bluuebunny/crossref_metadata_2025 huggingface dataset:
Denosumab: A potential new treatment option for recurrent Aneurysmal Bone Cyst of the spine
Authors: Kulkarni Arvind G. , Patel Ankit
Published: April 2019

ABCs are expansile osteolytic lesions typically containing blood-filled spaces separated by fibrous septae. Standard treatment includes surgical resection or curettage and packing; however, for some spinal lesions, the standard approach is not optimal. One therapeutic strategy is to treat spinal ABC with an agent that targets a pathway that is dysregulated in a disease with similar pathophysiology. Denosumab, a human monoclonal antibody to RANKL is effective in the treatment of GCT's. Spinal ABCs are a therapeutic challenge and local recurrence is a concern. We report a case of aggressive recurrent ABC of dorsal spine in a 14-year old female with progressive neurologic deficit who underwent surgical excision and decompression with a recurrence in a short period for which a decompression and fixation was done. She had a recurrence after an asymptomatic period of 6 months and neurologic worsening. Having ruled out use of embolization and radiotherapy, a remission was achieved by treatment with Denosumab using the regimen for GCTs for a duration of 6 months. Follow-up MRI and CT scans at 24 months following inception of Denosumab depicted complete resolution and no recurrence. We conclude that Denosumab can result in symptomatic and radiological improvement in the recurrent locally aggressive ABC and may be useful in selected cases. Long-term results are mandatory to confirm the efficacy of Denosumab and to evaluate local recurrence after stopping Denosumab.
The use of pararectus approach for Type 3B Paprosky acetabular defect with intrapelvic cup migration. Case report
Authors: Abdelnasser Mohammad K. , Khalifa Ahmed A. , Khalifa Yaser E. , Bakr Hatem M. , Mahran Mohammad A. , Moustafa Mohammad A. , Mohammad Ayman K. , Abdelaal Ahmed M.
Published: April 2019

Case: A case of Type 3B Paprosky acetabular defect with intrapelvic cup migration where anterior column plating and cup extraction was done through an abdominal pararectus approach.

A male patient 63 years old reported progressive pain and walking disability after five years of cementless THR for right hip AVN.

CT pelvis showed loose intrapelvic migrated cup, extensive osteolytic acetabular defects, and pelvic discontinuity.

Pararectus approach was used to remove the cup and the head with concomitant plating of the anterior column

Conclusion: The pararectus approach is a valid option for intrapelvic cup extraction and pelvic discontinuity fixation.
Die lasche Beobachtung eines Staatsfeindes: Der DDR- und bundesdeutsche Psychiater und Psychotherapeut Dietfried Müller-Hegemann in den Akten der Stasi
Authors: Steinberg Holger
Published: April 2019

Diese Untersuchung ist die erste, die bewusst und gezielt das vom Ministerium für Staatssicherheit der DDR (MfS) über Jahrzehnte gesammelte Material über einen Psychiater zusammenträgt und auswertet.

Grundlage bilden die Akten der Behörde des Bundesbeauftragten für die Unterlagen des Staatssicherheitsdienstes der ehemaligen DDR (BStU), die einen Bezug zur Person Dietfried Müller-Hegemanns (1910-1989) aufweisen. Diese Sammlung von Akten verschiedenster Provenienz und aus unterschiedlichen Themenzusammenhängen enthält quantitativ und qualitativ sehr unterschiedlich relevantes Material.

Müller-Hegemanns Karriere in der DDR unterlag in den 1950er-Jahren einem politisch gewollten Auf- und schließlich in den 1960er-Jahren Abstieg, bis er 1971 in die Bundesrepublik wechselte. Einerseits lehnt sich das Material zwar eng an die Spezifität des hier präsentierten Falles an, andererseits aber eignet dieser sich sicherlich insofern als Exempel als man das allgemein übliche Vorgehen des MfS gut erkennen kann. Die hier ausgewerteten Quellen zeigen, dass obwohl Müller-Hegemann ab Ende der 1950er-Jahre zumindest von leitenden ministeriellen Mitarbeitern als auch von einzelnen SED-Hierarchien sogar als ‘Staatsfeind’ eingestuft und bekämpft worden war, er jedoch niemals gezielt in den Fokus des MfS geriet. Erst nach seiner ‘Republikflucht’ 1971 wurde er erstmals Gegenstand einer ‘operativen Bearbeitung’.

Die Zweifelhaftigkeit der Ermittlungsmethodik des MfS sowie das niemals vollständige Erreichen seiner Ziele, so hier z. B. den menschlichen Kontakt zu Zurückgelassenen vollständig zu unterbinden, stehen in diesem konkreten Fall als Beispiele dafür, dass das MfS an Grenzen stieß. Des Weiteren soll die in der Forschung aufzufindende Auffassung, dass Psychiater besonders im Fokus des MfS standen, aufgrund des hier untersuchten Einzelfalles zwar nicht angezweifelt werden, jedoch kann die Beobachtung Müller-Hegemanns nur als ausgesprochen lasch bezeichnet werden.
Das Horrorhaus des H. H. Holmes
Authors: Hardinghaus Christian
Published: April 2019

