bluuebunny/crossref_metadata_2025 huggingface dataset:
Cancer Care at Times of Crisis and War: The Syrian Example
Authors: Sahloul Eman , Salem Riad , Alrez Wessam , Alkarim Tayseer , Sukari Ammar , Maziak Wasim , Atassi M. Bassel
Published: September 2016

Purpose

As Syria enters its fifth year of conflict, the number of civilians killed and injured continues to rise sharply. Along with this conflict comes the rapid decline of medical care, specifically cancer care. To determine physician and equipment availability, cancer screening and management, and possible solutions relative to various major cities, a survey was distributed to physicians inside Syria through the help of the humanitarian organization Syrian American Medical Society.

Methods

Online surveys were distributed to both certified oncologists who work in cancer clinics and general physicians who work in rural and mobile clinics inside Syria. Variables assessed were physician specialty, location, population, cost, regional situation (besieged versus government controlled), and resource availability and access. Results were stratified by location and physician specialty.

Results

Survey results revealed a large shortage of specialized physicians and inhibited accessibility to screening and management options in besieged areas compared with government-controlled regions. Physicians within both government-controlled and besieged cities reported limited or no targeted agents, radiation therapy, clinical trials, bone marrow transplantation, positron emission tomography scans, magnetic resonance imaging, and genetic testing.

Conclusion

The Syrian civil war has resulted in suboptimal oncology care in the majority of the region. In consideration of specific deficiencies in cancer care, we recommend several solutions that may better the level of care in Syria: patient education on medical documentation and self-examination; online consultation; and cheap, effective screening methods. The implementation of these recommendations may change the course of cancer care in a country that has deteriorated into the worst humanitarian crisis of the century.
Adrenomedullin2 (ADM2)/Intermedin (IMD): A Potential Role in the Pathophysiology of Preeclampsia
Authors: Chauhan Madhu , Balakrishnan Meena , Vidaeff Alex , Yallampalli Uma , Lugo Fernando , Fox Karin , Belfort Michael , Yallampalli Chandra
Published: September 2016

Context:

It is not known whether decreases in trophoblast invasion promoting the peptide, adrenomedullin2 (ADM2) system is associated with preeclampsia (PreE).

Objective:

The objective of the study was to assess the changes in ADM2 levels in plasma, placenta, and amniotic fluid (AF) and its receptor components in placenta from PreE pregnancy compared with the age-matched normal and study the effect of ADM2 on the synthesis of nitric oxide (NO), endothelial nitric oxide synthase (eNOS), and matrix-metalloproteinase (MMP)-2 and MMP-9 in trophoblast cells.

Results:

PreE is associated with a decreased expression of ADM2 in plasma and placenta (P < .05); ADM2 interacts with a seven-transmembrane G protein-coupled receptor, calcitonin receptor-like receptor (CRLR) in HTR-8/SVneo cells; placental expression of ADM2/CRLR complex is lower in PreE; mRNA for CRLR and receptor activity-modifying protein-3 are lower, whereas receptor activity-modifying protein-2 is higher in the PreE placenta (P < .05); ADM2 levels in the second trimester are lower in the AF from pregnant women who develop PreE later in gestation (P < .05); ADM2 is localized to the epithelium of the amnion and the ectoderm and mesoderm of the chorion in term fetal membranes; ADM2 increases NO production, eNOS, and MMP2/9-immunoreactivity, whereas ADM2 knockdown inhibits the expression of eNOS and MMP2/9 mRNA and S-nitrosylation in HTR-8/SVneo cells; and ADM2-induced increases in MMP2/9 activity is inhibited by L-nitro-arginine methyl ester in HTR-8SV/neo cells.

Conclusion:

Decreases in the ADM2 system in PreE at term, in AF from pregnant women during the second trimester who develop PreE later in gestation, and ADM2-induced increases in the NO and MMP-2/9 levels in trophoblast cells suggest a potential role for ADM2 via the NO-MMP system in the pathophysiology of PreE.
Effect of Linagliptin on Vascular Function: A Randomized, Placebo-controlled Study
Authors: Baltzis Dimitrios , Dushay Jody R. , Loader Jordan , Wu Jim , Greenman Robert L. , Roustit Matthieu , Veves Aristidis
Published: September 2016

Context:

The dipeptidyl peptidase-4 inhibitor, linagliptin, possesses pleiotropic vasodilatory, antioxidant, and anti-inflammatory properties in animals, independent of its glucose-lowering properties. Although large, randomized clinical trials are being conducted to better evaluate the efficacy and safety of linagliptin on cardiovascular outcomes, little is known about its effects on vascular function in humans.

Objective:

This study sought to evaluate the effect of linagliptin on surrogates of vascular and mitochondrial function.

Design and Setting:

This was a randomized, double-blind, placebo-controlled trial at a tertiary care center with a large type 2 diabetes referral base.

Patients and Intervention:

Forty participants with type 2 diabetes were included in a 12-wk treatment of either linagliptin 5mg/d or placebo.

Main Outcome Measures:

Micro- and macrovascular functions were assessed using laser Doppler coupled with iontophoresis and with brachial flow-mediated dilation, respectively. Mitochondrial function was assessed by phosphorus-31 metabolites changes in the calf muscle measured by magnetic resonance spectroscopy. Circulating endothelial progenitor cells, as well as inflammatory cytokines, growth factors, and biomarkers of endothelial function were also quantified.

