bluuebunny/crossref_metadata_2025 huggingface dataset:
1. What is a reptile?
Authors: Kemp T. S.
Published: January 2019

There are close to 10,000 different species of reptiles, with five different kinds of living animals making up the Class Reptilia: chelonians (turtles and tortoises); lizards; snakes; crocodilians; and the tuatara of New Zealand. ‘What is a reptile?’ explains that despite their huge range of body forms and ways of life, zoologists recognize them all as reptiles because of the fundamental characters that they all share, including dry and scaly skin, the ability to excrete urine waste as a solid, and the reproductive process of laying amniotic eggs on dry land. The evolutionary adaptations for moving to life on dry land, which began about 320 million years ago, are explained.
5. Crocodiles
Authors: Kemp T. S.
Published: January 2019

There are only about twenty-five species of living crocodilians, found in semi-aquatic habitats, mostly around freshwater rivers, lakes, and swamps, but also in marine areas. ‘Crocodiles’ explains how the crocodile body is very well adapted for the amphibious way of life; they can move quickly between the land, where they spend much of the day basking, and the water in which they mostly feed and to where they flee if threatened. It considers their skin; how they breathe, move, and feed; and their sense organs, including the unique integumentary sense organs. The social behaviour of crocodiles, especially courtship and the care of the young, is much more elaborate than in any other reptile group.
Roots
Authors: Como James
Published: January 2019

‘Roots’ recounts Clive Staples Lewis’s early life in a close-knit Christian family—his parents, Albert and Flora, and his brother, Warren—in County Down, Northern Ireland. His atheism was probably triggered by his mother’s death when he was not quite ten. His early schooling was much improved by his private tutor, William T. Kirkpatrick, who added dialectical precision to the rhetorical and argumentative disposition Lewis inherited from Albert. The impact of George MacDonald’s Phantastes on Lewis is highlighted, along with his service in World War I; his time as an undergraduate at Keble College, Oxford; his election to a fellowship at Magdalen College; his diary writing; and his conversion to Christianity.
End game
Authors: Como James
Published: January 2019

‘End game’ describes the growing friendship between C. S. Lewis and T. S. Eliot as well as the dislike held between Lewis and F. R. Leavis and his followers, the Leavisites. It describes his works, A Study in Words (1960) and An Experiment in Criticism (1961), as well as his numerous short essays, many of which dealt with religious themes, with the interaction of religion and society, with social and cultural features as he saw them, or with cultural mistakes. It also outlines The Discarded Image (1964), which was a masterly introduction to medieval and Renaissance literature. Ill health forced his resignation and he died on 22 November 1963.
1. Heidegger’s life
Authors: Inwood Michael
Published: January 2019

‘Heidegger’s life’ considers the controversial path that Heidegger followed during his lifetime. His early education and university studies were heavily influenced by Catholicism and scholasticism, and he initially began to train for the priesthood, before turning to philosophy. Teaching at Freiburg and Marburg in the 1920s, he published his masterwork, Being and Time, in 1927. Elected rector of Freiburg University in 1933, he joined the Nazi Party at the same time. Although cooperative with the regime, he soon resigned the rectorship and played little further political role. Despite his ban from teaching until 1949 during denazification, his career as a writer and lecturer soon recovered.
9. History and world-time
Authors: Inwood Michael
Published: January 2019

‘History and world-time’ explores how history can be accessed and serve as inspiration. Dasein’s intrinsic historicality means that the past is intertwined with the present, and history is not dead and gone. Heroes from the past can provide opportunities for repetition, giving possibilities that can shape the fate of authentic Dasein. Inauthentic historicity, like inauthentic Dasein, is dispersed in the world of the present. Past philosophers are to be read with a view to their possibilities, but need to be placed in world-time. World-time, like the world itself, is significant and everything present at hand has its place. This contrasts with temporal now-time, which is a homogeneous sequence of nows.
A Simplified Definition of Histologic Improvement in Ulcerative Colitis and its Association With Disease Outcomes up to 30 Weeks from Initiation of Therapy: Post Hoc Analysis of Three Clinical Trials
Authors: Li Katherine , Strauss Richard , Marano Colleen , Greenbaum Linda E , Friedman Joshua R , Peyrin-Biroulet Laurent , Brodmerkel Carrie , De Hertogh Gert
Published: January 2019

Background and Aims

Histologic evaluation is a meaningful complement to endoscopic and clinical measures in ulcerative colitis [UC]. There is a need for a definition of histologic improvement that can be used in clinical trials, and any such definition must be predictive of disease outcomes.

Methods

Biopsies were collected from clinical trials (PURSUIT-SC [n = 98], JAK-UC [n = 219], and PROgECT [n = 103]) in patients with moderate-to-severe UC. A pathologist assessed biopsies in a blinded fashion using the Geboes score. A dichotomous histologic improvement end point was defined by selecting Geboes score elements according to their association strength with endoscopic healing. Fisher’s exact test and Cramer’s V assessed the association of histology with other measures.

