bluuebunny/crossref_metadata_2025 huggingface dataset:
FM2-5 Shell shock or neurasthenia? The queen square experience in the first world war
Authors: Howard RD , Howard RS
Published: February 2019

Objectives

The neurological response to psychological trauma during the Great War changed between the initial engagements, the final offensive and the later reflections of the Southborough enquiry.

Design

At Queen Square, neurasthenia was a recorded diagnosis from 1890 and, for the next 30 years, between 4%–8% of all admissions were so described. The term ‘shell shock’ was first used in 1914 but the diagnosis burgeoned until, by 1918, it amounted to 25% of all admissions.

Subjects

Early in the war, affected soldiers were rapidly evacuated to the UK, but attitudes changed after the Somme, because of the need to expedite return to the frontline. The use of ‘Electrical Therapy’ at Queen Square was an example of this imperative (Linden 2013).

Results

Review of the case records suggests that ‘Shell Shock’ became an increasingly pejorative term as the condition was seen as a ‘contagious psychological response of the weak.’ The records show it was largely restricted to the lower ranks whilst officers were generally considered to have neurasthenia requiring a more gentle psychotherapeutic approach, occasionally involving transfer to specialist facilities.

Conclusions

Ultimately, at Queen Square, the diagnosis and management of acute traumatic neurosis was driven by the needs of war but also by popular prejudice.
FM2-6 Cell delivery for intracerebral cell transplantation
Authors: Abdulla MAH , Jathoul AP , Rosser AE , Gray WP
Published: February 2019

Objectives

Clinical trials of intracerebral cell replacement therapy (CRT) yield inconsistent results owing to poor graft survival and ectopic graft placement. A paucity of available CE marked specialised delivery systems and a lack of reliable delivery protocols could be major contributing factors to both phenomena. Here, we aimed to investigate current needle delivery strategiesin-vitroand in a large animal model in pigs.

Design

In-vitrolaboratory andin-vivopigs experiments.

Subjects

In-vitro

Agarose gelIn-vivo: 4 white Landracer pigs.

Methods

In-vitro: Human Embryonic Kidney cells expressing luciferase and 0.6% agarose gel were used to test 3 delivery strategies:

Bracelet deposit,

Large deposit in a pre–formed tract,

Multiple deposits in a pre–formed tract.

In-vivo: Pigs underwent MRI- guided Human Foetal Luciferase-transduced cell transplantation into the putamen and thalamus. Post-operative MRI, Bioluminescence imaging (BLI) and histology were used to identify graft location and viability.

Results

Using a commercially available needle delivery system, significant reflux of deposits was noted in all 3 delivery strategies duringin-vitrotesting. Depositing into a preformed tract yielded the best delivery, and was therefore used forin-vivotesting. Studies in pigs using MRI and BLI confirmed significant reflux and ectopic deposition of grafts.

Conclusions

Simple needle delivery systems appear to suffer from significant reflux and ectopic cell deposition. This may adversely affect the outcomes of CRT trials in humans.
FM2-7 Paediatric robot-assisted DBS surgery: electrode problems and revision techniques
Authors: Oviedova A , Ellenbogen J , Hasegawa H , Kaminska M , Perides S , Lumsden D , Lin J , Ashkan K , Selway R
Published: February 2019

Objectives

We review our cases of hardware problems requiring revision surgery and consider the technical aspects of revising the electrodes, including a frameless technique using the Renishaw Guide tubes.

Design

Retrospective Review.

Subjects

Children (≤18 years old) who presented with hardware problems following implantation of a DBS for dystonia at King’s College Hospital between May 2005 and April 2018.

Methods

Information was obtained from a prospectively kept database.

Results

Of 166 paediatric patients with DBS, 25 patients had hardware problems, and of these 21 (13%) patients had specifically electrode problems requiring replacement/revision of one or more electrodes. 7 patients had high impedances requiring revision, without obvious lead migration of fracture. 7 patients had lead migration and a further 7 patients had a lead fracture with or without lead migration. 15 patients had original DBS insertion with the Leksell Stereotactic System utilising the Medtronic Stimlock for lead fixation. 6 patients had DBS inserted with the Renishaw Sterotactic Robot and utilised the Renishaw Guide Tubes, in these patients who required lead replacement it was possible to revise the electrode without using stereotactic apparatus. As the guide tubes are implanted in the correct trajectory it is possible to measure the distance required to advance/implant the lead within this to target without the need for full stereotactic reimplantation.

Conclusions

Electrode dysfunction is relatively common in children with DBS and a systematic approach is required to identify the cause. When an electrode requires repositioning or replacement, the procedure can be performed in the conventional manner with a stereotactic frame, or freehand without a frame if a Renishaw Guide tube is used at time of first insertion.
P3 Outcomes following diagnostic brain biopsy: a 1 year case review
Authors: Ingleton R , Gorgun B , Gorgun N , Hayder M , Vindlacheruvu RR
Published: February 2019

Objectives

Stereotactic brain biopsy is an established neurosurgical procedure utilised in times of diagnostic or therapeutic uncertainty. Achieving a definitive tissue diagnosis allows tailored surgical, medical or oncological management. We present a 1 year case review of brain biopsies and compare suspected pre-operative diagnosis with final tissue outcome.

