bluuebunny/crossref_metadata_2025 huggingface dataset:
Resisting the perpetual update: Struggles against protocological power in video games
Authors: Švelch Jan
Published: February 2019

This article explores the evolution of video game updates and patches from a mechanism of customer support to a tool of control over the way games are played in the ecosystem of digital gaming platforms. It charts a historical trajectory across various cultural industries, including literary publishing, screen industries, and music, to show a shift from multiplicity of editions to one perpetually updated contingent commodity. Focusing on the issues of power and control enabled by the always-online platforms, the analysis shows that previously updating was often voluntary. However, now players must actively resist patches if they wish to play the game on their own terms. As illustrated by three case studies of update resistance, developers, publishers, and platform holders wield protocological power, which can be successfully opposed—although the outcome often remains localized and tends to alter a specific iteration of protocol and not the underlying infrastructure.
Anthropology is companion studies: A study of violent relations during fieldwork with my family
Authors: Newman Jonathan
Published: February 2019

Companions in the field influence ethnography, thus affecting research position whilst providing research insights. The research of violence takes place within the relations of violence being studied. Family companions who used to live in a field site are entwined in those violent relations. Capacity for violent threat or suffering is connected to the companions of family. Reporting on companions is problematic. Where anonymity is compromised, key information has to be withheld, which in turn leads readers to question integrity. The ethical balance between author, companions and reader reveals more about the relationality of violence. As anthropology turns towards analysing a relational positioning between multifarious companions, the study of family companions expands to consider how intimate companions, of one kind or another, unavoidably shape ethnography. The paper contributes to understanding violence, the research of violence, accompanied fieldwork and methodology in relational anthropological frameworks.
An Ever More Violent World?
Authors: Gleditsch Kristian Skrede
Published: February 2019

A recent report by the United Nations and the World Bank argues that the world has seen “a surge in violent conflicts in recent years,” with a sharp increase in reported battle-related and terrorist attacks, and calls for preventive action to ensure that increasing conflict does not undermine the UN Sustainable Development Goals. I will argue that this is a far too pessimistic assessment of conflict trends and not borne out of the available evidence, which indicates a decline in violent conflict since the end of the Cold War. Alarmist warnings may seem helpful to call for action, but they detract attention from what we can learn about the causes for why conflict has declined. For example, resort to violence has become less frequent where factors that can motivate resort to violence such as political and ethnic exclusion have decreased. Moreover, conflict of interest does not imply violence, and the space for nonviolent alternatives has increased. The future of conflict and peace depends on our confidence in whether positive changes will continue and our understanding of the possible challenges.
Health Advocacy for Busy Professionals: Effective Advocacy With Little Time
Authors: Hancher-Rauch Heidi L. , Gebru Yordanos , Carson Any’e
Published: February 2019

Health advocacy is a central responsibility for health educators and public health practitioners, as documented clearly in our professional competencies. Professional organizations such as the Society for Public Health Education and the American Public Health Association undertake frequent advocacy initiatives and strive to engage their members in advocacy strategies on a regular basis. Despite this understanding and advocacy training requirements in academic preparation programs for public health professionals, students and emerging professionals often lack advocacy experience. In this article, we provide descriptions of multiple effective health advocacy strategies spread across the time intensity spectrum, in order of least time intensive to most. Advocates may select the best strategy based on the needs of their target audience, the amount of time and energy they have for the task, and the level of confidence they have in practicing the strategy itself.
Role of genomic instability in human carcinogenesis
Authors: Moon Jung Joo , Lu Alexander , Moon Chulso
Published: February 2019

Genomic instability has been an area of active area of research in the last two decades. Based on the initial study for hereditary cancers, DNA repair gene family mutations have been identified. In sporadic (non-hereditary) cancers, several large-scale DNA sequencing studies suggest that mutations in DNA repair genes are less frequent, suggesting the complexity of tumorigenesis of sporadic cancers. So far, several important genes have been identified, by using mostly cell line models and mice studies. These include DNA damage response modifier like ataxia telangiectasia mutated (ATM), conventional tumor suppressor genes like TP53 and cyclin-dependent kinase inhibitor 2A (CDKN2A; which encodes p16INK4A and p14ARF). Various hypotheses for sporadic tumorigenesis have been developed, and so far, “oncogene-induced DNA replication stress model” has been gaining widespread interests. In this review, we will first describe some of the important concepts of genomic instability. Then, we will outline oncogene-induced genomic instability and discuss the role of the MYC gene during this process, which will be followed by detailed reviews of mutation data. We hope that this review can outline the overall perspectives of genomic instability.