Results

Using PURSUIT-SC biopsies, histologic improvement was defined as absence of erosion or ulceration, absence of crypt destruction, and <5% of crypts with epithelial neutrophil infiltration. Histologic improvement was associated with endoscopic healing, as >90% of those with endoscopic healing in JAK-UC [Week 8] and PROgECT [Week 30] achieved histologic improvement. In JAK-UC, patients with histologic improvement had lower disease activity than patients without histologic improvement’ [Mayo score = 3.8 vs 7.5] at Week 8. Week 4 histologic improvement was a strong indicator of histologic improvement, endoscopic healing, and clinical response or remission at Week 8 [all p < 0.005]. In PROgECT, 73% of patients with histologic improvement at Week 6 achieved histologic improvement at Week 30 [p = 0.0013].

Conclusions

Histologic improvement based on a simplified, dichotomous Geboes score is associated with favourable endoscopic and clinical outcomes across multiple clinical studies and two therapeutic mechanisms of action.

ClinicalTrials.gov number: NCT00487539 [PURSUIT-SC]; NCT01959282 [JAK-UC]; NCT01988961 [PROgECT].
A JAK1 Selective Kinase Inhibitor and Tofacitinib Affect Macrophage Activation and Function
Authors: De Vries L C S , Duarte J M , De Krijger M , Welting O , Van Hamersveld P H P , Van Leeuwen-Hilbers F W M , Moerland P D , Jongejan A , D’Haens G R , De Jonge W J , Wildenberg M E
Published: January 2019

Background

Janus kinases (JAKs) mediate cytokine signaling involved in inflammatory bowel disease. The pan-JAK inhibitor tofacitinib has shown efficacy in the treatment of ulcerative colitis. However, concerns regarding adverse events due to their wide spectrum inhibition fueled efforts to develop selective JAK inhibitors. Given the crucial role of myeloid cells in intestinal immune homeostasis, we evaluated the effect of pan-JAK and selective JAK inhibitors on pro- and anti-inflammatory macrophage polarization and function (M1/M2) and in experimental colitis.

Methods

Murine bone marrow–derived macrophages or human monocytes were treated using JAK1 and JAK3 selective inhibitors (JAK1i;JAK3i) and tofacitinib and were evaluated by transcriptional, functional, and metabolic analyses. In vivo, oral administration of JAK1i and tofacitinib (10 or 30 mg/kg) was tested in both acute and acute rescue dextran sodium sulfate (DSS) colitis.

Results

Both tofacitinib and JAK1i but not JAK3i effectively inhibited STAT1 phosphorylation and interferon gamma–induced transcripts in M1 polarized macrophages. Strikingly, transcriptional profiling suggested a switch from M1 to M2 type macrophages, which was supported by increased protein expression of M2-associated markers. In addition, both inhibitors enhanced oxidative phosphorylation rates. In vivo, JAK1i and tofacitinib did not protect mice from acute DSS-induced colitis but ameliorated recovery from weight loss and disease activity during acute rescue DSS-induced colitis at the highest dose.

Conclusion

JAK1i and tofacitinib but not JAK3i induce phenotypical and functional characteristics of anti-inflammatory macrophages, suggesting JAK1 as the main effector pathway for tofacitinib in these cells. In vivo, JAK1i and tofacitinib modestly affect acute rescue DSS-induced colitis.
Optimal control of elliptic surface PDEs with pointwise bounds on the state
Authors: Ahmad Ali Ahmad , Hinze Michael , Kröner Heiko
Published: January 2019

We consider a linear–quadratic optimal control problem for elliptic surface partial differential equations (PDEs) with additional state constraints. We approximate the optimization problem by a family of discrete problems and prove convergence rates for the discrete controls and the discrete states. With this we extend results known in the Euclidean setting to the surface case. We present numerical examples confirming our theoretical findings, with measures concentrated in points and measures concentrated on a line.
Does It work in Clinical Practice? A Comparison of Colonoscopy Cleansing Effectiveness in Clinical Practice Versus Efficacy from Selected Prospective Trials
Authors: Wang Chang (Nancy) , Yang Ruobing , Hookey Lawrence
Published: January 2019

Background

Adequate bowel preparation is essential for a high-quality colonoscopy. Many randomized controlled trials (RCTs) have investigated bowel preparation protocols, including split-dose and low-volume regimens. However, RCTs are conducted in an ideal, controlled setting, and translation of trial results to clinical practice is challenging. In this study, we compared the quality of bowel preparations of real-world patients from clinical practice with those enrolled in several prospective trials.

Methods

Bowel preparation quality, defined by the Ottawa Bowel Preparation Scale (OBPS), from four RCTs and one prospective trial were compared with two observational diary studies. Bowel preparations were polyethylene glycol preparation (PEG) or sodium picosulfate plus magnesium citrate (P/MC) taken via traditional or split-dose timing regimen. Age, sex, average number of bowel movements per day, comorbidities, colonoscopy indication and colonoscopy completion rates were also collected.

Results

Patients enrolled in prospective trials had a better OBPS by one point when compared with those in observational clinical practice studies (P<0.049), after controlling for age, sex, colonoscopy indication and type of bowel preparation used. We also found that each 10-year increase in age was associated with a 0.2 point increase in OBPS (P=0.008), and men were associated with a 0.5 increase in OBPS when compared with women P=0.014).

