bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-Term Health-Related Quality of Life Outcomes in Digital Replantation versus Revision Amputation
Authors: Bartow Matthew , Tremblay-Champagne Marie , Lin Alex , Landes Geneviève , Sebbag Sarah , Nikolis Andreas , Tessler Oren
Published: March 2017

Background Earlier, digit viability judged the success of digital replantation. Now, utility health-related quality of life (HRQOL) measures can better assess the impact of digital replantation.

Methods Overall, 264 digital injury patients were sent a regimen of utility measures: Disabilities of the Arm, Shoulder and Hand (DASH) score, European Quality of Life 5 Dimensions, visual analog scale (VAS), time trade-off (TTO), and standard gamble (SG). Overall, 51 patients responded completely to all of these—36 replantation patients and 15 revision amputation patients. The utility results of these patients were stratified between replantation versus revision amputation; dominant hand replantation versus nondominant hand replantation; and dominant hand revision amputation versus nondominant hand revision amputation.

Results The mean VAS score of replant (0.84) and revision amputation (0.75) groups was significantly different (p = 0.05). The mean DASH score of dominant hand replantations (29.72) and nondominant hand replantations (17.97) was significantly different (p = 0.027). The dominant hand revision amputation had higher anxiety levels in comparison to nondominant hand revision amputation (p = 0.027). Patients with two or more digits replanted showed a significant decrease in VAS, TTO, and SG scores in comparison to patients who only had one digit replanted (p = 0.009, 0.001, and 0.001, respectively).

Conclusions This study suggests that HRQOL can offer better indices for outcomes of digital replantation. This shows some specific replantation cohorts have a significantly better quality of life when compared with their specific correlating revision amputation cohort. These findings can be employed to further refine indications and contraindications to replantation and help predict the quality of life outcomes.
The analytical calibration model of temperature effects on a silicon piezoresistive pressure sensor
Authors: Nie Meng , Gao Yan
Published: March 2017

Presently, piezoresistive pressure sensors are highly demanded for using in various microelectronic devices. The electrical behavior of these pressure sensor is mainly dependent on the temperature gradient. In this paper, various factors,which includes effect of temperature, doping concentration on the pressure sensitive resistance, package stress, and temperature on the Young’s modulus etc., are responsible for the temperature drift of the pressure sensor are analyzed. Based on the above analysis, an analytical calibration model of the output voltage of the sensor is proposed and the experimental data is validated through a suitable model.
Molecular symmetry group analysis of the low-wavenumber torsions and vibration-torsions in the S1 state and ground state cation of p-xylene: An investigation using resonance-enhanced multiphoton ionization (REMPI) and zero-kinetic-energy (ZEKE) spectroscopy
Authors: Gardner Adrian M. , Tuttle William D. , Groner Peter , Wright Timothy G.
Published: March 2017

For the first time, a molecular symmetry group (MSG) analysis has been undertaken in the investigation of the electronic spectroscopy of p-xylene (p-dimethylbenzene). Torsional and vibration-torsional (vibtor) levels in the S1 state and ground state of the cation of p-xylene are investigated using resonance-enhanced multiphoton ionization (REMPI) and zero-kinetic-energy (ZEKE) spectroscopy. In the present work, we concentrate on the 0–350 cm−1 region, where there are a number of torsional and vibtor bands and we discuss the assignment of this region. In Paper II [W. D. Tuttle et al., J. Chem. Phys. 146, 124309 (2017)], we examine the 350–600 cm−1 region where vibtor levels are observed as part of a Fermi resonance. The similarity of much of the observed spectral activity to that in the related substituted benzenes, toluene and para-fluorotoluene, is striking, despite the different symmetries. The discussion necessitates a consideration of the MSG of p-xylene, which has been designated G72, but we shall also designate [{3,3}]D2h and we include the symmetry operations, character table, and direct product table for this. We also discuss the symmetries of the internal rotor (torsional) levels and the selection rules for the particular electronic transition of p-xylene investigated here.
Hydroelastic slamming of flexible wedges: Modeling and experiments from water entry to exit
Authors: Shams Adel , Zhao Sam , Porfiri Maurizio
Published: March 2017

Fluid-structure interactions during hull slamming are of great interest for the design of aircraft and marine vessels. The main objective of this paper is to establish a semi-analytical model to investigate the entire hydroelastic slamming of a wedge, from the entry to the exit phase. The structural dynamics is described through Euler-Bernoulli beam theory and the hydrodynamic loading is estimated using potential flow theory. A Galerkin method is used to obtain a reduced order modal model in closed-form, and a Newmark-type integration scheme is utilized to find an approximate solution. To benchmark the proposed semi-analytical solution, we experimentally investigate fluid-structure interactions through particle image velocimetry (PIV). PIV is used to estimate the velocity field, and the pressure is reconstructed by solving the incompressible Navier-Stokes equations from PIV data. Experimental results confirm that the flow physics and free-surface elevation during water exit are different from water entry. While water entry is characterized by positive values of the pressure field, with respect to the atmospheric pressure, the pressure field during water exit may be less than atmospheric. Experimental observations indicate that the location where the maximum pressure in the fluid is attained moves from the pile-up region to the keel, as the wedge reverses its motion from the entry to the exit stage. Comparing experimental results with semi-analytical findings, we observe that the model is successful in predicting the free-surface elevation and the overall distribution of the hydrodynamic loading on the wedge. These integrated experimental and theoretical analyses of water exit problems are expected to aid in the design of lightweight structures, which experience repeated slamming events during their operation.
A general method for the derivation of the functional forms of the effective energy terms in coarse-grained energy functions of polymers. I. Backbone potentials of coarse-grained polypeptide chains
Authors: Sieradzan Adam K. , Makowski Mariusz , Augustynowicz Antoni , Liwo Adam
Published: March 2017