Der Großteil der Menschen, die nach Namen von Serienmördern gefragt werden, nennen Jack the Ripper, gefolgt von Ted Bundy, Jeffrey Dahmer und anderen „Altbekannten“ aus Funk und Fernsehen. Nur Wenige kennen den ersten Täter, der mit dem Etikett „Serial Killer“ versehen wurde. Und dann ist es ausgerechnet ein Arzt, der in einigen Geschichtsbüchern der Kriminologie als der weltweit erste Serienmörder geführt wird. Dies ist die Geschichte von H. H. Holmes, der sich selbst als Teufel bezeichnete. In seinem Horror-Haus fanden die Ermittler Überreste von hundert Leichen. Experten vermuten, dass er bis zu 200 Menschen umbrachte. Gestanden, bevor er hingerichtet wurde, hat Holmes 27 Morde. Damit ist der Namensvetter des britischen Roman-Detektivs zwar nicht der Serienkiller, mit den meisten Morden auf dem Konto, aber die perfide Art, mit der er seine Opfer in ein eigens dafür geschaffenes Hotel lockte und sie darin quälte, bevor er sie auf brutalste Weise umbrachte, machen ihn zu einem der schrecklichsten Serienmörder aller Zeiten.
Bewegungsförderung in der Pädiatrischen Onkologie – Strukturelle Voraussetzungen und Finanzierungsmöglichkeiten anhand des Leipziger Bewegungskonzepts
Authors: Söntgerath Regine , Küpper Luise , Wulftange Markus , Schepper Florian , Christiansen Holger
Published: April 2019

Regelmäßige körperliche Aktivität ist eine wichtige Voraussetzung für die Gesundheit und die Entwicklung von Kindern und Jugendlichen. Insbesondere während aber auch nach einer Krebserkrankung sind Kinder und Jugendliche jedoch in sehr geringem Umfang körperlich aktiv und weisen eine stark ausgeprägte körperliche Inaktivität auf. Diese chronische körperlich-motorische Unterforderung hat, zusätzlich zu den Nebenwirkungen der Behandlung, weitere negative Folgen für die Gesundheit, wie z. B. starke Einbußen der körperlichen Leistungsfähigkeit und der Lebensqualität. Um diese Folgen zu verringern, kann den PatientInnen im Rahmen von gezielten sporttherapeutischen Bewegungsangeboten Zugang zu regelmäßiger körperlicher Aktivität ermöglicht werden. Bewegungsförderung für Kinder und Jugendliche mit Krebserkrankungen stellt eine supportive Maßnahme zur Verbesserung und Erhaltung der funktionalen Mobilität, der körperlichen Leistungsfähigkeit und der gesundheitsbezogenen Lebensqualität dar. Für eine nachhaltige Bewegungsförderung müssen sowohl die Verhaltensebene (Person) als auch die Verhältnisebene (Lebenswelt) berücksichtigt werden. Anhand des Leipziger Bewegungskonzepts werden Einflussebenen auf die körperliche Aktivität von Kindern und Jugendlichen mit Krebserkrankungen erläutert sowie inhaltliche, systemische und strukturelle Voraussetzungen für die Implementierung einer behandlungsbegleitenden Bewegungsförderung in der Pädiatrischen Onkologie beschrieben. Zusätzlich werden Finanzierungsmöglichkeiten, basierend auf dem SGB V §43, aufgezeigt.
Body Composition and Visceral Adipose Tissue in Female Collegiate Equestrian Athletes
Authors: Dengel Olivia H. , Raymond-Pope Christiana J. , Bosch Tyler A. , Oliver Jonathan M. , Dengel Donald R.
Published: April 2019

To examine measures of total and regional body composition using dual X-ray absorptiometry (DXA) in NCAA Division I collegiate equestrian athletes, 31 female collegiate equestrian athletes were matched to a population of normal controls by age and body mass index. Total and regional fat tissue mass (FM), lean tissue mass (LM), bone mineral density (BMD), and abdominal visceral adipose tissue (VAT) were measured by DXA. Equestrian athletes had a significantly (p=0.03) lower total body fat percentage (%fat) than controls. There were no significant differences in total LM and VAT between equestrian athletes and controls. However, equestrian athletes, when compared to the controls, had significantly lower leg %fat, leg FM and higher leg LM. The greater leg LM in equestrian riders resulted in a smaller upper to lower body LM ratio compared to controls. There was no difference in leg BMD between equestrian athletes and controls. There were no significant differences between the 2 styles of riding (i. e., hunt seat and western style) in regards to body composition. The lower total %fat in equestrian athletes seems to be influenced by differences in leg composition, with equestrian athletes having significantly more LM and less FM.
A Cautious Note on Thalidomide Usage in Cancer Treatment: Genetic Profiling of the TBX2 Sub-Family Gene Expression is Required
Authors: Nemer Georges , Khalil Athar
Published: April 2019

Thalidomide is still by excellence the mysterious drug that fascinated, blurred, misled, and changed the scientific community perspectives and policies. It was introduced in the 1950’s as a sedative drug, then shortly withdrawn because of the devastating birth defects that affected tens of thousands throughout more than 40 countries. Back into the market in the mid 1990’s and 2000’s the drug is now being used to treat skin immune-related conditions and some cancers like multiple myeloma. Despite numerous beneficial effects which led to the development of new analogs, its direct mechanisms of action are still elusive. The identification of CRBN and TBX5 as potential direct ligands for this drug have opened the way to better understand its efficiency and its failure.

We hereby review these mechanisms and provide evidence that could explain why thalidomide failed to make it as a drug of choice in lung cancer treatment. Linking the genetic signature of TBX2 subfamily in these tumors to their inability to respond properly to thalidomide raises concerns of worsening lung cancer patients’ health if this drug is utilized.
How to Control Subannular Hemorrhage during Aortic Root Enlarging Procedures
Authors: Alameddine Abdallah , Binnall Brian , Conlin Frederick , Alameddine Khaled
Published: April 2019

We describe an effective suture technique to control the persistent subannular bleeding at the aortoventricular curtain in four patients with aortic stenosis and small annulus who underwent aortic root enlargement and patch reconstruction. This technique approximates the left atrial roof to the aortic root without the need for re-replacement of the aortic prosthesis or revision of the patch. Reintervention for aortic root, valve, or the residual aorta was not required.
Correlation between Lumbar Spine Facet Joint Orientation and Intervertebral Disk Degeneration: A Positional MRI Analysis
Authors: Jiang Xin , Chen Dong , Li Zhongshi , Lou Yahao
Published: April 2019

Background and Study Aims The contribution of facet joint orientation (FO) to degeneration of the functional units of the lumbar spine remains unclear. The study used positional magnetic resonance imaging (MRI) to evaluate the association between intervertebral disk degeneration and FO at the L3–L4 to L5–S1 spinal segments.