Conclusion

Patients from clinical practice have higher OBPS than prospective trial patients. Increased age and male sex were also associated with increased OBPS. We believe increased patient motivation and education around bowel preparation regimen plays an important role in the success of bowel preparations.
Eleven Years of Cataract Surgery in Veterans Without Pre-existing Ocular Comorbidities
Authors: Magone M Teresa , Kueny Laura , Singh Gemini A , Chin Loy Katrina , Kim Caroline H , Grover Will , Shin Soo Y
Published: January 2019

Introduction

In 2017, over 75,000 cataract surgeries were performed within the Veterans Health Administration System (VHA). Previous reports of outcomes of cataract surgery in veterans include patients with pre-existing ocular disease, which can affect vision. To exclude the confounding factor of pre-existing ocular comorbidities, we investigated the long-term visual outcomes and complications associated with small incision cataract surgery performed on veterans without any pre-existing eye disease.

Materials and Methods

Institutional Review Board approved cohort study with detailed retrospective chart review of all phacoemulsification (small incision) cataract surgeries performed at the Veterans Affairs Medical Center in Washington D.C. over 11 years, including all pre-and postoperative visits until postoperative month 12.

Results

A total of 1,513 consecutive surgical cases without any pre-existing ocular disease except the cataract were included. Vision improved significantly after cataract surgery compared to the preoperative best-corrected visual acuity (BCVA) (p = 0.0001) and remained stable over the first intra- and postoperative year. All eyes without complicated surgery and 99.1% of eyes with complications achieved 20/40 or better final vision postoperatively. The most common intra-and postoperative complications were vitreous loss (3.1%) and cystoid macular edema (CME; 1.4%). Patients with complications achieved final mean BCVA of 0.04 (20/22, vitreous loss) and 0.06 (20/23, CME) mean logMAR (Snellen).

Conclusion

Analysis of 11 years of small incision cataract surgery in eyes without pre-existing ocular disease within the VHA showed significant improvement in vision and stability 12 months after uncomplicated and complicated surgery in veterans.
Development of Cohesion in Mixed-Gender Recruit Training
Authors: Orme Geoffrey J , Kehoe E James
Published: January 2019

Introduction

With the removal in 2016 of restrictions on recruiting women to the combat arms in the all-volunteer Australian Army, a key question has been whether adding women to small combat teams will reduce the sense of cohesion among their members, which entails their subjective bonds with each other, their leader, and wider organization. Despite recent initiatives in Australia and the USA, there are too few women in combat units in any country to answer this question and how these subjective bonds affect a team’s ability to stick together under pressure.

Men and women recruits in the Australian Army have undertaken basic soldier training in mixed-gender teams since 1995. Recruit training provides the foundation of teamwork and cohesion in all types of units. The present study capitalized on this well-established practice as an avenue for illuminating the development of cohesion in the form of subjective bonds within mixed-gender teams.

Materials and Methods

The respondents were 89 females and 434 males, who were members of 46 teams denoted as “sections,” each consisting of 9–12 recruits. The gender mix of the sections varied from 0% female (all males) up to 55.6% females. The recruits were surveyed on three occasions during the 81-day recruit training (Days 10, 46, 80). The questionnaire comprised 18 items asking the recruits’ ratings of “vertical” bonding with their instructor/leaders, “horizontal” bonding within their sections, and “organizational” bonding with the wider Australian Army. This study was conducted under Defence ethics approval DPR-LREP 069-15.

Results

At the start of training, vertical bonding of the recruits with their instructor/leaders was significantly higher than horizontal and organizational bonding, which were similar. During training, all three types of bonding as rated by both female and male recruits increased and largely converged to a high level. Any apparent gender-related differences were not statistically significant.

Bonding scores for females did decline slightly as the proportion of women increased, but only significantly for vertical bonding. Even these declines all occurred within a band of high scores. For male recruits, there was no discernible relationship of bonding scores with the percentage of females in a section; the lines of best fit appeared flat.

Conclusions

Within the Australian Army, women and men have been trained in mixed-gender sections since 1995 with sustained success, at least anecdotally. The present findings provide the first independent confirmation that all three dimensions of cohesion increase in strength during recruit training much to the same degree in women and men alike. To the extent that felt cohesion translates into effective teamwork, mixed-gender training establishes a sound foundation for integrating women into combat units as well as support units, where they have traditionally served.
Sero-Prevalence Surveillance to Predict Vaccine-Preventable Disease Outbreaks; A Lesson from the 2014 Measles Epidemic in Northern Vietnam
Authors: Choisy Marc , Trinh Son Tung , Nguyen Thi Ngoc Diep , Nguyen Tran Hien , Mai Quynh Le , Pham Quang Thai , Tran Nhu Duong , Dang Duc Anh , Horby Peter W , Boni Maciej F , Bryant Juliet , Lewycka Sonia O , Nadjm Behzad , Van Doorn H Rogier , Wertheim Heiman F L
Published: January 2019

Background

During the first half of 2014, a severe outbreak of measles occurred in northern Vietnam, causing 15 033 confirmed cases and 146 deaths.

Methods

To evaluate the population-level seroprevalence of protection against measles in the period before the outbreak, we made use of an existing age-stratified serum bank, collected over the year before the outbreak, between November 2012 and December 2013, from 4 sites across the country (Hanoi, Hue, Dak Lak, and Ho Chi Minh City). Data from the UNICEF’s Multiple Indicator Clustered Surveys (MICS), carried out in Vietnam during the first quarter of 2014, were used to assess the vaccine coverage in 6 ecological regions of Vietnam.