Impact statement

This review provides various genetic and cell line data previously published in a way to explain how cellular stress can lead into genetic instability.
Outcomes of Secondary Combined Proximal Interphalangeal Joint Release and Zone II Flexor Tenolysis
Authors: Zuo Kevin J. , Saggaf Moaath , von Schroeder Herbert P. , Binhammer Paul
Published: February 2019

Background: Tendon adhesions and capsular contractures following trauma to the proximal interphalangeal joint (PIPJ) may significantly reduce hand function. Traditional, staged surgical management prioritizes restoration of PIPJ passive range of motion with joint release prior to restoration of active range of motion (AROM) with tenolysis. This is expensive and burdensome for patients. Our objective was to evaluate functional outcomes of combined PIPJ release and zone II flexor tenolysis. Methods: We retrospectively reviewed patients who underwent combined PIPJ release and flexor tenolysis. Replantation and tendon graft cases were excluded. Data were collected on pre- and postoperative AROM, total active motion (TAM), tip to distal palmar crease (DPC) distance, and grip strength. Functional outcomes were graded using the Boyes, American Society for Surgery of the Hand, and modified Strickland scores. Results: Twelve patients (9 men and 3 women, median age = 40 years) with a total of 15 digits underwent combined PIPJ release and flexor tenolysis a median of 10.1 months after injury. At a median follow-up of 4.0 months, there were significant improvements in median PIPJ AROM (15° to 70°), TAM (105° to 223°), tip to DPC distance (6.0 to 2.0 cm), and grip strength (35% to 54% of unaffected hand). Modified Strickland score was good in 46% of digits and excellent in 38%. There were no tendon ruptures, surgical site infections, or devascularized digits. Conclusion: Proximal interphalangeal joint stiffness is a challenging complication of hand trauma. Although a complete return to premorbid range of motion and function is rarely attained with surgery, improved outcomes may be consistently achieved with secondary combined PIPJ release and zone II flexor tenolysis.
Characterization of Patients in a Lifestyle Medicine Practice
Authors: Henderson Richard C. , Shing Tracie L.
Published: February 2019

Objective. Lifestyle medicine is a relatively new specialty within medicine. The aim of this report is to characterize patients who present to a lifestyle medicine clinical practice. Methods. LifeStyle Medical Centers is an independent, community-based practice; this report is based on over 3200 patients within this practice. Most of the data presented were obtained from an intake questionnaire developed by the practice to provide background and screening particularly relevant to lifestyle medicine, including areas such as stress, sleep, physical activity, health knowledge, motivation, weight loss history and goals, and smoking. Results. Patients who present for lifestyle care come with varied goals, past histories, and current lifestyle issues. Many express a very high level of motivation to lose an unrealistically large amount of weight. The prevalence of physical inactivity, inadequate sleep, high stress, and risk of depression are high, yet the importance of these to health and well-being are often not recognized by the patient. Over 90% of the cost of care was covered by insurance. Conclusions. Having a better understanding of the patients who come to a lifestyle medicine clinic will help practices better design their lifestyle programs and guide lifestyle medicine providers to better engagement and care of their patients.
Perivascular spaces and their associations with risk factors, clinical disorders and neuroimaging features: A systematic review and meta-analysis
Authors: Francis Farah , Ballerini Lucia , Wardlaw Joanna M
Published: February 2019

Background

Perivascular spaces, visible on brain magnetic resonance imaging, are thought to be associated with small vessel disease, neuroinflammation, and to be important for cerebral hemodynamics and interstitial fluid drainage.

Aims

To benchmark current knowledge on perivascular spaces associations with risk factors, neurological disorders, and neuroimaging lesions, using systematic review and meta-analysis.

Summary of review

We searched three databases for perivascular spaces publications, calculated odds ratios with 95% confidence interval and performed meta-analyses to assess adjusted associations with perivascular spaces. We identified 116 relevant studies ( n = 36,108) but only 23 ( n = 12,725) were meta-analyzable. Perivascular spaces assessment, imaging and clinical definitions varied. Perivascular spaces were associated ( n; OR, 95%CI, p) with ageing (8395; 1.47, 1.28–1.69, p = 0.00001), hypertension (7872; 1.67, 1.20–2.31, p = 0.002), lacunes (4894; 3.56, 1.39–9.14, p = 0.008), microbleeds (5015; 2.26, 1.04–4.90, p = 0.04) but not WMH (4974; 1.54, 0.71–3.32, p = 0.27), stroke or cognitive impairment. There was between-study heterogeneity. Lack of appropriate data on other brain disorders and demographic features such as ethnicity precluded analysis.

Conclusions

Despite many studies, more are required to determine potential pathophysiological perivascular spaces involvement in cerebrovascular, neurodegenerative and neuroinflammatory disorders.
Covering the Boko Haram crisis beyond the nation: Analysis of shifting time and space frames in news reporting
Authors: Akinro Ngozi
Published: February 2019

Through framing analysis, this article considers how two prominent Nigerian daily newspapers and two prominent United States daily newspapers have reported on the activities of Boko Haram during the period February 2014 to May 2015. The article finds that all four of these newspapers shifted how they framed the Boko Haram activities over the 16-month period, although with some differences. At first, the coverage focused on how the Boko Haram acts affected individuals directly caught up in singular attacks indicating an episodic coverage. This focus on individuals and the present events bolster great emotional support. Further reporting over the 16-month period suggested a shift to the society and then international level which was more contextual (thematic) indicating the wider social impact of terrorism. This therefore shows that the shift in framing of the crisis can be understood in three ways: from the episodic to the thematic, from the individual (through the societal) to the international level, and from the present (immediate) to the future implications of terrorism. The significance of identifying these shifts is to draw attention to framing as a lens to understand terrorism news expansion salience.
The Berlin Memorial to the Homosexuals Persecuted under the National Socialist Regime: Ambivalent responses to homosexual visibility
Authors: Oettler Anika
Published: February 2019

