bluuebunny/crossref_metadata_2025 huggingface dataset:
Moderne Osteoprotektion in der Onkologie
Authors: Diel I. J.
Published: August 2018

Knochenmetastasen zerstören den Knochen, dadurch dass Tumorzellen über parakrine Sekretion von osteotropen Substanzen den RANK/RANKL/OPG-Signalweg aktivieren, der zu einer gesteigerten Osteoklastenaktivierung führt. Bei der subsequenten Zerstörung der Knochenmatrix werden zuvor eingelagerte Wachstumsfaktoren freigesetzt, die zu einer Steigerung der proliferativen Aktivität der Tumorzellen beitragen können (Circulus vitiosus, maligner Dialog). Antiosteolytische Substanzen hemmen die Neubildung und/ oder Aktivierung von Osteoklasten und reduzieren so das Ausmaß der skelettalen Zerstörung. Das Ziel aller Therapiemaßnahmen bei Knochenmetastasen ist die Reduktion so - genannter skelettaler Komplikationen, wie Knochenschmerz, pathologische Frakturen, spinale Kompressionssyndrome und hyperkalzämische Episoden, um die Lebensqualität der Patienten zu verbessern und deren Überlebenszeit zu verlängern. Nicht nur die Therapie kann im Rahmen einer Tumorerkrankung zu einer Osteoporose führen, auch die Grundkrankheit selbst kann durch reduzierte körperliche Aktivität, Immobilisierung, Nausea, Mangel ernährung und direkte Effekte des Tumors zu einer Reduktion der Knochenmasse führen. Als eigenständiger Risikofaktor gilt jedoch insbesondere die medikamentöse Therapie. Zahlreiche Chemotherapeutika können den Knochen direkt, auch ohne Ausschaltung der gonadalen Aktivität, schädigen. Weitaus nachhaltiger wird der Knochen durch den Hypogonadismus beeinträchtigt, der bei Patienten mit hormonempfindlichen Tumoren erwünschtes Therapieziel ist. Zur Behandlung und Prophylaxe der Osteoporose gibt es zahlreiche medikamentöse Möglichkeiten, aber mit keiner anderen Substanzklasse liegen bei der tumortherapieinduzierten (TTI) Osteoporose so gute Resultate vor wie zu den Bisphosphonaten. Zumindest gleich gute Ergebnisse erzielt man mit der Anwendung von Denosumab bei Mammakarzinompatientinnen mit Aromatasehemmer-induzierter Osteopenie und bei Männern mit Prostatakarzinom und Androgenblockade. Kaum eine Einsatzmöglichkeit von osteoprotektiven Substanzen ist in den vergangenen Jahren so kontrovers diskutiert worden wie die Option zur Vermeidung von Knochenmetastasen. Das liegt zum größten Teil an den sehr divergenten Ergebnissen der einzelnen Studien, insbesondere zum Einsatz von Clodronat oder Zoledronat adjuvant. Nach einer kürzlich erschienenen Metaanalyse verbessern Bisphosphonate signifikant das knochenmetastasenfreie und das Gesamtüberleben – und das trotz Unterschieden in Applikationsweise, Patientenkollektiven und Einschlusskriterien der jeweiligen Studien. Es gibt also berechtigte Hinweise, diese Indikation weiter zu untersuchen, um herauszufinden wer von einem adjuvanten Einsatz profitiert und wer nicht. Nach derzeitigem Wissensstand sind es Patientinnen mit hohem Rezidivrisiko, aktiviertem Knochenstoffwechsel (Östrogen - depletion, postmenopausal) und/oder Tumorzellen im Knochenmark.
Effekt von Ganzkörper-Elektromyostimulation – “A series of studies”
Authors: Teschler M. , von Stengel S. , Kemmler W.
Published: August 2018

Ziel der TEST-Studienreihe ist es, Effektivität, Applikabilität und Attraktivität der zeiteffektiven Trainingstechnologie Ganzkörper-Elektromyostimulation (WB-EMS) auf muskulo skelettale Risikofaktoren des älteren Menschen zu evaluieren.