Results

Results revealed a large discrepancy between levels of protection, as estimated from the serology and vaccine coverage estimated by UNICEF’s MICS. Variation in seroprevalence across locations and age groups corresponded with reported numbers of measles cases, most of which were among the 0–2-year-old age group and in the northern part of the country.

Conclusions

Our study presents a strong case in favor of a serosurveillance sentinel network that could be used to proactively tune vaccination policies and other public health interventions.
Consensus Guidelines for Facilities Performing Outpatient Procedures
Authors: Levy Barbara S. , Ness Debra L. , Weinberger Steven E.
Published: January 2019

In policy and law, regulation of abortion is frequently treated differently from other health services. The safety of abortion is similar to that of other types of office- and clinic-based procedures, and facility requirements should be based on assuring high-quality, safe performance of all such procedures. False concerns for patient safety are being used as a justification for promoting regulations that specifically target abortion. The Project on Facility Guidelines for the Safe Performance of Primary Care and Gynecology Procedures in Offices and Clinics was undertaken by clinicians, consumers, and representatives from accrediting bodies to review the available evidence and guidelines that inform safe delivery of outpatient care. Our overall objective was to develop evidence-informed consensus guidelines to promote health care quality, safety, and accessibility. Our consensus determined that requiring facilities performing office-based procedures, including abortion, to meet standards beyond those currently in effect for all general medical offices and clinics is unjustified based on an analysis of available evidence. No safety concerns were identified.
Best Mode of Delivery for Fetal Life-Limiting Conditions
Authors: Cooper Shontreal , Williams Nayo S.
Published: January 2019

A 38-year-old woman, gravida 3 para 2, with a history of two prior vaginal deliveries, at 18 weeks of gestation is diagnosed with fetal anencephaly. The patient asks: “May I undergo a scheduled primary cesarean delivery to optimize my baby's chance of survival?”
Bowel and Bladder Injury Repair and Follow-up After Gynecologic Surgery
Authors: Glaser Laura M. , Milad Magdy P.
Published: January 2019

Bowel and bladder injuries are relatively rare, but there can be serious complications of both open and minimally invasive gynecologic procedures. As with most surgical complications, timely recognition is key in minimizing serious patient morbidity and mortality. Diagnosis of such injuries requires careful attention to surgical entry and dissection techniques and employment of adjuvant diagnostic modalities. Repair of bowel and bladder may be performed robotically, laparoscopically, or using laparotomy. Repair of these injuries requires knowledge of anatomic layers and suture materials and testing to ensure that intact and safe repair has been achieved. The participation of consultants is encouraged depending on the primary surgeon’s skill and expertise. Postoperative care after bowel or bladder injury requires surveillance for complications including repair site leak, abscess, and fistula formation.
Impact of preimplantation genetic testing for aneuploidy on obstetrical practice
Authors: Chan Yiu-man , Li Tin-chiu , Poon Liona C.Y.
Published: January 2019

Purpose of review

To provide updated information on preimplantation genetic testing for aneuploidy (PGT-A), focusing on its implications on prenatal diagnostic approaches after transferal of mosaic aneuploid embryos.

Recent findings

PGT-A is a technology to screen for chromosome aneuploidy or major chromosome structural rearrangement in embryos before implantation using different cytogenetic analyses. PGT-A has been shown to reduce the negative effect of increasing maternal age on in-vitro fertilization (IVF) outcomes. PGT-A also encourages clinicians and patients to accept single embryo transfer after IVF-PGT-A to reduce the chance of multiple pregnancies. However, mosaic aneuploid embryo may be encountered following PGT-A. Recent discussions have focused on the consideration of transferal of mosaic aneuploid embryos in couples with no euploid embryo following multiple trials of IVF-PGT-A. A risk score for each chromosome has been developed to prioritize which mosaic embryos should be considered for transfer. However, there is a lack of long-term outcome data following mosaic aneuploid embryo transfer.

Recent advances in PGT-A increase the detection of embryos with mosaicism, which is associated with an increased risk of miscarriage, fetal mosaic aneuploidy, and uniparental disomy. Strategy in prenatal diagnostic testing after mosaic aneuploid embryo transfer is discussed in this review.
Neurofibromatosis Type 1: Review of Cutaneous and Subcutaneous Tumor Treatment on Quality of Life
Authors: Taylor Lawrence A. , Lewis Victor L.
Published: January 2019

Background:

Neurofibromatosis Type 1 (NF1) is the most common type of neurogenetic disorder with a worldwide incidence of between 1 in 2,600 and 1 in 3,000. NF1 has a wide range of manifestations; as a result, NF1 has no “public persona.” Beginning at puberty and continuing thereafter patients may grow cutaneous and subcutaneous tumors (neurofibromas) in large numbers, which cause severe problems with appearance, which are similar in severity to those of psoriasis. Appearance concerns due to tumors affect NF1 patients’ Quality of Life (QoL). NF1 patients are at increased risk for depression and treatment for depression and significantly enhance QoL. Improving appearance and QoL by decreasing the number of tumors is the NF1 patient’s greatest concern. Improving QoL is an end in itself.

Methods:

There are no currently available medical or pharmacological treatments for cutaneous and subcutaneous tumors of NF1. Surgery is the only treatment option for cutaneous and subcutaneous tumors. High Quantity (HQ) surgical removal by several methods has been used.

