bluuebunny/crossref_metadata_2025 huggingface dataset:
3D‐tapered resonators for FSSs with incident angle independence
Authors: Azemi Saidatul N. , Baum Thomas , Ghorbani Kamran , Rowe Wayne S.T.
Published: September 2017

A three‐dimensional (3D) frequency selective surface (FSS) with a response that is independent of incident angle is presented in this study. The proposed FSS is a periodic array of 3D hollow‐tapered resonators. The proposed 3D FSS has reduced sensitivity to the angle of incidence of the electromagnetic wave compared with other 2D and 3D FSSs as a result of tapered structure. The transverse electric (TE) and transverse magnetic (TM) incident angle independences are obtained by tapering the width of a cylinder with a square cross‐section from the upper opening to the lower opening. Impressive frequency stability and transmission characteristics have been achieved up to 80° for both TE and TM incidence angles. The principles of operation along with guidelines for the design of the proposed FSS structures are presented in this study. A prototype of the proposed 3D‐tapered FSS is also fabricated and tested using a free‐space measurement system to verify performance.
Enhanced 3D localisation accuracy of body‐mounted miniature antennas using ultra‐wideband technology in line‐of‐sight scenarios
Authors: Sharma Manmohan , Alomainy Akram , Parini Clive
Published: September 2017

This study presents experimental investigations on high‐precision localisation methods of body‐worn miniature antennas using ultra‐wideband (UWB) technology in line‐of‐sight conditions. Time of arrival data fusion and peak detection techniques are implemented to estimate the three‐dimensional (3D) location of the transmitting tags in terms of x, y, z Cartesian coordinates. Several pseudo‐dynamic experiments have been performed by moving the tag antenna in various directions and the precision with which these slight movements could be resolved has been presented. Some more complex localisation experiments have also been undertaken, which involved the tracking of two transmitter tags simultaneously. Excellent 3D localisation accuracy in the range of 1–4 cm has been achieved in various experiment settings. A novel approach for achieving subcentimetre 3D localisation accuracy from UWB technology has been proposed and demonstrated successfully. In this approach, the phase centre information of the antennas in a UWB localisation system is utilised in position estimation to drastically improve the accuracy of the localisation measurements to millimetre levels. By using this technique, the average localisation error has been reduced by 86, 31, and 72% for the x‐, y‐, and z‐axis coordinates, respectively.
Implementation of reactive power‐based MRAS for sensorless speed control of brushless doubly fed reluctance motor drive
Authors: Kiran Karuna , Das Sukanta
Published: September 2017

The present work introduces the concept of classical reactive power (Q)‐based model reference adaptive system (MRAS) for the speed estimation and control of low‐cost BDFR motor drive. The reasons behind such choice for this drive's control are: (i) MRAS‐based controllers can inherently take care of the machine parameter variations which had been a challenging issue with the other available sensorless speed estimation strategies and (ii) the employment of Q as a functional candidate inevitably makes the formulation immune to the variations in stator resistance. The experimental assessment, in this respect, confirms these claims. Furthermore, the analytical validation of Popov's hyperstability criteria on the proposed controller, confirms the drive's overall stability within the investigated speed control range. The speed control performance is examined in MATLAB/Simulink. The simulation results are further validated by a real‐time implementation using dSPACE‐1103‐based 1.6 kW BDFR machine prototype.
Non‐myopic sensor scheduling for multistatic sonobuoy fields
Authors: Angley Daniel , Ristic Branko , Suvorova Sofia , Moran Bill , Fletcher Fiona , Gaetjens Han , Simakov Sergey
Published: September 2017

Sonobuoy fields, consisting of many distributed emitter and receiver sonar sensors on buoys, are used to seek and track underwater targets in a defined search area. The authors seek a scheduling protocol, selecting both the emitter and its waveform in each time interval that optimises tracking performance. This study describes a stationary scheduling algorithm for sonobuoy fields called the continuous probability states algorithm. The algorithm replaces a full partially observed Markov decision process by a computationally feasible Markov decision process by focusing on probability of target detection. This approach is shown to result in high‐quality tracks for multiple targets in a realistic simulation of a sonobuoy field.
Outcomes of Venous Malformation Sclerotherapy: A Review of Study Methodology and Long-Term Results
Authors: Ali Sumera , Mitchell Sally
Published: September 2017

It is very important that patients seeking sclerotherapy for the treatment of venous malformations are aware of the expected course of the therapy. They should be thoroughly counseled about the complications, the need for multiple sessions of therapy, and also about the expected clinical outcome. The aim of this review is to discuss the long-term outcomes of sclerotherapy for the treatment of venous malformation. Many studies have discussed their individual center's experiences and short-midterm results, but there is a relative paucity of data on long-term outcomes. We have reviewed the literature and also shared our experience of a large cohort of patients (n = 116) with a relatively longer follow-up period of more than 1 year. Venous malformations are very complex lesions and their treatment is quite variable depending on its extent and complexity. As a result, outcome studies vary considerably in the choice of sclerosant, study methodology, outcome assessment (clinical vs. imaging), and grading scales. This review also highlights this extreme heterogeneity in the literature of the sclerotherapy outcome and summarizes a few national and international studies for comparison.
Magnetic Resonance Lymphangiography and Lymphatic Embolization in the Treatment of Pulmonary Complication of Lymphatic Malformation
Authors: Itkin Maxim
Published: September 2017

