bluuebunny/crossref_metadata_2025 huggingface dataset:
Usefulness of a Newly Developed Ultrasonic Microdissector in Neurosurgery: A Preliminary Experimental Study
Authors: Goto Tetsuya , Fujii Yusuke , Hanaoka Yoshiki , Hongo Kazuhiro , Okamoto Jun , Muragaki Yoshihiro , Ogiwara Toshihiro
Published: December 2018

Background Dissection and division of tissues are widely performed in microscopic neurosurgery, especially in brain tumor resection. Dissection maneuvers can be divided into two types: sharp dissection with microscissors and blunt dissection using a dissector. It is essential to use the appropriate method according to the intraoperative situation and conditions. Therefore, specific tools for each type of dissection maneuver are required. We developed an ultrasonic microdissector, a newly designed tool that functions as both microscissors and dissector to further advance brain tumor surgery. This preliminary experimental study was performed to evaluate the usefulness of this new device.

Methods Solfy F (J. Morita Mfg. Corp., Kyoto, Japan), a dental ultrasonic instrument, was used to provide power in this study. Two experiments were performed. The first one involved touching the brain parenchyma of a pig cadaver with the tip of the ultrasonic microdissector under various conditions to investigate its side effects. In the second experiment, the rat femoral artery, vein, and nerve were dissected from surrounding structures using a prototype of the ultrasonic microdissector. The effects of this device were then investigated histologically.

Results The amount of tissue damage was greater with the higher ultrasonic power. No irrigation and a long manipulation time also affected tissue degeneration. Dissection using the ultrasonic microdissector was superior to conventional dissection methods in terms of time (p < 0.05) and safety without any additional histologic damages.

Conclusions The newly developed ultrasonic microdissector can dissect soft tissue without damage to the surrounding tissue. Further studies are required to determine the optimal intensity for its clinical use.
Evolution of the Bacillus Calmette–Guerin Scar and Its Association with Birth and Pregnancy Characteristics in a Prospective Cohort of Infants in Iquitos, Peru
Authors: Schiaffino Francesca , Lee Gwenyth O. , Paredes-Olortegui Maribel , Cabrera Lilia , Penataro-Yori Pablo , Gilman Robert H. , Kosek Margaret N.
Published: December 2018

Background Bacillus Calmette–Guerin (BCG) scar formation is considered a visual marker of vaccination and cell-mediated immune response. This study characterized the association between pregnancy and birth characteristics with BCG scar formation.

Study Design Pregnant women were enrolled prospectively. Infants were followed up for the first 6 months of life, and the diameter of the BCG scar was recorded. Marginal models were fitted to assess the association of BCG scar diameter with pregnancy and birth characteristics using linear regressions with generalized estimating equations.

Results A total of 307 infants were enrolled, of whom 19.2% (59/307) were of low birth weight. Among those with known gestational age, 7.1% were preterm births (21/295). Overall, 98.7% (303/307) of infants developed a BCG scar. BCG scar trends in a tropical environment, such as the Amazon, differ from the trends evidenced in the capital of Peru. For every additional week of gestational age, the mean scar diameter increased by 0.1 mm (95% confidence interval [CI]: 0.02, 0.24; p = 0.017). Maternal illness during pregnancy impacted BCG scar size, as the infants of mothers who self-report fever had a smaller scar diameter (1 mm, 95% CI: 0.5, 1.8 mm; p = 0.001).

Conclusion The immune reaction to the BCG vaccination is affected by gestational age at birth and systemic inflammatory episodes during pregnancy.
Threefold extremal curve germs with one non-Gorenstein point
Authors: Mori S. , Prokhorov Yu. G.
Published: December 2018

An extremal curve germ is the analytic germ of a threefold with terminal singularities along a reduced complete curve admitting a contraction whose fibres have dimension at most one. The aim of the present paper is to review the results concerning contractions whose central fibre is irreducible and contains only one non-Gorenstein point.
Fano threefolds with infinite automorphism groups
Authors: Przyjalkowski V. V. , Cheltsov I. A. , Shramov K. A.
Published: December 2018

We classify smooth Fano threefolds with infinite automorphism groups.
Effect of MgO micro-powder on the characteristics of micro-arc oxidation coatings
Authors: Wang Ping , Gong Ze Yu , Hu Jie , Pu Jun , Cao Wen Jie
Published: December 2018

MgO micro-powder of different concentrations from 0 to 8 g L−1 was added in the electrolyte. Effects of MgO micro-powder concentration on properties of micro-arc oxidation (MAO) coating were analysed by scanning electron microscopy, energy dispersive spectrometer, X-ray diffraction, electrochemical workstation, thermal shock tester equipment, etc. The result revealed that the concentration of MgO has evident effects on the properties of the MAO coating. When MgO micro-powder increased, the oxide voltage, the coating thickness and hardness increased first and then decreased. In this case, the diameter of the hole on the coating surface also increased and more linear holes appeared. The phases mainly consist of γ-Al2O3, α-Al2O3, MgAl2O4 and Mg2SiO4. As a result, the corrosion resistance and the adhesion of the MAO coating increase first and then decrease mainly related to the surface morphologies and phase of the coating. The coating has good thermal shock resistance. The performance of micro-arc oxidation coating with MgO micro-powder was improved.
Effects of dietary protein contents and habitual endurance exercise on supplemental leucine oxidation in mice
Authors: Taniguchi Hirokazu , Akiyama Nao , Ishihara Kengo
Published: December 2018