A general and systematic method for the derivation of the functional expressions for the effective energy terms in coarse-grained force fields of polymer chains is proposed. The method is based on the expansion of the potential of mean force of the system studied in the cluster-cumulant series and expanding the all-atom energy in the Taylor series in the squares of interatomic distances about the squares of the distances between coarse-grained centers, to obtain approximate analytical expressions for the cluster cumulants. The primary degrees of freedom to average about are the angles for collective rotation of the atoms contained in the coarse-grained interaction sites about the respective virtual-bond axes. The approach has been applied to the revision of the virtual-bond-angle, virtual-bond-torsional, and backbone-local-and-electrostatic correlation potentials for the UNited RESidue (UNRES) model of polypeptide chains, demonstrating the strong dependence of the torsional and correlation potentials on virtual-bond angles, not considered in the current UNRES. The theoretical considerations are illustrated with the potentials calculated from the ab initio potential-energy surface of terminally blocked alanine by numerical integration and with the statistical potentials derived from known protein structures. The revised torsional potentials correctly indicate that virtual-bond angles close to 90° result in the preference for the turn and helical structures, while large virtual-bond angles result in the preference for polyproline II and extended backbone geometry. The revised correlation potentials correctly reproduce the preference for the formation of β-sheet structures for large values of virtual-bond angles and for the formation of α-helical structures for virtual-bond angles close to 90°.
Eckart ro-vibrational Hamiltonians via the gateway Hamilton operator: Theory and practice
Authors: Szalay Viktor
Published: March 2017

Recently, a general expression for Eckart-frame Hamilton operators has been obtained by the gateway Hamiltonian method [V. Szalay, J. Chem. Phys. 142, 174107 (2015) and V. Szalay, J. Chem. Phys. 143, 064104 (2015)]. The kinetic energy operator in this general Hamiltonian is nearly identical to that of the Eckart-Watson operator even when curvilinear vibrational coordinates are employed. Its different realizations correspond to different methods of calculating Eckart displacements. There are at least two different methods for calculating such displacements: rotation and projection. In this communication, the application of Eckart Hamiltonian operators constructed by rotation and projection, respectively, is numerically demonstrated in calculating vibrational energy levels. The numerical examples confirm that there is no need for rotation to construct an Eckart ro-vibrational Hamiltonian. The application of the gateway method is advantageous even when rotation is used since it obviates the need for differentiation of the matrix rotating into the Eckart frame. Simple geometrical arguments explain that there are infinitely many different methods for calculating Eckart displacements. The geometrical picture also suggests that a unique Eckart displacement vector may be defined as the shortest (mass-weighted) Eckart displacement vector among Eckart displacement vectors corresponding to configurations related by rotation. Its length, as shown analytically and demonstrated by numerical examples, is equal to or less than that of the Eckart displacement vector one can obtain by rotation to the Eckart frame.
Operational independence and tensor products of C*-algebras
Authors: Hamhalter Jan , Jin Shuilin
Published: March 2017

Complete C*-independence of operator algebras is introduced. Equivalent characterization is given for C*-subalgebras to be completely independent in terms of maximal tensor product. Besides, the independence of Banach algebras is considered, and we showed that Hahn–Banach independence is a generalization of C*-independence and discussed Hahn–Banach independence in Mn(A), where A is a C*-algebra. Among others, we characterize independence of operator algebras by projective and injective C*-tensor product in terms of simultaneous extensions of completely positive maps.
Magnetization reversal and inverted magnetoresistance of exchange-biased spin valves with a gadolinium layer
Authors: Milyaev M. , Naumova L. , Chernyshova T. , Proglyado V. , Kamensky I. , Krinitsina T. , Ryabukhina M. , Ustinov V.
Published: March 2017

FeMn-based spin valves with a gadolinium layer have been fabricated by magnetron sputtering. The magnetoresistive properties of the spin valves have been investigated at temperatures of 80–293 K. Temperature-induced switching between low- and high-resistance magnetic states has been revealed. Realization of the low- or high-resistance states depends on which magnetic moment dominates in the exchange-coupled Gd/CoFe, of Gd or CoFe. It has been shown that the switching temperature depends on the thickness of the gadolinium layer.
Miniature environmental chambers for temperature humidity bias testing of microelectronics
Authors: Hook Michael David , Mayer Michael
Published: March 2017