Material and Methods This was a retrospective study of 450 outpatients admitted to the Spine Surgery Department of our hospital between January 2013 and January 2015 and with positional lumbar MRI data. Grade of intervertebral disk degeneration, FO relative to the midsagittal plane, vertebral translation (VT), and angular variation (AV) were assessed.

Results No effect of baseline characteristics (age, sex, and body mass index) on intervertebral disk degeneration was observed. A significant difference in VT and AV was only present between grades 1 + 2 versus 4 at L5–S1 (both p = 0.005), and in FO only at L5–S1 between grades 1 + 2 versus 4 (p = 0.03) and grades 3 versus 4 (p = 0.04). AV and VT were correlated at all three lumbar segments (r = 0.224–0.309; p ≥ 0.01), with a correlation between FO and AV only at L3–L4 (r = 0.141; p = 0.035).

Conclusion Disk degeneration was associated with FO only at L5–S1. AV and VT of spinal segments of the mid to lower lumbar spine did not correlate with FO.
Hypertrophic Pisiform: A Case of Osteoid Osteoma
Authors: Hori Keiko , Nakamura Toshiyasu , Sato Kazuki , Ikegami Hiroyasu , Toyama Yoshiaki
Published: April 2019

We treated an extremely rare case of osteoid osteoma of the pisiform. Pisiform hypertrophy caused persistent pain and ulnar nerve irritation at Guyon's canal after the initial trauma. The re-enlargement of the pisiform attracted our attention allowing us to ultimately diagnose the condition as osteoid osteoma and treat the patient with a successful clinical result.
Research on the NOX concentration inversion based on the W-V-A wavelength selection method
Authors: Zhang Kai , Lu Houbing , Li Fei , Zhang Yujun , Shao Li
Published: April 2019

In view of the shortcomings of traditional wavelength selection algorithm in the processing of mixed NOX spectral data, combined with the absorption characteristics of engine exhaust component NO&NO2, the W-V-A (WPLS-VIP-ACO) spectral wavelength selection algorithm has been proposed. This algorithm combines the advantages of Ant Colony Optimization (ACO), Variable Importance in the Projection (VIP), and Weighted Partial Least Squares (WPLS) for the concentration inversion modeling. Wavelength selection and concentration inversion experiments have been carried out on the absorption spectrum of the mixed NOX with W-V-A algorithm. The results show that the wavelength of W-V-A algorithm has been selected and the concentration inversion of NOX has been performed precisely. The root mean square error (RMSEP) of NO concentrations has reduced from 0.0764 to 0.0095, and its cross validation of mean square error (RMSECV) has reduced from 0.0169 to 0.0078, meanwhile RMSEP of NO2 concentrations has reduced from 0.0123 to 0.0029, and its RMSECV has reduced from 0.0133 to 0.0041, all of which means the NOX concentration can be accurately inverted in the presence of interfering components. Moreover, compared with other traditional wavelength selection methods, W-V-A algorithm can minimize the RMSEP and RMSECV indicators of the established WPLS concentration inversion model with fewer wavelength points simultaneously.
Surface stress effects on the mechanical properties of silicon nanowires: A molecular dynamics simulation
Authors: Nasr Esfahani Mohammad
Published: April 2019

A primary challenge to use silicon nanowires as a truly potential building block in nanoscale devices is the implementation of scale effects into operational performance. Therefore, surface stress effects—as a direct result of size reduction—on transport properties became a major field of study. Previous computational simulations have focused so far on geometrical parameters with symmetrical cross sections, while silicon nanowires with nonsymmetrical cross sections are the major result of top-down fabrication techniques. A recent study has drawn a new aspect on the role played by the surface stress with a torsional profile on silicon nanowires to address the existing controversy from experimental and computational studies. Motivated by its success, the implications of this surface stress profile on the tensile properties of silicon nanowires are studied through molecular dynamics simulations. Deformation associated with the surface stress is computed for different length-to-thickness and width-to-thickness ratios. Then, tensile properties are investigated for a constant strain rate. Atomic calculations are carried out on silicon nanowires along the ⟨100⟩ crystal orientation for fixed-fixed and fixed-free boundary conditions. A combination of compressive uniaxial surface stress and torsional surface stress contributes to the mechanical behavior of silicon nanowires. A transition on elastic properties is obtained through changing the cross section from square to rectangular configuration. Further to addressing the controversy regarding the contribution of the surface stress on the mechanical properties, limits associated with available analytical approaches are highlighted for silicon nanowires.
Circular polarization is made to order in the extreme UV
Authors: Miller Johanna L.
Published: April 2019

Concepts from conventional optics underlie a flexible technique that uses high-energy photons to probe chiral effects.
Albert Einstein, celebrity physicist
Authors: Halpern Paul
Published: April 2019

In Einstein’s later years, although his contributions to physics became increasingly marginal and abstract, the press continued to trumpet his far-flung unification schemes as if they were confirmed scientific breakthroughs.
Origins of a Menschendarstellerin: Characterization and Operatic Performance in Fin-de-siècle Vienna
Authors: Gudesblatt Melanie
Published: April 2019

