addition, we sought to investigate the development of secondary OA in hips with FAI.

Methods:

Tissue samples were obtained from thirty hips undergoing arthroscopic surgery for FAI with or without labral tear and thirty hips undergoing total hip arthroplasty for OA. Quantitative real-time polymerase chain reaction (PCR) was performed to determine the gene expression of inflammatory cytokines and metabolic (anabolic and catabolic) enzymes. The differences in gene expression in articular tissues from the patients with FAI were also evaluated on the basis of clinical parameters (age range and alpha angle).

Results:

The messenger RNA (mRNA) expression of the inflammatory cytokines interleukin-1 beta (IL-1β) and IL-8 and of matrix metalloproteinase (MMP)-3 (a catabolic gene) in both the synovium and the labrum, and the expression of collagen type I alpha 1 (an anabolic gene) in the labrum, was higher in the samples from hips with OA than in those from hips with FAI (p < 0.05). In cartilage, however, the mRNA expression of the inflammatory cytokines and the catabolic genes MMP-13 and ADAMTS-4 (a disintegrin and metalloproteinase with thrombospondin motifs-4) was higher in the FAI samples compared with the OA samples (p < 0.01). When the expression of inflammatory cytokines was evaluated among the three types of tissues within each disease group, the expression levels were the highest in cartilage within the FAI samples (p < 0.01). In FAI cartilage, we found higher gene expression of aggrecan (ACAN) and ADAMTS-4 in the samples from patients with larger alpha angles (≥60°) (p < 0.01).

Conclusions:

Our results indicate that the metabolic conditions of articular cartilage in FAI and OA are different and that the expression of genes associated with inflammation is greater in the articular cartilage of patients with FAI compared with the synovium and the labrum. The metabolic changes were heightened by mechanical impingement.

Clinical Relevance:

The articular cartilage from the impingement lesion in patients with FAI showed biologically higher inflammation and degeneration, supporting the concept that FAI may be a trigger for joint degeneration.
Effectiveness of various surgical methods in treatment of Hirschsprung’s disease in children
Authors: Lukac Marija , Sindjic-Antunovic Sanja , Vujovic Dragana , Petronic Ivana , Nikolic Dejan , Radlovic Vladimir , Krstajic Tamara , Krstic Zoran
Published: January 2016

Background/Aim. Hirschsprung?s disease is the most common identifiable
developmental disorder of the enteric nervous system, characterized by a
failure of its formation in a variable segment of distal bowel. Currently
available surgical therapies for Hirschsprung?s disease, although lifesaving,
are associated with numerous complications. The aim of our study was to
evaluate the effectiveness of different surgical methods and the incidence of
serious complications after radical surgery of rectosigmoid Hirschsprung?s
disease. Methods. A retrospective analysis, from June 1997 until May 2012 was
carried out on 84 patients operated for Hirschsprung?s disease of
rectosigmoid colon. Transanal endorectal pull-through was performed in 30
(35.7%) patients (group I), while 54 (64.3%) patients were operated by other
(Soave, Duhamel or Swenson) procedures (group II). The age at operation, the
incidence and severity of postoperative complications, the need for previous
colostomy and the number of reoperations are countered in order to evaluate
the efficacy of surgical procedures. Results. In the group I, the mean age at
operation was 9.41 ? 6.37 months and in the group II the mean age at
operation was 16.8 ? 13.9 months which was significantly higher (p < 0.01).
In the group I there were only 3 (10%) patients with complications, one (3%)
of them was prone to only one redo procedure (1.00 ? 0.00) and there was no
need for previous colostomy in all patients (100%). In the group II there
were 16 (30%) patients with significantly frequent complications (p < 0.05),
about 2 reoperations on the average (1.94 ? 1.84) in 4 of them (25%) and 22
(41%) redo procedures, which was, in total, significantly higher than in the
group I (p < 0.01). Only Soave?s procedure was performed without previous
colostomy in 20 (37%) patients. Conclusion. Transanal endorectal pull-through
in surgical treatment of patients with Hirschsprung?s disease is more
effective than other procedures concerning earlier onset, low incidence and
less severe complications, which would require further operations, and no
scars.
Prevalence of Panton-Valentine leukocidin genes in community-associated methicillin-resistant Staphylococcus aureus in the district of Pomoravlje
Authors: Petrovic-Jeremic Ljiljana , Kuljic-Kapulica Nada , Ristanovic Elizabeta , Josic Dragana , Lepsanovic Zorica
Published: January 2016