Results:

Linagliptin was associated with an increase in axon reflex-dependent vasodilation, a marker of neurovascular function (P = .05). A trend indicating increased endothelium-dependent microvascular reactivity was observed (P = .07). These were associated with decreases in concentrations of IFNγ (P < .05), IL-6 (P = .03), IL-12 (P < .03), and MIP-1 (P < .04) following linagliptin treatment when compared with placebo.

Conclusions:

This study demonstrates that linagliptin tends to improve endothelial and neurovascular microvascular function and is associated with decreased markers of inflammation in patients with type 2 diabetes. There was no significant effect of linagliptin on mitochondrial function, macrovascular function, or endothelial progenitor cells.
IS THERE A PLACE FOR PSYCHEDELICS IN PHILOSOPHY?
Authors: Langlitz Nicolas
Published: September 2016

Based on anthropological fieldwork on the revival of hallucinogen research as well as on the epistemic culture of neurophilosophy, this Common Knowledge guest column examines two very different philosophical engagements with psychedelic drugs. In Thomas Metzinger's evidence-based philosophy of mind, hallucinogens help to operationalize questions about the nature of consciousness. While this project contributes to the great divide between empirically enlightened moderns and tradition-oriented premoderns, Metzinger's neurophilosophical reanimation of the ancient conception of philosophy as cultura animi can build a bridge to Aldous Huxley's perennial philosophy, which has informed the psychedelic intelligentsia like no other body of thought. In the sixteenth century, the philosophia perennis grew out of a decidedly nonmodern (but not pre- or antimodern) philosophy of religion that sought to suture the historical and cultural cracks that would come to define modernity. This essay argues that neurophilosophy and ethnographic studies of consciousness cultures could function as critical correctives in a contemporary rearticulation of perennial philosophy.
“VAGUENESS IS HUGE”
Authors: Perl Jeffrey M.
Published: September 2016

In this essay review of Megan Quigley's Modern Fiction and Vagueness: Philosophy, Form, and Language (2015), the editor of Common Knowledge comments on the explicit relationship between that book's arguments and those of the journal's six-part series “Fuzzy Studies: A Symposium on the Consequence of Blur,” published in 2011–13. He points out that there are aesthetic forms and concepts of vagueness that are related only tangentially to what analytic philosophers, in treating the “sorites paradox” and its implications, have meant by the term, and he suggests that this book suffers by limiting itself to Anglophone works, when the most relevant work is perhaps in French, and by limiting its reach to fiction, when the most relevant genres of art are perhaps poetry, painting, and music. The review concludes by regretting Quigley's making T. S. Eliot her study's straw man and by observing not only that her interpretation of Eliot's relationship to analytic philosophy is demonstrably incorrect but also that there is no point in valorizing vagueness or “fuzzy studies” if the upshot is not a sort of mutual respect and acceptance that scientistic clarity in the arts and humanities does not foster.
Illustrating and homology modeling the proteins of the Zika virus
Authors: Ekins Sean , Liebler John , Neves Bruno J. , Lewis Warren G. , Coffee Megan , Bienstock Rachelle , Southan Christopher , Andrade Carolina H.
Published: September 2016

The Zika virus (ZIKV) is a flavivirus of the family Flaviviridae, which is similar to dengue virus, yellow fever and West Nile virus. Recent outbreaks in South America, Latin America, the Caribbean and in particular Brazil have led to concern for the spread of the disease and potential to cause Guillain-Barré syndrome and microcephaly. Although ZIKV has been known of for over 60 years there is very little in the way of knowledge of the virus with few publications and no crystal structures. No antivirals have been tested against it either in vitro or in vivo. ZIKV therefore epitomizes a neglected disease. Several suggested steps have been proposed which could be taken to initiate ZIKV antiviral drug discovery using both high throughput screens as well as structure-based design based on homology models for the key proteins. We now describe preliminary homology models created for NS5, FtsJ, NS4B, NS4A, HELICc, DEXDc, peptidase S7, NS2B, NS2A, NS1, E stem, glycoprotein M, propeptide, capsid and glycoprotein E using SWISS-MODEL. Eleven out of 15 models pass our model quality criteria for their further use. While a ZIKV glycoprotein E homology model was initially described in the immature conformation as a trimer, we now describe the mature dimer conformer which allowed the construction of an illustration of the complete virion. By comparing illustrations of ZIKV based on this new homology model and the dengue virus crystal structure we propose potential differences that could be exploited for antiviral and vaccine design. The prediction of sites for glycosylation on this protein may also be useful in this regard. While we await a cryo-EM structure of ZIKV and eventual crystal structures of the individual proteins, these homology models provide the community with a starting point for structure-based design of drugs and vaccines as well as a for computational virtual screening.
Prevalence of depressive disorders in professional drivers – epidemiologic subanalysis of the RACER study.
Authors: Platek Anna , Szymanski Filip , Filipiak Krzysztof , Ozieranski Krzysztof , Kotkowski Marcin , Tyminska Agata , Kowalik Robert , Karpinski Grzegorz , Opolski Grzegorz , Steering Committee and Investigators RACER
Published: September 2016

Cel

Kierowcy zawodowi transportu publicznego są jedną z grup narażonych na ciężkie warunki pracy. Celem pracy było ustalenie częstości występowania depresji oraz związanego z pracą stresu w grupie zawodowych kierowców transportu publicznego stanowiących subpopulację badania RACER (Risk of Adverse Cardiovascular Events among professional dRivers in Poland – development of specific cardiovascular preventive program).

Metoda

Prospektywne badanie RACER obejmuje kolejnych kierowców zawodowych i ma na celu ustalenie częstości występowania czynników ryzyka sercowo-naczyniowego w tej grupie. Kierowców, poproszono o wypełnienie BDI-II. Wszystkich spytano także o narażenie na stres w pracy.

