bluuebunny/crossref_metadata_2025 huggingface dataset:
Moving towards a bilingual baseline in second language phonetic
research
Authors: Sakai Mari
Published: May 2018

This investigation compared adult sequential bilinguals and native speakers (NSs)
with the intention of determining if bilinguals are an appropriate comparison
group for second language (L2) learners in L2 phonetic research. To that end, 16
Spanish-English bilinguals were compared to 20 NSs of English on their
perception and production of two English vowels. In perception, both groups had
a similar category boundary and acoustic cue weighting. In production, both
groups produced distinct vowels that were highly intelligible, although the
bilinguals produced the phonemes closer together in the vowel space and had more
variable performance than the NSs. The inspection of these two participant
groups reveals that bilinguals have the ability to perceive and produce a
difficult L2 phonemic contrast, with slight and inconsequential differences when
compared to NSs. Thus, I argue that bilinguals who have acquired a target
structure are an apt comparison group in L2 phonetic experiments.
Pronunciation’s role in English speaking-proficiency ratings
Authors: Ma Rui , Henrichsen Lynn E. , Cox Troy L. , Tanner Mark W.
Published: May 2018

Although pronunciation is an integral part of speaking, the role pronunciation plays in determining speaking-proficiency levels is unclear (Higgs & Clifford, 1982; Kang, 2013). To contribute to our understanding of this area, the research reported here investigated the relationship between English as a Second Language (ESL) learners’ pronunciation ability and their speaking-proficiency ratings. At an intensive English program (IEP) in the United States, a speaking test was administered to 223 ESL students. Their speaking proficiency was rated using an oral proficiency assessment based on standardized guidelines. In addition, their pronunciation was rated in six categories (vowels, consonants, word stress, sentence stress, intonation, and rhythm) by 11 raters using a rubric specifically developed and validated for this study. Many-Facet Rasch Measurement (MFRM) was used to estimate the students’ pronunciation ability, which was then compared to their speaking ability. The study found that sentence stress, rhythm, and intonation accounted for 41% of the variance in the speaking-proficiency test scores with sentence stress being the most powerful factor.
Strongly attenuating highly positive concepts
Authors: Giora Rachel , Jaffe Inbal , Becker Israela , Fein Ofer
Published: May 2018

What are the constraints rendering stimuli, such as Alert he is not; He is not the most organized person around; Hospitality is not his best attribute; Do you really believe you are sophisticated? sarcastic by default? Recent findings (Filik, Howman, Ralph-Nearman, & Giora, in press; Giora et al., 2005, 2013, 2015a, 2015b, in progress a) suggest that strongly attenuating a highly positive concept, e.g., alert, sophisticated, most organized, best attribute (associated here with hospitality), induces sarcastic interpretations by default. To be interpreted sarcastically by default, items should be construable as such in the absence of factors inviting sarcasm.1 They should, thus, be (i) novel, noncoded in the mental lexicon, (ii) potentially ambiguous between literal and nonliteral interpretations, so that a preference is allowed, and (iii) free of specific and biasing contextual information. Online and offline studies, collecting self-paced reading times, eye-tracking data during reading, sarcasm rating, and pleasure ratings, alongside corpus-based studies, further support this view.2
Temporal-magnitudinal construal coding
Authors: Deckert Mikołaj , Molenda Marek
Published: May 2018

This article looks into the interface of temporality and quantification. Drawing on the principles of Cognitive Linguistics, we use experimental as well as corpus methods to provide evidence on how the conceptual organisation and linguistic coding of content can play a role in meaning construction. With that broad agenda in mind, a major objective is to shed light on the construct of conventionalisation. For that purpose, construal coding variants are examined with a focus on nominal phrases that express time quantities. The examination involves two construal types (termed “cumulative” and “fractional”) that differ primarily in their prominence configurations, across three granularity levels of time conceptualisation. Our main finding – that the fractional and cumulative constructions are asymmetrically conventionalised – is contextualised through a qualitative analysis of naturally-occurring data to identify additional language use patterns and offer explanatory hypotheses.
Some advances in the study of the translation of manner of motion events
Authors: Molés-Cases Teresa
Published: May 2018

Manner of motion represents a translation problem, especially between languages that belong to different typological groups, since their users (in this case mainly authors and translators) address the semantic component of Manner in different ways. In order to give a full account of the translation of manner of motion events in a German>Spanish parallel corpus of children’s and young adult literature, this contribution describes an interdisciplinary study by resorting to the theory of ‘Thinking for Translating’ (Slobin, 1997,2000,2005) and to the hypothesis of translation universals (Baker, 1993;Mauranen & Kujamäki, 2004).