Background/Aim. Community-associated methicillin-resistant Staphylococcus
aureus (CA-MRSA) strains appear to have rapidly disseminated among population
in the community without established risk factors for MRSA worldwide.
Panton-Valentine leukocidin (PVL) is a cytolytic toxin, encoded by the
lukF-PV and lukF-PV genes. PVL may be the key toxin responsible for enhanced
virulence of CA-MRSA. The aim of this study was to detect the genes encoding
PVL in CA-MRSA isolates from healthy people from the District of Pomoravlje.
Methods. We took throat and nose swabs from healthy, employed persons with
mandatory sanitary examinations and analyzed the presence of MRSA, between
January 2011 and December 2012 in the District of Pomoravlje. Susceptibility
of isolated strains to cefoxitin was investigated by using disc diffusion
according to the recommendation of CLSI (Clinical Laboratory Standard
Institute), and by E test. The presence of penicillin-binding protein 2a
(PBP2a) in Staphylococci was detected using latex agglutination Slidex ?MRSA
Detection test. The gold standard, polymerase chain reaction (PCR) assay, was
used for detection of mecA gene and PVL gene, and typing of SCCmec region.
Results. Our investigation showed that staphylococcal carrier state was
present in 2.58% of 52,910 throat and nasal swabs, and in 50 of them (3.67%)
MRSA was isolated. Among these MRSA, 2 (4%) isolates were PVL-positive.
Conclusion. The prevalence of CAMRSA and the presence of PVL gene among
healthy, employed population in the District of Pomoravlje were low. The
values obtained in this study show that, our region is not significantly
different from the other parts of our country, nor from the other European
countries.
Pleural empyema caused by Salmonella enteritidis in a patient with non-Hodgkin lymphoma
Authors: Kojic Miroslav , Nozic Darko , Tarabar Olivera , Perisic Nenad
Published: January 2016

Introduction. Extraintestinal manifestations of nontyphoidal salmonellosis
are usually seen in patients with cellular immunodeficiency. Pleural empyema
caused by nontyphoidal Salmonella is very rare clinical presentation of
salmonellosis and there are just a few cases described in a literature. We
presented a very rare case of pleural empyema caused by Salmonella
enteritidis in a patient with non-Hodgkin limphoma. Case report. A
60-year-old male with low grade B-cell lymphoma, mucosa associated lymphoid
tissue (MALT) type in IV clinical degree, manifested with infiltration of
stomach, bronchus, pleura and peritoneum was admitted to the hospital.
Initially the patient was presented with non-specific symptoms and signs,
suggesting poor general condition. During the hospitalization his pleural
fluid became purulent and changes in blood counts were registered with the
increase of leukocytes, especially neutrophils. A large number of leukocytes
was found by microscopic evaluation of pleural fluid and Salmonella
enteritidis was isolated by its culture. There were no pathogenic bacteria in
stool culture and hemoculture remained sterile. Toxins A and B of Clostridium
difficile were not detected in stool. The patient was treated by
ciprofloxacin and cefrtiaxone for 14 days with drainage of the purulent
content, what was followed by the resolution and organization of the pleural
fluid. After the stabilization of his general condition, chemotherapy with
cyclophosphamide, vincristine, prednisone (COP) was introduced, with complete
response. Conclusion. Although rare, pleural empyema caused by nontyphoidal
Salmonella should be considered in patients with severe immunosuppression,
because appropriate antimicrobial therapy with surgical measures are very
important for the outcome in these patients.
Some specificities in the management of hyperglycemia in patients with diabetic kidney disease
Authors: Dragovic Tamara , Marinkovic Dejan , Kikovic Sasa , Pejovic Janko , Hajdukovic Zoran
Published: January 2016

nema
A Protein Preload Enhances the Glucose-Lowering Efficacy of Vildagliptin in Type 2 Diabetes
Authors: Wu Tongzhi , Little Tanya J. , Bound Michelle J. , Borg Malcolm , Zhang Xiang , Deacon Carolyn F. , Horowitz Michael , Jones Karen L. , Rayner Christopher K.
Published: January 2016

OBJECTIVE

Nutrient “preloads” given before meals can attenuate postprandial glycemic excursions, at least partly by slowing gastric emptying and stimulating secretion of the incretins (i.e., glucagon-like peptide-1 [GLP-1] and glucose-dependent insulinotropic polypeptide [GIP]). This study was designed to evaluate whether a protein preload could improve the efficacy of the dipeptidyl peptidase-4 (DPP-4) inhibitor vildagliptin to increase incretin concentrations, slow gastric emptying, and lower postprandial glycemia in type 2 diabetes.