Grundsätzlich bestätigen alle bisherigen TEST-Untersuchungen den signifikanten und hochrelevanten Einfluss des WB-EMS auf muskuläre Parameter bei trainierten und untrainierten älteren Menschen. Weniger eindeutig ist der Effekt des WB-EMS auf die Knochendichte (BMD). Trotz Auswahl einer Gruppe mit niedriger BMD und geringer Sportaffinität zeigt WB-EMS nur grenzwertig signifikante Effekte für die BMD an der LWS. Bindungskriterien wie Drop-out und Anwesenheit liegen etwas günstiger als bei konventionellen Sportprogrammen, ein Faktor, zu dem der hohe personelle Betreuungs-schlüssel (1 : 2 bis 1 : 4) beiträgt.

Obwohl WB-EMS nicht als vollwertige Alternative zu komplexen Allroundtrainingsprogrammen zur Frakturprophylaxe gelten kann, ist diese Trainingstechnologie ein vielversprechendes “Tool”, Menschen, die aus verschiedenen Gründen konventionelle Sportangebote nicht durchführen können (oder möchten), zu mehr eigenverantwort licher, muskuloskelettaler Prävention zu animieren.
Können Hüftprotektoren das Risiko für Hüftfrakturen bei älteren Patienten wirksam vermindern?
Authors: Pfeifer M.
Published: August 2018

Entsprechend früherer Studien können Hüftprotektoren das Risiko für Hüftfrakturen bei älteren Bewohnern von Pflegeheimen reduzieren. Neuere Studien hingegen konnten diese Wirksamkeit nicht mehr bestätigen. Deshalb hat sich mittlerweile eine internationale Forschungsgruppe zum Thema Hüftprotektoren gebildet, die Kriterien formuliert hat, nach denen zukünftige Studien zum Nachweis der Wirksamkeit durchgeführt werden sollen. Die Erfüllung dieser Kriterien führt allerdings dazu, dass neuere klinische Studien noch teurer und aufwendiger werden. Dadurch wird es fraglich, ob diese Studien in Zukunft überhaupt noch durchgeführt werden.
Klinik und Diagnostik der Hypophosphatasie im Erwachsenenalter
Authors: Genest F. , Seefried L.
Published: August 2018

Bei der Hypophosphatasie handelt es sich um eine seltene genetisch determinierte und somit erbliche Stoffwechselerkrankung, bedingt durch eine Mutation im ALPL-Gen (OMIM 171760). Infolgedessen kommt es zu einer defizienten Aktivität der alkalischen Phosphatase. Die gewebeunspezifische AP spielt eine entscheidende Rolle für die Skelettmineralisierung und ist für mehr als 90 Prozent der im Serum gemessenen APAktivität verantwortlich. Sowohl durch die reduzierte Enzymaktivität wie auch durch die vermehrt anfallenden Substrate (PLP und PEA) kommt es zu einer gestörten Skelettmineralisierung. Je nach Manifestationsalter und Diagnosezeitpunkt unterscheidet man formal zwischen verschiedenen Formen der Hypophosphatasie (perinatale, pränatal benigne, infantile und adulte Form – die Odonoto-HPP stellt dabei eine Sonderform dar), wobei die Grenzen im klinischen Alltag oft verschwimmen und nicht konkret voneinander zu separieren sind. Diagnostisch steht an erster Stelle die Bestimmung der erniedrigten AP im Serum und nach wiederholter und differenzialdiagnotisch abgewägter Messung bringt letztlich eine genetische Untersuchung des ALPL-Gens Klarheit über das Vorliegen einer Hypophosphatasie.
Neurodegeneration und Sarkopenie
Authors: Drey M.
Published: August 2018

Es gibt zunehmend Hinweise, dass die Neurodegeneration eine eigenständige Ursache in der Genese der Sarkopenie darstellt. Die hier vorgenommene Trennung zwischen neurodegenerativen Ursachen des peripheren bzw. zentralen Nervensystems scheint eher von theoretischer Natur, v. a. wenn man die Ergebnisse der Untersuchungen von Caviness et al. zu Motoneuronenverlust und Parkinson-Syndrom berücksichtigt. Bereits im Jahre 1995 hat Uitti et al. ein neurodegeneratives Overlap-Syndrom aus Motoneuronenerkrankungen, Alzheimer-Demenz und Parkinson-Syndrom beschrieben (20). Wahrscheinlich muss diese Vorstellung um die Sarkopenie erweitert werden.
Therapie des Knochenmarködemsyndroms mit antiresorptiven Medikamenten
Authors: Niedhart C. , Maus U.
Published: August 2018

