bluuebunny/crossref_metadata_2025 huggingface dataset:
Genetic Ancestry Contributes to Somatic Mutations in Lung Cancers from Admixed Latin American Populations
Authors: Carrot-Zhang Jian , Soca-Chafre Giovanny , Patterson Nick , Thorner Aaron R. , Nag Anwesha , Watson Jacqueline , Genovese Giulio , Rodriguez July , Gelbard Maya K. , Corrales-Rodriguez Luis , Mitsuishi Yoichiro , Ha Gavin , Campbell Joshua D. , Oxnard Geoffrey R. , Arrieta Oscar , Cardona Andres F. , Gusev Alexander , Meyerson Matthew
Published: December 2020

Inherited lung cancer risk, particularly in nonsmokers, is poorly understood. Genomic and ancestry analysis of 1,153 lung cancers from Latin America revealed striking associations between Native American ancestry and their somatic landscape, including tumor mutational burden, and specific driver mutations in EGFR, KRAS, and STK11. A local Native American ancestry risk score was more strongly correlated with EGFR mutation frequency compared with global ancestry correlation, suggesting that germline genetics (rather than environmental exposure) underlie these disparities.

Significance:

The frequency of somatic EGFR and KRAS mutations in lung cancer varies by ethnicity, but we do not understand why. Our study suggests that the variation in EGFR and KRAS mutation frequency is associated with genetic ancestry and suggests further studies to identify germline alleles that underpin this association.

See related commentary by Gomez et al., p. 534.

This article is highlighted in the In This Issue feature, p. 521
Impact of Body Mass Index Change on the Prognosis of Chronic Obstructive Pulmonary Disease
Authors: Kim Eun Kyung , Singh Dave , Park Joo Hun , Park Yong Bum , Kim Seung-Il , Park Bumhee , Park Jisoo , Kim Jung-hyun , Kim Mi-Ae , Lee Ji-Hyun , Kim Tae-Hyung , Yoon Hyoung Kyu , Oh Yeon-Mok
Published: December 2020

Background: Low body mass index (BMI) is an important prognostic factor in chronic obstructive pulmonary disease (COPD). However, the prognostic value of longitudinal BMI change in COPD has not been well studied. Objective: We aimed to evaluate the association between longitudinal change of BMI and prognosis of COPD in Korean COPD cohort. Methods: This study was conducted in a prospective Korean Obstructive Lung Disease (KOLD) cohort where COPD patients were recruited on an outpatient basis at 17 hospitals in South Korea. Annual BMI was measured over a period of 3 years or more. All patients were categorized into underweight (UW), normal weight (NW), and overweight (OW) groups by BMI. Clinical characteristics and outcomes including exacerbation and mortality were compared based on initial BMI grade and longitudinal change of BMI. Results: This analysis included 537 COPD patients (mean age = 67.4 ± 7.9 years, male = 97.0%, mean BMI = 23.0 ± 3.1) of KOLD cohort. The proportions of UW, NW, and OW groups were 6.9% (n = 37), 68.9% (n = 370), and 24.2% (n = 130) respectively. The UW group showed lower forced expiratory volume in 1 s (FEV1) (p < 0.001), shorter 6-minute walk distance (p < 0.001), higher modified Medical Research Council score (p = 0.002), higher St. George Respiratory Questionnaire score (p < 0.001), higher emphysema index (p < 0.001) and air-trapping index (p < 0.001), and more frequent (p < 0.001) and severe exacerbations (p = 0.003). Multivariable analyses demonstrated that decrease of BMI (hazard ratio [HR] = 0.786, p = 0.038) and the descent of BMI group (HR = 3.167, p = 0.016) at 3-year follow-up along with age, initial BMI, post-bronchodilator FEV1, and severe exacerbations were significantly associated with mortality. Conclusions: This study demonstrated that BMI decrease during follow-up was independently associated with exacerbation and higher mortality of COPD, suggesting BMI reduction in COPD should be carefully managed.
Lithogenic Potential of Ureaplasma in Chronic Prostatitis
Authors: Magri Vittorio , Perletti Gianpaolo , Stamatiou Konstantinos , Montanari Emanuele , Trinchieri Alberto
Published: December 2020

Introduction: The role of Ureaplasma spp. (UPs) in the pathogenesis of chronic prostatitis is debated. The lithogenic potential of UPs could be a risk factor for the development of chronic prostatitis. Methods: A total of 143 patients with identification of UPs were retrospectively selected from a database including patients with prostatitis-like symptoms who were studied according to the same protocol including clinical, microbiological and microscopic evaluation, and transrectal prostate ultrasound. A control group of patients with negative UPs was considered including 393 with chronic bacterial prostatitis (CBP), 42 patients with Chlamydia trachomatis (CT), and 781 patients with chronic pelvic pain syndrome. UPs and Mycoplasma hominis (MH) were identified using a semiquantitative assay. Results: Calcifications were observed more frequently in patients with UPs (64%) than in patients with CBP without UPs (39%), CT infection (37%), and chronic pelvic pain syndrome (29%) (p < 0.0001). UPs were isolated in VB1 alone in 35 patients (urethral UPs), in expressed prostatic secretion (EPS) or post-massage urine (VB3) or sperm in 77 patients (prostatic UPs) and associated with other pathogens in 31 patients (associated UPs). Calcifications were more frequent in prostatic UPs (71%) and associated UPs (73%) than in urethral UPs (34%). Mean NIH-CPSI scores were not significantly different between groups, although mean WBC counts of sperm of patients with urethral UPs were significantly lower than in patients with prostatic UPs (p = 0.000) and associated UPs (p = 0.002). Conclusions: UPs identification in the urogenital fluids is related to higher rates of prostate calcifications. The ability of UPs to promote the formation of calcifications could be related to the chronicization of prostate infection. In particular, the presence of UPs in VB3/EPS/sperm is associated with higher rates of calcifications and high WBC sperm counts, suggesting a partial or full causative role of UPs in the pathogenesis of this disease.
Impact of Metabolic Surgery on Renal Injury in Pre-Clinical Models of Diabetic Kidney Disease
Authors: Martin William P. , le Roux Carel W. , Docherty Neil G.
Published: December 2020

