bluuebunny/crossref_metadata_2025 huggingface dataset:
Localized stress fluctuations drive shear thickening in dense suspensions
Authors: Rathee Vikram , Blair Daniel L. , Urbach Jeffrey S.
Published: August 2017

Significance

The nonintuitive behavior of shear-thickening suspensions, such as the familiar cornstarch–water mixture, is a subject of both fundamental and practical importance, but the microscopic phenomena responsible for the dramatic thickening are unknown. Here, we report direct measurements of the stresses at the boundaries of sheared suspensions to reveal dramatic spatial and temporal stress fluctuations not previously reported. We find that the suspension spontaneously and intermittently separates into two different fluid phases with substantially different properties, thus showing that the discontinuous liquid–solid transition that is the most dramatic form of shear thickening is actually ubiquitous and responsible for the observed shear thickening, even in regimes where the average viscosity increases smoothly with applied shear.
LEC1 sequentially regulates the transcription of genes involved in diverse developmental processes during seed development
Authors: Pelletier Julie M. , Kwong Raymond W. , Park Soomin , Le Brandon H. , Baden Russell , Cagliari Alexandro , Hashimoto Meryl , Munoz Matthew D. , Fischer Robert L. , Goldberg Robert B. , Harada John J.
Published: August 2017

Significance

Seed development is biphasic, consisting of the morphogenesis phase when the basic plant body plan is established and the maturation phase when the embryo accumulates storage reserves and becomes desiccation tolerant. Despite the importance of seeds as human food and animal feed, little is known about the gene-regulatory networks that operate during these phases. We identified genes that are regulated genetically and transcriptionally by a master regulator of seed development, LEAFY COTYLEDON1 (LEC1). We show that LEC1 transcriptionally regulates genes involved in photosynthesis and other developmental processes in early and maturation genes in late seed development. Our results suggest that LEC1 partners with different transcription factors to regulate distinct gene sets and that LEC1 function is conserved inArabidopsisand soybean seed development.
The change of Frisian infinitives
Authors: Bergstra Myrthe
Published: August 2017

This paper discusses the two types of infinitives in Frisian: infinitives ending in -E (e.g. rinne “walk”) and infinitives ending in -EN (e.g. rinnen “walk”). It shows that their distribution can be accounted for by their different underlying syntactic structure: the -E infinitive has a fully verbal structure whereas the -EN infinitive has a flexible structure which always involves a DP. Moreover, I argue that the fact that the difference between the two forms is disappearing can be explained both by Dutch influence and by the fact that the structure of the infinitives already showed much overlap.
Whose side are they on?
Authors: Hukker Vera , Hendriks Petra
Published: August 2017

Spatial prepositions express relations between objects in space. A subset of spatial prepositions is ambiguous due to the different perspectives from which these spatial relations can be considered. The ability to consider another person’s perspective is still developing in children. This study investigates how Dutch-speaking children (mean age 10) and adults interpret perspective-dependent spatial prepositions uttered by a speaker. We found that adults took the speaker’s perspective in a third of the cases, whereas children did so in a sixth of the cases. No differences in interpretation emerged between prepositions in assertions and requests, although these different speech acts reflect different speaker intentions. In general, children performed like adults, but less often took the speaker’s perspective withnaastcompared tovoorandachterin assertions. We conclude that 10-year-olds can take another person’s perspective when interpreting spatial prepositions, but, like adults, only do so in a minority of cases.
Language is a ‘Beautiful Creature’, not an ‘Old Fridge’
Authors: Bogetić Ksenija
Published: August 2017

Direct metaphor has been widely studied from the cognitive perspective, but its functions in the communicative dimension (Steen, 2011) remain less well understood. This study investigates direct metaphor as a tool of metaphorical framing (Ottati et al., 2014; Ritchie & Cameron, 2014) in discourse, by examining a corpus of British newspaper texts on the topic of language and language change. The analysis of direct metaphors is sufficient to point to major ideologies of language and communication in the observed media context, which echo broader anxieties over social change, social organization and control. Most notably, unlike the meanings stressed in existing studies, the vast majority of direct metaphors are here found to serve the specific role of relational argumentation. This function is achieved through a kind of ‘corrective framing’, which explicitly juxtaposes two conflicting representations through an ‘A is B and not C’ type of metaphor. The findings are discussed with respect to deliberateness, metaphorical framing and rhetorical goals in discourse. It is hypothesized that corrective framing is among the major functions of direct metaphor in public discourse, which can influence public opinion in ways different from other metaphorically created representations.
From metaphor to allegory
Authors: Cornevin Vanessa , Forceville Charles
Published: August 2017

Afuganisu-tanis an online manga by Timaking, published in English online in 2005, that presents selected historical events of modern Afghanistan in a series of 29 episodes plus an appendix. An episode consists of a four-panel micro-narrative in which Afghanistan and the countries with which its history is intertwined are consistently personified as young girls. Each manga episode is accompanied by a short, textual ‘memo’ describing historical events in a neutral, factual way. In this paper, we (1) propose that the extended personification of Afghanistan and other countries in this manga can be understood in terms of ‘allegory’; (2) sketch and evaluate how the manga part affects the construal of the country’s history; (3) consider some of the consequences of combining the manga part with memo text for the informative and educational value ofAfuganisu-tan.
Analysing metaphor in the family register through scripted sitcom conversations
Authors: Skorczynska Hanna , Giménez-Moreno Rosa
Published: August 2017