RESEARCH DESIGN AND METHODS

Twenty-two patients with type 2 diabetes treated with metformin were studied on four occasions, receiving either 50 mg vildagliptin (VILD) or placebo (PLBO) on both the evening before and the morning of each study day. The latter dose was followed after 60 min by a preload drink containing either 25 g whey protein (WHEY) or control flavoring (CTRL), and after another 30 min by a 13C-octanoate–labeled mashed potato meal. Plasma glucose and hormones, and gastric emptying, were evaluated.

RESULTS

Compared with PLBO/CTRL, PLBO/WHEY reduced postprandial peak glycemia, increased plasma insulin, glucagon, and incretin hormones (total and intact), and slowed gastric emptying, whereas VILD/CTRL reduced both the peak and area under the curve for glucose, increased plasma intact incretins, and slowed gastric emptying but suppressed plasma glucagon and total incretins (P < 0.05 each). Compared with both PLBO/WHEY and VILD/CTRL, VILD/WHEY was associated with higher plasma intact GLP-1 and GIP, slower gastric emptying, and lower postprandial glycemia (P < 0.05 each).

CONCLUSIONS

In metformin-treated type 2 diabetes, a protein preload has the capacity to enhance the efficacy of vildagliptin to slow gastric emptying, increase plasma intact incretins, and reduce postprandial glycemia.
Neurological Worsening in a Child of Miliary Tuberculosis with Neuro-Tuberculosis on Anti Tubercular Treatment
Authors: Arora Sunita , Narang Gursharan Singh , Dhillon Prabhjot Kaur
Published: January 2016

A seven and half year old male child presenting with pyrexia of unknown origin was diagnosed to be a case of miliary tuberculosis. Neuroimaging revealed multiple discrete ring as well as nodular enhancing lesions indicative of tuberculomas. After the initial response to ATT along with systemic steroids the child again presented with severe headache along with vomiting towards the end of intensive phase. Repeat neuroimaging showed appearance of new lesions with perilesional edema. Child was started again on systemic steroids and Streptomycin was added to the anti tubercular regimen, to which the child responded well.J Nepal Paediatr Soc 2015;35(2):185-188
Infantile Seborrheic Dermatitis
Authors: Pandita Aakash , Sharma Deepak , Murki Srinivas , Pratap Tejo
Published: January 2016

No abstract available.J Nepal Paediatr Soc 2015;35(2):206-207
Profile of Macrosomic Babies at a Tertiary Level Hospital
Authors: Shah Subhash Chandra , Shrestha Devendra , Dhakal Ajaya Kumar , Shakya Arati , Shakya Henish , Pradhan Amita
Published: January 2016

Introduction: Macrosomia is known to be associated with adverse neonatal outcomes. The aim of this study was to estimate the incidence of macrosomia in a tertiary teaching hospital of Nepal based on local intrauterine foetal growth percentile curve according to gestational age, risk factors for morbidity and mortality and neonatal outcome of macrosomia.Materials and Methods: This was a descriptive observational study done on live term macrosomic babies delivered during the study period at KIST Medical College Teaching Hospital, Lalitpur Nepal. The maternal and neonatal records of macrosomic babies were reviewed. All the macrosomic babies were followed up till discharge. Macrosomic babies needing admission into the neonatal care unit were considered as ones with complication. Maternal and neonatal risk factors associated with neonatal complications were analysed.Results: Among total of 2922 live singleton deliveries, 342 (11.7%) babies were macrosomic. The neonatal complications associated with macrosomia were seen in 19.6%. The risk factors significantly associated with neonatal complications were mode of delivery via caesarean section, instrumental delivery and 1 min low Apgar score. Maternal diabetes leading to macrosomia however was seen in only one case. The most common neonatal complications were neonatal sepsis (11.4%), significant hyperbilirubinaemia (2%) and transient tachypnoea of newborn (1.6%).Conclusions: Neonatal sepsis was the major cause of morbidity even in the macrosomic babies. Importance of early interventions for prevention and management of macrosomic babies with neonatal sepsis needs to be emphasized.J Nepal Paediatr Soc 2015;35(2):135-140
Adams – Oliver Syndrome
Authors: Joshi Avadhesh , Karnawat Bhag Singh , Jangid Manoj Kumar
Published: January 2016