Results:

HQ electrosurgical (ES) allows removal of large numbers of tumors, hundreds per surgical session, appears to be highly effective, and most patients are happy with their results. Other surgical techniques, such as scalpellic surgery, are not effective. Inadequate insurance payments, few plastic surgeons performing HQ tumor removal, lack of support from nonsurgeon physicians, few if any NF clinics providing HQ tumor removal, pediatric orientation, focus on basic research, and a dismissive attitude toward NF1 patients are all components in the unavailability of HQ NF tumor removal. Such surgery is not cosmetic but restoration of normal appearance from disfigurement due to a congenital, neoplastic disease.

Conclusions:

National legislation is required to mandate insurance companies to provide coverage for HQ tumor removal. Payments by health insurance companies to plastic surgeons must be reasonable and comparable with other procedures. Effort by neurologists and other nonsurgeons is needed to gain support of plastic surgeons. Strong pressure is needed by support groups of NF for providing NF1 HQ surgery at institutions with NF clinics and for proper payments for surgeons and others.
Reducing Primary Cesareans
Authors: Gams Becky , Neerland Carrie , Kennedy Sheila
Published: January 2019

Primary cesarean birth increases a woman's risk for hemorrhage, infection, pain, and cesarean births with subsequent pregnancies. A woman may experience difficulties with breastfeeding, bonding, and incorporating the newborn into the family structure. One urban, academic hospital in the Midwest participated in the American College of Nurse-Midwives Healthy Birth Initiative: Reducing Primary Cesarean Births Project. The project purpose was to reduce the rate of cesarean births in nulliparous, term, singleton, and vertex pregnancies. Strategies employed included use of intermittent auscultation, upright labor positioning, early labor lounge, one-to-one labor support, and team huddles. The baseline nulliparous, term, singleton, vertex cesarean rate in 2015 was 29.3%. In 2016, after 1 year of implementation of the project, the hospital decreased nulliparous, term, singleton, vertex cesarean rate to 26.1%—a reduction of 10%. In 2017, the rate was decreased to 25.3%—a reduction by 3.7%.
Biomechanical Efficacy of Shear-Reducing Diabetic Insoles: Elaborations on Future Design Criteria
Authors: Yavuz Metin , Ersen Ali , Richardson Mike , Adams Linda S. , Holmes Clayton F. , Wijesundara Muthu B.J. , Wukich Dane K. , La Fontaine Javier
Published: January 2019

Introduction

Increasing evidence suggests that plantar shear forces and related stresses play a major role in diabetic foot ulcerations. Several orthotic devices are commercially available to reduce plantar shear forces within the shoe. The biomechanical efficacy of these devices was not tested in vivo. To measure spatiotemporal characteristics of gait to assess the efficacy of such shear-reducing insoles (SRIs), control insoles were also tested for comparison purposes.

Material and Methods

Eighteen healthy volunteers walked along a 30.5-m line while wearing three types of insoles in randomized order. Spatiotemporal parameters of gait were quantified. Statistical comparisons between the control and SRIs were conducted using repeated measures analysis of variance. Intraclass correlation coefficients (ICCs) were also calculated to reveal the repeatability of the trials. Step length, gait speed, and cadence of the subjects remained similar regardless of the insole type.

Results

No significant difference was observed in any variable. The ICC values revealed excellent repeatability.

Conclusions

The lack of changes in gait parameters in these results suggest that shear-reducing diabetic inserts did not decrease plantar shear forces as intended. This might be caused by unrealistic in vitro testing conditions during the prototype development. Future designs should also consider friction at the lateral walls of the inserts, an increase in step repetition that accompanies a decrease in gait speed and/or step length, and a possible temperature increase within the shoe. We conclude that the future SRIs need to be redesigned based on comprehensive biomechanical guidelines.
A Digital Photogrammetric Method to Enhance the Fabrication of Custom-Made Spinal Orthoses
Authors: Grazioso Stanislao , Selvaggio Mario , Caporaso Teodorico , Di Gironimo Giuseppe
Published: January 2019

Introduction and Objectives

Fabrication processes for spinal orthoses require accurate three-dimensional (3D) models of the patients' trunk. Current methods for 3D reconstruction used in this field mainly include laser or structured light scanning; these methods are time expensive and invasive, especially for patients with partial disabilities. Therefore, a theoretically instant system for data acquisition of anatomical structure is highly desirable. The objective of this work is to show the feasibility of using digital photogrammetry for human body digitization to generate accurate 3D models of the patients' trunk for spinal orthoses fabrication.

Materials and Methods

Multiple synchronized two-dimensional images of the human torso are captured from different points of view using a photogrammetric scanner. A 3D model is generated using the state-of-the-art algorithms for point cloud and surface reconstruction. The digitized model is then used as input for the standard computer-aided design (CAD)/computer-aided manufacturing (CAM) process of fabrication. R4D from Rodin4D is used as prosthetics and orthotics CAD software. A robotic cell constituted by a six-axis KUKA KR 30–3 is used for milling a polyurethane foam. Vacuum forming is then adopted to generate the orthosis. Two spinal orthoses are fabricated using this approach and a classical one; then, they are evaluated using quantitative and qualitative metrics.

Results

The data acquisition using this approach lasts 50 milliseconds. The 3D reconstruction accuracy averages 0.21 ± 1.27 mm, which suits for the considered health care scenario. Results of the initial fitting of the orthoses fabricated with the presented method show better performances in terms of time (44%), product quality (35%), and patient experience (30%).