This study looks into the patterns of metaphor use in the family register of scripted sitcom conversations. Previous studies of metaphor in conversation adopted different approaches to the concept of register, resulting in a rich but complex picture (Cameron, 2003,2007,2008;Deignan, Littlemore & Semino, 2013;Kaal, 2012). This research attempts to reduce such complexity by using an approach to register based on closely defining communicative settings and the participants’ roles (Giménez-Moreno, 2006). In this way, we were able to focus on the register used by family members and close friends and the contexts of private oral communication, as opposed to other possible registers characteristic of professional conversations or those between friends. The study provides data on the frequency, typology, grammatical form and function of the metaphors used in the fictional dialogues between family members and close friends from two British sitcoms, “Gavin & Stacey” and “The Royle Family”. The findings, in general, confirm the patterns of metaphor use in naturally-occurring (UK) conversation, but show lower frequency ranges than other more purpose-oriented contexts. The main contribution of this study is the evaluation of metaphor as an ‘appraisal resource’ (Martin & White, 2005) and its frequent use in assessing the participants’ attitudes. The study suggests that defining register in terms of communicative setting and participants’ roles can help to provide comparable data on metaphor variation.
Our debt to Walker Connor: reflections from political theory
Authors: Moore Margaret
Published: August 2017

First, let me say that it is a pleasure to be asked to comment on the work of Walker Connor, who is a huge figure in the study of nationalism, and has been tremendously influential for me both personally and in my own work. Let me say something personal, first. In the spring of 2005, Walker Connor came to my home university, Queen's University in Kingston, Canada, as a Fulbright Fellow. This was our first Fulbright Fellow and we were thrilled to have an international star in nationalism join us. He was witty, humorous, smart, and very, very kind. He was also – I was struck by this – very generous with his time, with students, and with junior scholars. He talked at length to our graduate students who were working on nationalism. He told me that he enjoyed students very much, and that in his opinion the American liberal arts colleges were excellent places to work because one could see the impact of one's ideas and challenges on students.
𝐻¹-Superconvergence of a difference finite element method based on the 𝑃₁-𝑃₁-conforming element on non-uniform meshes for the 3D Poisson equation
Authors: He Ruijian , Feng Xinlong , Chen Zhangxin
Published: August 2017

In this paper, a difference finite element (DFE) method is presented for the 3D Poisson equation on non-uniform meshes by using the

P
1

−

P
1

P_1-P_1

-conforming element. This new method consists of combining the finite difference discretization based on the

P
1

P_1

-element in the

z
z

-direction with the finite element discretization based on the

P
1

P_1

-element in the

(
x
,
y
)

(x,y)

-plane. First, under the regularity assumption of

u
∈

H
3

(
Ω
)
∩

H
0
1

(
Ω
)

u\in H^3(\Omega )\cap H^1_0(\Omega )

and

∂

z
z

f
∈

L
2

(
(
0
,

L
3

)
;

\partial _{zz}f\in L^2((0, L_3);

H

−
1

(
ω
)
)

H^{-1}(\omega ))

, the

H
1

H^1

-superconvergence of the discrete solution

u
τ

u_\tau

in the

z
z

-direction to the first-order interpolation function

I
τ

u

I_\tau u

is obtained, and the

H
1

H^1

-superconvergence of the second-order interpolation function

I

2
τ

2

u
τ

I^2_{2\tau } u_\tau

in the

z
z

-direction to

u
u

is then provided. Moreover, the

H
1

H^1

-superconvergence of the DFE solution

u
h

u_h

to the

H
1

H^1

-projection

R
h

u
τ

R_hu_\tau

of

u
τ

u_\tau

is deduced and the

H
1

H^1

-superconvergence of the second-order interpolation function

I

2
τ

2

I

2
h

2

u
h

I^2_{2\tau }I^2_{2h} u_h

to

u
u

in the

(
(
x
,
y
)
,
z
)

((x,y),z)

-space is also established. Finally, numerical tests are presented to show the

H
1

H^1

-superconvergence results of the DFE method for the 3D Poisson equation under the above regularity assumption.
Neurodegeneration-associated mutant TREM2 proteins abortively cycle between the ER and ER–Golgi intermediate compartment
Authors: Sirkis Daniel W. , Aparicio Renan E. , Schekman Randy
Published: August 2017

Triggering receptor expressed on myeloid cells 2 (TREM2) is a transmembrane protein expressed on microglia within the brain. Several rare mutations in TREM2 cause an early-onset form of neurodegeneration when inherited homozygously. Here we investigate how these mutations affect the intracellular transport of TREM2. We find that most pathogenic TREM2 mutant proteins fail to undergo normal maturation in the Golgi complex and show markedly reduced cell-surface expression. Prior research has suggested that two such mutants are retained in the endoplasmic reticulum (ER), but we find, using a cell-free coat protein complex II (COPII) vesicle budding reaction, that mutant TREM2 is exported efficiently from the ER. In addition, mutant TREM2 becomes sensitive to cleavage by endoglycosidase D under conditions that inhibit recycling to the ER, indicating that it normally reaches a post-ER compartment. Maturation-defective TREM2 mutants are also efficiently bound by a lectin that recognizes O-glycans added in the ER–Golgi intermediate compartment (ERGIC) and cis-Golgi cisterna. Finally, mutant TREM2 accumulates in the ERGIC in cells depleted of COPI. These results indicate that efficient ER export is not sufficient to enable normal cell-surface expression of TREM2. Moreover, our findings suggest that the ERGIC may play an underappreciated role as a quality-control center for mutant and/or malformed membrane proteins.
Comprehensive process model of clinical information interaction in primary care: results of a “best-fit” framework synthesis
Authors: Veinot Tiffany C , Senteio Charles R , Hanauer David , Lowery Julie C
Published: August 2017

Objective

To describe a new, comprehensive process model of clinical information interaction in primary care (Clinical Information Interaction Model, or CIIM) based on a systematic synthesis of published research.