Aplasia cutis congenita is characterized by congenital absence of portion of skin over a localized or widespread area. Adams- Oliver syndrome (subtype-II of ACC) is associated with distal limb reduction anomalies. We describe an infant with this uncommon disease associated with multiple midline lesions, which is a rare occurrence.   J Nepal Paediatr Soc 2015;35(2):168-171
Childhood Poisoning at a Tertiary Hospital in South West Nigeria
Authors: Olatunya Oladele Simeon , Isinkaye Ayodeji Olusola , Ogundare Ezra Olatunde , Oluwayemi Isaac Oludare , Akinola Foluso John
Published: January 2016

Introduction: Poisoning is a preventable cause of childhood morbidity and mortality. Information on childhood poisoning in the developing world is scanty. This study describes the profile of childhood poisoning in a third world hospital.Materials and Methods: Children admitted with poisoning over a 48-months period at the Ekiti State University Teaching Hospital Ado-Ekiti, Southwest Nigeria, were reviewed.Results: It was found that 81 of 5256 admissions representing 1.54% of the total admissions were due to poisoning. Kerosene, Drugs, Alcohol based herbal concoction, pesticides, corrosive agents and carbon monoxide were involved in 37.0%, 22.2%, 19.8%, 8.6%, 6.2% and 6.2% respectively. Accidental and non-accidental intentions were involved in 85.2% and 14.8% cases respectively. Administration of palm oil (oil from Elais guineensis), vomiting induction and herbal concoction were the leading home interventions in 69.1%, 38.3% and 23.5% respectively. One patient required intensive care. There were seven deaths and overall mortality rate was 8.6%.Conclusion: Poisoning remains a cause of childhood morbidity and mortality in Nigeria. Establishment of poisoning information and control centre is recommended among other strategies to combat its scourge.J Nepal Paediatr Soc 2015;35(2):103-110
Analysis of Co-morbidities in Children with Severe Acute Malnutrition in Eastern Nepal
Authors: Thapa Anil , Shah Gauri Shankar , Mishra Om P
Published: January 2016

Introduction: Malnutrition is a common problem in developing countries and often associated with co-morbidities. The present study was undertaken with objectives of to find out the comorbidities in children with severe acute malnutrition (SAM).Materials and Methods: This was a hospital based study carried in 77 children with SAM, diagnosed on the basis of WHO criteria.Results: The age group of children was 1- 5 years (median age 23 months) with about 39% between 1- 2 years. There were 38 males (49.3%). Low maternal education (60%), overcrowding (60%), lower- middle socioeconomic status (87%) were some of the predisposing factors observed. Pneumonia (51%), acute gastroenteritis (21%) and bacterial meningitis (8%) were common co- morbidities found. Associated abnormal laboratory parameters found were anemia (60%), leucocytosis (38%), hyboalbuminemia (36%) hyponetremia (31%), and hypokalemia (17%).Conclusion: Presence of infections and biochemical abnormalities require urgent attention in SAM cases and appropriate treatment in a hospital setting to improve their survival.J Nepal Paediatr Soc 2015;35(2):99-102
Rickets with Alopecia Signals Vitamin D Dependent Rickets Type II
Authors: Yadav Shankar Prasad , Bhatta Nisha Keshary
Published: January 2016

Vitamin D-dependent rickets type II is a rare autosomal recessive disorder. We report 27 months female child with classical rachitic changes, very high level of 25-hydroxy Vitamin D, 1,25 (OH)2D and markedly elevated serum Alkaline phosphatase. Very high dose of oral calcium and vitamin D3 was prescribed with minor improvement in skeletal features and alopecia. This case report hints the physician to diagnose and manage Vitamin D-dependent rickets type II, when rachitic changes are associated with alopecia.J Nepal Paediatr Soc 2015;35(2):198-201
Childhood Systemic Lupus Erythematosus: A Tertiary Care Centre Experience
Authors: Bajracharya Luna , Thapa Surya Bahadur
Published: January 2016

