bluuebunny/crossref_metadata_2025 huggingface dataset:
The Silverskold Test, Are We All Doing it the Same?
Authors: Cheney Nicholas , Rockwell Kyle , Weis John , Lewis Dylan , Long Joseph , Law Timothy , Carr Adam
Published: September 2017

Category:

Pathophysiology

Introduction/Purpose:

Gastrocnemius eqiunus has been associated with a wide range of foot and ankle pathologies in the literature, however, many still question it’s involvement or existence. A recent response in Foot & Ankle International pointed out an incorrect demonstration of the Silfverskold test in a prior study. With a growing body of literature supporting gastrocnemius equinus as a contributing factor in foot and ankle pain, why do many feel that it still does not exist? It was our hypothesis that unless the examination is performed correctly, the diagnosis can be missed and could be the potential cause for disbelief in its existence or effect on foot and ankle pain. We sought to demonstrate the difference in examination findings when performing the test correctly and incorrectly.

Methods:

Thirty consecutive patients with conditions associated with gastrocnemius equinus in the literature were included in the study. Each patient was consented and had a Silverskold test performed correctly by inverting and locking the subtalar joint as well as stabilizing the talonavicular joint in order to isolate the ankle joint. We then performed the exam incorrectly without stabilizing the same two joints, allowing motion through the ipsilateral hindfoot and midfoot joints. A long arm goniometer was used to measure the angles with each arm along the length of the fibula and fifth metatarsal. The senior author performed all of the examinations to maintain consistency. The angles were recorded for later review.

Results:

We found that when the subtalar and talonavicular joints were stabilized, there was almost fifteen degrees less dorsiflexion than when the same joints were not stabilized. The average dorsiflexion when performed in the correct manner was seventy-eight degrees, while the average dorsiflexion with the exam performed incorrectly was ninety-three degrees.

Conclusion:

We demonstrated that if the examination is not performed correctly, the equinus contracture could go undiagnosed as motion through the hindfoot and midfoot joints can alter the findings. It is important to understand and perform the technique correctly to evaluate for the contracture as it has been shown to be a contributing factor in many foot and ankle problems. If we standardize the examination, there may be less disagreement about its existence or affect on foot and ankle pain.
A Biomechanical Comparison of a Limited Open and Standard Open Technique for Achilles Tendon Rupture Repair
Authors: Dekker Robert , Qin Charles , Lawton Cort , Muriuki Muturi , Havey Robert , Alshouli Mohammed , Patwardhan Avinash , Kadakia Anish
Published: September 2017

Category:

Basic Sciences/Biologics, Sports

Introduction/Purpose:

The drive to reduce soft tissue complications after Achilles tendon repair has led to increased interest in less invasive techniques. The PARS Achilles Jig System is one option that has gained popularity as an alternative to open repair. For many surgeons, standard open repair consists of a Krackow locking-loop technique. We compared the load to failure of a limited open and open Krackow technique for repair of Achilles tendon ruptures.

Methods:

Nine pairs of human cadaver lower limbs were randomized to undergo either a Krackow locking loop repair with epitendinous weave or a PARS Achilles Jig System Repair. Specimen were loaded to failure on a servo-hydraulic material testing machine. From load- displacement curves, initial linear stiffness, load to failure, and work to failure were calculated.

Results:

The average load to failure for Krackow repair (353.8 ± 88.8 N) and PARS repair (313.3 ± 99.9 N) was not statistically different (p = .38). The average work to failure for open repair (6.4 ± 2.3 J) and PARS repair (6.3 ± 3.5 J) was also not statistically different (p = .904). Mean initial linear stiffness of the Krackow repair (17.8 ± 5.4 N/mm) was significantly greater than the PARS repair (11.8 ± 2.5 N/mm) (p = .011). The predominant location of failure for Krackow repair was at the suture itself. In contrast, the PARS repair predominantly failed at the suture-tendon interface.

Conclusion:

The results suggest no difference between the Krackow and PARS repairs in terms of ultimate strength or work to failure. The Krackow repair demonstrated a higher initial linear stiffness than the PARS, which may imply a greater ability to withstand gap formation. With less devitalization to surrounding soft tissue and equal repair strength, the PARS system should be considered a favourable option for repair of ruptured Achilles tendons.
Overtightening of the Syndesmosis Revisited and the Effect of Syndesmotic Malreduction on Ankle Dorsiflexion
Authors: Ghorbanhoseini Mohammad , Kwon John Y. , Gonzalez Tyler , Velasco Brian , Lechtig Aron , Nazarian Ara , Egan Jonathan
Published: September 2017

Category:

Ankle, Trauma

Introduction/Purpose:

Ankle syndesmotic injuries are a significant source of morbidity and require anatomic reduction to optimize outcomes. Although a previous study concluded that maximal dorsiflexion during syndesmotic fixation was not required, methodologic weaknesses existed and several studies have demonstrated improved ankle dorsiflexion after removal of syndesmotic screws. The purposes of the current investigation are: To assess the effect of syndesmotic screw fixation on ankle dorsiflexion utilizing a controlled load and instrumentation allowing for precise measurement of ankle dorsiflexion. To assess the effect of anterior & posterior syndesmotic malreduction after syndesmotic screw fixation on ankle dorsiflexion.