Environmental chambers are commonly used for reliability testing of microelectronics and other products and materials. These chambers are large, expensive, and limit electrical connectivity to devices under test. In this paper, we present a collection of ten small, low-cost environmental chambers, with humidity control based on mixtures of water and glycerol placed inside the chambers. We demonstrate relative humidities from 44% to 90%, at temperatures from 30 to 85 °C, enabling industry-standard testing at 85% humidity and 85 °C. The division of samples between ten separate chambers allows different conditions to be applied to each sample, in order to quickly characterize the effects of the environment on device reliability, enabling extrapolation to estimate lifetimes in working conditions.
Pulse length of ultracold electron bunches extracted from a laser cooled gas
Authors: Franssen J. G. H. , Frankort T. L. I. , Vredenbregt E. J. D. , Luiten O. J.
Published: March 2017

We present measurements of the pulse length of ultracold electron bunches generated by near-threshold two-photon photoionization of a laser-cooled gas. The pulse length has been measured using a resonant 3 GHz deflecting cavity in TM110 mode. We have measured the pulse length in three ionization regimes. The first is direct two-photon photoionization using only a 480 nm femtosecond laser pulse, which results in short (∼15 ps) but hot (∼104 K) electron bunches. The second regime is just-above-threshold femtosecond photoionization employing the combination of a continuous-wave 780 nm excitation laser and a tunable 480 nm femtosecond ionization laser which results in both ultracold (∼10 K) and ultrafast (∼25 ps) electron bunches. These pulses typically contain ∼103 electrons and have a root-mean-square normalized transverse beam emittance of 1.5 ± 0.1 nm rad. The measured pulse lengths are limited by the energy spread associated with the longitudinal size of the ionization volume, as expected. The third regime is just-below-threshold ionization which produces Rydberg states which slowly ionize on microsecond time scales.
Note: Optimization of magnifying a polarization angle with Littrow layout blazed gratings
Authors: Sasao H. , Arakawa H. , Imazawa R. , Kawano Y. , Itami K. , Kubo H.
Published: March 2017

Magnification of a polarization angle with Littrow layout gratings has been developed. High magnification with a factor of 7.7 using two gratings in Littrow layout was experimentally proved. The magnification range was investigated by calculation at a wavelength of 10.6 μm. The method can be applied for a high magnification factor >30. Larger groove numbers and smaller blaze angles are suitable for the large magnification. Statistical fluctuation of the diffracted polarization angle is compared with that of the incident polarization angle.
Dependence of single-shot pulse durations on near-infrared filamentation-guided breakdown in air
Authors: Schmitt-Sody Andreas , Elle Jennifer , Lucero Adrian , Domonkos Matthew , Ting Anthony , Hasson Victor
Published: March 2017

We present results of an experimental investigation of laser pulsewidth dependence of filamentation-guided high voltage breakdown in air. The experiments are conducted at laser peak power levels of 1 TW and pulse durations of 0.7 to 10 ps with a discharge gap separation of 10 cm. Synchronized electrical and optical diagnostic techniques were used to determine the pulsewidth dependence on the breakdown mechanism, threshold levels, time delays and associated jitter. The results indicate that longer pulses provide greater than 30% reduction in breakdown threshold voltage.
Leaf gas film retention during submergence of 14 cultivars of wheat (Triticum aestivum)
Authors: Konnerup Dennis , Winkel Anders , Herzog Max , Pedersen Ole
Published: March 2017

Flooding of fields after sudden rainfall events can result in crops being completely submerged. Some terrestrial plants, including wheat (Triticum aestivum L.), possess superhydrophobic leaf surfaces that retain a thin gas film when submerged, and the gas films enhance gas exchange with the floodwater. However, the leaves lose their hydrophobicity during submergence, and the gas films subsequently disappear. We tested gas film retention time of 14 different wheat cultivars and found that wheat could retain the gas films for a minimum of 2 days, whereas the wild wetland grass Glyceria fluitans (L.) R.Br. had thicker gas films and could retain its gas films for a minimum of 4 days. Scanning electron microscopy showed that the wheat cultivars and G. fluitans possessed high densities of epicuticular wax platelets, which could explain their superhydrophobicity. However, G. fluitans also had papillae that contributed to higher hydrophobicity during the initial submergence and could explain why G. fluitans retained gas films for a longer period of time. The loss of gas films was associated with the leaves being covered by an unidentified substance. We suggest that leaf gas film is a relevant trait to use as a selection criterion to improve the flood tolerance of crops that become temporarily submerged.
Characterisation of microsatellites for Litoria nannotis (Amphibia : Hylidae), an endangered waterfall frog endemic to the Australian Wet Tropics
Authors: Puschendorf Robert , Todd Erica V. , Gardner Michael G.
Published: March 2017