It presents a proposal of seven translation techniques adapted to Manner of motion, as well as quantitative data regarding these techniques. Qualitative and quantitative data on the semantic subcomponents of Manner (speed, sound, motor pattern, etc.) are also included. The findings confirm that, in terms of Manner of motion, the translation is simpler than the original text and that motor pattern is the semantic subcomponent of Manner that has been affected by translation to the greatest extent.
Y luego se pintan patrás…
Authors: Beké Len
Published: May 2018

The expanded use ofpatrásis among the most salient features of US Spanish and commonly attributed to English influence. ForLipski (1986), it constitutes a syntactic calque from English constructions withback;Otheguy (1999)maintains it shows cultural but not linguistic influence; Villa (2005,2010) ascribespatrásto grammaticalization processes internal to Spanish. Previous studies lack a detailed account of the semantics of the spatial adverbial in its historical and contemporary usage. ApplyingTalmy’s (1983)typology of motion events to corpus data, this paper traces a grammaticalization path forpatrásfrom its historical use to its contemporary use in Nuevomexicano Spanish.Patráshas shifted from primarily atelicbackwards motionmeanings to primarily telicreturnmeanings. This shift is evident across Germanic languages for adverbs deriving from the nounbackand in the Romance prefixre-from Latin adverbretro. This study proposes contact with English led to an increased frequency of satellite-framed constructions in Nuevomexicano Spanish, creating the frequency conditions for innovations in the form and meaning ofpara atrásto conventionalize and lead to systematic linguistic change.
NWJC2Vec
Authors: Asahara Masayuki
Published: May 2018

In this paper, we present a word embedding dataset NWJC2Vec constructed using ‘NINJAL Web Japanese Corpus (NWJC)’. NWJC is a Web-crawled text corpus that contains 25.8 billion tokens. We construct two types of the word embedding dataset: one is based on the surface form, and the other is based on the complete morpheme information provided by UniDic, which is a lexicon for the Japanese morphological analyser MeCab. We perform an evaluation of the dataset by comparing it with the ‘Word List by Semantic Principles (Bunrui Goihyo)’.
Recognition of irrelevant phrases in automatically extracted lists of domain terms
Authors: Mykowiecka Agnieszka , Marciniak Małgorzata , Rychlik Piotr
Published: May 2018

In our paper, we address the problem of recognition of irrelevant phrases in terminology lists obtained with an automatic term extraction tool. We focus on identification of multi-word phrases that are general terms or discourse expressions. We defined several methods based on comparison of domain corpora and a method based on contexts of phrases identified in a large corpus of general language. The methods were tested on Polish data. We used six domain corpora and one general corpus. Two test sets were prepared to evaluate the methods. The first one consisted of many presumably irrelevant phrases, as we selected phrases which occurred in at least three domain corpora. The second set mainly consisted of domain terms, as it was composed of the top-ranked phrases automatically extracted from the analyzed domain corpora.

The results show that the task is quite hard as the inter-annotator agreement is low. Several tested methods achieved similar overall results, although the phrase ordering varied between methods. The most successful method, with a precision of about 0.75 on half of the tested list, was the context based method using a modified contextual diversity coefficient.

Although the methods were tested on Polish, they seems to be language independent.
HYPHEN
Authors: Thompson Paul , Ananiadou Sophia
Published: May 2018

Narrative clinical records and biomedical articles constitute rich sources of information aboutphenotypes, i.e., markers distinguishing individuals with specific medical conditions from the general population. Phenotypes help clinicians to provide personalised treatments. However, locating information about them within huge document repositories is difficult, since each phenotypic concept can be mentioned in many ways. Normalisation methods automaticallymapdivergent phrases to unique concepts in domain-specific terminologies, to allow location and linking of all mentions of a concept of interest. We have developed a hybrid normalisation method (HYPHEN) to handle concept mentions with wide ranging characteristics, across different text types. HYPHEN integrates various normalisation techniques that handlesurface-levelvariations (e.g., differences in word order, word forms or acronyms/abbreviations) andlexical-levelvariations (where terms have similarmeanings, but potentially unrelatedforms). HYPHEN achieves robust performance for both biomedical academic text and narrative clinical records, and has the ability to significantly outperform related methods.
Anthropology of kinship meets human rights rationality: limits of marriage and family life in the European Court of Human Rights
Authors: Hart Linda
Published: May 2018

The question of what kinds of constellations of personal relationships are recognised as family life by Member States of the Council of Europe has been under intense litigation in recent years in the European Court of Human Rights (ECtHR). This article examines the ECtHR as an arena where different realms of knowledge come together and produce interpretations of human rights norms according to historically contingent and sometimes conflicting attempts to produce decisions that reflect ‘human rights rationality’. By analysing five judgments from the 2000s and 2010s, this article focuses on State-argued cultural understandings of limits of acceptable forms of marriage and family life. The cases concern marriage between former in-laws, sexual relations between genetically related siblings and understandings of maternity in contexts of egg donation and surrogacy. The judgments offer examples of legal arguments and extra-legal knowledge that have been applied by States and the ECtHR itself when arguing for, or against, giving particular understandings of family life legal protection in interpreting the European Convention on Human.
Intelligent pattern recognition and diagnosis of ultrasonic inspection of welding defects based on neural network and information fusion
Authors: Gang T. , Takahashi Y. , Wu L.
Published: May 2018

The detection of defects in real manual metal arc welds using ultrasonic non-destructive testing has been investigated. Twenty-six features, extracted from three domains, were applied for recognition of defect type. To increase the reliability and accuracy of identification and classification, statistical analysis was used to evaluate the features extracted from ultrasonic defect echoes. The subset of optimum feature was then selected using the method of discriminant analysis. An intelligent defect evaluation method derived from the study is presented. The results show that statistical analysis is an effective method for feature evaluation. The uncertainty of defect diagnosis can be decreased by the information fusion method, and for three specific defect types, defects were correctly identified in approximately 93% of cases.
Influence of laser beam variables on AZ91D weld fusion zone microstructure
Authors: Marya M. , Edwards G. R.
Published: May 2018