Materials and Methods

We used the “best fit” framework synthesis approach. Searches were performed in PubMed, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Library and Information Science Abstracts, Library, Information Science and Technology Abstracts, and Engineering Village. Two authors reviewed articles according to inclusion and exclusion criteria. Data abstraction and content analysis of 443 published papers were used to create a model in which every element was supported by empirical research.

Results

The CIIM documents how primary care clinicians interact with information as they make point-of-care clinical decisions. The model highlights 3 major process components: (1) context, (2) activity (usual and contingent), and (3) influence. Usual activities include information processing, source-user interaction, information evaluation, selection of information, information use, clinical reasoning, and clinical decisions. Clinician characteristics, patient behaviors, and other professionals influence the process.

Discussion

The CIIM depicts the complete process of information interaction, enabling a grasp of relationships previously difficult to discern. The CIIM suggests potentially helpful functionality for clinical decision support systems (CDSSs) to support primary care, including a greater focus on information processing and use. The CIIM also documents the role of influence in clinical information interaction; influencers may affect the success of CDSS implementations.

Conclusion

The CIIM offers a new framework for achieving CDSS workflow integration and new directions for CDSS design that can support the work of diverse primary care clinicians.
Magnetically advected winds
Authors: Contopoulos I. , Kazanas D. , Fukumura K.
Published: August 2017

Observations of X-ray absorption lines in magnetically driven disc winds around black hole binaries and active galactic nuclei yield a universal radial density profile ρ ∝ r−1.2 in the wind. This is in disagreement with the standard Blandford and Payne profile ρBP ∝ r−1.5 expected when the magnetic field is neither advected nor diffusing through the accretion disc. In order to account for this discrepancy, we establish a new paradigm for magnetically driven astrophysical winds according to which the large-scale ordered magnetic field that threads the disc is continuously generated by the Cosmic Battery around the inner edge of the disc and continuously diffuses outward. We obtain self-similar solutions of such magnetically advected winds (MAW) and discuss their observational ramifications.
Nasopharyngeal Pneumococcal Density Is Associated With Viral Activity but Not With Use of Improved Stoves Among Young Andean Children
Authors: Howard Leigh M , Fan Roger , Zhu Yuwei , Griffin Marie R , Edwards Kathryn M , Hartinger Stella , Williams John V , Vidal Jorge E , Klugman Keith P , Gil Ana I , Lanata Claudio F , Grijalva Carlos G
Published: August 2017

Background

Indoor smoke exposure is common in developing countries and may influence nasopharyngeal (NP) pneumococcal colonization density and risk of acute respiratory illness. We compared colonization density among Andean children living in households previously enrolled in a randomized controlled trial of a home intervention package including improved stoves to reduce smoke, kitchen sinks, and water disinfection.

Methods

We enrolled 260 children aged <3 years and made weekly household visits to assess for acute respiratory illness (ARI) and collect nasal swabs for respiratory virus polymerase chain reaction (PCR) testing during ARI. At monthly intervals, NP swabs were collected to determine pneumococcal colonization density through quantitative lytA PCR. We used linear quantile mixed-effects models to compare median log-transformed colonization densities among children in households randomized to the control (n = 129) versus intervention (n = 131) in sequential time points, accounting for random effects of multiple samples from individual children. Other covariates included age, sex, month, antibiotic exposure, and timing of sample collection relative to ARI with and without viral detection.

Results

Age and sociodemographic characteristics were similar between groups. Although no differences were observed in densities between groups, colonization density varied significantly over time in both groups, with highest densities coinciding with spring months. Time during and after virus-associated ARI was also associated with higher pneumococcal colonization density than time remote from ARIs.

Conclusions

A home intervention package, including improved stoves, was not associated with changes in pneumococcal densities in young Andean children. However, increasing pneumococcal density was observed with spring season and viral-associated ARIs.
Evaluation of a Pomegranate Peel Extract as an Alternative Means to Control Olive Anthracnose
Authors: Pangallo Sonia , Nicosia Maria G. Li Destri , Agosteo Giovanni E. , Abdelfattah Ahmed , Romeo Flora V. , Cacciola Santa O. , Rapisarda Paolo , Schena Leonardo
Published: August 2017