Methods:

Fifteen cadaveric leg specimens were utilized for the study. Ankle dorsiflexion was measured utilizing a precise micro- sensor system after application of a consistent load in the intact state, after compression fixation with a syndesmotic screw and after anterior & posterior malreduction of the syndesmosis.

Results:

Following screw compression of the nondisplaced syndesmosis, dorsiflexion ROM was 99.7±0.87% (mean ± standard error) of baseline ankle ROM. Anterior and posterior displacement of the syndesmosis resulted in dorsiflexion ROM that was 99.1±1.75% and 98.6±1.56% of baseline ankle ROM, respectively. One-way ANOVA was performed showing no statistical significance between groups (p-value =0.88). Two-way ANOVA comparing the groups with respect to both the reduction condition (intact, anatomic reduction, anterior displacement, posterior displacement) and the displacement order (anterior first, posterior first) did not demonstrate a statistically significant effect (p-value= 0.99).

Conclusion:

Maximal dorsiflexion of the ankle is not required prior to syndesmotic fixation. Anterior or posterior syndesmotic malreduction following syndesmotic screw fixation has no effect on ankle dorsiflexion thus poor patient outcomes after syndesmotic malreduction does not appear to be the result of loss of dorsiflexion due to mechanical block.
Surgical Treatment for Stenosing Peroneal Tenosynovitis
Authors: Karnovsky Sydney , Drakos Mark , Levine David , Watson Geoffrey
Published: September 2017

Category:

Ankle

Introduction/Purpose:

Stenosing Peroneal Tenosynovitis is an uncommon entity that is equally difficult to diagnose. In our practice, we have found 14 patients with this diagnosis. They were all successfully treated with release of the peroneal tendon sheath and debridement of the calcaneal exostosis. Further, the ultrasound guided anesthetic injection of the tendon sheath preoperatively essential in confirming this diagnosis and evaluating for successful outcomes after surgical intervention.

Methods:

14 patients were diagnosed with Stenosing Peroneal Tenosynovitis. Upon initial presentation, the patients all reported a persistent history of pain along the ankle and had exhausted conservative treatment options. Patients with MRIs had images that appeared normal. In order to confirm the diagnosis as Stenosing Peroneal Tenosynovitis, ultrasound guided injections of anesthetics were administered into the peroneal tendon sheath. If the injection alleviated the pain, this confirmed the diagnosis of Stenosing Peroneal Tenosynovitis. Patients also had neurological consults to rule out possible sural neuritis. In patients with a confirmed diagnosis of stenosing peroneal tenosynovitis, we proceeded with surgical intervention. They underwent surgery between 2006 and 2014 by two fellowship trained orthopedic surgeons at one institution. Retrospective chart review was performed and functional outcomes were assessed pre-and postoperatively using the Foot and Ankle Outcome Score (FAOS) and Short Form-12 (SF-12) general health questionnaire.

Results:

All patients that underwent this procedure were given the Foot and Ankle Outcome Score (FAOS) and Short Form 12 (SF-12) general health questionnaire pre-operatively. Questionnaire results were collected post-operatively and were successfully obtained at one year or greater from 11 patients. Of these 11 patients, all showed significant improvements (student t test used, p<0.05) in four of five categories of the FAOS (pain, daily activities, quality of life) as well as significant improvement in their overall SF-12 score and pain scale score (Table).

Conclusion:

Stenosing peroneal tenosynovitis is an uncommon entity. The presentation of the disease is one of persistent lateral sided ankle pain with minimal radiologic findings. We present a case series in which the peroneal tendon sheath was diagnostically injected with an anesthetic to determine if the pain could be relieved. In each of the cases, symptomatic improvement was obtained following the injection, helping to confirm the diagnosis. With the fact that many of these patients had advanced imaging denoting no significant tears, we believe, this diagnostic injection is paramount in assisting with determining the success of surgical outcome.
Mobility Changes in the First TMT Joint after Proximal First Metatarsal Osteotomy for Hallux Valgus Evaluated by Weightbearing CT and a 3D Analysis System
Authors: Kimura Tadashi , Kubota Makoto , Hattori Hidekazu , Minagawa Kazuhiko , Suzuki Naoki , Hattori Asaki , Marumo Keishi
Published: September 2017

Category:

Bunion

Introduction/Purpose:

In a previous study, we found that feet with hallux valgus show significantly greater three-dimensional mobility than normal feet in all joints of the first ray. Displacement was particularly pronounced in the first TMT joints, indicating that this is the primary cause of first ray hypermobility. We developed a plate used specifically for proximal first metatarsal osteotomy to perform three-dimensional correction of hallux valgus and associated deformities. In this study, we evaluated changes in mobility of the first TMT joints after surgery in 3D using weightbearing CT.

Methods:

The subjects were 5 feet of 5 female patients with hallux valgus (mean age 56 years, mean hallux valgus angle 38°). We performed non-weightbearing and weightbearing (using a load equivalent to body weight) CT scans before surgery using an original loading device (Fig a). We reconstructed 3D models from captured images by segmentation and defined axial coordinate system (Fig b). Next, we measured the three-dimensional displacement of the first metatarsal bone relative to the medial cuneiform bone under weightbearing conditions. At 1 to 1.5 years after proximal metatarsal osteotomy for all patients, we performed a follow-up CT scans using the same method and compared preoperative and postoperative displacement. Student’s t- test was performed to statistically compare data and statistical significance was set at p < 0.05.