The influence of the laser beam variables on rapidly solidified magnesium alloy AZ91D weld microstructures was investigated using a continuous 1.2 kW Nd-YAG laser. To generate two- or three-dimensional heat flow thermal cycles, 2 mm thickness specimens were bead on plate welded using a focused 0.7 mm beam, 600 and 900 W power, and travel speeds from 10 to 110 mm s-1. The fusion zones were examined via microscopy, electron dispersive spectroscopy (EDS), and X-ray diffraction (XRD) and tested for microhardness. Fusion zone dimensions were first measured and correlated with laser beam variables, and then used to estimate weld solidification times from well known formulations. Measurements showed that fusion zone hardness increased considerably for short solidification times (of the order of 15 ms). Hardness was lower near the fusion line, but greater where the last liquid solidified. Using EDS and XRD it was demonstrated that short solidification times led to greater fractions of redistributed aluminium in the last liquid left at the weld surface when heat flow was three-dimensional. Hardness was correlated not only with β-Mg17Al12 fractions, but also with finer microstructures, consistent with the Mg-Al phase equilibria and concepts of solidification.
Function determinants of TET proteins: the arrangements of sequence motifs with specific codes
Authors: Liu Dongyang , Li Guangpeng , Zuo Yongchun
Published: May 2018

The ten-eleven translocation (TET) proteins play a crucial role in promoting locus-specific reversal of DNA methylation, a type of chromatin modification. Considerable evidences have demonstrated that the sequence motifs with specific codes are important to determine the functions of domains and active sites. Here, we surveyed major studies and reviews regarding the multiple functions of the TET proteins and established the patterns of the motif arrangements that determine the functions of TET proteins. First, we summarized the functional sequence basis of TET proteins and identified the new functional motifs based on the phylogenetic relationship. Next, we described the sequence characteristics of the functional motifs in detail and provided an overview of the relationship between the sequence motifs and the functions of TET proteins, including known functions and potential functions. Finally, we highlighted that sequence motifs with diverse post-translational modifications perform unique functions, and different selection pressures lead to different arrangements of sequence motifs, resulting in different paralogs and isoforms.
Predicting Cancer Drug Response using a Recommender System
Authors: Suphavilai Chayaporn , Bertrand Denis , Nagarajan Niranjan
Published: May 2018

Motivation

As we move toward an era of precision medicine, the ability to predict patient-specific drug responses in cancer based on molecular information such as gene expression data represents both an opportunity and a challenge. In particular, methods are needed that can accommodate the high-dimensionality of data to learn interpretable models capturing drug response mechanisms, as well as providing robust predictions across datasets.

Results

We propose a method based on ideas from ‘recommender systems’ (CaDRReS) that predicts cancer drug responses for unseen cell-lines/patients based on learning projections for drugs and cell-lines into a latent ‘pharmacogenomic’ space. Comparisons with other proposed approaches for this problem based on large public datasets (CCLE and GDSC) show that CaDRReS provides consistently good models and robust predictions even across unseen patient-derived cell-line datasets. Analysis of the pharmacogenomic spaces inferred by CaDRReS also suggests that they can be used to understand drug mechanisms, identify cellular subtypes and further characterize drug-pathway associations.

Availability and implementation

Source code and datasets are available at https://github.com/CSB5/CaDRReS.

Supplementary information

Supplementary data are available at Bioinformatics online.
SV-plaudit: A cloud-based framework for manually curating thousands of structural variants
Authors: Belyeu Jonathan R , Nicholas Thomas J , Pedersen Brent S , Sasani Thomas A , Havrilla James M , Kravitz Stephanie N , Conway Megan E , Lohman Brian K , Quinlan Aaron R , Layer Ryan M
Published: May 2018

SV-plaudit is a framework for rapidly curating structural variant (SV) predictions. For each SV, we generate an image that visualizes the coverage and alignment signals from a set of samples. Images are uploaded to our cloud framework where users assess the quality of each image using a client-side web application. Reports can then be generated as a tab-delimited file or annotated Variant Call Format (VCF) file. As a proof of principle, nine researchers collaborated for 1 hour to evaluate 1,350 SVs each. We anticipate that SV-plaudit will become a standard step in variant calling pipelines and the crowd-sourced curation of other biological results.

Code available at https://github.com/jbelyeu/SV-plaudit

Demonstration video available at https://www.youtube.com/watch?v=ono8kHMKxDs
Reining in the QTc: reducing the risk of Torsades de Pointes across a major health system
Authors: Cheung Dora , Cumbler, Ethan , Hale, Gary , Pell Jonathan
Published: May 2018

Hospitalized patients have a high prevalence of prolonged QTc and are a high-risk population for Torsades de Pointes (TdP). One modifiable risk factor for TdP is the use of QT prolonging drugs. Electronically alerting providers who are ordering QT prolonging drugs in at-risk patients may help to achieve safer prescribing practices. Our previous study decreased inappropriate prescription of IV haloperidol by 36% using a targeted “smart” electronic alert. We wanted to assess an approach to expanding this type of electronic alert to commonly used QT prolonging medications and evaluate how this would affect prescribing practice. This retrospective cohort study evaluated the impact of these alerts for 12 frequently prescribed high-risk medications across a major health system. Between October 2016 and June 2017, a total of 6453 alerts fired and resulted in 3020 (46.8%) orders being cancelled by the provider. Our focused electronic alert significantly decreased prescribing of QT prolonging medications in high-risk patients.
Using wearable technology to predict health outcomes: a literature review
Authors: Burnham Jason P , Lu Chenyang , Yaeger Lauren H , Bailey Thomas C , Kollef Marin H
Published: May 2018

Objective

To review and analyze the literature to determine whether wearable technologies can predict health outcomes.