Olive anthracnose is caused by different species of Colletotrichum spp. and may be regarded as the most damaging disease of olive fruit worldwide, greatly affecting quality and quantity of the productions. A pomegranate peel extract (PGE) proved very effective in controlling the disease. The extract had a strong in vitro fungicidal activity against Colletotrichum acutatum sensu stricto, was very effective in both preventive and curative trials with artificially inoculated fruit, and induced resistance in treated olive tissues. In field trials, PGE was significantly more effective than copper, which is traditionally used to control the disease. The highest level of protection was achieved by applying the extract in the early ascending phase of the disease outbreaks because natural rots were completely inhibited with PGE at 12 g/liter and were reduced by 98.6 and by 93.0% on plants treated with PGE at 6 and 3 g/liter, respectively. Two treatments carried out 30 and 15 days before the expected epidemic outbreak reduced the incidence of the disease by 77.6, 57.0, and 51.8%, depending on the PGE concentration. The analysis of epiphytic populations showed a strong antimicrobial activity of PGE, which sharply reduced both fungal and bacterial populations. Because PGE was obtained from a natural matrix using safe chemicals and did not have any apparent phytotoxic effect on treated olive fruit, it may be regarded as a safe and effective natural antifungal preparation to control olive anthracnose and improve olive productions.
Transgender and Gender Nonconforming Patient Experiences at a Family Medicine Clinic
Authors: Hinrichs Amanda , Link Carrie , Seaquist Lea , Ehlinger Peek , Aldrin Stephanie , Pratt Rebekah
Published: August 2017

Purpose

Transgender and gender nonconforming (TGNC) patients have a wide array of often negative experiences when accessing health care, and may encounter insensitive or subcompetent care; thus, the authors conducted a qualitative study with patients at one family medicine residency clinic to assess how primary care clinics can improve care for TGNC patients.

Method

In 2015, the authors held three separate focus groups at Smiley’s Family Medicine Clinic in Minneapolis, Minnesota. They invited diverse TGNC participants who have accessed TGNC-related and/or primary care at Smiley’s. The authors analyzed and coded data using a grounded theory approach with NVivo10 (QSR). The authors also administered short demographic questionnaires and analyzed the results with REDCap.

Results

Twenty-three patients participated in the focus groups, and 22 completed the survey. Gender identities among the participants were diverse. Four main themes emerged: (1) shared negative experiences with health care, (2) the need for sensitive and inclusive primary care, (3) defining TGNC-sensitive care, and (4) the challenges of mainstreaming TGNC-competent care into primary care settings.

Conclusions

Providing sensitive and competent primary care to TGNC patients involves allowing patients to self-identify, respecting the gender identities of every patient, and focusing on the whole person—not the trans status of the patient. Education and training on TGNC care at a clinic-wide level is needed.
The Road to Rural Primary Care: A Narrative Review of Factors That Help Develop, Recruit, and Retain Rural Primary Care Physicians
Authors: Parlier Anna Beth , Galvin Shelley L. , Thach Sarah , Kruidenier David , Fagan Ernest Blake
Published: August 2017

Purpose

To examine the literature documenting successes in recruiting and retaining rural primary care physicians.

Method

The authors conducted a narrative review of literature on individual, educational, and professional characteristics and experiences that lead to recruitment and retention of rural primary care physicians. In May 2016, they searched MEDLINE, PubMed, CINAHL, ERIC, Web of Science, Google Scholar, the Grey Literature Report, and reference lists of included studies for literature published in or after 1990 in the United States, Canada, or Australia. The authors identified 83 articles meeting inclusion criteria. They synthesized results and developed a theoretical model that proposes how the findings interact and influence rural recruitment and retention.

Results

The authors’ proposed theoretical model suggests factors interact across multiple dimensions to facilitate the development of a rural physician identity. Rural upbringing, personal attributes, positive rural exposure, preparation for rural life and medicine, partner receptivity to rural living, financial incentives, integration into rural communities, and good work–life balance influence recruitment and retention. However, attending medical schools and/or residencies with a rural emphasis and participating in rural training may reflect, rather than produce, intention for rural practice.

Conclusions

Many factors enhance rural physician identity development and influence whether physicians enter, remain in, and thrive in rural practice. To help trainees and young physicians develop the professional identity of a rural physician, multifactorial medical training approaches aimed at encouraging long-term rural practice should focus on rural-specific clinical and nonclinical competencies while providing trainees with positive rural experiences.
Factors that predict instability in pediatric diaphyseal both-bone forearm fractures
Authors: Kutsikovich Jeffrey I. , Hopkins Christopher M. , Gannon Edwin W. , Beaty James H. , Warner William C. , Sawyer Jeffrey R. , Spence David D. , Kelly Derek M.
Published: August 2017

The aim of this study was to determine the factors that may predict failure of closed reduction and casting of diaphyseal forearm fractures in children. Demographic and radiographic data of children with closed reduction and casting of these fractures in the emergency department were evaluated. Of 174 patients with adequate follow-up to union, 19 (11%) required a repeat procedure. Risk factors for repeat reduction included translation of 50% or more in any plane, age more than 9 years, complete fracture of the radius, and follow-up angulation of the radius more than 15° on lateral radiographs or of the ulna more than 10° on anteroposterior radiographs.
A Long-term Follow-up of Young Adults With Idiopathic Clubfoot: Does Foot Morphology Relate to Pain?
Authors: Graf Adam N. , Kuo Ken N. , Kurapati Nikhil T. , Krzak Joseph J. , Hassani Sahar , Caudill Angela K. , Flanagan Ann , Harris Gerald F. , Smith Peter A.
Published: August 2017

Background:

Individuals with clubfoot, treated in infancy with either the Ponseti method or comprehensive clubfoot release, often encounter pain as adults. Multiple studies have characterized residual deformity after Ponseti or surgical correction using physical exam, radiographs and pedobarography; however, the relationship between residual foot deformity and pain is not well defined. The purpose of the current study was 2-fold: (1) to evaluate the relationship between foot morphology and pain for young adults treated as infants for idiopathic clubfoot and (2) to describe and compare pedobarographic measures and outcome measures of pain and morphology among surgically treated, Ponseti treated, and typically developing feet.