The Memorial to Homosexuals Persecuted under the National Socialist Regime, unveiled in Berlin in 2008 at the edge of the Tiergarten park, forms part of an impressive commemorative landscape. It caused considerable controversy from the outset due to its twofold intention of recognizing past repression and creating a symbol against the exclusion of gays and lesbians. The article departs from these debates and describes the polyphonous field of visitor reactions to the memorial. It is based empirically on expert interviews, covert observation, and almost one hundred “express interviews” with visitors. The findings suggest that the relationships between visitors and the memorial are shaped by a pronounced aesthetic attitude. Identity-related visitor reactions center on the video installation inside the memorial, which depicts an endless male-to-male kiss. The article shows how visitors derive meaning from the memorial regardless of the superficiality of their encounters.
Public health delivery in the information age: the role of informatics and technology
Authors: Williams F , Oke A , Zachary I
Published: February 2019

Aim:

Public health systems have embraced health informatics and information technology as a potential transformational tool to improve real-time surveillance systems, communication, and sharing of information among various agencies. Global pandemic outbreaks like Zika and Ebola were quickly controlled due to electronic surveillance systems enabling efficient information access and exchange. However, there is the need for a more robust technology to enhance adequate epidemic forecasting, data sharing, and effective communication. The purpose of this review was to examine the use of informatics and information technology tools and its impact on public health delivery.

Method:

Investigators searched six electronic databases. These were MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete, Cochrane Database of Systematic Reviews, COMPENDEX, Scopus, and Academic Search Premier from January 2000 to 31 March 2016.

Results:

A total of 60 articles met the eligibility criteria for inclusion. These studies were organized into three areas as (1) definition of the term public health informatics; (2) type of public health surveillance systems and implications for public health; and (3) electronic surveillance systems functionality, capability, training, and challenges. Our analysis revealed that due to the growing expectations to provide real-time response and population-centered evidence-based public health in this information-driven age there has been a surge in informatics and information technology adoption. Education and training programs are now available to equip public health students and professionals with skills in public health informatics. However, obstacles including interoperability, data standardization, privacy, and technology transfer persist.

Conclusion:

Re-engineering the delivery of public health is necessary to meet the demands of the 21st century and beyond. To meet this expectation, public health must invest in workforce development and capacity through education and training in informatics.
Health promotion interventions for older people living alone: a systematic review
Authors: Ilgaz A , Gözüm S
Published: February 2019

Aims:

The aim of this systematic literature review was to identify health promotion interventions for older people living alone and to describe the effectiveness of these interventions.

Methods:

A literature search was conducted using five databases, including CINAHL, Ovid MEDLINE, PubMed, Cochrane, Scopus, and Web of Science, and this comprehensive literature search process was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Potentially relevant studies were evaluated and selected by two authors. Studies were assessed based on inclusion criteria. The Standardised Critical Appraisal Tool from Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used to appraise the methodological quality of these studies.

Results:

Of the 2852 unique studies identified in the systematic search, the full texts of three studies meeting the inclusion criteria were reviewed. The results showed that the level of physical activity and self-efficacy for physical activity, activities of daily living, food enjoyment, and energy intake increased and leisure engagement decreased with health promotion interventions.

Conclusion:

The findings of this review indicate that interventions to improve health promotion positively affect the health of older people living alone and enhance their quality of life. There is a need for further research involving multidimensional interventions for older people living alone.
Does Patient-Specific Instrumentation Have a Higher Rate of Early Osteolysis Than Standard Referencing Techniques in Total Ankle Arthroplasty? A Radiographic Analysis
Authors: Escudero Mario I. , Symes Michael , Bemenderfer Thomas Bradford , Barahona Maximiliano , Anderson Robert , Davis Hodges , Wing Kevin J. , Penner Murray J.
Published: February 2019

Introduction: Patient-specific instrumentation (PSI) has been developed for total ankle arthroplasty (TAA), with proven benefits. One concern regarding PSI is the need for more soft tissue dissection in order to accurately position the PSI guides, which has the theoretical disadvantage of increased osteolysis. The purpose of our study is to compare the incidence and magnitude of osteolysis for the INFINITY Total Ankle System between PSI and standard referencing (SR) techniques. Methods: Sixty-seven patients who underwent primary TAA using Prophecy (PSI) or SR technique between 2013 and 2015 were reviewed in a retrospective observational study. Osteolysis was assessed on radiographs at 2 years. The incidence was calculated by binomial distribution. The number of zones compromised and the magnitude of osteolysis was calculated using the median as a summary statistic and interquartile range as dispersion statistic. Fisher exact test was used to compare both groups, then a regression model was estimated to calculate the odds ratio for osteolysis. Results: Of the 67 TAAs, 51 were in the PSI group and 16 in the SR group. In the PSI group the incidence, number of compromised zones (CZ), and magnitude was 41% (25%-59%), 1 [1-2], and 2 [2-3], respectively. In the SR group these were 36% (13%-65%), 3 [2-3], and 3 [2-4], respectively. No significant differences were found ( P = .46, P = .12, P = .33). A slightly higher risk of osteolysis was found in the PSI group (odds ratio = 1.33 [0.36-4.83]) ( P = .46). The majority of lesions were in 1 zone with size of 2 to 5 mm (63% for all cohort, 64% PSI, 60% SR). Two cases underwent revision for aseptic loosening, 1 in the SR group and 1 in the PSI group. Conclusion: According to our data, there is no significant difference between PSI and SR in terms of risk, incidence, size and magnitude of osteolysis in the INFINITY Total Ankle System at 2 years.