Materials and methods

We queried Ovid Medline 1946 -, Embase 1947 -, Scopus 1823 -, the Cochrane Library, clinicaltrials.gov 1997 – April 17, 2018, and IEEE Xplore Digital Library and Engineering Village through April 18, 2018, for studies utilizing wearable technology in clinical outcome prediction. Studies were deemed relevant to the research question if they involved human subjects, used wearable technology that tracked a health-related parameter, and incorporated data from wearable technology into a predictive model of mortality, readmission, and/or emergency department (ED) visits.

Results

Eight unique studies were directly related to the research question, and all were of at least moderate quality. Six studies developed models for readmission and two for mortality. In each of the eight studies, data obtained from wearable technology were predictive of or significantly associated with the tracked outcome.

Discussion

Only eight unique studies incorporated wearable technology data into predictive models. The eight studies were of moderate quality or higher and thereby provide proof of concept for the use of wearable technology in developing models that predict clinical outcomes.

Conclusion

Wearable technology has significant potential to assist in predicting clinical outcomes, but needs further study. Well-designed clinical trials that incorporate data from wearable technology into clinical outcome prediction models are required to realize the opportunities of this advancing technology.
Red blood cell distribution width and mortality and hospitalizations in peritoneal dialysis patients
Authors: Soohoo Melissa , Molnar Miklos Z , Ujszaszi Akos , Obi Yoshitsugu , Kovesdy Csaba P , Kalantar-Zadeh Kamyar , Streja Elani
Published: May 2018

Background

Red blood cell distribution width (RDW) is found to be associated with different types of anemia and has recently been studied as a prognostic marker of mortality in hemodialysis patients. However, the relationship of RDW with mortality and hospitalization rate in peritoneal dialysis (PD) patients is less known.

Methods

Among 14 323 incident PD patients between 2007 and 2011 in the USA, we examined the relationship of baseline and time-varying RDW with the risk of mortality and time to first hospitalization using adjusted Cox models. In addition, we examined the relationship of baseline RDW and hospitalization rate using an adjusted negative-binomial regression model. Sensitivity analyses included competing risk models and subgroup analyses.

Results

The study population comprised patients 56 ± 16 years of age, including 43% females, 23% African Americans and 62% diabetics, with a mean RDW of 15.3 ± 1.6%. In models adjusted for clinical characteristics and laboratory parameters, RDW exhibited an incremental relationship with the mortality risk, where RDW ≥16.5% had a 40% and 69% higher risk of death in baseline and time-varying analyses, respectively, compared with an RDW of 14.5–15.5%. Moreover, higher baseline RDW ≥16.5% was also associated with a higher risk of time to first hospitalization {hazard ratio 1.22 [95% confidence interval (CI) 1.14–1.29]} and a higher rate of hospitalizations [incidence rate ratio 1.16 (95% CI 1.09–1.23)]. These results were consistent across numerous sensitivity analyses.

Conclusions

Higher RDW is associated with a higher risk of mortality and hospitalizations among incident PD patients. Further studies are needed to examine the mechanism behind RDW and adverse outcomes.
Convection-Enhanced Delivery of Muscimol Into the Bilateral Subthalamic Nuclei of Nonhuman Primates
Authors: Heiss John D , Walbridge Stuart , Argersinger Davis P , Hong Christopher S , Ray-Chaudhury Abhik , Lonser Russell R , Elias W Jeffrey , Zaghloul Kareem A
Published: May 2018

BACKGROUND

Muscimol is a gamma-aminobutyric acid receptor agonist that selectively and temporarily inhibits neurons. Local bolus injection of muscimol has been used experimentally to inhibit neuronal populations within discrete anatomical structures and discern their physiological function.

OBJECTIVE

To determine the safety and behavioral effects of convection-enhanced delivery of muscimol into the bilateral subthalamic nuclei (STN) of nonhuman primate rhesus macaques (NHPs).

METHODS

Six awake NHPs underwent co-infusion of gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA), a surrogate magnetic resonance imaging (MRI) tracer, with increasing concentrations of muscimol for behavioral and histological assessment. Three other NHPs were co-infused with Gd-DTPA and 3H-muscimol into the STN to determine muscimol distribution by MRI and autoradiography. Two NHPs underwent microcatheter implantation without muscimol infusion for control comparison.

RESULTS

MRI revealed selective and complete perfusion of the bilateral STN in animals infused with Gd-DTPA and muscimol. No abnormal movements occurred at 0.125 mM. Muscimol doses between 0.25 and 4.4 mM resulted in transient, dose-dependent hyperkinesia. Muscimol (8.8 mM) resulted in severe bilateral dyskinesias, ballistic movements, and sedation. An 88.8 mM dose produced unresponsiveness in 1 animal. Infusion-related pathological abnormities or toxicity was not present on histological examination. MRI distribution of co-infused Gd-DTPA was similar to autoradiographic distribution of 3H-muscimol (Vd; R = 0.94). Mean Vd of infused animals was 37.9 mm3 ± 11.7 mm3 and mean Vd: Vi 7.6 ± 2.3.