In fin-de-siècle Vienna frustrations with ‘lifelessness’ began to boil over. Unlike previous generations of opera-goers, however, the Viennese did not so much fear singers becoming automata as desire dramatic performance that foregrounded humanness and subjectivity. Critics increasingly fetishized vitality – manifested in characters with dramatic integrity and singers capable of nestling themselves in their roles – and by 1910 wanted singers to communicate their own interiority and ‘wilfulness’ as well. This article uses the reception of the soprano Marie Gutheil-Schoder (1874–1935) to demonstrate the growing currency of these imperatives. A controversial hire for the Hofoper, she was initially disparaged by critics as vocally ‘weak’, but the Viennese gradually ‘learnt to love this voice’ for the way in which it could be pressed into the service of the drama and her will. I explain her changing fortunes, arguing that opera-goers valued certain voices in accordance with evolving conceptions of characterization, acting technique and human subjectivity.
Boris Asafiev in 1948
Authors: Zuk Patrick
Published: April 2019

The venerable founder of Soviet musicology Boris Asafiev aroused widespread dismay by his actions in 1948 after the promulgation of a Central Committee resolution condemning the USSR's leading composers: he not only acquiesced in his appointment as chairman of the Composers’ Union, but agreed to give a keynote address endorsing the resolution at its first national congress. His admirers have claimed that he must have been coerced into collaboration and that his address did not reflect his real views. The present essay re-examines the circumstances, arguing that the evidence of Asafiev's willing complicity is overwhelming. A close analysis of his keynote address reveals its contents to be wholly consistent with views that he had regularly expressed throughout his career, as one of the principal progenitors of an anti-modernist, ethnic nationalist and xenophobic strain in Soviet writing on music that was given forceful expression in the 1948 resolution.
RETRACTED: One-Leap Fuzzy Enabled Clustering Technique for Under Water Wireless Sensor Networks to Improve the Stability and Energy Exhaustion Rate of the Nodes
Authors: Viswa Bharathy A M , Krishna Chaitanya Rao K
Published: April 2019

UWSNs will find packages in information series, oceanographic, environmental monitoring and surveillance. UWSNs are difficult to deploy and collect data where the conditions are unpredictable and unreliable. These UWSN nodes collaborate together and perform collective operations which is highly challenging due to the prevailing factors. The fact underwater communications are significantly laid low with network dynamics, because of massive inter-diffusion delays are true. The communication dynamics within the UWSN could be influenced greatly by the integrity of the nodes in the network. The motto of this technique is to alleviate the exhaustion rate and aggravate the stability of the network with cluster head selection algorithm and proposed algorithm One-Leap Fuzzy based Clustering Technique (OL-FCT). Cluster head selection process will be performed with particle swarm optimization approach. The experimental consequences of the work compared with the present strategies shows that OL-FCT performs better than other techniques.
Pregnancy in women with cystinosis
Authors: Blakey Hannah , Proudfoot-Jones Jemma , Knox Ellen , Lipkin Graham
Published: April 2019

Cystinosis is a rare autosomal recessive disease causing cystine deposition in all tissues, primarily affecting the kidneys. There are few published reports of pregnancy in women with cystinosis, and little evidence is available regarding optimal management. Kidney transplantation and cystine-depleting therapy have transformed the prognosis of cystinosis, and pregnancy is increasingly considered. The evidence base for cystinosis management in pregnancy, therefore, requires expansion. We report three successful pregnancy outcomes and five early pregnancy losses in two women with cystinosis. The challenges of pregnancy in patients with cystinosis are discussed. Pre-pregnancy planning and antenatal management in a specialist renal obstetric clinic are paramount.
Enhanced SVM–KPCA Method for Brain MR Image Classification
Authors: Neffati Syrine , Ben Abdellafou Khaoula , Taouali Okba , Bouzrara Kais
Published: April 2019

Automated classification of magnetic resonance brain images (MRIs) is a hot topic in the field of medical and biomedical imaging. Various methods have been suggested recently to improve this technology. In this paper, to reduce the complexity involved in the medical images and to ameliorate the classification of MRIs, a novel 3D magnetic resonance (MR) brain image classifier using kernel principal component analysis (KPCA) and support vector machines (SVMs) is proposed. Experiments are carried out using A deep multiple kernel SVM (DMK-SVM) and a regular SVM. An algorithm entitled SVM–KPCA is put forward. Its main task is to classify a brain MRI as a normal brain image or as a pathological brain image. This algorithm, firstly, adopts the discrete wavelet transform technique to extract features from images. Secondly, KPCA is applied to decrease the dimensionality of features. SVM is then applied to the reduced data. A K-fold cross-validation strategy is used to avoid overfitting and to ameliorate the generalization of the SVM–KPCA algorithm. Three databases are used to validate the suggested SVM–KPCA method. Three conclusions are obtained from this work. First, KPCA is highly efficient in increasing the classifier’s performance compared with similar algorithms working on the proposed database. Second, the SVM–KPCA algorithm performs well in differentiating between two classes of medical images. Third, the approach is robust and might be utilized for other MRIs. This proposes a significant role for computer aided diagnosis analysis systems used for clinical practice.
A bivalent fusion vaccine composed of recombinant Apx proteins shows strong protection against Actinobacillus pleuroneumoniae serovar 1 and 2 in a mouse model
Authors: Park Byung-Sun , Lee Nakhyung
Published: April 2019

