bluuebunny/crossref_metadata_2025 huggingface dataset:
Postoperative analgesia and opioid use following hip arthroscopy with ultrasound-guided quadratus lumborum block: a randomized controlled double-blind trial
Authors: Yuan Liangjing , Zhang Ye , Xu Chengshi , Wu Anshi
Published: May 2020

Objective

To investigate the postoperative analgesic effect of ultrasound-guided quadratus lumborum block (QLB) in patients undergoing arthroscopic hip surgery.

Methods

Patients who were scheduled to undergo elective arthroscopic hip surgery were randomly assigned to the QLB (Q) or control (C) group (n = 40 each). After general anesthesia induction, unilateral QLB was performed under ultrasound guidance in the Q group. The amount of opioid use via patient-controlled analgesia (PCA) and the resting and movement pain visual analog scale (VAS) scores when the patient left the postanesthesia care unit (PACU) and 4, 8, 12, and 24 hours after surgery were recorded. Postoperative complications were recorded for both groups.

Results

At 24 hours post-surgery, opioid consumption amounts via PCA (48.4 [48.1–48.6] mL) in the Q group were significantly lower compared with the C group (52.0 [51.0–53.8] mL). A significant reduction in opioid consumption was observed between the two groups at each time point. Resting and movement VAS scores at each time point were significantly lower in the Q compared with the C group.

Conclusions

Hip arthroscopy patients who received QLB and general anesthesia in combination had less pain and a lower opioid requirement within 24 hours postoperatively.
Cost-effectiveness analysis of fruquintinib as third-line treatment for patients with metastatic colorectal cancer
Authors: Zhang Peng-Fei , Xie Dan , Li Qiu
Published: May 2020

Objective:

To evaluate the cost-effectiveness of addition of fruquintinib to best supportive care (BSC) in third-line treatment for patients with metastatic colorectal cancer (CRC).

Methods:

To conduct the cost-effectiveness analysis, a Markov model was established to simulate the course of metastatic CRC. Three health states—progression-free survival (PFS), progressive disease (PD), and death—were included. Clinical data were derived from the FRESCO trial and health utility values were extracted from previous literature. The primary outcome of the study was incremental cost-effectiveness ratio (ICER) in US dollars per quality-adjusted life-years (QALYs) from a Chinese societal perspective. One-way sensitivity analyses and probabilistic sensitivity analyses were performed to test the robustness of the study.

Results:

Addition of fruquintinib to BSC gained 0.54 QALY at a cost of $15,404.57 while the BSC group gained 0.38 QALY at a cost of $9603.94. ICER of fruquintinib versus BSC was $36,253.94/QALY. In the 1-way sensitivity analyses, utility for PD in both groups, utility for PFS in both groups, and cost of fruquintinib significantly influenced the results of the analysis. At the willingness-to-pay threshold of $28,988.40/QALY, probabilities of addition of fruquintinib to BSC or BSC alone as the cost-effective option were 0% and 100%, indicating addition of fruquintinib is not a dominant option compared with BSC.

Conclusions:

Addition of fruquintinib to BSC is not a cost-effective regimen in the third-line setting for patients with metastatic CRC from the Chinese societal perspective.
The transfer of group practice strategy instruction to beginning instrumentalists’ individual practice
Authors: Weidner Brian N
Published: May 2020

This quasi-experimental study investigated the transfer of learning for effective practice strategies from large ensemble to individual rehearsal. Five middle school bands were randomly assigned to one of three conditions. Two treatment conditions had teachers use an iterative, explicit instruction protocol to teach a targeted practice strategy during a sight-reading activity on a novel piece of music over a series of six lessons. The control condition included non-specific sight-reading activities. A sample of students from each band (N=66) participated in a cycle of pre-test/post-test/delay-test observations that involved a ten- minute practice session followed by a performance on a new piece of music similar to those used in the treatment sessions. Student practice sessions were analyzed for frequency of usage of the targeted strategies, and performances were rated for pitch and rhythmic accuracy. A 3x2x3 ANOVA identified a significant effect for strategy used within groups (F(1,63)=122.388, p<.001, η2=.660), but no significant effect or interactions were found between groups. The results of a 3x3 ANOVA identified a moderate-sized main effect for test cycle on performance scores (F(2,63)=2.192, p<.001, η2=.414), leading to a series of repeated measures t-tests that demonstrated significant changes in performance scores from pre- to post-test in both treatment conditions
Mechanical Properties of High Early Strength Class C Fly Ash-Based Alkali Activated Concrete
Authors: Gomaa Eslam , Sargon Simon , Kashosi Cedric , Gheni Ahmed , ElGawady Mohamed A.
Published: May 2020

This paper presents the mechanical properties of alkali activated concrete (AAC) cured at 70°C for 24 h. The AAC mixtures were synthesized using five class C fly ashes (FAs) having different chemical and physical properties. Sodium hydroxide (SS) and sodium silicate (SH) were used as the alkali activators in this study. A conventional concrete (CC) mixture, having a compressive strength of 34.5 MPa, was synthesized using ordinary Portland cement (OPC) mixture for comparison purposes. The slump, as well as the compressive, tensile splitting, and flexural strengths were investigated at different concrete ages up to 28 days. The results revealed that with increasing the calcium content in an FA used to synthesized AAC mixture, the slump value and the mechanical properties decreased. All AAC mixtures reached approximately 92% of their 28-day compressive strength after 1 day compared with only 29% in the case of CC. Therefore, AAC can be used in applications where rapid strength gain is required, such as urgent repair, precast industry, and so forth. The measured data was also used to develop a set of equations to accurately predict the splitting tensile and flexural strengths.
Full-Scale Laboratory Evaluation of the Effectiveness of Subgrade Soil Stabilization Practices for Portland Cement Concrete Pavements Patching Applications
Authors: Behnood Ali , Olek Jan
Published: May 2020