CONCLUSION

Bilateral convection-enhanced delivery of muscimol into the primate STN resulted in dose-related hyperkinetic movements that resolved after stopping the infusion. Muscimol was not toxic to brain tissue. Gd-DTPA accurately tracked muscimol distribution.
Advances in in vitro genetic code reprogramming in 2014–2017
Authors: Katoh Takayuki , Passioura Toby , Suga Hiroaki
Published: May 2018

To date, various genetic code manipulation methods have been developed to introduce non-proteinogenic amino acids into peptides by translation. However, the number of amino acids that can be used simultaneously remains limited even using these methods. Additionally, the scope of amino acid substrates that are compatible with ribosomal translation systems is also limited. For example, difficult substrates such as d-amino acids and β-amino acids are much less efficiently incorporated into peptides than l-α-amino acids. Here, we focus on three recently developed methodologies that address these issues: (i) artificial division of codon boxes to increase the number of available amino acids, (ii) orthogonal ribosomal translation systems to ‘duplicate’ the codon table and (iii) development of novel artificial tRNAs that enhance incorporation of difficult amino acid substrates.
Incorporating Group Interviews Into Holistic Review in Baccalaureate Nursing School Admissions
Authors: Roach Ashley , Rose Anastasia , Beiers-Jones Kristen , Wallace Sharon , Licaycay Winnie , Nielsen Ann
Published: May 2018

Holistic review in admissions considers an applicant’s background and experience in combination with academic achievement. In order to evaluate baccalaureate nursing school applicants more holistically, a school of nursing added group interviews as part of the admissions process. The school’s Admission and Progression Committee consulted with other schools, developed interview questions, and implemented a strategy to interview applicants. Results of this process were high levels of candidate and faculty satisfaction and enrollment of a diverse cohort of students with a high preadmission grade point average. Areas for improvement and further research are discussed.
Pride and Competency in Accelerated Nursing Programs
Authors: Tornwall Joni , Tan Alai , Bowles Wendy
Published: May 2018

AIM

The aim of this study was to examine student-level and school-level variation in pride and competency in accelerated nursing programs and the relationship between student satisfaction with instructional methods and perceptions of pride and competency.

BACKGROUND

Nursing students in accelerated, second-degree programs have a greater need to feel competent when compared to traditionally educated nurses; however, evidence to illuminate a relationship between faculty instructional methods and student pride and competency is lacking.

METHOD

The method was a secondary analysis of data collected from 3,506 students in 130 programs over seven years.

RESULTS

Higher levels of satisfaction with instructional methods were associated with higher levels of pride and competency in nursing skills. There was no significant variation in pride and competency in nursing skills across institutions.

CONCLUSION

Student satisfaction with instructional methods in accelerated nursing education has an impact on student pride and competency.
Is the evidence of local allergic rhinitis growing?
Authors: Rondón Carmen , Eguiluz-Gracia Ibon , Campo Paloma
Published: May 2018

Purpose of review

To examine the recent advances on epidemiological studies, diagnostic approach and clinical management of local allergic rhinitis (LAR) in adults and children.

Recent findings

Evidence about LAR is growing especially in pediatric and Asian populations. The prevalence of LAR is lower in Asian countries compared with western countries in both children and adults. LAR is considered a chronic condition and an independent rhinitis phenotype that affects up to 26.5% of nonatopic rhinitis patients. The disease rapidly progress toward the clinical worsening with associated onset of asthma and conjunctivitis, which further impairs patient's quality of life. Nasal Allergen Provocation Test is the diagnostic gold standard that can be complemented by basophil activation test and the detection of specific IgE in nasal secretions. Allergen immunotherapy induces a significant and early improvement in both clinical symptoms and quality of life in LAR patients.

LAR is a common entity, with different prevalence depending on geographical locations. LAR has to be considered in the process of differential diagnosis in children and adults with rhinitis. Diagnosis of LAR is crucial in order to start an etiologic treatment such as allergen immunotherapy, which has proven to be very effective in these patients.
Effectiveness of Lumbar Facet Joint Blocks and Predictive Value before Radiofrequency Denervation
Authors: Cohen Steven P. , Doshi Tina L. , Constantinescu Octav C. , Zhao Zirong , Kurihara Connie , Larkin Thomas M. , Griffith Scott R. , Jacobs Michael B. , Kroski William J. , Dawson Timothy C. , Fowler Ian M. , White Ronald L. , Verdun Aubrey J. , Jamison David E. , Anderson-White Mirinda , Shank Stephanie E. , Pasquina Paul F.
Published: May 2018

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

With facet interventions under scrutiny, the authors’ objectives were to determine the effectiveness of different lumbar facet blocks and their ability to predict radiofrequency ablation outcomes.

Methods

A total of 229 participants were randomized in a 2:2:1 ratio to receive intraarticular facet injections with bupivacaine and steroid, medial branch blocks, or saline. Those with a positive 1-month outcome (a 2-point or more reduction in average pain score) and score higher than 3 (positive satisfaction) on a 5-point satisfaction scale were followed up to 6 months. Participants in the intraarticular and medial branch block groups with a positive diagnostic block (50% or more relief) who experienced a negative outcome proceeded to the second phase and underwent radiofrequency ablation, while all saline group individuals underwent ablation. Coprimary outcome measures were average reduction in numerical rating scale pain score 1 month after the facet or saline blocks, and average numerical rating scale pain score 3 months after ablation.