Wyniki

Spośród badanej populacji wyselekcjonowano kierowców autobusów. Do analizy włączono 292 kolejnych kierowców autobusów transportu publicznego oraz autokarów jeżdżących na trasach międzynarodowych. (96.6% stanowili mężczyźni, średni wiek wyniósł 48,2±10,7 lat). Zgodnie ze stosowanymi obecnie kryteriami BDI-II kierowców podzielono na grupę z i bez objawów. Objawy depresyjne rozpoznano u 5,8% badanych. Nie obserwowano różnic pomiędzy grupami w kwestii wieku i wskaźnika masy ciała(p>0,05). Badane osoby poproszono także o odpowiedź na pytanie „Czy uważa Pan/Pani, że jego/jej praca jest stresująca?” Odpowiedzi „tak” udzieliło 205(70,2%) badanych. Nie zaobserwowano istotnej różnicy w częstości występowania objawów depresji pomiędzy kierowcami, którzy określali swoją pracę jako stresującą lub nie, ani pomiędzy kierowcami międzynarodowych autokarów i autobusów miejskich.

Wnioski

W grupie kierowców zawodowych częstość występowania objawów depresyjnych oraz związanego z pracą stresu jest stosunkowo wysoka. Nie istnieją kliniczne czynniki predykcyjne pozwalające przewidzieć, którzy kierowcy zagrożeni są podwyższonym ryzykiem rozwoju zaburzeń depresyjnych. W zestawieniu z podwyższonym ryzykiem sercowo-naczyniowym związanym z występowaniem depresji, uzasadnia to konieczność wykonywania rutynowych, przesiewowych badań psychologicznych u kierowców zawodowych.
The effectiveness of metacognitive training for patients with schizophrenia: a narrative systematic review of studies published between 2009 and 2015
Authors: Pankowski Daniel , Kowalski Joachim , Gawęda Łukasz
Published: September 2016

Cel

Celem tego artykułu jest dokonanie przeglądu wyników badań skuteczności treningu metapoznawczego (metacognitive training – MCT) u pacjentów z rozpoznaniem schizofrenii w redukcji objawów psychotycznych i zniekształceń poznawczych. Analizie poddano również inne zmienne takie jak funkcjonowanie społeczne, wgląd w objawy choroby i funkcjonowanie neuropoznawcze.

Metoda

Przeszukiwano bazy PubMed, EBSCO, Google Scholar, EMBASE, Cochrane Central Register of Controlled Trials oraz PsycINFO w celu identyfikacji publikacji dotyczących treningu MCT . W przeglądzie uwzględniono łącznie 14 badań opublikowanych w latach 2009-2015, w których istniała możliwość porównania między grupą MCT i grupą kontrolną.

Wyniki

Łączna liczba pacjentów w grupie MCT wyniosła 354 osoby, zaś w grupie kontrolnej 355. Największa siłę efektu uzyskano dla redukcji nasilenia urojeń (d <0,23;1>). Szczególnie wyraźna jest redukcja w zakresie pewności co do urojeń i zmniejszenie dystresu związanego z urojeniami. Siła efektu dla objawów negatywnych była niewielka. Zauważono wysoką siłę efektu dla poprawy wglądu klinicznego (d <0,45;1,32>). MCT pozytywnie wpływa na zniekształcenia poznawcze (d <0,21;0,83>) (szczególnie przeskok do konkluzji). Zauważono poprawę niektórych aspektów funkcji poznawczych (d <0,2;0,63>). Nie zauważono istotnej poprawy funkcjonowania społecznego pacjentów w grupie MCT. Badania podłużne z randomizacją wskazują, iż poprawa objawowa utrzymuje się co najmniej 6 miesięcy.

Wnioski

MCT jest skuteczną formą oddziaływań w zakresie redukcji urojeń, zniekształceń poznawczych związanych ze schizofrenią oraz poprawy wglądu klinicznego. Relatywnie łatwa dostępność oraz trwałość efektów wskazuje, iż MCT może być efektywnie wykorzystywany w terapii schizofrenii. Dla poprawy skuteczności, szczególnie w zakresie funkcjonowania ogólnego, pomocne może być łączenie MCT z innymi formami oddziaływań.
Family association study of Transforming Growth Factor Beta1 gene polymorphisms in schizophrenia
Authors: Kapelski Paweł , Skibińska Maria , Maciukiewicz Małgorzata , Zaremba Dorota , Jasiak Maria , Hauser Joanna
Published: September 2016

Cel pracy

Schizofrenia jest poważną chorobą psychiczną z chronicznymi objawami i znaczącym upośledzeniem funkcjonowania psychospołecznego. Postuluje się rolę zaburzeń immunologicznych w etiopatologii schizofrenii. Wskaźniki zapalne są dobrze znanymi etiologicznymi czynnikami zaburzeń psychicznych, w tym schizofrenii. Podjęto wiele badań nad możliwym wpływem leków przeciwpsychotycznych na procesy zapalne i neurogenezy. Dodatkowo badano wspomagające leczenie przeciwzapalne jako opcję leczenia schizofrenii. Szlaki sygnałowe aktywowane przez czynnik wzrostu transformujący beta1 (Transforming Growth Factor Beta 1 - TGFB1) są kluczowe dla wielu procesów biologicznych, między innymi proliferacji, różnicowania i regeneracji. Wiele czynników należących do nadrodziny białek TGFB1 odgrywa rolę w rozwoju układu nerwowego i jest regulowana przez aktywność neuronalną. Przeprowadziliśmy badanie metodą rodzinną, aby ocenić czy gen TGFB1 jest związany z podatnością na zachorowanie na schizofrenię w populacji polskiej.