Background: Surgical approaches to the treatment of obesity and type 2 diabetes, most notably the Roux-en-Y gastric bypass (RYGB) procedure, have been shown to be renoprotective, reducing the incidence of albuminuria and end-stage kidney disease over 15- to 20-year follow-up in patients with obesity. The tissue level effects of metabolic surgery on the diabetic kidney are not easily interrogated in clinical samples. However, elucidation of the cellular and molecular basis for the renoprotective effects of metabolic surgery is now emerging from a body of pre-clinical work in rodent models of diabetic kidney disease (DKD). Summary: Experimental metabolic surgery (RYGB, sleeve gastrectomy [SG], Roux-en-Y oesophagojejunostomy, and duodenojejunal bypass) exerts a pronounced albuminuria-lowering effect in rat models of DKD. Following RYGB in the Zucker diabetic fatty rat, glomerular histology is improved as demonstrated by reductions in podocyte stress, glomerulomegaly, and glomerulosclerosis. Glomerular ultrastructure improves after RYGB and after SG, manifested by quantifiable reductions in podocyte foot process effacement. The transcriptional programme underpinning these structural improvements has been characterized at the pathway level using RNA sequencing and is associated with a significant reduction in the activation of inflammatory and fibrotic responses. Key Messages: Experimental metabolic surgery reduces biochemical, histological, and molecular indices of DKD. These pre-clinical data support a growing interest in the potential utility of metabolic surgery as a therapeutic approach to slow renal functional decline in patients with obesity and DKD.
Social Isolation and Loneliness of Older Adults in Times of the COVID-19 Pandemic: Can Use of Online Social Media Sites and Video Chats Assist in Mitigating Social Isolation and Loneliness?
Authors: Hajek André , König Hans-Helmut
Published: December 2020

The COVID-19 pandemic is a serious global burden. Epidemiological data suggest that the severity of COVID-19, in particular its case fatality rate, rises strongly with age. It is possible that neither a vaccine nor an effective treatment will be available for >1 year. Thus, it may be necessary for older adults to protect themselves by avoiding direct social contact and practicing social distancing for a rather long period of time. This may result in loneliness and social isolation because, for example, grandchildren cannot visit their grandparents. In turn, both loneliness and social isolation can have serious deleterious consequences (e.g., in terms of morbidity and mortality). Thus, the question arises: are there ways to mitigate loneliness and social isolation? One way to stay in contact is to use online social media such as Facebook or using video calling software such as Skype. However, there are very few studies examining whether the use of online social media or video chats are associated with loneliness and social isolation in older adults. We sum up some preliminary findings and make a call for further research on the link between online social media use/video chat and loneliness, as well as social isolation, in older adults.
A auditoria das demonstrações contábeis da Concessionária Sigma, após captação de recursos via instrumento financeiro sintético
Authors: Costa Junior Jorge Vieira da
Published: December 2020

O caso envolve uma situação hipotética de uma concessionária, que precisa cumprir com sua obrigação contratual de execução de seu orçamento de capital - CAPEX regulatório, mas se encontra altamente endividada. Capta recursos no mercado por meio de um arranjo contratual sofisticado (um instrumento financeiro – IF sintético “tailor made”) e contabiliza a transação de modo a evitar a quebra de “covenants” previstos em contratos de dívida. No momento da captação, a companhia encontra-se próxima do limite da quebra. O auditor independente precisa exercer uma série de julgamentos profissionais e adotar os procedimentos de auditoria requeridos, em particular no tocante à avaliação de risco inerente vis-à-vis os incentivos da administração para informação enganosa e à avaliação da política contábil criada pela administração para o IF sintético, com ceticismo e mente questionadora, visando a assegurar uma representação fidedigna da informação contábil.
Research network propagation: The impact of PhD students’
temporary international mobility
Authors: Horta Hugo , Birolini Sebastian , Cattaneo Mattia , Shen Wenqin , Paleari Stefano
Published: December 2020