Adequate quality of subgrade under patched areas can extend the service life of concrete pavements and reduce their maintenance costs. In this study, the performance of various subgrade stabilization scenarios was evaluated and compared with each other in a full-scale laboratory-based setup. For this purpose, a test box with the footprint of 6 × 6 ft and a height of 4 ft was constructed using C steel channels. The test box was used to investigate the effects of various types of soil stabilization methods, such as chemical (cement) stabilization, use of aggregate base course (ABC), geogrid (GG) and geotextile (GT) with ABC, GT with cement-stabilized soil, GT with in-situ compacted soil, flowable fill, and lean concrete. The test results showed that all stabilization techniques successfully improved the performance of the subgrade layer by decreasing the deformation under the fatigue loading representing a single axle load of 9,000 lbf/tire. The use of GT with aggregate-based layers was found to significantly reduce the amount of settlement. Subgrade layers stabilized with GG also experienced lower values of deformations compared with the unmodified (control) section. However, GG was not as effective as GT. The use of cement-treated aggregate and lean concrete reduced the deformations to negligible levels.
Diafiltration flowrate is a determinant of the extent of adsorption of amikacin in renal replacement therapy using the ST150®-AN69 filter: An in vitro study
Authors: Baud Frédéric Joseph , Houzé Pascal , Raphalen Jean-Herlé , Winchenne Anaïs , Philippe Pascal , Carli Pierre , Lamhaut Lionel
Published: May 2020

Introduction:

In continuous renal replacement therapy, conduction and convection are controlled allowing prescribing dosage regimen improving survival. In contrast, adsorption is an uncontrolled property altering drug disposition. Whether adsorption depends on flowrates is unknown. We hypothesized an in vitro model may provide information in conditions mimicking continuous renal replacement therapy in humans.

Methods:

ST150®-AN69 filter and Prismaflex dialyzer, Baxter-Gambro were used. Simulated blood flowrate was set at 200 mL/min. The flowrates in the filtration (continuous filtration), dialysis (continuous dialysis), and diafiltration (continuous diafiltration) were 1500, 2500, and 4000 mL/h, respectively. Routes of elimination were assessed using NeckEpur® analysis.

Results:

The percentages of the total amount eliminated by continuous filtration, continuous dialysis, and continuous diafiltration were 82%, 86%, and 94%, respectively. Elimination by effluents and adsorption accounted for 42% ± 7% and 58% ± 5%, 57% ± 7% and 43% ± 6%, and 84% ± 6% and 16% ± 6% of amikacin elimination, respectively. There was a linear regression between flowrates and amikacin clearance: Y = 0.6 X ± 1.7 (R2 = 0.9782). Conversely, there was a linear inverse correlation between the magnitude of amikacin adsorption and flowrate: Y = –16.9 X ± 84.1 (R2 = 0.9976).

Conclusion:

Low flowrates resulted in predominant elimination by adsorption, accounting for 58% of the elimination of amikacin from the central compartment in the continuous filtration mode at 1500 mL/h of flowrate. Thereafter, the greater the flowrate, the lower the adsorption of amikacin in a linear manner. Flowrate is a major determinant of adsorption of amikacin. There was an about 17% decrease in the rate of adsorption per increase in the flowrate of 1 L/min.
Income Inequality and Self-Reported Health Among Older Adults in Brazil
Authors: Massa Kaio Henrique Correa , Chiavegatto Filho Alexandre Dias Porto
Published: May 2020

This study analyzes the association between income inequality and self-reported health (SRH) in older adults, and separately for the young-old and very-old groups, residing in each of the 27 Brazilian capitals. The sample consisted of 4,912 individuals aged 60 or older residing in Brazilian capitals in 2013. Bayesian multilevel models were applied to the whole sample and separately for individuals aged 60 to 79 (young-old), and 80 or more (very-old). Our results show significant associations between income inequality and SRH, even after controlling for individual and contextual factors. We found greater odds of poor SRH among older adults living in areas with medium (odds ratio [OR] = 1.66, 95% confidence interval [CI]: 1.49–1.86) and high-income inequality (OR = 2.21, 95% CI: 2.05–2.38). The negative association between income inequality and health, independently of the individual and contextual characteristics, suggests that living in unequal areas can have a detrimental effect on the health of older adults.
Ammonia inhibition of waste degradation in landfills – A possible consequence of leachate recirculation in arid climates
Authors: Chamem Oumaima , Fellner Johann , Zairi Moncef
Published: May 2020