Metoda

Przeprowadzono analizę dwóch funkcjonalnych polimorfizmów: rs1800469 (C-509T) oraz rs1800470 (T869C) genu TGFB1 w grupie 147 trio (pacjent z diagnozą schizofrenii i jego zdrowi rodzice) przy użyciu testu Transmission Disequilibrium Test (TDT).

Wyniki

Nie stwierdziliśmy asocjacji powyższych polimorfizmów ze schizofrenią w populacji polskiej.

Wnioski

Wskazane są dalsze badania asocjacyjne na większych liczebnie grupach pacjentów poszerzone o korelację z poziomami białek.
Letter to Editor. Psychiatric hospital architecture – selected problems of existing infrastructure
Authors: Bil Jakub
Published: September 2016

no summary
Letter to the Editor. When and where was Ludwika Karpińska-Woyczyńska born?
Authors: Dembińska Edyta , Rutkowski Krzysztof
Published: September 2016

no summary
A Certain Version of Preservationism
Authors: Makaś Michał
Published: September 2016

A certain approach to paraconsistency was initiated by works of R. Jennings and P. Schotch. In their “Inference and necessity” [4] they proposed a notion of a level of inconsistency (incoherence) of a given set of premises. This level is a measure that assigns to a given set of premises X, the least number of elements of covers of X that consist of consistent subsets of X. The idea of the level of inconsistency allows to formulate a paraconsistent inference relation called by the authors forcing, while the obtained approach  preservationism. Similarly as classical inference relation is truth-preserving, the obtained inference relation is preserving the level of inconsistency.We will discuss some examples of inferences that are valid in the sense of Jennings-Schotch inference relation and rise some questions on them. Based on that we formulate an inference relation as an answer to the mentioned doubts.As regards forcing inference relation, the set of premises needed to derive a given conclusion can vary when changing covers from one to another. Our proposal is to stipulate to have some common set of relevant premises.
‘Once a caesarean, always a caesarean’? Challenging perceptions around vaginal birth after caesarean
Authors: Meredith Dawn , Hugill Kevin
Published: September 2016

What happens to women's bodies during their first childbirth experience can have profound impacts and consequences for them, including their emotional and physical health and long-term wellbeing. These experiences can affect women's choices and decisions in subsequent pregnancies. A history of previous caesarean birth has considerable and significant influence on how women make choices about future pregnancies. The aim of this article is to increase midwives' knowledge and understanding of the factors and influences around choosing vaginal birth after a previous caesarean birth. The issues explored highlight the importance of informed individualised decision-making and the need for further research to ensure that the evidence base develops greater robustness. Paying attention to these aspects is an essential component of the midwife's role in supporting women's birth choices and ensuring that the risks of adverse events are reduced.
‘Bump, Baby and Beyond’: Participant-led antenatal sessions using creative collaboration
Authors: Ireland Jillian , Evans Ruth , Buisson-Lex Rachel
Published: September 2016

This article describes a project that was set up to offer user participation in the development of a group for pregnant women and new mothers in an area of the UK where attendance at NHS antenatal classes and other groups was low. Responsibility for the implementation of the project was shared between a midwife, a health visitor and a children's centre manager who successfully applied for an NHS Patients First programme bursary from the Foundation of Nursing Studies. In the first 6 months of the project, women sampled crafts, music, ‘pampering’ and hypnobirthing, and worked with facilitators to design a rolling programme of activities of their choice. The aims of the project included building confidence for labour and motherhood, and making connections with a supportive local network of fellow mothers and children's centre staff.
Mindfulness – a power boost for a busy lifestyle
Authors: Bridges Glenys
Published: September 2016

Glenys Bridges considers how harnessing this philosophical practice may redress the balance when the many demands of your professional world take over
Would patients rather learn about oral health from a singing dentist or a shocking advert?
Authors: Bissett Julie
Published: September 2016

What gets our patients brushing when it comes to heeding the warnings of the risks to our oral health – the softly, softly approach with a sing-song and a dentist who wiggles his eyebrows, or some hard-hitting images of a beautiful woman's gap-toothed smile and her bleeding gums? Julie Bissett investigates
‘Same meal, different kitchen’
Authors: Welsh Fiona
Published: September 2016

Fiona Welsh is a dental nurse at Community Dental Services – a member of the Association of Dental Groups. Here, she discusses an ‘average’ day…
Dental nurses and the CQC
Authors: Hancock Dave
Published: September 2016

How do the fundamental standards and KLOEs relate to the role and activities of dental nurses? Dave Hancock investigates
Ilizarov tibial lengthening in the skeletally immature patient
Authors: Donnan L. T. , Gomes B. , Donnan A. , Harris C. , Torode† I. , Heidt C.
Published: September 2016

Aims

We wished to examine the effectiveness of tibial lengthening using a two ring Ilizarov frame in skeletally immature patients. This is a potentially biomechanically unstable construct which risks the loss of axial control.

Patients and Methods

We retrospectively reviewed a consecutive series of 24 boys and 26 girls, with a mean age of 8.6 years (4 to 14), who underwent 52 tibial lengthening procedures with a mean follow-up of 4.3 years (4.0 to 16.9). Tibial alignment was measured before and after treatment using joint orientation lines from the knee and a calculation of the oblique plane axis.