Conclusions

Digital photogrammetry can be used to enhance the data acquisition and data processing of anatomical surfaces for the CAD/CAM process of spinal orthoses. The data acquisition time, almost instant, allows an easy compliance of many patients. The data processing allows generating accurate models of the patient's body. The overall process generates orthoses with a better quality with respect to those manufactured using conventional procedures.
Parosteal osteosarcoma of the fibula in a middle-aged patient
Authors: Chen Guiping , Xu Qiang , Zhang Bin , Dai Min
Published: January 2019

Rationale:

Parosteal osteosarcoma (PO) is relatively rare, accounting for about 1% of primary malignant bone tumors and 4% of all osteosarcomas. Onset is generally at approximately 20 to 40 years of age; the distal posterior surface of femur is the most common site, accounting for more than 60% cases. However, PO in middle-aged or elderly patients is extremely rare and PO occurring in the fibula is even rarer. To our knowledge, this is the first case of PO occurring in the fibula of a middle-aged adult.

Patient concerns:

We present a case of a 47-year-old female who had a lateral mass on her left knee for 3 months with no obvious cause.

Diagnoses:

The patient was initially diagnosed with a proximal left fibula tumor via x-ray scan at a local hospital. Subsequently, osteochondroma was highly suspected through computed tomography (CT) and magnetic resonance imaging (MRI) obtained at our hospital. Finally, the postoperative pathological report confirmed PO.

Interventions:

She underwent a complete resection of the left fibula tumor and received postoperative adjuvant chemotherapy.

Outcomes:

The patient recovered well and was discharged on the 10th day after admission. Additionally, there was no evidence of recurrence at the 4-year follow-up after surgery.

Lessons:

In middle-aged or elderly patients, early diagnosis of PO in the fibula is difficult and misdiagnosis or missed diagnosis is common. In clinical practice, PO is uncommon in middle-aged or elderly patients, occurs more rarely in the peroneal bone, and should be carefully identified. CT and MRI are essential for diagnosis, with pathological examination being effective for confirmation. Because of the limited reports of PO of the fibula in middle-aged or elderly adults, the present case raises awareness of this rare condition.
Effects of theophylline therapy on respiratory muscle strength in patients with prolonged mechanical ventilation
Authors: Yu Teng-Jen , Liu Yu-Chih , Chu Chien-Min , Hu Han-Chung , Kao Kuo-Chin
Published: January 2019

Mechanical ventilation may cause diaphragm weakness an effect termed ventilator-induced diaphragm dysfunction (VIDD). The prevalence of VIDD among patients receiving mechanical ventilation is very high, with the degree of diaphragmatic atrophy being associated with the length of mechanical ventilation. Theophylline is known to increase diaphragmatic contractility and reduce fatigue, so in this study, we evaluated the effect of theophylline in patients with prolonged mechanical ventilation.

Patients who depended on mechanical ventilation were included in the study. We compared the maximum inspiratory pressure (PImax) values, rapid shallow breathing index (RSBI) values, and successful weaning rates of theophylline-treated and non-theophylline-treated patients.

Eighty-four patients received theophylline and 76 patients did not. These 2 groups’ clinical characteristics, including their PImax and RSBI at initial admission, were similar. The results showed that the theophylline-treated group had significantly better PImax and RSBI, with a higher last PImax (30.1 ± 9.7 cmH2O vs 26.9 ± 9.1 cmH2O; P = .034) and lower last RSBI (107.0 ± 68.4 vs 131.4 ± 77.7; P = .036). The improvements to each respective patient's PImax and RSBI were also significantly higher in the theophylline-treated group (PImax: 20.1 ± 5.7% vs 3.2 ± 1.1%, P = .005; RSBI: 11.2 ± 3.0% vs 2.7 ± 1.6%, P = .015). The weaning success rate of the theophylline-treated group was also higher, but not significantly so.

Theophylline might improve respiratory muscle strength in patients with prolonged mechanical ventilation and it needs further prospective studies to confirm.
A simple method for preventing graft detachment during phacoemulsification cataract surgery after Descemet stripping automated endothelial keratoplasty
Authors: Hsu Shiuh-liang , Lee Po-yen , Chiu Li-yi
Published: January 2019

Rationale:

Graft detachment and endothelial cell damages are 2 major concerns for cataract surgeries in cases after Descemet stripping automated endothelial keratoplasty (DSAEK). We invented a simple but innovative method to anchor the DSAEK graft with sutures during the surgery to avoid possible graft detachment.

Patient concerns:

We present a 59-year-old male who had done DSAEK surgery. Due to progressed blurry vision due to cataract, he underwent sequential cataract surgery 1 year after DSAEK surgery. We applied the method to the patient successfully and the result was satisfying.

Diagnosis:

Cataract post-DSAEK surgery.

Interventions:

At the beginning of surgery, we made 4 radial fixation sutures with Nylon 10-0 though cornea-DSAEK graft at paracentral point and then through limbus. The sutures were located at 45°, 135°, 225°, and 315°. At the end of surgery, 4 fixation sutures were removed.

Outcomes:

The DSAEK graft was kept well attached during and after the surgery. Only low-grade corneal edema was found postoperation.

