bluuebunny/crossref_metadata_2025 huggingface dataset:
Article 2—Notice of Arbitration
Authors: Gusy Martin F , Hosking James M
Published: May 2019

This chapter examines the ICDR Notice of Arbitration. Article 2 of the 2014 ICDR Rules concerns the basic initial pleadings to be made in respect of the claim or counterclaim, and the general notice provision. Under the ICDR Rules, the initial pleading is called a ‘Notice of Arbitration’. In accordance with general practice in institutional international arbitration, Article 2(3)(e) requires the Notice of Arbitration to set forth ‘a description of the claim and of the facts supporting it’. The ICDR Notice of Arbitration needs to be prepared before the appointment of any of the arbitrators. Article 2 does not require the claimant to nominate its arbitrator within the Notice of Arbitration. The chapter then details the required information for the Notice of Arbitration and looks at the filing fees and the ICDR fee schedules.
Article 9—Amendment or Supplement of Claim, Counterclaim, or Defense
Authors: Gusy Martin F , Hosking James M
Published: May 2019

This chapter focuses on Article 9, which affords the parties relatively wide latitude to modify claims, counterclaims, or defenses, including set-offs. The ICDR Rules provide a permissive standard, establishing that modification by means of amendment and supplementation is possible at any time during the proceedings, as long as the arbitral tribunal considers it appropriate. Such claim, counterclaim, set-off, or defense modifications are required to be within the scope of the arbitration agreement—that is, the boundaries of an arbitral tribunal’s jurisdiction. The parties’ general right to amend their claims or defenses, including set-off, is subject to the tribunal’s power of rejection on grounds of unexcused delay or prejudice to the parties or proceedings.
Article 19—Arbitral Jurisdiction
Authors: Gusy Martin F , Hosking James M
Published: May 2019

This chapter looks at Article 19 of the ICDR Rules. An arbitral tribunal must consider whether it has jurisdiction over the subject matter of any dispute that comes before it. Article 19 provides the tribunal with authority to determine this preliminary question by deciding any objections to its jurisdiction relating to the ‘existence, scope, or validity of the arbitration agreement’. Under Article 19(3), jurisdictional objections must be made no later than the filing of the Answer to a particular claim, counterclaim, or set-off. Meanwhile, Article 19(4) is a new provision added to the ICDR Rules with the 2014 amendments to make clear that objections to jurisdiction will not prevent the ICDR from administrating the case in the preliminary stages of the arbitration, including for purposes of constituting the tribunal.
Article 27—Closure of Hearing
Authors: Gusy Martin F , Hosking James M
Published: May 2019

This chapter looks at Article 27 of the ICDR Rules. The purpose of Article 27(1) is to provide a mechanism for closing the hearing stage of the arbitration. One ambiguity in Article 27 is whether the close of the ‘hearing’ is intended to cover only the oral hearing or also any additional post-hearing submissions and evidence tendered. Additionally, Article 27(2) gives the tribunal the discretion, of its own motion or upon application of one of the parties, to reopen the hearings at any time before the award is made. In any event, it is likely to be applied only rarely. Appropriate circumstances might arise, for example, where the tribunal’s deliberations have thrown up an issue not adequately covered in the hearing to date, where previously unavailable evidence has come to light, or where a post-hearing development has arisen that affects the issues in dispute.
Article 31—Applicable Laws and Remedies
Authors: Gusy Martin F , Hosking James M
Published: May 2019

This chapter studies Article 31 of the ICDR Rules, which is an amalgam of various rules addressing the issue of laws applicable to the arbitration and certain matters relating to the remedies available to the tribunal. Its touchstone is ‘party autonomy’—that is, respecting the choice of the parties, as expressed in the arbitration agreement or in positions taken before the tribunal. Absent party agreement, the arbitrators enjoy a broad discretion. Nevertheless, the parties’ freedom and the tribunal’s discretion may be restricted by mandatory rules of law at the place of arbitration or of enforcement. This limitation is also reflected in Article 1(2), which provides that any applicable mandatory law takes precedence over the powers recognized in Article 31.
Article 34—Costs
Authors: Gusy Martin F , Hosking James M
Published: May 2019

This chapter focuses on Article 34 of the ICDR Rules, which empowers the tribunal to fix the ‘costs of the arbitration’ and to allocate those costs between the parties. As with most sets of arbitration rules, Article 34 identifies what kinds of costs may be recoverable but leaves the tribunal a broad discretion to decide what costs are reasonable and how recovery of those costs should be allocated between the parties. Evidently, the parties’ agreement, the applicable national laws, and the legal cultures of the respective parties and the tribunal may also play a role in this determination. In considering Article 34, it is also important to bear in mind that US domestic litigation practice provides very few opportunities for any cost-shifting with respect to a party’s attorney fees or otherwise. This so-called ‘American Rule’, at least to some extent, remains the practice in US domestic arbitration.
Article 39—Interpretation of Rules
Authors: Gusy Martin F , Hosking James M
Published: May 2019