Results

The mean percentage length gain was 20% (13 to 31) with a mean bone-healing index (BHI) of 34 days per centimetre (20 to 54). Age at surgery and location of the osteotomy site showed a strong relationship as the location of the osteotomy migrated more proximally with age. However, no significant correlation was found between BHI and the position of the osteotomy. The coronal and sagittal joint orientation of the lengthened tibias were within the normal range in 67% and 92% of cases, respectively. The oblique plane angulation calculation revealed a statistically significant change pre- to post-operatively in both magnitude (p < 0.05) and direction (p < 0.01), but without clinical consequence. The majority of complications were minor (n = 40 in 27 patients; 1.48 complications per segment lengthened) with no residual disability reported.

Conclusion

Two-ring tibial lengthening is effective in maintaining segmental alignment, efficient in callous production and relatively comfortable for the patient with few significant complications. Cite this article: Bone Joint J 2016;98-B:1276–82.
A comparison of anterior screw fixation and halo immobilisation of type II odontoid fractures in elderly patients at increased risk from anaesthesia
Authors: Joestl J. , Lang N. , Bukaty A. , Platzer P.
Published: September 2016

Aims

We performed a retrospective, comparative study of elderly patients with an increased risk from anaesthesia who had undergone either anterior screw fixation (ASF) or halo vest immobilisation (HVI) for a type II odontoid fracture.

Patients and Methods

A total of 80 patients aged 65 years or more who had undergone either ASF or HVI for a type II odontoid fracture between 1988 and 2013 were reviewed. There were 47 women and 33 men with a mean age of 73 (65 to 96; standard deviation 7). All had an American Society of Anesthesiologists score of 2 or more.

Results

Patients who underwent ASF had a significantly better outcome than those who were treated by HVI. There was a rate of nonunion of 10% after ASF and 23% after HVI. Failure of reduction or fixation occurred in 11 patients (15%) but there was no significant difference between the two groups. Mortality rates were also similar: 9% (n = 3) after ASF and 8% (n = 4) after HVI.

Conclusion

We conclude that ASF is the preferred method of treatment in this group of elderly patients, having a significantly higher rate of fusion, better clinical outcome and a similar rate of general and treatment-related complications. Cite this article: Bone Joint J 2016;98-B:1222–6.
The technique of delivery of peri-operative analgesia does not affect the rehabilitation or outcomes following total knee arthroplasty
Authors: McDonald D. A. , Deakin A. H. , Ellis B. M. , Robb Y. , Howe T. E. , Kinninmonth A. W. G. , Scott N. B.
Published: September 2016

Aims

This non-blinded randomised controlled trial compared the effect of patient-controlled epidural analgesia (PCEA) versus local infiltration analgesia (LIA) within an established enhanced recovery programme on the attainment of discharge criteria and recovery one year after total knee arthroplasty (TKA). The hypothesis was that LIA would increase the proportion of patients discharged from rehabilitation by the fourth post-operative day but would not affect outcomes at one year.

Patients and Methods

A total of 242 patients were randomised; 20 were excluded due to failure of spinal anaesthesia leaving 109 patients in the PCEA group and 113 in the LIA group. Patients were reviewed at six weeks and one year post-operatively.

Results

There was no difference in the proportion of patients discharged from rehabilitation by the fourth post-operative day, (77% in the PCEA group, 82% in the LIA group, p = 0.33), mean length of stay (four days in each group, p = 0.540), day of first mobilisation (p = 0.013) or pain (p = 0.278). There was no difference in mean Oxford Knee Scores (41 points in each group, p = 0.915) or the rate of complications in the two groups.

Conclusion

Both techniques provided adequate pain relief, enabled early mobilisation and accelerated rehabilitation and good patient-reported outcomes up to one year post-operatively. PCEA and LIA are associated with similar clinical outcomes following TKA. Cite this article: Bone Joint J 2016;98-B1189–96.
Fluoroscopy-guided reduction and fibular nail fixation to manage unstable ankle fractures in patients with diabetes
Authors: Ashman B. D. , Kong C. , Wing K. J. , Penner M. J. , Bugler K. E. , White T. O. , Younger A. S. E.
Published: September 2016

Aims

Patients with diabetes are at increased risk of wound complications after open reduction and internal fixation of unstable ankle fractures. A fibular nail avoids large surgical incisions and allows anatomical reduction of the mortise.

Patients and Methods

We retrospectively reviewed the results of fluoroscopy-guided reduction and percutaneous fibular nail fixation for unstable Weber type B or C fractures in 24 adult patients with type 1 or type 2 diabetes. The re-operation rate for wound dehiscence or other indications such as amputation, mortality and functional outcomes was determined.

Results

Two patients developed lateral side wound infection, one of whom underwent wound debridement. Three other patients required re-operation for removal of symptomatic hardware. No patient required a below-knee amputation. Six patients died during the study period for unrelated reasons. At a median follow-up of 12 months (7 to 38) the mean Short Form-36 Mental Component Score and Physical Component Score were 53.2 (95% confidence intervals (CI) 48.1 to 58.4) and 39.3 (95% CI 32.1 to 46.4), respectively. The mean Visual Analogue Score for pain was 3.1 (95% 1.4 to 4.9). The mean Ankle Osteoarthritis Scale total score was 32.9 (95% CI 16.0 to 49.7).