Lymphatic malformations (LMs; especially those involving the central conducting lymphatic channels) are characterized by dysplastic and incompetent lymphatic channels in multiple tissues and organs. The major cause of mortality and morbidity in patients with thoracic LM is deterioration of pulmonary function due to chronic chylous effusions and progressive interstitial lung disease. The etiology of these pulmonary processes is unknown, although lymphatic involvement is certain. Understanding of the changes in the lymphatic anatomy in patients with LM has been hindered by difficulty of imaging of the lymphatic system. Recently developed dynamic contrast-enhanced magnetic resonance lymphangiography (DCMRL) allows dynamic MR imaging of the lymphatic system by injecting gadolinium contrast agent in the groin lymph nodes. Using this technique, pathological lymphatic flow from the central lymphatic system and/or retroperitoneal and mediastinal masses into lung parenchyma (“pulmonary lymphatic perfusion syndrome”) has been demonstrated in patients with LM. This abnormal lymphatic perfusion overflows pulmonary parenchyma and results in deterioration of pulmonary function due to interstitial process and/or compression effect of chylous effusions. Percutaneous thoracic duct embolization or lymphatic interstitial embolization of the lymphatic masses results in cessation of the pulmonary lymphatic overflow and significant improvement in pulmonary symptoms in these patients.
Evaluation of 18S rRNA PCR in the Diagnosis of Neonatal Fungal Sepsis
Authors: Sonika Pallavi , Gathwala Geeta , Goel Nidhi , Lather Sandeep , Dhaulakhandi Dhara
Published: September 2017

Neonatal fungal infections constitute a significant disease burden in India. In the absence of an ideal diagnostic test for the detection of fungal sepsis, the management of sepsis remains enigmatic. At present, blood culture is the method of choice for neonatal fungal sepsis, but it is not 100% sensitive. Together with the requirement for prolonged incubation, blood cultures are of limited utility in investigating neonates for invasive fungal infections, and especially for guiding initial therapy. For quite some time, molecular methods based on polymerase chain reaction (PCR) for detecting microorganisms are gaining prominence in clinical practice, particularly due to their precision, specificity, sensitivity, and shorter reporting time. Amplification of the 18S rRNA subunit gene by PCR from the DNA extracted from patient's blood specifically identifies the causative organism at least at genus level. Here, we evaluate the diagnostic utility of 18S rRNA PCR in neonatal fungal sepsis as part of a prospective cohort study in a tertiary health care setting.
Most Effective Regimen of Tranexamic Acid for Reducing Bleeding and Transfusions in Primary Total Knee Arthroplasty: A Meta-Analysis of Randomized Controlled Trials
Authors: Dai Wen-Li , Zhou Ai-Guo , Zhang Hua , Zhang Jian
Published: September 2017

The use of tranexamic acid (TXA) during primary total knee arthroplasty (TKA) is well documented. However, considering the potential side effects, including deep vein thrombosis (DVT) and pulmonary embolism (PE), the ideal route of administration remains controversial. Therefore, we performed a meta-analysis to compare the efficacy of topical versus intravenous TXA and explore the most effective regimen in patients undergoing primary TKA. We conducted a systematic literature search in PubMed, Embase, and the Cochrane database through July 2016 to identify randomized controlled trials (RCTs) evaluating the efficacy and safety of topical and intravenous TXA in primary TKA. We assessed the risk of bias using the Cochrane Collaboration's tool. We assessed the quality of evidence using the GRADE profiler software. A total of 15 RCTs including 1,240 participants met the inclusion criteria. We found no statistically significant difference between topical and intravenous TXA in terms of transfusion rate (p = 0.75), total blood loss (p = 0.51), total drain output (p = 0.60), maximum hemoglobin drop (p = 0.24), length of stay (p = 0.08), and thromboembolic complications (p = 0.73). Subgroup analyses showed that compared with 1 g topical TXA, 2 g topical TXA was more effective to reduce blood transfusion rate and total blood loss, and did not increase thromboembolic complications. We also found three times intravenous TXA was more effective than one time of intravenous TXA to reduce blood transfusion rate and total blood loss without increasing of thromboembolic complications. Topical TXA had a similar efficacy to intravenous TXA in reducing blood transfusion and blood loss, and did not increase the risk of thromboembolic complications in primary TKA. Besides, the current meta-analysis suggested that three times of intravenous TXA is efficient and safe. We also recommended 2 g topical TXA instead of 1 g topical TXA because it was more efficient to reduce blood transfusion rate and total blood loss and did not increase thromboembolic complications.
Nivel de evidencia de la RICMA comparada con el JHSE y JHSA
Authors: Rosales R. , González V. J. , Pollwein M. E. , Reboso-Morales L. , Hidalgo Y.
Published: September 2017

Objetivo: El propósito del presente trabajo fue evaluar el nivel de evidencia científica de artículos de investigación clínica publicados en las Revista Ineroamericana de Cirugía de la Mano (RICMA) y compararlo con las revistas Europea (JHSE) y Americana (JHSA).

Material y método: Un total de 932 trabajos de investigación clínicos publicados entre 2005 y 2009 (RICMA 60, JHSE, JHSA 461 y 411) fueron revisados. Dos observadores independientes clasificaron el nivel de evidencia basado en la Clasificación Internacional de Oxford, siendo 5 el nivel más bajo y 1 el nivel más alto de evidencia científica. Las frecuencias observadas de nivel de evidencia para cada revista científica fueron comparadas con las frecuencias esperadas mediante un test de chi- cuadrado (X2) para variables categóricas con un nivel de significancia del 0.05.