This chapter studies Article 39 of the ICDR Rules. Article 39 provides a bright-line rule that seeks to clarify when the arbitrators, as opposed to the institution, are responsible for interpreting and applying the ICDR Rules: to the extent that a rule impacts on the tribunal’s powers and duties, then the tribunal is charged with its application; in all other cases, this duty falls on the ICDR. Practically speaking, however, given the ICDR’s extensive experience with applying the rules, arbitrators typically will consult with the institution before making such an interpretation. Article 39 is substantially the same as its predecessor in Article 36 of the 2009 ICDR Rules. The only notable revision is that the provision now expressly provides that any emergency arbitrator or consolidation arbitrator will have the same authority as the arbitral tribunal to interpret and apply the Rules.
Articles E-2 to E-5—Commencing a Case Under the Expedited Procedures
Authors: Gusy Martin F , Hosking James M
Published: May 2019

This chapter examines Articles E-2 through E-5 of the ICDR Rules, which contain provisions on how an arbitration should be commenced under the Expedited Procedures. Although these provisions preserve the arbitrator’s authority to resolve certain issues, Articles E-2 through E-5 generally address matters that will not yet involve the arbitrator. These include submission of the initiating document and answering document, the preliminary administrative conference call, objection to application of the Expedited Procedures, and amendment of claims and counterclaims. Ultimately, the provisions in Articles E-2 through E-5 are designed to facilitate an expedited resolution of the dispute by frontloading certain activities in the arbitration and by preliminarily resolving procedural matters before the case is transferred to the arbitrator.
Article E-6—Appointment and Qualifications of the Arbitrator
Authors: Gusy Martin F , Hosking James M
Published: May 2019

This chapter focuses on Article E-6 of the ICDR Rules, which contains provisions for the appointment of a sole arbitrator for arbitrations that fall within the scope of the Expedited Procedures. The provisions of Article E-6 are more streamlined than those contained in the parallel provision in Article 12 of the main ICDR Rules, which expedites the time required for the appointment of the arbitrator. Moreover, the provision for one arbitrator, as opposed to three, furthers the ICDR’s goal of reducing the time and cost of an arbitration falling within the Expedited Procedures. However, Article E-6 does not address situations where the parties’ agreement conflicts with the provisions contained in the Article.
Unravelling the origin of the counter-rotating core in IC 1459 with KMOS and MUSE
Authors: Prichard Laura J , Vaughan Sam P , Davies Roger L
Published: May 2019

The massive early-type galaxy IC 1459 is a slowly rotating galaxy that exhibits a rapidly counter-rotating kinematically decoupled core (KDC, RKDC ≈ 5 arcsec ≈ 0.1Re). To investigate the origin of its KDC, we coupled large data mosaics from the near-infrared and optical integral field unit instruments K-band Multi-Object Spectrograph (KMOS) and Multi-Unit Spectroscopic Explorer (MUSE), respectively. We studied IC 1459’s stellar populations and, for the first time for a KDC, the spatially resolved initial mass function (IMF). We used full-spectral-fitting to fit the stellar populations and IMF simultaneously, and an alternative spectral-fitting method that does not assume a star formation history (SFH; although does not constrain the IMF) for comparison. When no SFH is assumed, we derived a negative metallicity gradient for IC 1459 that could be driven by a distinct metal-poor population in the outer regions of the galaxy, and a radially constant old stellar age. We found a radially constant bottom-heavy IMF out to ${\sim }\frac {1}{3}R_{\rm e}$. The radially flat IMF and age extend beyond the counter-rotating core. We detected high-velocity dispersion along the galaxy’s major axis. Our results potentially add weight to findings from orbital modelling of other KDCs that the core is not a distinct population of stars but in fact two smooth co-spatial counter-rotating populations. No clear picture of formation explains the observational results of IC 1459, but we propose it could have included a gas-rich intense period of star formation at early times, perhaps with counter-rotating accreting cold streams, followed by dry and gas-rich mergers through to the present day.
Directly testing gravity with Proxima Centauri
Authors: Banik Indranil , Kroupa Pavel
Published: May 2019

The wide binary orbit of Proxima Centauri around α Centauri A and B differs significantly between Newtonian and Milgromian dynamics (MOND). By combining previous calculations of this effect with mock observations generated using a Monte Carlo procedure, we show that this prediction can be tested using high precision astrometry of Proxima Centauri. This requires ≈10 yr of observations at an individual epoch precision of $0.5 \, \mu\rm as$, within the design specifications of the proposed Theia mission. In general, the required duration should scale as the 2/5 power of the astrometric precision. A long-period planet could produce a MOND-like astrometric signal, but only if it has a particular ratio of mass to separation squared and a sky position close to the line segment connecting Proxima Centauri with α Centauri. Uncertainties in perspective effects should be small enough for this test if the absolute radial velocity of Proxima Centauri can be measured to within ≈10 m s−1, better than the present accuracy of 32 m s−1. We expect the required improvement to become feasible using radial velocity zero-points estimated from larger samples of close binaries, with the Sun providing an anchor. We demonstrate that possible astrometric microlensing of Proxima Centauri is unlikely to affect the results. We also discuss why it should be possible to find sufficiently astrometrically stable reference stars. Adequately, addressing these and other issues would enable a decisive test of gravity in the currently little explored low acceleration regime relevant to the dynamical discrepancies in galactic outskirts.
Extraordinarily long development of the Antarctic gastropod Antarctodomus thielei (Neogastropoda: Buccinoidea)
Authors: Moran A L , Harasewych M G , Miller B A , Woods H A , Tobalske B W , Marko P B
Published: May 2019