Litoria nannotis is an endangered waterfall frog from the wet tropics region in north Queensland that has suffered significant population declines due to the emerging fungal disease known as chytridiomycosis. The species has two deeply divergent lineages, and we used 454 shotgun sequencing of DNA extracted from one individual of the northern lineage to identify and design PCR primers for 576 microsatellite loci. Thirty markers were tested for amplification success and variability in a population sample from each lineage. Of these, 17 were found to be polymorphic in the northern lineage and 10 loci were polymorphic in the southern lineage. Numbers of alleles per locus ranged from 2 to 14 (mean = 6.47, s.d. = 4.02) for the northern lineage (17 polymorphic loci), and from 2 to 8 (mean = 5.40, s.d. = 2.55) in the southern lineage (10 polymorphic loci). Levels of heterozygosity were high in both lineages (northern mean HE = 0.63, s.d. = 0.21, range = 0.27–0.89; southern mean HE = 0.57, s.d. = 0.25, range = 0.18–0.81). These loci will be useful in understanding the genetic variation and connectivity amongst populations of this species recovering from mass population declines due to disease.
Paris: optimism, pessimism and realism
Authors: Heatley Brian
Published: March 2017

The climate agreement signed in Paris in December 2015 has been widely hailed as a huge step towards limiting climate change to a safe 2°C. It is not; Paris locks the world into a future where at least a 3–4°C rise by 2100 is virtually inevitable. This will mean a world where there will be massive famine and conflict in much of Africa and the Middle East, serious hunger in South Asia, huge migration pressures but manageable problems in the Americas and more difficult but probably still manageable problems in Europe. Globalisation may collapse, which will be particularly challenging for the UK with its dependence on food imports and international trade. In politics the 200-year hegemony of the idea of progress will be over, while our focus will become more local, putting great pressure on the idea of human universalism.
Efficiency of lamellipodia protrusion is determined by the extent of cytosolic actin assembly
Authors: Dimchev Georgi , Steffen Anika , Kage Frieda , Dimchev Vanessa , Pernier Julien , Carlier Marie-France , Rottner Klemens
Published: March 2017

Cell migration and cell–cell communication involve the protrusion of actin-rich cell surface projections such as lamellipodia and filopodia. Lamellipodia are networks of actin filaments generated and turned over by filament branching through the Arp2/3 complex. Inhibition of branching is commonly agreed to eliminate formation and maintenance of lamellipodial actin networks, but the regulation of nucleation or elongation of Arp2/3-independent filament populations within the network by, for example, formins or Ena/VASP family members and its influence on the effectiveness of protrusion have been unclear. Here we analyzed the effects of a set of distinct formin fragments and VASP on site-specific, lamellipodial versus cytosolic actin assembly and resulting consequences on protrusion. Surprisingly, expression of formin variants but not VASP reduced lamellipodial protrusion in B16-F1 cells, albeit to variable extents. The rates of actin network polymerization followed a similar trend. Unexpectedly, the degree of inhibition of both parameters depended on the extent of cytosolic but not lamellipodial actin assembly. Indeed, excess cytosolic actin assembly prevented actin monomer from rapid translocation to and efficient incorporation into lamellipodia. Thus, as opposed to sole regulation by actin polymerases operating at their tips, the protrusion efficiency of lamellipodia is determined by a finely tuned balance between lamellipodial and cytosolic actin assembly.
Cell–cell and cell–extracellular matrix adhesions cooperate to organize actomyosin networks and maintain force transmission during dorsal closure
Authors: Goodwin Katharine , Lostchuck Emily E. , Cramb Kaitlyn M. L. , Zulueta-Coarasa Teresa , Fernandez-Gonzalez Rodrigo , Tanentzapf Guy
Published: March 2017

Tissue morphogenesis relies on the coordinated action of actin networks, cell–cell adhesions, and cell–extracellular matrix (ECM) adhesions. Such coordination can be achieved through cross-talk between cell–cell and cell–ECM adhesions. Drosophila dorsal closure (DC), a morphogenetic process in which an extraembryonic tissue called the amnioserosa contracts and ingresses to close a discontinuity in the dorsal epidermis of the embryo, requires both cell–cell and cell–ECM adhesions. However, whether the functions of these two types of adhesions are coordinated during DC is not known. Here we analyzed possible interdependence between cell–cell and cell–ECM adhesions during DC and its effect on the actomyosin network. We find that loss of cell–ECM adhesion results in aberrant distributions of cadherin-mediated adhesions and actin networks in the amnioserosa and subsequent disruption of myosin recruitment and dynamics. Moreover, loss of cell–cell adhesion caused up-regulation of cell–ECM adhesion, leading to reduced cell deformation and force transmission across amnioserosa cells. Our results show how interdependence between cell–cell and cell–ECM adhesions is important in regulating cell behaviors, force generation, and force transmission critical for tissue morphogenesis.
Playable Bodies
Authors: Miller Kiri
Published: March 2017

Playable Bodies investigates what happens when machines teach humans to dance. Dance videogames work as engines of humor, shame, trust, and intimacy, urging players to dance like nobody’s watching—while being tracked by motion-sensing interfaces in their living rooms. The chart-topping dance game franchises Just Dance and Dance Central transform players’ experiences of popular music, invite experimentation with gendered and racialized movement styles, and present new possibilities for teaching, learning, and archiving choreography. The book shows how these games teach players to regard their own bodies as both interfaces and avatars, and how a convergence of choreography and programming code is driving a new wave of full-body virtual-reality media experiences. Drawing on five years of ethnographic research with players, game designers, and choreographers, Playable Bodies situates dance games in a media ecology that includes the larger game industry, viral music videos, reality TV competitions, marketing campaigns, consumer reviews, social media discourse, and emerging surveillance technologies. Miller tracks the circulation of dance gameplay and related “body projects” across media platforms to reveal how dance games function as “intimate media,” configuring new relationships among humans, interfaces, music and dance repertoires, and social media practices.
Listening Like a Dancer
Authors: Miller Kiri
Published: March 2017