The effects of dietary protein contents and regular exercise on the oxidation of supplemented leucine were examined. In the short-term study, male BALB/cCrSlc mice were fed diets containing 0, 10, 20, 35, and 60% protein: energy ratios for 1 week. In the long-term study, exercised and sedentary mice were fed diets containing 20, 35, and 60% protein ratios for 9 weeks. After the feeding periods, the mice were a bolus administered oral supplements of l-[1-13C] leucine. Expired gas was analyzed, and oxidized leucine was expressed as a relative 13CO2/12CO2 ratio. In the short-term study, the peak 13CO2/12CO2 ratio significantly increased with diet protein concentrations. Moreover, the long-term study also showed that the peak 13CO2/12CO2 ratio was significantly increased by high protein diets in both exercised and sedentary mice. Our results indicate that supplemental leucine oxidation is associated with consumption of a high-protein diet, irrespective of exercise status.

Abbreviations: AUC: area under the curve; EX: exercise; RQ: respiratory quotient; SED: sedentary; VO2/W: oxygen uptake per body weight
Protective effects of calcitonin on IL-1 stimulated chondrocytes by regulating MMPs/TIMP-1 ratio via suppression of p50-NF-κB pathway
Authors: Bai Xiaodong , Guo Ai , Li Yadong
Published: December 2018

The aim of this study was to investigate the effects and underlying mechanisms of calcitonin (CT) on interleukin 1 beta (IL-1β) stimulated human chondrocytes. IL-1β (5 ng/mL) was added into chondrocytes to establish osteoarthritis (OA) model in vitro. Different concentrations of CT (0.1, 0.5, 1, 5, 10 and 50 nM) were used for treating IL-1β stimulated chondrocytes. Cell viability of chondrocytes was measured by cell counting kit-8 (CCK8) method. Western blotting was performed to evaluate the expression of matrix metalloproteinases (MMP-13), tissue inhibitor of metalloproteinases 1 (TIMP-1), p50 and p38. CT inhibited MMP-13 expression and promoted TIMP-1 expression in the IL-1β stimulated human chondrocytes. The CT-mediated alteration of MMP-13/TIMP-1 ratio was partially attributed to the inactivation of the p50- nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) pathway by suppressing p50 in IL-1β stimulated chondrocytes. CT might play a protective role in IL-1β stimulated OA model via p50-NF-κB pathway.

Abbreviations: CT: calcitonin; IL-1β: interleukin-1β; MMP-13: matrix metalloproteinases-13; TIMP-1: tissue inhibitors of metalloproteinases-1.
Removal of 2,4-dinitrophenol (2,4-DNP) by using magnetic nanoparticles (MNPs) coated with polypyrrole (PPy)
Authors: Sani Nor Azean Nadhirah Mohamed , Mazlan Nurul Aqilla , Mohamed Ahmad Husaini , Sambasevam Kavirajaa Pandian , Jantan Khairil Anuar , Ramachandran Muggundha Raoov , Sapari Jamil Mohamed
Published: December 2018

The research represented here is oriented towards developing a new approach to functionalise a surface of Magnetic Nanoparticles with Polypyrrole (MNPs-PPy). This development will then applied to remove 2,4 dinitrophenol (2,4-DNP) in aqueous solution. A various analytical technique such as Fourier Transform Infrared Spectroscopy (FTIR) analysis, Scanning Electron Microscope (SEM), X-ray Diffraction (XRD) was employed for complete characterisation of MNPs-PPy. FT-IR spectra have shown the peak of Fe-O at 580 cm-1 while; the SEM images illustrated the globular structure of the surface of MNPs-PPy. Also, XRD result has shown the MNPs-PPy is in the crystalline form. The ultimate aims would then be the optimisation of the superlative condition of several parameters such as effect pH, temperature and concentration, contact time, amount of adsorbent, interfering ions and reusability for the removal of (2,4-DNP) in an aqueous solution by MNPs-PPy. The optimum conditions were observed at pH 6, 318 K, 10 ppm of analyte, 75 minutes and 50 mg of adsorbents which shown 98.67 % removal of analyte.
Intra-amniotic inflammation induces preterm birth by activating the NLRP3 inflammasome†
Authors: Faro Jonathan , Romero Roberto , Schwenkel George , Garcia-Flores Valeria , Arenas-Hernandez Marcia , Leng Yaozhu , Xu Yi , Miller Derek , Hassan Sonia S , Gomez-Lopez Nardhy
Published: December 2018