Antarctic animals share many traits that are attributed to evolution in a stable, extremely cold climate. Among invertebrates, development is exceptionally slow, making observational studies of development logistically challenging, particularly when conducted under natural conditions in the field. Using multiple deployments to McMurdo Station, Antarctica, we characterized the development, in the field, of an unidentified buccinoidean gastropod species with encapsulated development. Thirteen egg capsules collected at Granite Harbor, McMurdo Sound, Ross Sea, were attached to natural rock and outplanted at a depth of ~25 m at the base of the McMurdo Intake Jetty on 2 December 2007, photographed on 5 October 2011 and 6 September 2012 and then returned to the laboratory on 27 November 2015. In 2015, four capsules were open and empty, five were open and contained a single large hatchling and the remaining four capsules were intact but not open, each containing a single large juvenile snail. To identify the developing embryos, we sequenced mitochondrial cytochrome c oxidase subunit I (COI) from two hatchlings and compared those sequences with those from adults collected near the egg mass, as well as with sequences of other buccinoideans from GenBank. Based on the close match between hatchling and adult COI sequences (hatchling sequences differed from those of an adult at only 2 of 658 nucleotide positions), we identified the embryos as Antarctodomus thielei (Powell, 1958)). The egg mass morphology and development of this species have not been previously described. Our study shows that A. thielei has a development time of more than 8 years, which is the longest measured for any gastropod.
Evolview v3: a webserver for visualization, annotation, and management of phylogenetic trees
Authors: Subramanian Balakrishnan , Gao Shenghan , Lercher Martin J , Hu Songnian , Chen Wei-Hua
Published: May 2019

Evolview is an interactive tree visualization tool designed to help researchers in visualizing phylogenetic trees and in annotating these with additional information. It offers the user with a platform to upload trees in most common tree formats, such as Newick/Phylip, Nexus, Nhx and PhyloXML, and provides a range of visualization options, using fifteen types of custom annotation datasets. The new version of Evolview was designed to provide simple tree uploads, manipulation and viewing options with additional annotation types. The ‘dataset system’ used for visualizing tree information has evolved substantially from the previous version, and the user can draw on a wide range of additional example visualizations. Developments since the last public release include a complete redesign of the user interface, new annotation dataset types, additional tree visualization styles, full-text search of the documentation, and some backend updates. The project management aspect of Evolview was also updated, with a unified approach to tree and project management and sharing. Evolview is freely available at: https://www.evolgenius.info/evolview/.
Rescue of spinal muscular atrophy mouse models with AAV9-Exon-specific U1 snRNA
Authors: Donadon Irving , Bussani Erica , Riccardi Federico , Licastro Danilo , Romano Giulia , Pianigiani Giulia , Pinotti Mirko , Konstantinova Pavlina , Evers Melvin , Lin Shuo , Rüegg Markus A , Pagani Franco
Published: May 2019

Spinal Muscular Atrophy results from loss-of-function mutations in SMN1 but correcting aberrant splicing of SMN2 offers hope of a cure. However, current splice therapy requires repeated infusions and is expensive. We previously rescued SMA mice by promoting the inclusion of a defective exon in SMN2 with germline expression of Exon-Specific U1 snRNAs (ExspeU1). Here we tested viral delivery of SMN2 ExspeU1s encoded by adeno-associated virus AAV9. Strikingly the virus increased SMN2 exon 7 inclusion and SMN protein levels and rescued the phenotype of mild and severe SMA mice. In the severe mouse, the treatment improved the neuromuscular function and increased the life span from 10 to 219 days. ExspeU1 expression persisted for 1 month and was effective at around one five-hundredth of the concentration of the endogenous U1snRNA. RNA-seq analysis revealed our potential drug rescues aberrant SMA expression and splicing profiles, which are mostly related to DNA damage, cell-cycle control and acute phase response. Vastly overexpressing ExspeU1 more than 100-fold above the therapeutic level in human cells did not significantly alter global gene expression or splicing. These results indicate that AAV-mediated delivery of a modified U1snRNP particle may be a novel therapeutic option against SMA.
Physical Activity and Exercise Outcomes in Huntington Disease (PACE-HD): Protocol for a 12-Month Trial Within Cohort Evaluation of a Physical Activity Intervention in People With Huntington Disease
Authors: Drew Cheney J G , Quinn Lori , Hamana Katy , Williams-Thomas Rhys , Marsh Lucy , Dimitropoulou Polyxeni , Playle Rebecca , Griffin Beth Ann , Kelson Mark , Schubert Robin , Muratori Lisa , Reilmann Ralf , Rosser Anne , Busse Monica
Published: May 2019

Background

Exercise is emerging as an important aspect in the management of disease-related symptoms and functional decline in people with Huntington disease (HD). Long-term evaluation of physical activity and exercise participation in HD has yet to be undertaken.

Objective

The objective is to investigate the feasibility of a nested randomized controlled trial (RCT) alongside a longitudinal observational study of physical activity and exercise outcomes in people with HD.

Design

This will be a 12-month longitudinal observational study (n = 120) with a nested evaluation of a physical activity intervention (n = 30) compared with usual activity (n = 30) using a “trial within a cohort” design.

Setting

The study will take place in HD specialist clinics in Germany, Spain, and the United States, with intervention delivery in community settings.