Design

Retrospective analysis of all brain biopsies performed in 2017 in an adult-only neurosurgical unit.

Subjects

All patients undergoing brain biopsy.

Methods

Theatre records were retrospectively analysed to identify patients undergoing brain biopsy in 2017. Further information was obtained using electronic patient records and radiology reports.

Results

41 patients underwent brain biopsy in 2017. Only 1 proved inconclusive and required repeat procedure. 26 patients had a suspected diagnosis documented pre-operatively based on radiological/clinical evidence. The most commonly suspected pathologies were low grade and high grade gliomas (9 and 15 patients). Of 25 patients with both a pre-operative differential and subsequent conclusive tissue diagnosis, 10 (40%) were ultimately given diagnoses which did not match the suspected pathology. Significantly, 1 biopsy diagnosed cerebral lymphoma.

Conclusions

Brain biopsy is a relatively safe and simple neurosurgical procedure which can reliably provide a definitive tissue diagnosis. We have demonstrated how it remains a crucial component in formally establishing diagnosis prior to determining optimum management plans.
P9 Impact of the relocation of a regional neuroscience service on major trauma patients
Authors: Cabaret C , Nelson M , Foroughi M
Published: February 2019

Objectives

Evaluating the impact of relocating a regional neuroscience service on major trauma patients.

Design

Retrospective analysis of prospectively collected data from 01/08/2013 to 31/07/2017.

Subjects

Patients≥20 years with a TBI in the 2 years pre-relocation (cohort 1) and 2 years post-relocation (cohort 2).

Methods

Patients were identified using the TARN registry. Comparison of the cohorts for demographics, type of neurosurgical input, site of first presentation and the times to first CT head and operation was conducted using cross-tabulation, percentages and statistical analysis (SPSS).

Results

30% of patients in cohort 1 (112 or 373) were admitted in neurosurgery. This increased to 40% of patients in cohort 2 (181 of 450). There was an increase in admissions for monitoring (70% vs 82%). Patients<60 years had a higher increment in admission (+16 points) than patients≥60 years (+8 points). A strong association was found between the relocation of the neuroscience service and the increase in proportion of patients first transported to the major trauma centre (63% vs 74%; p=0.037). There was a significant decrease in the mean time to operation (3.9 hour vs 2.0 hour; p=0.008) and no significant difference in the mean time to first CT head (1.3 hour vs 1.4 hour; p=0.689).

Conclusions

The relocation of neurosurgery has resulted in a significant increase in admission of patients<60 years with TBI in neurosurgery for monitoring, an increase in the proportion of patients first transported to the MTC and a reduction in the time to operation.
P10 Traumatic brain injury outcomes in older adults: is there an age-dependent cut off?
Authors: Lavrador JP , Rajwani KM , Ansaripour A , Maratos E , Tolias C
Published: February 2019

Objectives

To assess the outcomes in patients>60 years with traumatic brain injury (TBI) and determine if there is an age cut-off for worse prognosis.

Design

Single centre retrospective study. Data collected as part of TrIBAL study.

Subjects

All patients with TBI admitted to our hospital over a 4 month period.

Methods

Patients were divided into 6 groups based on their age; group 0 included patients<60 years, 60≤Group 1<65, 65≤Group 2<70, 70≤Group 3<75, 75≤Group 4<80 and Group 5>80. Data was collected on various factors that influence outcomes in TBI patients including presenting GCS, hypotension, hypoxia, antithrombotic therapy and Marshall CT score. Glasgow outcome score (GOS) at discharge from hospital was used. A multinomial logistic regression analysis was performed.

Results

Over the 4 month period 144 patients with TBI were admitted. There were no significant differences in baseline characteristics including presenting GCS and Marshall CT scores between the groups. The GOS at discharge was significantly worse only in Group 5 when Group 0 was considered as the base outcome (p<0.001). Groups 1 to 5 had a significant increased number of patients on antithrombotic therapy when compared with Group 0 (p<0.05). The adjusted analysis for GOS at discharge revealed the use of antithrombotic therapy in Group 5 was the only factor that influenced outcome (p=0.014).

Conclusions

In this cohort, age >80 years was the cut off for worse prognosis. In this age group anticoagulation was the only factor we found that influenced outcome.
P14 Management of traumatic skull base fractures and their complications – a seven-year experience
Authors: Matloob SA , Hanrahan J , McKenna GS , Uff C , Paraskevopoulos D
Published: February 2019

Objectives

We aim to present our experience of managing traumatic base of skull fractures and our outcomes.

Design

Retrospective case note review.

Subjects

All patients in our trauma database with radiographic evidence of a skull base fracture from January 2010 to June 2017.

Methods

Skull base fractures were classified according to their anatomical location. Evidence of vascular injury, CSF leak or cranial nerve injury were recorded. The mechanism of injury, length of follow up, interventions and outcomes were documented.

