bluuebunny/crossref_metadata_2025 huggingface dataset:
The Abiotrophies of the Retina and Choroid
Authors: Sorsby Arnold
Published: July 2019

Hereditary lesions fall into three groups:— Malformations: Present at birth. Abiotrophies: At birth the tissue is fully differentiated but it undergoes degenerative changes at some period in post-natal life. Phakomatoses: A group possessing features of the two previous groups and some features of neoplasms. The conception of abiotrophy draws attention to a large group of affections which have a hereditary character and develop in apparently normal tissues, making their appearance in different families at different periods of life. The conception is well established in neurology. Ophthalmology offers numorous examples. A large variety of familial fundus lesions (other than hereditary congenital anomalies), the corneal dystrophies (generally setting in at about puberty), “senile” cataract (occurring with regular frequency in certain families at certain ages), all illustrate the occurrence of familial groups of affections in tissues that show no obvious congenital anomaly, structurally or functionally. Whether this group is called heredo-degenerations or abiotrophies or by some other name is of little significance in comparison with the recognition of the existence of such a clinically distinct group. The understanding of the nature of these affections is rudimentary. Studies in the mode of inheritance of the different abiotrophies help to explain their distribution, but not their nature, just as the genetics of congenital malformations do not explain the embryological mechanism underlying these defects. The earlier workers of this branch of genetics were inclined to attribute the degenerative process in post-natal life to a failure inherent in the cell. Present evidence indicates that in the abiotrophies it is the environment of the cells rather than the cells themselves that is at fault. Work along these lines has already led to valuable therapeutic results in affections that were previously regarded as incurable (acholuric familial jaundice; Schüller-Christian syndrome). The abiotrophies of the retina and choroid are indicated. The solution of the problems they present lies in the study of their general associations. These are discussed.
Some Observations on the Surgical Treatment of Urinary Incontinence
Authors: Millin Terence
Published: July 2019

Types: A. Essential. B. Paradoxical. C. False. D. True.

True incontinence.—A. Congenital: (a) Developmental abnormalities. (b) Malformations of nervous system. B. Acquired: (a) Local abnormalities. (b) False passages. (c) Disturbance of innervation.

Anatomy of sphincteric mechanism in male and female.

Diagnosis: Need for careful investigation including cysto-urethroscopy, cysto-urethrography, and cysto-manometry.

Treatment: A. Physiotherapy. B. Direct surgical repair. C. Surgical diversion of urine.

Types of true incontinence amenable to direct surgical repair: A. Epispadias. B. Aberrant ureteric ostia. C. Fistulæ. D. Congenital or acquired defective sphincteric mechanism.

Operative treatment of vesico-vaginal fistulæ.

Transvesical operation for cure of congenitally defective sphincteric mechanism—report of seven cases.

Stress incontinence.—Value of urethrograms to ascertain nature of defect. Operative treatment.

Incontinence following prostatic surgery.—Types of operation advocated.

New operative procedure utilizing ribbon catgut with demonstrative moving picture.
Autonomic Imbalance and Borderline States of Thyrotoxicosis
Authors: Martin Laurence
Published: July 2019

Primary thyrotoxicosis may be regarded as having two main components—thyroid overactivity or dysfunction, and instability of the autonomic nervous system. Clinical observation suggests that the proportion of each component varies in individual cases. Results of treatment show that the larger the thyroid element the greater is the benefit of thyroidectomy or X-ray therapy, and the fewer the subsequent residual signs. When nervous instability predominates less relief is obtained by surgery or X-rays, and symptoms may be little changed or even made worse by the addition of hypothyroidism.

Cases in which nervous instability predominates, with minimal thyroid dysfunction, have been termed “autonomic imbalance”, “neurocirculatory asthenia”, or “Basedow's disease with no thyrotoxicosis”.

Thirteen such cases are described, all of which were females, with average age of 32 years. 9 had enlarged thyroids, 11 complained of palpitations, and 8 of excessive sweating.

The basal metabolic rate, estimated in 8 cases, did not exceed +10%. There was some loss of weight in 6 cases, but in none was the appetite increased. The average diurnal pulse-rate did not exceed 95 and sleeping pulse was significantly lower. X-rays of heart, taken in 6 cases, were normal. Psychological troubles in 6 cases. Three cases treated by X-ray therapy and I surgically with no benefit. Remaining 10 cases treated medically with improvement. The group is ill-defined and requires further investigation of cause and treatment.

The recognition of autonomic imbalance is important in order to avoid useless thyroidectomy or X-ray therapy, and encourage more extended use of psychotherapy. Investigation of its cause may yield information of value in the ætiological problem of thyrotoxicosis.
Leukopenic Myelosis
Authors: Scott Ronald Bodley
Published: July 2019

The term “leukopenic myelosis” is used to describe a type of “myeloblastic leukæmia” in which the leukocyte content of the peripheral blood is subnormal for the whole or the greater part of the course of the disease. Separation from the frankly leukæmic cases is made only on the grounds of clinico-hæmatological convenience.