Conclusion

Fluoroscopy-guided reduction and fibular nail fixation of unstable ankle fractures in patients with diabetes was associated with a low incidence of wound and overall complications, while providing effective surgical fixation. Cite this article: Bone Joint J 2016;98-B:1197–1201.
Total hip arthroplasty following failure of core decompression and tantalum rod implantation
Authors: Olsen M. , Lewis P. M. , Morrison Z. , McKee M. D. , Waddell J. P. , Schemitsch E. H.
Published: September 2016

Aims

One method of femoral head preservation following avascular necrosis (AVN) is core decompression and insertion of a tantalum rod. However, there may be a high failure rate associated with this procedure. The purpose of this study was to document the clinical and radiological outcomes following total hip arthroplasty (THA) subsequent to failed tantalum rod insertion.

Patients and Methods

A total of 37 failed tantalum rods requiring total hip arthroplasty were identified from a prospective database. There were 21 hips in 21 patients (12 men and nine women, mean age 37 years, 18 to 53) meeting minimum two year clinical and radiographic follow-up whose THAs were carried out between November 2002 and April 2013 (mean time between tantalum rod implantation and conversion to a THA was 26 months, 6 to 72). These were matched by age and gender to individuals (12 men, nine women, mean age 40 years, 18 to 58) receiving THA for AVN without prior tantalum rod insertion.

Results

There were no functional outcome differences between the two groups. Tantalum residue was identified on all post-operative radiographs in the tantalum group. Linear wear rates were comparable between groups with no evidence of catastrophic wear in either group.

Conclusion

In the short term, tantalum rod implantation does not demonstrate an adverse effect on subsequent total joint replacement surgery. There is however, a high rate of retained tantalum debris on post-operative radiographs and thus there is an unknown risk of accelerated articular wear necessitating longer term study. Cite this article: Bone Joint J 2016;98-B:1175–9.
Regionalisation of trauma care in England
Authors: Metcalfe D. , Perry D. C. , Bouamra O. , Salim A. , Woodford M. , Edwards A. , Lecky F. E. , Costa M. L.
Published: September 2016

Aims

We aimed to determine whether there is evidence of improved patient outcomes in Major Trauma Centres following the regionalisation of trauma care in England.

Patients and Methods

An observational study was undertaken using the Trauma Audit and Research Network (TARN), Hospital Episode Statistics (HES) and national death registrations. The outcome measures were indicators of the quality of trauma care, such as treatment by a senior doctor and clinical outcomes, such as mortality in hospital.

Results and Conclusion

A total of 20 181 major trauma cases were reported to TARN during the study period, which was 270 days before and after each hospital became a Major Trauma Centre. Following regionalisation of trauma services, all indicators of the quality of care improved, fewer patients required secondary transfer between hospitals and a greater proportion were discharged with a Glasgow Outcome Score of “good recovery”. In this early post-implementation analysis, there were a number of apparent process improvements (e.g. time to CT) but no differences in either crude or adjusted mortality. The overall number of deaths following trauma in England did not change following the national reconfiguration of trauma services. Evidence from other countries that have regionalised trauma services suggests that further benefits may become apparent after a period of maturing of the trauma system. Cite this article: Bone Joint J 2016;98-B:1253–61.
Does bariatric surgery prior to total hip or knee arthroplasty reduce post-operative complications and improve clinical outcomes for obese patients?
Authors: Smith T. O. , Aboelmagd T.  , Hing C. B. , MacGregor A.
Published: September 2016

Aims

Our aim was to determine whether, based on the current literature, bariatric surgery prior to total hip (THA) or total knee arthroplasty (TKA) reduces the complication rates and improves the outcome following arthroplasty in obese patients.

Methods

A systematic literature search was undertaken of published and unpublished databases on the 5 November 2015. All papers reporting studies comparing obese patients who had undergone bariatric surgery prior to arthroplasty, or not, were included. Each study was assessed using the Downs and Black appraisal tool. A meta-analysis of risk ratios (RR) and 95% confidence intervals (CI) was performed to determine the incidence of complications including wound infection, deep vein thrombosis (DVT), pulmonary embolism (PE), revision surgery and mortality.

Results

From 156 potential studies, five were considered to be eligible for inclusion in the study. A total of 23 348 patients (657 who had undergone bariatric surgery, 22 691 who had not) were analysed. The evidence-base was moderate in quality. There was no statistically significant difference in outcomes such as superficial wound infection (relative risk (RR) 1.88; 95% confidence interval (CI) 0.95 to 0.37), deep wound infection (RR 1.04; 95% CI 0.65 to 1.66), DVT (RR 0.57; 95% CI 0.13 to 2.44), PE (RR 0.51; 95% CI 0.03 to 8.26), revision surgery (RR 1.24; 95% CI 0.75 to 2.05) or mortality (RR 1.25; 95% CI 0.16 to 9.89) between the two groups.

Conclusion

For most peri-operative outcomes, bariatric surgery prior to THA or TKA does not significantly reduce the complication rates or improve the clinical outcome. This study questions the previous belief that bariatric surgery prior to arthroplasty may improve the clinical outcomes for patients who are obese or morbidly obese. This finding is based on moderate quality evidence. Cite this article: Bone Joint J 2016;98-B:1160–6.
Anticoagulation therapy and proximal femoral fracture treatment
Authors: Ktistakis Ioannis , Giannoudis Vasileios , Giannoudis Peter V.
Published: September 2016

Hip fractures in the elderly population have become a ‘disease’ with increasing incidence. Most of the geriatric patients are affected by a number of comorbidities. Coagulopathies continue to be a special point of interest for the orthopaedic trauma surgeon, with the management of this high-risk group of patients a hot topic of debate among the orthopaedic community. While a universal consensus on how to manage thromboprophylaxis for this special cohort of patients has not been reached, multiple attempts to define a widely accepted protocol have been published.