Ammonia inhibition of anaerobic waste degradation has been extensively investigated on a laboratory scale. It is hence well known that at ammonium levels above 2500 mg/l, methanogenic bacteria are inhibited, which leads to both reduced methane (CH4) production and increased organic pollution of the leachate. In the present paper, and for the first time, data on a full-scale landfill indicating ammonia inhibition of waste degradation is presented. The leachate of the landfill is characterized by extremely high concentrations of chloride (up to 70,000 mg/l) and ammonium–nitrogen (up to 20,000 mg/l). These high pollution levels are explained by the following facts: first, the landfill is located in an arid climate (annual precipitation of 200 mm), resulting in low fresh water infiltration; and second, leachate or concentrate resulting from reverse osmosis treatment at the site has been recirculated. The high ammonium levels obviously caused inhibitory effects on the anaerobic degradation, which resulted in chemical oxygen demand concentrations in the leachate of far above 300,000 mg/l. Furthermore, a comparatively low level of landfill gas (LFG) generation and a shift towards higher carbon dioxide and lower CH4 contents in the collected LFG was observed. Based on the gas compositional data, the overall reduction in CH4 generation was assessed to be 50%. In order to reduce organic leachate pollution and to enhance LFG production at the site investigated, fresh (rain) water infiltration should be enhanced and the recirculation of leachate or treatment residues derived thereof should be terminated.
Voice after Exit? Bulgarian Civic Activists between Protest and Emigration
Authors: Rone Julia , Junes Tom
Published: May 2020

This article belongs to a forthcoming special cluster, “Contention Politics and International Statebuilding in Southeast Europe” guest-edited by Nemanja Džuverovic, Julia Rone and Tom Junes.

Historically, civic activists who left their home countries in the wake of protests would either risk disappearing in anonymity or become engaged in political “exile networks.” However, since the outbreak of the “global wave” of protest, the ability of activists to take advantage of freedom of movement and technological advances in social media changed the framework and conditions of such “exile.” This article addresses the question of what happens when protest activists decide to go abroad to study, work, and build a life. We focus in particular on the case of Bulgaria, the fastest shrinking country in the world. On the basis of structured qualitative interviews with Bulgarian activists who have gone abroad in the aftermath of the 2013 Bulgarian protests, we trace how migration and intra-EU mobility affect the political participation of activists, the ways in which they participate, and their diagnoses of the present. In other words, we explore whether one can speak of “exit after voice,” leading in the long run to a decrease in activism. We argue instead that we are witnessing a transformation of the dichotomy “exit-voice” into a more complex scale of forms of protest organization and participation, facilitated by social media and the freedom of movement within the EU. Herein, the real risk might be not that migration leads to political passivity, but that the new “voice” found through the experience abroad remains rather marginal as activists’ networks are transformed and community building becomes a challenge in an increasingly precarious world.
Introduction: Contentious Politics and International Statebuilding in Southeast Europe
Authors: Džuverović Nemanja , Rone Julia , Junes Tom
Published: May 2020

This article belongs to a forthcoming special cluster, “Contention Politics and International Statebuilding in Southeast Europe” guest-edited by Nemanja Džuverovic, Julia Rone and Tom Junes.
Analysis of the influence of yarn angle on the mechanical behaviors of cured woven composites
Authors: Liang Biao , Zhang Weizhao , Gao Sasa
Published: May 2020

Manufacturing process would modify the yarn angle of woven composites. To have a high-fidelity mechanical analysis, it is necessary to study its potential impact. In this article, experimental tests were specifically designed and conducted to investigate the influence of yarn angle on the mechanical behaviors of cured woven composites. The results show that yarn angle variation has a significant impact on the elastic modulus, Poisson’s ratio, and yield stress. The tensile deformation along yarn directions and shear deformation between two yarns were also investigated and their coupling with yarn angle variation was analyzed. It shows that when the yarn angle variation (from 90°) is less than 10°, the influence of the tension–shear coupling on the tensile behavior along yarn directions and shear behavior between two yarn directions is small and can be neglected. When the yarn angle variation is more than 20°, the influence of tension–shear coupling is significant and must be accounted for in constructing the constitutive law for the cured non-orthogonal woven composites.
Investigation on surface quality of high-speed cutting titanium alloy Ti6Al4V based on Split-Hopkinson pressure bar
Authors: Zhang Zhanfei , Wang Zengqiang , Wang Wenhu , Jiang Ruisong , Xiong Yifeng
Published: May 2020

High-speed cutting technology has the characteristics of high material removal rate and excellent processing quality. To investigate the surface quality of high-speed cutting Ti6Al4V alloy, the orthogonal cutting experiment is the cutting device based on improved Split-Hopkinson pressure bar carried out with a cutting speed of about 7–16 m/s. Surface roughness, residual stress and three-dimensional surface topography are examined to characterize the surface quality. And the chip geometry parameters are measured to analyze the formation mechanism of surface topography. The result shows that cutting force and surface roughness increase rapidly with the increase in depth of cut. In the meantime, the periodic microwaves appeared on the machined surface, and their amplitudes increase with the increase in depth of cut. However, surface roughness, residual stress and microwave amplitude all decrease with the increase in cutting speed. Moreover, it is found that the evolution trend of chip thickness and surface roughness with cutting parameters is very similar. Therefore, it can be inferred that there is a strong relationship between surface topography and chip morphology.
Influence of cooling media in achieving grain refinement of AA2014 alloy using friction stir processing
Authors: Satyanarayana MVNV , Kumar Adepu
Published: May 2020