As the global mobility of researchers increases, many of whom are supported by national funding agencies’ mobility schemes, there is growing interest in understanding the impact of this overseas mobility on knowledge production and networking. This study addresses a relatively understudied mobility—the temporary international mobility of PhD students in STEM fields—and its relation to the establishment of research collaborations between mobile PhD students and researchers at the host university and with other researchers overseas. First, we find that 55% of the participants established relevant international collaborations (i.e., with hosting supervisors and/or others at the hosting university), and we explore these collaboration patterns in detail by taking a novel research propagation approach. Second, we identify features of the visiting period that influence the formation of research collaborations abroad, such as the prestige of the host university, the duration of the international mobility period, the cultural distance, and the number of peer PhD students at the host university. Previous research collaborations between the home and host supervisors are also found to play a crucial role in research collaboration development. Age at the time of mobility is not found to be particularly relevant. We find that female PhD students are less able to benefit from collaborative research efforts than male students. These findings advance the knowledge of global research networks and provide important insights for research funding agencies aiming to promote international research mobility at the doctoral level.
Revision of the spider genus Sparianthis Simon, 1880 (Araneae, Sparassidae, Sparianthinae)
Authors: RHEIMS CRISTINA A.
Published: December 2020

The genus Sparianthis Simon is revised. Pseudosparianthis Simon and Sampaiosia Mello-Leitão are considered junior synonyms of Sparianthis and thus, seven new combinations are proposed: S. accentuata (Caporiacco) comb. nov., S. chickeringi (Gerstch) comb. nov., S. fusca (Simon) comb. nov., S. megalopalpa (Caporiacco) comb. nov., S. picta (Simon) comb. nov. and S. ravida (Simon) comb. nov. are transferred from Pseudosparianthis and S. crulsi (Mello-Leitão) comb. nov. from Sampaiosia. Two additional new combinations are proposed: Decaphora ambigua (Caporiacco) comb. nov. and Uaiuara jayuyae (Petrunkevitch) comb. nov. are transferred from Pseudosparianthis and, together with S. fusca, are considered nomina dubia. Sparianthis accentuata is considered incertae sedis. The male of S. chickeringi and the female of S. crulsi are described for the first time and six new species are described: S. beebei sp. nov. (♂♀) from Trinidad and S. caracarai sp. nov. (♂♀) from Roraima, S. boraris sp. nov. (♂♀) and S. juruti sp. nov. (♂♀) from Pará, and S. humaita sp. nov. (♂♀) and S. juazeiro sp. nov. (♀) from Acre, all in Brazil. All species are redescribed and illustrated. In addition, an identification key and updated distribution maps for all species of the genus are included.
What Does Climate Change Mean to Us, the Maasai? How Climate-Change Discourse is Translated in Maasailand, Northern Tanzania
Authors: de Wit Sara
Published: December 2020

This chapter explores the varying ways in which the Maasai pastoralists in Terrat village in northern Tanzania give meaning to climate-change discourses. This study moves away from the idea that there is a “linear” (from global to local/science to citizen) and “correct” way of interpreting and understanding climate change as a scientific discourse, but turns the question around by asking “what does climate change mean to the Maasai”? Based on fourteen months of multi-sited ethnographic fieldwork, this chapter contextualizes climate change discourses in the historical, environmental and political dimensions of the Maasai’s “interpretive horizons”. It is argued that local discourses and interpretations are not just barriers in the global pursuit for climate change adaptation, even if they contradict global discourses and policies, but reveal crucial insights about local priorities, values, and agency. In other words, the rejection of this new discourse should not be seen as a form of ignorance, but rather as an act of cultural translation and resistance.
Gender Segregation and Its Correlates at Midlife and Beyond
Authors: Mehta Clare , Wilson Jenna , Smirles Kimberly Eretzian-Schnauber
Published: December 2020

We investigated gender segregation and its correlates in the friendships of U.S. adults aged 50–74 years (177 women; 52 men). Gender segregation existed in our midlife sample such that 74% of friend nominations were same gender. Similar to research on other periods of the adult lifespan we found that for women, gender segregation was negatively correlated with competitive activity orientation, positively correlated with beliefs about same-gender peers’ communicative responsiveness and negatively correlated with beliefs about other-gender peers’ communicative responsiveness. Women’s gender segregation was also negatively correlated with masculinity and positively correlated with gender-reference group identity. For men, gender segregation was negatively correlated with beliefs about other-gender peers’ communicative responsiveness and positively correlated with gender-reference group identity. Our results suggest that gender segregation continues to exist at midlife and that there is some continuity in the correlates of gender segregation across adulthood.
Transoral Robotic Surgery for Cancer of the Soft Palate Posterior Surface
Authors: Chebib Emilien , Lechien Jérôme R. , Chekkoury Younes , Hans Stéphane
Published: December 2020

The surgical treatment of oropharyngeal squamous cell carcinoma (OSCC) has undergone a considerable evolution, with, among others, transoral robotic surgery (TORS). However, TORS is rarely used for the surgery of soft palate. A 73-year-old man presented a human papilloma virus OSCC of the posterior soft palate. The tumor was resected using TORS. This report describes the surgical technique step by step of the tumor resection. The resection of early stage OSCC of the posterior surface of soft palate is possible through TORS. The procedure is noninvasive, rapid, and seems to be associated with excellent functional outcomes.
The effectiveness of peroneal nerve functional electrical simulation for the reduction of bradykinesia in Parkinson’s disease: A feasibility study for a randomised control trial
Authors: Taylor Paul N , Sampson Trish , Beare Ben , Donavon-Hall Maggie , Thomas Peter W , Marques Elsa , Strike Paul , Seary Coralie , Stevenson Valerie L , Padiachy Diran , Lee James , Nell Sheila
Published: December 2020

Objectives:

To assess the feasibility of a multi-site randomised controlled trial to evaluate the effect of functional electrical stimulation on bradykinesia in people with Parkinson’s disease.