Levels of Evidence: Therapeutic, Level III, Retrospective cohort study
A medium-throughput screen for inhibitors of human metapneumovirus
Authors: Becker Jennifer C , Tollefson Sharon J , Weaver David , Williams John V
Published: February 2019

Human metapneumovirus, a paramyxovirus discovered in 2001, is a major cause of lower respiratory infection in adults and children worldwide. There are no licensed vaccines or drugs for human metapneumovirus. We developed a fluorescent, cell-based medium-throughput screening assay for human metapneumovirus that captures inhibitors of all stages of the viral lifecycle except budding of progeny virus particles from the cell membrane. We optimized and validated the assay and performed a successful medium-throughput screening. A number of hits were identified, several of which were confirmed to inhibit viral replication in secondary assays. This assay offers potential to discover new antivirals for human metapneumovirus and related respiratory viruses. Compounds discovered using the medium-throughput screening may also provide useful probes of viral biology.
Early intravenous beta-blockers in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: A patient-pooled meta-analysis of randomized clinical trials
Authors: Hoedemaker Niels PG , Roolvink Vincent , de Winter Robbert J , van Royen Niels , Fuster Valentin , García-Ruiz José M , Er Fikret , Gassanov Natig , Hanada Kenji , Okumura Ken , Ibáñez Borja , van ’t Hof Arnoud W , Damman Peter
Published: February 2019

Background:

Conflicting evidence is available on the efficacy and safety of early intravenous beta-blockers before primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. We performed a patient-pooled meta-analysis of trials comparing early intravenous beta-blockers with placebo or routine care in ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention.

Aim:

The aim of this study was to evaluate the clinical and safety outcomes of intravenous beta-blockers in ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention.

Methods:

Four randomized trials with a total of 1150 patients were included. The main outcome was one-year death or myocardial infarction. Secondary outcomes included biomarker-based infarct size, left ventricular ejection fraction during follow-up, ventricular tachycardia, and a composite safety outcome (cardiogenic shock, symptomatic bradycardia, or hypotension) during hospitalization.

Results:

One-year death or myocardial infarction was similar among beta-blocker (4.2%) and control patients (4.4%) (hazard ratio: 0.96 (95% confidence interval: 0.53–1.75, p=0.90, I2=0%). No difference was observed in biomarker-based infarct size. One-month left ventricular ejection fraction was similar, but left ventricular ejection fraction at six months was significantly higher in patients treated with early intravenous beta-blockade (52.8% versus 50.0% in the control group, p=0.03). No difference was observed in the composite safety outcome or ventricular tachycardia during hospitalization.

Conclusion:

In ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention, the administration of early intravenous beta-blockers was safe. However, there was no difference in the main outcome of one-year death or myocardial infarction with early intravenous beta-blockers. A larger clinical trial is warranted to confirm the definitive efficacy of early intravenous beta-blockers.
Gossypiboma (retained surgical sponge) induces septic shock after previous breast surgery: A case report
Authors: Shih Pin-Keng
Published: February 2019

Foreign body granuloma caused by retained surgical sponge is also called gossypiboma or textiloma, is mostly described in the abdominal cavity, with only a very few cases of retained surgical sponges located in breasts. A 48-year-old female came to our emergency department due to shortness of breath with consciousness disturbance. Sixteen years previously, she had gone through modified radical mastectomy. Eight years later, she received breast reconstruction. At emergency department, her hemodynamic status was unstable. Besides, there was one mass lesion with abscess in the right axillary region, and percutaneous abscess drainage was performed. She was sent to the medical intensive care unit for further care of septic shock. Because her symptoms and signs did not improve, we decided to perform fasciectomy and surprisingly found one retained surgical sponge in her breast. After the operation, she recovered well and the wound was stable. Due to limited literature available, we present a case of gossypiboma in the breast with a clinical manifestation of septic shock.
Performance and cost of a renal cancer specialist multidisciplinary team meeting: Results from 1500 discussions
Authors: Neves Joana B , Shepherd Scott , Cullen David , Powles Tom , Aitchison Michael , Tran Maxine G B
Published: February 2019

Objectives:

To report on the performance and cost of a surgeon-led renal cancer specialist multidisciplinary team meeting at a high-volume centre.

Materials and methods:

Retrospective analysis of 1500 consecutive cases discussed from 2 September 2015 onwards. Performance was assessed as the number of cases where a clinical recommendation was made. The cost per meeting, discussion and patient were calculated using the mid-point of pay band attributable to the attendees (National Health Service pay scales 2015).

Results:

Over 34 meetings, 1500 discussions occurred (933 patients: 61.7% male; mean age 63.8). Above a one-quarter of discussions ( n = 399, 26.6%) were new referrals. Each patient’s case was discussed a mean of 1.6 times, the majority being discussed once ( n = 563, 60.3%). In 93.3% of discussions, a clinical recommendation was made. Only 100 discussions (6.7%) were deferred due to incomplete clinical information. A total of 11.1% ( n = 166) cases were discharged. The average costs were: £141,901 per year, £2729 per meeting, £62 per case discussed and £99 per patient.