Introduction: Systemic lupus erythematosus (SLE) is a chronic immunologic disorder with multisystem manifestations. Even more awareness is required to diagnose the disease at younger age. Objective of this study was to explore clinico-laboratory manifestations and management of SLE in children at Tribhuvan University Teaching Hospital (TUTH).Materials and Methods: The study was retrospective hospital based study conducted from 15th July, 2008 to 14th July, 2014. Medical charts of all children and adolescent (6- 16years of age) with SLE admitted at TUTH were reviewed for analysis of data.Results: The total number of patients was 33, with 28(84.8%) girls and 5 (15.2%) boys. The mean age of diagnosis was 12.12 (SD 1.89). Facial puffiness (27.3%) and arthralgia (24.2%) were the commonest presentations at disease onset. The most frequent clinical features during the entire course of illness were edema (78.9%), anemia (69.7%) and fever (66.7%). Twenty three (69.6%) patients underwent renal biopsy in which class IV was the commonest lupus nephritis. The commonly used drugs after prednisolone were intravenous cyclophosphamide, intravenouse methylprednisolone and mycophenolate mofetil. Total 17 (51.5%) patients went into remission. Two patients died due to active lupus and four due to sepsis.Conclusion: Lupus nephritis was the commonest feature at disease onset, at the time of diagnosis and throughout the disease course among Nepalese children with SLE. The most frequently used medications were prednisolone and iv cyclophosphamide. Infection and active lupus were the leading causes of complications and death.J Nepal Paediatr Soc 2015;35(2):111-116
Rare Association of Bilateral Anotia with Congenital Facial Palsy
Authors: Bhatnagar Ruchika , Prasad Prem Lochan
Published: January 2016

Anotia is a birth defect and is associated with facial palsy and congenital heart defect as various presentation of cardiofacial syndrome. Herein we report a case of bilateral anotia and unilateral congenital facial palsy without congenital heart disease. It may occur due to single gene abnormality, teratogenic effect of maternal ingestion of thalidomide, retinoic acid, misoprostol or maternal diabetes, dietary lack of carbohydrates and folate.J Nepal Paediatr Soc 2015;35(2):195-197
Protein S Deficiency - An Uncommon Cause with Common Presentation
Authors: Kora Nabanita , Das Rajib , Som Sabyasachi , Laha Sumanta , Bannerji Nayan , Rana Kriti S
Published: January 2016

Correction: The correct PDF for this article was loaded on 9th March 2017. We offer our sincere apologies for having the wrong PDF loaded for this article.Stroke in child poses a major health problem. Thrombophilic factors have been implicated in 4-8% of young stroke worldwide. Protein S deficiency is a very rare cause of stroke. A few cases have been reported in literature. We are reporting a rare case of protein S deficiency causing stroke in a two year old child.J Nepal Paediatr Soc 2015;35(2):192-194
Propranolol Therapy for an Abdominal Giant Haemangioma in a Neonate
Authors: Docx Martine Karine Francine , Vandenberghe P , Van De Broek Dr , Govaert P
Published: January 2016

A one day old Moroccan boy was admitted to our neonatal unit with a giant tuberous right abdominal haemangioma. The clinical examination revealed no other vascular tumours. There was no evidence of heart failure. Ultrasound and MRA documented a giant vascular structure suggestive of haemangioma. The tumor responded well to propranolol treatment.J Nepal Paediatr Soc 2015;35(2):189-191
What We Still Don't Know About Peer Review
Authors: Sabaj Meruane Omar , González Vergara Carlos , Pina-Stranger Álvaro
Published: January 2016

Despite criticisms, the peer review process (PRP) is undoubtedly well established as an official and legitimated mechanism for evaluating and controlling scientific production. Although PRP has been a prominent object of study, we argue in this article that empirical research on PRP has not been addressed in a comprehensive way. Nine categories were applied to 150 empirical research articles on the topic with results revealing various gaps in empirical PRP research: (1) the research has been dedicated to the evaluation of the system rather than to the actual description of PRP as a concrete socio-discursive practice; (2) the most productive group of studies considers the multiple relationships between the sociological attributes (socio-demographic or scientometrical) of the actors (authors, reviewers, and editors) and the results of the process but does not take into account the texts exchanged by those actors; and (3) the few studies that do analyze the texts interchanged in the process do not take into account any of the variables included (such as scientometrical data, agreement, and rejection rates) in the more productive areas of the field. This lack of integration among the methodological approaches to PRP results in a partial comprehension of this important process, which determines the production and dissemination of an important part of scientific knowledge.
Pyrazole Supported Zinc(II) Benzoates as Catalysts for the Ring Opening Copolymerization of Cyclohexene Oxide and Carbon Dioxide
Authors: Lephoto Mapudumo , Nakano Koji , Appavoo Divambal , Owaga Bernard , Nozaki Kyoko , Darkwa James
Published: January 2016