Actinobacillus pleuropneumonia (APP) causes porcine pleuropneumoniae, resulting in severe economic losses in the swine industry. Since there are diverse serotypes of APP, it is necessary for vaccines to induce cross-protection. In this report, we developed a bivalent fusion vaccine, the L vaccine composed of ApxIA and ApxIIA fragments. According to the experimental results of the L vaccine, recombinant protein specific-IgG antibody level increased significantly as well as Apx toxin specific-IgG antibody, suggesting toxin-neutralizing effect. Also, the production of both IgG1 and IgG2a indicates this fusion vaccine induces Th1 and Th2 immune reactions. In addition, lymphocytes were proliferated and immune related-cytokines of TNF-α, IL-12, IFN-γ and IL-5 were detected in the serum after the vaccination. The L vaccine showed a perfect cross-protection against APP serovar 1 and 2 that each secrete different Apx exotoxins. These findings reveal that the fusion L vaccine induces specific humoral and cellular immunity, leading to a perfect cross-protection against A. pleuropneumoniae infections in a murine model.
Gecko Adhesion in Space and Time: A Phylogenetic Perspective on the Scansorial Success Story
Authors: Bauer A M
Published: April 2019

An evolutionary perspective on gecko adhesion was previously hampered by a lack of an explicit phylogeny for the group and of robust comparative methods to study trait evolution, an underappreciation for the taxonomic and structural diversity of geckos, and a dearth of fossil evidence bearing directly on the origin of the scansorial apparatus. With a multigene dataset as the basis for a comprehensive gekkotan phylogeny, model-based methods have recently been employed to estimate the number of unique derivations of the adhesive system and its role in lineage diversification. Evidence points to a single basal origin of the spinulate oberhautchen layer of the epidermis, which is a necessary precursor for the subsequent elaboration of a functional adhesive mechanism in geckos. However, multiple gains and losses are implicated for the elaborated setae that are necessary for adhesion via van der Waals forces. The well-supported phylogeny of gekkotans has demonstrated that convergence and parallelism in digital design are even more prevalent than previously believed. It also permits the reexamination of previously collected morphological data in an explicitly evolutionary context. Both time-calibrated trees and recently discovered amber fossils that preserve gecko toepads suggest that a fully-functional adhesive apparatus was not only present, but also represented by diverse architectures, by the mid-Cretaceous. Further characterization and phylogenetically-informed analyses of the other components of the adhesive system (muscles, tendons, blood sinuses, etc.) will permit a more comprehensive reconstruction of the evolutionary pathway(s) by which geckos have achieved their structural and taxonomic diversity. A phylogenetic perspective can meaningfully inform functional and performance studies of gecko adhesion and locomotion and can contribute to advances in bioinspired materials.
Effectiveness of a “Spring Pillow” Versus Education in Chronic Nonspecific Neck Pain: A Randomized Controlled Trial
Authors: Vanti Carla , Banchelli Federico , Marino Claudia , Puccetti Andrea , Guccione Andrew A , Pillastrini Paolo
Published: April 2019

Background

Different types of pillows have been proposed for neck pain, but no previous randomized controlled trial has investigated the effectiveness of a “spring pillow” for adults with chronic nonspecific neck pain.

Objective

We evaluated the effectiveness of using a pillow made from viscoelastic polyurethane and 60 independent springs compared with an educational intervention in individuals with chronic nonspecific neck pain.

Design

This was a randomized controlled trial with crossover study design.

Setting

The setting was the Occupational Medicine Unit, University Hospital, Bologna (Italy).

Participants

We recruited 70 adults with chronic nonspecific neck pain, of whom 64 completed the trial.

Intervention

Participants were randomly assigned to 2 groups. One group used the spring pillow for 4 weeks, and the other group followed educational advice for 4 weeks while continuing to use their own pillows. After 4 weeks of treatment and 4 weeks of washout, groups were crossed over. Pain perceived in the neck, thoracic, and shoulder areas and headache were the primary outcome measures. In addition, disability, sleep quality, subjective improvement, and pillow comfort were assessed. Measures were captured at pretreatment, after 4 weeks, after the 4-week washout period, and 4 weeks after crossover. The mean differences (MD) in outcomes between groups were assessed.

Results

Treatment with the spring pillow appeared to reduce neck pain (MD = −8.7; 95% confidence interval [CI] = −14.7 to −2.6), thoracic pain (MD = −8.4; 95% CI = −15.2 to −1.5), and headache (MD = −16.0; 95% CI = −23.2 to −8.7). Reductions in shoulder pain were not statistically significant between groups (MD = −6.9; 95% CI = −14.1–0.3). Neither the crossover sequence nor the period (first vs second intervention administration) significantly affected the results.

Limitations

Education may not have been the best comparator for the spring pillow; drug consumption, actual pillow use, and the implementation of the educational suggestions as prescribed were not controlled.

Conclusions

Use of the spring pillow in this study was more effective than an educational intervention for improving cervical, thoracic, and head pain. Whether a spring pillow is more effective than other ergonomic pillows remains to be tested.
Addressing the opioid crisis: social and behavioral research contributions at the National Institutes of Health
Authors: Spaniol Erin D , Smith Wendy B , Thomas David A , Clark David B
Published: April 2019

This commentary highlights current NIH efforts aimed at addressing the opioid crisis, specifically activities related to behavioral and social science research. Implications for this commentary will inform researchers, practitioners, and policymakers on current endeavors and future funding opportunities.
Diaporthe gulyae: The New Pathogen on Common Buckwheat (Fagopyrum esculentum)
Authors: Duellman Kasia M. , Mathew Febina M. , Markell Samuel G. , Castlebury Lisa A.
Published: April 2019

A fungus associated with stem disease on common buckwheat (Fagopyrum esculentum Moench) was shown to be pathogenic on this crop, with differences in reaction of buckwheat varieties to causal agent. Sequence analyses support identification of the pathogen as Diaporthe gulyae, which has also been shown to be a pathogen on soybean and sunflower. As a result, the use of buckwheat in rotations with sunflower or soybean may need to be reconsidered.
Patient-reported Outcomes Following Surgical Intervention for Adolescent Idiopathic Scoliosis
Authors: Aghdasi Bayan , Bachmann Keith R. , Clark DesRaj , Koldenhoven Rachel , Sultan Mark , George Jose , Singla Anuj , Abel Mark F.
Published: April 2019

Study Design:

This was a systematic review and meta-analysis.