Intra-amniotic inflammation is strongly associated with spontaneous preterm labor and birth, the leading cause of perinatal mortality and morbidity worldwide. Previous studies have suggested a role for the NLRP3 (NLR family pyrin domain-containing protein 3) inflammasome in the mechanisms that lead to preterm labor and birth. However, a causal link between the NLRP3 inflammasome and preterm labor/birth induced by intra-amniotic inflammation has not been established. Herein, using an animal model of lipopolysaccharide-induced intra-amniotic inflammation (IAI), we demonstrated that there was priming of the NLRP3 inflammasome (1) at the transcriptional level, indicated by enhanced mRNA expression of inflammasome-related genes (Nlrp3, Casp1, Il1b); and (2) at the protein level, indicated by greater protein concentrations of NLRP3, in both the fetal membranes and decidua basalis prior to preterm birth. Additionally, we showed that there was canonical activation of the NLRP3 inflammasome in the fetal membranes, but not in the decidua basalis, prior to IAI-induced preterm birth as evidenced by increased protein levels of active caspase-1. Protein concentrations of released IL1β were also increased in both the fetal membranes and decidua basalis, as well as in the amniotic fluid, prior to IAI-induced preterm birth. Finally, using the specific NLRP3 inhibitor, MCC950, we showed that in vivo inhibition of the NLRP3 inflammasome reduced IAI-induced preterm birth and neonatal mortality. Collectively, these results provide a causal link between NLRP3 inflammasome activation and spontaneous preterm labor and birth in the context of intra-amniotic inflammation. We also showed that, by targeting the NLRP3 inflammasome, adverse pregnancy and neonatal outcomes can be significantly reduced.
A partial agonist for retinoid X receptor mitigates experimental colitis
Authors: Onuki Masayoshi , Watanabe Masaki , Ishihara Narumi , Suzuki Koichiro , Takizawa Kei , Hirota Masato , Yamada Takahiro , Egawa Aiko , Shibahara Osamu , Nishii Midori , Fujihara Michiko , Makishima Makoto , Takahashi Daisuke , Furusawa Yukihiro , Kakuta Hiroki , Hase Koji
Published: December 2018

Inflammatory bowel disease (IBD), including ulcerative colitis and Crohn’s disease, is an intractable disease of the gastrointestinal tract. Multiple environmental factors, including food ingredients, have been implicated in the development of these diseases. For example, animal fat-rich diets are predisposing factors for ulcerative colitis, whereas n-3 unsaturated fatty acids such as docosahexaenoic acid (DHA) show protective effects in experimental colitis and are negatively correlated with the incidence of ulcerative colitis and Crohn's disease. Given that DHA exhibits agonistic activity on retinoid X receptor (RXR), activation of RXR could be a therapeutic strategy for IBD. However, conventional full RXR agonists are known to show considerable adverse effects. We therefore took advantage of a partial RXR agonist, CBt-PMN, to minimize the adverse effects, and evaluated its efficacy in dextran sodium sulfate-induced colitis. Administration of CBt-PMN efficiently ameliorated the symptoms of colitis. This effect was attributed to the down-regulation of pro-inflammatory cytokines such as Tnf and Il6 in colon-infiltrating monocytes. Down-regulation of pro-inflammatory cytokines by CBt-PMN was also evident in lipopolysaccharide-stimulated bone marrow-derived macrophages (BMDMs). Among many RXR-associated nuclear receptors, activation of peroxisome proliferator-activated receptor δ (PPARδ) and nuclear hormone receptor 77 (Nur77) suppressed cytokine production by BMDMs. These observations suggest that the activation of PPARδ/RXR and Nur77/RXR heterodimers by CBt-PMN through the permissive mechanism is responsible for diminishing the monocyte-mediated inflammatory response in the gut. Our data highlight the importance of RXR activation in the regulation of colitis.
Documenting social determinants of health-related clinical activities using standardized medical vocabularies
Authors: Arons Abigail , DeSilvey Sarah , Fichtenberg Caroline , Gottlieb Laura
Published: December 2018

Objectives

Growing recognition that health is shaped by social and economic circumstances has resulted in a rapidly expanding set of clinical activities related to identifying, diagnosing, and intervening around patients’ social risks in the context of health care delivery. The objective of this exploratory analysis was to identify existing documentation tools in common US medical coding systems reflecting these emerging clinical practices to improve patients’ social health.

Materials and Methods

We identified 20 social determinants of health (SDH)-related domains used in 6 published social health assessment tools. We then used medical vocabulary search engines to conduct three independent searches for codes related to these 20 domains included in common medical coding systems (LOINC, SNOMED CT, ICD-10-CM, and CPT). Each of the 3 searches focused on one of three clinical activities: Screening, Assessment/Diagnosis, and Treatment/Intervention.

Results

We found at least 1 social Screening code for 18 of the 20 SDH domains, 686 social risk Assessment/Diagnosis codes, and 243 Treatment/Intervention codes. Fourteen SDH domains (70%) had codes across all 3 clinical activity areas.

Discussion

Our exploratory analysis revealed 1095 existing codes in common medical coding vocabularies that can facilitate documentation of social health-related clinical activities. Despite a large absolute number of codes, there are addressable gaps in the capacity of current medical vocabularies to document specific social risk factor screening, diagnosis, and interventions activities.

Conclusions

Findings from this analysis should help inform efforts both to develop a comprehensive set of SDH codes and ultimately to improve documentation of SDH-related activities in clinical settings.
Home-based Cognitive Prehabilitation in Older Surgical Patients: A Feasibility Study
Authors: Vlisides Phillip E. , Das Abhijit R. , Thompson Allie M. , Kunkler Bryan , Zierau Mackenzie , Cantley Michael J. , McKinney Amy M. , Giordani Bruno
Published: December 2018

Background:

Cognitive training is beneficial in various clinical settings, although its perioperative feasibility and impact remain unknown. The objective of this pilot study was to determine the feasibility of home-based cognitive prehabilitation before major surgery in older adults.

Materials and Methods:

Sixty-one patients were enrolled, randomized, and allocated to either a home-based preoperative cognitive training regimen or no training before surgery. Outcomes included postoperative delirium incidence (primary outcome; assessed with the 3D-Confusion Assessment Method), perioperative cognitive function based on NIH Toolbox measures, hospital length of stay, and physical therapy session participation. Reasons for declining enrollment were reported, as were reasons for opting out of the training program.