Twenty-two cases have been seen in the past four years. The age-incidence varied from 3–73 years; 10 were in males and 12 in females. Acute, subacute, and chronic types may be recognized. In all the main characteristic is a progressive anæmia; in acute cases hæmorrhagic phenomena and necrotic angina are common.

The blood-count is characterized by orthochromic or hyperchromic anæmia, sometimes with reticulocytosis and erythroblastosis. Leukopenia may persist throughout the course, or a terminal leukæmia may occur—especially in the chronic cases. The features of the differential count are the presence of myeloblasts—although the percentage may be below 5%—and the hiatus leukæmicus. Thrombocytopenia usually means a rapid course.

This clinico-hæmatological picture may be mimicked more or less closely by pernicious anæmia, aplastic anæmia, agranulocytosis, and the leuko-erythroblastic anæmias. The sternal puncture findings are, however, diagnostic, and show a great preponderance of primitive myeloid cells, most frequently with a predomincnce of myeloblasts. In two cases evidence was found that the erythropoietic tissues shared in the hyperplasia.
Surgery in the Treatment of Rheumatoid Arthritis and Ankylosing Spondylitis
Authors: Law W. Alexander
Published: July 2019

The pain, deformities and disabilities resulting from rheumatoid arthritis and ankylosing spondylitis must be treated by a team composed of physician, physical medicine expert, orthopædic surgeon, and, in certain cases, deep X-ray therapist working simultaneously.

The principle of “rest” in order to relieve pain has to be combined with methods designed to preserve and restore function. The multiple joint deformities in these cases may necessitate a long programme of reconstructive or functional treatment, which entails whole-hearted co-operation on the part of the patient in intensive post-operative exercise regime.

Procedures advocated for the upper limb include excision of the acromion process together with the subacromial bursa to allow free movement between the central tendon of the deltoid and the tendinous shoulder cuff: arthrodesis of the shoulder in cases where there is more severe joint destruction: in certain cases of elbow-joint arthritis, excision of the radial head and sub-total synovectomy may preserve joint function and avoid or delay the necessity for arthroplasty which can be carried out in two ways: ( a) similar to the formal joint excision, or ( b) re-shaping the lower end of the humerus and upper end of the ulna lining these surfaces with fascia. The former method is preferable in cases of rheumatoid arthritis. To overcome wrist-joint deformity and restore pronation and supination excision of the lower end of the ulna together with radiocarpal fusion in position for optimum function is advocated. Finger and toe joints may be corrected by resection of the bone ends and capsulectomy.

In the lower limbs bilateral involvement of the hip-joint is best treated by vitallium mould arthroplasty which may be carried out in four ways: (1) Routine arthroplasty; (2) Modified Whitman procedure; (3) Modified Colonna operation; and (4) The proximal shaft or intertrochanteric arthroplasty. It is essential in these operations to have knowledge of the operative technique, the use of special hip gouges and reamers, and detailed post-operative supervision.

For dorsal kyphosis of the spine, spinal osteotomy at the lumbar level provides excellent correction but is an operation demanding care and skill in its execution.

The author's remarks are based on experience gained when working with Dr. M. N. Smith-Petersen at the Massachusetts General Hospital, Boston, U.S.A.
The Capsular Complications of Cataract Extraction
Authors: Goulden Charles
Published: July 2019

The author considered the following important points:

(1) Anterior capsular synechia to a corneal incision (made by a keratome) after the evacuation of a traumatic cataract. This might be detached early by the use of a blunt-ended knife following a perforation of the cornea with a sharp-pointed knife, much like a tenotome.

(2) The involuntary prolapse of capsule with a cataract incision.

( a) The danger of this was demonstrated as the cause of glaucoma, especially if it be found necessary to divide opaque capsular membrane after the extraction.

( b) The danger of sympathetic ophthalmia.

Prolapse might be prevented:

( a) By intracapsular extraction.

( b) By extracting the lens through an intact pupil, after the use of capsule forceps, followed either by a partial or total iridectomy.

(3) The treatment of opaque after-cataract.

Various types of opaque capsule membrane were described.

( a) Opaque lens fibres imprisoned between anterior and posterior remains of capsule.

( b) Grey membrane made of new lens fibres from proliferating subcapsular cells.

( c) Elschnig's cells.

( d) Much thickened capsular membrane following an extensive hæmorrhage into the anterior chamber occurring about the fifth day after extraction.

( e) A thick membrane formed of fibrous tissue following the invasion of the coloboma of the iris after infection at the time of operation. The fibrous tissue comes from the undersurface of the conjunctival flap and causes an updrawn coloboma which is also made narrower by its contraction.

When performing a capsulotomy thickened bands should be avoided and an incision made in thin capsule, parallel to thick bands.

If the membrane is very thick and shows signs of being torn from its peripheral attachment when a single needle is used, then

(1) Two needles may be used after the method of Bowman;

(2) A Wheeler operation may be performed (Wheeler, 1939, Collected Papers, New York, 197);

(3) Thick capsule may be divided by means of a Ziegler knife, as described by the author, but not in the manner described by Ziegler.