Conclusion:

One discussion was usually sufficient to decide management; deferral was uncommon; and, given the low discharge rate, referrals seemed appropriate. The cost per patient was modest, and represented good value in providing a focused and shared clinical decision-making pathway for renal cancer patients.

Level of evidence:

2C
Patient and Provider Perspectives on 30-Day Readmissions, Preventability, and Strategies for Improving Transitions of Care for Patients with HIV at a Safety Net Hospital
Authors: Nijhawan Ank E. , Higashi Robin T. , Marks Emily G. , Tiruneh Yordanos M. , Lee Simon Craddock
Published: February 2019

Thirty-day hospital readmissions, a key quality metric, are common among people living with HIV. We assessed perceived causes of 30-day readmissions, factors associated with preventability, and strategies to reduce preventable readmissions and improve continuity of care for HIV-positive individuals. Patient, provider, and staff perspectives toward 30-day readmissions were evaluated in semistructured interviews (n = 86) conducted in triads (HIV-positive patient, medical provider, and case manager) recruited from an inpatient safety net hospital. Iterative analysis included both deductive and inductive themes. Key findings include the following: (1) The 30-day metric should be adjusted for safety net institutions and patients with AIDS; (2) Participants disagreed about preventability, especially regarding patient-level factors; (3) Various stakeholders proposed readmission reduction strategies that spanned the inpatient to outpatient care continuum. Based on these diverse perspectives, we outline multiple interventions, from teach-back patient education to postdischarge home visits, which could substantially decrease hospital readmissions in this underserved population.
Rates and Risk Factors for Revision Open and Arthroscopic Proximal Biceps Tenodesis
Authors: Forsythe Brian , Agarwalla Avinesh , Puzzitiello Richard N. , Mascarenhas Randy , Werner Brian C.
Published: February 2019

Background:

Biceps tenodesis may be performed for symptomatic tendinopathy or tearing of the long head of the biceps tendon. Biceps tenodesis is also commonly performed as an adjunctive procedure. However, the indications and prevalence of biceps tenodesis have expanded.

Purpose:

To establish the incidence and risk factors for revision biceps tenodesis.

Study Design:

Case-control study; Level of evidence, 2.

Methods:

The PearlDiver database of Humana patient data was queried for patients undergoing arthroscopic or open biceps tenodesis (Current Procedural Terminology [CPT] 29828 and CPT 23430, respectively) from 2008 through the first quarter of 2017. Patients without a CPT laterality modifier were excluded from analysis. Revision biceps tenodesis was defined as patients who underwent subsequent ipsilateral open or arthroscopic biceps tenodesis. The financial impact of revision biceps tenodesis was also calculated. Multivariate binomial logistic regression was performed to identify risk factors for revision biceps tenodesis, such as patient demographics as well as concomitant procedures and diagnoses. Odds ratios (ORs) and 95% CIs were calculated, and all statistical comparisons with P < .05 were considered significant.

Results:

There were 15,257 patients who underwent biceps tenodesis. Of these, 9274 patients (60.8%) underwent arthroscopic biceps tenodesis, while 5983 (39.2%) underwent open biceps tenodesis. A total of 171 patients (1.8%) and 111 patients (1.9%) required revision biceps tenodesis after arthroscopic and open biceps tenodesis, respectively ( P = .5). Male sex (OR, 1.38 [95% CI, 1.04-1.85]; P = .02) was the only independent risk factor for revision biceps tenodesis after the index open biceps tenodesis. After arthroscopic biceps tenodesis, age >45 years (OR, 0.58 [95% CI, 0.39-0.89]; P = .01) and concomitant rotator cuff tear (OR, 0.58 [95% CI, 0.47-0.71]; P < .001) were independent protective factors for revision biceps tenodesis. The total cost of revision biceps tenodesis after open and arthroscopic biceps tenodesis was US$3427.95 and US$2174.33 per patient, respectively.

Conclusion:

There was no significant difference in the revision rate between arthroscopic and open biceps tenodesis. Risk factors for revision surgery included male sex for open biceps tenodesis, while age >45 years and rotator cuff tears were protective factors for arthroscopic biceps tenodesis.
Successful Management of Thrombotic Thrombocytopenic Purpura in a Jehovah’s Witness: An Individualized Approach With Joint Decision-Making
Authors: Lim Ming Y , Greenberg Charles S
Published: February 2019

The management of thrombotic thrombocytopenic purpura (TTP) presents a unique challenge in individuals who are unable to accept plasma due to religious beliefs, given that therapeutic plasma exchange (TPE) is the standard of care. A 61-year-old Jehovah’s Witness woman presented to our hospital with neurological symptoms and laboratory findings suggestive of TTP. On admission, she refused transfusion of blood products, specifically red blood cells, platelets, and plasma but accepted albumin and intravenous immunoglobulin (IVIG); fractions of plasma. She was started on steroids, IVIG, and TPE with albumin as replacement therapy with minimal improvement. After a detailed discussion with the patient and family, they agreed to accept cryosupernatant. The patient started TPE with cryosupernatant for replacement therapy, which resulted in clinical improvement. This case highlights the importance of an individualized approach with joint decision-making given the significant heterogeneity that exists in Jehovah’s Witnesses’ attitude toward the receipt of blood products.
Geochemical and mineralogical characterization of smectites from the Ventzia basin, western Macedonia, Greece
Authors: Kaufhold Stephan , Chryssikos George D. , Kacandes George , Gionis Vassilis , Ufer Kristian , Dohrmann Reiner
Published: February 2019