Results

Mean reduction in average numerical rating scale pain score at 1 month was 0.7 ± 1.6 in the intraarticular group, 0.7 ± 1.8 in the medial branch block group, and 0.7 ± 1.5 in the placebo group; P = 0.993. The proportions of positive blocks were higher in the intraarticular (54%) and medial branch (55%) groups than in the placebo group (30%; P = 0.01). Radiofrequency ablation was performed on 135 patients (45, 48, and 42 patients from the intraarticular, medial branch, and saline groups, respectively). The average numerical rating scale pain score at 3 months was 3.0 ± 2.0 in the intraarticular, 3.2 ± 2.5 in the medial branch, and 3.5 ± 1.9 in the control group (P = 0.493). At 3 months, the proportions of positive responders in the intraarticular, medial branch block, and placebo groups were 51%, 56%, and 24% for the intraarticular, medial branch, and placebo groups, respectively (P = 0.005).

Conclusions

This study establishes that facet blocks are not therapeutic. The higher responder rates in the treatment groups suggest a hypothesis that facet blocks might provide prognostic value before radiofrequency ablation.
Anesthesia Care Team Composition and Surgical Outcomes
Authors: Sun Eric C. , Miller Thomas R. , Moshfegh Jasmin , Baker Laurence C.
Published: May 2018

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

In the United States, anesthesia care can be provided by an anesthesia care team consisting of nonphysician providers (nurse anesthetists and anesthesiologist assistants) working under the supervision of a physician anesthesiologist. Nurse anesthetists may practice nationwide, whereas anesthesiologist assistants are restricted to 16 states. To inform policies concerning the expanded use of anesthesiologist assistants, the authors examined whether the specific anesthesia care team composition (physician anesthesiologist plus nurse anesthetist or anesthesiologist assistant) was associated with differences in perioperative outcomes.

Methods

A retrospective analysis was performed of national claims data for 443,098 publicly insured elderly (ages 65 to 89 yr) patients who underwent inpatient surgery between January 1, 2004, and December 31, 2011. The differences in inpatient mortality, spending, and length of stay between cases where an anesthesiologist supervised an anesthesiologist assistant compared to cases where an anesthesiologist supervised a nurse anesthetist were estimated. The approach used a quasirandomization technique known as instrumental variables to reduce confounding.

Results

The adjusted mortality for care teams with anesthesiologist assistants was 1.6% (95% CI, 1.4 to 1.8) versus 1.7% for care teams with nurse anesthetists (95% CI, 1.7 to 1.7; difference −0.08; 95% CI, −0.3 to 0.1; P = 0.47). Compared to care teams with nurse anesthetists, care teams with anesthesiologist assistants were associated with non–statistically significant decreases in length of stay (−0.009 days; 95% CI, −0.1 to 0.1; P = 0.89) and medical spending (−$56; 95% CI, −334 to 223; P = 0.70).

Conclusions

The specific composition of the anesthesia care team was not associated with any significant differences in mortality, length of stay, or inpatient spending.
Classic Papers Revisited: My Love Affair with the Venous System
Authors: Gelman Simon
Published: May 2018

The Pathophysiology of Aortic Cross-clamping and Unclamping. By Gelman S. ANesthesiology 1995; 82:1026–60. Reprinted with permission.

Aortic cross-clamping (AoX) and unclamping are associated with severe hemodynamic disturbances in virtually all organs and systems. The main hemodynamic changes induced by AoX result from an increase in impedance to aortic flow, an increase in systemic vascular resistance and afterload, blood volume redistribution caused by collapse and constriction of venous vasculature distal to the aortic clamp, and a subsequent increase in preload. Preload may not increase if the aorta is clamped distal to the celiac artery; in that case, blood volume from distal venous vasculature may be redistributed to the splanchnic vasculature without associated increases in preload. Increases in afterload and preload demand an increase in contractility, which results in an autoregulatory increase in coronary blood flow. Without increases in coronary blood flow and myocardial contractility, decompensation may occur. Aortic cross-clamping is associated with the formation and release of many mediators which constitute a double-edged sword: they may mitigate or aggravate the harmful hemodynamic effects of AoX and unclamping. Injuries to the lungs, kidneys, spinal cord, or abdominal viscera are caused mainly by ischemia and reperfusion of organs distal to aortic cross-clamping. A clear understanding of the pathophysiologic mechanisms involved in these processes should help to promote rational, well-focused, and effective measures to prevent and treat homeostatic disturbances occurring during AoX and unclamping.
Does Sacral Slanting Affect Distal Adding-on in Lenke Type 1A Adolescent Idiopathic Scoliosis?
Authors: Joo Yoon Suk , Hwang Chang Ju , Cho Jae Hwan , Baik Jong-Min , Cho Nam Ik , Lee Dong-Ho , Lee Mi Young , Yoon So Jung , Lee Choon Sung
Published: May 2018

Study Design.

A retrospective clinical study.

Objective.

The purpose of this study was to identify risk factors for postoperative distal adding-on in Lenke 1A adolescent idiopathic scoliosis.

Summary of Background Data.

Distal adding-on is a postoperative complication associated with the Lenke type 1A curve. Although various factors are known to cause postoperative adding-on, no study has reported a correlation between sacral slanting and adding-on.

Methods.