Results

872 cases had a skull base fracture diagnosed by head CT scan, of which 760 had sufficient radiological and clinic data to analyse. 79.4% of the cohort were male, with a mean age of 43 years. Median length of stay was 8 days and median length of follow up was 114 days. 40.1% were lost to follow up. The mortality rate was 14.9%. Injuries predominantly affected the middle cranial fossa. Vascular injury was the commonest complication (n=87), followed by CSF leak (n=38). 28 patients sustained injury to the facial nerve. Complications were managed conservatively in most cases.

Conclusions

There is little reported literature on the long term outcomes of patients who sustain CSF leak, vascular injury or cranial nerve deficit following a base of skull fracture. In our experience, many of these patients are lost to follow up and indeed, the nature of this study is limited by it’s retrospective nature. Further prospective work must be done in this patient group to better understand the history of these patients.
P16 Relation of timing of surgery to outcome from traumatic acute subdural haematoma
Authors: Paranathala M , Quake S , Prasad M
Published: February 2019

Objectives

Acute subdural haemorrhage (ASDH) is a neurosurgical emergency with high mortality and morbidity rates. Time to surgical intervention is implicated as an important factor affecting patient outcomes, however, more recent studies do not support this. We aimed to determine the correlation between time interval to surgery and outcome of patients with traumatic ASDH.

Methods

We retrospectively reviewed consecutive ASDH patients who underwent haematoma evacuation in the period between 2010 and 2016 at this tertiary neurosurgical centre. 49 patients were included for the analysis. Patient data was extracted from theatre records, patient notes and electronic records.

Results

The median time interval from injury to surgery was 403 min (6 hours 43 min) with road traffic accident being the commonest mechanism of injury. 20 of 49 (34.7%) patients underwent evacuation within five hours from time of injury. Of these, 12 (41.4%) had good recovery (GOS 5), versus 15 (51.7%) amongst the 29 patients who underwent operation after five hours. Spearman rank correlation test (rs=0.07375) showed no statistically significant correlation between time interval to surgery and patient outcomes as measured by GOS. The overall mortality rate of evacuated patients at JCUH was 8.16% and the majority had good functional status, 55.1% with GOS 5.

Conclusions

Longer time interval of more than four hours from injury to surgical intervention was not associated with higher mortality rate, or worse functional outcome.
P17 Evaluation of new orleans criteria for cranial CT scan in mild traumatic brain injury at an emergency trauma unit of a developing country
Authors: Yusuf AS , Mahmud MR , Dalhat NK , Olayiwola AI , Alfin JD , Abimbola AI
Published: February 2019

Objectives

To assess compliance to New Orleans Criteria for cranial CT scan and its predictive value for intracranial pathology in mild TBI.

Design

A retrospective review.

Subjects

All patients with mild traumatic brain injury presenting at the emergency unit of a National Trauma Centre of a Developing Country over 24 months.

Methods

Patients information were retrieved from medical record and entered into SPSS spreadsheet. The New Orleans Criteria (NOC) was used to determine indications for brain CT scan. Compliance to the criteria was determined. The CT scan findings were evaluated in all patients that had scan and the findings were compared between those met NOC and those who did not.

Results

One-hundred and eighteen patients were studied. Majority were males 92 (82%) with mean age of 27 year. Most injuries (66.9%) resulted from road traffic crashes. Among 65 (55.1%) patients who met NOC only 41 (63.1%) had CT scan while 25 (47.2%) patients who did not had CT giving a compliance rate of 58.5%. Twenty three (56.1%) patients who met NOC had abnormal CT compared to 9 (36%) patients that did not. The most common abnormal CT findings in both groups were skull vault fractures (9 for NOC group and 2 for non NOC group) only two patients had surgical intervention and both met NOC criteria.

Conclusions

The compliance for NOC guideline was below average in our Centre. NOC guideline is useful in predicting abnormal CT findings. There is a need for continuous education of emergency physicians to ensure optimal CT scan utilisation in mild TBI.
P18 The role of decompressive craniectomy for traumatic brain injury: should we be leaving the lid off?
Authors: Saukila LF , Little B , Phillips NI , Anderson IA
Published: February 2019

Objectives

The RESCUEicp study has not culminated in consensus about the role of decompressive craniectomy following head injury. Another study (RESCUE-ASDH) also questions craniectomy for patients with ASDH. We examined our own practice over 5 years.

Design

Retrospective analysis at a single UK unit. Comparison of outcomes with RESCUEicp results and national data obtained from the Neurosurgical National Audit Programme (NNAP).

Subjects

82 patients over 5 years. 87% male. 90% adults (age >16).

Methods

Local data: demographics, CT features, pre-op GCS/pupil reaction/ICP, primary/secondary craniectomy, operative timings, length of stay (critical care/overall), Extended Glasgow Outcome Scores, discharge location. NNAP data analysis.

Results

43% had ASDH with MLS >5 mm (91% primary decompression). Median time to primary surgery from referral 1 h37. 11 primary, 6 secondary decompressions/year; no change over 5 years 3 extensions of craniectomy, 3 had previous craniotomy converted. 30 day mortality 28%. Overall GOS-E: death 33%, lower severe disability 6%, upper severe disability 6%, moderate disability 16%, good recovery 37% (improved by better presentation GCS). 75% had cranioplasty. Median length of stay 41 days.