Results:

Postoperative delirium incidence was 6 of 23 (26%) in the prehabilitation group compared with 5 of 29 (17%) in the control group (P=0.507). There were no significant differences between groups in NIH Toolbox cognitive function scoring, hospital length of stay, or physical therapy participation rates. Study feasibility data were also collected and reported. The most common reasons for declining enrollment were lack of computer access (n=19), time commitment (n=9), and feeling overwhelmed (n=9). In the training group, only 5 of 29 (17%) included patients were able to complete the prescribed 7 days of training, and 14 of 29 (48%) opted out of training once home. Most common reasons were feeling overwhelmed (n=4) and computer difficulties (n=3).

Conclusions:

Short-term, home-based cognitive training before surgery is unlikely to be feasible for many older patients. Barriers to training include feeling overwhelmed, technical issues with training, and preoperative time commitment.
Management of early-onset hip osteoarthritis in an adolescent patient with osteopetrosis tarda: a case report
Authors: Erkus Serkan , Turgut Ali , Köse Ozkan , Kalenderer Önder
Published: December 2018

Osteopetrosis (OP) is a group of rare sclerosing bone dysplasia characterized by increased bone density. The benign autosomal dominant form is the most common type. It typically carries a full life expectancy, despite increased propensity for fractures and other musculoskeletal problems, particularly hip osteoarthritis. In the current literature, the youngest OP patient having hip osteoarthritis is 16 years of age and treated with total hip arthroplasty. Within the present study, a 16-year-old female patient with early-onset hip osteoarthritis treated with hip joint debridement and femoral head reshaping is presented. The pain relieved and hip joint movements recovered to almost normal range. At the final follow-up at 2 years after the surgery, the patient was still free of pain and ambulating without restriction. Hip joint debridement and femoral shaping may be beneficial in hip osteoarthritis secondary to OP in adolescents, and may delay hip arthroplasty in a young age.
Sex-specific and Age-specific Analgesia for Early Postoperative Pain Management After Lumbar Decompressive Surgery
Authors: Kim Sang-Il , Ha Kee-Yong , An Howard S. , Rhyu Kee-Won , Lee Hyun-Woo , Oh In-Soo
Published: December 2018

Study Design:

This was a randomized clinical trial.

Objective:

To compare the efficacy and safety of nonsteroidal anti-inflammatory drug and opioid for acute pain management after lumbar decompressive surgery.

Summary of Background Data:

Multimodal analgesia is associated with synergistic effects while reducing opioid-related adverse effects. However, there is no consensus on the ideal multimodal analgesic regimen. We assumed that each agent in various multimodal regimens under different conditions may have different effects.

Materials and Methods:

This prospective randomized clinical trial recruited adult patients who underwent single-level lumbar decompressive surgery. Patients were randomized to receive our postoperative analgesic regimen including either nonsteroidal anti-inflammatory drug (celecoxib) or opioid (extended-release oxycodone) from postoperative day 3 to 14. The Visual Analog Scale (VAS) and Oswestry Back Pain Disability Index (ODI) were used to evaluate effectiveness preoperatively and on postoperative days 2, 3, 7, and 14, and at 6 months. Drug-related adverse effects were also recorded.

Results:

One hundred patients were enrolled and 93 patients (46 patients with celecoxib vs. 47 patients with oxycodone) were randomized. No differences were observed in patient demographics and preoperative VAS and ODI between the 2 groups. VAS and ODI were not different at all postoperative time points. However, subanalysis according to sex and age, revealed significant differences in efficacy: celecoxib was effective in female individuals and oxycodone was effective in male individuals on postoperative days 7 and 14; oxycodone was effective in patients aged above 65 years on postoperative days 7 and 14. Although nausea/vomiting and constipation were more common in the oxycodone group than in the celecoxib group, other adverse effects were not different.

Conclusions:

In patients who underwent single-level lumbar decompressive surgery, treatment with celecoxib and oxycodone for postoperative pain management showed no significant differences in efficacy. However, subanalysis showed that each drug was effective in different ages and sex groups.

Level of Evidence:

Level II.
Improvement in sleep outcomes with a 17β-estradiol–progesterone oral capsule (TX-001HR) for postmenopausal women
Authors: Kagan Risa , Constantine Ginger , Kaunitz Andrew M. , Bernick Brian , Mirkin Sebastian
Published: December 2018

Objective:

The aim of the study was to evaluate the effects of TX-001HR, a single-capsule 17β-estradiol–progesterone on sleep parameters in postmenopausal women with vasomotor symptoms (VMS) using the Medical Outcomes Study (MOS)-Sleep scale questionnaire in the REPLENISH trial.

Methods:

In the REPLENISH trial (NCT01942668), women were randomized to one of four doses of TX-001HR or placebo, and the 12-item MOS-Sleep questionnaire (secondary endpoint) was self-administered at baseline, week 12, and months 6 and 12. Changes from baseline in the MOS-Sleep total score and 7 subscale scores were analyzed for treatment groups versus placebo at all time points. Somnolence was also collected as an adverse event.