The bis(pyrazole)zinc(II) benzoate complexes bis(3,5-diphenylpyrazole)zinc(II) benzoate (1), bis(3,5-diphenylpyrazole)zinc(II) 3,5-dinitrobenzoate (2), bis(3,5-diphenylpyrazole)zinc(II) 4-hydroxybenzoate (3), and bis(3,5-di-tert-butylpyrazole)zinc(II) 2-chlorobenzoate (4) were synthesized from the reaction of 3,5-diphenylpyrazole (L1) or 3,5-di-tert-butylpyrazole (L2), zinc(II) acetate and the appropriate benzene carboxylic acid. The molecular structure of complex 2 confirmed that these zinc(II) benzoate complexes adopt a 4-coordinate tetrahedral geometry. All four complexes were screened as catalysts for the copolymerization of carbon dioxide (CO2) and cyclohexene oxide (CHO) and were found to be active for the formation of poly(cyclohexene carbonate) (PCHC) at CO2 pressures as low as 1.0 MPa under solvent-free conditions and without the use of a co-catalyst. At some reaction condition, most of the catalysts produced PCHC with high carbonate content of up to 98% and a good amount of cyclic cyclohexene carbonate (CCHC). The copolymers produced have low to moderate molecular weights (5200–12300 g/mol) and with polydispersity indices that vary from 1.19 to 2.50. Matrix Assisted Laser Desorption/Ionization-Time of Flight Mass Spectra (MALDI-TOF MS) of these copolymers showed they have benzoate and hydroxyl end groups.
Optimal Siting and Sizing of Distributed Generators in Distribution Systems Considering Cost of Operation Risk
Authors: Gong Qingwu , Lei Jiazhi , Ye Jun
Published: January 2016

With the penetration of distributed generators (DGs), operation planning studies are essential in maintaining and operating a reliable and secure power system. Appropriate siting and sizing of DGs could lead to many positive effects forthe distribution system concerned, such as the reduced total costs associated with DGs, reduced network losses, and improved voltage profiles and enhanced power-supply reliability. In this paper, expected load interruption cost is used as the assessment of operation risk in distribution systems, which is assessed by the point estimate method (PEM). In light with the costs of system operation planning, a novel mathematical model of chance constrained programming (CCP) framework for optimal siting and sizing of DGs in distribution systems is proposed considering the uncertainties of DGs. And then, a hybrid genetic algorithm (HGA), which combines the GA with traditional optimization methods, is employed to solve the proposed CCP model. Finally,the feasibility and effectiveness of the proposed CCP model are verified by the modified IEEE 30-bus system, and the test results have demonstrated that this proposed CCP model is more reasonable to determine the siting and sizing of DGs compared with traditional CCP model.
Detection of Intelligent Intruders in Wireless Sensor Networks
Authors: Wang Yun , Chu William , Fields Sarah , Heinemann Colleen , Reiter Zach
Published: January 2016

Most of the existing research works on the intrusion detection problem in a wireless sensor network (WSN) assume linear or random mobility patterns in abstracting intruders’ models in traversing the WSN field. However, in real-life WSN applications, an intruder is usually an intelligent mobile robot with environment learning and detection avoidance capability (i.e., the capability to avoid surrounding sensors). Due to this, the literature results based on the linear or random mobility models may not be applied to the real-life WSN design and deployment for efficient and effective intrusion detection in practice. This motivates us to investigate the impact of intruder’s intelligence on the intrusion detection problem in a WSN for various applications. To be specific, we propose two intrusion algorithms, the pinball and flood-fill algorithms, to mimic the intelligent motion and behaviors of a mobile intruder in detecting and circumventing nearby sensors for detection avoidance while heading for its destination. The two proposed algorithms are integrated into a WSN framework for intrusion detection analysis in various circumstances. Monte Carlo simulations are conducted, and the results indicate that: (1) the performance of a WSN drastically changes as a result of the intruder’s intelligence in avoiding sensor detections and intrusion algorithms; (2) network parameters, including node density, sensing range and communication range, play a crucial part in the effectiveness of the intruder’s intrusion algorithms; and (3) it is imperative to integrate intruder’s intelligence in the WSN research for intruder detection problems under various application circumstances.
Preparation and Properties of Gelatin Fibers Fabricated by Dry Spinning
Authors: Chaochai Thitirat , Imai Yusuke , Furuike Tetsuya , Tamura Hiroshi
Published: January 2016