Resultados: Más del 80% de los trabajos publicados en la RICMA y el JHSE , y el 67.6% en el JHSA presentaron un nivel IV de evidencia. Trabajos de nivel I o II no fueron publicados en la RICMA, comparado con el JHSE (0.9% nivel I, 5% nivel II), y con el JHSA (8.3% nivel I, 10% nivel II). El porcentaje de artículos con nivel III publicados en la RICMA (16,7%) fue mayor al observado en el JHSE (11.1%) y en el JHSA (14.1%). Todos los resultados fueron estadísticamente significativos (X2=63.95; p<0.001).

Conclusiones: El nivel de evidencia de las publicaciones en investigación clínica en cirugía de la mano depende del tipo de revista, siendo el mayor nivel de evidencia en aquellos trabajos publicados en el JHSA, seguido del JHSE y finalmente la RICMA.
Nueva interpretación de los estabilizadores anatómicos en la fractura de muñeca. Parte I: Evolución de la región de la muñeca y nueva clasificación de las fracturas de radio
Authors: Rotella J. M. , Rotella P.
Published: September 2017

En este trabajo se presenta una nueva interpretación personal de las lesiones de muñeca basada en el estudio de la filogenia, embriología, anatomía y biomecánica de esta región y en base a esta nueva interpretación planteamos una nueva clasificación (parte I del trabajo), que ayudará a entender los patrones lesionales de las distintas fracturas (parte II del trabajo) y a definir una nueva “estrategia” para el tratamiento de las fracturas de radio (parte III del trabajo).

El eje post-axial es el encargado del desarrollo del miembro superior. El carpo y la mano siempre estuvieron articulados al cúbito y para que pueda aparecer el movimiento de supinación, parte del carpo necesitó migrar al radio.

Se describen tres sectores en la región de la muñeca: cubital (interno); central (medio) y radial (externo); cada uno de ellos presentan diferentes orígenes: evolutivo, formativo, constitutivo y funcional.

Cada sector tiene un rol biomecánico diferente, de los que surgen diferentes “patrones” de lesión. Estos distintos patrones producen desplazamientos e inestabilidades en las diferentes zonas que responden al origen filogénico de cada uno de los estabilizadores anatómicos.

Cuando sucede un traumatismo en la muñeca, las fuerzas se distribuyen de forma diferente en los tres sectores de la muñeca. En el sector externo, es decir, en el radio, se producen fuerzas de “compresión”. En el sector interno, los ligamentos y estiloides del cúbito, actúan fuerzas de “distracción”.
Artrodesis de cuatro esquinas de la muñeca
Authors: Delgado P. J. , Figueredo F. A. , Díez-Montiel A. , Gil de Rozas M. , Truan J. R.
Published: September 2017

La artrosis de la muñeca es una de las patologías más frecuentes y precisa un estudio detallado de la misma para realizar el tratamiento más adecuado. La artrodesis de cuatro esquinas con resección del escafoides es un procedimiento aceptable para tratar los cambios degenerativos, especialmente en la muñeca SLAC/SNAC. El objetivo es fusionar las articulaciones mediocarpianas dolorosas manteniendo la movilidad a través de la articulación radiolunar. Las técnicas quirúrgicas se han ido desarrollando a lo largo de las últimas décadas y los resultados funcionales han mejorado, pero no sus complicaciones. En este artículo se presentan los métodos de fijación y se revisa su evidencia científica en la literatura, así como los nuevos conceptos y técnicas, como la artroscopia.
Tumor location is a risk factor for lymph node metastasis in superficial Barrett’s adenocarcinoma
Authors: Yamada Masayoshi , Oda Ichiro , Tanaka Hirohito , Abe Seiichiro , Nonaka Satoru , Suzuki Haruhisa , Yoshinaga Shigetaka , Kuchiba Aya , Koyanagi Kazuo , Igaki Hiroyasu , Taniguchi Hirokazu , Sekine Shigeki , Saito Yutaka , Tachimori Yuji
Published: September 2017

Background and study aims Endoscopic treatment is indicated for superficial Barrett’s adenocarcinoma (BA) with a negligible risk of lymph node metastasis (LNM). However, risk factors associated with LNM in superficial BA are still not well characterized. The aim of the current study was to clarify risk factors for LNM of superficial BA.

Patients and methods A retrospective study was conducted in 87 consecutive patients with BA that was resected at National Cancer Center Hospital, Tokyo, Japan between 1990 and 2013. We assessed tumor size, macroscopic type, histological type, tumor depth of invasion, lymphovascular invasion and tumor location to analyze factors associated with LNM. Tumor location was classified into following 2 groups according to Siewert classification: 1) BA of the esophagogastric junction (EGJ-BA) as those having their center within 1 cm proximal from the EGJ; and 2) Esophageal-BA as those having their center at 1 cm or more proximal to the EGJ. EGJ was defined as distal end of the palisade vessels.

Results LNM was detected in 10 (11 %) patients. Univariable analysis revealed that tumor size, tumor depth of invasion, histological type of mixed differentiated and undifferentiated-type adenocarcinoma, lymphovascular invasion and tumor location of esophageal-BA were significantly associated with LNM. Multivariable analysis revealed that tumor location of esophageal-BA [odds ratio 7.8 (95 %CI: 1.3 – 48.1)] was a potential risk factor for LNM.