Participants

The participants will have early-mid–stage HD and be participating in the Enroll-HD study.

Intervention

This will be a 12-month physical activity behavioral change intervention, delivered by physical therapists in 18 sessions, targeting uptake of aerobic exercise and increased physical activity.

Measurements

All participants (n = 120) will complete Enroll-HD assessments (motor, cognitive, behavioral, and quality of life) at baseline and at 12 months. Additional Physical ACtivity and Exercise Outcomes in Huntington Disease (PACE-HD) assessments include fitness (predicted maximal oxygen uptake [V  o2max]), self-reported and quantitative measures of physical activity, disease-specific symptoms, and walking endurance. RCT participants (n = 60) will complete an additional battery of quantitative motor assessments and a 6-month interim assessment. Enroll-HD data will be linked to PACE-HD physical activity and fitness data.

Limitations

The limitations include that the embedded RCT is open, and assessors at RCT sites are not blinded to participant allocation.

Conclusion

PACE-HD will enable determination of the feasibility of long-term physical activity interventions in people with HD. The novel “trial within a cohort” design and incorporation of data linkage have potential to reduce participant burden. This design could be applied to other neurological diseases and movement disorders where recruitment and retention are challenging.
TCBH Duncan Tanner Essay Prize Winner 2018 Financing the Information Age: London TeleCity, the Legacy of IT-82, and the Selling of British Telecom
Authors: Ward Jacob
Published: May 2019

This article is a history of the privatization of British Telecom. BT's privatization occupies a central position in histories of Thatcherism as a pivotal moment in Thatcherism's ideological focus on popular capitalism. These histories, however, overlook the important intersection of financial institutions and information technology policy in shaping BT's privatization. Financial institutions in the City of London formed a lobbying group, the City Telecommunications Committee, that pressured for BT's privatization and secured preferential treatment for the City from BT, ending a decades-long policy of uniform telecommunications services across Britain. Margaret Thatcher's government positioned BT's privatization as central to the success of two of Britain's information industries, electronics manufacturing and the City of London. Her government also cast BT's privatization as essential to an ‘information revolution’ that, through personal, networked computing, would further personal freedom and free markets. BT's privatization thus performed two important and related functions. First, it oriented Britain's telecommunications network to the City of London's needs, and secondly, it enacted an ‘information revolution’ that was portrayed as essential to the success of the City of London and British electronics. I label this fusion of City finance, neoliberal politics, and British telecommunications the ‘London ideology’, and this ideology shaped the broadly-held assumption that privatizing telecommunications was essential to reaching the ‘information age’.
4Psychoanalysis
Authors: Arnold Lucy
Published: May 2019

In 2018 trauma emerged as one of the key preoccupations in the field of psychoanalytic scholarship, not only in terms of its manifestations in the clinic but in the social sphere and the cultural imaginary. This year’s review examines six texts which, implicitly and explicitly, interrogate the significance and function of trauma from a range of standpoints. It is divided into four sections: 1. Introduction; 2. Theorizing Trauma and the Subject (which examines John L. Roberts’s Trauma and the Ontology of the Modern Subject and Rudi Vermont’s Reading Bion); 3. Memory, History, and Trauma (which explores Roger Frie’s History Flows Through Us and Eric R. Severson and David M. Goodman’s edited collection, Memories and Monsters: Psychology, Trauma and Narrative); 4. Mothers and (M)others—Trauma and the Family (which considers Jacqueline Rose’s Mothers: An Essay on Love and Cruelty and Jean Owen and Naomi Segal’s edited collection, On Replacement: Cultural, Social and Psychological Representations).
An integrated study of the biodiversity within the Pseudechiniscus suillus–facettalis group (Heterotardigrada: Echiniscidae)
Authors: Cesari Michele , Montanari Martina , Kristensen Reinhardt M , Bertolani Roberto , Guidetti Roberto , Rebecchi Lorena
Published: May 2019

Pseudechiniscus is the second most species-rich genus in Heterotardigrada and in the family Echiniscidae. However, previous studies have pointed out polyphyly and heterogeneity in this taxon. The recent erection of the genus Acanthechiniscus was another step in making Pseudechiniscus monophyletic, but species identification is still problematic. The present investigation aims at clarifying biodiversity and taxonomy of Pseudechiniscus taxa, with a special focus on species pertaining to the so-called ‘suillus–facettalis group’, by using an integrated approach of morphological and molecular investigations. The analysis of sequences from specimens sampled in Europe and Asia confirms the monophyly of the genus Pseudechiniscus. Inside the genus, two main evolutionary lineages are recognizable: the P. novaezeelandiae lineage and the P. suillus–facettalis group lineage. Inside the P. suillus–facettalis group, COI molecular data points out a very high variability between sampled localities, but in some cases also among specimens sampled in the same locality (up to 33.3% p-distance). The integrated approach to the study of Pseudechiniscus allows confirmation of its monophyly and highlights the relationships in the taxon, pointing to its global distribution.
Effective patient education techniques for preventing unintended pregnancies
Authors: Brown Gina R. , Walker Megan , Rosco Monica , Muff Katherine
Published: May 2019