Methods:

We performed a case-control study of individuals treated for clubfoot at 2 separate institutions with either the Ponseti method or comprehensive clubfoot release between 1983 and 1987. All subjects (24 treated with comprehensive clubfoot release, 18 with Ponseti method, and 48 controls) were evaluated using the International Clubfoot Study Group (ICFSG) morphology scoring, dynamic pedobarography, and foot function index surveys. During pedobarography, we collected the subarch angle and arch index as well as the center of pressure progression (COPP) on all subjects.

Results:

Foot morphology (ICFSG) scores were highly correlated with foot function index pain scores (r=0.43; P<0.001), although the difference in pain scores between the surgical and Ponseti group did not reach significance. The surgical group exhibited greater subarch angle and arch indexes than the Ponseti group, demonstrating a significant difference in morphology, a flatter foot. Finally, we found more abnormalities in foot progression, decreased COPP in the forefoot and increased COPP in the midfoot and hindfoot, in the surgical group compared with controls.

Conclusions:

Measures of foot morphology were correlated with pain among all treated for clubfoot. Compared with Ponseti method, comprehensive surgical release lead to greater long-term foot deformity, flatter feet and greater hindfoot loading time.

Level of Evidence:

Level III—Therapeutic.
Fat Graft and Bone Wax Interposition Provides Better Functional Outcomes and Lower Reossification Rates Than Extensor Digitorum Brevis After Calcaneonavicular Coalition Resection
Authors: Masquijo Javier , Allende Victoria , Torres-Gomez Armando , Dobbs Matthew B.
Published: August 2017

Background:

Calcaneonavicular coalitions are the most common form of tarsal coalitions. The prefered treatment for symptomatic coalitions is surgical resection; however, there are no published studies that directly compare different interposition techniques. The purpose of the present study was to retrospectively compare pain relief, functional outcomes, and complications of children and adolescents who had a resection of a symptomatic calcaneonavicular coalition with interposition of fat graft, bone wax, or extensor digitorum brevis (EDB).

Methods:

In total, 48 patients (56 ft) underwent calcaneonavicular coalition resection-interposition at 3 institutions from July 2008 to July 2015. There were 23 feet in group 1 (fat graft), 18 feet in group 2 (bone wax), and 15 feet in group 3 (EDB). Patient demographic characteristics were similar between all groups for age, sex, coalition type, and symptoms onset. Data concerning clinical and radiographic features, surgical technique, and postoperative complications were obtained from all available medical records. Radiographs were evaluated at last follow-up to determine coalition regrowth. Preoperative and postoperative pain was assessed with the visual analog scale, and function was assessed with use of the American-Orthopaedic-Foot and Ankle Society (AOFAS) score.

Results:

Pain improved to an average of 0.5 in the first group (range, 0 to 6), 0 in group 2, and 1.7 in group 3 (range, 0 to 5) (P=0.033). The average AOFAS score improved from 59 (range, 33 to 71 points) to 98 points (range, 62 to 100 points) in the fat graft group, from 50 (range, 34 to 62 points) to 98 points (range, 88 to 100 points) in the bone wax group, and from 48 (range, 30 to 60 points) to 75 points (range, 70 to 95 points) in the EDB group (P<0.001). Eight feet had regrowth of the coalition on the postoperative radiographs: 1 in group 1 (4%), 1 in group 2 (6%), and 6 in group 3 (40%) (P=0.004). Five feet from the third group developed progressive symptoms.

Conclusions:

In our study, autogenous fat graft and bone wax interposition techniques provided better pain relief, gave better functional scores, and avoided more effectively coalition reossification than EDB technique. Further studies are required to evaluate safety of bone wax as an interposition material.

Level of Evidence:

Level III—therapeutic.
Redefining Optimal Nail to Medullary Canal Diameter Ratio in Stainless Steel Flexible Intramedullary Nailing of Pediatric Femur Fractures
Authors: Shaha James S. , Cage Jason M. , Black Sheena R. , Wimberly Robert L. , Shaha Steven H. , Riccio Anthony I.
Published: August 2017

Purpose:

The ideal canal fill for flexible intramedullary fixation of pediatric femoral shaft fractures is considered to be 80% based upon relatively few clinical studies. The purpose of this study is to assess the relationship between the summed nail to intramedullary canal diameter (ND/MCD) ratio and alignment at radiographic union following flexible intramedullary nailing (FIMN) of pediatric femoral shaft fractures.

Methods:

An Internal Review Board approved, retrospective review of a consecutive series of patients who sustained a femoral shaft fracture treated by retrograde, stainless steel FIMN was performed at a single level 1 pediatric trauma center from 2005 to 2012. Preoperative radiographs were analyzed to determine fracture pattern, location, and isthmic canal diameter. ND/MCD ratio was calculated using the sum of the known nail diameters and the measured isthmic diameter. Radiographs at bony union were reviewed to measure shortening, coronal angulation, and sagittal angulation. ND/MCD ratio was analyzed to determine correlative factors with final radiographic outcomes.