Design:

A two-arm assessor blinded randomised controlled trial with an 18 weeks intervention period and 4 weeks post-intervention follow-up.

Setting:

Two UK hospitals; a therapy outpatient department in a district general hospital and a specialist neuroscience centre.

Participants:

A total of 64 participants with idiopathic Parkinson’s disease and slow gait <1.25 ms−1.

Interventions:

Functional electrical stimulation delivered to the common peroneal nerve while walking in addition to standard care compared with standard care alone.

Main measures:

Feasibility aims included the determination of sample size, recruitment and retention rates, acceptability of the protocol and confirmation of the primary outcome measure. The outcome measures were 10 m walking speed, Unified Parkinson’s Disease Rating Scale (UPDRS), Mini Balance Evaluation Systems Test, Parkinson’s Disease Questionnaire-39, EuroQol 5-dimension 5-level, New Freezing of Gait questionnaire, Falls Efficacy Score International and falls diary. Participants opinion on the study design and relevance of outcome measures were evaluated using an embedded qualitative study.

Results:

There was a mean difference between groups of 0.14 ms−1 (CI 0.03, 0.26) at week 18 in favour of the treatment group, which was maintained at week 22, 0.10 ms−1 (CI –0.05, 0.25). There was a mean difference in UPDRS motor examination score of –3.65 (CI –4.35, 0.54) at week 18 which was lost at week 22 –0.91 (CI –2.19, 2.26).

Conclusion:

The study design and intervention were feasible and supportive for a definitive trial. While both the study protocol and intervention were acceptable, recommendations for modifications are made.
A strain based criterion to assess ductile failure initiation in dented pipelines under tensile loading
Authors: Plata Uribe Yerlin Andres , Ruggieri Claudio , Ohata Mitsuru
Published: December 2020

This work addresses the problem of describing ductile fracture behavior and predicting ductile failure initiation in dented pipelines under tensile loading based upon a 3-D computational cell approach coupled with a stress-modified, critical strain (SMCS) criterion for void coalescence. A series of tension tests conducted on notched tensile specimens with different notch radius for a carbon steel pipe provides the stress–strain response of the tested structural steel from which the SMCS criterion is calibrated. Full scale cyclic bend tests also performed on a 165 mm O.D tubular specimen with 11 mm wall thickness enable verification of the proposed approach in assessing ductile cracking behavior in damaged pipelines. These exploratory analyses predict the tensile failure load for the pipe specimen associated with ductile crack initiation in the highly damaged area inside the denting and buckling zone which are in good agreement with experimental measurements.
Risk Factors Associated With School Bullying Behaviors: A Chinese Adolescents Case-Control Study, 2019
Authors: Qian Yining , Yang Yaming , Lin Ping , Xiao Yue , Sun Yan , Sun Qiannan , Li Xinyu , Fei Gaoqiang , Stallones Lorann , Xiang Henry , Zhang Xujun
Published: December 2020

This research aimed to identify risk factors including individual characteristics and environment circumstances related to different types of school bullying (physical, relational, verbal, sexual, and possession bullying) among middle school students in China. Cases were the respondents reporting perpetrating bullying behaviors three or more times in the past year. One control was selected for each case from those participants who were not involved in school bullying in the past 12 months. Data were collected between April 2019 and May 2019 in China. After considering potential confounding variables including gender, grade level, and school, multivariable conditional logistic regression analysis was performed based on the univariate logistic analysis including 1,594 adolescents. According to conditional logistic regression analysis, alcohol use and lack of emotional management and control were the significant individual characteristics positively associated with involvement in school bullying. Alcohol use was related to all five types of school bullying perpetration. Poor relationships between family members, father’s alcohol use, and parental neglect were strong risk factors for relational bullying. Lack of a sense of safety and absence of trusted people were associated with physical, relational, and verbal bullying perpetration. Results of this study provide evidence about risk factors for school bullying and have implications for potential policies to reduce bullying. Effective policies and programs need to take individual characteristics (social-emotional skills, anger control), family (parent training in conflict resolution, appropriate disciplining), peer and school factors (promoting prosocial networks, zero tolerance for bullying, appropriate disciplining policies against students who bully others, teacher training on building positive teacher–student relationships and positive discipling techniques) into consideration in order to develop effective prevention programs.
Profile of Reported Trafficking in Persons in Brazil Between 2009 and 2017
Authors: Passos Taciana Silveira , Santos Santana Mateus Felipe , Cordero-Ramos Nuria , Almeida-Santos Marcos Antonio
Published: December 2020

