bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment Fidelity in Mind–Body Interventions
Authors: Robins Jo Lynne , Jallo Nancy , Kinser Patricia A.
Published: September 2018

Purpose: To contribute to the treatment fidelity literature by providing real-world examples and suggestion for future research and potential clinical application, this article reports on implementation, assessment, and evaluation of treatment fidelity in mind–body self-care approaches in at-risk women. Method: Aligning with best practices, treatment fidelity was integrated into three randomized clinical trials. The first examined the effects of a tai chi intervention designed to decrease cardiometabolic risk factors in women; the second examined the effects of a tailored guided imagery intervention on pregnancy outcomes in African American women; and the third explored effects of a mindful physical activity intervention (yoga) on psychological outcomes in women with moderate to severe depressive symptoms. Findings: Each of the studies successfully designed, implemented, and evaluated strategies to address recommended treatment fidelity components. These strategies provided qualitative and quantitative data that informed intervention refinement, directions for future research, and application in clinical practice. Conclusions: The treatment fidelity framework used here is based on best practices and was a feasible and reliable approach for ensuring and reporting on treatment fidelity, which is contributing to future research to foster translation of potentially effective mind–body self-care approaches into practice.
Taxi planning: Branch and price decomposition
Authors: Ibanez Luís C , Marín Angel G
Published: September 2018

Taxi planning problem studies aircraft routing and scheduling on the airport ground. Taxi planning has been formulated using a binary multicommodity flow model in a space-time airport network. The flow capacity constraints are used to represent the conflicts among aircraft, given an airport’s capacity. Branch and price methodology has been adapted to take advantage of the integer model structures. The computational tests have been run with real data from Adolfo Suárez Madrid-Barajas airport. The tests were oriented toward comparing the new adapted branch and price with the classic Branch and Bound algorithm, trying to obtain conclusions that are useful for airport managers.
Penalized multiple inflated values selection method with application to SAFER data
Authors: Li Qiuya , Tso Geoffrey KF , Qin Yichen , Lovejoy Travis I , Heckman Timothy G , Li Yang
Published: September 2018

Expanding on the zero-inflated Poisson model, the multiple-inflated Poisson model is applied to analyze count data with multiple inflated values. The existing studies on the multiple-inflated Poisson model determined the inflated values by inspecting the histogram of count response and fitting the model with different combinations of inflated values, which leads to relatively complicated computations and may overlook some real inflated points. We address a two-stage inflated values selection method, which takes all values of count response as potential inflated values and adopts the adaptive lasso regularization on the mixing proportion of those values. Numerical studies demonstrate the excellent performance both on inflated values selection and parameters estimation. Moreover, a specially designed simulation, based on the structure of data from a randomized clinical trial of an HIV sexual risk education intervention, performs well and ensures our method could be generalized to the real situation. An empirical analysis of a clinical trial dataset is used to elucidate the multiple-inflated Poisson model.
Efficacy and Safety of Appetite-Stimulating Medications in the Inpatient Setting
Authors: Howard Meredith L. , Hossaini Roya , Tolar Catherine , Gaviola Marian L.
Published: September 2018

Background: Hospitalized patients are subject to acute illness and stress which may impact appetite or weight. Loss of appetite may lead to increased morbidity or mortality. Medications such as dronabinol, megestrol, and mirtazapine are used for weight gain in the outpatient setting; however, there is limited information about safety or effectiveness when initiated inpatient. Objectives: To analyze the effectiveness and safety of appetite-stimulating medications in hospitalized patients. Methods: This was a retrospective cohort study of hospitalized patients initiated on dronabinol, megestrol, or mirtazapine for appetite. The primary outcome was change in meal intake between drug initiation and discontinuation. Secondary outcomes included documented improvement in appetite, change in weight and various laboratory parameters, and incidence of adverse effects. Results: A total of 38 patients met inclusion criteria, and mirtazapine was most commonly used (42%). There was no significant difference between groups of appetite-stimulating medications with regard to mean change in meal intake, weight, albumin, or documented improvement in diet. Within groups, each agent showed numerical improvement in percentage meal intake, with a mean change from initiation to discontinuation of 17.12%. Almost half (48%) of the patients experienced improvement in diet after the start of medications. No serious adverse effects were observed. Conclusion and Relevance: In inpatients, there was no difference in change in meal intake or weight between dronabinol, megestrol, or mirtazapine, but they may show numerical improvements in meal intake. To our knowledge, this is the first study to evaluate the use of dronabinol, megestrol, and mirtazapine initiated in the inpatient setting.
Right Ventricular Function in Left Heart Disease
Authors: Del Rio J. Mauricio , Grecu Loreta , Nicoara Alina
Published: September 2018

Right ventricular (RV) function is an independent prognostic factor for short- and long-term outcomes in cardiac surgical patients. Patients with mitral valve (MV) disease are at increased risk of RV dysfunction before and after MV operations. Yet RV function is not part of criteria for decision making or risk stratification in this setting. The role of MV disease in the development of pulmonary hypertension (PHTN) and the ultimate impact of PHTN on RV function have been well described. Nonetheless, there are other mechanisms by which MV disease and MV surgery affect RV performance. Research suggests that PHTN may not be the most important determinant of RV dysfunction. Both RV dysfunction and PHTN have independent prognostic significance. This review explores the unique anatomic and functional features of the RV and the pathophysiologic and prognostic implications of RV dysfunction in patients with MV disease in the perioperative period.
Effect of oral misoprostol, alone or in combination with aglepristone, on mid-term pregnancy termination in cats
Authors: Ay Serhan Serhat , Aslan Selim , Önyay Firdevs , Kaya Duygu , Koldaş Ece , Arslan Serhat , Fındık Murat
Published: September 2018

Objectives

This study aimed to determine the efficacy and safety of oral misoprostol (MIS) administration in the induction of mid-term pregnancy termination in cats.