Three samples of bulk smectite clay from the Pilori and Velanida bentonite deposits of the Ventzia basin, western Macedonia, Greece, were characterized in detail. Chemical analyses and X-ray diffraction (XRD; Rietveld method) showed that the samples are rich in Fe and Mg (8–13 mass% and 6–10 mass% as oxides, respectively) and contain ~60–65 mass% smectite. The high Fe and Mg content as well as the high Cr (0.3–0.5 mass%) and Ni content (0.1–0.3 mass%) are consistent with the formation of these clays from ultramafic precursor sediments of the Vourinos ophiolite complex. Both XRD and infrared spectroscopy indicate the presence of other clay minerals besides smectite, such as minor amounts of kaolinite, trioctahedral-rich palygorskite, serpentine and talc (depending on the sample). The position of the d060 reflection (1.51–1.52 Å) is compatible with either high Fe content or partial trioctahedral character, or probably both. The predominance of ferruginous smectite or nontronite was confirmed by infrared spectroscopy, but the minor presence of a trioctahedral magnesian smectite in some of the samples cannot be excluded. Layer charge densities, determined by the νO-D (oxygen-deuterium IR-stretching) method calibrated against the structural formula method, are in the 0.48–0.52 eq/FU range. Various methods point to the existence of a significant amount of tetrahedral charge, which is typical of ferruginous smectites. The major exchangeable cation is Mg2+ (73–90%), which represents a special property of these materials compared with other bentonites.
Stimulated release of intraluminal vesicles from Weibel-Palade bodies
Authors: Streetley James , Fonseca Ana-Violeta , Turner Jack , Kiskin Nikolai I. , Knipe Laura , Rosenthal Peter B. , Carter Tom
Published: February 2019

Weibel-Palade bodies (WPBs) are secretory granules that contain von Willebrand factor and P-selectin, molecules that regulate hemostasis and inflammation, respectively. The presence of CD63/LAMP3 in the limiting membrane of WPBs has led to their classification as lysosome-related organelles. Many lysosome-related organelles contain intraluminal vesicles (ILVs) enriched in CD63 that are secreted into the extracellular environment during cell activation to mediate intercellular communication. To date, there are no reports that WPBs contain or release ILVs. By light microscopy and live-cell imaging, we show that CD63 is enriched in microdomains within WPBs. Extracellular antibody recycling studies showed that CD63 in WPB microdomains can originate from the plasma membrane. By cryo-electron tomography of frozen-hydrated endothelial cells, we identify internal vesicles as novel structural features of the WPB lumen. By live-cell fluorescence microscopy, we directly observe the exocytotic release of EGFP-CD63 ILVs as discrete particles from individual WPBs. WPB exocytosis provides a novel route for release of ILVs during endothelial cell stimulation.
Comprehensive clinical-molecular transplant scoring system for myelofibrosis undergoing stem cell transplantation
Authors: Gagelmann Nico , Ditschkowski Markus , Bogdanov Rashit , Bredin Swann , Robin Marie , Cassinat Bruno , Shahswar Rabia , Thol Felicitas , Heuser Michael , Socié Gerard , Beelen Dietrich , Triviai Ioanna , Badbaran Anita , Kröger Nicolaus
Published: February 2019

Allogeneic hematopoietic stem cell transplantation is curative in myelofibrosis, and current prognostic scoring systems aim to select patients for transplantation. Here, we aimed to develop a prognostic score to determine prognosis after transplantation itself, using clinical, molecular, and transplant-specific information from a total of 361 patients with myelofibrosis. Of these, 205 patients were used as a training cohort to create a clinical-molecular myelofibrosis transplant scoring system (MTSS), which was then externally validated in a cohort of 156 patients. Multivariable analysis on survival identified age at least 57 years, Karnofsky performance status lower than 90%, platelet count lower than 150 × 109/L, leukocyte count higher than 25 × 109/L before transplantation, HLA-mismatched unrelated donor, ASXL1 mutation, and non-CALR/MPL driver mutation genotype being independent predictors of outcome. The uncorrected concordance index for the final survival model was 0.723, and bias-corrected indices were similar. Risk factors were incorporated into a 4-level MTSS: low (score, 0-2), intermediate (score, 3-4), high (score, 5), and very high (score, >5). The 5-year survival according to risk groups in the validation cohort was 83% (95% confidence interval [CI], 71%-95%), 64% (95% CI, 53%-75%), 37% (95% CI, 17%-57%), and 22% (95% CI, 4%-39%), respectively (P < .001). Increasing score was predictive of nonrelapse mortality (P < .001) and remained applicable to primary (0.718) and post-essential thrombocythemia (ET)/polycythemia vera (PV) myelofibrosis (0.701) improving prognostic ability in comparison with all currently available disease-specific systems. In conclusion, this MTSS predicts outcome of patients with primary and post-ET/PV myelofibrosis undergoing allogeneic stem cell transplantation.
Newborn DNA-methylation, childhood lung function, and the risks of asthma and COPD across the life course
Authors: den Dekker Herman T. , Burrows Kimberley , Felix Janine F. , Salas Lucas A. , Nedeljkovic Ivana , Yao Jin , Rifas-Shiman Sheryl L. , Ruiz-Arenas Carlos , Amin N. , Bustamante Mariona , DeMeo Dawn L. , Henderson A. John , Howe Caitlin G. , Hivert Marie-France , Ikram M. Arfan , de Jongste Johan C. , Lahousse Lies , Mandaviya Pooja R. , van Meurs Joyce B. , Pinart Mariona , Sharp Gemma C. , Stolk Lisette , Uitterlinden André G. , Anto Josep M. , Litonjua Augusto A. , Breton Carrie V. , Brusselle Guy G. , Sunyer Jordi , Smith George Davey , Relton Caroline L. , Jaddoe Vincent W.V. , Duijts Liesbeth
Published: February 2019