Gelatin fibers have been prepared by dry spinning based on the sol-gel transition phenomena of aqueous gelatin solutions. This method is simple and environmentally friendly because only water is used for the spinning, thereby avoiding the use of any toxic organic solvents. A sol-state aqueous solution of gelatin at 50 °C was extruded into air through a thin nozzle at room temperature followed by high-speed stretching in air. As a result, a stretched and shiny gelatin fiber was produced. To improve the mechanical and water-resistant properties of the fibers, a crosslinking treatment by the addition of sugars, denacol, and glutaraldehyde vapor was used. Despite their smooth surfaces, the gelatin fibers exhibited a multi-porous phase on the inside, probably owing to the retention of water during the spinning process. The mean diameters of the obtained fibers with all crosslinking agents were approximately 50–60 μm. Furthermore, the mean tensile strength was increased by all crosslinking agents. In particular, the use of N-acetyl-d-glucosamine and glutaraldehyde as the crosslinkers resulted in a remarkable increase in tensile strength and water resistance. Moreover, their properties were further improved after heat treatment. These fibers also exhibited good water resistance and maintained their morphologies for more than 90 days.
Pledges of Commitment and Cooperation in Partnerships
Authors: Deer Lachlan , Bayer Ralph-C.
Published: January 2016

We use experimental methods to investigate whether pledges of commitment can improve cooperation in endogenously-formed partnerships facing a social dilemma. Treatments vary in terms of the individual’s: (1) opportunity to commit to their partner; (2) the cost of dissolving committed partnerships; and (3) the distribution of these dissolution costs between partners. Our findings show that pledges of commitment alone can increase cooperation and welfare in committed partnerships. The introduction of relatively large and equally split costs yields similar gains. In contrast, when costs to dissolve committed partnerships fall solely on the individual choosing to break up, pledges of commitment fail to improve cooperation and welfare.
Measuring Indoor Air Quality and Engaging California Indian Stakeholders at the Win-River Resort and Casino: Collaborative Smoke-Free Policy Development
Authors: Klepeis Neil , Dhaliwal Narinder , Hayward Gary , Acevedo-Bolton Viviana , Ott Wayne , Read Nathan , Layton Steve , Jiang Ruoting , Cheng Kai-Chung , Hildemann Lynn , Repace James , Taylor Stephanie , Ong Seow-Ling , Buchting Francisco , Lee Juliet , Moore Roland
Published: January 2016

Most casinos owned by sovereign American Indian nations allow smoking, even in U.S. states such as California where state laws restrict workplace smoking. Collaborations between casinos and public health workers are needed to promote smoke-free policies that protect workers and patrons from secondhand tobacco smoke (SHS) exposure and risks. Over seven years, a coalition of public health professionals provided technical assistance to the Redding Rancheria tribe in Redding, California in establishing a smoke-free policy at the Win-River Resort and Casino. The coalition provided information to the casino general manager that included site-specific measurement of employee and visitor PM2.5 personal exposure, area concentrations of airborne nicotine and PM2.5, visitor urinary cotinine, and patron and staff opinions (surveys, focus groups, and a Town Hall meeting). The manager communicated results to tribal membership, including evidence of high SHS exposures and support for a smoke-free policy. Subsequently, in concert with hotel expansion, the Redding Rancheria Tribal Council voted to accept a 100% restriction of smoking inside the casino, whereupon PM2.5 exposure in main smoking areas dropped by 98%. A 70% partial-smoke-free policy was instituted ~1 year later in the face of revenue loss. The success of the collaboration in promoting a smoke-free policy, and the key element of air quality feedback, which appeared to be a central driver, may provide a model for similar efforts.
Basic Characteristics and Spatial Patterns of Pseudo-Settlements—Taking Dalian as An Example
Authors: Gao Jiaji , Zhang Yingjia , Li Xueming
Published: January 2016