Methods

Twenty-eight cats that were pregnant for 30–40 days were allocated to four groups. The aglepristone (AGL) group (n = 7) received 10 mg/kg SC aglepristone q24h for two consecutive days. In the AGL+MIS group (n = 7), AGL (as administered in the AGL group) and MIS (200 µg/cat PO q12h until the start of abortion) were administered. The MIS200 (n = 7) and MIS400 groups (n = 7) received MIS (200 or 400 µg/cat misoprostol, respectively) alone PO q12h until the start of abortion. Blood samples were collected at the start of treatment (d0), 4 days after the start of treatment (d4) and on the day of complete abortion/end of administration (dA/d7).

Results

The efficacy of the treatment was 71.4% in the AGL group, 100% in the AGL+MIS group, 0% in MIS200 group and 57.4% in MIS400 group ( P = 0.004). No significance was found in relation to the interval from treatment to the start/end of abortion and the duration of abortion in all groups. The most observed side effect was vomiting in both groups administered MIS, particularly in the MIS400 group (56.7%). Progesterone (P4) concentrations were reduced during the abortion, but not to basal levels, in all groups. P4 concentrations were significantly lower at dA/d7 in the MIS400 group compared with the AGL and AGL+MIS groups ( P = 0.002).

Conclusions and relevance

The results obtained from this study showed that low doses of MIS do not induce abortions in cats but increase the effect of AGL. Although higher doses could terminate pregnancies, this also causes intense unwanted side effects. Therefore, the use of MIS alone as an abortifacient in cats is not recommended. For mid-term pregnancy termination in cats, the combination of misoprostol and aglepristone provides a more effective abortifacient than using either of them alone.
Low wear rate at 6-year follow-up of vitamin E-infused cross-linked polyethylene: a randomised trial using 32- and 36-mm heads
Authors: Lindalen Einar , Thoen Peder S , Nordsletten Lars , Høvik Øystein , Röhrl Stephan M
Published: September 2018

Background:

Free radicals formed in the cross-linking process may over time alter the mechanical properties of highly cross-linked polyethylene. Vitamin E-infused highly cross-linked polyethylene was therefore developed to achieve low wear-rate and good mechanical properties in the long term.

Aim:

To present 6-year results from the initial randomised controlled trial.

Patients and methods:

We measured wear and periacetabular bone remodelling in cementless total hip arthroplasty; 32- or 36-mm Biolox Delta heads and vitamin E-infused highly cross-linked polyethylene (E-Poly) were used. Markerless radiosterometric analysis measured the in vivo wear and dual energy x-ray absorptiometry was used to analyse bone remodelling in 40 hips at 6-year follow-up.

Results:

In the proximal direction the wear for 32- and 36-mm heads was 0.15 mm (95% confidence interval [CI], 0.08–0.21) and 0.06 mm (95% CI, -0.002–0.12), respectively ( p = 0. 015). However, between 3 months and 6 years (excluding the period of “bedding in”), the proximal wear for 32- and 36-mm heads was 0.10 mm (95% CI, 0.05–0.15) and 0.05 mm (95% CI, -0.01–0.11), respectively ( p = 0.12). The annual proximal wear rate for 32- and 36-mm heads from 3 months to 6 years was 0.02 mm and 0.01 mm, respectively. There was no difference in bone remodelling around the cup from baseline to 6 years for the total material and no differences between study groups.

Conclusion:

Wear of this vitamin E-infused highly cross-linked polyethylene is still low at 6-year follow-up, with no significant difference in wear from 3 months to 6 years between 32- and 36-mm heads.
Effects of circumferential and axial grooves on the nonlinear oscillations of the full floating ring bearing supported turbocharger rotor
Authors: Zhang Congcong , Men Rixiu , He Hong , Chen Wei
Published: September 2018

It is seen that with the reduction in land areas owing to the floating-rings featured grooves, there is reduction in the load capacities and bearing torques of the oil-films, which have an influence on the nonlinear oscillations of turbocharger rotors. In the present paper, the impact of the reduced load capacities and bearing torques caused by circumferential or/and axial grooves in full-floating-ring bearings on the nonlinear oscillations of turbocharger rotors is investigated. The numerical solution of the Reynolds equation for full-floating-ring bearings with grooves by means of a finite difference or finite element approach imposes a prohibitive simulation times, sine in every time-integration step a direct discretization of the Reynolds equation has to be solved simultaneously with the rotor model. To be able to perform transient simulations, a computationally efficient full-floating-ring bearing model is mandatory. To surmount this problem, a very time-efficient but rather precise method is proposed. The major point of the proposed method is the manipulation of the Reynolds equation to allow a speed parameter varying within (−1, +1) to reflect the relative weights of the journal and floating ring’s rotation and squeezing effects. Given the diameter-to-length ratio of each fluid film, groove widths, and boundary conditions, the fluid force databases can be easily established by the finite difference method. During the transient response analysis, the required fluid forces and bearing torques from each film can be evaluated by interpolation using the existent forces and torques of the closest points in the databases. Using transient simulations with the proposed method, the effect of circumferential or/and axial grooves in full-floating-ring bearings on the amplitudes and frequencies of the nonlinear oscillations of turbocharger rotors is qualitatively investigated. It is shown that the reduction of the load capacities and bearing torques due to grooves exert a large influence on the nonlinear rotor oscillations.
e-Health and multiple sclerosis: An update
Authors: Lavorgna Luigi , Brigo Francesco , Moccia Marcello , Leocani Letizia , Lanzillo Roberta , Clerico Marinella , Abbadessa Gianmarco , Schmierer Klaus , Solaro Claudio , Prosperini Luca , Tedeschi Gioacchino , Giovannoni Gavin , Bonavita Simona
Published: September 2018