This chapter addresses multisensory musicality in dance games, situating gameplay as a form of embodied popular music reception that intersects with other kinds of musical experience and social media practice. Dance games capitalize on players’ prior relationships with particular songs, artists, and genres. They offer curated collections of licensed popular music tracks, and their dance routines are kinesthetic transcriptions of these musical works. Game choreographers employ specific listening techniques to create these routines; players report that performing game choreography transforms their listening experience. The chapter focuses on three aspects of interactive audio in dance games: how game developers turn song into dance, how players learn to listen like choreographers, and how gameplay offers experiential lessons in multisensory musicality by engaging players in proprioceptive interaction with sound. Interactive audio in dance games serves to cultivate a choreographic listening sensibility, bringing the listening ear and the moving body into intimate alignment.
Intimate Media
Authors: Miller Kiri
Published: March 2017

This chapter addresses dance games as “intimate media,” showing how they configure intimate relationships among humans, interfaces, musical and choreographic repertoires, and other social media practices. It guides readers through my research experience: navigating social media feeds, following chains of related videos, reading scholarly literature alongside comment threads, and learning to listen for concord, discord, echoes, and rhymes across these materials. The chapter presents six portraits of collective body projects mobilized via social media, placing dance games in the context of a broader media ecology that includes user-generated content, advertising campaigns, commercial music videos, mobile apps, and viral videos. These six body projects—uploading, disciplining, infringing, autodancing, belonging, and circulating—show us players negotiating the dynamics of control and consent that drive so many interactive media experiences today.
Characteristics of the VARHS Data and Other Data Sources
Authors: Brandt Kasper , Tarp Finn
Published: March 2017

The VARHS was first implemented in 2002 when it was realized that more information on household resources and the interaction of resources was needed in Viet Nam. From 2006 and onwards, households from twelve provinces are surveyed biennially and data collected. The studies of this book almost exclusively rely on households that are present in all VARHS datasets between 2006 and 2014, which covers 2,162 households being interviewed five times. The sample of VARHS households resembles, to a large extent, the samples in the representative VHLSS datasets and the 2009 population census. This implies that the results put together in this book are likely to apply to a more extensive part of the Vietnamese population than initially planned for.
Local Antibiotic Therapy to Reduce Infection After Operative Treatment of Fractures at High Risk of Infection: A Multicenter, Randomized, Controlled Trial (VANCO Study)
Authors: O'Toole Robert V. , Joshi Manjari , Carlini Anthony R. , Murray Clinton K. , Allen Lauren E. , Scharfstein Daniel O. , Gary Joshua L. , Bosse Michael J. , Castillo Renan C. ,   METRC
Published: March 2017

A number of clinical studies in the spine literature suggest that the use of local vancomycin powder may substantially reduce surgical site infections (SSIs). These studies are primarily retrospective and observational and few focus on orthopaedic trauma patients. This study is a phase III, prospective, randomized, clinical trial to assess the efficacy of locally administered vancomycin powder in the prevention of SSI after fracture surgery. The primary goal of the VANCO Study is to compare the proportion of deep SSI 6 months after fracture fixation surgery. A secondary objective is to compare species and antibacterial susceptibilities among study patients who develop SSI. An additional objective is to build and validate a risk prediction model for the development of SSI. The study population consists of patients aged 18–80 years with tibial plateau or pilon (tibial plafond) fractures, at higher risk of infection, and definitively treated with plate and screw fixation. Participants are block randomized (within center) in a 1:1 ratio to either treatment group (local vancomycin powder up to a maximum dose of 1000 mg, placed immediately before wound closure) or control group (standard of care) for each study injury location, and return to the clinic for evaluations at 2 weeks, 3 months, and 6 months after fixation. The targeted sample size for the study is 500 fractures per study arm. This study should provide important information regarding the use of local vancomycin powder during the definitive treatment of lower extremity fractures and has the potential to significantly reduce the incidence of infection after orthopaedic trauma.
Assessment of Severe Extremity Wound Bioburden at the Time of Definitive Wound Closure or Coverage: Correlation With Subsequent Postclosure Deep Wound Infection (Bioburden Study)
Authors: Bosse Michael J. , Murray Clinton K. , Carlini Anthony R. , Firoozabadi Reza , Manson Theodore , Scharfstein Daniel O. , Wenke Joseph C. , Zadnik Mary , Castillo Renan C. ,   METRC
Published: March 2017