Results:

In total, 261 children underwent retrograde FIMN at an average age of 8.2 years (range, 2.2 to 17.0 y). ND/MCD ratio of ≥80% was seen in 108 (41.4%) patients. When compared with those with <80% ND/MCD ratio, there were no significant differences in age (8.8 vs. 8.0 y), sex (76.9% vs. 71.0% males), or body mass index (18.5 vs. 17.2 kg/m2). There were significantly more length unstable fractures in the <80% ND/MCD ratio group (49.4% vs. 29.7%; P<0.01). Radiographic outcome was no different with respect to coronal angulation (2.7 vs. 3.0 degrees), sagittal angulation (3.0 vs. 3.2 degrees), or shortening (2.5 vs. 4.1 mm). ND/MCD ratio of ≥70% was seen in 176 (67.4%) patients and, when compared with the <70% ND/MCD ratio group, there were no differences in shortening (3.3 vs. 3.9 mm), coronal angulation (2.8 vs. 3.0 degrees), or sagittal angulation (3.0 vs. 3.4 degrees). Finally, 6.9% of the population (18 patients) had ND/MCD ratios <60% and did not demonstrate a significant increase in shortening, coronal, or sagittal angulation compared with groups with higher ND/MCD ratios. No group had an increased rate of infection, implant removal, nonunion, or need for reoperation.

Conclusions:

In a large series of consecutive patients treated with retrograde stainless steel FIMN there does not appear to be any correlation between the ND/MCD ratio and radiographic outcome. Stainless steel flexible IM nails seem to maintain fracture alignment without an increase in complications at lower ND/MCD ratios than previously reported as “optimal.”

Level of Evidence:

Level III.
Elastic Intramedullary Nailing Versus Open Reduction Internal Fixation of Pediatric Tibial Shaft Fractures
Authors: Pennock Andrew T. , Bastrom Tracey P. , Upasani Vidyadhar V.
Published: August 2017

Background:

The optimal fixation strategy for unstable pediatric tibia fractures is unclear with some favoring elastic intramedullary nails (EIN) and others favoring plate and screws [open reduction internal fixation (ORIF)]. The purpose of this study was to compare outcomes and complications of skeletally immature patients undergoing surgical stabilization of the tibia with either EIN or ORIF.

Methods:

A retrospective review was performed on all patients undergoing EIN or ORIF of a diaphyseal fracture at a single pediatric level I trauma center between 2010 and 2016. Patients were included if they had open growth plates, no intra-articular or physeal involvement, and radiographic follow-up until union. Patient demographic, injury, radiographic, and surgical data were recorded. Outcome measures included achievement of union, time to healing, residual deformity, complications, need for additional procedures, and return to sport. Statistical analysis was performed with alpha set at P<0.05.

Results:

A total of 70 patients met inclusion, 44 underwent EIN and 26 underwent ORIF. There were no significant differences between demographics or injury variables between groups other than ORIF patients having more distal fractures (44% vs. 32%; P=0.006). At a mean follow-up of 1.4 years, 97% of fractures healed and there was no difference in healing rates between groups. The mean time to union was 15 weeks. ORIF patients had a shorter cast duration (7 vs. 10 wk; P<0.001), less angular deformities >5 degrees (15% vs. 41%; P=0.03), and lower rates of subsequent surgery (35% vs. 91%; P<0.001), but trended toward longer operating room times (69 vs. 59 min; P=0.06), and higher rates of wound complications (23% vs. 9%; P=0.10). Regardless of surgical technique, nearly all patients returned to full activities with no significant deficits.

Conclusions:

Surgical stabilization of unstable pediatric tibia fractures with ORIF or EIN constructs lead to predictable healing in the majority of patients. Complications can occur and differ based on surgical approach. ORIF led to more anatomic reductions and lower rates of second surgeries, but trended toward higher rates of wound-related complications and slightly longer operating room times.

Level of Evidence:

Level III—therapeutic study.
Comparison of Symptoms From C6 and C7 Radiculopathy
Authors: Rainville James , Joyce Andrew A. , Laxer Eric , Pena Enrique , Kim David , Milam R. Alden , Carkner Eric
Published: August 2017

Study Design.

Case series.

Objective.

This study compared the locations of arm pain, sensory symptoms, and subjective complaints of arm weakness in patients with cervical radiculopathy from MRI confirmed C6 and C7 nerve root compression.

Summary of Background Data.

Cervical radiculopathy is defined as arm pain, sensory and motor symptoms caused by irritation of a cervical nerve root. The C6 and C7 roots are most commonly involved, and differentiating symptoms associated with each root has proven difficult. Cervical MRI allows accurate identification of nerve root compression and therefore makes it possible to explore symptom patterns that may differentiate C6 from C7 radiculopathy.

Methods.

A total of 122 patients with symptoms suggestive of cervical radiculopathy were recruited. Of these, 30 patients had MRI confirmed C6 and 39 patients C7 nerve root compression. By completing a study questionnaire, patients reported specific arm weakness, and marked the location of arm pain and tingling/numbness on graphic representations of the arm. Marked areas were interpreted by superimposing a grid that divided the arm into 54 distinct areas. The frequencies of reported symptoms with C6 and C7 were totaled and then compared with likelihood rations. Power analysis calculated that 27 patients would be needed in each group based on the assumption that a 30 percentage point difference in frequency of specific symptom would be clinically useful for differentiating C6 from C7 radiculopathy.