A person’s living behavior patterns are closely related to three types of settlements: real-life settlements, imagined settlements, and pseudo-settlements. The term “pseudo-settlement” (PS) refers to the places that are selectively recorded and represented after the mass media chose and restructure the residence information. As the mass media rapidly develops and people’s way of obtaining information gradually change, PS has already become one of the main ways for people to recognize and understand real-life settlements, as well as describe their impressions of imagined settlements. PS also has a profound impact on tourism, employment, investment, migration, real estate development, etc. Thus, the study of PSs has important theoretical and practical significance. This paper proposes to put forward residential quarters where the mass media is displayed as the object of study and establishes the pseudo-settlement index system of Dalian in and elaborate analysis of the concept of PSs. From three aspects, including pseudo-buildings, pseudo-districts and pseudo-culture, this paper uses the ArcGIS 10.0 kernel density (spacial analyst) to analyze and interpret the basic characteristics and spatial patterns of 14 elements of the PS in Dalian. Through systemic clustering analysis, it identifies eight major types of PSs in Dalian. Then it systematically elaborates current situations and characteristics of the spatial pattern of PSs in Dalian, namely: regionally concentrated, widely scattered and blank spaces without pseudo-settlements. Finally, this paper discusses the mechanism of formation of PSs in Dalian.
Hierarchy and the Nature of Information
Authors: Cottam Ron , Ranson Willy , Vounckx Roger
Published: January 2016

We address the nature of information from a systemic structural point of view. Starting from the Natural hierarchy of living systems, we elucidate its decomposition into two partial hierarchies associated with its extant levels and inter-level regions, respectively. External observation of a hierarchical system involves the generation of approximate hyperscalar representations of these two partials, which then reintegrate to give a singular metascalar result. We relate Havel’s categories of reality and Peirce’s categories of experience to this result, and indicate that the ultimate result of the reintegration of hyperscalar data and context is a sign which is information.
Information Technology Support for Clinical Genetic Testing within an Academic Medical Center
Authors: Aronson Samuel , Mahanta Lisa , Ros Lei , Clark Eugene , Babb Lawrence , Oates Michael , Rehm Heidi , Lebo Matthew
Published: January 2016

Academic medical centers require many interconnected systems to fully support genetic testing processes. We provide an overview of the end-to-end support that has been established surrounding a genetic testing laboratory within our environment, including both laboratory and clinician facing infrastructure. We explain key functions that we have found useful in the supporting systems. We also consider ways that this infrastructure could be enhanced to enable deeper assessment of genetic test results in both the laboratory and clinic.
Stomach Chitinase from Japanese Sardine Sardinops melanostictus: Purification, Characterization, and Molecular Cloning of Chitinase Isozymes with a Long Linker
Authors: Kawashima Satoshi , Ikehata Hiroki , Tada Chihiro , Ogino Tomohiro , Kakizaki Hiromi , Ikeda Mana , Fukushima Hideto , Matsumiya Masahiro
Published: January 2016

Fish express two different chitinases, acidic fish chitinase-1 (AFCase-1) and acidic fish chitinase-2 (AFCase-2), in the stomach. AFCase-1 and AFCase-2 have different degradation patterns, as fish efficiently degrade chitin ingested as food. For a comparison with the enzymatic properties and the primary structures of chitinase isozymes obtained previously from the stomach of demersal fish, in this study, we purified chitinase isozymes from the stomach of Japanese sardine Sardinops melanostictus, a surface fish that feeds on plankton, characterized the properties of these isozymes, and cloned the cDNAs encoding chitinases. We also predicted 3D structure models using the primary structures of S. melanostictus stomach chitinases. Two chitinase isozymes, SmeChiA (45 kDa) and SmeChiB (56 kDa), were purified from the stomach of S. melanostictus. Moreover, two cDNAs, SmeChi-1 encoding SmeChiA, and SmeChi-2 encoding SmeChiB were cloned. The linker regions of the deduced amino acid sequences of SmeChi-1 and SmeChi-2 (SmeChi-1 and SmeChi-2) are the longest among the fish stomach chitinases. In the cleavage pattern groups toward short substrates and the phylogenetic tree analysis, SmeChi-1 and SmeChi-2 were classified into AFCase-1 and AFCase-2, respectively. SmeChi-1 and SmeChi-2 had catalytic domains that consisted of a TIM-barrel (β/α)8–fold structure and a deep substrate-binding cleft. This is the first study showing the 3D structure models of fish stomach chitinases.