Results:

Women (mean age 55 y) were randomized to TX-001HR (estradiol/ progesterone [E2/P4] [mg/mg]) doses: 1/100 (n = 415), 0.5/100 (n = 424), 0.5/50 (n = 421), 0.25/50 (n = 424), or placebo (n = 151). TX-001HR significantly improved MOS-Sleep total score, Sleep Problems Index II subscale, and sleep disturbance subscale versus placebo at all time points, except with 0.25 mg E2/50 mg P4 at week 12. Differences in LS mean changes between TX-001HR and placebo for MOS-Sleep total scores ranged from −6.5 to −7.6 at 12 months (all; P ≤ 0.001). All doses of TX-001HR significantly improved the Sleep Problems Index I subscale at all time points. The sleep somnolence subscale significantly improved from baseline with 0.5 mg E2/100 mg P4 and 0.5 mg E2/50 mg P4 at month 12. The incidence of somnolence as a treatment-emergent adverse event ranged from 0.2% to 1.2% versus 0% with placebo.

Conclusion:

TX-001HR significantly improved MOS-Sleep parameters from baseline to week 12, which was sustained for up to 12 months, and was associated with a very low incidence of somnolence.
Innovations in Computer Technologies Have Impacted Radiation Dosimetry Through Anatomically Realistic Phantoms and Fast Monte Carlo Simulations
Authors: George Xu X.
Published: December 2018

Radiological physics principles have not changed in the past 60 y when computer technologies advanced exponentially. The research field of anatomical modeling for the purpose of radiation dose calculations has experienced an explosion in activity in the past two decades. Such an exciting advancement is due to the feasibility of creating three-dimensional geometric details of the human anatomy from tomographic imaging and of performing Monte Carlo radiation transport simulations on increasingly fast and cheap personal computers. The advent of a new type of high-performance computing hardware in recent years—graphics processing units—has made it feasible to carry out time-consuming Monte Carlo calculations at near real-time speeds. This paper introduces the history of three generations of computational human phantoms (the stylized medical internal radiation dosimetry-type phantoms, the voxelized tomographic phantoms, and the boundary representation deformable phantoms) and new development of the graphics processing unit-based Monte Carlo radiation dose calculations. Examples are given for research projects performed by my students in applying computational phantoms and a new Monte Carlo code, ARCHER, to problems in radiation protection, imaging, and radiotherapy. Finally, the paper discusses challenges and future opportunities for research.
Quality and Safety Initiatives for Radiation Safety in Imaging
Authors: Bhargavan-Chatfield Mythreyi
Published: December 2018

There is a substantial infrastructure for quality and safety in radiologic imaging, built over decades, that is available to practices and providers. The purpose of this review is to provide an overview of those resources and place them in the context of patient care. Successful application of these resources requires both the technology as well as the culture to use the techniques. We are beginning to see more tools to support the culture change necessary to take advantage of the resources, and increased attention to the patient perspective.
The 42nd Lauriston S. Taylor Lecture: Radiation Dosimetry Research for Medicine and Protection—A European Journey
Authors: Menzel Hans-Georg
Published: December 2018

The assessment of doses related to exposures to ionizing radiation is an essential part of all applications of ionizing radiation including radiation medicine, radiation protection, radiation biology, radiation epidemiology, and also industrial uses of radiation. Absorbed dose is generally considered to be the fundamental quantity of radiation dosimetry. It is a metrologically sound quantity for which even primary standards exist for some materials, and it is used routinely in practice. However, there is no unique correlation between absorbed dose and the radiation-induced biological effect considered. There are also different objectives of radiation dosimetry for different applications. In radiation protection, quantities are required to set meaningful exposure limits and to implement the principle of optimization. In radiation therapy, the dependence of clinical outcomes on temporal aspects of the irradiations must be accounted for. In radiation diagnostics, quantities are needed to enable and monitor optimization of radiation dose and image quality. In radiation protection and in therapy with high linear-energy-transfer radiations, appropriate methods and parameters are needed to account for differences in radiation quality. These limitations of the quantity absorbed dose have led to the use of a multiplicity of dose quantities and dose modification factors. Radiation dosimetry continues, therefore, to be a field of active research regarding fundamental and conceptual aspects, taking account of advances in technologies, of novel methods in radiation therapy and diagnostics, and of progress in computational dosimetry. Dosimetry of high-energy radiations such as cosmic radiation encountered at flight altitudes and during space missions as well as at high-energy accelerators has become an important issue. In Europe, collaboration and coordination of radiation research in general, and dosimetry research in particular, are playing an important role. Dedicated research programs of the European Commission have been and still are very valuable and include collaborations with institutes in Eastern Europe and non-European countries. Several current and recent research topics in radiation dosimetry are addressed based on research carried out within European research programs, at European research centers including the European Organization for Nuclear Research (known as CERN), in European particle therapy projects, and at national metrological institutes. One focus is the quantification of radiation quality in radiation protection and in high linear-energy-transfer radiation therapy with emphasis on measurements with low-pressure proportional counters. Another focus is dosimetry of high-energy radiations with respect to measurements of cosmic radiation and at CERN’s high-energy accelerators.
Doses, Benefits, Safety, and Risks in Oral and Maxillofacial Diagnostic Imaging
Authors: Lurie Alan G.
Published: December 2018