The present paper studies the influence of different cooling media (water and cryogenic media) on microstructure, mechanical, and corrosion behavior of friction stir processing of AA2014. From the electron backscattered diffraction results, it was observed that the grain size in stir zone of air-cooled friction stir processing, dry ice-cooled friction stir processing, and underwater friction stir processing are 4.9 µm, 3.5 µm, and 0.9 µm respectively, and the fraction of high angle grain boundaries are more in underwater friction stir processing sample compared to other conditions. The ultra-fine grained structure (0.9 µm) was achieved in underwater friction stir processing due to uniform heat dissipation from the processing zone to the water. Mechanical properties such as hardness and strength were improved in underwater friction stir processing compared to other conditions. The fine precipitates formed in the underwater friction stir processing sample were distributed randomly at grain boundaries, and hence corrosion resistance was improved in underwater friction stir processing sample compared to other conditions.
Additive manufacturing for refrigerant compressors
Authors: Thomas C , Hesse U
Published: May 2020

The requirements for compressors in refrigeration industry become more demanding each year. Requirements regarding efficiency, durability, and also the possibility / demand of dry running machines are the main driving factors. So far, the majority of compressors are mainly manufactured out of cast iron, aluminum, steel, and other metals (not including sealing elements), which lead to high costs as well as weights. The scope of this work includes a demonstration of new manufacturing methods and material choices for small-scale compressors as well as a possible transfer to even larger machines. A detailed look on the potential of different material classes and compounds will be presented. The paper also takes into consideration if the new materials have to be used for lubricated compressors or if there is even a possibility for an operation without any oil. Thermodynamic and strength limits will be pointed out as well as the potential to substitute the nowadays used metals-based components by lightweight materials.
Transaction Frame Determines Preferences: Valuation of Labor by Employee and Contractor
Authors: Ritov Ilana , Schurr Amos
Published: May 2020

A major concern in today’s economic reality is the extent to which a sharing economy, in comparison with a traditional economy, promotes inequality. In the transformation from a traditional to a sharing economy, wage setting is replaced by contract pricing. The switch to contract trading implies that the party who carries out the labor evaluates the transaction from a buyer’s rather than a seller’s perspective. Drawing on psychological research on constructed and reference-dependent preferences, we predicted that the net valuation of work would decrease when the regimen involved contract trading. Three experiments ( N = 1,105) eliciting work valuation under the two regimens confirmed our prediction, thus pointing to a novel factor that increases inequality.
Being wrong the right way: A multiple case study of three transmasculine persons’ experience with the Danish health system
Authors: Pultz Sabina , Goldfinger Eva
Published: May 2020

This article examines how three transmasculine persons are subjectified in the Danish treatment system. Based on a multiple case study with three transmasculine persons, we analyse how the treatment system encourages them to perform a more traditional masculinity in order to be culturally intelligible and in order to be assessed as being eligible for treatment. We explore the struggle of subjectivity embedded in these practices. By investigating the concrete subjectification mechanisms and the ways these are dealt with by transmasculine persons, we support existing literature identifying the queer community as a strategic resource in regard to teaching new patients how to “be wrong the right way.” They do so by sharing knowledge about how best to manage the system in order to get closer to living the lives they want. The study contributes theoretically by shedding light on the subjectification processes producing not only boundaries between normal and abnormal (such as binary and nonbinary), but also between legitimate abnormal (binary transgender) and illegitimate abnormal (nonbinary transgender).
Prevalence and influential factors of thrombocytopaenia in systemic lupus erythematosus patients: a retrospective analysis of 3140 cases in a Chinese population
Authors: Mao Yan-Mei , Shi Pei-Li , Wu Li , Hu Yu-Qian , He Yi-Sheng , Xiang Kun , Tao Jin-Hui , Pan Hai-Feng , Wu Guo-Cui
Published: May 2020

Introduction

The present study aimed to investigate the prevalence and influential factors of thrombocytopaenia in systemic lupus erythematosus (SLE) patients among the Chinese population in order to provide evidence for improving the treatment and nursing of SLE patients.

Methods

A retrospective analysis of 3140 SLE patients admitted to two large tertiary hospitals was conducted in Anhui, China, from 2011 to 2018. In addition, the influential factors related to SLE with thrombocytopaenia were analysed through univariate and multivariate analysis.

Results

A total of 804 SLE patients had thrombocytopaenia (25.6%). The top 5 clinical manifestations of SLE inpatients were proteinuria (51.0%), lupus nephritis (45.9%), new rash (38.4%), haematuria (36.7%) and pyuria (32.2%). The incidence of neurological manifestations, oral mucosal ulceration, pleurisy, pericarditis, hyperglycaemia, leucocytopaenia, urinary casts, haematuria, pyuria and high disease activity in the thrombocytopaenia group were higher than those in the non-thrombocytopaenia group ( p < 0.05). Multivariate analysis showed age (odds ratio (OR) = 1.009, p = 0.005), neurological manifestations (OR = 1.373, p = 0.048), pericarditis (OR = 1.394, p = 0.048), hyperglycaemia (OR = 1.717, p < 0.001), leucocytopaenia (OR = 2.551, p < 0.001), haematuria (OR = 1.582, p < 0.001), serum C3 level <0.85 g/L (OR = 1.525, p = 0.001), serum C4 concentration <0.10 g/L (OR = 1.287, p = 0.020), serum CRP concentration <8 ng/L (OR = 1.314, p = 0.005), prothrombin time >15.30 seconds (OR = 1.479, p = 0.032), activated partial thromboplatin time >45 seconds (OR = 1.924, p < 0.001) and thrombin time >21 seconds (OR = 1.629, p = 0.015) were associated with thrombocytopaenia.