Conclusions The current study demonstrated that tumor location is a potential risk factor for LNM in BA. Therefore, indications for endoscopic treatment of esophageal-BA and EGJ-BA could be different.
Gender and Age Differences in Lipid Profile Among Chinese Adults in Nanjing: a Retrospective Study of Over 230,000 Individuals from 2009 to 2015
Authors: Gu Tianwei , Zhou Weihong , Sun Jie , Wang Jing , Zhu Dalong , Bi Yan
Published: September 2017

Background Previous national survey suggested that dyslipidemia is an increasing burden in China and more severe in urban population. In this study, we retrospectively analyzed the gender and age differences in lipids and lipoproteins in a large Chinese urban population in Nanjing city.

Methods A total of 236, 945 adults (age ≥20 years old) who undertook a health check between 2009 and 2015 in our medical examination center were involved in the analysis. Fasting total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol and triglyceride (TG) were measured by standard methods.

Results The age-standardized estimates of serum total cholesterol, HDL cholesterol, LDL cholesterol and triglyceride were 4.77 (4.76–4.79), 1.19 (1.18–1.19), 2.53 (2.52–2.54) and 1.74 (1.72–1.76) mmol/L in males (n=130954), and 4.79 (4.78–4.80), 1.46 (1.45–1.46), 2.44 (2.43–2.45) and 1.21 (1.19–1.22) mmol/L in females (n=105991), respectively. The prevalence of dyslipidemia was significantly elevated in females above 50 years old, and the peak prevalence of dyslipidemia in males was in the age group of 40–59 years, earlier as compared to females (peaked at 60–69 years old). In addition, an increasing secular trend was observed in LDL cholesterol levels from 2009 to 2015 in both males and females.

Conclusions Dyslipidemia is an increasing epidemic in China, characterized by a rising trend of LDL cholesterol. The gender and age differences in serum levels of lipid profile as well as prevalence of dyslipidemia suggested that the middle-age men and postmenopausal women should be the prioritized target for better control of dyslipidemia and early prevention of cardiovascular disease.
Neuro-Behcet: The Value of Transcranial Doppler
Authors: Goma Samar , Selim Zahraa , Shehata Ghaydaa , Sayed Doaa , Ahmed Dalia
Published: September 2017

Abstract Neurological involvement in Behcet disease (BD) is one of the most serious causes of long term morbidity and mortality and can be found in up to 49% of cases. There are 2 main types of CNS involvement, parenchymal and non-parenchymal. Transcranial Doppler (TCD) ultrasonography provides a relatively inexpensive, noninvasive, evaluation of the haemodynamics within intracranial arteries.

Material and Methods Case control study of 15 patients with NBD all of them fulfilled the criteria of the International Study Group for Behcet’s disease and fifteen apparently healthy volunteers age and sex matched. All patients and healthy controls were examined by TCD. Cranial Magnitic Resonance Imaging (MRI) examination was performed to the patients group.

Results Transcranial Doppler showed significant decline in the mean velocity (MV) of all the examined cerebral arteries in all NBD patients with the highest significant decrease in the vertebral artery (VA). On the other hand, a significant increase in the pulsatility index (PI) was detected only in the posterior cerebral artery (PCA). Regarding MRI examinations of our patients, 7 of 15 (46.7%) patients had parenchymal lesions, 13% had vascular lesions coexisting with parenchymal lesions (mixed). The parenchymal were located in the periventricular and superficial cerebral white matter, thalamus and brainstem followed by the cerebellum. Vascular lesions were dural and transverse sinus thrombosis.

Conclusion TCD provides a sensitive and accurate bed-side non-invasive imaging tool for the detection of flow pattern abnormalities in patients with NBD. MRI remains the gold standard for diagnosis.
Field-effect mobility of a two dimensional electron gas in an n–channel of Si-SiO2 MOS structure with due consideration of some practical features
Authors: Basu A. , Middya T. R. , Bhattacharya D. P.
Published: September 2017

The field-effect mobility characteristics of a non-degenerate ensemble of a two dimensional electron gas for interaction with acoustic mode lattice vibrations in the Si-SiO2 MOS structure at the high surface electric fields are calculated here for the low and high temperature cases. The calculation takes due account of some features which are usually neglected. These include the effects of (i) the transverse component of the phonon wave vector, (ii) the realistic model of the infinite triangular potential well along the transverse direction, while applying the momentum conservation approximation, and (iii) the full form of the phonon distribution function at low temperatures. The results seem to be interesting in that they are significantly different from what follows from other theories that neglect the effects of the above features. Moreover, the agreement between the results which are obtained here with the experimental data seems to be significantly better. The scope for further refinement of the present theory has been discussed.
Vegetative desiccation tolerance of Tripogon spicatus (Poaceae) from the tropical semiarid region of northeastern Brazil
Authors: Aidar Saulo de T. , Chaves Agnaldo R. de M. , Fernandes Júnior Paulo I. , Oliveira Melquisedec de S. , Costa Neto Benjamim P. da , Calsa Junior Tercílio , Morgante Carolina V.
Published: September 2017