Diagnostic imaging is essential in dentistry. Doses range from low to very low, benefits to patients can be immense, and safe techniques are well known but widely ignored. Doses range from very low with properly executed intraoral, cephalometric, and panoramic imaging to higher than multidetector computed tomography with cone-beam computed tomography. Benefits are substantial: imaged dental disease, often obscured from direct vision by size and anatomy, can pose a mortal threat to the patient. Additionally, imaging is often central in planning complex dental procedures. Safe imaging in dental environments is straightforward; the means for minimizing dose and maximizing diagnostic efficacy have been widely and inexpensively available for decades. Such techniques reduce patient dose by some 80% over traditional techniques but are infrequently used. Digital panoramic equipment reduces doses markedly. For cone-beam computed tomography imaging, selection criteria are critical in defining appropriate fields of view and presets; several publications address this. It is treacherous to discuss risk in oral and maxillofacial radiology. There are more than 330 million dental x-ray examinations annually, the majority being intraoral examinations, with steady increases in panoramic and cone-beam computed tomography. Radiation carcinogenesis from conventional imaging is unlikely, while large field-of-view, high-resolution preset cone-beam computed tomography can be comparable in carcinogenesis risk to craniofacial multidetector computed tomography. Uncertainties in risk estimation from low doses coupled with the huge numbers of dental images taken annually and the rapid growth of cone-beam computed tomography dictate that safe oral and maxillofacial imaging is in the interests of patients, staff, and the public. As low as reasonably achievable (ALARA) practices and linear no-threshold risk modeling continue to be prudent and appropriate.
Radiation Protection Responsibility in Medicine: A Wrap-up
Authors: Frush Donald P. , Dauer Lawrence T.
Published: December 2018

The 54th Annual Meeting of the National Council on Radiation Protection and Measurements was held at the Hyatt Regency Bethesda, Maryland, on 5–6 March 2018. This annual meeting, entitled “Radiation Protection Responsibility in Medicine,” was the first to deal entirely with radiation protection in medical imaging since the 43rd annual meeting in 2007 (“Advances in Radiation Protection in Medicine”). The 2018 meeting addressed updates for various modalities and included discussion on radiation dose metrics and benefit/risk dialogue. In addition, the 2018 meeting dedicated entire sessions to patient communications and innovations in medical imaging.
Contact Lens Versus Non–Contact Lens–Related Corneal Ulcers at an Academic Center
Authors: Bennett Lisa , Y. Hsu Hugo , Tai Shannon , Ernst Benjamin , Schmidt Eric J. , Parihar Rohit , Horwood Chelsea , Edelstein Sean L.
Published: December 2018

Purpose:

To compare the infectious contact lens–related corneal ulcer (CLRU) and non-CLRU cases at Saint Louis University.

Methods:

Retrospective review of corneal ulcer cases identified by search of the ophthalmology and microbiology department databases between 1999 and 2016.

Results:

Six hundred seventy-seven cases of corneal ulcers were identified, of which 46% were CLRU. CLRU cases were seen more commonly in younger patients (P<0.001) and women (P=0.03) than non-CLRU cases. Many of the infections were vision-threatening as defined by central/paracentral location (73% CLRU and 71% non-CLRU [P=0.60]) and large size of ulcer >2 mm2 in 36% CLRU and 51% non-CLRU (P=0.002). Causative pathogen in cultured CLRU was predominately Pseudomonas species (44%, P<0.001 vs. the non-CLRU group), other gram-negative (6%), gram-positive (33%), fungi (13%), and Acanthamoeba (5%). Comparatively, cultured non-CLRU was predominately gram-positive (64%, P<0.001 vs. the CLRU group), gram-negative (26%), and fungi (11%). The combined oxacillin-resistant Staphylococcus aureus and coagulase-negative Staphylococcus isolates were 35% and 34%, respectively. Despite the progressive increase in the number of corneal ulcers seen, the annual trend for any one particular organism for either CLRU cases or non-CLRU cases did not change significantly.

Conclusions:

Most of the cases were non-CLRU. CLRU was disproportionately associated with Pseudomonas species and non-CLRU with Staphylococcal species. Fungal infections were predominately caused by filamentous organisms in both groups. Acanthamoeba keratitis was exclusively associated with CL use.
Tumor necrosis factor receptor 1 inhibition is therapeutic for neuropathic pain in males but not in females
Authors: del Rivero Tania , Fischer Roman , Yang Fan , Swanson Kathryn A. , Bethea John R.
Published: December 2018

Tumor necrosis factor (TNF) is a proinflammatory cytokine, which is involved in physiological and pathological processes and has been found to be crucial for pain development. In the current study, we were interested in the effects of blocking Tumor necrosis factor receptor 1 (TNFR1) signaling on neuropathic pain after peripheral nerve injury with the use of transgenic mice and pharmacological inhibition. We have previously shown that TNFR1−/−mice failed to develop neuropathic pain and depressive symptoms after chronic constriction injury (CCI). To investigate the therapeutic effects of inhibiting TNFR1 signaling after injury, we delivered a drug that inactivates soluble TNF (XPro1595). Inhibition of solTNF signaling resulted in an accelerated recovery from neuropathic pain in males, but not in females. To begin exploring a mechanism, we investigated changes in N-methyl-D-aspartate (NMDA) receptors because neuropathic pain has been shown to invoke an increase in glutamatergic signaling. In male mice, XPro1595 treatment reduces elevated NMDA receptor levels in the brain after injury, whereas in female mice, NMDA receptor levels decrease after CCI. We further show that estrogen inhibits the therapeutic response of XPro1595 in females. Our results suggest that TNFR1 signaling plays an essential role in pain induction after CCI in males but not in females.
Role of anxiety in young children's pain memory development after surgery
Authors: Fischer Shanaya , Vinall Jillian , Pavlova Maria , Graham Susan , Jordan Abbie , Chorney Jill , Rasic Nivez , Brookes James T. , Hoy Monica , Yunker Warren K. , Noel Melanie
Published: December 2018