Conclusion

Thrombocytopaenia has a high prevalence in SLE patients and is related to some baseline, clinical and laboratory characteristics, affecting multiple organs and systems.
Adherence to national guidelines for colorectal cancer screening in Israel: Comprehensive multi-year assessment based on electronic medical records
Authors: Paltiel Ora , Keidar Tirosh Aravah , Paz Stostky Orit , Calderon-Margalit Ronit , Cohen Arnon D , Elran Einat , Valinsky Liora , Matz Eran , Krieger Michal , Yehuda Arye Ben , Jaffe Dena H , Manor Orly
Published: May 2020

Objectives

To assess time trends in colorectal cancer screening uptake, time-to-colonoscopy completion following a positive fecal occult blood test and associated patient factors, and the extent and predictors of longitudinal screening adherence in Israel.

Setting

Nation-wide population-based study using data collected from four health maintenance organizations for the Quality Indicators in Community Healthcare Program.

Methods

Screening uptake for the eligible population (aged 50–74) was recorded 2003–2018 using aggregate data. For a subcohort (2008–2012, N = 1,342,617), time-to-colonoscopy following a positive fecal occult blood test and longitudinal adherence to screening guidelines were measured using individual-level data, and associated factors assessed in multivariate models.

Results

The annual proportion screened rose for both sexes from 11 to 65%, increasing five-fold for age group 60–74 and >six-fold for 50–59 year olds, respectively. From 2008 to 2012, 67,314 adults had a positive fecal occult blood test, of whom 71% eventually performed a colonoscopy after a median interval of 122 (95% confidence interval 110.2–113.7) days. Factors associated with time-to-colonoscopy included age, socioeconomic status, and comorbidities. Only 25.5% of the population demonstrated full longitudinal screening adherence, mainly attributable to colonoscopy in the past 10 years rather than annual fecal occult blood test performance (83% versus 17%, respectively). Smoking, diabetes, lower socioeconomic status, cardiovascular disease, and hypertension were associated with decreased adherence. Performance of other cancer screening tests and frequent primary care visits were strongly associated with adherence.

Conclusions

Despite substantial improvement in colorectal cancer screening uptake on a population level, individual-level data uncovered gaps in colonoscopy completion after a positive fecal occult blood test and in longitudinal adherence to screening, which should be addressed using focused interventions.
7th A. N. Verma Memorial Lecture by Mr Göran Persson on ‘The European Union in a Time of Great Change’
Authors: Persson Göran
Published: May 2020

Editor’s note: The A. N. Verma Memorial Lectures are annual events organised by the India Development Foundation in memory of Mr A. N. Verma and his contributions to Indian economic policymaking; especially his role in pushing through the liberalisation reforms of the early 1990s. This year’s lecture was delivered by Mr Göran Persson, the ex-Prime Minister of Sweden. The topic of the lecture was especially appropriate for this journal as it talked about one of the biggest Western examples at market integration, the EU. As the readers will see, the lecture was also very prescient in terms of happenings in Europe.
Context and Validation of the Korean Subjective Underemployment Scale (K-SUS): 한국의 불완전 취업 실태 및 주관적인 불완전 취업 척도 타당화
Authors: Kim Taewon , Allan Blake A.
Published: May 2020

Underemployment is a multidimensional construct that captures various suboptimal work statuses. Although recent economic depressions and insecure job markets in Korea have increased underemployment, no appropriate scale exists to measure underemployment in a Korean context. Therefore, the aim of this study was to translate the Subjective Underemployment Scales (SUS) into Korean and validate the Korean SUS (K-SUS) with a sample of 427 Korean employees. We found that a bifactor model fit the data best, suggesting a different internal structure from the English version. Scores from the K-SUS were also invariant across gender, age, income, and employment status. In addition, we found evidence for construct validity by relating scores from the K-SUS to similar constructs and indicators of well-being. Findings from the current study help describe Korean employees’ experiences of subjective underemployment and suggest how psychologists, employers, and policy makers can address structural and psychological issues related to underemployment.
Effect of Microfracture on Functional Outcomes and Subchondral Sclerosis Following Distraction Arthroplasty of the Ankle Joint
Authors: Gianakos Arianna L. , Haring R. Sterling , Shimozono Yoshiharu , Fragomen Austin , Kennedy John G.
Published: May 2020

Background:

Treatment for post-traumatic osteoarthritis (PTOA) of the ankle remains challenging. Distraction arthroplasty (DA) is an alternative for patients who are averse to or poor candidates for arthrodesis or joint replacement. The purpose of this study was to examine the role of microfracture (MFX) and concentrated bone marrow aspirate (CBMA) on the outcome of patients undergoing DA for end-stage PTOA of the ankle joint.

Methods:

Ninety-five patients who underwent DA for the treatment of end stage PTOA from 2009 to 2014 were selected from the hospital ankle registry. Demographic data, functional activity levels, complications, and radiographs taken at 6, 12, 24, and 36 months postoperatively were reviewed. Foot and Ankle Outcome Scores (FAOS) were obtained at the same time intervals. A total of 78 patients were included in this study. Interventions were divided into 4 groups for comparison: DA+MFX (n = 8), DA+MFX+CBMA (n = 35), DA+CBMA (n = 22), and DA alone (n = 13).