Results.

Arm pain and sensory symptoms were diffuse, and were not distinctly different for C6 or C7 radiculopathy. Some weakness was reported by 41 percent of patients, with specific descriptions of weakness having limited value for differentiating between radiculopathies.

Conclusion.

The location of pain and sensory symptoms, and specific weakness complaints associated with symptomatic C6 and C7 nerve root compression overlap to the extent that caution should be exercised when predicting root involvement based on symptoms.

Level of Evidence: 3
Predictive Findings of the Presence of Stooping in Patients With Lumbar Degenerative Kyphosis by Upright Whole Spine Lateral Radiography
Authors: Son Seung Min , Shin Jong Ki , Goh Tae Sik , Suh Kuen Tak , Lee Jung Sub
Published: August 2017

Study Design.

A retrospective study.

Objective.

The aim of this study was to identify the relationships between radiological findings and the presence of stooping in lumbar degenerative kyphosis (LDK).

Summary of Background Data.

Many studies have addressed fixed sagittal imbalances and surgical treatments. However, information regarding the relationship between radiological findings and stooping in LDK is sparse.

Methods.

The study included 73 patients with LDK and 44 with normal lumbar lordosis. Of those with LDK, 63 patients exhibited stooping (group 1) and 10 did not (group 2). Of those with 44 normal lumbar lordosis, 13 patients exhibited stooping (group 3) and 31 patients did not (group 4). Radiographic parameters such as sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), thoracic kyphosis (TK), lumbar lordosis (LL), horizontal distance between C7 plumb line and the posterosuperior corner of the sacrum (C7PL), sacrofemoral distance (SFD), C7PL/SFD ratio (C7/SFD), spinosacral angle (SSA), spinopelvic angle (SPA), C2-C7 lordosis (CL), C2-C7 sagittal vertical axis (C2-C7 SVA), T1 slope, and T1 slope minus C2-C7 lordosis (TS-CL) were analyzed.

Results.

Significant differences were observed in TK, LL, C7PL, SFD, C7/SFD, PT, SS, SSA, SPA, C2-C7 SVA, and TS-CL between LDK and normal lumbar lordosis, but no significant intergroup difference was observed in PI, CL, or T1 slope. These results showed that groups 1 and 3 had higher C7PL, C7/SFD, PT, and CL values than groups 2 and 4. Logistic regression analysis revealed that C7/SFD and CL could significantly predict stooping in LDK.

Conclusion.

C7/SFD and CL predict the presence of stooping in LDK. Furthermore, patients with LDK with compensatory mechanisms to maintain sagittal balance have low C7PL values, that is, C7/SFD < 0.5 and high PT and CL on upright whole spine lateral radiography.

Level of Evidence: 3
Adiponectin Downregulates TNF-α Expression in Degenerated Intervertebral Discs
Authors: Yuan Bin , Huang Liangliang , Yan Ming , Zhang Shilei , Zhang Yongfeng , Jin Boquan , Ma Ying , Luo Zhuojing
Published: August 2017

Study Design.

Given the results of previous in vitro investigations of the expression patterns of adiponectin and its receptors in healthy and degenerated intervertebral discs (IVDs), we studied the effects of adiponectin on tumor necrosis factor-alpha (TNF-α) production in degenerated nucleus pulposus (NP) cells and analyzed the association between adiponectin levels in IVD tissues and IVD Pfirrmann grades.

Objective.

The aim of this study was to investigate the potential role of adiponectin in the pathogenesis of IVD degeneration.

Summary of Background Data.

Adiponectin has been reported to be involved in physiologic and pathologic processes associated with bone and cartilage diseases. However, the expression profiles of adiponectin and its receptors in human IVD tissues and the function of adiponectin in the pathogenesis of IVD degeneration remain unknown.

Methods.

Real-time polymerase chain reaction, immunohistochemistry, and western blotting were performed to examine the expression levels of adiponectin, adiponectin receptors, and TNF-α in IVD tissues and isolated NP cells. The effects of adiponectin on TNF-α production in degenerated NP cells were detected by enzyme linked immunosorbent assay.

Results.

Adiponectin expression levels were downregulated, while adiponectin receptor 1 (adipoR1) and adipoR2 expression levels were upregulated in degenerated IVD tissues and degenerated NP cells compared with those in healthy IVD tissues and healthy NP cells. Moreover, we confirmed that TNF-α production by degenerated NP cells was downregulated by adiponectin administration in a dose- and time-dependent manner. Furthermore, our data showed that adiponectin levels in degenerated IVD tissues were inversely correlated with IVD Pfirrmann grades.

Conclusion.

These results indicated that adiponectin may play an anti-inflammatory role with respect to the maintenance of IVD homeostasis by downregulating TNF-α production.

Level of Evidence: N/A
Can C7 Slope Substitute the T1 slope?
Authors: Tamai Koji , Buser Zorica , Paholpak Permsak , Sessumpun Kittipong , Nakamura Hiroaki , Wang Jeffrey C.
Published: August 2017

Study Design.

Retrospective analysis of consecutive 45 radiographs and 120 kinematic magnetic resonance images (kMRI)

Objective.