e-Health (or digital healthcare) is becoming increasingly relevant in multiple sclerosis (MS) clinical management. We aim to review and discuss current status and future perspective of e-health in people with multiple sclerosis (pwMS). The first part of this review describes how information on MS can be conveyed through the Web and digital media. The second part illustrates recent advances in digital technology that can improve clinical management and in motor and cognitive rehabilitation of pwMS. Finally, this review advocates future development of the “digital case manager” as a new figure to coordinate clinical management and care of pwMS. The digital revolution is changing the medical approach to MS in terms of information conveying and sharing, rehabilitation, and healthcare management.
Using Rasch analysis to investigate the validity of the Everyday Discrimination Scale in a national sample
Authors: Berenbon Rebecca F
Published: September 2018

The Everyday Discrimination Scale (EDS) is a widely used measure of discrimination. Rasch analysis was used to examine the psychometric properties of the EDS based on a national sample ( N = 2666). Items largely fit the Rasch model and yielded excellent separation and item reliability. However, severe floor effects were observed. Implications are discussed for use of the scale in populations that experience low levels of discrimination. An ordinal-to-interval conversion table for the EDS is also provided.
Which group to credit (and blame)? Whites make attributions about White-minority biracials’ successes and failures based on their own (anti-)egalitarianism and ethnic identification
Authors: McClanahan Kaylene J. , Ho Arnold K. , Kteily Nour S.
Published: September 2018

Individuals’ perceptions of biracials can vary based on the motives of the perceiver. Here, we examine how two factors—perceivers’ group-level identification motives and their system-level beliefs about the desirability of hierarchy (i.e., social dominance orientation)—predict the degree to which they attribute a biracial target’s successes or failures to that target’s White versus minority background. Across three studies examining different contexts, more anti-egalitarian White participants and more highly identified White participants rated a half-White, half-minority target as being shaped more by his minority (vs. White) background when he was disreputable (vs. reputable)—patterns broadly consistent with prior theorizing on the motivations to maintain social stratification and protect ingroup standing, respectively. In direct contrast, however, egalitarian White participants and White participants low on ethnic identification credited a target’s outgroup minority background when he was reputable (vs. disreputable), consistent with a desire to promote social equality and forgoing the opportunity to “bask in reflected glory” on behalf of the ingroup. Our results extend extant theorizing by underlining the benefits of jointly considering both group- and system-level motives when analyzing perceptions and attributions of individuals and groups, and by shedding new light on the understudied psychology of social egalitarians.
A feasibility study on identifying drinking-related contents in Facebook through mining heterogeneous data
Authors: ElTayeby Omar , Eaglin Todd , Abdullah Malak , Burlinson David , Dou Wenwen , Yao Lixia
Published: September 2018

Binge drinking is a severe health problem faced by many US colleges and universities. College students often post drinking-related text and images on social media, portraying their alcohol use as socially desirable. In this project, we investigated the feasibility of mining the heterogeneous data (e.g. text, images, and videos) on Facebook to identify drinking-related contents. We manually annotated 4266 posts during 21 October 2011 and 3 November 2014 from “I’m Shmacked” group on Facebook, where 511 posts were drinking-related. Our machine learning models show that by combining heterogeneous data types, we were able to identify drinking-related posts with an F1-score of 0.81. Prediction models built on text data were more reliable compared to those built on image and video data for predicting drinking-related contents. As the first step of our efforts in this direction, this feasibility study showed promise toward unleashing the potential of mining social media to identify students who binge drink.
Deterioration assessment of buildings using an improved hybrid model updating approach and long-term health monitoring data
Authors: Nguyen Andy , Kodikara KA Tharindu Lakshitha , Chan Tommy HT , Thambiratnam David P
Published: September 2018