Cite this article: Ktistakis I, Giannoudis V, Giannoudis PV. Anticoagulation therapy and proximal femoral fracture treatment: an update. EFORT Open Rev 2016;1:310-315. DOI: 10.1302/2058-5241.1.160034.
A General Framework for Considering Selection Bias in EHR-Based Studies: What Data
are Observed and Why?
Authors: Haneuse Sebastien , Daniels Michael
Published: September 2016

Electronic health records (EHR) data are increasingly seen as a resource for
cost-effective comparative effectiveness research (CER). Since EHR data are collected
primarily for clinical and/or billing purposes, their use for CER requires consideration
of numerous methodologic challenges including the potential for confounding bias, due to
a lack of randomization, and for selection bias, due to missing data. In contrast to the
recent literature on confounding bias in EHR-based CER, virtually no attention has been
paid to selection bias possibly due to the belief that standard methods for missing data
can be readily-applied. Such methods, however, hinge on an overly simplistic view of the
available/missing EHR data, so that their application in the EHR setting will often fail
to completely control selection bias. Motivated by challenges we face in an on-going
EHR-based comparative effectiveness study of choice of antidepressant treatment and
long-term weight change, we propose a new general framework for selection bias in
EHR-based CER. Crucially, the framework provides structure within which researchers can
consider the complex interplay between numerous decisions, made by patients and health
care providers, which give rise to health-related information being recorded in the EHR
system, as well as the wide variability across EHR systems themselves. This, in turn,
provides structure within which: (i) the transparency of assumptions regarding missing
data can be enhanced, (ii) factors relevant to each decision can be elicited, and (iii)
statistical methods can be better aligned with the complexity of the data.
Evaluating the neighborhood, hybrid and reversion search techniques of a simulated annealing algorithm in solving forest spatial harvest scheduling problems
Authors: Dong Lingbo , Bettinger Pete , Liu Zhaogang , Qin Huiyan , Zhao Yinghui
Published: September 2016

Heuristic techniques have been increasingly used to address the complex forest planning problems over the last few decades. However, heuristics only can provide acceptable solutions to difficult problems, rather than guarantee that the optimal solution will be located. The strategies of neighborhood, hybrid and reversion search processes have been proved to be effective in improving the quality of heuristic results, as suggested recently in the literature. The overall aims of this paper were therefore to systematically evaluate the performances of these enhanced techniques when implemented with a simulated annealing algorithm. Five enhanced techniques were developed using different strategies for generating candidate solutions. These were then compared to the conventional search strategy that employed 1-opt moves (Strategy 1) alone. The five search strategies are classified into three categories: i) neighborhood search techniques that only used the change version of 2-opt moves (Strategy 2); ii) -hybrid search techniques that oscillate between 1-opt moves and the change version of 2-opt moves (Strategy 3), or the exchange version of 2-opt moves (Strategy 4); iii) reversion search techniques that utilize 1-opt moves and the change version of 2-opt moves (Strategy 5) or the exchange version of 2-opt moves (Strategy 6). We found that the performances of all the enhanced search techniques of simulated annealing were systematic and often clear better than conventional search strategy, however the required computational time was significantly increased. For a minimization planning problem, Strategy 6 produced the lowest mean objective function values, which were less than 1% of the means developed using conventional search strategy. Although Strategy 6 performed very well, the other search strategies should not be neglected because they also have the potential to produce high-quality solutions.self
Factors associated with intelligence in young children with Down syndrome
Authors: Kawanto Frieda Handayani , Soedjatmiko Soedjatmiko , Hendarto Aryono
Published: September 2016

Introduction Despite the considerable number of children withDo\Vll syndrome in Indonesia, there is little data available on thesuccess of intervention programs. This study was performed todefine factors affecting the intelligence of young children withDo\Vll syndrome.Objective To determine factors associated Mth lower intelligencein children with Down syndrome, including growth parametersand participation in intervention programs.Methods This cross􀁃sectional study was undertaken fromDecember 2010 to March 2011. Subjects were 60 childrenwith Down syndrome aged 2􀁃6 years who were enrolled inan intervention program at both the Medical RehabilitationDepartment, Cipto Mangunkusumo Hospital, and the Growthand Development Clinic, Harapan Kita Women's and Children'sHospital. Parents' data was obtained through self history􀁃takingand perusal of medical records. Subjects' anthropometricdata (body weight, body height, and head circumference) wasobtained through measurements using calibrated instruments.A psychologist administered IQ tests on the subjects. Results ofthe anthropometric and IQ tests were given to parents one weekfollowing the examinations.Results From the 111 children with Down syndromeregistered in the intervention programs, 60 children (36boys and 24 girls) met the inclusion criteria. The mean ageof subjects was 4 years 6 months. Most subjects were well􀁃nourished. Fifty􀁃five subjects had microcephaly. Eighty􀁃twopercent of subjects participated in the program regularly and70% of subjects had started in the program at less than 1 yearof age. Subjects' mean IQ was 52.8. Analysis showed thatgirls, subjects who were overweight and obese, subjects withmicrocephaly, those with irregular attendance in the program,and those living under the poverty line were at highest riskfor severe mental retardation.Conclusion Factors associated v.ith the intelligence in childrenwith Down syndrome were female gender, overweight/obesity, severe microcephaly, below􀁃poverty line economic status, andirregular participation in the program. [Paediatr Indones.2012;52:194-9].
Efficacy of salbutamol .. ipratropium bromide nebulization compared to salbutamol alone in children with mild to moderate asthma attacks
Authors: Harumdini Matahari , Supriyatno Bambang , Sekartini Rini
Published: September 2016