Objective:

This study aims to perform a systematic review and quantitative meta-analysis of patient-reported outcome measures after spinal fusion for adolescent idiopathic scoliosis (AIS).

Summary of Background Data:

Radiographic correction of scoliosis is extensively reported in the literature but there is a need to study the impact of spinal fusion on patient-reported outcome measures. Prior reviews lacked homogeneity in outcome measures, did not perform quantitative meta-analysis of pooled effect size, or interpret the results in light of minimally clinically important difference thresholds.

Materials and Methods:

A systematic review of medical databases identified all studies that prospectively reported Scoliosis Research Society (SRS)-22 questionnaire data after spinal fusion for AIS. We screened 2314 studies for eligibility. Studies were included that reported preoperative and postoperative data at 24- or >60-month follow-up. Studies were excluded that failed to report means and SDs which were needed to calculate Cohen d effect sizes and 95% confidence intervals in estimating the magnitude and precision of the effect.

Results:

A total of 7 studies met eligibility criteria for inclusion in quantitative meta-analysis of effect sizes and 95% confidence intervals. Patients report large improvements in total score, self-image, and satisfaction; and moderate improvements in pain, function and mental health at 2 and 5 years after spinal fusion for AIS. All domains showed statistically significant improvement at all times except function at >60 months. All domains surpassed the minimally clinically important difference at all times except mental health.

Conclusions:

Moderate evidence suggests that spinal fusion improves quality of life for adolescents with idiopathic scoliosis in medium and long-term follow-up. Our results may help inform patient expectations regarding surgery.

OCEMB Level of Evidence:

Level I—systematic review and meta-analysis of prospective studies.
Early Postoperative Physical Therapy Evaluation After Total Hip and Knee Arthroplasty Reduces Hospital Length of Stay
Authors: Tsirakidis Lana , DeLucia Lauren , Elsabrout Kerri , Apold Susan
Published: April 2019

Purpose:

To evaluate whether the timing of physical therapy (PT) after total hip arthroplasty (THA) and total knee arthroplasty (TKA) is associated with inpatient length of stay (LOS), patients with PT initiated on postoperative day (POD) 0 versus POD 1 were compared.

Methods:

For this evidence-based quality improvement project, a total of 260 patients were studied, with 122 patients receiving THA and 138 receiving TKA. Of the patients receiving THA, 85 received PT POD 0, and of the patients receiving TKA, 91 received PT POD 0. Data were compared with patients receiving THA and TKA who had PT on POD 1 during the same timeframe.

Results:

The average LOS for patients undergoing THA with PT on POD 0 versus POD 1 was 2.78 (standard deviation [SD] = 1.084) and 3.68 (SD = 2.484) days, respectively, and 2.95 (SD = 1.068) and 3.26 (SD = 0.920) days for patients undergoing TKA. Pearson χ2 analysis demonstrated a statistically significant shortened LOS for the POD 0 group (THA and TKA combined, χ2 = 16.535, P < .001). Patients in the POD 0 group were 3 times more likely to be discharged within 3 days compared with the POD 1 group (THA and TKA combined, 32% vs 11%). A greater proportion of the POD 0 group were discharged home compared with the POD 1 group (75% vs 46%).

Conclusions:

Our preliminary results show that providing PT evaluations on POD 0 is associated with a decreased LOS for patients following THA and TKA, which contributes to a considerable cost savings.
Allogenic Hematopoietic Cell Transplantation in Thalassemia Major: A Single-center Retrospective Analysis From India
Authors: Choudhary Dharma , Doval Divya , Sharma Sanjeev K. , Khandelwal Vipin , Setia Rasika , Handoo Anil
Published: April 2019

Thalassemia is a major public health problem in developing countries. Sibling matched hematopoietic stem cell transplantation (HCT) is the recommended treatment for thalassemia major (TM). We retrospectively analyzed our data of thalassemia major patients who underwent HCT at a tertiary care center in Northern India from January 2008 to September 2017. The primary end points were overall survival (OS) and thalassemia-free survival (TFS), and secondary end points were complications post HCT (graft-versus-host-disease [GVHD], hemorrhagic cystitis [HC], and sinusoidal obstruction syndrome [SOS]). Data of 203 transplants for 200 patients (3 s transplants) were evaluated. Median follow-up period was 29.1 months (range, 0.3 to 116.7 mo). The overall survival (OS) was 88.5% and TFS was 82%. Class risk analysis showed a significantly higher OS and TFS in class I and class II compared to class III high risk group (OS: P=0.0017; TFS: P=0.0005) and (OS: P=0.0134; TFS: P=0.0027) respectively. Acute and chronic GVHD was seen in 59 (29.5%) and 18 (9%) patients, respectively, and SOS and HC were seen in 23 (11.5%) and 11 (5.5%) patients, respectively. This study reconfirms that allogenic HCT is feasible in developing world with the overall survival and TFS comparable to that reported in Western literature and should be considered early in all TM patients with available matched sibling donors.
Guiding the Process of Dying
Authors: White Dianne , Meeker Mary Ann
Published: April 2019

Some of the most ethically challenging and emotionally demanding aspects of nursing occur in caring for patients and their family at the end of life. The aims of this study were to examine the views of acute care nurses caring for patients during transition to comfort care, to describe the personal impact on nurses, and to identify nurses’ strategies for self-support and development of competence. Using a qualitative descriptive approach, we analyzed data from 26 semistructured interviews.