The objective of this study was to analyze the temporal evolution of the number of human trafficking cases notified by the health system in Brazil, considering the characteristics of the population. This article carries out a descriptive study on reports of trafficking in persons in consultation with the Department of Informatics of the Unified Health System. This is a profile of reported trafficking in persons in Brazil between 2009 and 2017. Incidence rates were calculated with adjustments to the population record for each year and presented on a scale of 1:1,000,000 inhabitants. We developed a Poisson regression model to evaluate the ratio of the incidence rate. According to available data, there were 1,011 victims reported in the health system during the study period. The predominant profile of the population exposed to such violence is female, aged between 20 and 29 years, with low education and brown skin. There was a trend growth of annual reports about 10 percentage points ( p < .0001) and all regions had significantly higher incidence rates than the Southeast ( p < .0001), mainly Midwest, North and South. This means that the regions with the highest incidence rates have international land borders. Given the predominance of women in young adulthood, it is inferred that the majority were trafficked for sexual exploitation. This research represents a pioneering approach to the use and modeling of human trafficking data available in the Brazilian public health system. There is a probable underreporting of cases of trafficking in persons who transit health services. As such, identification methods for hard-to-reach populations should be integrated into future research on human trafficking to increase the likelihood of capturing victims.
Optimal kinematic synthesis of 6 bar rack and pinion Ackerman steering linkage
Authors: Pradhan Debendra , Ganguly Krishanu , Swain Biswajit , Roy Haraprasad
Published: December 2020

In this article, synthesis and simultaneous optimization of a steering mechanism is proposed for enhancing the cornering performance of a Formula Students competition car. A planar six-bar steering mechanism is synthesized assuming it as two separate slider-crank arrangements with a rigid link between the sliders. Numerical optimization is performed using multi-objective genetic algorithm (MOGA), which includes minimization of differences between both slider displacements and summation of deviations from true Ackerman geometry for a set of steering inputs. The selection of various parameters for running MOGA is well established based on iterative way. The seven variables (such as wheelbase and track width lengths, tie rod, tie-arm etc.) are optimized and used to construct the Ackerman steering geometry. Finally, the outer to inner tyre rotations of obtained geometry is calculated and compared with the predefined targeted values of actual Ackerman criteria.
Layering memories: Frank Chiche’s Je vous ai compris (2012)
Authors: Rousseau Sandra
Published: December 2020

This article discusses Frank Chiche’s 2012 film Je vous ai compris and sheds light on the way rotoscoping complicates memorial discourses on the Algerian War of Independence. I argue that the superposition of different media and the changing allegiances of the film’s characters unsettle binary understandings of the conflict and challenge generic expectations. As the first ever BD-movie, it suggests that historical remembrance is akin to a constantly changing sculpture, defined not only by the memorial constraints of characters, but also by the perspectives of its viewers. Through an analysis of the genres and media, the construction of characters, and the description of memory as layered, I show that Je vous ai compris offers a sophisticated representation of a memorial quagmire that continues to inspire historians and artists alike.
The Prevalence of Nonsyndromic Oral Clefts in Twins Compared to Singletons: The Association With Birth Weight
Authors: Kariyawasam Diluma , Jahanfar Shayesteh
Published: December 2020

Purpose:

To examine the prevalence of nonsyndromic oral clefts in twins compared to singletons in the United States and to evaluate the association between birth weight and nonsyndromic oral clefts.

Design:

A large population-based cross-sectional study was performed using the data from the US National Center for Health Statistics database in 2017.

Participants:

Our sample consisted of 128 310 twins and 3 723 273 singletons.

Methods:

The variables collected were sociodemographic variables, environmental predictors, and clinical measures. Descriptive analysis, bivariate, and multivariate logistic regression were performed.

Main Outcome Measure:

The main outcome variable in our study is nonsyndromic oral clefts.

Results:

The prevalence of nonsyndromic oral clefts was 5.22 per 10 000 in twins and 5.12 per 10 000 in singletons. Results show no significant risk of nonsyndromic oral clefts in twins compared to singletons ( P = .92). There was a significant relationship between birth weight and infant diagnosed with nonsyndromic oral clefts ( P = .01). Unadjusted odds ratio for birth weight was 2.52 (95% CI: 2.25-2.82). Adjusted odds for potential confounders such as mother’s age, race, mother’s education, gender of the infant, APGAR 5-minute score, gestational age, prenatal smoking, number of prenatal care visits, and mother’s body mass index were resulted in similar but with a slightly lower odds of 2.11 (95% CI: 1.78-2.50).

Conclusion:

Compared to singletons, twins did not have higher risk of nonsyndromic oral clefts. Infants with low birth weight were more prone to have nonsyndromic oral clefts.
Increasing Screening for Intimate Partner Violence and Reproductive Coercion: Understanding Provider Motivations
Authors: Burton Candace W. , Carlyle Kellie E.
Published: December 2020

Current estimates indicate that as few as 2% of health providers may be universally screening patients or clients for intimate partner violence and reproductive coercion. Barriers to screening have been well-described in the literature; however, little attention has been paid to the factors that motivate providers to carry out screenings. This study explored data from a sample of providers who had received specific screening and intervention training to ascertain what factors motivated them to complete screenings in practice. Patient-related, provider-related, and work setting factors were identified. Findings may support improved provider training and, ultimately, screening rates.
Periprosthetic femoral fractures in sideways fall configuration: comparative numerical analysis of the influence of femoral stem design
Authors: Franceschini Massimo , Barbera Luigi La , Anticonome Alberto , Ottardi Claudia , Tanaka Atsuki , Villa Tomaso
Published: December 2020

Introduction:

The aim of this study was to investigate the mechanisms of periprosthetic fractures occurring as a result of a sideways fall in total hip arthroplasty patients, and to compare the predictions of numerical models in terms of load distribution on the implanted femur with clinical data.