The danger of performing a capsulotomy in the presence of soft lens matter was pointed out.

The occasional occurrence of localized vitreous opacification at the site of a capsulotomy, even in the absence of iridocyclitis, was mentioned.
Enzyme Stimulation and Inhibition in the Metabolism of Drugs
Authors: Burns J J , Conney A H
Published: July 2019

Studies in recent years have disclosed two types of drug interaction which may be important in drug therapy:

(1) Administration of one drug can speed up the metabolism of another drug. Animal experiments show that this results from the ability of drugs to induce the synthesis of drug-metabolizing enzymes in liver microsomes. This effect has considerable importance in pharmacologic and toxicologic studies carried out in animals, and recent work indicates that it may explain altered therapeutic responses observed in some patients when they receive several drugs at the same time. Substances present in the environment, such as the insecticides chlordane and DDT, have been shown in animals to stimulate drug-metabolizing enzymes in liver, but the significance of this observation for man is not known. Drugs which stimulate drug metabolism also enhance the hydroxylation of testosterone, estradiol, progesterone and cortisol by enzymes in liver microsomes. Further research is required to establish the physiological importance of this interaction of drugs in steroid metabolism.

(2) One drug may inhibit the metabolism of another drug and thus intensify and prolong its pharmacologic action. Although this effect is well documented in animals, recent reports suggest that this may also be important in man. For instance, the action of coumarin anticoagulants can be potentiated by administration of certain drugs which inhibit their metabolism. Monoamine oxidase inhibitors block the metabolism of certain sympathomimetic amines and this can lead to serious side-effects. Thus, hypertensive crises have been observed in patients receiving monoamine oxidase inhibitors who have eaten cheese with a high tyramine content.
Pain: Its Experimental Investigation
Authors: Smith Robert
Published: July 2019

Dr Robert Smith discusses the relationship between pain and emotional disturbance and describes experiments which he has undertaken in general practice, using a pressure algometer. Amongst other findings, he shows that aspirin did not relieve pressure pain but did delay or even suppress the onset of ultraviolet light burns.

Dr K D Keele describes experiments to define individual pain thresholds and correlates these with the pain of cardiac infarction, and the morphine requirements in that condition.

Professor C A Keele considers the chemistry of pain production and describes his technique for applying chemical algogens to experimentally induced blisters. He further considers the similarity between such substances and those contained in animal and plant venoms and speculates as to an even closer relationship between these and painful medical conditions.
Adolescence
Authors: Model A
Published: July 2019

Dr A Model describes his experience in general practice with adolescent patients. He describes their problems and shows how these differ according to age and sex, and considers the role of the general practitioner in their eyes.

Dr Faith Spicer describes the sexual problems of adolescence and shows how these differ between the sexes. She enquires into the emotional and mental processes which contribute to early sex experience in the young.

Dr A Ryle contrasts working in a student health service with his experience of adolescents in general practice. He concludes that there should be a range of alternative sources of help for adolescents.
Old People [Abridged]
Authors: Meyrick R L
Published: July 2019

Dr Roger Meyrick outlines the scope of geriatrics and defines three categories of elderly people characterized by reduced activity, reduced resources and reduced independence.

Dr John Agate considers the deprivations which may occur in old age such as: malnutrition, vitamin deficiencies, deprivation of minerals and water, hypothermia and psychological deprivation.

The role of the family doctor in the care of the elderly is discussed by both speakers.
The Relevance of Object Size to the Recognizability of Drawings by Individuals with Congenital Blindness
Authors: Szubielska Magdalena , Niestorowicz Ewa , Marek Bogusław
Published: July 2019

Introduction:

The aim of this study was to determine whether individuals with congenital blindness make more recognizable drawings of known objects that are furniture sized (table, man, tree) rather than hand sized (egg, coconut, banana; Hypothesis 1). We also investigated whether knowledge that the tactile drawings had been produced by people who are blind increased judges’ perceptions of their recognizability (Hypothesis 2).

Methods:

The raised-line drawings were made by children and teenagers who are blind and had no prior experience in tactile graphics. After a minimal initial training in line drawing, the subjects were asked to draw six objects from memory. The judges used a 7-point Likert-type scale to assess recognizability. All objects were identified for the judges prior to their assessment. One group of judges was told that the drawings they were assessing were made by persons who are blind, while the second group was informed that the drawings were made without the use of sight.

Results:

The real-life size of the objects depicted in the drawings affected judges’ perception of their recognizability. Depictions of hand-sized objects were found to be less recognizable than were depictions of furniture-sized objects. Knowledge of the artists’ blindness had no effect on the judgments of recognizability.

Discussion:

Hypothesis 1 was confirmed, which suggests that individuals with congenital blindness have more difficulty in creating drawings of hand-sized objects than they did creating drawings of furniture-sized objects. Hypothesis 2 was not confirmed, which is inconsistent with the results of previous research in which the awareness of the artists’ disability status influenced the assessment of the artworks. Although the present research focused on recognizability, the issue in earlier research was aesthetic judgment.