Nurses experienced moral distress in situations of continuing treatment when a cure was unlikely. In managing symptoms for patients, they struggled to foster an often-tenuous balance of patient comfort and calm without oversedation. They struggled to manage the competing demands of a workload including patients receiving curative care juxtaposed with those focused on comfort care. Nurses reflected on their fears as new nurses caring for end-of-life patients, the inadequacy of their preparation for this role, and their distress when the care provided felt inadequate to them.

Nurses navigated challenges through support from nurse colleagues and effective leaders. They appealed to administrators to attend to care concerns arising from time-intensive nature of care. Mentoring and education facilitated assimilation to comfort-care nursing for novice nurses.
Accuracy of the Surprise Question on an Inpatient Oncology Service
Authors: Singh Sarguni , Graham Zachary , Rodriguez Adrian , Lee Darrell , Wenger Barbara , Min Sung-Joon , Fischer Stacy
Published: April 2019

The surprise question (SQ), “Would you be surprised if your patient died within a year?”, has been studied in the cancer population as a prognostic prompt. Studies have almost exclusively directed the SQ to physicians, whereas perspectives of nurses remain underevaluated. We asked the SQ for patients admitted to an inpatient medical oncology service to medical oncology, palliative care, and hospital medicine teams and bedside nurses. We performed a 1-year retrospective chart review to identify how concordant various provider types were in their prognostic estimations and identified the missed opportunity rate (MOR) defined as the number of patients who died within a particular time frame but who the providers had predicted would be alive and may not have had a palliative approach. Oncologists had higher MORs for the 6-month and 1-year SQ when compared with hospital medicine providers. Bedside nurses were least concordant in their estimations of prognosis and had higher MORs for all time frames of the SQ. Missed opportunities might have significant implications for the end-of-life care for cancer patients, and continued research is needed to understand what influences provider prognostication and how this impacts palliative care utilization for patients with life-limiting disease.
Determination of Mismatch Repair Status in Human Cancer and Its Clinical Significance: Does One Size Fit All?
Authors: Corti Chiara , Sajjadi Elham , Fusco Nicola
Published: April 2019

The clinical management of cancers has progressed rapidly into the immunopathology era, with the unprecedented histology-agnostic approval of pembrolizumab in mismatch repair (MMR) deficient tumors. Despite the significant recent achievements in the treatment of these patients, however, the identification of clinically relevant subclasses of cancers based on the MMR status remains a major challenge. Many investigations have assessed the role of different diagnostic tools, including immunohistochemistry, microsatellite instability, and tumor mutational burden in both prognostic and therapeutic settings, with heterogenous results. To date, there are no tumor-specific guidelines or companion diagnostic tests for MMR assessment, and this analysis is often performed with locally developed methods. In this review, we provide a comprehensive overview of the current state-of-knowledge of MMR alterations in syndromic and sporadic tumors and discuss the available armamentarium for MMR pathologic characterization, from morphology to high-throughput molecular tools.
DICER1 and FOXL2 Mutation Status Correlates With Clinicopathologic Features in Ovarian Sertoli-Leydig Cell Tumors
Authors: Karnezis Anthony N. , Wang Yemin , Keul Jacqueline , Tessier-Cloutier Basile , Magrill Jamie , Kommoss Stefan , Senz Janine , Yang Winnie , Proctor Lily , Schmidt Dietmar , Clement Philip B. , Gilks C. Blake , Huntsman David G. , Kommoss Friedrich
Published: April 2019

Sertoli-Leydig cell tumors (SLCTs) are rare ovarian sex cord-stromal neoplasms. The only known recurrent genetic abnormality is DICER1 mutation, with rare mutations reported in FOXL2. We set out to establish a molecular classifier using DICER1 and FOXL2 somatic mutation status and clinicopathologic features in 42 SLCTs. Five tumors (12%) were well differentiated, 31 (74%) moderately differentiated, and 6 (14%) poorly differentiated. Eight (19%) had heterologous elements, and 2 (5%) showed retiform differentiation; all 10 were moderately differentiated. DICER1 RNase IIIb domain mutations were identified in 18/41 (44%; 17 moderately, 1 poorly differentiated), including all cases with retiform or heterologous elements. FOXL2 c.402C>G (p.C134W) mutation was identified in 8/42 (19%) tumors (5 moderately, 3 poorly differentiated). DICER1 and FOXL2 mutations were mutually exclusive. Median age for the cohort was 47 years (range, 15 to 90 y). Patients with DICER1 mutations were younger (median, 24.5 y; range, 15 to 62 y) than patients with FOXL2 mutation (median, 79.5 y; range, 51 to 90 y) (P<0.0001). Nine of 10 tumors with retiform or heterologous elements occurred in premenopausal patients (median, 26.5 y; range, 15 to 57 y). Patients with tumors that were wild type for DICER1 and FOXL2 (15/42, 37%) had an intermediate age (median, 51 y; range, 17 to 74 y). All tumors were FOXL2 positive by immunohistochemistry. Patients with FOXL2 mutation trended toward presenting more often with abnormal bleeding (P=0.13); DICER1-mutant patients trended toward having more androgenic symptoms (P=0.22). Our data suggest at least 3 molecular subtypes of SLCT with distinct clinicopathologic features: DICER1 mutant (younger, more androgenic symptoms, moderately/poorly differentiated, retiform or heterologous elements), FOXL2 mutant (postmenopausal, abnormal bleeding, moderately/poorly differentiated, no retiform or heterologous elements), and DICER1/FOXL2 wild type (intermediate age, no retiform or heterologous elements, including all well-differentiated tumors).
Clinicopathologic Features of Anal and Perianal Squamous Cell Carcinomas and Their Relationship to Human Papillomavirus
Authors: Ju Jennifer Y. , Stelow Edward B.
Published: April 2019