Infection remains the most common and significant complication after high-energy fractures. The Bioburden Study is a multicenter, prospective, observational cohort study of wound bacterial bioburden and antibiotic care in severe open lower extremity fractures. The aims of this study are to (1) characterize the contemporary extremity wound “bioburden” at the time of definitive wound closure; (2) determine the concordance between polymerase chain reaction results and hospital microbiology; (3) determine, among those who develop deep infections, the concordance between the pathogens at wound closure and at deep infection; and (4) compare the probability of deep infection between those who did and did not receive an appropriate course of antibiotics based on bioburden at the time of wound closure. To address these aims, sites collected tissue samples from severe lower extremity injuries at the time of wound closure and at first surgery for treatment of a deep infection, nonunion, flap failure, amputation, or other complications (because these surgeries may be due to undetected infection). Otherwise, if no further surgical treatment occurred, participants were followed for 12 months. The study was conducted at 38 US trauma centers and has enrolled 655 participants aged 18–64 years. This is the first large multi-institutional study evaluating the wound bioburden of severe open tibia fractures and correlating this bioburden with the risk of wound complications after definitive soft tissue closure.
The Sterility of Partially Used Hyaluronic Acid Fillers After Long Storage
Authors: Al-Haddab Mohammed , Abduljabbar Amr , Al-Somaily Ali
Published: March 2017

BACKGROUND

Hyaluronic acid (HA) gel fillers represent most soft tissue augmentation procedures currently used, because they have lower rates of complications compared with other materials. Many patients do not consume an entire syringe of filler but may require a retouch or intermittent augmentation after some time. The remaining material is commonly stored in a specific environment for reuse by the same patient.

OBJECTIVE

There are an insufficient number of recommendations concerning the safety of storing and reusing dermal fillers in the literature because of the paucity of studies. The aim of this study was to investigate the potential infectious contamination associated with the storage of HA fillers after patient treatment.

METHODS

Hyaluronic acid from previously used syringes was stored at room temperature under sterile conditions for varying durations beginning from 2009. Later, the material was submitted for panculture, including gram-positive and gram-negative bacteria, mycobacteria, and fungi.

RESULTS

No fungal or mycobacterial agents were cultured from any of the samples. There were a few positive bacterial cultures, but they were predominantly contaminated with normal skin surface flora.

CONCLUSION

Although it is commonly practiced, the storage of HA fillers after initial patient injection carries a real but small risk of contamination.
Long-Term Outcomes of Melanoma In Situ Treated With Topical 5% Imiquimod Cream: A Retrospective Review
Authors: Park Andrew J. , Paul Joan , Chapman M. Shane , Samie Faramarz H.
Published: March 2017

BACKGROUND

Melanoma in situ (MIS) is a noninvasive form of melanoma for which nonsurgical therapeutic options continue to be explored. The off-label use of topical 5% imiquimod cream in the management of MIS has shown potential but reported recurrence rates vary considerably between 0% and 40%. Furthermore, the long-term efficacy of imiquimod is not well established.

OBJECTIVE

To determine the recurrence rate of MIS among patients treated with topical 5% imiquimod cream at Dartmouth-Hitchcock Medical Center with at least 1 year of follow-up.

METHODS

A retrospective chart review identified 12 patients with MIS who have been treated with topical 5% imiquimod cream for 6 to 12 weeks. Patients who underwent surgical treatment for MIS were excluded from analysis.

RESULTS

Of 12 patients with histologically confirmed MIS treated with topical 5% imiquimod cream, there were 2 recurrences (17%) during a median follow-up time of 5.5 years.

CONCLUSION

Although surgery is still considered the gold standard for the treatment of MIS, imiquimod may represent a potentially effective noninvasive treatment option for patient who are not surgical candidates.
Development and Validation of an LC-MS/MS Method for the Simultaneous Quantification of Abiraterone, Enzalutamide, and Their Major Metabolites in Human Plasma
Authors: van Nuland Merel , Hillebrand M. J. X. , Rosing H. , Schellens J. H. M. , Beijnen J. H.
Published: March 2017

Background:

Abiraterone acetate and enzalutamide are 2 novel drugs for the treatment of metastatic castration-resistant prostate cancer. The metabolism of these drugs is extensive. Major metabolites are N-desmethyl enzalutamide, enzalutamide carboxylic acid, abiraterone N-oxide sulfate, and abiraterone sulfate; of which N
-desmethyl enzalutamide is reported to possess antiandrogen capacities. A liquid chromatography-tandem mass spectrometry method for simultaneous quantification of abiraterone, enzalutamide, and the main metabolites has been developed and validated to support therapeutic drug monitoring.

Methods:

Human plasma samples of patients treated with abiraterone or enzalutamide were harvested at the clinic and stored at −20°C. Proteins were precipitated by acetonitrile, and the final extract was injected on a Kinetex C18 column and separated with gradient elution. Analytes were detected by liquid chromatography-mass spectrometry (Triple Quad 6500).

Results:

The method was validated over various linear ranges: 1–100 ng/mL for abiraterone, 5–500 ng/mL for enzalutamide and enzalutamide carboxylic acid, 10–1000 ng/mL for N-desmethyl enzalutamide, 30–3000 ng/mL for abiraterone N-oxide sulfate, and 100–10,000 ng/mL for abiraterone sulfate. Intra-assay and interassay variabilities were within ±15% of the nominal concentrations for quality control samples at medium and high concentrations and within ±20% at the lower limit of quantification, respectively.