Rationale

We aimed to identify differentially methylated regions (DMRs) in cord blood DNA associated with childhood lung function, asthma and chronic obstructive pulmonary disease (COPD) across the life course.

Methods

We meta-analysed epigenome-wide data of 1688 children from five cohorts to identify cord blood DMRs and their annotated genes, in relation to forced expiratory volume in 1 s (FEV1), FEV1/forced vital capacity (FVC) ratio and forced expiratory flow at 75% of FVC at ages 7–13 years. Identified DMRs were explored for associations with childhood asthma, adult lung function and COPD, gene expression and involvement in biological processes.

Results

We identified 59 DMRs associated with childhood lung function, of which 18 were associated with childhood asthma and nine with COPD in adulthood. Genes annotated to the top 10 identified DMRs wereHOXA5,PAOX,LINC00602,ABCA7,PER3,CLCA1,VENTX,NUDT12,PTPRN2andTCL1A. Differential gene expression in blood was observed for 32 DMRs in childhood and 18 in adulthood. Genes related with 16 identified DMRs were associated with respiratory developmental or pathogenic pathways.

Interpretation

Our findings suggest that the epigenetic status of the newborn affects respiratory health and disease across the life course.
Description of the surgical technique for condylectomy with minimally invasive surgery to treat interdigital helomas on the lesser toes: a Delphi study
Authors: Marti‐Martinez Luis M. , Gracia‐Sánchez Alba , Ferrer‐Torregrosa Javier , Lorca‐Gutierrez Rubén , Garcia‐Campos Jonatan , Sánchez‐Pérez Salvador Pedro
Published: February 2019

Background

Descriptions of the techniques for condylectomies via minimally invasive surgery (MIS) to treat interdigital helomas of the lesser toes are scarce in the literature. This study aimed to define and describe this surgical technique.

Methods

This observational study was performed using the Delphi method. We collected the anonymous opinions of a multidisciplinary international panel of ten experts by answering a 43‐items questionnaire via e‐mail. Statements with an average score ≥ 3 were included in the next round, as were those in which none of the three statements reached the minimum score of 3 within the same item.

Results

Response rate: 90%. Three rounds were needed to reach consensus on proposed items. A new statement that combined two statements was proposed in round 3. Eleven recommendations regarding the incision and instruments used to perform this surgical technique were obtained based on the expert consensus.

Conclusions

A longitudinal incision to the distal pulp of the toe or an incision to the centre of the plantar aspect of the head of the proximal phalanx should be performed according to the affectation, and a Beaver 64 scalpel blade, a blunt elevator and a Shannon‐Isham burr are the most acceptable tools for this kind of surgery.
Combining spectral induced polarization with X-ray tomography to investigate the importance of DNAPL geometry in sand samples
Authors: Johansson Sara , Rossi Matteo , Hall Stephen A. , Sparrenbom Charlotte , Hagerberg David , Tudisco Erika , Rosqvist Håkan , Dahlin Torleif
Published: February 2019

Although many studies have been performed to investigate the spectral induced polarization (SIP) response of nonaqueous phase liquid (NAPL)-contaminated soil samples, there are still many uncertainties in the interpretation of the data. A key issue is that altered pore space geometries due to the presence of a NAPL phase will change the measured IP spectra. However, without any information on the NAPL distribution in the pore space, assumptions are necessary for the SIP data interpretation. Therefore, experimental data of SIP signals directly associated with different NAPL distributions are needed. We used high-resolution X-ray tomography and 3D image processing to quantitatively assess NAPL distributions in samples of fine-grained sand containing different concentrations of tetrachloroethylene and link this to SIP measurements on the same samples. The total concentration of the sample constituents as well as the volumes of the individual NAPL blobs were calculated and used for the interpretation of the associated SIP responses. The X-ray tomography and image analysis showed that the real sample properties (porosity and NAPL distributions) differed from the targeted ones. Both contaminated samples contained less NAPL than expected from the manual sample preparation. The SIP results showed higher real conductivity and lower imaginary conductivity in the contaminated samples compared to a clean sample. This is interpreted as an effect of increased surface conductivity along interconnected NAPL blobs and decreased surface areas in the samples due to NAPL blobs larger than and enclosing grains. We conclude that the combination of SIP, X-ray tomography, and image analysis is a very promising approach to achieve a better understanding of the measured SIP responses of NAPL-contaminated samples.
A tale of two genes: divergent evolutionary fate of haptoglobin and hemopexin in hemoglobinless antarctic icefishes
Authors: Bilyk Kevin T. , Zhuang Xuan , Murphy Katherine R. , Cheng C-H. Christina
Published: February 2019