Implications for practitioners:

Although few people would question the importance of illustrations in books for sighted children, the value of tactile graphics and the benefits of engaging children who have visual impairments in making and exploring raised-line drawings are not always understood. Full participation in subjects that rely on visual information such as geometry, art, and geography by learners who are born blind requires access to tactile graphics. Basic training in raised-line drawing may be sufficient for some children, particularly those who are older (aged 10 years or more), with congenital blindness who have never drawn before to create from memory recognizable drawings of known objects, especially larger objects.
Assessment of Age-related Oxygenation Changes in Calf Skeletal Muscle by Photoacoustic Imaging: A Potential Tool for Peripheral Arterial Disease
Authors: Kirkham Brooke M. , Schultz Susan M. , Ashi Khalid , Sehgal Chandra M.
Published: July 2019

Peripheral artery disease is often asymptomatic, and various imaging and nonimaging techniques have been used for assessment and monitoring treatments. This study is designed to demonstrate the ability of photoacoustic imaging to noninvasively determine changes in tissue oxygenation that occur in mice’s hind limb skeletal muscle as they age. Mice from two age cohorts were scanned bilaterally with a pulsed laser. The photoacoustic signal was unmixed to generate a parametric map of estimated oxygen saturation and then overlaid on grayscale ultrasound images. Tissue oxygenation measured in young and old mice was compared. Photoacoustic imaging visually and quantitatively showed the decrease in skeletal muscle oxygenation that occurs with age. Percent tissue oxygenation decreased from 30.2% to 3.5% ( p < 0.05). This reduction corresponded to reduced fractional area of oxygenation, which decreased from 60.6% to 6.0% ( p < 0.05). The change in oxygenation capacity of the still active vascular regions was insignificant ( p > 0.05). Intrasubject, intra-, and interobserver comparisons showed low variability in measurements, exhibited by high regression and intraclass correlations exceeding 0.81 for all ages. The decrease in oxygenation detected by photoacoustic imaging paralleled the known oxygenation decrease observed in aging tissues, demonstrating that photoacoustic imaging can assess age-related changes in a mouse calf muscle. These intramuscular changes could potentially act as a strong diagnostic marker for peripheral artery disease. This study thus opens the doors for a novel, affordable, noninvasive method of evaluation free of radiation or exogenous material.
The Effect of Classroom Emotions, Attitudes Toward English, and Teacher Behavior on Willingness to Communicate Among English Foreign Language Learners
Authors: Dewaele Jean-Marc
Published: July 2019

Willingness to communicate (WTC) in a foreign language is linked to a range of interacting learner-internal and learner-external variables. The present study identified the predictors of WTC of 210 foreign language learners of English from Spain. Multiple regression analyses revealed that the strongest (negative) predictor of WTC was foreign language classroom anxiety, while foreign language enjoyment and frequency of foreign language use by the teacher were positive predictors.
A New Method for Model-Based Health Economic Evaluation Utilizing and Extending Moment-Generating Functions
Authors: Snowsill Tristan
Published: July 2019

Background. Health economic evaluations frequently include projections for lifetime costs and health effects using modeling frameworks such as Markov modeling or discrete event simulation (DES). Markov models typically cannot represent events whose risk is determined by the length of time spent in state (sojourn time) without the use of tunnel states. DES is very flexible but introduces Monte Carlo variation, which can significantly limit the complexity of model analyses. Methods. We present a new methodological framework for health economic modeling that is based on, and extends, the concept of moment-generating functions (MGFs) for time-to-event random variables. When future costs and health effects are discounted, MGFs can be used to very efficiently calculate the total discounted life-years spent in a series of health states. Competing risks are incorporated into the method. This method can also be used to calculate discounted costs and health effects when these payoffs are constant per unit time, one-off, or exponential with regard to time. MGFs are extended to additionally support costs and health effects which are polynomial with regard to time (as in a commonly used model of population norms for EQ-5D utility). Worked Example. A worked example is used to demonstrate the application of the new method in practice and to compare it with Markov modeling and DES. Results are compared in terms of convergence and accuracy, and computation times are compared. R code and an Excel workbook are provided. Conclusions. The MGF method can be applied to health economic evaluations in the place of Markov modeling or DES and has certain advantages over both.
Personalized Decision Making for Biopsies in Prostate Cancer Active Surveillance Programs
Authors: Tomer Anirudh , Rizopoulos Dimitris , Nieboer Daan , Drost Frank-Jan , Roobol Monique J. , Steyerberg Ewout W.
Published: July 2019