Results:

Postoperatively (when performing a follow up CT), the mean hallux valgus angle improved from 38° to 10° and the mean first-second metatarsal angle improved from 23° to 7°. The mean score on the Japanese Society for Surgery of the Foot hallux scale improved from 62 points to 97 points. Displacement of the first metatarsal bone relative to the medial cuneiform bone between non-weightbearing and weightbearing conditions decreased significantly in all directions, from 4.2° ± 1.8° to 1.6° ± 1.1° of dorsiflexion (p = 0.02), 4.9° ± 1.8° to 0.7° ± 0.9° of inversion (p = 0.001), and 4.4° ± 1.9° to 1.7° ± 0.8° of adduction (p = 0.01).

Conclusion:

Displacement of the first TMT joints under weightbearing conditions decreased after our surgery. This indicates that the surgery corrected hallux valgus and associated pes planus and produced favorable functional outcomes by improving the shape of the foot and hypermobility of the first ray through correction of the orientation and tension of surrounding tendons and ligaments and the plantar aponeurosis. In the future, we plan to further examine the pathology and treatment of hallux valgus with a focus on postoperative changes in soft tissue orientation.
Prevalence of Symptomatic Venous Thrombo-Embolism in Patients with Total Contact Cast for Diabetic foot Complications; A Retrospective Case Series
Authors: King Roland , Platt Simon , Jackson Gillian
Published: September 2017

Category:

Ankle, Diabetes, Midfoot/Forefoot

Introduction/Purpose:

Venous thrombo-embolism (VTE) is a costly and potentially life threatening complication of limb immobilisation in a plaster of Paris cast. It is now generally recommended that patients undergoing limb immobilisation in cast are given LMWH therapy. The gold standard of treatment for diabetic patients with Charcot feet is total contact casting (TCC). TCC is also employed in the management of diabetic foot ulceration (DFI). Such casting is often prolonged with a time frame greater than 6 weeks. In general diabetic patients with established complication, (Charcot, DFI) often have comorbidities which increase the risk of VTE when the limb is immobilised. One would anticipate these patients to have a high rate of VTE given the immobile limb and comorbidities contributing to higher risk.

Methods:

A retrospective review was undertaken. A search on patients’ records up to April 2015 was undertaken to identify patients placed into total contact casting. These patients all had DFI or Charcot treated with a TCC. The patient’s electronic and paper records were reviewed for any documentation of VTE, as well as other co-morbidities.

Results:

18 patients aged between 43 and 78 (mean 60) were identified. These patients were casted between one week to 3 months. None of these 18 patients sustained a documented VTE. None of them were on prophylactic anti-coagulation for the time they were in cast. All of the patients had a documented significant cardiovascular history (as well as Diabetes Mellitus), with HbA1c values ranging from 45 to 122 (median 74). Body mass index values for all of the patients were unavailable.

Conclusion:

Despite high risk for the developing a VTE, none of the patients in our series suffered a documented symptomatic PE or DVT. We recognise the limitations of our study; small numbers with retrospective review. Nonetheless, we hypothesised that with prolonged contact casting in patients with significant comorbidity the prevalence of VTE would be higher than that observed. We believe that this is the first study looking for VTE in a TCC and diabetic population.
Liposomal Bupivacaine versus Continuous Popliteal Nerve Block in Total Ankle Arthroplasty
Authors: Mulligan Ryan , Morash Joel , DeOrio James , Parekh Selene
Published: September 2017

Category:

Ankle, Ankle Arthritis

Introduction/Purpose:

The use of liposomal bupivacaine (LB) has recently gained popularity in joint arthroplasty. Despite it’s proven safety and efficacy, there is little reported on the use of LB in foot and ankle surgery. Catheter placement for a continuous popliteal sciatic nerve block (CPSNB) has an excellent track record for pain relief, and is commonly used by our group for major foot and ankle reconstructions. The purpose of this study was to compare the use of intraoperative LB injection to CPSNB as a regional anesthetic for total ankle arthroplasty (TAA), with attention to postoperative pain scores, narcotic use, and complications.

Methods:

Retrospective review of TAA patients treated by two fellowship-trained orthopedic foot and ankle surgeons was performed. Patient demographic data, operative, and postoperative details were collected, including type of regional anesthetic used. Patient’s received either preoperative single-shot popliteal sciatic nerve block with 0.25% bupivacaine followed by intraoperative injection of LB, or preoperative CPSNB alone. Outcomes examined were VAS pain score at 8 hours, 24 hours, 1 week, and 3 weeks following surgery, need for opioid pain medication refill, physician office notification for pain issues or other adverse events, and complications within the first 90 days following surgery. Standard statistical analysis was performed and p < 0.05 was considered significant.

Results:

75 patients were identified who underwent TAA and met inclusion criteria. 41 received LB and 34 received CPSNB. No statistical difference was seen between groups with regard to complications, emergency department visits, readmissions, reoperations, VAS pain score at any time point, physician office contacts, and narcotic refills. Mean VAS with LB use was 1.8, 3.5, 2.6, and 2.2 at 8 hours, 24 hours, 1 week, and 3 weeks respectively, compared with mean VAS 2.1, 3.2, 2.2, and 1.9 at similar time points for CPSNB (p=0.59, 0.65, 0.27, and 0.40, respectively). 16 of 41 LB patients needed narcotic refills, versus 12 of 34 CPSNB patients (p=0.81). 3 of 41 LB patients had a complication postoperatively, versus 4 of 34 CPSNB patients.