The vegetative desiccation tolerance of Tripogon spicatus (Nees) Ekman was confirmed by its ability to recover the physiological functionality of intact plants previously subjected to extreme dehydration. Photosynthesis became undetectable when leaf relative water content (RWCleaf) achieved ~60%, whereas photochemical variables showed a partial decrease. Until the minimum RWCleaf of 6.41%, total chl decreased by 9%, and total carotenoids increased by 29%. Superoxide dismutase (SOD) activity decreased by 57%, on average, during dehydration, but catalase (CAT) and peroxidase (APX) activities showed no significant differences throughout the experiment. Malondialdehyde (MDA) content increased by 151%, total leaf and root amino acids decreased by 62% and 77%, respectively, whereas leaf and root proline decreased by 40% and 61%, respectively, until complete desiccation. After rehydration, leaves completely recovered turgidity and total chl contents. Carotenoids and MDA remained high, whereas SOD was 60% lower than the measured average measured before dehydration. With the exception of root amino acid contents, total amino acids and proline concentrations recovered completely. Gas exchange and photochemical variables remained substantially higher 4 days after rehydration, compared with the control. Besides increasing MDA, the overall physiological results showed that membrane functionality was preserved, leading to the vegetative desiccation tolerance of T. spicatus during the dehydration–rehydration cycle.
PHAST, PHASTER and PHASTEST: Tools for finding prophage in bacterial genomes
Authors: Arndt David , Marcu Ana , Liang Yongjie , Wishart David S
Published: September 2017

PHAST (PHAge Search Tool) and its successor PHASTER (PHAge Search Tool – Enhanced Release) have become two of the most widely used web servers for identifying putative prophages in bacterial genomes. Here we review the main capabilities of these web resources, provide some practical guidance regarding their use and discuss possible future improvements. PHAST, which was first described in 2011, made its debut just as whole bacterial genome sequencing and was becoming inexpensive and relatively routine. PHAST quickly gained popularity among bacterial genome researchers because of its web accessibility, its ease of use along with its enhanced accuracy and rapid processing times. PHASTER, which appeared in 2016, provided a number of much-needed enhancements to the PHAST server, including greater processing speed (to cope with very large submission volumes), increased database sizes, a more modern user interface, improved graphical displays and support for metagenomic submissions. Continuing developments in the field, along with increased interest in automated phage and prophage finding, have already led to several improvements to the PHASTER server and will soon lead to the development of a successor to PHASTER (to be called PHASTEST).
MAJIQ-SPEL: web-tool to interrogate classical and complex splicing variations from RNA-Seq data
Authors: Green Christopher J , Gazzara Matthew R , Barash Yoseph
Published: September 2017

Analysis of RNA sequencing (RNA-Seq) data have highlighted the fact that most genes undergo alternative splicing (AS) and that these patterns are tightly regulated. Many of these events are complex, resulting in numerous possible isoforms that quickly become difficult to visualize, interpret and experimentally validate. To address these challenges we developed MAJIQ-SPEL, a web-tool that takes as input local splicing variations (LSVs) quantified from RNA-Seq data and provides users with visualization and quantification of gene isoforms associated with those. Importantly, MAJIQ-SPEL is able to handle both classical (binary) and complex, non-binary, splicing variations. Using a matching primer design algorithm it also suggests to users possible primers for experimental validation by RT-PCR and displays those, along with the matching protein domains affected by the LSV, on UCSC Genome Browser for further downstream analysis.

Availability and implementation

Program and code will be available at http://majiq.biociphers.org/majiq-spel.

Supplementary information

Supplementary data are available at Bioinformatics online.
Site-Specific Considerations in the Surgical Management of Skull Base Chondrosarcomas
Authors: Raza Shaan M , Gidley Paul W , Kupferman Michael E , Hanna Ehab Y , Su Shirley Y , DeMonte Franco
Published: September 2017

BACKGROUND

Numerous approaches have been reported in the management of skull base chondrosarcomas. Data are lacking for surgical outcomes by the tumor site of origin.

OBJECTIVE

To provide insight into outcomes by site of origin and factors affecting resection in order to aid in surgical approach selection.

METHODS

A retrospective review was conducted of 49 patients with chondrosarcoma treated at our institution. Charts were reviewed for tumor- and treatment-related factors. Extent of resection was the primary outcome, while neurological function and surgical complications were secondary outcomes. Statistical analyses were performed assessing variables for their impact on the primary outcome.

RESULTS

The gross total resection rate for the overall cohort was 67.3%, and 97.8% of patients were either neurologically stable or improved postoperatively. A petroclival site of origin had lower rates of resection vs all other sites (P < .05). Histology and previous surgery did not predict outcome (P > .05), while previous radiotherapy and cavernous sinus invasion correlated with a subtotal resection (P < .05). In the petroclival cohort, clival, jugular tubercle, and soft tissue involvement correlated with a subtotal resection (P < .05). An endoscopic endonasal transpterygoid approach alone or combined with a transcranial approach yielded the highest resection rates for petroclival tumors (P < .05).

CONCLUSION

Chondrosarcomas pose unique challenges based on the site of origin and pattern of extension. While current surgical strategies appear to yield adequate results at a majority of skull base sites, petroclival tumors represent a particular cohort in which improvement is needed. Based on our analysis, strategies incorporating both endoscopic and transcranial skull base approaches are likely necessary to achieve optimal outcomes.
Morphological evidence for a past minor merger in the Seyfert galaxy NGC 1068
Authors: Tanaka Ichi , Yagi Masafumi , Taniguchi Yoshiaki
Published: September 2017