Conclusions

Our practice has not changed over time, despite RESCUEicp. Good outcomes observed may be due to local specialist management of these patients, or reflect judicious case selection. Case-by-case decisions are crucial and may explain why large trials fail to change real-world management strategies. NNAP data comparison ongoing.
P23 Investigating synaptopathy following traumatic brain injury in a preclinical model
Authors: Jamjoom AAB , Qui Z , Rhodes J , Andrews PJD , Grant SGN
Published: February 2019

Objectives

The impact of Traumatic Brain Injury (TBI) on the synapse is poorly understood. We examined the impact of TBI on the distribution of two postsynaptic density proteins (PSD95 and SAP102) at single-synapse resolution.

Subjects

44 male transgenic knock-in mice, aged 8–16 weeks, expressing fluorescently labelled PSD95 and SAP102.

Methods

Mice were randomised to a mild lateral fluid percussion injury (LFPI) or sham treatment and brain sections were examined at 7 and 28 days. Using high resolution confocal microscopy and machine learning algorithms, the synaptic puncta density, size and intensity were mapped across 222 brain regions. Microglia and presynaptic changes were indexed using Iba1 and SV2A immunostaining. Pearson correlation and t-tests were used (significance p<0.05).

Results

We found a significant reduction in synaptic puncta density at 28 days post-injury in brain regions distal to the injury site including the hippocampus. PSD95 and SAP102 density changes had a strong positive correlation at 28 days (r=0.8; p<0.0001). We also observed evidence of synapse recovery in the ipsilateral cortex between 7 and 28 days. Puncta density had a positive correlation with SV2A (r=0.7; p<0.01) and a negative correlation with (r=−0.6; p<0.001) Iba1 count.

Conclusions

Focal LFPI induced progressive region-specific loss of synapses for which microglia may play a role. Our study highlights the value of brain-wide synaptome mapping technology and suggests a capacity for synaptic recovery which could be a therapeutic target.
Farming tasks and the development of rheumatoid arthritis in the agricultural health study
Authors: Parks Christine G , Meyer Armando , Beane Freeman Laura E , Hofmann Jonathan N , Sandler Dale P
Published: February 2019

Objectives

Farming has been associated with rheumatoid arthritis (RA). Some studies have evaluated the effects of pesticides, but other agricultural exposures may also affect immune response.

Methods

We investigated non-pesticide agricultural exposures in relation to RA in licensed pesticide applicators (n=27 175, mostly male farmers) and their spouses (n=22 231) in the Agricultural Health Study (AHS) cohort (1993–1997) who completed at least one follow-up survey through 2015. Incident RA cases (n=229 applicators and 249 spouses) were identified based on self-report confirmed by use of disease-modifying antirheumatic drugs or medical records. Hazard Ratios (HRs) and 95% Confidence Intervals (CIs) were estimated by Cox proportional hazard models adjusting for applicator status, state, smoking, education and specific pesticide use, allowing estimates to vary by median age when hazards assumptions were not met.

Results

Overall, RA was associated with regularly applying chemical fertilisers (HR=1.50; 95% CI 1.11 to 2.02), using non-gasoline solvents (HR=1.40; 95% CI 1.09 to 1.80), and painting (HR=1.26; 95% CI 1.00 to 1.59). In older applicators (>62 years), RA was associated with driving combines (HR=2.46; 95% CI 1.05 to 5.78) and milking cows (HR=2.56; 95% CI 1.01 to 6.53). In younger participants (≤62 years), RA was inversely associated with raising animals as well as crops (HR=0.68; 95% CI 0.51 to 0.89 vs crops only). Associations with specific crops varied by age: some (eg, hay) were inversely associated with RA in younger participants, while others (eg, alfalfa) were associated with RA in older participants.

Conclusion

These findings suggest several agricultural tasks and exposures may contribute to development of RA.
Raymond John Imberger
Authors: Imberger Tricia
Published: February 2019

Always known as ‘the Australian vet’, he had an integral role at a number of equine studs. His empathy and intuition with animals were renowned.
Thermal dependence of size-at-hatch in the lake whitefish (Coregonus clupeaformis)
Authors: Mitz Charles , Thome Christopher , Cybulski Mary Ellen , Somers Christopher M. , Manzon Richard G. , Wilson Joanna Y. , Boreham Douglas R.
Published: February 2019

Lake whitefish (Coregonus clupeaformis) embryos incubated at low temperatures have a longer incubation period and hatch at a significantly greater size than those incubated at warmer temperatures. We examined hatch timing and morphological characteristics for whitefish embryos reared under different constant and varying temperatures to determine whether the thermal dependence of hatching size reflects differences in their development stage. Our results show that lake whitefish embryos hatch at different temperature-dependent developmental stages, and this is the dominant factor affecting size-at-hatch. The term “heterograde” is proposed for the thermal dependence of hatching stage to differentiate it from hatching that occurs at a fixed developmental stage. A method to quantify this effect is given using a ratio that describes the difference in relative development at hatching between different viable constant incubation temperatures. Heterograde hatching is proposed as a possible mechanism to synchronize the timing of hatch to the break-up of winter ice cover despite variability in the date of spawning and in the onset of spring break-up.
QUANTILE ANALYSIS OF INVESTMENT IN PRIVATE PARTICIPATION IN INFRASTRUCTURE PROJECTS
Authors: YANG JIE , WU WUQING , MAO XIAO , CAI ZONGWU
Published: February 2019