Conclusion:

This is the first study evaluating the use of LB for total ankle arthroplasty. LB was both safe and effective for postoperative pain control, with comparable results to CPSNB. As LB gains more widespread use in foot and ankle surgery, further investigation is warranted to determine potential unseen complications and cost-effectiveness.
Outcomes of Revision Ankle Arthroplasty using a Fixed-bearing, Stemmed Intramedullary Prosthesis
Authors: Schipper Oliver , Haddad Steven , Van den Avont Alexander
Published: September 2017

Category:

Ankle, Ankle Arthritis

Introduction/Purpose:

As in all total joint arthroplasty, longevity is finite, and the need for predictable revision surgery is mandatory. Literature is sparse describing revision total ankle arthroplasty (TAA) feasibility and outcomes. Revision total ankle arthroplasty involving implant exchange remains in its infancy, making critical assessment of outcomes necessary to guide future treatment options. The purpose of this study was to analyze the clinical outcomes of revision TAA using a minimum 2-year follow-up to evaluate for early failure and outcomes.

Methods:

Retrospective chart review identified 18 patients that underwent revision of their TAA to a third generation FDA approved fixed-bearing, intramedullary stemmed implant with a minimum 2 year follow up. Once identified, all patients were contacted for an in-office outcomes questionnaire, examination, and radiographic follow up. Outcomes included the Foot & Ankle Disability Index (FADI) Score, Foot Function Index (FFI), Visual Analog Scale (VAS) used for pain, and ankle range of motion.

Results:

The mean age of patients at the time of revision was 59.6±9.7years and the mean follow up was 4.2±2.1 years. The mean FADI score was 69.9±17.9, the mean FFI was 49.1±15.2, and the mean VAS score was 33.3±25.8. Mean ankle dorsiflexion was 19.6±7.8 degrees and mean ankle plantar flexion was 18.6±7.5degrees. Postoperative complications included one infection requiring irrigation and debridement with hardware removal for a medial ankle soft tissue abscess, and one medial malleolus fracture that underwent open reduction and internal fixation. Three revision prostheses failed during the follow-up period, requiring additional surgery. Reasons for failure included talar subsidence in 2 patients secondary to osteolysis and/or avascular changes to the talus, and medial/lateral gutter impingement due to an oversized talar component in 1 patient.

Conclusion:

Revision of ankle arthroplasty requires significant planning in extraction of the failed prosthesis, implantation of the revision prosthesis, and alignment of the foot. Major complications are potentially avoidable through careful bone assessment prior to revision surgery, and results are acceptable in this early follow-up study using a fixed-bearing intramedullary stemmed implant system.
Functional Outcomes after Fracture-Dislocation of the Ankles
Authors: Tantigate Direk , Vosseller J. Turner , Greisberg Justin , Ascherman Benjamin , Kirschenbaum Joshua , Freibott Christina , Ho Gavin
Published: September 2017

Category:

Ankle, Trauma

Introduction/Purpose:

Fracture-dislocation of the ankle represents a substantial injury to the bony and soft tissue structures of the ankle. Although there is a wealth of reported outcome after operative treatment of ankle fractures, there has been a limited focus on functional outcome of surgically treated ankle fracture-dislocations. The purpose of this study is to compare short-term functional outcome after open reduction and internal fixation (ORIF) in ankle fractures with and without dislocation.

Methods:

A retrospective chart review of ankle fractures surgically treated by ORIF over a three year period was performed. All ankle fracture patients 18 years or older with a minimum of 12 months follow-up were included. Demographic data, type of injury (bimalleolar, trimalleolar, etc.), operative time, complications, and functional outcomes were recorded. Functional outcome was determined by Foot and Ankle Outcome Score (FAOS) at the latest follow up visit. Comparison of demographic variables and the subcategories of FAOS including symptoms, pain, activities of daily living (ADL), sport activity and quality of life (QOL) were performed in ankle fractures with dislocation and without dislocation. A total of 62 patients were eligible for analysis, 38 (61.3%) were female. Twenty patients (32.3%) were fracture-dislocations and 42 (67.7%) had no dislocation. Mean age of patients was 48.44 ± 17.89 years (range, 19-85 years). Mean follow-up time is 39.79 ± 13.53 months (range, 12-76 months).

Results:

The fracture-dislocation cohort demonstrated worse FAOS than the nondislocation cohort (symptoms 73 vs 79, pain 75 vs 85, ADL 80 vs 88, Sport 63 vs 76 and QOL 54 vs 60, respectively), although none of these differences were statistically significant. Patients with ankle fracture-dislocation had more bony injury (i.e. more bimalleolar and trimalleolar injuries) (P = .007) and had a higher rate of subsequent hardware removal (11.9% vs 35%, P = .031) There was no statistically significant difference in patient demographics or the rate of complications.