In recent years, it has become increasingly important to develop methodologies for reliable deterioration assessment of civil structures over their life cycle to facilitate maintenance and/or rehabilitation planning processes. Several approaches have been established to address this issue mainly using Bayesian probabilistic model updating techniques with some capability to incorporate uncertainties in the updating process. However, Bayesian model updating techniques are often found to be complex and computationally inefficient as opposed to their deterministic counterparts such as conventional or hybrid techniques of sensitivity-based model updating. Nevertheless, the deterministic model updating techniques have not been well developed for sophisticated assessment applications such as deterioration evaluation. To address these issues, this article presents a novel methodology for deterioration assessment of building structures under serviceability loading conditions, based upon an improved hybrid model updating approach incorporating the use of long-term monitoring data. This is first realized by a simple but effective scheme to simulate the deterioration mechanism in serviceability loading conditions before enhanced with innovative solutions to classify structural elements as well as to handle measurement and updating uncertainties in a meaningful way. The effectiveness of the established methodology is illustrated through a benchmark 10-story reinforced concrete building which is equipped with a long-term structural health monitoring system.
Amelioration of the Protein Expression of Cox2, NFκB, and STAT-3 by Some Antioxidants in the Liver of Sodium Fluoride–Intoxicated Rats
Authors: Alhusaini Ahlam , Faddaa Laila , Ali Hanaa M. , Hassan Iman , El Orabi Nagla F. , Bassiouni Yieldiz
Published: September 2018

The present study aimed to explore the efficiency of N-acetyl cysteine (NACC) or thymoquinone (TMQ) alone or in combination in the downregulation of inflammatory molecule expression and decreasing hepatic injury in response to sodium fluoride (SF). Sodium fluoride upregulated serum alanine and aspartate transferases activities, tumor necrosis factor α and hepatic malondialdehyde and nitric oxide levels, and the expression of cyclooxygenase 2, nuclear factor κB cell, and signal transducer and activator of transcription 3. In contrast, hepatic glutathione level, superoxide dismutase activity, and nuclear factor erythroid 2-related factor 2 expression were decreased. However, the concurrent treatment with antioxidants, alone or in combination, modulated the levels of these parameters. Histopathological examination revealed that SF treatment resulted in focal areas of massive hepatic degeneration and many degenerated hepatocytes, whereas the treatment with TMQ or NACC exhibited moderate improvement in cellular degeneration of the liver with many abnormal cells. Rats receiving a combination of TMQ and NACC showed marked improvement in cellular degeneration of liver with apparently normal hepatic architecture with very few degenerated hepatocytes. The results also revealed that the combination of TMQ and NACC is the most effective regimen in ameliorating SF toxicity, suggesting their efficacy against the toxicity of fluoride compounds. Their activities might be mediated via multiple molecular pathways.
Multiple aneurysms on the subarcuate artery arising from the anterior inferior cerebellar artery in a patient with a Borden type I transverse-sigmoid dural arteriovenous fistula manifesting as subarachnoid hemorrhage: A case report
Authors: Suzuki Tomoaki , Okamoto Kouichirou , Genkai Nobuyuki , Ito Yasushi , Abe Hiroshi
Published: September 2018

Background

Peripheral anterior inferior cerebellar artery (AICA) aneurysms are rare and commonly associated with vascular malformations, such as cerebellar arteriovenous malformations (AVMs). We present a case wherein multiple AICA feeding aneurysms on the subarcuate artery as a feeding artery of a Borden type I transverse-sigmoid dural arteriovenous fistula (dAVF) manifested as subarachnoid hemorrhage.

Case description

A 67-year-old woman presented with acute severe headache. Brain computed tomography (CT) demonstrated subarachnoid hemorrhage mainly in the posterior fossa. A transverse-sigmoid dAVF was detected on magnetic resonance angiography (MRA) and three-dimensional-CT angiography (3D-CTA), with no cortical venous reflex. The patient underwent conventional angiography, which showed multiple aneurysms on a small branch of the AICA, feeding a transverse-sigmoid dAVF (Borden type I). The AICA aneurysms seemed flow dependent and ruptured owing to high-flow arteriovenous shunts through the dAVF. Based on the source images of the MRA, the small artery arising from the AICA was considered the subarcuate artery, and it was confirmed on 3D-CTA after the artery was successfully embolized with Onyx without any complications. Multiple aneurysms on the subarcuate artery are extremely rare, and the artery has not been identified as a feeding artery of the transverse-sigmoid dAVF.

Conclusion

A rare case of multiple ruptured aneurysms on the subarcuate artery was reported in a patient with a Borden type I dAVF at the transverse-sigmoid sinuses manifesting as subarachnoid hemorrhage. Onyx embolization of the parent artery occlusion was feasible and useful in treating this type of feeding artery aneurysm of the AICA with a dAVF.
Cryotherapy for the Treatment of Chronic Rhinitis: A Qualitative Systematic Review
Authors: Kompelli Anvesh R. , Janz Tyler A. , Rowan Nicholas R. , Nguyen Shaun A. , Soler Zachary M.
Published: September 2018

Background

Chronic rhinitis impacts 60 million Americans and is associated with significant costs for patients. Although medical treatments are first line, some patients require surgical intervention such as vidian or posterial nasal neurectomy. Previous reviews have investigated the role of surgical management in chronic rhinitis, but none have investigated a longstanding treatment with recent interest: cryotherapy.

Objective

To identify the safety, efficacy, and durability of treatment response of cryotherapy in treating chronic rhinitis.

Methods

A systematic literature review was performed to identify studies that investigated the utility of cryotherapy in chronic rhinitis. Only studies with the primary objective of assessing the efficacy of cryotherapy on chronic rhinitis were included. Patients were classified as allergic rhinitis, nonallergic rhinitis (vasomotor rhinitis), or mixed rhinitis using the original author’s criteria. Data were extracted regarding reported complications, treatment efficacy, and length of follow-up.