Understanding the factors influencing investor’s decision to participate in a private participation in infrastructure (PPI) project is key to mobilizing private funding and closing up infrastructure financial gap among developing countries. However, inconsistent empirical results have been obtained in the literature regarding the importance of PPI determinants. Different from the existing literature, we propose using a quantile regression method to reconcile the discrepancy and capture a non-homogeneous relationship between various affecting factors and PPI investment based on data from Belt and Road (B&R) countries. As investment size grows, institutional factors, such as country’s stability, degree of democracy and regulatory quality, play an increasingly critical part in drawing funds, and investors become more sensitive towards country’s governance standard. With regard to multilateral development banks’ (MDBs’) role in supporting PPI and its underlying mechanisms, our results show that MDBs’ aiding role is more significant among medium and large-scaled projects and monetary support is proved to be the most efficient means among other support types offered by MDBs. Further test reveals that instead of hindering PPI investment due to potentially conflicting objectives among multiple MDBs, MDBs’ joint effort in one PPI project shows a compounded positive effect on PPI financing, suggesting that an increased collaborations among MDBs may be beneficial. However, no empirical support is found between financial market development of host country and total PPI investments. Overall, this study sheds lights on host country and MDBs’ future policy designs along B&R countries.
Predicting Amputation and Multiple Debridements in Tooth Knuckle Injuries
Authors: Smith H.R. , Conyard C. , Loveridge J. , Gunnarsson R.
Published: February 2019

Background: Tooth knuckle injuries can be expensive to treat and may necessitate amputation in some cases. Several limitations exist in the literature regarding our knowledge around the factors predicting amputation and the need for multiple debridements in treating this injury.

Methods: A historic cohort study of 321 patients treated for tooth knuckle injuries was undertaken. Twenty-one demographic, clinical and laboratory variables were collected. Two outcome measurements were collected - the need for amputation and the need for more than one surgical debridement. A multivariate logistic regression was performed to determine the relationship between the predictor variables and the outcome measurements.

Results: Of the 321 patients examined, 1.6% required amputations and 25% required multiple debridements. Osteomyelitis was found to be a major predictor for amputation in these patients (OR = 35). Delayed presentation (OR = 1.1) and diabetes (OR = 2.6) were found to significantly increase the risk of requiring multiple debridements.

Conclusions: Our models were able to predict what patients were at the greatest risk for amputation and multiple debridement. Reducing rates of osteomyelitis and delays in presentation may help reduce the incidence of amputation and reoperation in this injury.
Ulnar Variance in Scaphoid Fractures: Retrospective Analysis of 182 Cases
Authors: Osinga Rik , Estermann L. , Klein H.J. , Schibli-Beer S. , Jandali A.R. , Hug U.
Published: February 2019

Background: Literature provides little and controversial evidence regarding the influence of ulnar variance (UV) on the incidence of scaphoid fractures. The aim of this retrospective study was to assess UV in a large number of patients with acute scaphoid fracture in comparison to a control group of the same population.

Methods: During a two year period, 182 patients with acute scaphoid fractures (fracture group) and 182 ethnicity-, gender- and age-matched patients with wrist contusions (control group) were treated in three non-university hospitals. Using standardized digital wrist radiographs, UV values were measured by means of the method of perpendiculars by two independent examiners. The UV values of the fracture group were then compared to the UV values of the control group.

Results: Analyses of the agreement between the two raters resulted in a good to excellent inter-item correlation of 0.89, with a high intra-class coefficient of 0.93 (95% confidence interval: 0.87–0.95). Mean (SD) UV value was -0.82 mm (1.77) in the fracture group and 0.27 mm (1.44) in the control group. Paired sample t-test showed a significant difference between the two groups (p < 0.0001).

Conclusions: According to this study, patients with scaphoid fractures are significantly more likely to show a negative UV than matched patients with wrist contusions.
Citation Analysis of Articles about Hand Surgery Published in Orthopaedic and Hand Surgery Journals
Authors: Fujihara Yuki , Fujihara Nasa , Yamamoto Michiro , Hirata Hitoshi
Published: February 2019

Background: To date, little is known about the characteristics of highly cited studies in hand surgery compared with other orthopaedic subspecialties. We aimed to assess the position of hand surgery within the orthopedic surgery literature.

Methods: We conducted a bibliographic analysis using the Web of Science database to review 1,568 articles published between January 2012 and December 2012 in 4 relevant general orthopedic and 2 hand surgery journals. We used the number of citations within 3 years of publication to measure the impact of each paper. To analyze prognostic factors using logistic regression analysis, we extracted data on orthopedic subspecialty, published journal, location of authorship, and type of study for all articles. For clinical studies, we also recorded details on study design and sample size.