A total of 126 consecutive patients who underwent posterior correction and fusion surgery for Lenke type 1A adolescent idiopathic scoliosis were included in this study. Curve type was further categorized into L4-left (L4-L) or L4-right (L4-R), based on the direction of the L4 vertebral tilt. Several clinical and radiological parameters including sacral slanting were investigated to identify risk factors associated with postoperative distal adding-on.

Results.

A total of 36 patients (28.6%) exhibited sacral slanting. Nineteen out of 20 L4-L type patients had left-sided sacral slanting, whereas 12 out of 16 L4-R type patients had right-sided sacral slanting. The group with adding-on (n = 13) demonstrated a significantly lower age than the group without adding-on (n = 113). Preoperative lumbar Cobb angle (P = 0.022) was determined to be an independent factor for adding-on according to logistic regression analysis. In the L4-R type, the last touching vertebra (LTV) level and the gap difference in levels between lowest instrumented vertebra and LTV (lowest instrumented vertebra-LTV) comprised significant variables.

Conclusion.

Sacral slanting typically occurs to the left in the L4-L type and to the right in the L4-R type. The size of the preoperative lumbar curve was found to be an independent risk factor that caused adding-on in patients with Lenke type 1A scoliosis. In the L4-R type, right-sided sacral slanting tended to lower the LTV. Therefore, the fusion level might be shorter to save the motion segments resulting in distal adding-on.

Level of Evidence: 4
The Impact of Sarcopenia on Cervical Spine Sagittal Alignment After Cervical Laminoplasty
Authors: Koshimizu Hiroyuki , Sakai Yoshihito , Harada Atsushi , Ito Sadayuki , Ito Kenyu , Hida Tetsuro
Published: May 2018

Study Design:

This was a prospective follow-up study.

Objective:

The main objective of this study was to evaluate the effects of sarcopenia on the sagittal alignment of the cervical spine after cervical laminoplasty in order to investigate the relationship between sarcopenia and spinal malalignment.

Summary of Background Data:

Sarcopenia, a progressive and all over loss of skeletal muscle mass and strength associated with aging, has been reported to be related to spinal malalignment. The causes of poor surgical outcome after cervical laminoplasty have been examined in recent years, including the sagittal malalignment of the cervical spine. However, there are few reports about the impact of sarcopenia on the sagittal alignment of the cervical spine.

Materials and Methods:

A total of 171 patients who underwent cervical laminoplasty at our hospital between 2009 and 2015 were assigned to this study. The appendicular skeletal muscle mass [appendicular skeletal muscle index (SMI)] is commonly used to assess sarcopenia. Appendicular SMI (kg/m2) was obtained from arm and leg muscle mass using dual-energy x-ray absorptiometry. Sanada and colleagues reference value for the Japanese appendicular SMI was used to diagnose sarcopenia. C2–C7 sagittal vertical axis (SVA), C2–C7 lordosis angle, and C2–C7 range of motion were measured for evaluation. The primary outcome was evaluated using the Japanese Orthopedic Association Score System for Cervical Myelopathy (JOA score) and the SF-36 Health Survey Physical Function (PF).

Results:

Of the 171 patients, 48 were diagnosed with sarcopenia. Preoperative (P=0.001), postoperative (P=0.011), and 1-year follow-up (P=0.007) C2–C7 SVA were greater in the sarcopenia group. Preoperative (P=0.009), postoperative (P=0.018), and 1-year follow-up (P=0.023) SF-36 scores were higher in the nonsarcopenia group. Preoperative (P<0.001), postoperative (P<0.001), and 1-year follow-up (P=0.002) JOA scores were higher in the nonsarcopenia group. C2–C7 SVA and JOA scores were negatively correlated at 1-year follow-up (R=−0.213, P=0.005). C2–C7 SVA and SF-36 scores were not correlated at 1-year follow-up (R=−0.167, P=0.070).

Conclusions:

C2–C7 SVA was greater and postoperative outcome was worse after cervical laminoplasty in the sarcopenia group than in the nonsarcopenia group; thus, we believe it is necessary to evaluate sarcopenia before cervical laminoplasty, because sarcopenia may impact postoperative cervical alignment and postoperative outcome.

Level of Evidence:

Level III.
Association Between Lumbar Spinal Degeneration and Anatomic Pelvic Parameters
Authors: Strube Patrick , Pumberger Matthias , Sonnow Lena , Zippelius Timo , Nowack Dimitri , Zahn Robert K. , Putzier Michael
Published: May 2018

Study Design:

Retrospective cohort study.

Objective:

The objective was to prove the association between anatomic pelvis parameters and specific types of lumbar spinal degeneration.

Summary of Background Data:

Different spinopelvic sagittal profile types are suggested to be associated with specific degenerative lumbar spine pathologies. Because pelvic morphology plays a key role defining the spinal shape as well as its load and function it thereby potentially predisposes the development of spinal degeneration.

Materials and Methods:

Patients with symptomatic lumbar spinal degeneration who were surgically treated in 2 spine departments from March 2011 until August 2016 were included in this retrospective analysis. Single-level degenerative pathologies were classified as lumbar disc herniation (LDH), degenerative disc disease (DDD), lumbar spinal stenosis (LSS), and degenerative spondylolisthesis (DSPL). The constant anatomic pelvic parameters pelvic incidence (PI), pelvic radius (PR), and sacral table angle (STA) were assessed in lateral radiographs of the lumbar spine and compared between the pathologies.