Results

A total of 110 abstracts were identified, of which 15 were included in this review. Epistaxis and nasal obstruction were commonly reported complications. No serious adverse events were reported. For obstructive symptoms, “reduced” symptoms were reported in 63.4% to 100% of patients. In regard to rhinorrhea, reports of reduced symptoms were experienced from 77% to 100% of patients. Seven studies used only patient-reported improvements without stratifying results based on symptom type; general improvements ranged from 67% to 100%. Nine studies noted symptom improvement in nonallergic cohorts ranging from 67% to 97.5% of patients. Four studies noted improvement in allergic cohorts ranging from 63.4% to 80% of patients. Two studies noted improvement in patients with mixed pictures ranging from 92.5% to 100%.

Conclusions

Although cryotherapy appears safe and efficacious, heterogeneous past investigations with low-quality evidence make strong, evidence-based recommendations difficult to make. Further study with validated metrics and controlled populations is certainly warranted and should be encouraged.
Retrospective Analysis of Geriatric Patients Undergoing Hip Fracture Surgery: Delaying Surgery Is Associated With Increased Morbidity, Mortality, and Length of Stay
Authors: Bennett Andrew , Li Hsin , Patel Aakash , Kang Kevin , Gupta Piyush , Choueka Jack , Feierman Dennis E.
Published: September 2018

Introduction:

Hip fractures are common in elderly patients. However, this population frequently presents with significant medical comorbidities requiring extensive medical optimization.

Methods:

This study sought to elucidate optimal time to surgery and evaluate its effect on postoperative morbidity, mortality, and length of stay (LOS). We performed a retrospective analysis of data collected from 2008 to 2010 on 841 patients who underwent hip fracture surgery. Patients were classified based on time to surgery and were also classified and analyzed according to the American Society of Anesthesiologists (ASA) physical classification system.

Results:

Patients with a delay of greater than 48 hours had a significant increase in overall LOS, postoperative days, and overall postoperative complications. Patients classified as ASA 4 had an odds ratio for postoperative morbidity of 3.32 compared to the ASA 1 and 2 group ( P = .0002) and 2.26 compared to the ASA 3 group ( P = .0005). Delaying surgery >48 hours was also associated with increased in-hospital mortality compared to 24 to 48 hours ( P = .0197). Increasing ASA classification was also associated with significantly increased mortality. Patients classified as ASA 4 had 5.52 times the odds of ASA 1 and 2 ( P = .0281) of in-hospital mortality. Those classified ASA 4 had 2.97 times the odds of ASA 3 ( P = .0198) of an in-house mortality. Anesthetic technique (spinal vs general) and age were not confounding variables with respect to mortality or morbidity.

Discussion:

Surgical timing and ASA classification were evaluated with regard to LOS, number postoperative days, morbidity, and mortality.

Conclusions:

Delaying surgery >48 hours, especially in those with increased ASA classification, is associated with an increase in overall LOS, postoperative days, morbidity, and mortality. However, rushing patients to surgery may not be beneficial and 24 to 48 hours of preoperative optimization may be advantageous.
Perceived Health Status in Rural Manufacturing Workers
Authors: Logsdon Stacy , Branstetter M. Laurie , Main Eve
Published: September 2018

Manufacturing workers comprise 8.8% of the total U.S. workforce representing a sizable population for disease prevention and health promotion by occupational health nurses within worksite wellness programs. The purpose of this study was to examine the relationship between perceived health status and objective health status including existing chronic disease among rural manufacturing workers. Rural manufacturing workers ( n = 114) completed a general health survey and consented to a retrospective chart review. All were participants in a direct incentive wellness program with biometric data available. The majority of participants were males between the ages of 46 and 60 years, and nearly half of the sample had a college degree. A statistically significant difference was observed between number of chronic diseases and lower perceived health status. These findings have implications for occupational health nurses and other health care providers to identify workers at risk for chronic illness through self-perceived health status assessment.
Predictors of Successful Outcomes of Selective Nerve Root Blocks for Acute Lumbar Disc Herniation
Authors: Kanna Rishi M. , Shetty Ajoy P. , Rajasekaran S.
Published: September 2018

Study Design:

Prospective, observational cohort study.

Objective:

Selective nerve root block (SNRB) is an effective, standard interventional procedure for failed medical management in lumbar disc herniation (LDH). However, the factors that would predict successful outcomes in patients undergoing SNRB have not been clearly studied.

Methods:

Patients with failed conservative treatment for acute LDH, treated with SNRB were periodically followed till 1 year. Patients who failed to have pain relief or had recurrent pain after SNRB, underwent surgery. The pattern of radiculogram during SNRB was classified into 4 types—“arm,” “arrow,” “linear,” and “splash.” Various clinical factors, radiological factors, and radiculograms were compared between patients who had consistent pain relief (group A) and those patients who did not (group B).

Results:

A total of 91 patients underwent SNRB. Sixty-nine had good pain relief maintained till 1 year (75.8% success). Twenty-two patients underwent surgery after failed NRB at a mean of 6.3 weeks. Patients with sensory symptoms ( P = .01), higher mean preinjection Oswestry Disability Index (ODI) score ( P = .02), higher mean postinjection ODI score at 3 weeks ( P = .004), nonmanual job ( P = .01), lumbosacral transitional segment ( P = .00 005), and splash pattern of radiculogram ( P = .005) were predictive of failed NRB. Logistic regression analysis showed that lumbosacral transitional segment at the level of LDH is the most significant factor predicting poor outcome.