Materials and methods:

3 numerical models were built: 1 for intact femur and 2 for implanted femur with a straight stem (resembling PBF, Permedica) and with an anatomical stem (resembling ABG II, Stryker). 4 loading configurations were simulated; 1 simulates a vertical load, and 3 simulate a fall with impact on the greater trochanter in different directions. Stress state calculated in the implanted femur was compared for the 2 models with reference to the intact case. These were compared with clinical data collected at a single centre (Istituto Ortopedico Gaetano Pini, Milan, Italy) where 41 patients were investigated after periprosthetic fracture: 26 patients had a straight uncemented stem and 15 an anatomical uncemented stem.

Results:

The maximum calculated strain in compression in the case of ABG II implanted femur was 2 times higher than in the presence of PBF stem in the vertical loading configuration. For configurations of sideways fall, in both models, there was a progressive increase of stress state in the bone with increasing angle. Simulations of sideways fall elicited results in accordance with clinical observations: due to the peculiar stem design and consequent state of stress in the bone, anatomical stems seem to induce trochanteric fractures more frequently, while for straight stems type B fractures are more likely to occur.

Conclusions:

Clinical findings confirmed numerical model predictions: stem design seems to highly influence distribution of stress in the bone and consequent localisation of the fracture site.
Femoral revision in periprosthetic fractures using a titanium modular fluted tapered stem: mortality and clinical and radiological outcomes
Authors: Munegato Daniele , Caminita Agostino Dario , Sotiri Romeo , Rossi Andrea , Bigoni Marco , Zatti Giovanni
Published: December 2020

Introduction:

The aim of the study was to evaluate the mortality and the outcomes of femoral revision in periprosthetic femoral fractures (PFF) using a titanium modular fluted tapered stem.

Methods:

We retrospectively reviewed femoral revisions performed for PFF with a titanium modular fluted tapered stem in 25 patients. The average age was 74.32 years. In 21 patients the type of fracture was Vancouver B2 and type B3 in 4 cases. The mean follow-up was 29.16 (0.83–104.1) months SD ± 29.49.

Results:

The 30-day and 1-year mortality were 8% and 12% respectively. The mean value of the Charlson Comorbidity Index was 4.8 and the mean value of ASA score was 2.4. The average time to surgery from admittance was 5.45 days with 20% of patients operated on within 48 hours. A significant correlation was found between ASA score and mortality. The mean HHS was 76 points; good-excellent results were recorded in 56% of patients. 72% had no pain and 28% had slight pain (VAS 1–3). 52% of patients were able to walk without pain, limp or aids. The mean implant subsidence was 1.57 mm and superior to 5 mm in 2 cases. As complications we recorded 4 implant dislocations (16%) and 2 infections. Reoperation rate was 12%.

Conclusions:

Femoral revision with a modular fluted tapered stem in patients with periprosthetic fractures results in good clinical and radiological outcomes. However, mortality remains high and, despite the modularity design, dislocation is the most frequent complication.
15-year follow-up of MoM 36-mm THA: clinical, laboratory, and radiological (CT and MRI) prospective assessment
Authors: Bozza Nicola , Guindani Nicola , Pezzotta Giuseppe , Alberto Ferrari , Castelli Claudio C
Published: December 2020

Introduction:

There is limited knowledge of the long-term results of metal-on-metal total hip arthroplasty (MoM THA), particularly concerning adverse local tissue reaction (ALTR), Co/Cr ions level and revision rate. Even if MoM bearing surfaces are no longer used, long-term data could help in defining the course and best management for these patients. The purpose of this study is to investigate the clinical outcomes, describe radiological findings including CT metal artefact reduction algorithm for orthopaedic implants (O-MAR) and MRI multi acquisition variable resonance image combination (MAVRIC) in 36-mm MoM THA.

Methods:

In this long-term prospective study, 46 consecutive patients with primary MoM THA (mono- or bilateral) were enrolled between 2004 and 2005. Pinnacle acetabular cup, Summit cementless stem with 36-mm metal head and Ultamet CoCr alloy liner (Depuy Inc.) were implanted, in the same centre by the same senior surgeon. Patients were reviewed at 5-, 10- and 15-years, including Co/Cr levels and standard radiographs at every follow-up, whilst the 15-year follow-up included hip sonography, MRI MAVRIC and CT O-MAR.

Results:

At 15 years, the overall survival rate of the implants (both stems and cups) was 83% (30/36). Revisions were performed in 9% (4/46) because of ALTR, 2% (1/46) septic loosening and 2% periprosthetic fracture. Both Cr and Co concentration increased over time, even though remaining at low level risk at 15 years: Co from 0.11 (+/– 0.18) to 4.29 (+/– 3.26) and Cr from 0.38 (+/– 0.32) to 1.37 (+/– 1.15). Functional scores in non-revised patients showed good to excellent results in more than 90%. Engh-score correlated with time from surgery ( p = 0.017) and with sonographic, CT and RM findings ( p < 0.05). Concordance has been found between CT and MRI findings (sign-rank test, p = 0.241; Intraclass Correlation Coefficients 0.987); however, no specific MRI or CT lesion patterns could be recognised among symptomatic and non-symptomatic patients.