Conclusion:

Fracture-dislocations of the ankle presented with more bimalleolar and trimalleolar fractures, although there was no statistically significant difference in terms of functional outcome. Subsequent surgery for hardware removal was higher in the dislocation cohort. Although our data showed no difference in outcome, there was a trend towards worse outcomes in the dislocation cohort that a larger study may be able to discern.
Expression of Concern to: Role of physiotherapy in the mobilization of patients with spinal cord injury undergoing human embryonic stem cells transplantation
Authors: Shroff Geeta , Thakur Dipin , Dhingra Varun , Baroli Deepak Singh , Khatri Deepanshu , Gautam Rahul Dev
Published: September 2017

The Editors‐in‐Chief of Clinical and Translational Medicine are issuing an editorial expression of concern to alert readers that concerns have been raised regarding the ethics of this study [1]. Appropriate editorial action will be taken once this has been fully investigated. Geeta Shroff disagrees with this notice. Dipin Thakur, Varun Dhingra, Deepak Singh Baroli, Deepanshu Khatri and Rahul Dev Gautam have not responded to our correspondence about this article.
Body Composition and Ectopic Lipid Changes With Biochemical Control of Acromegaly
Authors: Bredella Miriam A , Schorr Melanie , Dichtel Laura E , Gerweck Anu V , Young Brian J , Woodmansee Whitney W , Swearingen Brooke , Miller Karen K
Published: September 2017

Context

Acromegaly is characterized by growth hormone (GH) and insulinlike growth factor-1 (IGF-1) hypersecretion, and GH and IGF-1 play important roles in regulating body composition and glucose homeostasis.

Objective

The purpose of our study was to investigate body composition including ectopic lipids, measures of glucose homeostasis, and gonadal steroids in patients with active acromegaly compared with age-, body mass index (BMI)−, and sex-matched controls and to determine changes in these parameters after biochemical control of acromegaly.

Design

Cross-sectional study of 20 patients with active acromegaly and 20 healthy matched controls. Prospective study of 16 patients before and after biochemical control of acromegaly.

Main Outcome Measures

Body composition including ectopic lipids by magnetic resonance imaging/proton magnetic resonance spectroscopy; measures of glucose homeostasis by an oral glucose tolerance test; gonadal steroids.

Results

Patients with active acromegaly had lower mean intrahepatic lipid (IHL) and higher mean fasting insulin and insulin area under the curve (AUC) values than controls. Men with acromegaly had lower mean total testosterone, sex hormone−binding globulin, and estradiol values than male controls. After therapy, homeostasis model assessment of insulin resistance, fasting insulin level, and insulin AUC decreased despite an increase in IHL and abdominal and thigh adipose tissues and a decrease in muscle mass.

Conclusions

Patients with acromegaly were characterized by insulin resistance and hyperinsulinemia but lower IHL compared with age-, BMI-, and sex-matched healthy controls. Biochemical control of acromegaly improved insulin resistance but led to a less favorable anthropometric phenotype with increased IHL and abdominal adiposity and decreased muscle mass.
Quantitative study of synaptic boutons on frog intracardiac neurons
Authors: Batulevičius Darius , Skripkienė Gertrūda , Andrijauskis Denas , Kėrytė Berta , Skripka Valdas
Published: September 2017

The frog is a useful model to study the structure and function of intracardiac neurons. The goal of this study was to evaluate the size and distribution of synaptic boutons on the intracardiac neurons in the frog Rana temporaria. Interatrial septa from four animals were double-labelled immunohistochemically for the cholinergic marker choline acetyltransferase (ChAT) and the marker of synaptic vesicles synaptophysin (SYP). One hundred intracardiac neurons were analysed by confocal microscopy. Terminals of preganglionic axons were strongly positive for ChAT, while synaptic boutons were strongly positive for both ChAT and SYP. The number of synaptic boutons per neuron ranged from 2 to 121 and was 10±2 (mean±SE). The total area of synaptic boutons ranged from 6 μm2 to 270 μm2 and was 98±6 μm2. The largest total area of synaptic boutons was found on the axonal half of neuronal soma (59±4 μm2). The total areas of synaptic boutons on both the non-axonal half of soma and the proximal axon were smaller (36±3 μm2; 6±2 μm2; P<0.001). Synaptic boutons occupied 13±1% of the area of the neuronal soma profile. Conclusions: 1) The axonal half of the soma of the frog intracardiac neuron is more densely innervated than the non-axonal half of the soma. 2) The axosomatic and axoaxonic synapses are present on frog intracardiac neurons. The study provides a framework for further experimental studies on the formation and rearrangement of synapses on frog intracardiac neurons.
Multiform spectrum of pulmonary disease in lethal HIV infection cases in Latvia (2012–2016)
Authors: Kleina Regina , Fjodorova Olga , Dabužinskienė Anita , Nazarovs Jurijs , Mahmajeva Oksana
Published: September 2017