Results:

Patients undergoing DA+MFX or DA+MFX+CBMA had significantly worse motion ( P = .003) when compared with DA alone. Patients undergoing MFX had significantly reduced postoperative joint space and a greater length of time to return to activity when compared to subgroups not using MFX ( P = .01). The use of MFX was associated with significantly lower FAOS scores.

Conclusion:

The current study showed no benefit from MFX when combined with DA in the treatment of PTOA. CBMA may have helped mitigate the adverse effect of MFX but conferred no benefit when used with DA alone. DA remains a useful alternative to ankle arthrodesis and arthroplasty in patients with PTOA. However, MFX and biologic augmentation using CBMA appeared to have no additional benefit.

Level of Evidence:

Level III, comparative study.
A MicroRNA Signature in Acute Coronary Syndrome Patients and Modulation by Colchicine
Authors: Barraclough Jennifer Y. , Joglekar Mugdha V. , Januszewski Andrzej S. , Martínez Gonzalo , Celermajer David S. , Keech Anthony C. , Hardikar Anandwardhan A. , Patel Sanjay
Published: May 2020

Background:

Circulating microRNAs (miRNAs) may play a pathogenic role in acute coronary syndromes (ACS). It is not yet known if miRNAs dysregulated in ACS are modulated by colchicine. We profiled miRNAs in plasma samples simultaneously collected from the aorta, coronary sinus, and right atrium in patients with ACS.

Methods:

A total of 396 of 754 miRNAs were detected by TaqMan real-time polymerase chain reaction from EDTA-plasma in a discovery cohort of 15 patients (n = 3 controls, n = 6 ACS standard therapy, n = 6 ACS standard therapy plus colchicine). Fifty-one significantly different miRNAs were then measured in a verification cohort of 92 patients (n = 13 controls, n = 40 ACS standard therapy, n = 39 ACS standard therapy plus colchicine). Samples were simultaneously obtained from the coronary sinus, aortic root, and right atrium.

Results:

Circulating levels of 30 of 51 measured miRNAs were higher in ACS standard therapy patients compared to controls. In patients with ACS, levels of 12 miRNAs (miR-17, -106b-3p, -191, -106a, -146a, -130a, -223, -484, -889, -425-3p, -629, -142-5p) were lower with colchicine treatment. Levels of 7 of these 12 miRNA were higher in ACS standard therapy patients compared to controls and returned to levels seen in control individuals after colchicine treatment. Three miRNAs suppressed by colchicine (miR-146a, miR-17, miR-130a) were identified as regulators of inflammatory pathways. MicroRNAs were comparable across sampling sites with select differences in the transcoronary gradient of 4 miRNA.

Conclusion:

The levels of specific miRNAs elevated in ACS returned to levels similar to control individuals following colchicine. These miRNAs may mediate ACS (via inflammatory pathways) or increase post-ACS risk, and could be potentially used as biomarkers of treatment efficacy.
The (Un) Certainty of Post-Qualitative Research: Textures of Life-in-Motion as Articulation
Authors: Carlson David Lee
Published: May 2020

This paper argues that post-qualitative inquiry offers scholars the opportunity to work with the articulation of language in the research endeavor. Drawing from literature, the author argues that scholars in the post-qualitative inquiry field can articulate the nuanced aspects of research rather than rely on rationalistic and propositional expressions.
Earnin’ Your Raising: An Autoethnographic Remembrance of Mother–Daughter Stories and Reflections on Parenting
Authors: Copple Janie
Published: May 2020

Mothers of daughters approaching adolescence often find themselves navigating the complexities of encouraging independence while maintaining open, healthy communication. Grappling with this dynamic can sometimes lead to conflict. This autoethnographic piece explores ways family stories and memories of mothers and daughters shed insight into how we understand ourselves as parents. Through a series of family vignettes, the author draws upon Ellis’s themes of independence and dependence as an entry point into reflections on how mothers and daughters negotiate the entanglement of interconnectedness.
Anticancer agents and phytotherapy: Interactions that are often unrecognized
Authors: Laurent Vanille , Saillard Justine , Thierry Margot , Lepelletier Aline , Fronteau Clémentine , Huon Jean-François
Published: May 2020

Phytotherapy is the main complementary medicine for which patients afflicted with cancer have recourse but the associated consumption of phytotherapy products gives rise to a risk of interaction with anticancer agents. The aim of this prospective study was to measure the prevalence of the consumption of phytotherapy products as well as their interactions with anticancer agents in a cohort of patients from January 2018 to August 2019. Patients hospitalized in the conventional hematology unit and outpatients who had their prescriptions for oral anticancer agents filled at the hospital pharmacy were questioned about consumption of phytotherapy products by pharmacy externs trained in pharmaceutical interviews. Among the 110 hospitalized patients who answered the questionnaire, 40% (n = 44) used phytotherapy and 5 of them continued to consume it during the cycles of injectable chemotherapy. As a result, 10 interactions were found between the plants and the anticancer agents (prevalence of 27%). Among the 59 outpatients, 17% (n = 10) consumed phytotherapy. Eight interactions were identified (prevalence of 80%). The potential consequences were an increase or a decrease in the concentration of the anticancer agents and an increase in the risk of bleeding, hepatoxicity, and hypokalemia. The consumption of phytotherapy was unknown by a health professional for 44% of hospitalized patients and 60% of the outpatients. The risk of interactions between plants and anticancer agents is not negligible and professionals should be cognizant of this in their daily practice. The availability of tools for training and detection of interactions is indispensable for managing patients undergoing onco-hematology treatments.
Biosimilar infliximab administration for the management of acute graft-versus-host disease
Authors: Tollkuci Eris , Fitzpatrick Paul , N Seddon Amanda , Myers Rebecca , Nathan Sunita , Ustun Celalettin
Published: May 2020