Deep optical imaging with both Hyper Suprime-Cam and Suprime-Cam on the 8.2 m Subaru Telescope reveals a number of outer faint structures around the archetypical Seyfert galaxy NGC 1068 (M 77). We find three ultra diffuse objects (UDOs) around NGC 1068. Since these UDOs are located within the projected distance of 45 kpc from the center of NGC 1068, they appear to be associated with NGC 1068. Hereafter, we call them UDO-SW, UDO-NE, and UDO-SE where UDO = Ultra Diffuse Object, SW = southwest, NE = northwest, and SE = southeast; note that UDO-SE was already found in the SDSS Stripe 82 data. Among them, UDO-NE and UDO-SW appear to be a part of a loop or stream structure around the main body of NGC 1068, providing evidence for the physical connection to NGC 1068. We consider that UDO-SE may be a tidal dwarf galaxy. We also find another UDO-like object that is two magnitudes fainter and smaller by a factor of 3 to 5 than those of the three UDOs. This object may belong to a class of low surface brightness galaxy. Since this object is located along the line connecting UDO-NE and UDO-SW, it is suggested that this object is related to the past interaction event that formed the loop by UDO-NE and UDO-SW, thus implying the physical connection to NGC 1068. Another newly discovered feature is an asymmetric outer one-arm structure emanating from the western edge of the outermost disk of NGC 1068 together with a ripple-like structure at the opposite side. These structures are expected to arise in a late phase of a minor merger, according to published numerical simulations of minor mergers. All these lines of evidence show that NGC 1068 experienced a minor merger several billion years ago. We then discuss the minor-merger driven triggering of nuclear activity in the case of NGC 1068.
A Retrospective Analysis of the Clinical Effectiveness of Supraclavicular, Ultrasound-guided Brachiocephalic Vein Cannulations in Preterm Infants
Authors: Breschan Christian , Graf Gudrun , Jost Robert , Stettner Haro , Feigl Georg , Neuwersch Stefan , Stadik Christian , Koestenberger Markus , Likar Rudolf
Published: September 2017

Background

The aim of this retrospective analysis was to evaluate the clinical effectiveness of the supraclavicular ultrasound-guided cannulation of the brachiocephalic vein in preterm infants.

Methods

The ultrasound probe was placed in the supraclavicular region so as to obtain the optimum sonographic long-axis view of the brachiocephalic vein. By using a strict in-plane approach the brachiocephalic vein was cannulated by advancing a 22- or 24-gauge iv cannula from lateral to medial under the long axis of the ultrasound probe under real-time ultrasound guidance into the vein.

Results

One hundred and forty-two cannulations in infants weighing between 0.59 and 2.5 kg (median: 2.1; CI: 2.0 to 2.2) were included. Ultimate success rate was 94% (134 of 142). One cannulation attempt was required in 100 (70%) patients, two attempts in 21 (15%), and three attempts in 13 (9%). The smaller the weight of the infant the more attempts were needed. More attempts also were needed for the right brachiocephalic vein, which was primarily targeted in 75 (53%) neonates. One (1%) inadvertent arterial puncture was noted.

Conclusions

This supraclavicular, in-plane, real-time, ultrasound-guided cannulation of the brachiocephalic vein seems to be a convenient and effective method to insert central venous catheters in preterm infants.
Impact of Emerging Technologies on Clinical Considerations: Targeted Muscle Reinnervation Surgeries, Pattern Recognition, Implanted Electrodes, Osseointegration, and Three-Dimensional Printed Solutions
Authors: Lipschutz Robert D.
Published: September 2017

In the recent past, there have been several technological advancements and applications to the field of Upper Limb Prosthetics that warrant attention to clinicians and the healthcare community. Targeted Muscle Reinnervation is a surgical procedure used to enhance the functional capabilities of myoelectric prosthesis users. This procedure has been in practice since 2002 and is no longer considered experimental. The other surgical procedure on the horizon for individuals with upper limb amputations is Osseointegration. Although this procedure that has been around in various forms for decades, refinement of the surgical intervention and minimization of negative outcomes has enabled individuals to benefit from this technology. Two other technologies that have been around for decades are Pattern Recognition and 3-D Printing. However, the application of these two processes, to the field of Upper Limb Prosthetics, is new, exciting and challenging. Integration of these and other technologies can meet opposition at first; as any changes do. The prosthetists will need to educate themselves in these technologies in order to continue seeking ways to improve the lives of individuals with whom they work.
Extrapolation of Emerging Technologies and Their Long-Term Implications for Myoelectric versus Body-Powered Prostheses: An Engineering Perspective
Authors: ff. Weir Richard F.
Published: September 2017

The field of prosthetic rehabilitation is at the cusp of a revolution in upper-limb prosthetic techniques and treatment options. After 50 years of largely incremental developments in the design of both body-powered and myoelectric upper extremity prostheses, new technologies are coming of age that will provide sensory feedback to the user. This, in turn, will promote embodiment of the prosthesis, allowing users to believe the device is a true extension of themselves. This will facilitate the incorporation of the prosthesis into their body image and allow users to finally begin to think of the prosthesis as a true limb replacement rather than as a tool. This review surveys innovations in upper-limb prosthetic rehabilitation from an engineering perspective.
Impact of Changeover to Newer Endoscopic Systems on Quality and Efficiency of Screening and Surveillance Colonoscopy
Authors: Singh Manpreet , Sacatos Melody , Laine Loren
Published: September 2017

Goals:

The goal of this study is to assess whether changeover to newer endoscopic systems impacts quality or efficiency, and quantify the relation between increased withdrawal time and detection rates of sessile serrated polyps (SSPDR) and adenomas (ADR) in real-world practice.

Study:

Beginning 2 months after new endoscopic systems were implemented at 2 endoscopy units, we included all outpatients undergoing screening/surveillance colonoscopy for 4 months. Outpatients during the same 4-month period 1 year earlier comprised the control group. Quality endpoints included ADR, advanced ADR, SSPDR, polyp detection rate (PDR), and withdrawal time. The efficiency endpoint was procedure time. Statistical adjustment for potential confounding factors was performed with multivariable analysis.