Background. Low-risk prostate cancer patients enrolled in active surveillance programs commonly undergo biopsies for examination of cancer progression. Biopsies are conducted as per a fixed and frequent schedule (e.g., annual biopsies). Since biopsies are burdensome, patients do not always comply with the schedule, which increases the risk of delayed detection of cancer progression. Objective. Our aim is to better balance the number of biopsies (burden) and the delay in detection of cancer progression (less is beneficial) by personalizing the decision of conducting biopsies. Data Sources. We used patient data of the world’s largest active surveillance program (Prostate Cancer Research International Active Surveillance; PRIAS). It enrolled 5270 patients, had 866 cancer progressions, and an average of 9 prostate-specific antigen (PSA) and 5 digital rectal examination (DRE) measurements per patient. Methods. Using joint models for time-to-event and longitudinal data, we model the historical DRE and PSA measurements and biopsy results of a patient at each follow-up visit. This results in a visit and patient-specific cumulative risk of cancer progression. If this risk is above a certain threshold, we schedule a biopsy. We compare this personalized approach with the currently practiced biopsy schedules via an extensive and realistic simulation study, based on a replica of the patients from the PRIAS program. Results. The personalized approach saved a median of 6 biopsies (median: 4, interquartile range [IQR]: 2–5) compared with the annual schedule (median: 10, IQR: 3–10). However, the delay in detection of progression (years) is similar for the personalized (median: 0.7, IQR: 0.3–1.0) and the annual schedule (median: 0.5, IQR: 0.3–0.8). Conclusions. We conclude that personalized schedules provide substantially better balance in the number of biopsies per detected progression for men with low-risk prostate cancer.
Feasibility of ischemic leg ulcer healing using percutaneous techniques: a real-life study
Authors: Kehagias Elias , Ioannou Christos V , Bouloukaki Izolde , Papadaki Evangelia , Galanakis Nikolaos , Kontopodis Nikolaos , Tsetis Dimitrios
Published: July 2019

Background

Percutaneous transluminal angioplasty is established as the first-line vascular procedure in patients with lower extremity artery disease.

Purpose

We aimed to evaluate the technical and clinical effectiveness of percutaneous transluminal angioplasty in the management of ischemic foot ulcers.

Material and Methods

All consecutive patients presenting with a foot ulcer at the outpatient vascular surgery clinic of our hospital between June 2009 and June 2015 were evaluated using foot pulse assessment, ankle-brachial index, and duplex scanning. If non-invasive parameters suggested lower extremity artery disease, CT angiography and/or digital subtraction angiography were performed and a percutaneous transluminal angioplasty was carried out when feasible during the same session. All patients were followed until healing, amputation, death, or for at least two years. Short- and long-term clinical success was evaluated based on ulcer size and appearance. Patients with worsening ulcers after percutaneous transluminal angioplasty underwent bypass grafting or amputation.

Results

Percutaneous transluminal angioplasty was performed in 161 patients (100%) with stenoses > 50%, including cases lesions > 10 cm and/or multiple/calcified lesions, 144 of which completed the study. In 88 (61.2%) patients, percutaneous transluminal angioplasty was performed in the suprapopliteal axis exclusively, in 10 (6.8%) patients in the infrapopliteal axis only, and in 46 (31.9%) in both levels. Percutaneous transluminal angioplasty was technically successful in 141 (98%) patients. After 3.1 years, the rate of healing was 68%, limb salvage 88%, overall survival 69.5%, and amputation-free survival 64%.

Conclusion

Our data suggest that percutaneous transluminal angioplasty for ischemic foot ulceration treatment is in the majority of patients feasible, effective, and safe with high rates of healing and limb salvage.
New inflammatory indicators: association of high eosinophil-to-lymphocyte ratio and low lymphocyte-to-monocyte ratio with smoking
Authors: Çekici Yusuf , Yılmaz Mücahid , Seçen Özlem
Published: July 2019

Objective

Smoking has been proven to increase systemic inflammation in previous studies using different biomarkers. The eosinophil-to-lymphocyte ratio (ELR), neutrophil-to-lymphocyte ratio (NLR), and lymphocyte-to-monocyte ratio (LMR) are new indicators of systemic inflammation that are used as predictors of systemic inflammation, morbidity, and mortality associated with many diseases. We investigated the effects of smoking on these inflammatory indicators.

Methods

In total, 616 consecutive smoking healthy subjects and 387 age-matched nonsmoking healthy subjects were enrolled. White blood cell counts (neutrophils, lymphocytes, basophils, eosinophils, and monocytes) were determined by electrical impedance with an automatic blood cell counting device. The ELR, LMR, and NLR were calculated based on these cell counts. Smoking habits of participants were calculated as pack/year.

Results

The NLR and ELR were significantly higher and the LMR was significantly lower in smokers than nonsmokers. The pack-years were positively correlated with the NLR and ELR and negatively correlated with the LMR.

Conclusion

A high NLR and ELR and low LMR are associated with cigarette smoking and may be useful indicators of systemic inflammation activity, even in healthy smokers. Smokers with a high NLR and ELR and low LMR can easily be identified during routine blood analysis and might benefit from preventive treatment.
Precise Placement of Fixed Retainers Using Mini Molds
Authors: Doshi Umal Hiralal
Published: July 2019

Over the years, several methods for delivering fixed lingual retainers have been introduced. However, the accurate and passive placement of the retainer in any clinical situation has always been a matter of concern. This article presents a precise method for placement of a fixed retainer using resin tubes formed from commercially available molds. This method ensures accurate, passive placement of fixed retainer in any clinical situation. Additionally, the same technique can be used for correction of minor crowding relapse by placing an active lingual retainer.
Biomechanical Comparison of Onlay Distal Biceps Tendon Repair: All-Suture Anchors Versus Titanium Suture Anchors
Authors: Otto Alexander , Mehl Julian , Obopilwe Elifho , Cote Mark , Lacheta Lucca , Scheiderer Bastian , Imhoff Andreas B. , Mazzocca Augustus D. , Siebenlist Sebastian
Published: July 2019

Background:

A rupture of the distal biceps tendon is the most common tendon rupture of the elbow and has received increased attention in the past few years. Newly developed all-suture anchors have the potential to minimize surgical trauma and the risk of adverse events because of the use of flexible drills and smaller drill diameters.