Lessons:

We provide this special method and applied it to our patient successfully. By using our method, surgeons can reassure graft adhesion during and after surgery, especially for those need cataract surgery after DSAEK surgery.
Nonobstructive coronary artery myocardial infarction complicated by heart failure, ventricular aneurysm, and incessant ventricular arrhythmia
Authors: Li Beibei , Ming Zhixu , Wu Jing , Zhang Mingyou
Published: January 2019

Rationale:

Myocardial infarction with nonobstructive coronary artery (MINOCA) is one of the common causes of cardiac related death. While patients with MINOCA usually do not need coronary artery intervention treatments, the prognosis could be worsened if the condition is not appropriately managed. This report describes a case of MINOCA patient suffered with multiple complications.

Patient concerns:

A 63-year-old female was admitted to the emergency department with acute onset of chest pain, electrocardiogram showed ST segment elevation in precordium leads.

Diagnosis:

Emergency coronary artery angiogram no significant coronary artery stenosis being observed. The diagnosis of MINOCA was established. She subsequently developed ventricular thrombus, heart failure, and ventricular arrhythmia.

Interventions:

The patient's ventricular tachycardia (VT) was refractory to different treatments. Due to the presence of a ventricular thrombus, epicardial ablation was performed but the VT recurred. The patient was then successfully treated with an implantable cardioverter defibrillator and surgical removal of the ventricular aneurysm.

Outcomes:

The patient was free of events during the 3-month follow-up period after the surgery.

Lessons:

MINOCA can occur with multiple complications, and surgical removal of a ventricular aneurysm can successfully recover the cardiac geometry during contraction leading to an improvement of the left ventricular bump function, as well as the removal of the potentially pathological loci of the VT.
Interferon-induced transmembrane protein-3 rs12252-CC is associated with low differentiation and progression of hepatocellular carcinoma
Authors: Hou Yuli , Zhang Yonghong , Qin Ling , Zhang Chi , Wang Shanshan , Chen Dexi , Li Ang , Lou Jinli , Yu Yanhua , Dong Tao , Li Ning , Zhao Yan
Published: January 2019

Interferon-induced transmembrane protein 3 (IFITM3) is a component of ISG (Interferon-Stimulated Gene) family. The association between IFITM3 and hepatocellular carcinoma (HCC) has been reported. While the relationship between this genetic variation and the progress of HCC remains unclear. To address this issue, we explore the relationship between the IFITM3-rs12252 genetic variants and the progression of HCC in this study.

A total of 336 candidates were enrolled in the study, including 156 patients with HBV related HCC and 180 patients with chronic Hepatitis B infections or liver cirrhosis. Liver cirrhosis or chronic hepatitis B were diagnosed with clinical characteristics and staging, laboratory testing, and imaging results of viral infection and hepatic damage. Polymerase chain reaction (PCR) was employed to determine the gene polymorphism of IFITM3, and analyzed with the GraphPad Prism v 5.

The patients with HCC had a significantly higher proportion of IFITM3 rs12252-CC as compared with the patients with chronic HBV infection or liver cirrhosis. Moreover, the distribution of CC genotype in HCC patients with low differentiation was significantly higher than that in those with high differentiation. Furthermore, the patients with CC genotype were found with bigger tumor size, higher percentage of vascular thrombosis, higher distribution of low differentiation and higher 5-year relapse rate than those with CT/TT genotypes.

This study indicates a correlation between the IFITM3-rs12252 CC genotype and the progression of HCC.
The diagnosis and treatment of cardiac lymphangioma
Authors: Diao Wen-Jie , Shi Chao , Liu Ge , Liu Xue-Gang , Li Hai-Hui , Meng Jin-Jin , Shi Yu , Chang Ming-Ming , Liu Yi-Yao
Published: January 2019

Rationale:

Cardiac lymphangioma is a rare disease. Until now, there have been only a few cases of cardiac lymphangioma reported in the literature.

Patient concerns:

We report the case of a 57-year-old female patient with cardiac lymphangioma from atrial septum.

Diagnosis:

Color Doppler echocardiography was performed, which revealed a tumor occupying a large amount of space in the left and right atrium.

Interventions:

The patient underwent thoracoscopic cardiac tumor resection under general anesthesia according to the procedure used for benign tumors.

Outcomes:

The patient recovered completely and was discharged home. Follow-up color Doppler echocardiography scans obtained from 6 months to 2 years after the operation showed no recurrent mass.

Lessons:

Once the tumor is detected, surgical treatment should be implemented as soon as possible.
Multifocal intraosseous hemangioma
Authors: Yao Kai , Tang Fan , Min Li , Zhou Yong , Tu Chongqi
Published: January 2019

Rationale:

Multifocal intraosseous hemangioma, which affects multiple body parts, is rare. The selection of appropriate lesion sites for biopsy and effective treatment in multifocal intraosseous hemangioma is challenging. Here, we report a case of multifocal intraosseous hemangioma.

Patient concerns:

A 49-year-old woman was admitted to our department with a chief complaint of aggravated lumber pain for 10 days.

Diagnoses:

Radiographic imaging revealed lesions involving the bilateral ribs, lumbar vertebrae, ilium, pubis, and proximal femur. Open biopsy in the ilium established the pathological diagnosis of intraosseous hemangioma.

Interventions:

For the symptomatic lumbar spine, the patient selected radiotherapy as the initial treatment.