In 2016, the proportion of HIV-infected persons in the Baltic countries was as follows: Latvia 18.5, Estonia 17.4, Lithuania 7.4 per 100,000 of population. The aim of our study was to evaluate the spectrum and morphology of combined lung pathologies in fatal HIV/AIDS cases in Latvia from 2010 to 2016. We did a retrospective review of the HIV/AIDS patients’ medical autopsy case files and histological slides at the Pathology Centre of Riga Eastern Clinical University Hospital. All statistical data were processed in IBM SPSS Statistics 23. We analysed 455 cases – 311 (69%) men, 134 (31%) women. The mean age of the analysed patients was 40 years (±9 SD, range 22–68). The conditions leading to death were opportunistic infections (OI) – 28%, tuberculosis (TB) – 23%, wasting syndrome complicated by nonspecific pneumonia and sepsis or HIV/AIDS unrelated conditions – 27%, malignancies – 11% (B large cell lymphoma, primary and secondary cancers of the lung, Kaposi sarcoma), and end stage liver disease – 11%. Lungs were affected in 380 cases (83.5%). We identified 112 cases of tuberculosis (TB). In 21%, it was isolated pulmonary TB, in 79% – disseminated TB. Additionally, OI were proved in 26% of these patients. The prevalence of OI was higher in patients who died from isolated pulmonary TB. We also identified 10 cases of disseminated atypical mycobacteriosis. Opportunistic infections were diagnosed in 126 persons – 77% (n=97) of them had one, but 23% (n=29) had two or more OIs. The most common isolated OI with lung involvement was Pneumocystis jiroveci (PC) pneumonia (n=71, 15.6%); 10% had cryptococcosis, 1% – pulmonary aspergillosis and Candida pneumonia each. 40 patients (9%) had disseminated cytomegalovirus (CMV). Among the various combinations of oppor tunistic infections, the most common was PC+CMV. 81% of HIV patients were unemployed and prisoners with interrupted treatment. We concluded that our study revealed that combined opportunistic infections and TB were the most frequently observed pulmonary infections, followed by primary and secondary lung malignancies and bacterial pneumonia in HIV/AIDS unrelated cases of multiorgan disease. Diagnostic difficulties occurred mainly in disseminated diseases due to nonspecific clinical presentation, similar appearance on imaging studies and limited bacterial diagnostic possibilities after death.
Infection as the cause of perinatal mortality in Latvia
Authors: Franckeviča Ivanda , Rucka Liene , Smilga Santa , Jaunākā Agnese Anna
Published: September 2017

Infection is one of the leading causes of perinatal mortality worldwide – accounting for 36% of cases. Perinatal mortality in Latvia is slowly decreasing: from 7.3 per 1000 live births in 2013 to 6.7 per 1000 live births in 2015. Intrauterine infection still is a global problem and a significant factor that affects morbidity and mortality of the mother and the child.This study includes data about the cause of death, including infections, from 417 autopsy protocols of all fetuses and neonates between 22 weeks of gestation and < 7 days postpartum from 2013 to 2015.The main cause of perinatal mortality was antenatal fetal asphyxia in 50% (n=210), followed by infections – 39% (n=163), including cases of chorioamnionitis. The highest mortality rate was found in the 22nd–27th+6 (i.e. 27 full weeks and 6 days) gestational weeks – 32% of cases (n=135). Intrauterine pneumonia accounted for 24% (n=39) of all the infection caused deaths, meconium aspiration pneumonia – 0.04% (n=6), early neonatal sepsis – 0.03% (n=4) and specific infections like syphilis and cytomegalovirus – 0.02% (n=3). Histological examination of the placenta, the placental cord and fetal membranes was made in 61% (n=255) of cases, and 19.6% (n=50) of them had an infection.
To the Concept «Estimation» in Accounting
Authors: Поленова С. , Polenova S.
Published: September 2017

On the base of the studies, called on scientist in sphere of the concept «estimation» in accounting, in article it is executed attempt to give its determination and off er the use of the miscellaneous type estimations in the purpose of the accounting, accounting and financial reporting, coming from their integer and such characteristic of the estimation as express sing and income sing.
Financial Planning in the Process of Budget Execution
Authors: Парасоцкая Н. , Parasotskaya N. , Зубрицкая А. , Zubrickaya A.
Published: September 2017

Issues relating to process improvement and cash planning are relevant because they allow to identify the operational use of temporarily free budget funds and forward them to the provision of budget expenditures.
Four-Dimensional Space’s Hypersurface Mapping Singularity
Authors: Ляшков А. , Lyashkov A. , Панчук К. , Panchuk K. , Варепо Л. , Varepo L.
Published: September 2017

Investigation of singularity related to a mapping by the orthogonal projection in a four-dimensional space of a hypersurface given by parametric equations is presented in this paper. On this investigation’s basis have been proposed in a united way three approaches to the hypersurface’s discriminant determination. Thus, have been defined conditions which the investigated hypersurface’s discriminant set and criminant are satisfied. Have been obtained dependencies settling the relationship between parameters of the hypersurface at its discriminant points. They are used to determine the singularity of the hypersurface mapping by analytical methods in general form. The complexity of this approach (the first one) is that an equation connecting the hypersurface’s parameters contains its differential characteristics, and often is the transcendental one in applications, that causes certain difficulties when solving it. Have been obtained dependences in carrying out of which the hypersurface’s discriminant has an edge of regression. A study of hypersurface sections by hyperplanes which are parallel to coordinate hyperplanes has been performed. The last ones contain a coordinate axis along which the hypersurface mapping is performed. It has been established that curves obtained in these sections have extreme points belonging to the hypersurface’s discriminant. Such property is used to calculate the points of the hypersurface’s discriminant by numerical methods without using the hypersurface’s differential characteristics, and it is a basis for the second approach to solving the problem posed. It has been also demonstrated the use of 3D modeling for study of hypersurface’s different sections, as well as its discriminant that represents the third approach to the study. All three approaches having a common basis can be used both independently and complement each other in determining the envelope for one-parameter family of surfaces. As an example has been considered a hypersurface formed by a family of spheres. Based on stated results have been obtained equations determining the hypersurface’s discriminant and this family’s corresponding envelope, as well as various sections. These equations have been used for creating of polygonal 3D models of the hypersurface’s discriminant, and some of the hypersurface’s sections.
Loci of Points Equally Spaced From Two Given Geometrical Figures. Part 1
Authors: Вышнепольский Владимир , Vyshnyepolskiy Vladimir , Сальков Николай , Sal'kov Nikolay , Заварихина Е. , Zavarihina E.
Published: September 2017