Purpose/Hypothesis:

The purpose was to biomechanically compare all-suture anchors and titanium suture anchors for distal biceps tendon repair in cadaveric specimens. The hypothesis was that all-suture anchors would show no differences in load to failure or displacement under cyclic loading compared with titanium suture anchors.

Study Design:

Controlled laboratory study.

Methods:

Sixteen unpaired, fresh-frozen human cadaveric elbows were randomized to 2 groups, which underwent onlay distal biceps tendon repair with 2 anchors. Bone mineral density at the radial tuberosity was evaluated in each specimen. In the first group, distal biceps tendon repair was performed using all-suture anchors. In the second group, titanium suture anchors were applied. After cyclic loading for 3000 cycles, the repair constructs were loaded to failure. The peak load to failure as well as repair construct stiffness and mode of failure were determined.

Results:

The mean (±SD) peak load was 293.53 ± 122.15 N for all-suture anchors and 280.02 ± 69.34 N for titanium suture anchors ( P = .834); mean stiffness was 19.78 ± 2.95 N/mm and 19.30 ± 4.98 N/mm, respectively ( P = .834). The mode of failure was anchor pullout for all specimens during load to failure. At the proximal position, all-suture anchors showed a displacement of 1.53 ± 0.80 mm, and titanium suture anchors showed a displacement of 0.81 ± 0.50 mm ( P = .021) under cyclic loading. At the distal position, a displacement of 1.86 ± 1.04 mm for all-suture anchors and 1.53 ± 1.15 mm for titanium suture anchors was measured ( P = .345). A positive correlation between bone mineral density and load to failure was observed ( r = 0.605; P = .013).

Conclusion:

All-suture anchors were biomechanically equivalent at time zero to titanium suture anchors for onlay distal biceps tendon repair. While the proximally placed all-suture anchors demonstrated greater displacement than titanium suture anchors, the comparable displacement at the distal position as well as the similar load and mechanism of failure make this difference unlikely to be clinically significant.

Clinical Relevance:

All-suture anchors performed similarly to titanium suture anchors for onlay distal biceps tendon repair at time zero and represent a reasonable alternative.
Günther Anders in Silicon Valley: Artificial intelligence and moral atrophy
Authors: Schwarz Elke
Published: July 2019

Artificial Intelligence as a buzzword and a technological development is presently cast as the ultimate ‘game changer’ for economy and society; a technology of which we cannot be the master, but which nonetheless will have a pervasive influence on human life. The fast pace with which the multi-billion dollar AI industry advances toward the creation of human-level intelligence is accompanied by an increasingly exaggerated chorus of the ‘incredible miracle’, or the ‘incredible horror’, intelligent machines will constitute for humanity, as the human is gradually replaced by a technologically superior proxy, destined to be configured as a functional (data) component at best, a relic at worst. More than half a century ago, Günther Anders sketched out this path toward technological obsolescence, and his work on ‘Promethean shame’ and ‘Promethean discrepancy’ provides an invaluable means with which to recognise and understand the relationship of the modern human to his/her technological products. In this article, I draw on Anders’s writings to unpack and unsettle contemporary narratives of our relation to AI, with a view toward refocusing attention on the responsibilities we bear in producing such immersive technologies. With Anders, I suggest that we must exercise and develop moral imagination so that the human capacity for moral responsibility does not atrophy in our technologically mediated future.
Resident-to-Resident Aggression in Long-Term Care: Analysis of Structured and Unstructured Data From the National Violent Death Reporting System, 2003-2016
Authors: DeBois Kristen A. , Evans Shelly D. , Chatfield Sheryl L.
Published: July 2019

Aging adults are at risk for multiple types of abuse including emotional, sexual, or physical abuse. Adults in skilled nursing or assisted living facilities might be particularly vulnerable to injury, including fatal injury resulting from incidents of resident-to-resident aggression (RRA). The purpose of this research is to report findings from the multistate National Violent Death Reporting System (NVDRS) related to fatal RRA incidents between years 2003 and 2016. We analyzed structured categorical data and unstructured narrative data on 101 identified fatal RRA incidents among individuals aged 65+. Findings included that victims average 16 years older than exhibitors and dementia diagnoses are present in most cases. Qualitative analysis revealed that events are described as both unexpected and preventable. Training to improve long-term care staff recognition and reporting of RRA events may potentially improve prevention and provide more accurate trend data. NVDRS data provide a useful source to follow trends in fatal RRA going forward.
Biomass co-pyrolysis: Effects of blending three different biomasses on oil yield and quality
Authors: Hopa Derya Yeşim , Alagöz Oğuzhan , Yılmaz Nazan , Dilek Meltem , Arabacı Gamze , Mutlu Tunçer
Published: July 2019