Conclusions:

SNRB is an effective technique to provide consistent symptom relief at least till 1 year in patients with acute LDH. The study identified several factors that predicted poor outcomes of SNRB and such patients can be forewarned about need for later surgery.
Back to the Original Question in Endometriosis: Implantation or Metaplasia?
Authors: Viganò Paola , Somigliana Edgardo , Gentilini Davide , Benaglia Laura , Vercellini Paolo
Published: September 2018

The pathogenesis of some forms of endometriosis is still controversial. Different research approaches have been used to clarify this issue and an intense debate has derived over the years among scientists. This paper presents and discusses aged and modern ideas derived from various observations in different research areas on this specific topic. More specifically, data derived from histological results, animal studies, anatomical findings and basic research activity are presented.

Although an increasing body of evidence tends to support the implantation theory, which currently represents the most recognized pathogenic model for endometriosis, some aspects of this disease remain obscure and the scientific and medical communities have still not made significant progress in terms of completely elucidating the histogenesis of some forms of the disease.
Recent Advances in Molecular Genetics of Endometriosis
Authors: Silveira Cássia Gisele Terrassani , Rogatto Silvia Regina , Podgaec Sérgio , Abrão Mauricio Simões
Published: September 2018

Endometriosis (MIM 131200) is a prevalent and complex gynecological disease polygenically inherited with multifactorial pathogenesis. It is increasingly recognized as a major women's health issue. Endometriosis is characterized by the presence of endometrial-like tissue in sites outside the uterus, mainly the pelvic peritoneum, ovaries and rectovaginal septum causing severe dysmenorrhoea, dyspareunia, chronic pelvic pain and subfertility. Recent advances in molecular technologies have provided many evidences about the underlying biological events that are likely to be involved in the development of endometriosis. Different chromosomal regions, genes and other molecules, such as microRNAs, have been identified as potentially involved in endometriosis pathogenesis. Moreover, genome-wide analyses of endometriosis have showed novel molecular signatures or individual genes that had not been previously associated with the disease. The goal of these studies is to provide information that might, in turn, lead to new therapies. In this review, some previous studies were updated supporting the polygenic/multifactorial inheritance and the association with malignant neoplasias. We have also emphasized the importance of identifying the causative genes and determining novel diagnostic and predictive biomarkers.
Involvement of Iron, Nuclear Factor-Kappa B (NF-κB) and Prostaglandins in the Pathogenesis of Peritoneal Endometriosis-Associated Inflammation: A Review
Authors: Lousse Jean-Christophe , Defrère Sylvie , Ramos Reinaldo González , Van Langendonckt Anne , Colette Sébastien , Donnez Jacques
Published: September 2018

Peritoneal endometriosis is a chronic pelvic inflammatory disease, characterized by increased numbers of peritoneal macrophages and their secreted products such as cytokines, growth and angiogenic factors in peritoneal fluid. Inflammation plays a major role in pain and infertility associated with endometriosis, but is also extensively involved in the molecular and cellular processes that lead to peritoneal endometriotic lesion development. Several inflammatory mediators have therefore been studied in the context of endometriosis over the last few years.

The aim of this review is to focus on three that have been clearly implicated in the pathogenesis of endometriosis and may be linked: peritoneal iron metabolism, nuclear factor-kappa B (NF-κB) activation, and prostaglandin biosynthesis.

Peritoneal iron overload has been conclusively demonstrated in endometriosis patients and may induce oxidative stress in the peritoneal cavity. Oxidative stress and proinflammatory cytokines are well known to be potent activators of the NF-κB pathway, which has recently been implicated in peritoneal endometriosis. Induced NF-κB activation leads to expression of numerous proinflammatory genes such as cytokines, which may provide positive feedback to the pathway, self-perpetuating the inflammatory response. Other important NF-κB-regulated molecules are prostaglandin biosynthesis enzymes, and cyclooxygenase-2 (COX-2) in particular. Increased concentrations of prostaglandins have been evidenced in the peritoneal fluid of endometriosis patients and COX-2 inhibitors have proved to be effective in ‘in vitro’ and ‘in vivo’ experimental models.

In the light of available data collected from patient biopsies, as well as ‘in vitro’ and ‘in vivo’ studies, the respective implication and potential molecular association of iron, NF-κB and prostaglandins in the pathogenesis of endometriosis are discussed. The key role of peritoneal macrophages is emphasized and potential therapeutic targets are examined.
The Early Genes c-fos and c-jun: Potential Targets to Modulate Estrogen Action in Endometriosis?
Authors: Reis Fernando M. , Morsch Débora M. , Rocha Ana L. , Carneiro Márcia M. , Spritzer Poli M.
Published: September 2018

Endometriosis is a common estrogen-dependent disorder. C-fos and c-jun are early transcription factors probably related to estradiol-dependent cell proliferation. C-fos gene expression is higher in endometriotic implants compared to normal endometrium and the distribution of c-Fos protein is higher in the stroma of endometriotic tissue. C-Jun expression is also more abundant in ectopic endometrial tissue. These findings point to an increased estrogen signaling in endometriosis and suggest that c-fos and c-jun could be potential targets to emerging treatments designed to affect selectively the endometriotic tissue, such as tissue-specific gene therapy.
Quality of the Clinical Diagnosis of Endometriosis
Authors: Djalali Schima , Janson Dietlinde , Altgassen Christopher , Agic Admir , Diedrich Klaus , Hornung Daniela
Published: September 2018

Background

Endometriosis is a benign but chronic disease, often associated with chronic pelvic pain and sterility in reproductive age women. Definite diagnosis of endometriosis requires surgical intervention. In our study we determined the sensitivity and specificity of the routine non-invasive diagnosis of endometriosis.