Results:

Significant increases occurred in postchangeover (N=1122) versus prechangeover (N=1131) procedure time (difference=2.6 minutes; 1.6 to 3.6) and withdrawal time (difference=1.6 minutes; 0.8 to 2.5). Significant increases also occurred in ADR [435 (39%) vs. 380 (34%)], advanced ADR [82 (7%) vs. 50 (4%)], and PDR [664 (59%) vs. 611 (54%)], but these differences lost significance when withdrawal time was added to the multivariable model. For every minute increase in withdrawal time a significant increase was seen in ADR (OR=1.09; 1.08 to 1.11), advanced ADR (OR=1.10; 1.08 to 1.13), SSPDR (OR=1.07; 1.06 to 1.09), and PDR (OR=1.16; 1.14 to 1.18).

Conclusions:

After changeover to newer endoscopy systems withdrawal times lengthened, resulting in increased procedure time, ADR, and advanced ADR. Regardless of endoscopic system, lengthening withdrawal time increased SSPDR, ADR, and advanced ADR: odds of detection increased 7% to 10% with every additional minute of withdrawal time. Greater attention to withdrawal time and endoscopist examination may be more productive than upgrading endoscopic systems.
Enteroaggregative Escherichia coli Subclinical Infection and Coinfections and Impaired Child Growth in the MAL‐ED Cohort Study
Authors: Lima Aldo A.M. , Soares Alberto M. , Filho José Q.S. , Havt Alexandre , Lima Ila F.N. , Lima Noélia L. , Abreu Cláudia B. , Junior Francisco S. , Mota Rosa M.S. , Pan William K.‐Y. , Troeger Christopher , Medeiros Pedro H.Q.S. , Veras Herlice N. , Prata Mara A. , McCormick Ben J.J. , McGrath Monica , Rogawski Elizabeth T. , Houpt Eric R. , Platts‐Mills James A. , Gratz Jean , Samie Amidou , Bessong Pascal , Babji Sudhir , Kang Gangadeep , Qureshi Shahida , Shakoor Sadia , Bhutta Zulfigar A. , Haque Rashidul , Ahmed Tahmeed , Mduma Estomih R. , Svensen Erling , Kosek Margaret , Yori Pablo P. , Bodhidatta Ladaporn , Jasmin Shrestha , Mason Carl J. , Lang Dennis , Gottlieb Michael , Guerrant Richard L.
Published: September 2017

Objective:

We evaluated the impact of subclinical enteroaggregative Escherichia coli (EAEC) infection alone and in combination with other pathogens in the first 6 months of life on child growth.

Methods:

Nondiarrheal samples from 1684 children across 8 Multisite Birth Cohort Study, Malnutrition and Enteric Diseases (MAL‐ED) sites in Asia, Africa, and Latin America were tested monthly; more than 90% of children were followed‐up twice weekly for the first 6 months of life.

Results:

Children with subclinical EAEC infection did not show altered growth between enrollment and 6 months. Conversely, EAEC coinfection with any other pathogen was negatively associated with delta weight‐for‐length (P < 0.05) and weight‐for‐age (P > 0.05) z scores between 0 and 6 months. The presence of 2 or more pathogens without EAEC was not significantly associated with delta weight‐for‐length and weight‐for‐age. The most frequent EAEC coinfections included Campylobacter spp, heat‐labile toxin‐producing enterotoxigenic E coli, Cryptosporidium spp, and atypical enteropathogenic E coli. Myeloperoxidase levels were increased with EAEC coinfection (P < 0.05). EAEC pathogen codetection was associated with lower neopterin levels compared to those of no‐pathogen control children (P < 0.05). Mothers of children with EAEC coinfections had lower levels of education, poorer hygiene and sanitation, lower socioeconomic status, and lower breast‐feeding rates compared to mothers of children in whom no pathogen was detected (P < 0.05).

Conclusions:

These data emphasize the public health importance of subclinical EAEC infection in early infancy in association with other pathogens and the need for improved maternal and child care, hygiene, sanitation, and socioeconomic factors.
Economic and Clinical Outcomes Resulting From the Stage 4 Chronic Kidney Disease Case Management Quality Improvement Initiative
Authors: Everett Beverly , Castel Liana D. , McGinnis Matthew , Beresky Amy , Cane Rudolph C. , Cooper Tasha , Davda Rajesh K. , Farmer Donna , John Stella M. , Sollars Denise L. , Rausch John F.
Published: September 2017

Purpose of Study:

Chronic kidney disease (CKD) is a costly and burdensome public health concern. The goal of this study was to evaluate the impact on outcomes and utilization of a pilot program to identify and engage beneficiaries with CKD at risk for progression from Stage 4 to Stage 5.

Primary Practice Settings:

A quality improvement initiative was conducted to assess the impact of case management on costs and outcomes among 7,720 Cigna commercial medical beneficiaries with Stage 4 CKD enrolled in the United States between January 2012 and October 2012.

Methodology and Sample:

Claims data were analyzed to compare 3,861 beneficiaries randomized to receive condition-focused case management with 3,859 controls, with follow-up through July 2013. After using an algorithm to identify beneficiaries at highest risk of progression, a case management team implemented, among those assigned to the intervention, an evidence-based assessment tool, provided education and follow-up, engaged nephrologists and other providers, and conducted weekly rounds. Primary outcome measures were hospital admissions, emergency department visits, nephrologist visits, dialysis, arteriovenous (AV) fistula creation, and total medical costs. Analysis of variance techniques were used to test group differences.