Pediatric pain is common, and memory for it may be distressing and have long-lasting effects. Children who develop more negatively biased memories for pain (ie, recalled pain is higher than initial pain report) are at risk of worse future pain outcomes. In adolescent samples, higher child and parent catastrophic thinking about pain was associated with negatively biased memories for postsurgical pain. This study examined the influence of child and parent anxiety on the development of younger children's postsurgical pain memories. Seventy-eight children undergoing a tonsillectomy and one of their parents participated. Parents reported on their anxiety (state and trait) before surgery, and trained researchers observationally coded children's anxiety at anaesthesia induction. Children reported on their postsurgical pain intensity and pain-related fear for 3 days after discharge. One month after surgery, children recalled their pain intensity and pain-related fear using the same scales previously administered. Results revealed that higher levels of postsurgical pain and higher parent trait anxiety predicted more negatively biased memories for pain-related fear. Parent state anxiety and child preoperative anxiety were not associated with children's recall. Children who developed negatively biased pain memories had worse postsurgical pain several days after surgery. These findings underscore the importance of reducing parental anxiety and effective postsurgical pain management to potentially buffer against the development of negatively biased pain memories in young children.
Current Practices and Perceptions of Admission Criteria at Physical Therapist Education Programs in the United States
Authors: Mitchell Katy , Ellison Jennifer , Gleeson Peggy
Published: December 2018

Introduction.

Entry-level Doctor of Physical Therapy (DPT) programs in the United States (US) have developed admission criteria (AC) to identify applicants most capable of program success; however, there is little evidence to support these criteria. The purpose of this study was to 1) gather data on the use and weighting of AC, 2) explore the perceptions of the value of AC, 3) explore a possible discrepancy between the use of AC and their perceived value, 4) determine whether differences in AC exist between programs with higher versus lower licensure pass rates, higher versus lower student retention rates, and across geographic regions in the US.

Subjects.

All DPT programs (N = 218) in the US accredited by the Commission on Accreditation of Physical Therapy Education were eligible for recruitment in this study. The survey was completed by a program director, an admission committee chair, or a faculty member familiar with the program's admission process. Of the 218 programs invited to complete the survey, 73 responded with a response rate of 33.5%.

Methods.

An anonymous, 30-item survey was used for data collection. Descriptive and comparative statistical methods were used on the data as a whole and by subgroups.

Results.

Undergraduate overall grade point average (GPA), math/science GPA, or verbal and quantitative Graduate Record Examination (GRE) scores were weighted heavily in admission decisions. The personal essay, volunteer hours, and letters of recommendation were not considered predictive of program success. There were significant differences in the proportion of programs that use the verbal and quantitative GRE scores when subdivided by licensure pass rate, either ≥95% or <95% (P = .005 and P = .049, respectively). There were no proportional differences in the utilization or weighting of criteria when programs were divided by student retention rate, either ≥95% or <95%. Geographic differences were found in the use and weighting of AC when comparing the West region with other parts of the US.

Conclusion.

Previous literature suggests that undergraduate GPA is the best predictor of success in a DPT program; however, this study found no significant differences between the use or weight given to the GPA on licensure examination pass rates or student retention rates. Programs may wish to reconsider requiring a number of criteria that were not weighted heavily or considered to be a top predictor of success in a DPT program, particularly those criteria that are resource intensive.
Effect of Repeating Undergraduate Prerequisite Courses on Academic Performance in Doctor of Physical Therapy Program
Authors: Clark Richard C. , Chiu Yi-Po
Published: December 2018

Introduction.

Identifying potential candidates with the highest potential for success in a doctoral-level physical therapy (DPT) program continues to challenge admissions boards nationwide. Although multiple studies have looked at admissions factors looking to identify specific relationships that predict academic success, it has been noted that many schools are now limiting the number of prerequisite courses that may be retaken by candidates. The purpose of this study was to identify whether there was a difference in DPT academic performance between students who repeated a prerequisite course (rPR) and those who did not repeat a prerequisite course (nrPR).

Methods.

Admissions data were retrospectively collected for 159 students from 5 graduating classes at 2 separate DPT programs between the years 2012–2015. Students were divided into 2 groups (rPR = 71; nrPR = 88) and were analyzed using 2-tailed independent t tests to identify statistically significant differences in DPT academic performance between groups.

Results.

Although the nrPR group showed better performance than the rPR group in all 3 DPT grade point averages (GPAs), there was no statistically significant difference found in DPT academic performance between the 2 groups: for 1GPA, t(157) = 1.294, P = .198; for 2GPA, t(157) = 0.876, P = .382; and for GGPA, t(157) = 0.682, P = .492.

Discussion and Conclusion.

The results of this study demonstrated no statistically significant difference in DPT academic performance between students repeating prerequisite courses versus those who did not repeat prerequisites. This suggests that the practice of limiting the number of repeated prerequisites may not serve to identify the best candidates.
An Artificial Placenta Protects Against Lung Injury and Promotes Continued Lung Development in Extremely Premature Lambs
Authors: Coughlin Megan A. , Werner Nicole L. , Church Joseph T. , Perkins Elena M. , Bryner Benjamin S. , Barks John D. , Bentley John K. , Hershenson Marc B. , Rabah Raja , Bartlett Robert H. , Mychaliska George B.
Published: December 2018