Conclusions:

The described method for simultaneous determination of abiraterone and enzalutamide was validated successfully and provides a useful tool for therapeutic drug monitoring in patients treated with these agents.
Simultaneous Determination of Protein-Unbound Cyclosporine A and Mycophenolic Acid in Kidney Transplant Patients Using Liquid Chromatography–Tandem Mass Spectrometry
Authors: Bittersohl Heike , Herbinger Juliane , Wen Ming , Renders Lutz , Steimer Werner , Luppa Peter B.
Published: March 2017

Background:

Therapeutic drug monitoring (TDM) of immunosuppressants is essential to optimize patient care after organ transplantation. In blood, most immunosuppressive drugs are bound to plasma proteins or located inside blood cells. However, it is generally assumed that only protein-unbound (free) drug concentrations are pharmacologically active and could therefore better reflect the clinical outcome. Study data are still limited due to lacking rapid analytical methods. Therefore, a simple multiplex method for direct measurement of free cyclosporine A (CsA) and mycophenolic acid (MPA) has been developed.

Methods:

The sample preparation included ultracentrifugation, followed by liquid–liquid extraction. Stable isotope labeled analogues of CsA and MPA were used as internal standards. The LC-MS/MS analysis was performed on a triple quadrupole mass spectrometer in the multiple reaction monitoring mode. The validated assay was used in a study of 40 blood samples from kidney transplant patients.

Results:

The lower limits of quantification were 0.1 (CsA) and 0.5 ng/mL (MPA). Assay linearity was confirmed in the concentration ranges of 0.1–10.0 ng/mL (CsA) and 0.5–100 ng/mL (MPA). For both analytes, inaccuracy was ≤9.8% and imprecision was ≤7.8%. The extraction efficiency ranged between 91% and 96%. In the patient samples the average free CsA and MPA fractions were 5.8% (2.1%–16.8%) and 1.2% (0.5%–2.4%) respectively.

Conclusions:

A reliable and highly sensitive LC-MS/MS method as a new suitable tool for measuring protein-unbound CsA and MPA has been developed, validated and applied in kidney transplant patient samples. Now, larger studies can be conducted to investigate the benefit of free drug monitoring in transplant recipients.
Wound Measurement Tools and Techniques: A Review
Authors: Wendland Deborah M. , Taylor David W. M.
Published: March 2017

Background:

Chronic wounds in the United States are prevalent and costly, both financially and socially. Wound measurement is a cornerstone of best practice for wound management and reimbursement. For evidence-based best practice, wound measurement should be accurate and reliable to optimize patient care and outcomes.

Purpose:

The purpose of this narrative review was to articulate available measurement tools and techniques along with their accuracy, reliability, and clinical feasibility.

Methods:

CINAHL and MEDLINE were searched using combinations of key words related to wound measurement, wound types, measurement tools, reliability, repeatability, accuracy, or feasibility.

Results:

A total of 71 articles were included. Descriptions of the measurement tools were reported, as well as advantages/disadvantages related to inter- and intrarater reliability, accuracy, and feasibility were extracted. Measurement mechanisms were classified as contact versus noncontact. Measurement mechanisms described include rulers, manual tracing, photography, smartphone technology, laser-assisted technology, and stereophotogrammetry.

Conclusion:

Accuracy, reliability, and feasibility of wound measurement are critical to optimal evidence-based practice. This review finds that, at a minimum, noncontact measurement methods such as digital planimetry or analysis software should be used along with digital photography. More expensive accurate and reliable options, including laser-assisted technology or stereophotogrammetry, are appropriate if financially feasible.
Cane Handle Designs—Pressure and Preference: A Pilot Study
Authors: Beasley Jeanine , Kenyon Lisa , Midena Amber , Chartier Jaimie , Meyers Karrie , Ashby Blake , Anderson Kirk
Published: March 2017

Purpose:

There is limited evidence to guide clinical reasoning processes regarding the selection of mobility-related assistive devices in the acute care setting. The purpose of this study was to determine whether there was a significant difference in pressure while grasping a standard cylindrical or an ergonomic cane handle during an ambulation activity, and to identify which handle the participants preferred.

Methods:

The Novel Pliance-X system was used to collect mean and maximum pressure applied to the 2 cane handle designs by the dominant hands of 43 unimpaired participants walking with a 2-point modified gait.

Results:

There was no statistically significant difference found between the average mean pressure applied using the standard cane versus the ergonomic cane. The average maximum pressure for the ergonomic cane was significantly greater than the average maximum pressure for the standard cane. Participants preferred the ergonomic cane handle.

Conclusions:

Pressure applied while grasping a cane handle is a complex biomechanical activity involving many factors. In this study no clear differences were found in average mean pressure when comparing the 2 cane handles used by individuals without impairment. Additional research is needed to assist therapists in selecting the most appropriate cane handle for specific patients.
Impact of Chronic Suppurative Otitis Media in Pediatric Cochlear Implant Recipients—Insight into the Challenges from a Tertiary Referral Center in UK
Authors: Baruah Paramita , Hanvey Kate , Irving Richard , Tzifa Konstance
Published: March 2017

Objective:

Analyze the presentation and evolution of chronic suppurative otitis media (CSOM) in children with cochlear implants (CI) and explore the merit of early intervention.