Results:

In total, 249 patients were assigned to the LDH (n=73), DDD (n=67), LSS (n=42), and DSPL (n=67) groups. Group comparisons revealed significant differences in the anatomic pelvic parameters PR (LDH, 139.5±10.8 mm; DDD, 135.9±14.0 mm; LSS, 127.8±14.3 mm; DSPL, 135.8±12.7 mm; P<0.001), PI (LDH, 53.1±10.0 degrees; DDD, 50.0±9.9 degrees; LSS, 54.5±9.6 degrees; DSPL, 57.1±10.8 degrees; P=0.001), and STA (LDH, 95.3±12.7 degrees; DDD, 105.4±9.0 degrees; LSS, 105.9±11.5 degrees; DSPL, 98.6±9.5 degrees; P<0.001). Post hoc tests indicated significant differences between the PR of the LSS group and that of all other subgroups (P<0.012), the PI of the DDD group and that of DSPL (P<0.001), and the STA of the LDH/DSPL groups and that of the LSS/DDD group (P<0.005).

Conclusions:

We found all the constant anatomic parameters to be specific for distinct types of degeneration, suggesting pelvis shape is a predisposing factor for their development.

Level of Evidence:

Level III.
Upper Instrumented Vertebrae Distal to T2 Leads to a Higher Incidence of Proximal Junctional Kyphosis During Growing-rod Treatment for Early Onset Scoliosis
Authors: Pan Aixing , Hai Yong , Yang Jincai , Zhang Yangpu , Zhang Yaoshen
Published: May 2018

Study Design:

A retrospective case series.

Objective:

We sought to evaluate the prevalence and risk factors of proximal junctional kyphosis (PJK) after growing-rod surgery in patients with early onset scoliosis (EOS).

Summary of Background Data:

Growing-rod surgery is the primary treatment in patients with progressive EOS when conservative treatment fails. PJK is one of the most commonly reported postoperative complications.

Materials and Methods:

We retrospectively evaluated 50 patients (24 boys and 26 girls) diagnosed with EOS who underwent growing-rod surgery. Preoperative and follow-up demographic data, surgical strategies, and radiographic parameters were recorded and analyzed to identify PJK risk factors.

Results:

The mean age of patients at the time of the initial surgery was 8.6±2.5 years. Mean follow-up was 33.5±10.8 months, and mean number of lengthening surgeries were 2.14±1.52. Twenty-eight of the surgical procedures were single growing-rod surgeries, of which 22 were dual growing-rod surgeries. The upper instrumented vertebrae (UIV) ranged from C6–T6, and the lower instrumented vertebrae ranged from L1–S1. Ultimately, PJK developed in 14 (28%) of 50 patients. Taller patients, UIV distal to T2, and greater postoperative upper thoracic scoliosis (UTS) were suspected potential risk factors of PJK during the univariate analysis (P<0.1). Multifactorial regression analysis confirmed that UIV distal to T2 (hazard ratio=5.474; P=0.044) and postoperative UTS >50 degrees (hazard ratio=1.049; P=0.046) were the independent risk factors of PJK during growing-rod treatment in patients with EOS.

Conclusions:

The prevalence of PJK was 28% during growing-rod treatment in EOS. The independent risk factors for PJK were UIV distal to T2 and postoperative UTS >50 degrees. It is important for spine surgeons to recognize these risk factors when planning surgeries, and counseling patients and families about this possible complication.

Level of Evidence:

Level III.
Comparison of Freehand Sagittal Trajectories for Inserting Pedicle Screws Between C7 and T5
Authors: Oshina Masahito , Horii Chiaki , Hirai Shima , Matsubayashi Yoshitaka , Taniguchi Yuki , Hayashi Naoto , Tanaka Sakae , Oshima Yasushi
Published: May 2018

Study Design:

Anatomic study using computed tomographic scans.

Objective:

The purpose of this paper was to determine the trajectory of pedicle screw insertions, in regard to posterior bony landmarks encountered during standard posterior exposure of the spine between the seventh cervical (C7) and the fifth thoracic (T5) vertebrae, when lateral fluoroscopic and radiographic guidance may be obstructed by the scapula and shoulders.

Summary of Background Data:

Only a few studies have evaluated the intraoperative sagittal trajectory of pedicle screw insertion.

Materials and Methods:

We assessed 64 participants of a health screening program using whole-spine computed tomographic scans. On the basis of 5 previously reported methods, we designed 3 freehand trajectories: lamina surface method (angle between the superior vertebral endplate and the surface of the lamina), spinous process method (angle between the superior vertebral endplate and a line connecting the tips of the index spinous process and the one cephalad to it), and facet tilt method (angle between the superior endplate and the superior facet tilt). We calculated each of the angles for the C7–T5 vertebrae and determined the most reliable method using coefficients of variation (CV) and intraobserver and interobserver reliability.

Results:

The lamina surface method had the smallest CVs for C7 and T1, and the mean angles were larger than 90 degrees (range, 94.7–102.4 degrees). The spinous process method had the smallest CVs between T2 and T5, and the mean angles were <90 degrees (range, 85.0–87.0 degrees). The intraobserver and interobserver reliabilities were good or excellent for both methods.

Conclusions:

The ideal sagittal trajectories for pedicle screw insertion are nearly orthogonal to the lamina surface or the line connecting the spinous processes, but were different for each of the vertebrae. The lamina surface method was the most reliable for C7 and T1, whereas the spinous process method was most reliable between T2 and T5.

Level of Evidence:

Level III.