Introduction

Acute graft-versus-host disease (aGVHD) is a significant immune-mediated complication of allogeneic hematopoietic stem cell transplant (HSCT). Despite prophylactic immunosuppression, the incidence of grades II–IV aGVHD post-HSCT varies from 20 to 80%. Tumor necrosis factor (TNF) is an important cytokine involved in the pathogenesis of GVHD, and medications such as infliximab (Remicade®) have been utilized as second-line treatment options in patients with steroid-refractory GHVD. Infliximab-dyyb (Inflectra®) and infliximab-qbtx (Ixifi®) are biosimilars approved by the FDA for a variety of autoimmune disorders. This is the first case report documenting the utility of infliximab-dyyb and -qbtx for the management of steroid-refractory aGVHD.

Case report

We report the post-transplant course of three patients treated with infliximab biosimilars as a part of therapy for management of steroid-refractory aGVHD.

Management and outcome

Steroid-refractory aGVHD is associated with poor prognosis and its management, as highlighted in our three patient cases, and can be very diverse often requiring different therapeutic modalities which overlap in administration.

Discussion

In these patients with steroid-refractory aGVHD, we were able to show that infliximab biosimilars could be used in lieu of the reference infliximab product. Although we had important limitations, this case report supports the use of anti-TNF agents in highly mortal steroid-refractory acute GI GVHD and that replacement of infliximab with its biosimilars is feasible.
Incidence of hemorrhagic cystitis after cyclophosphamide therapy with or without mesna: A cohort study and comprehensive literature review
Authors: Almalag Haya M , Alasmari Sarah S , Alrayes Mounerah H , Binhameed Munirah A , Alsudairi Reem A , Alosaimi Maha M , Alnasser Ghada A , Abuzaid Rawan A , Khalil Najma , Abouzaid Hanan H , Alarfaj Abdulrahman S
Published: May 2020

Background

Cyclophosphamide is an alkylating agent associated with significant toxicities, most importantly hemorrhagic cystitis. Many approaches including mesna use were established to reduce this toxicity. However, data on mesna efficacy are conflicting.

Objective

To investigate the incidence of hemorrhagic cystitis in patients receiving cyclophosphamide therapy with or without mesna.

Methods

A retrospective chart review was done on all adult patients receiving cyclophosphamide therapy with or without mesna at the King Saud University Medical City. The incidence of hemorrhagic cystitis was recorded. Patients receiving mesna were compared with those not receiving mesna. Data were reported as numbers and percentages, and appropriate statistical tests of association were used. This step was followed by a comprehensive literature review using appropriate keywords in PubMed from the inception of the database until August 2019. All studies of interest were reported.

Results

A total of 718 patients’ medical records were reviewed. The majority of the patients received mesna (n = 433, 60%). The mesna group had a greater incidence of hemorrhagic cystitis (3.5% vs. 0.4%, p < 0.004) and received a significantly larger cumulative dose (3103 ± 1696 vs. 2465 ± 1528, p < 0.001) mg of cyclophosphamide therapy. Our literature review revealed large differences in the conclusions of published trials with highly diverse study designs and populations, emphasizing on the need of large prospective trials to address this topic. Conclusion and relevance: Our study results do not support the use of mesna in preventing hemorrhagic cystitis. We found that the only influential factor in the development of hemorrhagic cystitis was the dose of cyclophosphamide therapy.
Morphological and physical properties of kefiran-whey protein isolate bionanocomposite films reinforced with Al2O3 nanoparticles
Authors: Moradi Zahra
Published: May 2020

Considering environmental pollution caused by the non-biodegradable polymers used in food packaging, developing and enhancing the properties of biodegradable films seem to be necessary. For this aim, in the present study, kefiran-whey protein isolate bionanocomposite films were prepared and the impact of different concentrations (1, 3 and 5% w/w) of Al2O3 (alumina) nanoparticles on their physical, morphological, thermal and mechanical properties was studied. Based on the obtained results, an increase in the nanoparticles content led to a significant decrease (p < 0.05) in the water vapor permeability, moisture absorption, moisture content, and water solubility. Scanning electron microscope images showed a homogeneous structure, confirming the good dispersion of alumina nanoparticles with smooth surface up to concentration of 3%. In addition, both thermal stability and mechanical properties of the films were improved by the increased concentrations of alumina. The results of X-ray diffraction indicated that the intensity of the crystalline peaks of film increased with the addition of Al2O3 to kefiran-whey protein isolate matrix. By considering all results, the concentration of 3% was proposed as the appropriate concentration of Al2O3 for the nano-reinforcement of kefiran-whey protein isolate bionanocomposites.
The load-carrying capacity of sandwich beams in different collapse mechanisms
Authors: Guo Lu , Mao Renwei , Li Shiqiang , Liu Zhifang , Lu Guoxing , Wang Zhihua
Published: May 2020