Loci of points (LOP) equally spaced from two given geometrical figures are considered. Has been proposed a method, giving the possibility to systematize the loci, and the key to their study. The following options have been considered. A locus equidistant from N point and l straight line. N belongs to l. We have a plane that is perpendicular to l and passing through N. N does not belong to l – parabolic cylinder. A locus equidistant from F point and a plane. In the general case, we have a paraboloid of revolution. The F point belongs to the given plane. We get a straight line perpendicular to the plane and passing through the F point. A locus equidistant from a point and a sphere. The point coincides with the sphere center. We get the sphere with a radius of 0.5 R. The point lies on the sphere. We get the straight line passing through the sphere center and the point. The point does not coincide with the sphere center, but is inside the sphere. We get the ellipsoid. The point is outside the sphere. We have parted hyperboloid of rotation. A locus equidistant from a point and a cylindrical surface. The point lies on the cylindrical surface’s axis. We get the surface of revolution which generatix is a parabola. The point lies on the generatrix of the cylindrical surface of rotation. We get a straight line, perpendicular to that generatrix and passing through the cylinder axis. The point does not lie on the axis, but is located inside the cylindrical surface. We get the surface with a horizontal sketch line – the ellipse, and a front sketch lines – two different parabolas. The point is outside the cylindrical surface. A locus consists of two surfaces. The one with the positive Gaussian curvature, and the other – with the negative one.
Fractals In Three-Dimensional Space. I-Fractals
Authors: Жихарев Л. , Zhikharev L.
Published: September 2017

It has long been known that there are fractals, which construction resolve into cutting out of elements from lines, curves or geometric shapes according to a certain law. If the fractal is completely self-similar, its dimensionality is reduced relative to the original object and usually becomes fractional. The whole fractal is often decomposing into a set of separate elements, organized in the space of corresponding dimension. German mathematician Georg Cantor was among the first to propose such fractal set in the late 19th century. Later in the early 20th century polish mathematician Vaclav Sierpinski described the Sierpinski carpet – one of the variants for the Cantor set generalization onto a two-dimensional space. At a later date the Austrian Karl Menger created a three-dimensional analogue of the Sierpinski fractal. Similar sets differ in a number of parameters from other fractals, and therefore must be considered separately. In this paper it has been proposed to call these fractals as i-fractals (from the Latin interfican – cut). The emphasis is on the three-dimensional i-fractals, created based on the Cantor and Sierpinski principles and other fractal dependencies. Mathematics of spatial fractal sets is very difficult to understand, therefore, were used computer models developed in the three-dimensional modeling software SolidWorks and COMPASS, the obtained data were processing using mathematical programs. Using fractal principles it is possible to create a large number of i-fractals’ three dimensional models therefore important research objectives include such objects’ classification development. In addition, were analyzed i-fractals’ geometry features, and proposed general principles for their creation.
Computer Visual Representation For the Color Gamut of Reproduction Systems For Multicolor Image
Authors: Варепо Л. , Varepo L. , Трапезникова О. , Trapeznikova O. , Панчук К. , Panchuk K. , Ляшков А. , Lyashkov A. , Голунов А. , Golunov A.
Published: September 2017

Methods of surfaces’ geometric simulation are widely used for construction of different solid figures. Colours at the XYZ color system are located at the same distance stated geometrically. It doesn't generate a complete visual presentation for the color gamut of reproduction system for multicolor image. The computer visualization of correspondent pictures at multicolor image’s reproduction accuracy estimation is one of priority tasks. In this paper have been presented results related to practical implementation of geometrical model and software for evaluation of printing system’s color reproduction, construction of color gamut bodies, and a projection representation of reproducible colors’ geometric models for different playback systems: additive and autotype synthesis of color. The color gamut construction is performed over CIE L*a*b* color space. The color is presented as the one lightness coordinate and two color-difference coordinates of chromaticity. A color gamut body volume calculation has been performed in automated mode using software tools. Calculation of the playback system’s color gamut is carried out with Qhull (Quickhull) algorithm realised in the Matlab software. The practical algorithm realisation has been considered on example of ink jet printing based on Epson 3880. The color gamut bodies’ surfaces projections construction was performing in light tones (lightness L = 80), middle tones (L = 50), and shadow tones (L = 20). Has been performed a section of the color gamut bodies’ constructed surfaces. Have been demonstrated the results of computer visualization for geometrical models interpreting the multicolor image’s reproduction accuracy relative to the original.
An Adaptive Large Neighborhood Search for the Location-routing Problem with Intra-route Facilities
Authors: Schiffer Maximilian , Walther Grit
Published: September 2017

Recent research on location-routing problems has been focusing on locating facilities as the starting and end point of routes. In this paper, we investigate a new type of location-routing problem. In the location-routing problem with intra-route facilities, the location of depots is known, whereas the location of facilities for intermediate stops has to be determined to keep vehicles operational. We present an adaptive large neighborhood search which is enhanced by local search and dynamic programming components, and derive new penalty functions for time-efficient neighborhood evaluation. We show that this algorithm is suitable for solving various problems with intra-route facilities by deriving new best known solutions for the recently published electric location-routing problem with time windows and partial recharging, as well as for the battery swap station electric vehicle location-routing problem. Additionally, we create new real-world benchmark instances and show results as well. Furthermore, we assess the competitiveness of our algorithm on the electric vehicle routing problem with time windows for full and partial recharging, and derive new best known solutions for both problem variants.