Discussion:

The long-term rate of ALTR after 36-mm MoM THA was comparable with previous studies; a regular follow-up for those implants is mandatory. During follow-up Co-Cr levels increased over time and radiography was a suitable screening technique; the Engh score in particular, proved to be a reliable assessment tool. CT O-MAR and MRI with MAVRIC protocols may add valuable data in clinical practice, although MRI is significantly more efficient than CT in the identification of ALTR lesions, peri-articular effusion and in the evaluation of soft tissues.
Unstable total hip replacement: why? Clinical and radiological aspects
Authors: Perticarini Loris , Rossi Stefano M P , Benazzo Francesco
Published: December 2020

Introduction:

Dislocation after total hip arthroplasty (THA) is the most common cause of revision hip surgery in the United States, ahead of aseptic loosening and infection, and is responsible for considerable economic cost related to frequent readmission and/or revision surgery. The aim of this article is to identify the clinical and radiological factors related to the unstable total hip replacement.

Methods:

We performed a literature search to assess current strategies to define clinical and radiological characteristics of dislocation after primary THA using the PubMed platform. The characteristics related to THA instability were divided into patient related factors, implant related factors and surgeon experience.

Results:

Patient-related factors for instability identified are: age; inflammatory joint disease; prior hip surgery; preoperative diagnosis; comorbidity; ASA score; presence of spino-pelvic abnormality; and neurological disability. Gender, simultaneous bilateral THA and restrictive postoperative precautions do not influence rate of THA dislocation. Implant related factors identified are: surgical approach; component malposition; femoral head size; and the use of dual-mobility or constrained solution. Surgeon experience also reduces the rate of dislocation.

Discussion:

Dislocation is a major complication of THAs, and causes include patient-derived factors, surgical factors, or both. It is imperative to determine the cause of the instability via a complete patient and radiographic evaluation and to adjust the reconstruction strategy accordingly.
Isolated Neck Extensor Myopathy Associated With Cervical Spondylosis: A Case Report and Brief Review
Authors: Chu Eric Chun-Pu , Wong Arnold Yu-Lok , Lin Andy Fu-Chieh
Published: December 2020

Dropped head syndrome (DHS) is manifested as the inability to maintain the head in an upright posture. It has been associated with a wide spectrum of myopathies and neurological conditions. Isolated neck extensor myopathy (INEM) is one of many potential causes of DHS. This is a case report of a 72-year-old man who presented with degenerative cervical spondylosis and DHS for 2 years. He had previously failed to achieve a positive outcome to medication, cervical collar and exercise rehabilitation. However, he was able to regain his voluntary head control after a 4-month chiropractic program. It is believed that INEM is caused by isolated myopathic changes from chronic injury and overloading of the cervical muscles. Cervical spondylosis has been attributed as the cause of DHS secondary to denervation of the cervical extensors. While INEM associated with degenerative spondylosis is not medically treatable, manipulative therapies may be adopted before considering surgical intervention.
The Feasibility and Effects of Qigong Intervention (Mind-Body Exercise) in Cancer Patients With Insomnia: A Pilot Qualitative Study
Authors: Low Sara L. K. , Cheema Birinder S. , Tan Hsiewe Ying , Birling Yoann , Zhu Xiaoshu
Published: December 2020

Background:

Up to 80% of cancer patients experience insomnia that significantly affects their quality of life. This pilot qualitative study investigated the feasibility and effects of a 3-week Qigong (mind-body exercise) intervention with a 1-week follow-up in cancer patients experiencing insomnia.

Methods:

Cancer patients with insomnia who had completed radiotherapy or chemotherapy treatment and/or were at least 8 weeks post-cancer-related surgery were recruited. Primary outcomes were feasibility outcomes, which included recruitment, retention, attendance, completion of assessment, adverse events and participant feedback via a questionnaire and focus group/individual interview. Secondary outcomes on insomnia severity and sleep quality were measured using the Insomnia Severity Index (ISI) and the Pittsburgh Sleep Quality Index (PSQI) at baseline, mid, post-intervention and follow-up.

Results:

Seven participants were recruited and two withdrew from the study. The participant retention rate was 71.4% with an overall attendance rate of more than 84% and participants were able to complete all required assessments. An adverse event relating to the worsening of existing musculoskeletal condition was reported. Qualitative analysis of participant feedback identified 4 emerging themes: (1) experience from Qigong intervention; (2) class preferences; (3) barriers to participation; and (4) recommendation for improvement. Participants reported increased relaxation, improved sleep and energy level, better upper body flexibility and reduced stress. Both ISI and PSQI scores improved significantly ( P < .05).

Conclusion:

This study demonstrated that it is feasible to employ the current clinical trial design using Qigong intervention on insomnia in cancer patients. Preliminary data suggest that the intervention may improve sleep outcomes, however, these findings need to be confirmed by future robust randomized controlled trials.

Trial registration:

The trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12618001670268) http://www.ANZCTR.org.au/ACTRN12618001670268.aspxon10October2018 .
The ischemic penumbra: From concept to reality
Authors: Ermine Charlotte M , Bivard Andrew , Parsons Mark W , Baron Jean-Claude
Published: December 2020