Background The efficacy of salbutamol􀁓ipratropiumbromidenebulization in children \\lith moderate asthma attacks remainsunclear, and studies on patients with mild attacks have beenrelatively few, especially in Indonesia. However, it is commonpractice for this drug combination to be given to patients withmild􀁓moderate asthma attacks.Objective To compare the efficacy of salbutamol􀁓ipratropiumbromide nebulization to salbutamol alone in children v.ith mildto moderate asthma attacks.Methods This single􀁓blind, randomized clinical trial was heldin the Department of Child Health at Cipto MangunkusumoHospital, the Tebet Community Health Center, and the MHThamrin Salemba Hospital on children aged 5􀁓18 years withmild to moderate asthma attack. We randomized subjectsto receive either 2.5 mg salbutamol plus 0.5 mg ipratropiumbromide (experimental group) or 2.5 mg salbutamol alone(control group). Nebulization was given twice, with a 20minute interval between treatments. We assessed clinicalscores, vital signs, oxygen saturations, and peak flow rates(PFRs) at baseline, and every 20 minutes up to 120 minutespost􀁓nebulization .Results A total of 46 patients were randomized to either theexperimental or the control group. Subjects had similar baselinemeasurements. At 20 minutes post􀁓nebulization, the percentageincrease of PFR was 19% higher in the experimental group(p􀀽O.OI, 95% CI 1.8 to 47.2). The proportion of PFR reversibilitywas 27% higher in the experimental group, although this resultwas statistically insignificant (P=0.06, 95% CI 0.03 to 0.52).There were no significant differences in clinical scores, oxygensaturations, respiratory rates, or hospitalization rates between thetwo groups. Side effects also did not differ significantly.Concl usion Salbutamol􀁓ipratropium bromide nebulizationimproved PFR measurements better than salbutamol alone.However, other clinical parameters were not significantly differentbetween the two groups. [paediatr lndones. 2012;52:200,8].
Delayed cord clamping for prevention of iron deficiency anemia in term infants
Authors: Siregar Olga Rasiyanti , Lubis Bugis , Lubis Muara , Lubis Bidasari , Tjipta Guslihan Dasa
Published: September 2016

Background Iron deficiency childhood is a concern due to its potentially detrimental effectson development, some of which may be irreversible even after irontreatment. Delayed cord clamping may prevent IDA by increasingan infant's iron reserve at birth.Objective We aimed to evaluate the effect of delayed umbilicalcord clamping at birth on the iron status in newborns at age 24hours of life.Methods This randomized, single􀁒blind study was conducted fromMarch to May 2009, at two general hospitals in Medan, NorthSumatera Province. Eligible newborn infants were randomlyassigned to one of two groups: early cord clamping (Eee)performed 15 seconds after delivery or delayed cord clamping(DeC) performed 2 minutes after delivery. Infants were placed ontheir mothers' abdomens before the umbilical cords were clamped.Hematologic status was determined from umbilical cord blood.Results Sixty􀁒three subjects were included in our study, consistingof31 infants in the Eee group and 32 infants in the Dec group.We found that mean neonatal hemoglobin level was higher inthe Dec group than in the Eee group ( 18.4 g% and 16.2 g%,respectively, P=O.OOOl). Also, mean ferritin level was higher inthe Dec group than in the Eee group (556 mg/dL and 329 mg/dL, respectively, p=o.o 15). Other hematological status indicators,including mean hematocrit and mean corpuscular volume (MeV)level, were also higher in the Dec group. However, mean redblood cell levels were not significantly groups. Nor was there a significant level between the Dec and Eee groups.Concl usion Dela y ed cord c l a m p i n g m a y improve ironstatus and prevent IDA in term infants. [Paediatr Indones.2012;52:223-8].
The effect of exclusive breastfeeding on reducing acute respiratory infections in low birth weight infants
Authors: Tallo Karolina Trigemayanti , Suandi I Kompyang Gede , Wandita Setya
Published: September 2016

Background Infants who are breastfed receive natural protectionagainst certain infections. Despite the known benefits of exclusivebreastfeeding, many Indonesian mothers choose to supplementwith formula. There have been few Indonesian studies on theeffect of exclusive breastfeeding in reducing acute respiratoryinfections in low birth weight infants in their first four monthsof life.Objective To investigate the effect of exclusive breastfeeding inreducing the incidence of acute respiratory infections in low birthweight infants during their first four months of life.Methods We conducted a prospective cohort study on low birthweight babies in Sanglah Hospital, Denpasar. The total numberof subjects was 181. The incidence of acute respiratory infectionsduring the first 4 months of life and the duration of breast feedingwere assessed by questionnaires. Data was analyzed Mth Chisquare and logistic regression tests.Results Infants who were exclusively breastfed for 4 months hada lower risk of acute respiratory infection than those who were notexclusively breastfed (RR 0.07; 95% CI 0.03 to 0.14; P􀁄O.OOI).After adjustment for gestational age, parity, maternal nutritionalstatus, family size, smoke exposure, and history of atopy, infantswho were exclusively breastfed still had a lower risk for acuterespiratory infection than those who were not exclusively breastfed(RR 0.06; 95% CI 0.03 to 0.13; P 􀁄 0.001)Conclusion Exclusive breastfeeding reduced the risk of acuterespiratory infection in low birth weight infants in the first fourmonths after birth. [Paediatr Indones. 2012;52:229,32].