Results:

As compared with controls, intervention beneficiaries were 12% more likely to have fistula creation (p = .004). Intervention beneficiaries were observed to have savings of $199 per member per month (PMPM), F = 23.05, p = .04. This difference equated to 6% lower total medical costs in the intervention group. Savings observed were derived half from improved in-network utilization and half from reduced hospital costs.

Implications for Case Management Practice:

The observed 12% increased rate of creation of AV fistulas and $199 (6%) decrease in PMPM cost between the intervention and control groups corresponded to a savings of more than $18 million in 2015 U.S. dollars (USD).

On the basis of observation of substantial improvements in outcomes and cost savings, health plan administrators could better serve those at highest risk of progression by implementing focused case management.

Our findings support the value of care coordination between nephrologists, providers, and health plan case managers in improving outcomes and reducing total medical costs among beneficiaries at risk for CKD progression from Stage 4 to Stage 5.
Empowering Parents of Australian Infants and Children in Hospital: Translation, Cultural Adaptation, and Validation of the EMpowerment of PArents in The Intensive Care-30-AUS Questionnaire
Authors: Gill Fenella J. , Wilson Sally , Aydon Laurene , Leslie Gavin D. , Latour Jos M.
Published: September 2017

Objectives:

To translate, culturally adapt, and psychometrically test the EMpowerment of PArents in The Intensive Care-30 questionnaire in Australian pediatric critical care, neonatal, and pediatric ward settings.

Design:

Cross-sectional, descriptive, multicenter study conducted in two phases; 1) translation and cultural adaptation and 2) validation of the EMpowerment of PArents in The Intensive Care-30 questionnaire.

Settings:

Two Western Australian sites, the PICU and two pediatric wards of a children’s hospital and the neonatal unit of a women’s and newborn hospital.

Participants:

Parents whose baby or child was admitted to the participating wards or units with a length of hospital stay greater than 24 hours.

Intervention:

None.

Measurements and Main Results:

Phase 1: A structured 10-step translation process adhered to international principles of good practice for translation and cultural adaptation of patient-reported outcomes. Thirty parents participated in cognitive debriefing. Phase 2: A total of 328 parents responded to the EMpowerment of PArents in The Intensive Care-30-AUS questionnaire. Reliability was sufficient (Cronbach α at domain level 0.70 –0.82, for each clinical area 0.56–0.86). Congruent validity was adequate between the domains and three general satisfaction items (r
s 0.38–0.69). Nondifferential validity showed no significant effect size between three patient or parent demographic characteristics and the domains (Cohen’s d < 0.36). Between the different clinical areas, significant differences in responses were found in all domains.

Conclusions:

The translated and culturally adapted EMpowerment of PArents in The Intensive Care-30-AUS is a reliable and valid questionnaire to measure parent-reported outcomes in pediatric critical care, pediatric ward, and neonatal hospital settings. Using this questionnaire can provide a framework for a standardized quality improvement approach and identification of best practices across specialties, hospital services and for benchmarking similar health services worldwide.
A Pharmacokinetics, Efficacy, and Safety Study of Gadoterate Meglumine in Pediatric Subjects Aged Younger Than 2 Years
Authors: Scala Mario , Koob Meriam , de Buttet Sophie , Bourrinet Philippe , Felices Mathieu , Jurkiewicz Elzbieta
Published: September 2017

Objectives

The primary objective of this study was to investigate the pharmacokinetic profile of gadoterate meglumine in pediatric patients younger than 2 years; the secondary objectives were to document its efficacy and safety.

Material and Methods

This was a Phase IV open-label, prospective study conducted in 9 centers (4 countries). Forty-five patients younger than 2 years with normal estimated glomerular filtration rate and scheduled to undergo routine gadolinium-enhanced magnetic resonance imaging (MRI) of any organ were included and received a single intravenous injection of gadoterate meglumine (0.1 mmol/kg). To perform the population pharmacokinetics analysis, 3 blood samples per subject were drawn during 3 time windows at time points allocated by randomization.

Results

Gadoterate meglumine concentrations were best fitted using a 2-compartmental model with linear elimination from central compartment. The median total clearance adjusted to body weight was estimated at 0.06 L/h per kg and increased with estimated glomerular filtration rate according to a power model. The median volume of distribution at steady state (Vss) adjusted to body weight was estimated at 0.047 L/kg. Estimated median terminal half-life (t1/2β) was 1.35 h, and the median systemic exposure (area under the curve) was 1591 μmol h/L. Efficacy was assessed by comparing precontrast +postcontrast images to precontrast images in a subset of 28 subjects who underwent an MRI examination of brain, spine, and associated tissues. A total of 28 lesions were identified and analyzed in 15 subjects with precontrast images versus 30 lesions in 16 subjects with precontrast + postcontrast images. Lesion visualization was improved with a mean (SD) increase in scores at subject level of 0.7 (1.0) for lesion border delineation, 0.9 (1.6) for internal morphology, and 3.1 (3.2) for contrast enhancement. Twenty-six adverse events occurred postinjection in 13 subjects (28.9%), including 3 serious reported in 1 subject (2.2%). One subject (2.2%) experienced 1 rash of moderate intensity considered as related to gadoterate meglumine.

Conclusions

The pharmacokinetic profile of gadoterate meglumine after a single intravenous injection of 0.1 mmol/kg was appropriately described in newborns and infants younger than 2 years, for whom no dose adjustment is required. The improved efficacy of gadoterate meglumine for contrast-enhanced MRI examination of brain, spine, and associated tissues, as well as its good safety profile, was also demonstrated in this population.