The load-carrying capacity of the symmetrical and asymmetrical sandwich beams, under a quasi-static central load, is investigated in this paper. Three collapse mechanisms such as face yield, core shear and indentation are considered for symmetrical sandwich beams. Core shear mechanism is taken into account for fully clamped asymmetrical sandwich beams. Continuity equations are established by simple ‘equal area’ method for the postyield behavior of the sandwich beams in face yield and core shear mechanisms at different boundary conditions. In indentation mechanism theoretical model, the effect of the local denting on the large deflection of the sandwich beam is taken into account. Then, finite element simulations are carried out to verify the validity of the proposed analysis, and a good agreement is presented. It is shown that in the core shear mechanism under fully clamped condition, no plateau phase is presented. The effect of the core thickness on the response of the symmetrical beams is discussed in detail. For asymmetry beams in core shear mechanism under fully clamped condition, the effect of the asymmetric factor (strength or thickness) for face-sheets on the load–deflection behavior of the postyield beams can be neglected, if the sum of the strength or thickness of the face sheets is constant.
Outcomes of Ahmed glaucoma valve in paediatric glaucoma following congenital cataract surgery in persistent foetal vasculature
Authors: Spiess Karina , Peralta Calvo Jesús
Published: May 2020

Purpose

To evaluate the outcomes of primary Ahmed glaucoma valve in refractory secondary glaucoma following congenital cataract surgery, particularly in persistent foetal vasculature.

Method

Retrospective review of paediatric patients after Ahmed glaucoma valve implantation for refractory post-lensectomy glaucoma in a tertiary referral centre in Spain. Surgical complications, additional and/or replacements of Ahmed glaucoma valve, intraocular pressure, cup-to-disc ratio, glaucoma medications and final visual acuity were studied.

Results

A total of 29 eyes, 41% with persistent foetal vasculature and 59% with non–persistent foetal vasculature were included with mean follow-up of 105 ± 67 and 74 ± 45 months, respectively, after first Ahmed glaucoma valve implant. Median survival time for the first Ahmed glaucoma valve was significantly lower in persistent foetal vasculature (7.0 ± 3.2 months) compared to non–persistent foetal vasculature (over 129 months), p = 0.001. The cumulative probability of success in persistent foetal vasculature and non–persistent foetal vasculature eyes with Ahmed glaucoma valve were, respectively, 37.5% and 88.2% at year 1 and 28.1% and 71.9% at year 5. Cox regression model suggested persistent foetal vasculature as predictive risk factor of time to Ahmed glaucoma valve failure (hazard ratio: 5.77, p = 0.004). Four eyes developed phthisis bulbi. Mean intraocular pressure prior glaucoma surgery was 32.66 ± 6.73 mmHg and decreased to 16.54 ± 2.75 mmHg (p < 0.001) at final visit. The most frequent early postoperative complication was severe hypotony (32.6%) which tended to be self-limiting. Vitreous haemorrhage was associated with persistent foetal vasculature (p = 0.024). Ahmed glaucoma valve replacements after complications and additional Ahmed glaucoma valve implantations due to unsatisfactory intraocular pressure were more common in the persistent foetal vasculature group.

Conclusion

Eyes with persistent foetal vasculature and secondary glaucoma after congenital cataract surgery followed by AGV implantation had a higher number of complications and a decreased probability of success compared to the non-persistent foetal vasculature group. Both groups achieved a significant decrease in intraocular pressure; thus, Ahmed glaucoma valve may be considered as first-line treatment in refractory glaucoma following congenital cataract surgery.
Pediatric posttraumatic orbital subperiosteal hematoma
Authors: Eshraghi Bahram , Razi-Khosroshahi Marjan , Hasani Hamidreza , Silbert David I
Published: May 2020

Aim

To report five children with posttraumatic orbital subperiosteal hematoma.

Methods

In this study, five cases with posttraumatic orbital subperiosteal hematoma were studied and reviewed along with similar cases in a systematic literature review.

Results

The mean age of our patients was 9.40 ± 3.51 years, ranging from 4 to 13 years, and all were male. Mechanisms of injuries were blunt trauma, falling from a building, car accident, and falling from a bicycle. All patients had unilateral involvement. Treatment options included needle aspiration, surgical drainage, and observation for spontaneous resolution. Except for one patient, positive outcomes were achieved.

Conclusion

The most common location for posttraumatic orbital subperiosteal hematoma is the superior orbital wall. Traumatic optic neuropathy and permanent visual loss are uncommon. Observation, surgical drainage, and aspiration are common treatment options.
Does the duration of childhood starvation affect life at age 45 or older in China? The mediating role of socioeconomic and health statuses
Authors: Liu Yiwei , Zhao Yuxiao , Tian Yong , Xu Ling
Published: May 2020

This study investigated the impact of the duration of childhood starvation experience on life satisfaction among Chinese people and examined whether and how socioeconomic and health statuses mediated this association. Data were derived from the China Health and Retirement Longitudinal Study, a nationwide social survey project that was conducted among Chinese individuals aged 45 or older in 2014. The results show that the duration of childhood starvation experience was significantly negatively associated with life satisfaction, and socioeconomic and health statuses mediated this relationship. The findings suggested that more interventions should be conducted among people who have experienced childhood starvation.