Ample resources exist detailing the variety of contraceptive options for patients who want to prevent an unintended pregnancy; however, few resources provide tools to guide clinicians in best practices for history taking and patient education about contraceptive use. This article attempts to fill this gap by reviewing current recommendations on timing of patient education, techniques to open a discussion, and common patient misunderstandings about pregnancy and contraception.
‘My patient died’
Authors: Brittain Chaka
Published: May 2019

How one student's traumatic experience inspired his educator to help students expect the unexpected in patient care
An Introduction to Machine Learning for Clinicians
Authors: Rowe Michael
Published: May 2019

The technology at the heart of the most innovative progress in health care artificial intelligence (AI) is in a subdomain called machine learning (ML), which describes the use of software algorithms to identify patterns in very large datasets. ML has driven much of the progress of health care AI over the past 5 years, demonstrating impressive results in clinical decision support, patient monitoring and coaching, surgical assistance, patient care, and systems management. Clinicians in the near future will find themselves working with information networks on a scale well beyond the capacity of human beings to grasp, thereby necessitating the use of intelligent machines to analyze and interpret the complex interactions between data, patients, and clinical decision makers. However, as this technology becomes more powerful, it also becomes less transparent, and algorithmic decisions are therefore progressively more opaque. This is problematic because computers will increasingly be asked for answers to clinical questions that have no single right answer and that are open-ended, subjective, and value laden. As ML continues to make important contributions in a variety of clinical domains, clinicians will need to have a deeper understanding of the design, implementation, and evaluation of ML to ensure that current health care is not overly influenced by the agenda of technology entrepreneurs and venture capitalists. The aim of this article is to provide a nontechnical introduction to the concept of ML in the context of health care, the challenges that arise, and the resulting implications for clinicians.
Professionalism Lapses and Adverse Childhood Experiences: Reflections From the Island of Last Resort
Authors: Williams Betsy White
Published: May 2019

This Invited Commentary highlights the prevalence of adverse childhood experiences and the potential effect that such experiences can have in the medical education setting on trainees, colleagues, and faculty. The author draws on 20 years of experience working in organizations devoted to helping physicians with disruptive behavior learn new behavioral skills to enable them to function within the complex medical environment. A case example—an amalgam of individuals who have presented for remediation—is used to illustrate the issues that result from adverse childhood experiences. There is a broad and well-understood literature demonstrating a correlation between early life trauma and medical and mental health issues. Adverse early life experiences can also contribute to attachment-related difficulties including problems with boundaries, trust, and suspiciousness; lack of reciprocity; lack of attunement with others’ emotional states; as well as regulation issues, including difficulties labeling and expressing feelings and internal states. Difficulties with self-concept, including a lack of continuous and predictable sense of self, low self-esteem, and shame and guilt, are also associated with exposure to adverse childhood experiences. Given the documented high proportion of health care workers, including physicians, who are trauma survivors, trauma-sensitive education must be a priority, not only in medical school but across the educational continuum.
Posterior vertebral column resection for congenital rigid spinal deformities
Authors: Hussien Mohamed Ali , Wafa Mohamed Abdulsalam , Elbadrawi Ahmed Mohamed , EL Zahlawy Hany , Morsi Ahmed Mohamed , Khattab Mohamed Fawzy , Elkhateeb Tameem Mohamed
Published: May 2019

Background:

The goal in surgical management of complex spinal deformities is to safely realign the spine as much as possible in both sagittal and coronal planes. Standard posterior and or middle column osteotomies are associated with limitations to correct the severe rigid curves. The purpose of this study was to assess the clinical and radiographic results of posterior vertebral column resection (PVCR) for surgical management of complex congenital rigid spinal deformities.

Methods:

Thirty-five patients with congenital rigid spinal deformities were enrolled in this prospective study. Preoperative measurement of curve magnitude and stiffness was done. Postoperative degrees of correction also were measured. The mean percentage of correction was calculated. Intraoperative and postoperative complications were reported. The minimum follow-up period was 2 yr.

Results:

Nineteen patients had rigid kyphosis and 16 had kyphoscoliosis. Their etiologies were due to congenital vertebral anomalies. An average of 1.5 vertebrae were resected intraoperatively. Radiographically the mean preoperative kyphosis was 68.9 degrees and in those patients with kyphoscoliosis, the mean preoperative value was 38 degrees. They improved on immediate follow-up to 24.5 and 11 degrees, respectively. At final follow-up the mean loss of correction in the sagittal plane was 3.6 degrees, which was statistically insignificant. All patients showed solid fusion at final follow-up. Complications were noted in seven patients, including dural tear, pleural tear, and postoperative wound infection that were managed accordingly.

Conclusions:

Single-stage PVCR is a highly effective option in the management of rigid spinal deformities with satisfactory clinical and radiographic outcomes.
The use of sublaminar bands in treatment of spinal deformity: an operative technique
Authors: Venezia Michael , Battista Christopher , Steffensmeier Andrew , Sirois Zachary J. , Albert Michael C.
Published: May 2019

Background:

Pedicle screws are commonly used in the surgical treatment and correction of spinal deformity. In recent years, polyester bands have been used as adjuncts to pedicle screws and hooks. Currently, the implementation of polyester sublaminar bands in the treatment of pediatric spinal deformity has led to improved results with similar complications as other techniques. This paper further highlights the innovative use of sublaminar bands utilized in a hybrid construct leading to improved results. Furthermore, we describe the surgical technique and indications for sublaminar bands in pediatric spinal deformity.