The discovery that brain tissue could potentially be salvaged from ischaemia due to stroke, has led to major advances in the development of therapies for ischemic stroke. In this review, we detail the advances in the understanding of this area termed the ischaemic penumbra, from its discovery to the evolution of imaging techniques, and finally some of the treatments developed. Evolving from animal studies from the 70s and 80s and translated to clinical practice, the field of ischemic reperfusion therapy has largely been guided by an array of imaging techniques developed to positively identify the ischemic penumbra, including positron emission tomography, computed tomography and magnetic resonance imaging. More recently, numerous penumbral identification imaging studies have allowed for a better understanding of the progression of the ischaemic core at the expense of the penumbra, and identification of patients than can benefit from reperfusion therapies in the acute phase. Importantly, 40 years of critical imaging research on the ischaemic penumbra have allowed for considerable extension of the treatment time window and better patient selection for reperfusion therapy. The translation of the penumbra concept into routine clinical practice has shown that “tissue is at least as important as time.”
Negative pressure rooms and COVID-19
Authors: Al-Benna Sammy
Published: December 2020

The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes 2019 novel coronavirus disease (COVID-19), has rapidly developed into a global pandemic and public health emergency. The transmission and virulence of this new pathogen have raised concern for how best to protect healthcare professionals while effectively providing care to the infected patient requiring surgery. Although negative pressure rooms are ideal for aerosol-generating procedures, such as intubation and extubation, most operating theatres are generally maintained at a positive pressure when compared with the surrounding areas. This article compares negative and positive pressure rooms and the advantages of a negative pressure environment in optimising clinical care and minimising the exposure of patients and health care professionals to SARS-CoV-2.
Abrupt and Gradual Realignments: The Case of Costa Rica, 1958–2018
Authors: Perelló Lucas , Navia Patricio
Published: December 2020

Studies on party system change in Latin America commonly label similar processes as constituting dealignment or realignment. To clarify the boundaries between both concepts, we distinguish between abrupt and gradual realignments. While both imply change, they differ in the number of election cycles involved. Abrupt realignments occur in a single election cycle, while gradual realignments take place in two or more. We apply this conceptualisation to Costa Rica, Latin America’s longest-running democracy, and a country where the party system has decayed without collapsing. To better identify the type of change that has taken place, we use canton-level election data from 1958 to 2018 and public opinion surveys from 1978 to 2018. The evidence contests the notion of electoral dealignment. Instead, we show that the party system experienced an abrupt realignment in the 2002 election and gradual realignment in more recent election cycles.
Extracellular vesicles derived from human dental pulp stem cells promote osteogenesis of adipose-derived stem cells via the MAPK pathway
Authors: Jin Qiaoqiao , Li Peilun , Yuan Keyong , Zhao Fen , Zhu Xiaohan , Zhang Pengfei , Huang Zhengwei
Published: December 2020

Recent studies have shown that co-culture systems play an important role in bone tissue engineering. In this study, human dental pulp stem cells (hDPSCs) were co-cultured with human adipose-derived stem cells (hADSCs), and osteoblastic phenotypes were found to be enhanced in co-cultures compared with monocultures of hDPSCs or hADSCs. Furthermore, GW4869, an inhibitor of extracellular vesicle (EV) formation, suppressed the mineralization of co-cultured cells. Studies indicate that the therapeutic potential of DPSCs is realized through paracrine action, in which EVs play an important role. To study their role, we successfully obtained and identified hDPSC-derived extracellular vesicles (hDPSC-EVs), and further investigated their effects on hADSCs and the underlying mechanism. hADSCs were stimulated with hDPSC-EVs, which were found to promote the migration and mineralization of hADSCs. Moreover, hDPSC-EVs promoted osteogenic differentiation by enhancing the phosphorylation of ERK 1/2 and JNK in hADSCs. To investigate the specific proteins in EVs that might play a role in hADSC osteogenic differentiation, we performed proteomic analysis of hDPSC-EVs. We determined the top 30 enriched pathways, which notably included the insulin signaling pathway. The number of genes enriched in the insulin signaling pathway was the largest, in addition to the “protein processing in endoplasmic reticulum” term. The MAPK cascade is a typical downstream pathway mediating insulin signaling. To further study the effects of hDPSC-EVs on maxillofacial bone regeneration, we used hDPSC-EVs as a cell-free biomaterial in a model of mandibular defects in rats. To assess the therapeutic potential of EVs, we analyzed their proteome. Animal experiments demonstrated that hDPSC-EVs promoted the regeneration of bone defects. Overall, these results highlight the potential of hDPSC-EVs to induce lineage specific differentiation of hADSCs. The results also indicated the importance of considering hDPSC-EVs as biomimetic materials for clinical translation of treatments for oral maxillofacial defects.
Digoxin-specific antibody fragments for the treatment of suspected Nerium oleander toxicosis in a cat
Authors: Galton Aaron F , Granfone Marcella C , Caldwell Dana J
Published: December 2020

Case summary

A 6-year-old castrated male domestic shorthair cat presented for lethargy and gastrointestinal signs after possible exposure to Nerium oleander leaves. The cat developed a ventricular arrhythmia that responded positively to the administration of digoxin-specific antibody fragments. Underlying hypertrophic cardiomyopathy was also diagnosed after the development of congestive heart failure. Humane euthanasia was elected owing to a lack of significant response to continued therapy.

Relevance and novel information

To our knowledge, this is the first report to describe the use of digoxin-specific antibody fragments in a cat. Nerium oleander toxicosis is associated with significant morbidity and mortality, and digoxin-specific antibody fragments have been used effectively in humans and animals. The development of cardiac necrosis may have contributed to worsening arrhythmias and highlights the importance of early intervention. The use of digoxin-specific antibody fragments for suspected N oleander toxicosis in a cat resulted in a rapid response and appeared to be well tolerated.