The online appendix is available at https://doi.org/10.1287/trsc.2017.0746 .
Preventing skin problems in the older population
Authors: Todd Marie
Published: September 2017

Dry skin, pressure ulcers and skin tears can have a serious impact on an older person's quality of life in care. In this article, Marie Todd explains how and when a person may have these problems, and what can be done to prevent them before they occur
LEVEL CROSSING SAFETY IN THE CZECH REPUBLIC
Authors: Kobosil Martin , Novák Jan
Published: September 2017

This paper describes safety threats at level crossings according to the different type of security equipment. Initially were explored statistical data, which consist of numbers of level crossings classified by crossing type and numbers of traffic accidents on level crossings. Afterwards paper describes specific problems of each individual level crossing type. Specifically their causation and consequences, which are being discussed between professional and general public. In conclusion paper describes possible solutions to these problems leading to reducing risks at level crossings. At first is mentioned the statistics - number of crossing and number of accidents on the crossing. Then paper describes specific problems, which are discussed in professional and general public. They are also solutions of this problems, which brings another point of view and search the actual causes.
CANT EXCESS AND CANT DEFICIENCY EVALUATION IN RELATION TO TRAIN SPEED
Authors: Valehrach Jan , Říha Tomáš , Dušek Erik
Published: September 2017

The paper deals with the evaluation of measured speeds of the vehicles on the chosen sections of the railway network in the Czech Republic. In connection with the phased implementation of the AVV system (automatic train operation) and the European ETCS system, the dispersion of the train speeds will be reduced. Measured data were used to assess the weighted average of the cant excess or cant deficiency in relation to the rail defects. Within the framework of the research, the speeds were statistically evaluated covering more aspects like types and sorts of the trains, their operators, daytime and more.
PREPARING OF THE CHAMELEON COATING BY THE ION JET DEPOSITION METHOD
Authors: Skocdopole Jakub , Aversa Lucrezia , Golan Martin , Schenk Antonin , Baldi Giacomo , Kratochvilova Irena , Kalvoda Ladislav , Nozar Petr
Published: September 2017

Preparation of chameleon coatings using an Ionized Jet Deposition (IJD) technique is reported in the present paper. IJD is a new flexible method for thin film deposition developed by Noivion, Srl. The chameleon coatings are thin films characterised by a distinct change of their tribological properties according to the external conditions. The deposited films of SiC and TiN materials were examined by the Raman spectroscopy, SEM and XPS. The results of the Raman spectroscopy have proved an amorphous structure of SiC films. The data from XPS on TiN films have shown that the films are heavily oxidized, but also prove that the films are composed of TiN and pure Ti. The SEM provided information about the size of grains and particles constituting the deposited films, which is important for tribological properties of the films. Deposition of the chameleon coating is very complex problem and IJD could be ideal method for preparation of this coating.
The Arts of Amnesia: The Case for Audio Drama, Part Two
Authors: Verma Neil
Published: September 2017

This article examines what the relationship between audio drama and radio drama might illuminate about both forms. Drawing on some 40 podcasts and other audio forms that take a serial structure, I explore the rise of audio drama podcasts since 2015 and situate them in both a more recent historical context since the late 1990s and in a broader history stretching back to the first Golden Age of radio. By listening closely to key works on Serendipity, Homecoming and other podcasts, I argue that contemporary audio has profound potential to change both how we listen and how we relate to the sound media of the past.
Budd-Chiari Syndrome
Authors: Grus Tomáš , Lambert Lukáš , Grusová Gabriela , Banerjee Rohan , Burgetová Andrea
Published: September 2017

Budd-Chiari syndrome (BCS) is a rare disease with an incidence of 0.1 to 10 per million inhabitants a year caused by impaired venous outflow from the liver mostly at the level of hepatic veins and inferior vena cava. Etiological factors include hypercoagulable conditions, myeloprolipherative diseases, anatomical variability of the inferior vena cava, and environmental conditions. Survival rates in treated patients range from 42 to 100% depending on the etiology and the presence of risk factors including parameters of Child-Pugh score, sodium and creatinine plasma levels, and the choice of treatment. Without treatment, 90% of patients die within 3 years, mostly due to complications of liver cirrhosis. BCS can be classified according to etiology (primary, secondary), clinical course (acute, chronic, acute or chronic lesion), and morphology (truncal, radicular, and venooclusive type). The diagnosis is established by demonstrating obstruction of the venous outflow and structural changes of the liver, portal venous system, or a secondary pathology by ultrasound, computed tomography, or magnetic resonance. Laboratory and hematological tests are an integral part of the comprehensive workup and are invaluable in recognizing hematological and coagulation disorders that may be identified in up to 75% of patients with BCS. The recommended therapeutic approach to BCS is based on a stepwise algorithm beginning with medical treatment (a consensus of expert opinion recommends anticoagulation in all patients), endovascular treatment to restore vessel patency (angioplasty, stenting, and local thrombolysis), placement of transjugular portosystemic shunt (TIPS), and orthotopic liver transplantation as a last resort rescue treatment.