Results: Of eligible hand surgery articles (n = 307), the majority (62%) were case reports/series. Only 19% were comparative studies, comprising a significantly smaller proportion of comparative studies from other subspecialties in general orthopedic journals. Systematic reviews/meta-analyses generated a significantly higher number of average citations, whereas educational reviews were consistently cited less frequently than other study types (14.9 and 6.1 average citations, respectively). Being published in the Journal of Bone and Joint Surgery, American volume, having authorship in North America or Europe and Australia, focusing on subspecialties like hip & knee, sports, or shoulder, utilizing a comparative or randomized clinical trial study design, and having a larger sample size increased the odds of receiving more citations.

Conclusions: Clinical studies related to hand surgery published in general orthopedic journals are most often of lower quality study design. Having a larger sample size or using a comparative study or randomized clinical trial design can improve the quality of study and may ultimately increase the impact factor of hand surgery journals.
Cross-Shaped Bone Grafting and Locking Plate Fixation for Arthrodesis of the Trapeziometacarpal Joint: Surgical Technique and Early Mobilization
Authors: Muramatsu Keiichi , Tominaga Yasuhiro , Hashimoto Takahiro , Taguchi Toshihiko
Published: February 2019

Background: The trapeziometacarpal joint is the second most common site of osteoarthritis in the hand and the most frequent one to require surgery. Arthrodesis of the trapeziometacarpal joint is recognized as one of the valuable technique but unfortunately there has been wide variation in the union rate. The purpose of this study was to evaluate a new arthrodesis technique involving a cross-shaped bone graft and locking plate fixation.

Methods: Eleven male patients diagnosed as Eaton’s stage III osteoarthritis of the trapeziometacarpal join were treated in our institute. The mean patient age was 62 years (range 50 to 80 years). At the day after surgery, physical therapy was started and free use of the hand was permitted.

Results: Patients showed radiographic evidence of trapeziometacarpal joint union after an average postoperative period of 8.3 weeks (range 6–12 weeks). The VAS pain score significantly decreased from 7.2 points preoperatively to 0.4 points after surgery. Mean side pinch strength increased significantly from 3.8 kg (53% compared to unaffected side) prior to surgery to 6.2 kg (86%). The DASH score improved from 38.6 (range 34.1–43.2) preoperatively to 17.0 (6.8–22.7) postoperatively.

Conclusions: These data suggested that our technique is a successful procedure for the trapeziometacarpal joint arthrodesis. Cross-shaped bone grafts have the advantages of restoring thumb length and providing internal stabilization, especially for rotational force. No complications arose at the bone harvest site of the iliac crest. The procedure seems to be technically demanding, particularly for adapting the bone graft to perfectly match the shape of the defect.
Clinical Outcomes of Zone 2 Flexor Tendon Repairs Using the Modified Lim/Tsai Technique
Authors: Chang Min Kai , Acharyya Sanchalika , Lim Zeus Yiwei , Tay Shian Chao
Published: February 2019

Background: The single looped suture modified Lim/Tsai technique is widely used for flexor tendon repairs. It has been shown to possess better biomechanical properties and require less repair time per tendon as compared to the double looped suture original Lim/Tsai technique. However, there is no clinical data on the modified technique.

Methods: The retrospective study included zone 2 flexor tendon repairs made using the modified Lim/Tsai technique from January 2008 to December 2014. Clinical outcome was assessed using the revised Strickland and Glogovac criteria, which categorises repairs based on the total active motion of the repaired digit.

Results: Sixty-two patients with 74 digits were included. The overall mean total active motion was 122°. The overall satisfactory outcome of the modified Lim/Tsai technique was 81.1%. The rupture rate of the modified Lim/Tsai technique was 2.7%. Using multivariate linear regression model, we found that outcomes were negatively influenced by subzone 2C and crush/saw injuries, but not by concomitant neurovascular injuries or post-operative follow-up duration.

Conclusions: Based on this retrospective study of patients with zone 2 flexor tendon injuries, the clinical outcomes of modified and original Lim/Tsai techniques are comparable. As such, there is no clinical evidence favouring one over the other.
Repair of Chronic Concomitant Avulsion Fractures of the Extensor Carpi Radialis Longus and Brevis
Authors: Beutel Bryan G. , Melamed Eitan
Published: February 2019

Combined simultaneous radial wrist extensor injuries, namely ipsilateral extensor carpi radialis longus (ECRL) and brevis (ECRB) avulsion fractures, are rare. While non-operative management with cast immobilization has been described, most recommend operative intervention in the acute setting. Surgical repair of chronic injuries, however, has received little attention in the literature. This case describes a 50-year-old male who sustained combined ipsilateral ECRL and ECRB avulsion fractures from the bases of the index and middle metacarpals. Five months after the initial trauma, he underwent surgical repair with lengthening of the tendons using a novel technique and suture anchor fixation. This case demonstrates that successful repair of this rare injury can be achieved with retracted extensor tendons in the chronic setting.
Two-Staged Reconstruction for Symptomatic Humeral Medial Epicondyle Nonunion in Children: A Case Report
Authors: Namba Jiro , Miyamura Satoshi , Okamoto Michio , Yamamoto Koji
Published: February 2019