In the present study, pyrolysis and co-pyrolysis of sugarcane bagasse, poppy capsule pulp, and rice husk were conducted in a fixed bed reactor at 550⁰C in nitrogen atmosphere. The moisture (5%–8%), ash (4%–17%), volatile matter (60%–76%), and fixed carbon analyses (11%–24%) of the utilized biomass were conducted. The decomposition behavior of biomasses due to the heat effect was investigated by thermogravimetric analysis/differential thermal analysis . In the pyrolysis of biomasses separately, the highest bio-oil yield was obtained with sugarcane bagasse (27.4%). In the co-pyrolysis of the binary blends of biomass, the highest bio-oil yield was obtained with the rice husk and sugarcane bagasse blends. While the mean bio-oil yield obtained with the separate pyrolysis of these two biomasses was 23.9%, it was observed that the bio-oil yield obtained with the co-pyrolysis of biomass blends was 28.4%. This suggested a synergistic interaction between the two biomasses during pyrolysis. It was observed that as the total ash content in the biomasses used in the pyrolysis increased, the bio-oil yield decreased, and the solid product content increased. Characterization studies of bio-oils were conducted by Fourier-transform infrared spectroscopy, gas chromatography–mass spectrometry (GC-MS), and hydrogen-1 nuclear magnetic resonance analyses. Results of these studies revealed that, all bio-oils were mainly composed of aliphatic and oxygenated compounds. The calorific values of bio-oils were determined by calorimeter bomb. Based on the GC-MS, the bio-oils with high fatty acid and its ester content also had high calorific values. The highest calorific value was 29.68 MJ kg-1, and this was obtained by pyrolysis of poppy capsule and sugarcane bagasse blend.
Controversies Surrounding the Pathophysiology of Tics
Authors: Singer Harvey S. , Augustine Farhan
Published: July 2019

Tics are sudden, rapid, recurrent, nonrhythmic motor movements or vocalizations (phonic productions) that are commonly present in children and are required symptoms for the diagnosis of Tourette syndrome. Despite their frequency, the underlying pathophysiology of tics/Tourette syndrome remains unknown. In this review, we discuss a variety of controversies surrounding the pathophysiology of tics, including the following: Are tics voluntary or involuntary? What is the role of the premonitory urge? Are tics due to excess excitatory or deficient inhibition? Is it time to adopt the contemporary version of the cortico-basal ganglia-thalamocortical (CBGTC) circuit? and Do we know the primary abnormal neurotransmitter in Tourette syndrome? Data from convergent clinical and animal model studies support complex interactions among the various CBGTC sites and neurotransmitters. Advances are being made; however, numerous pathophysiologic questions persist.
An improved active drag reduction system for formula race cars
Authors: Dimastrogiovanni Mauro , Reina Giulio , Burzoni Andrea
Published: July 2019

Drag reduction systems are largely employed in racing car competitions to help drivers in overtaking manoeuvres, ensuring a good show to the public. This paper presents a full-design approach to drag reduction systems that includes the computational fluid dynamics estimation of the forces acting on the rear wing, the dynamic analysis of the drag reduction system mechanism and the whole vehicle behaviour through the simulation of an overtaking manoeuvre. For the purposes of this work, a novel drag reduction system mechanism is proposed that features lower aerodynamic disturbance and comparable manufacturing costs than those of drag reduction systems of the main Formula categories.
Underdog Status Yields Support for Musicians
Authors: Michniewicz Kenneth S. , Edelman Laura L.
Published: July 2019

Prior research suggests that underdogs elicit from others an increased affiliation (e.g., liking, identification) as well as an increased desire for success (e.g., support). In the present study, we examined whether or not people similarly endorsed underdog, relative to topdog, musicians. In Study 1, we found that underdog (relative to topdog) musicians received greater affiliation, in the form of higher interpersonal evaluations, and support, in the form of greater desire for career success. Moreover, this support weakened when statistically accounting for interpersonal support. Study 2 replicated Study 1 but additionally asked participants to listen to a sample of music ostensibly produced by the musician described prior to answering questions about the musician. Findings suggest that although underdog status did not bolster liking of the music sample itself, people nonetheless expressed greater affiliation and support for the musician. These findings emphasize the critical role of identity presentation in listeners’ evaluations of musicians, particularly when that musician communicates underdog status. We discuss the implications of underdog status on a musician’s identity as well as future research directions exploring the ways underdog status may be established and maintained. We additionally discuss the role of the aspects of music, such as the musician’s genre or platform, in communicating this underdog status.
Status Incongruity and Backlash against Female Legislators: How Legislative Speechmaking Benefits Men, but Harms Women
Authors: Yildirim T. Murat , Kocapınar Gülnur , Ecevit Yuksel Alper
Published: July 2019