Methods

543 women underwent laparoscopy or laparotomy for benign gynecological reasons; of these, 156 women presented with endometriosis and 387 women presented without endometriosis. Charts were examined for preoperative prediction and diagnosis of endometriosis by gynecologists in private practice and by clinicians. Charts were also examined for the diagnosis after surgical and histological confirmation.

Results

Out of 101 cases, where first time endometriosis was diagnosed, in 43 patients (42.6%) the diagnosis of endometriosis was accurately predicted preoperatively by clinicians. Gynecologists in private practice suspected endometriosis in 29.7% of the cases. In the group of at least one recurrence of endometriosis (n=55), 89.1% clinic and 74.5% private practice suspected the correct diagnosis before surgery. The sensitivity for clinical diagnosis of endometriosis was calculated to be 59.0% in the clinic and 54.5% in private practice. The specificity was calculated to be 95.6% in the clinic and 96.9% in private practice.

Conclusions

According to the results of this study, the sensitivity of the clinical diagnosis for patients with newly detected endometriosis is very low, whereas it increases significantly for patients with recurrent disease. We recommend more investigations using non-invasive diagnostic tools. It should thereupon be possible to detect endometriosis earlier than the current delay of around nine years between the onset of symptoms and the final diagnosis.
Expression of the Epidermal Growth Factor Receptor Family in Correlation to the Estrogen Receptor α Expression in Peritoneal and Ovarian Endometriosis
Authors: Herbel Johanna , Mechsner Sylvia , Gericke Christine , Bartley Julia , Loddenkemper Christoph , Salomon David S. , Ebert Andreas D.
Published: September 2018

Purpose

Endometriosis is a benign estrogen-responsive disease which shares some characteristics with malignant tumors such as invasion and unrestrained growth. In this respect, the epidermal growth factor receptor family (EGFR or erbB-1 and erbB-2 to -4) is known to play an important role in tumor biology. The aims of the present study were: 1) to investigate the expression patterns of the four erbB receptors, 2) to ascertain if there was a correlation between the EGFR family expression and the expression of the estrogen receptor α (ERα).

Methods

Retrospective study: 48 peritoneal and 12 ovarian human endometriotic lesions were analyzed by immunohistochemistry. The confirmation of the immunohistochemical findings was made by Western blot analysis. Using the Mann-Whitney-U test, statistical analysis was performed.

Results

In peritoneal and ovarian endometriosis, all members of the EGFR family and ERα are detectable in stromal and epithelial cells, but the expression is different within the tissues. Only in ovarian endometriosis was a statistical association observed between EGF receptor and ERα expression (p<0.017).

Conclusions

The differential expression of the erbB receptors suggest that the erbB family might play an important role in the pathogenesis of endometriosis. A significant association between EGF receptor expression and the ERα expression was only found in ovarian endometriosis.
Hysterectomy-Related Morbidity and Mortality Rates in Turkey from 1999 to 2008
Authors: Güven Davut , Kilico Ismail , Koçak Idris , üstün Cazip
Published: September 2018

Objective

The aim of this study was to report the morbidity and mortality rates associated with hysterectomies performed at our unit and to recommend a plan to reduce complications. Methods: In this retrospective review of morbidity and mortality rates, we reviewed the charts of 1188 patients who underwent hysterectomy between 1999 and 2008 at the Ondokuz Mayis University Hospital in Samsun, Turkey.

Results

The overall hysterectomy-related morbidity rate was 4.3%. There were no operative or postoperative deaths. The incidence of intraoperative bowel injury was 0.4%, bladder injury was 0.5%, while the incidence of vesicovaginal fistula was 0.2% in this study.

Conclusions

In order to reduce the hysterectomy-related morbidity rate, proper selection, pre-operative preparation and less invasive alternative treatments can be employed, such as various methods of endometrial ablation or resections. (Journal of Endometriosis 2010; 2: 41–4)
Incisional Endometriosis after Cesarean Section: A Case Report
Authors: Yavuz Erhan , Turgut Esra , ÇakiroğLu Hasan , Güven Davut , Üstün Cazip
Published: September 2018

Endometriosis is a disorder in which abnormal growths of tissue, histologically resembling the endometrium, are present in locations other than the uterine lining. Endometriosis is most commonly observed in the dependent portions of the pelvis, most frequently on the ovaries, followed by the anterior and posterior cul-de-sacs, the uterosacral ligaments, the posterior uterus, and the posterior broad ligaments. It is known that endometriosis can occur in scar tissue after a Cesarean section, an appendectomy, laparoscopy through trocar sites and amniocentesis. In our case, the cyclic painful mass about 3 cm x 2 cm on the right side of the scar underskin developed 7 years after the patient's last cesarean section. Management of scar endometriosis usually includes both surgery and hormonal suppression. Optimal management is by extensive surgical excision with care to remove all affected tissue. (Journal of Endometriosis 2010; 2: 45–6)
Primary Umbilical Endometriosis
Authors: Battista Raffaele , Tamburro Stefano , Leonenko Marina , Lesec Guy , Bayeh Samih , Nohuz Erdogan
Published: September 2018

Introduction

Endometriosis is a common gynecological disease that affects 5% to 10% of fertile women. The pelvis is the most common site of the disease. Extragenital endometriosis is less common but even more difficult to diagnose and treat.