Evolution of Antarctic notothenioid fishes in the isolated freezing Southern Ocean have led to remarkable trait gains and losses. One of the most extraordinary was the loss of the major oxygen carrier hemoglobin (Hb) in the icefishes (family Channichthyidae). While the mechanisms of this loss and the resulting compensatory changes have been well studied, the impact of Hb loss on the network of genes that once supported its recycling and disposal has remained unexplored. Here we report the functional fate and underlying molecular changes of two such key Hb-supporting proteins across the icefish family - haptoglobin (Hp) and hemopexin (Hx), crucial in removing cytotoxic free Hb and heme respectively. Hp plays a critical role in binding free Hb for intracellular recycling and absent its primary client, icefish Hp transcription is now vanishingly little and translation into a functional protein is nearly silenced. Hp genotype degeneration has manifested in separate lineages of the icefish phylogeny with three distinct nonsense mutations and a deletion-frameshift, as well as mutated polyadenylation signal sequences. Thus, Hb loss appears to have diminished selective constraint on Hp maintenance, resulting in its stochastic, co-evolutionary drift towards extinction. Hx binds free heme for iron recycling in hepatocytes. In contrast to Hp, Hx genotype integrity is preserved in the icefishes and transcription occurs at comparable levels to the red-blooded notothenioids. The persistence of Hx likely owes to continued selective pressure for its function from mitochondrial and non-Hb cellular hemoproteins.
Hemodynamically self-corrected ΔADC analysis in idiopathic normal pressure hydrocephalus
Authors: Takatsuji-Nagaso Marina , Miyati Tosiaki , Ohno Naoki , Mase Mitsuhito , Kasai Harumasa , Shibamoto Yuta , Kobayashi Satoshi , Gabata Toshifumi , Kitagawa Kiyohide
Published: February 2019

Objective:

To clarify the cause of higher water fluctuation of the brain in idiopathic normal pressure hydrocephalus (iNPH), we assessed change in hemodynamic-independent apparent diffusion coefficient during the cardiac cycle (ΔADC) in iNPH.

Methods:

Electrocardiographically synchronized single-shot diffusion echo-planer imaging (b = 0, 500, and 1000 s/mm2) was performed in healthy volunteers, atrophic ventricular dilation group, and iNPH group, respectively. The ΔADC (b = 0 and 1000 s/mm2) and maximum ADC (b = 0 and 500 s/mm2) in the cardiac cycles were measured at the frontal white matter in the brain. Then, self-corrected ΔADC was obtained from the ΔADC divided by the maximum ADC (ADCpeak: perfusion-related diffusion) to correct the blood flow effect.

Results:

The ΔADC after correction was significantly higher in the iNPH group than in the other two groups. However, there was no significant difference in ADCpeak values among the groups.

Conclusion:

Self-corrected ΔADC in iNPH increased because of changes in the biomechanical properties of the brain. Self-corrected ΔADC analysis makes it possible to obtain information on hemodynamically independent water fluctuation as well as perfusion in iNPH.

Advances in knowledge:

Analysis self-corrected ΔADC provides simultaneously information on biomechanical properties, perfusion, and water fluctuation in iNPH.
Temporary Perfusion Branches to Decrease Spinal Cord Ischemia in the Endovascular Treatment of Thoraco-Abdominal Aortic Aneurysms
Authors: Jayia Parveen , Constantinou Jason , Hamilton Hamish , Ivancev Krassi
Published: February 2019

Based on a Presentation at the 2013 VEITH Symposium, November 19–23, 2013 (New York, NY, USA)

Background:
Spinal cord ischemia (SCI) is one of the most feared complications following the repair of thoraco- abdominal aortic aneurysms (TAAA). Endovascular repair of TAAA is now possible with branched stent grafts, but spinal cord ischaemia rates are still unacceptably high. A number of techniques have been utilized to reduce these levels, however, SCI remains a challenge to endovascular repair of TAAA. The use of sac perfusion branches aims to reduce the incidence of this catastrophic complication.

Methods:
A retrospective analysis of all patients undergoing branched endovascular aortic repair for all thoraco-abdominal aneurysms (TAAA) using custom made devices during January 2008 to August 2014. We describe a two staged technique in which perfusion of segmental vessels is maintained by a temporary endoleak through an open perfusion branch, incorporated within the branched stent graft, followed by a closure of this branch at a later date to complete exclusion of the aneurysm.

Results:
Forty-seven patients underwent TAAA repair. Twenty-five (53%) had a two-stage procedure using either a sac perfusion branch or a target vessel to perfuse the sac. Nine patients (19.15%) suffered some form of SCI with eight patients having temporary SCI (lasting less than 72 hours) and one patient having permanent SCI. Of eight patients that had temporary spinal cord ischemia, all had a perfusion strategy. There was one case of permanent SCI (2.13%).

Conclusion:
Sac perfusion branches provide a safe method for preventing SCI, however this needs to be used in conjunction with controlling MAP and CSF drainage.