Study Design:

Retrospective patient review.

Setting:

Tertiary referral hospital and cochlear implant programme.

Patients:

Children with a CI who developed CSOM.

Intervention:

Tympanoplasty.

Main Outcome Measures:

Disease control, recurrence of cholesteatoma, cochlear implant preservation.

Results:

Eight children fit our inclusion criteria with a mean follow up of 8 years. Onset of CSOM symptoms was observed on an average of 5 years after implantation (range, 2–13 yr) and led to surgical intervention in an average of 15.6 months following symptom onset. Cholesteatoma was found in four of the eight patients. Of these, one patient underwent a subtotal petrosectomy and explantation with reimplantation at the same stage but the reimplant failed to function and was explanted subsequently. One patient was initially managed by a canal wall up mastoidectomy and explantation but went on to require subtotal petrosectomy and labyrinthectomy for recurrent disease. One patient underwent a subtotal petrosectomy with explantation and is awaiting a reimplantation. The fourth patient had limited disease around the electrodes that was excised without compromising the implant. In the group of patients with CSOM without cholesteatoma, one underwent an explantation due to recurrent ear infections and a subsequent cartilage tympanoplasty for a retracted eardrum. The remaining three patients underwent successful excision of retraction pockets and repair of eardrums using cartilage with the implant in situ. A mean follow up of 2 years after the implant preservation surgeries shows good functioning of the CI.

Conclusion:

Early recognition of CSOM is paramount in patients with CI as delay in treatment can result in the infection spreading via the cochleostomy resulting in loss of the cochlea. Recurrent ear infections in an implanted ear should prompt early examination to exclude the presence of middle ear disease, which may require anesthesia in a young child.
Chronologic Changes and Correlates of Loop Diuretic Dose in Patients with Left Ventricular Assist Device
Authors: Kido Kazuhiko , George Bennet , Charnigo Richard J. , Macaulay Tracy E. , Brouse Sara D. , Guglin Maya
Published: March 2017

No study has systematically evaluated the prevalence and dosages of diuretic use for patients after left ventricular assist device (LVAD) implantation. The primary objective was to characterize chronologic change in prevalence and doses of loop diuretics after LVAD placement. The secondary objective was to identify correlates of actual doses of loop diuretics. We retrospectively reviewed medical records of adult patients with LVAD implantation at the University of Kentucky. Prevalence of diuretic use and furosemide equivalent dose were assessed before LVAD implantation and at seven time points thereafter: 1 week, 1 month, 3 months, 6 months, 1 year, 18 months, and 2 years. Correlation analyses and linear mixed modeling were used to identify correlates of diuretic dose before and after LVAD implantation. Eighty-two consecutive eligible patients were reviewed. The prevalence of loop diuretic use was 95% at baseline but significantly lower than that at all subsequent time points (p < 0.048 for all). Nevertheless, more than half of patients on whom we had such follow-up data were on loop diuretics 2 years after LVAD implantation. Average furosemide equivalent dose was significantly lower at every time point after implantation compared with baseline (p < 0.006 for all). Blood urine nitrogen (BUN) was the most robust predictor of dose after LVAD implant. The prevalence and average furosemide equivalent dose were significantly reduced after LVAD implantation, but the use of loop diuretic remained more than 50% for up to 2 years. Consistent association with BUN may indirectly indicate overuse of diuretics post-LVAD implant.
Novel regulators of plasma lipid levels
Authors: Loaiza Natalia , Oldoni Federico , Kuivenhoven Jan A.
Published: March 2017

Purpose of review

To highlight very recent studies identifying novel regulatory molecules and mechanisms in plasma lipid metabolism.

Recent findings

Two novel regulatory mechanisms of LDL receptor (LDLR) intracellular trafficking have been described. The “COMMD/CCDC22/CCDC93” and “Wiskott–Aldrich syndrome protein and SCAR homologue” complexes were found to be involved in LDLR endosomal sorting and recycling, whereas the GRP94 was shown to protect LDLR from early degradation within the hepatocyte secretory pathway. Additionally, the transcription factors PHD1 and Bmal1 were identified to regulate LDL-C levels in mice by modulating cholesterol excretion. Important advances are reported on the relevance of two Genome Wide Association Studies hits: Reassessment of GALNT2 showed, in contrast to previous reports, that loss of GALNT2 reduces HDL-cholesterol in humans and other mammalian species, while phospholipid transfer protein was identified as an additional target of GALNT2. Tetratricopeptide repeat domain protein 39B was found to promote ubiquitination and degradation of Liver X receptor, and its deficiency increased HDL-cholesterol and cholesterol removal while also inhibiting lipogenesis in mice.

The unraveling of mechanisms how new factors modulate plasma lipid levels keep providing interesting opportunities to rationally design novel therapies to treat cardiovascular disease but also metabolic disorders.