The aim was to assess the visibility of C7 and T1 endplates on radiographs, and to verify the correlation between C7 or T1 slope and cervical balance parameters using kMRI.

Summary of Background Data.

Because the T1 slope is not always visible due to the anatomical interference, several studies have used C7 slope instead of T1. However, it is still unclear whether the C7 endplate is more visible on radiographs than T1, and if C7 slope has similarity with T1 slope.

Methods.

The endplate visibility was determined using weight-bearing radiography. Subsequently, using weight-bearing MR images, the C7 slope of upper and lower endplate, T1 slope, C1 inclination, C2 slope, atlas-dens interval (ADI), C2–C7 lordotic angle, cervical sagittal vertical axis (cSVA), cervical tilt, cranial tilt, neck tilt, thoracic inlet angle (TIA) were measured, for the analysis of correlation between three types of slopes and cervical balance parameters.

Results.

82% of the upper C7, and 18% of T1 endplate were clearly visible. The upper C7 endplate was significantly visible, whereas T1 endplate was significantly invisible (residual analysis, P < 0.01). Linear regression analysis showed correlation between the upper C7 slope and T1 slope (R
2 = 0.818, P < 0.01) and, lower C7 slope and T1 slope (R
2 = 0.840, P < 0.01). T1 slope significantly correlated with neck tilt, TIA, C2–C7 angle, cSVA, cervical and cranial tilt, but not with the C1 inclination, C2 slope, and ADI. Upper and lower C7 slopes showed the close resemblance with T1 slope in terms of correlation with those parameters.

Conclusion.

Both, upper and lower C7 slope correlated strongly with T1 slope and showed similar relationship with cervical balance parameters as T1 slope. Therefore, C7 slope could potentially substitute T1 slope, especially upper C7 slope due to the good visibility.

Level of Evidence: 3
Fingertip Winding Suture: Pull-out Suture Technique for Flexor Tendon Repair in Zone I
Authors: Mahmoud Mostafa , Elian Motaz , Seif Elnasr Abdalah
Published: August 2017

Injuries to flexor tendons in zone I has always been challenging during repair. Over the time several techniques were developed and modified to achieve the highest repair strength and thus the best functional outcome. These techniques vary from pull-out sutures with internal and external fixation to the use of bone anchors. All techniques were accompanied with advantages and disadvantages as well as postoperative morbidities related to certain techniques. In the present technique we introduce a subperiosteal pull-out suturing technique. It is a simple, strong, and cost-effective method for repair of flexor tendon injuries in zone I or in the context of tendon grafting.
Mood-stabilizing effects of rapamycin and its analog temsirolimus: relevance to autophagy
Authors: Kara Nirit Z. , Flaisher-Grinberg Shlomit , Anderson Grant W. , Agam Galila , Einat Haim
Published: August 2017

Accumulated data support a relationship between mood disorders and cellular plasticity and resilience, some suggesting relevance to autophagy. Our previous data show that pharmacological enhancement of autophagy results in antidepressant-like effects in mice. The current study was designed to further examine the effects of autophagy enhancement on mood by testing the effects of subchronic treatment with the mammalian target of rapamycin (mTOR) inhibitors and autophagy enhancers rapamycin and temsirolimus in a model for mania and in a model for antidepressant action, respectively. The results show that rapamycin reduced mania-like aggression and reward-seeking behaviors, with no effects on locomotion. Temsirolimus reduced depression-related immobility in the forced-swim test without effects on locomotion in the open field or on anxiety-related measures in the elevated plus maze. Taken together with our previous findings, these data support the notion that enhancing autophagy may have mood-stabilizing effects.
T-type and L-type Calcium Channel Blockers for the Treatment of Cardiac Iron Overload: An Update
Authors: Kumfu Sirinart , Chattipakorn Siriporn C. , Chattipakorn Nipon
Published: August 2017

In patients with thalassemia, iron overload cardiomyopathy is a major cause of cardiac dysfunction and mortality. Despite many advances in the development of new iron chelating agents, heart failure still occurs in some patients and can lead to an increase in mortality rate. Recently, potential novel therapeutic strategies in the treatment of these patients have focused on L-type and T-type calcium channel blockers. These 2 channels have been reported as being the main routes for cardiac iron uptake under conditions of iron overload. In this review, the effects of these calcium channel blockers on both cardiac iron uptake and cardiac function under conditions of iron overload are discussed, and both consistent and inconsistent findings published in various studies are summarized and reviewed. Through this we hope to provide a greater insight into how future studies can most effectively use these drugs at the clinical trial stage.
Endometriosis in adolescents
Authors: Dowlut-McElroy Tazim , Strickland Julie L.
Published: August 2017

Purpose of review

The current article addresses recent literature regarding the diagnosis and management of endometriosis in adolescents.

Recent findings

An increasing body of literature suggests that advanced-stage endometriosis (revised scoring system of the American Society for Reproductive Medicine Stage III or IV) and deeply invasive endometriosis are relatively common in adolescents. There remains limited data on the efficacy of postoperative hormonal management of endometriosis in the adolescent population.

Strong consideration should be made for surgical diagnosis of endometriosis in adolescents with pelvic pain, including noncyclic pain, with a concurrent family history of endometriosis and personal history of atopic disease. More research is needed regarding the benefits of the routine use of hypoestrogenic and other hormonal agents in the prevention of disease progression and long-term sequela in adolescents with endometriosis.