Methods:

Innovative sublaminar band hybrid construct description and comparison to current practices regarding surgical indications, complications, and comparative outcomes compared to the use of pedicle screw fixation.

Results:

The described hybrid sublaminar band implementation further validates the use of hybrid constructs as an innovative method and approach to pediatric spinal deformity. Hybrid constructs with sublaminar band utilization may become more favored in the future as they continue to have a safe track record within the literature and are able to optimize sagittal correction better than an all-pedicle screw construct, all while reducing operative time, blood loss, and radiation exposure.

Conclusions:

This novel surgical technique of sublaminar band utilization offers a user-friendly procedure with a short learning curve. This technique, if applied in the correct surgical candidates, has been proven to be a successful method of spinal deformity correction in pediatric spinal fusions.

Level of Evidence:

Level IV.
Ninety-Five Degree Angled Blade Plate Fixation of High-Energy Unstable Proximal Femur Fractures Results in High Rates of Union and Minimal Complications
Authors: Berkes Marschall B. , Schottel Patrick C. , Weldon Matthew , Hansen Denise H. , Achor Timothy S.
Published: May 2019

Objectives:

To describe the surgical technique and clinical outcomes of high-energy proximal femur fractures treated with a 95-degree angled blade plate.

Design:

Retrospective case series.

Setting:

Single academic Level I trauma center.

Patient/Participants:

Forty-five consecutive patients from March 2012 to April 2017 who sustained a high-energy, unstable proximal femur fracture including (OTA/AO 31-A1, 31-A2, 31-A3, 31-B3, 32-A1a, and 32-C3i).

Intervention:

Open reduction internal fixation with a 95-degree angled blade plate used in conjunction with an articulated tensioning device.

Main Outcome Measurements:

Nonunion, malunion, secondary operations, and postoperative infection.

Results:

Twenty six patients were available for follow-up. The mean age was 43.8 (range 22–86) years, and 81% (21/26) were men. The most common fracture pattern was OTA/AO 31-A3.3. Two fractures were open. The articulated tensioner was used in 100% of cases. Average clinical follow-up was 19.2 (range 7–40) months. Twenty-four of 26 patients (92%) achieved osseous union after the index procedure. One patient underwent nonunion repair, and 2 patients had the blade plate removed as it was symptomatic laterally. No other secondary procedures were performed, and no instances of implant failure were seen. No patients had evidence of a superficial or deep infection.

Conclusions:

We found that high-energy proximal femur fractures treated with a 95-degree condylar blade plate and articulated tensioning device had a high rate of union with minimal postoperative complications. Although intramedullary nailing of these fractures remains a preferred treatment modality, the angled blade plate with articulated tensioning device is an excellent option to restore anatomical alignment and obtain bony union in certain highly comminuted fracture patterns.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Eight Years of the Pediatric Orthopaedic Fellowship Match: What Have We Learned?
Authors: Swarup Ishaan , Luhmann Scott , Woiczik Marcella , Sankar Wudbhav N.
Published: May 2019

Background:

Pediatric orthopaedic surgery fellowships in North America have been organized, assigned, and administered through the San Francisco Match Program since 2011. However, trends in application numbers and match rates have not been assessed to this point. The purpose of this study is to describe these trends and applicants’ perspective of the fellowship match.

Methods:

The San Francisco Match databank was queried for program and applicant data from 2011 to 2018. Specifically, we obtained data regarding the number of applicants, programs, match rates, and match results. Each year, applicants also completed an anonymous post-match survey administered by the Pediatric Orthopaedic Society of North America fellowship committee, which included information on the number of applications, interview process, estimated costs, and suggested changes. Descriptive statistics were used to summarize the data, and univariate statistics were used to assess differences in categorical and continuous variables.

Results:

From 2011 to 2018, 524 applicants participated in the pediatric orthopaedic fellowship match, and the mean number of annual applicants was 66 (range, 55 to 76). The mean number of fellowship programs and available positions during the same time period was 43 (range, 40 to 47) and 69 (range, 63 to 74), respectively. Each fellowship interview was estimated by the applicant to cost a mean of $458 (range, $372 to $566), and annual application costs across all applicants were extrapolated to be over $200,000/year. The mean overall match rate was 81% (range, 74% to 91%). The mean match rate for North American applicants was 98.7% and international applicants were 40.9% (P<0.01). Approximately, 93% of applicants obtained one of their top 5 choices of fellowship program (range, 78% to 100%), and 50% of matched applicants obtained their top choice each year (range, 43% to 56%).

Conclusion:

In the pediatric orthopaedic fellowship match, the number of applicants and fellowship programs has remained relatively stable over the study period, and the majority of applicants match one of their top choices for fellowship. Proposed changes to the match should focus on decreasing the financial burden on applicants.

Level of Evidence:

Level II.
Mechanical Function of the Nucleus Pulposus of the Intervertebral Disc Under High Rates of Loading
Authors: Newell Nicolas , Carpanen Diagarajen , Evans John H. , Pearcy Mark J. , Masouros Spyros D.
Published: May 2019

Study Design.

Bovine motion segments were used to investigate the high-rate compression response of intervertebral discs (IVD) before and after depressurising the nucleus pulposus (NP) by drilling a hole through the cranial endplate into it.

Objective.