Case report

We report one case of primary umbilical and pelvic endometriosis. A 32-year-old woman presented with a cutaneous black mass in the umbilicus. She had a previous history of abdominal pain, dyspareunia and infertility.

Technique

The patient was offered surgical management and she underwent laparoscopy with excision of the nodule and umbilical reconstruction.

Conclusions

Complete excision is the mainstay of treatment for this condition. Diagnostic laparoscopy should be suggested in these patients to ensure a complete surgical approach.
The Characteristic Expression of CD3+ T Cells, CD8+ T Cells and CD57+ NK Cells in Distinct Zones of Peritoneal Endometriotic Lesions
Authors: Ganewatta Subha P. , Berbic Marina , Luscombe Georgina , Markham Robert , Fraser Ian S.
Published: September 2018

Background: Endometriosis is a benign gynecological condition, associated with a dysfunctional immune response that facilitates progression of peritoneal lesions. Specific immune cells are hypothesized to be recruited to peritoneal endometriotic lesions; though little is known about the significance of specific T and NK cell expression and the microanatomical zoning of lesions. This study aimed to characterize the zoning of T and NK cell populations in endometriotic peritoneal lesions compared to histologically normal peritoneum.

Methods and Results: Immunohistochemical analysis of CD3+ and CD8+ T cells and CD57+ NK cells in 18 peritoneal endometrial lesions and 20 normal peritoneal biopsies revealed greatly increased expression of these immune cells in women with confirmed endometriosis. Alpha-smooth muscle actin (α-SMA) antibody was used to detect the reactive a-SMA zone surrounding the core glands and stroma. CD57+ NK cells and CD3+ and CD8+ T cells were significantly over-expressed (p<0.01) throughout the peritoneal endometriotic lesions compared to normal peritoneum (in women without endometriosis) and these cells were highly expressed in the core lesion zone compared to expression in the adjacent α-SMA zone and surrounding peritoneum.

Conclusions: Our observations support the concept that immune cell populations are recruited into developing endometriotic lesions. We have for the first time shown that NK and T immune cells are distributed differentially across various microanatomical zones of peritoneal lesions. Such understanding of zone specific immune-cell expression is crucial for better defining the roles these immune cells play in endometriotic lesion establishment and progression.
Comparison of KD3-M and KD3-L Multiligamentous Knee Injuries and Analysis of Predictive Factors That Influence the Outcomes of Single-Stage Reconstruction in KD3 Injuries
Authors: Sundararajan Silvampatti Ramasamy , Sambandam Balaji , Rajagopalakrishnan Ramakanth , Rajasekaran Shanmuganathan
Published: September 2018

Background:

The knee dislocation–3 (KD3) injury pattern is the most common form of multiligamentous injury. Medial KD3 (KD3-M) and lateral KD3 (KD3-L) are 2 anatomically different varieties of this injury.

Purpose:

To compare the surgical outcomes of KD3-M and KD3-L multiligamentous knee injury patterns and to determine the factors that could influence the outcomes after single-stage reconstruction.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

A cohort of 45 patients with multiligamentous knee injuries (31 KD3-M, 14 KD3-L) who were operated on between 2011 and 2015 were compared. The cruciate ligaments were reconstructed, and the collateral ligaments were managed either conservatively or surgically depending on intraoperative laxity, tissue condition, injury site, and chronicity. The mean follow-up was 36 months (range, 24-72 months). The International Knee Documentation Committee (IKDC) score, Lysholm score, knee flexion range of motion (ROM), and laxity on stress radiographs were compared. Various factors likely to influence the outcomes were also analyzed.

Results:

The mean IKDC score, Lysholm score, and knee flexion ROM for the 45 patients were 74.74, 87.66, and 126.78°, respectively. There was no significant difference between the KD3-M and KD3-L groups in terms of the postoperative IKDC score ( P = .768), Lysholm score ( P = .689), knee flexion ROM ( P = .798), and laxity on stress radiographs ( P = .011). Patients with a transient dislocation had better outcomes (76.51, 89.41, and 128.61°, respectively) than those with a frank dislocation (67.62, 80.66, and 119.44°) ( P = .037, .007, and .043). The acute group had better outcomes (77.00, 89.51, and 127.86°) when compared with the subacute (66.26, 86.00, and 121.00°) and chronic groups (67.40, 76.40, and 125.00°) ( P = .045, .006, and .486). Regression analysis showed the influence of these factors on outcomes. The presence or absence of dislocations, time frame in which surgery was performed, and follow-up duration were found to influence the outcome. All other factors had no bearing on outcomes. Two patients had knee stiffness and underwent arthrolysis.

Conclusion:

Despite anatomic and biomechanical differences between KD3-M and KD3-L injuries, single-stage management did not produce any significant difference in results. The presence of a frank dislocation, delay in surgery, and duration of follow-up were found to influence outcomes.