Anal squamous cell carcinomas (ASCCs) frequently harbor human papillomavirus (HPV), most commonly high-risk (HR-) HPV type 16. While p16 immunohistochemistry (IHC) is typically used as a surrogate for HR-HPV status in the oropharynx and cervix, its overexpression can also occur as a result of oncogenic stress and sometimes prove nonspecific. There have been recent investigations into the use of HPV RNA in situ hybridization (RISH) assays as an alternative method, which have shown robust results for squamous cell carcinomas of the oropharynx and cervix. Our study evaluated HPV RISH and p16 IHC in 50 ASCCs, as well as the clinicopathologic features of ASCC relative to HPV status. We found that HPV RISH and p16 IHC were closely in agreement with 96% concordance. Using the 2 methodologies, 78% of ASCCs were HR-HPV positive, 10% were low-risk HPV positive, and 12% were HPV-negative. None of our cases showed co-infection across HR-HPV and low-risk HPV. ASCCs that were not related to HR-HPV were more likely to have a typical keratinizing morphology (P=0.05) and more likely to involve the perianal area (P=0.006). HPV-negative cases were particularly aggressive with high rates of metastases and patient death within 2 years of diagnosis. Overall, HPV RISH appears to be a reliable methodology for testing, and HPV status may have implications for prognostication of ASCCs.
Congenital Malaria in a Febrile Infant Born to an Immigrant Mother With No Travel During Pregnancy
Authors: Fatima Saba , Skarzynska Malgorzata
Published: April 2019

Congenital malaria is a condition that can be acquired during pregnancy or perinatally at the time of delivery by transplacental transmission of parasitized maternal erythrocytes. Because of its rare incidence in the United States, it is most frequently missed as a differential diagnosis by physicians when evaluating a febrile infant born to an immigrant mother. Timely diagnosis for physicians is also a challenge when there is no recent history of travel. Pediatric emergency department physicians hence must obtain a thorough history and elicit any exposure to malaria in the past when evaluating a febrile infant. We report a case of an 18-day male infant with congenital malaria and no maternal history of travel and febrile illnesses during pregnancy.
Retrospective Comparison of Intranasal Fentanyl and Inhaled Nitrous Oxide to Intravenous Ketamine and Midazolam for Painful Orthopedic Procedures in a Pediatric Emergency Department
Authors: Míguez Ma Concepción , Ferrero Clara , Rivas Arístides , Lorente Jorge , Muñoz Lucía , Marañón Rafael
Published: April 2019

Objectives

To compare the efficacy and adverse events of 2 pharmacological strategies: intranasal fentanyl and nitrous oxide (FN) inhaled against intravenous ketamine and midazolam (KM) as procedural sedation and analgesia (PSA) in painful orthopedic procedures in the pediatric emergency department (ED).

Methods

This is an observational retrospective cohort study. Patients were included that submitted to PSA for carrying out a painful orthopedic procedure in the ED of a tertiary hospital over a period of 2 years. The main outcome variable was efficacy and adverse events of the PSA procedure.

Results

Eighty-three patients were included. Fifty-two patients received FN and 31 KM. The PSA strategy was considered efficacious in 82.7% of the patients in the KM group and 80.6% in the FN cohort. No differences between both strategies were found (P= 0.815). Seventeen children showed early adverse events, 2 in the FN cohort and 15 in the KM group (relative risk of the KM strategy, 23.48; 95% confidence interval (CI), 3.24–169.99). The average of satisfaction obtained by the families was of 10 (CI, 10–10) in the KM cohort and of 9 (CI, 8–9.5) in the FN group (P= 0.152). The length of stay in the ED was longer in the KM cohort (P< 0.001). Hospital admission rate differences were not statistically different (9.6% vs 22.6%,P= 0.144) in the KM versus FN cohort.

Conclusions

Both PSA strategies presented similar efficacy. The FN strategy was associated with a lower risk of adverse events and shorter ED length of stay than KM in this ED setting.
FDG PET/CT Findings of Unsuspected Pulmonary Epithelioid Angiosarcoma Manifested as a Brain Metastasis
Authors: Zhang Gui-Xiong , Zheng Yongjiang , Huang Wen-Shan , Yang Min , Xu Jie-Hua
Published: April 2019

A 42-year-old man presented paroxysmal sharp pain in the right side of the head. Head CT showed a lesion in the right frontal lobe. MRI of the head suggested the possibility of metastasis. FDG PET/CT showed increased uptake corresponding to lesions in the right frontal lobe of the brain, the left upper lobe of lung, and the left adrenal gland, respectively. Cerebral and pulmonary lesions were both resected. Histopathology confirmed that both lesions are primary epithelioid angiosarcomas.
Pneumonitis Related to Melanoma Immunotherapy
Authors: García-Gómez Francisco Javier , Álamo-de la Gala María Carmen , de la Riva-Pérez Pablo Antonio , de la Cruz-Merino Luis , de la Cinta Calvo-Morón María
Published: April 2019

Several regimens of immunotherapy have recently proven successful for multiple cancers, due to increased survival and quality of life. Rarely, immunotherapy with anti-programmed cell death protein 1 and programmed death-ligand 1 antibodies across cancer may cause immune-related pulmonary toxicity, with a low overall incidence, being particularly low among patients with melanoma and highest among individuals with lung cancer. In this vein, pulmonary toxicity is staged at 4 degrees according to the severity of the clinic and radiological findings, and its management is based on suppression of immunotherapy and administration of glucocorticoids. We report a case of pulmonary toxicity related to melanoma immunotherapy observed by 18F-FDG PET/CT.