Few cases of humeral medial epicondyle nonunion develop to symptomatic condition. We report a pediatric case of distally displaced nonunion. At first, the palliative repair surgery was chosen due to irreduciblity of the epicondyle fragment at 10 years old. After 2 years and 3 months wait for maturation of ossification at the trochlea, the definitive surgery consisting of epicondylectomy and ligament reconstruction was performed. This is the first pediatric case of humeral medial epicondyle nonunion with an unossified trochlea which needed a two-staged surgery. We highlight the surgical plan aimed at anatomical ligament reconstruction focusing an isometric point of MCL.
Reinnervation of Extrinsic Finger Flexors and Brachioradialis 22 and 36 Months Following Traumatic Pan-Brachial Plexopathy: A Case Report
Authors: Head Linden K. , Wolff Gerald , Boyd Kirsty U.
Published: February 2019

A 25-year-old man sustained a right-sided brachial plexus injury from a high-velocity motocross accident. Physical examination and electromyography were consistent with a pan-brachial plexopathy with no evidence of axonal continuity. The patient underwent a spinal accessory to suprascapular nerve transfer and an intercostal to musculocutaneous nerve transfer with interpositional sural nerve grafts. He recovered MRC 4/5 elbow flexion and MRC 2/5 shoulder abduction and external rotation. Twenty-two months post-injury the patient displayed a flicker of flexion of his flexor pollicis longus and flexor digitorum profundus to his index finger – he went on to recover a functional pinch. Thirty-six months post-injury the patient displayed a flicker of contraction in brachioradialis with motor unit potentials on electromyography. This case demonstrates that some patients may have capacity for functional recovery after prolonged denervation and highlights the potential impact of anatomical anomalies in the assessment and treatment of peripheral nerve injuries.
Evaluating Digital Cultural Heritage ‘In the Wild’
Authors: Galani Areti , Kidd Jenny
Published: February 2019

Digital heritage interpretation is often untethered from traditional museological techniques and environments. As museums and heritage sites explore the potential of locative technologies and ever more sophisticated content-triggering mechanisms for use outdoors, the kinds of questions that digital heritage researchers are able to explore have become increasingly more complex. Researchers now find themselves in the realm of the immersive, the experiential, and the performative. Working closely with their research participants, they navigate ambiguous terrain, including the often unpredictable affective resonances that are the direct consequences of interaction.

This article creates a dialogue between two case studies which, taken together, help to unpack some key methodological and ethical questions emerging from these developments. First, we introduce
With New Eyes I See,
an itinerant and immersive digital heritage encounter which collapsed boundaries between physical/digital, fact/fiction and past/present. Second, we detail
Rock Art on Mobile Phones
, a set of dialogic web apps that aimed to explore the potential of mobile devices in delivering heritage interpretation in the rural outdoors.

Looking outward from these case studies, we reflect on how traditional evaluation frameworks are being stretched and strained given the kinds of questions that digital heritage researchers are now exploring. Drawing on vignettes from experience-oriented qualitative studies with participants, we articulate specific common evaluative challenges related to the embodied, multimodal, and transmedial nature of the digital heritage experiences under investigation. In doing so, we make the case for reflexivity as a central and more collaborative feature of research design within this field going forward — paying attention to and advocating the reciprocal relationship between researchers and the heritage experiences that we study.
Dependencies for Graphs
Authors: Fan Wenfei , Lu Ping
Published: February 2019

This article proposes a class of dependencies for graphs, referred to as
graph entity dependencies
(GEDs). A GED is defined as a combination of a graph pattern and an attribute dependency. In a uniform format, GEDs can express graph functional dependencies with constant literals to catch inconsistencies, and keys carrying id literals to identify entities (vertices) in a graph. We revise the chase for GEDs and prove its Church-Rosser property. We characterize GED satisfiability and implication, and establish the complexity of these problems and the validation problem for GEDs, in the presence and absence of constant literals and id literals. We also develop a sound, complete and independent axiom system for finite implication of GEDs. In addition, we extend GEDs with built-in predicates or disjunctions, to strike a balance between the expressive power and complexity. We settle the complexity of the satisfiability, implication, and validation problems for these extensions.
Graph-Based Skill Acquisition For Reinforcement Learning
Authors: MendonÇa Matheus R. F. , Ziviani Artur , Barreto AndrÉ M. S.
Published: February 2019

In machine learning, Reinforcement Learning (RL) is an important tool for creating intelligent agents that learn solely through experience. One particular subarea within the RL domain that has received great attention is how to define macro-actions, which are temporal abstractions composed of a sequence of primitive actions. This subarea, loosely called skill acquisition, has been under development for several years and has led to better results in a diversity of RL problems. Among the many skill acquisition approaches, graph-based methods have received considerable attention. This survey presents an overview of graph-based skill acquisition methods for RL. We cover a diversity of these approaches and discuss how they evolved throughout the years. Finally, we also discuss the current challenges and open issues in the area of graph-based skill acquisition for RL.
Top-N Recommendation with Multi-Channel Positive Feedback using Factorization Machines
Authors: Loni Babak , Pagano Roberto , Larson Martha , Hanjalic Alan
Published: February 2019