To investigate the effect of depressurising the NP on the force–displacement response, and the energy absorption in IVDs when compressed at high strain rates.

Summary of Background Data.

The mechanical function of the gelatinous NP located in the center of the IVDs of the spine is unclear. Removal of the NP has been shown to affect the direction of bulge of the inner anulus fibrosus (AF), but at low loading rates removal of the NP pressure does not affect the IVD's stiffness. During sports or injurious events, IVDs are commonly exposed to high loading rates, however, no studies have investigated the mechanical function of the NP at these rates.

Methods.

Eight bovine motion segments were used to quantify the change in pressure caused by a hole drilled through the cranial endplate into the NP, and eight segments were used to investigate the high-rate response before and after a hole was drilled into the NP.

Results.

The hole caused a 28.5% drop in the NP pressure. No statistically significant difference was seen in peak force, peak displacement, or energy-absorption of the intact, and depressurized NP groups under impact loading. The IVDs absorbed 72% of the input energy, and there was no rate dependency in the percentage energy absorbed.

Conclusion.

These results demonstrate that the NP pressure does not affect the transfer of load through, or energy absorbed by, the IVD at high loading rates and the AF, rather than the NP, may play the most important role in transferring load, and absorbing energy at these rates. This should be considered when attempting surgically to restore IVD function.

Level of Evidence: N/A
Reducing Risk in Bilateral Total Knee Arthroplasty
Authors: Gabor Jonathan A. , Long William J. , Schwarzkopf Ran , Vigdorchik Jonathan M.
Published: May 2019

As the utilization of total knee arthroplasty increases and the population ages, the number of patients who require surgical treatment of both knees is rising. These procedures may be conducted simultaneously or sequentially; the simultaneous bilateral approach is increasingly considered the preferred option because it permits a symmetric recovery while avoiding risks associated with an additional operation, anesthetic, hospitalization, and recovery period while reducing the costs associated with sequential procedures. Despite these advantages, concerns have been raised regarding increased risks for deep vein thrombosis, pulmonary embolism, cardiac complications, and mortality. Results reported in the literature with regards to the relative safety of these procedures have been conflicting; however, it is agreed upon that careful patient selection is essential for reducing risk associated with simultaneous bilateral total knee arthroplasty. A set of guidelines have been established which may be used to help guide the management of patients with bilateral degenerative joint disease seeking knee replacement surgery.
Effect of Increasing Blood Pressure With Noradrenaline on the Microcirculation of Patients With Septic Shock and Previous Arterial Hypertension
Authors: Fiorese Coimbra Karla Tuanny , de Freitas Flávio Geraldo Rezende , Bafi Antônio Tonete , Pinheiro Tuanny Teixeira , Nunes Nathaly Fonseca , de Azevedo Luciano César Pontes , Machado Flávia Ribeiro
Published: May 2019

Objectives:

To assess whether an increase in mean arterial pressure in patients with septic shock and previous systemic arterial hypertension changes microcirculatory and systemic hemodynamic variables compared with patients without arterial hypertension (control).

Design:

Prospective, nonblinded, interventional study.

Setting:

Three ICUs in two teaching hospitals.

Patients:

After informed consent, we included patients older than 18 years with septic shock for at least 6 hours, sedated, and under mechanical ventilation. We paired patients with and without arterial hypertension by age.

Interventions:

After obtaining systemic and microcirculation baseline hemodynamic variables (time 0), we increased noradrenaline dose to elevate mean arterial pressure up to 85–90 mm Hg before collecting a new set of measurements (time 1).

Measurements and Main Results:

We included 40 patients (20 in each group). There was no significant difference in age between the groups. After the rise in mean arterial pressure, there was a significant increase in cardiac index and a slight but significant reduction in lactate in both groups. We observed a significant improvement in the proportion of perfused vessels (control: 57.2 ± 14% to 66 ± 14.8%; arterial hypertension: 61.4 ± 12.3% to 70.8 ± 7.1%; groups: p = 0.29; T0 and T1: p < 0.001; group and time interaction: p = 0.85); perfused vessels density (control: 15.6 ± 4 mm/mm2 to 18.6 ± 4.5 mm/mm2; arterial hypertension: 16.4 ± 3.5 mm/mm2 to 19.1 ± 3 mm/mm2; groups: p = 0.51; T0 and T1: p < 0.001; group and time interaction: p = 0.70), and microcirculatory flow index (control: 2.1 ± 0.6 to 2.4 ± 0.6; arterial hypertension: 2.1 ± 0.5 to 2.6 ± 0.2; groups: p = 0.71; T0 and T1: p = 0.002; group and time interaction: p = 0.45) in both groups.

Conclusions:

Increasing mean arterial pressure with noradrenaline in septic shock patients improves density and flow in small vessels of sublingual microcirculation. However, this improvement occurs both in patients with previous arterial hypertension and in those without arterial hypertension.
Argon Inhalation for 24 Hours After Onset of Permanent Focal Cerebral Ischemia in Rats Provides Neuroprotection and Improves Neurologic Outcome
Authors: Ma Shuang , Chu Dongmei , Li Litao , Creed Jennifer A. , Ryang Yu-Mi , Sheng Huaxin , Yang Wei , Warner David S. , Turner Dennis A. , Hoffmann Ulrike
Published: May 2019

Objectives:

We tested the hypothesis that prolonged inhalation of 70% argon for 24 hours after in vivo permanent or temporary stroke provides neuroprotection and improves neurologic outcome and overall recovery after 7 days.