The literature on nomination procedures and intra-party politics shows that engagement in personalized parliamentary activities helps legislators get re-elected and promoted in the party list. However, as a considerable body of scholarly work suggests, women in leadership positions who are perceived to disconfirm the well-known gender stereotypes by being “too assertive” and “agentic” in the workplace may suffer from what social psychologists call the “backlash effect” (i.e., facing economic and social sanctions). Integrating insights from the literatures on perceptions of female leadership and intra-party politics, we reveal the differential effect of legislative speechmaking on the career prospects of male and female members of parliament (MPs). Specifically, using an original dataset of over thirty-five thousand parliamentary speeches and the biographies of 2,140 MPs who served in the Grand National Assembly of Turkey between 1995 and 2011, we show that the well-documented positive effect of engagement in parliamentary activities on career prospects holds for male MPs, but not for their female counterparts. In fact, we found that female MPs who were active on the legislative floor were significantly less likely to get renominated and promoted in the party rank. These results imply that the challenges facing women in leadership positions go beyond electoral competition.
What Tests Are Useful to Investigate a Possible Infection of Total Ankle Arthroplasty (TAA)? What Are Their Thresholds?
Authors: Uçkay Ilker , Pedowitz David , Assal Mathieu , Stull Justin D.
Published: July 2019

Recommendation:

Overall, the approach to a potentially infected total ankle arthroplasty (TAA) does not change compared to other periprosthetic joint infections (PJIs). There are no novel or unique diagnostic procedures for TAA infection, specifically. Joint aspiration or intraoperative tissue/synovial biopsies with microbiological cultures are the most important diagnostic tests for suspected TAA infections. In the absence of specific data related to TAA, the threshold for these tests should be derived from the hip and knee PJI literature.

Level of Evidence:

Strong

Delegate Vote:

Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus)
What Strategies Can Be Implemented to Help Isolate the Causative Organism in Patients With Infection of the Foot and Ankle?
Authors: Ellington Kent , Raikin Steven , Bemenderfer Thomas B.
Published: July 2019

Recommendation:

Transfer of synovial aspirate in blood culture bottles, obtaining deep biopsy of tissues and bone, obtaining multiple samples, increasing incubation period of cultures, and the use of molecular techniques for culture negative cases are some of the strategies that can help improve the ability to isolate the causative organism(s) in infections of foot and ankle.

Level of Evidence:

Moderate.

Delegate Vote:

Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus)
What Is the Optimal Antibiotic (Type, Dose and Route of Administration) Treatment for Infections After Foot/Ankle Fracture or Fusion Procedures?
Authors: Pedowitz David , Stull Justin
Published: July 2019

Recommendation:

The optimal antibiotic treatment after foot/ankle fractures or fusion should be determined based on the result of culture. In the absence of culture results, administered antibiotics should include coverage against common pathogens such as Staphylococcus aureus.

Level of Evidence:

Strong.

Delegate Vote:

Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus).
Associations Between Adverse Underwater Events and ADHD Diagnosis Among Military Divers
Authors: Van Wijk Charles H. , Meintjes W. A. J.
Published: July 2019

Objective: Adult ADHD (A-ADHD) has been associated with an increased risk of accidents and workplace injuries. ADHD within professional diving may have major potential occupational health and safety implications, as accidents underwater may have severe consequences. The study investigated any association of increased risk for adverse underwater incidents with an ADHD diagnosis. Method: This analysis used retrospective records from 156 navy divers and computed an odds ratio using cases of ADHD and cases of underwater accidents. Results: Although the odds ratio was increased, it failed to reach significance. Conclusion: We do not yet have statistical evidence suggesting that the risk for adverse underwater events is significantly increased among the ADHD group in this sample of navy divers. Sufficiently powered studies are required to further address the potential risk of A-ADHD in working divers.
Gender differences in self-reported camouflaging in autistic and non-autistic adults
Authors: Hull Laura , Lai Meng-Chuan , Baron-Cohen Simon , Allison Carrie , Smith Paula , Petrides KV , Mandy William
Published: July 2019

Social camouflaging describes the use of strategies to compensate for and mask autistic characteristics during social interactions. A newly developed self-reported measure of camouflaging (Camouflaging Autistic Traits Questionnaire) was used in an online survey to measure gender differences in autistic ( n = 306) and non-autistic adults ( n = 472) without intellectual disability for the first time. Controlling for age and autistic-like traits, an interaction between gender and diagnostic status was found: autistic females demonstrated higher total camouflaging scores than autistic males (partial η2 = 0.08), but there was no camouflaging gender difference for non-autistic people. Autistic females scored higher than males on two of three Camouflaging Autistic Traits Questionnaire subscales: Masking (partial η2 = 0.05) and Assimilation (partial η2 = 0.06), but not on the Compensation subscale. No differences were found between non-autistic males and females on any subscale. No differences were found between non-binary individuals and other genders in either autistic or non-autistic groups, although samples were underpowered. These findings support previous observations of greater camouflaging in autistic females than males and demonstrate for the first time no self-reported gender difference in non-autistic adults.