User interactions can be considered to constitute different feedback channels, for example, view, click, like or follow, that provide implicit information on users’ preferences. Each implicit feedback channel typically carries a unary, positive-only signal that can be exploited by collaborative filtering models to generate lists of personalized recommendations. This article investigates how a learning-to-rank recommender system can best take advantage of implicit feedback signals from multiple channels. We focus on Factorization Machines (FMs) with Bayesian Personalized Ranking (BPR), a pairwise learning-to-rank method, that allows us to experiment with different forms of exploitation. We perform extensive experiments on three datasets with multiple types of feedback to arrive at a series of insights. We compare conventional, direct integration of feedback types with our proposed method, which exploits multiple feedback channels during the
sampling
process of training. We refer to our method as
multi-channel
sampling. Our results show that multi-channel sampling outperforms conventional integration, and that sampling with the relative “level” of feedback is always superior to a level-blind sampling approach. We evaluate our method experimentally on three datasets in different domains and observe that with our multi-channel sampler the accuracy of recommendations can be improved considerably compared to the state-of-the-art models. Further experiments reveal that the appropriate sampling method depends on particular properties of datasets such as popularity skewness.
Survey on Brain-Computer Interface
Authors: Bablani Annushree , Edla Damodar Reddy , Tripathi Diwakar , Cheruku Ramalingaswamy
Published: February 2019

A brain-computer interface (BCI) provides a way to develop interaction between a brain and a computer. The communication is developed as a result of neural responses generated in the brain because of motor movements or cognitive activities. The means of communication here includes muscular and non-muscular actions. These actions generate brain activities or brain waves that are directed to a hardware device to perform a specific task. BCI initially was developed as the communication device for patients suffering from neuromuscular disorders. Owing to recent advancements in BCI devices—such as passive electrodes, wireless headsets, adaptive software, and decreased costs—it is also being used for developing communication between the general public. The BCI device records brain responses using various invasive and non-invasive acquisition techniques such as electrocorticography (ECoG), electroencephalography (EEG), magnetoencephalography (MEG), and magnetic resonance imaging (MRI). In this article, a survey on these techniques has been provided. The brain response needs to be translated using machine learning and pattern recognition methods to control any application. A brief review of various existing feature extraction techniques and classification algorithms applied on data recorded from the brain has been included in this article. A significant comparative analysis of popular existing BCI techniques is presented and possible future directives are provided.
Better External Memory LCP Array Construction
Authors: Kärkkäinen Juha , Kempa Dominik
Published: February 2019

The suffix array, perhaps the most important data structure in modern string processing, needs to be augmented with the longest-common-prefix (LCP) array in many applications. Their construction is often a major bottleneck, especially when the data is too big for internal memory. We describe two new algorithms for computing the LCP array from the suffix array in external memory. Experiments demonstrate that the new algorithms are about a factor of two faster than the fastest previous algorithm. We then further engineer the two new algorithms and improve them in three ways. First, we speed up the algorithms by up to a factor of two through parallelism. Eight threads is sufficient for making the algorithms essentially I/O bound. Second, we reduce the disk space usage of the algorithms making them in-place: the input (text and suffix array) is treated as read-only, and the working disk space never exceeds the size of the final output (the LCP array). Third, we add support for large alphabets. All previous implementations assume the byte alphabet.
GRAINS
Authors: Li Manyi , Patil Akshay Gadi , Xu Kai , Chaudhuri Siddhartha , Khan Owais , Shamir Ariel , Tu Changhe , Chen Baoquan , Cohen-Or Daniel , Zhang Hao
Published: February 2019

We present a
generative neural network
that enables us to generate plausible 3D indoor scenes in large quantities and varieties, easily and highly efficiently. Our key observation is that indoor scene structures are inherently
hierarchical
. Hence, our network is not convolutional; it is a
recursive
neural network, or RvNN. Using a dataset of annotated scene hierarchies, we train a
variational recursive autoencoder
, or RvNN-VAE, which performs scene object grouping during its encoding phase and scene generation during decoding. Specifically, a set of encoders are recursively applied to group 3D objects based on support, surround, and co-occurrence relations in a scene, encoding information about objects’ spatial properties,
semantics
, and
relative
positioning with respect to other objects in the hierarchy. By training a variational autoencoder (VAE), the resulting fixed-length codes roughly follow a Gaussian distribution. A novel 3D scene can be generated hierarchically by the decoder from a randomly sampled code from the learned distribution. We coin our method GRAINS, for Generative Recursive Autoencoders for INdoor Scenes. We demonstrate the capability of GRAINS to generate plausible and diverse 3D indoor scenes and compare with existing methods for 3D scene synthesis. We show applications of GRAINS including 3D scene modeling from 2D layouts, scene editing, and semantic scene segmentation via PointNet whose performance is boosted by the large quantity and variety of 3D scenes generated by our method.