Outcomes:

As of the one-year follow-up, no symptoms of recurrence have been observed.

Lessons:

This rare case demonstrates the importance of the selection of the appropriate lesion to confirm the diagnosis and effective treatment for patients with multifocal disease. Radiotherapy plays an important role in the treatment of patients with symptomatic vertebral hemangiomas without neurologic deficits.
Infection of finger caused by Morganella morganii leading to digital amputation
Authors: Li Di , Gao Wenshan , Niu Yanan , Zhao Pei , Zheng Wenkui , Li Cong Jie
Published: January 2019

Rationale:

Digital infection is a common disease in clinic, featured by pain and swelling of digits. As far as we know, no article has reported a case of digital infected byMorganella morganii.

Patient concerns:

A 58-year-old Chinese female complains about whitlow with pain and swelling for 2 weeks. She has a history of diabetes for 10 years. She received incision and drainage before coming to our hospital and preoperative X-ray of left ring finger presented no bone eroded.

Diagnosis:

She is diagnosed with infection of ring finger caused byM morganiiin our hospital.

Interventions:

We perform aggressive operative debridement and drainage firstly. Meanwhile, we provide tissue samples for diagnosis and the result indicatesM morganiiinfection. Then, she is treated with anti-infection therapy and regulation of diabetes. However, 1 week after first surgery, her condition deteriorate presenting bone erosion in distal phalanx of ring finger from X-ray. Considering severity of illness, we decide to perform digital amputation.

Outcomes:

At 3-month follow-up, the patient has a satisfactory result and X-ray shows no bone eroded.

Lessons:

Clinicians should considerM morganii, which is rare in hand infection, as a cause of digital infection. This case reminds us that some whitlow is dangerous, amputation should be considered if necessary.
Regional cerebral hypoperfusion after acute sleep deprivation
Authors: Zhou Fuqing , Huang Muhua , Gu Lili , Hong Shunda , Jiang Jian , Zeng Xianjun , Gong Honghan
Published: January 2019

Previous neuroimaging studies have shown that functional changes occur after acute sleep deprivation, which suggest detrimental effects of a lack of sleep on the intrinsic functional architecture of the brain. We aimed to identify regional resting perfusion changes in subjects with acute sleep deprivation.

Thirty-three healthy subjects with habitual good sleep participated in 36 hours (2 days and 1 night) of sleep deprivation and then underwent the attention network test and pseudo-continuous arterial spin labeling scanning. Regional cerebral blood flow was used to compare cerebral perfusion before and after sleep deprivation. Correlation analyses of regional perfusion changes and scores on the attention network test were performed.

Compared with the baseline (n = 20) scans, the scans of subjects after sleep deprivation (n = 26) revealed a slower response time (549.99 milliseconds vs 603.36 milliseconds; t = −2.301; P = .028) and a significantly higher lapse rate (0.88% vs 22.85%; t = −2.977; P = .006). The sleep deprivation subjects showed lower cerebral blood flow (CBF) in the left parahippocampal gyrus/fusiform cortex (pHipp/Fus), right pHipp/Fus, and right prefrontal cortex (PFC) relative to the baseline subjects (Gaussian random field correction, voxel level P < .01, and cluster level P < .05). Although no significant relationships were observed between the altered regional CBF (rCBF) values and the attention network test scores, the receiver-operating characteristic and leave-one-out cross-validation analyses revealed that significant decreases in rCBF in the bilateral pHipp/Fus and right PFC could discriminate between sleep deprivation and good sleep status.

We observed that rCBF was reduced after 36 hours (2 days and 1 night) of sleep deprivation. Our preliminary findings suggest an acute vulnerability to hypoperfusion due to lack of sleep.
Prognostic value of pretreatment albumin to bilirubin ratio in patients with hepatocellular cancer
Authors: Xu Yi-Xin , Wang Yi-Bo , Tan Yu-Lin , Xi Cheng , Xu Xue-Zhong
Published: January 2019

Background:

Hepatic function is closely associated with prognosis in patients with hepatocellular cancer (HCC). In this study, a meta-analysis of the published studies was performed to assess the prognostic value of ALBI grade in HCC patients.

Methods:

Databases, including PubMed, EMbase, Web of Science, and Cochrane Library were retrieved up to August 2018. The primary outcome was OS and secondary outcome was DFS, the prognostic impact of which was assessed by using hazard ratio (HRs) with corresponding 95% confidence intervals (CIs). The enrolled studies were analyzed by using STATA version 12.0 software.

Results:

A total of 22,911 patients with HCC in 32 studies were included. Our results demonstrated that high pretreatment ALBI is associated with poor OS (HR = 1.719, 95%CI: 1.666–1.771, P = .000, univariate results; HR = 1.602, 95%CI: 1.470–1.735, P = .000, multivariate results) and poor DFS (HR = 1.411, 95%CI: 1.262–1.561, P = .000, univariate results; HR = 1.264, 95%CI: 1.042–1.485, P = .000, multivariate results). Meanwhile, when the analysis was stratified into subgroups, such as treatment methods, sample size, geographic area, and ALBI grade, the significant correlation in ALBI and poor long-term survival was not altered.

Conclusion:

High pretreatment ALBI is closely associated with poor prognosis in HCC, and High ALBI should be treated as an ideal predictor during hepatocellular therapy.