Design:

Controlled, randomized, double-blinded laboratory study.

Setting:

Animal research laboratories.

Subjects:

Adult Wistar male rats (n = 110).

Interventions:

Rats were subjected to permanent or temporary focal cerebral ischemia via middle cerebral artery occlusion, followed by inhalation of 70% argon or nitrogen in 30% oxygen for 24 hours. On postoperative day 7, a 48-point neuroscore and histologic lesion size were assessed.

Measurements and Main Results:

After argon inhalation for 24 hours immediately following “severe permanent ischemia” induction, neurologic outcome (neuroscore, p = 0.034), overall recovery (body weight, p = 0.02), and infarct volume (total infarct volume, p = 0.0001; cortical infarct volume, p = 0.0003; subcortical infarct volume, p = 0.0001) were significantly improved. When 24-hour argon treatment was delayed for 2 hours after permanent stroke induction or until after postischemic reperfusion treatment, neurologic outcomes remained significantly improved (neuroscore, p = 0.043 and p = 0.014, respectively), as was overall recovery (body weight, p = 0.015), compared with nitrogen treatment. However, infarct volume and 7-day mortality were not significantly reduced when argon treatment was delayed.

Conclusions:

Neurologic outcome (neuroscore), overall recovery (body weight), and infarct volumes were significantly improved after 24-hour inhalation of 70% argon administered immediately after severe permanent stroke induction. Neurologic outcome and overall recovery were also significantly improved even when argon treatment was delayed for 2 hours or until after reperfusion.
Are patients in haemodialysis good candidates for immunotherapy treatment?
Authors: Fernandez-Diaz Amaya B. , Cunquero-Tomas Alberto J , Garcia-Medina Adrian , Ferrer-Guillen Blanca , Berrocal Alfonoso
Published: May 2019

The effectiveness and safety of nivolumab, an anti-programmed cell death protein 1 mAbmonoclonal antibody, in patients with renal replacement therapy is unclear, with limited evidence supporting its usefulness in this context. Therefore, we report a case of recurrent metastatic melanoma in a patient on haemodialysis successfully treated with nivolumab. As seen in patients without renal impairment, significant regression of the lesions was observed after 8 weeks of treatment, reaching complete clinical response after 4 months. During follow-up, no dose adjustment, delay, or treatment suspension due to toxicity were required.
Nivolumab for patients with metastatic uveal melanoma previously untreated with ipilimumab: a single-institution retrospective study
Authors: Namikawa Kenjiro , Takahashi Akira , Mori Taisuke , Tsutsumida Arata , Suzuki Shigenobu , Motoi Noriko , Jinnai Shunichi , Kage Yuta , Mizuta Haruki , Muto Yusuke , Nakano Eiji , Yamazaki Naoya
Published: May 2019

We evaluated the efficacy of nivolumab in patients with metastatic uveal melanoma previously untreated with ipilimumab. We performed a retrospective study at the National Cancer Center Hospital in Tokyo, Japan, where nivolumab was approved 1 year earlier than ipilimumab. Clinical efficacy outcomes were determined by assessing best overall response according to the Response Evaluation Criteria in Solid Tumors (version 1.1), progression-free survival and overall survival. Fourteen patients were analyzed; none had received any prior systemic therapies although eight had undergone transarterial chemoembolization. The median follow-up period was 15 months. The objective response and disease control rates were 7.1% and 42.9%, respectively (one partial response and five stable diseases). The median progression-free survival and overall survival were 10 (range, 4–105) and 60 (range, 5–105) weeks, respectively. Liver metastases in three patients were all programmed cell death-1 ligand negative. Lower lactate dehydrogenase, development of vitiligo, and a neutrophil-to-lymphocyte ratio less than 5 at week 6 were associated with favorable progression-free survival and overall survival; of these, only a neutrophil-to-lymphocyte ratio less than 5 at week 6 was statistically significant. Even with the use of nivolumab before ipilimumab, metastatic uveal melanoma appears to remain refractory to nivolumab monotherapy. However, because one patient in our cohort achieved an objective response, and the median overall survival exceeded 1 year, treatment strategies that incorporate anti-PD1 antibody should be further investigated. Whether a neutrophil-to-lymphocyte ratio less than 5 at week 6 is a favorable early on-treatment marker should be validated in larger cohorts.
Coexistence of Pemphigus Foliaceus and Grover Disease After a Radical Surgery for Basal Cell Carcinoma
Authors: Magdaleno-Tapial Jorge , Valenzuela-Oñate Cristian , Martínez-Doménech Álvaro , García-Legaz-Martínez Marta , Carballeira-Braña Alexo , Sánchez-Carazo José Luis , Pérez-Ferriols Amparo , Alegre-de Miquel Víctor
Published: May 2019

The differential diagnosis of Grover disease (GD) includes pemphigus foliaceus. However, the focal nature of the histologic findings and negative direct immunofluorescent point to the diagnosis of GD. It has been associated with a variety of systemic and cutaneous diseases, but its association with other primary acantholytic disorders has been rarely documented. In this article, we describe the first case of GD in association with pemphigus foliaceus.