An artificial placenta (AP) utilizing extracorporeal life support (ECLS) could protect premature lungs from injury and promote continued development. Preterm lambs at estimated gestational age (EGA) 114–128 days (term = 145) were delivered by Caesarian section and managed in one of three groups: AP, mechanical ventilation (MV), or tissue control (TC). Artificial placenta lambs (114 days EGA, n = 3; 121 days, n = 5) underwent venovenous (VV)-ECLS with jugular drainage and umbilical vein reinfusion for 7 days, with a fluid-filled, occluded airway. Mechanical ventilation lambs (121 days, n = 5; 128 days, n = 5) underwent conventional MV until failure or maximum 48 hours. Tissue control lambs (114 days, n = 3; 121 days, n = 5; 128 days, n = 5) were sacrificed at delivery. At the conclusion of each experiment, lungs were procured and sectioned. Hematoxylin and eosin (H&E) slides were scored 0–4 in seven injury categories, which were summed for a total injury score. Slides were also immunostained for platelet-derived growth factor receptor (PDGFR)-α and α-actin; lung development was quantified by the area fraction of double-positive tips of secondary alveolar septa. Support duration of AP lambs was 163 ± 9 (mean ± SD) hours, 4 ± 3 for early MV lambs, and 40 ± 6 for late MV lambs. Total injury scores at 121 days were 1.7 ± 2.1 for AP vs. 5.5 ± 1.6 for MV (p = 0.02). Using immunofluorescence, double-positive tip area fraction at 121 days was 0.017 ± 0.011 in AP lungs compared with 0.003 ± 0.003 in MV lungs (p < 0.001) and 0.009 ± 0.005 in TC lungs. At 128 days, double-positive tip area fraction was 0.012 ± 0.007 in AP lungs compared with 0.004 ± 0.004 in MV lungs (p < 0.001) and 0.016 ± 0.009 in TC lungs. The AP is protective against lung injury and promotes lung development compared with mechanical ventilation in premature lambs.
Improved Outcome in Local Ewing Sarcoma With an Intensified Pilot Treatment Protocol SCMCIE 94
Authors: Ash Shifra , Yaniv Isaac , Toledano Helen , Stein Jerry , Kollender Yehuda , Fenig Eyal , Konen Osnat , Bar-Sever Zvi , Issakov Josephine , Avigad Smadar , Cohen Ian J.
Published: December 2018

This study evaluated the effect of an intensified pilot protocol, SCMCIE 94, on the outcome of Ewing sarcoma (EWS). The cohort included 121 patients with local or metastatic EWS treated at a tertiary pediatric medical center with the SCMCIE 94 (protocol 3, 1994 to 2011) or an earlier protocol (protocol 2, 1988 to 1994; protocol 1, 1985 to 1988). All protocols included 4 to 6 courses of chemotherapy, radiation, and surgery. Clinical data were collected retrospectively by chart review. Survival rates for protocol 3 were as follows: all patients—5-year event-free survival (EFS): 52.5%±5.6%, 10-year EFS: 49.3%±5.8%, 5-year overall survival (OS): 68.8%±5.3%, and 10-year OS: 51.1%±6.3%; patients with localized disease (any site)—5-year EFS: 63.5%±6.0% and 5-year OS: 77.2%±5.3%; patients with localized extremity disease—5-year EFS: 78.95%±8.3%, 10-year EFS: 68.6%±10.0%, 5-year OS: 90.7%±6.2%, and 10-year OS: 71.1%±11.2%. Protocol 3 was associated with an increase in 10-year EFS of 16% overall and 33% in patients with localized extremity disease compared with protocols 1+2, and a significant improvement in 5-year EFS and OS in patients with any localized disease (P=0.001). No survival benefit was found for metastatic disease. On multivariate analysis, protocol and metastatic disease were significantly independent prognostic factors. The intensified SCMCIE 94 protocol seems to increase survival in patients with localized but not metastatic EWS.
S100 Staining Adds to the Prognostic Significance of the Combination of Perineural Invasion and Lymphovascular Invasion in Colorectal Cancer
Authors: Conte Gabriella A. , Qari Omar , Fasano Genevieve A. , Guinto Robyn K. , Palo Laura , Parker Glenn S. , Rangwala Anis F. , Minassian Haig , Greenberg Patricia J. , Dewan Asa A. , Topilow Arthur A.
Published: December 2018

Studies have suggested that perineural invasion (PNI) and lymphovascular invasion (LVI) serve as independent prognostic factors in colorectal cancer (CRC). Currently, little is known regarding the combination of PNI and LVI as prognostic factors, independent of stage. We hypothesized that this combination was a better prognostic marker than either PNI or LVI alone, and that S100 staining would detect PNI not seen with hematoxylin and eosin (H&E). Surgical pathology slides were retrospectively reviewed for 151 stages I to IV CRC patients who had surgery between January 1, 2008 and December 8, 2008 at 3 Hackensack Meridian Health hospitals in New Jersey. PNI and LVI were detected by H&E staining and a subset of 127 patient samples were additionally examined for PNI by S100 staining. Correlation between staining characteristics and patient outcomes was assessed using the Pearson χ2 tests and the Fisher exact tests. Survival was analyzed using Kaplan-Meier methods. Of the 151 cases reviewed, 30.5% were positive for PNI and 35.1% were positive for LVI by H&E. The use of S100 staining for PNI enabled its detection in 27 additional cases. Median time from patient diagnosis to death was significantly shorter for patients who were positive for both PNI and LVI (P<0.001). PNI and LVI were individual markers for poor survival in CRC patients and their combined presence had an even worse outcome. Failure to detect PNI on H&E can be overcome by S100 staining.