Das Knochenmarködemsyndrom (KMÖS) ist eine teilweise sehr schmerzhafte, selbstlimitierende Erkrankung, bei der ein Ödem vorwiegend im Bereich von Hüfte, Knie oder Sprunggelenk/Fuß auftritt. Die Beschwerden sind teilweise so ausgeprägt, dass eine über die reine Schmerztherapie hinausgehende Behandlung notwendig ist. Die möglichen Optionen reichen von der konservativen Therapie bis hin zur operativen Therapie. Ein Bestandteil der konservativen Therapie können antiresorptive Medikamente sein, für die teilweise sehr gute Ergebnisse vorliegen. Die Auswertung der vorliegenden Literatur zeigte positive Ergebnisse für Alendronat als orales Bisphosphonat, aber auch für Pamidronat, Clodronat, Ibandronat und Zoledronat als i. v.-Bisphosphonate. Die Datenlage zu Ibandronat ist valider als für die anderen Wirkstoffe. Es konnte allerdings für alle Bisphosphonate eine schneller Rückgang der Beschwerden und eine Besserung des kernspintomografischen Befundes nachgewiesen werden. Auch für Denosumab und für Teri-paratid, welches allerdings kein antiresorptives, sondern ein osteoanaboles Medikament ist, liegen vergleichbare Ergebnisse vor. Zusammengefasst konnte für die Antiresorptiva eine gute Wirksamkeit beim KMÖS nachgewiesen werden.
Radiologische Bildgebung der Osteomyelitis
Authors: Liesaus Y. N. , Wirth S. , Marschner C. A.
Published: August 2018

In der Radiologie gilt die Osteomyelitis (OM) klassisch und zu Recht als diagnostisches Chamäleon. Das liegt an der breiten Alters-verteilung, den verschiedenen und nicht selten multifaktoriellen Ursachen und den resultierenden, manchmal sehr unterschiedlichen Erscheinungsformen. Die in den Bildern häufig ähnlichen Differenzialdiagnosen, z. B. aseptische Knochennekrosen oder Knochentumoren, würden eine völlig andere Behandlungskonsequenz nach sich ziehen. Eine schnelle und präzise Diagnostik ist daher Voraussetzung für eine optimale Therapie -gestaltung. Hierfür ist die Einbeziehung des Patientenalters, der Anamnese sowie der klinischen und laborchemischen Untersuchungen unerlässlich. Bei der radiologischen Diagnostik ist die MRT heute am sensitivsten, aber nicht unbedingt immer am spezifischsten. Oft ist die Osteomyelitis von einer Weichteilreaktion begleitet, zu deren Detektion sich insbesondere bei Kindern zunächst eine Sonografie in Kombination mit einer Radiografie bewährt hat. Die wichtigsten radio-logischen Zeichen sind in Abhängigkeit der Untersuchungsmodalität u. a.: spongiöse/kortikale Destruktion, umgebende Periost- und/ oder Weichteilreaktion, Ödembildung, Diffusionsstörung (native MRT) oder fokale KM-Affinität in Schnittbilduntersuchungen.
Die bakterielle unspezifische “pyogene” Spondylodiszitis
Authors: Heyde C.-E.
Published: August 2018

Aus einer Reihe von Gründen nimmt die Häufigkeit der unspezifischen bakteriellen ,,pyogenen“ Spondylodiszitis zu. Verschiedenste Risikofaktoren und Komorbiditäten erhöhen das Erkrankungsrisiko. Trotz verbesserter und z. T. standardisierter Diagnosealgorithmen erfolgt die Diagnose häufig mit einer gewissen Verzögerung. Je nach Befund und Allgemeinzustand ist eine konservative oder operative Therapie abzuwägen. Eine, wenn möglich gezielte und ausreichend lange Antibiotikatherapie ist obligat, dabei kommt einem Erregernachweis eine hohe Bedeutung zu. Das Ziel der Therapie ist eine Ausheilung der Infektion bei einer gut belastbaren, schmerzarmen bzw. schmerzfreien Wirbelsäule ohne neurologische Defizite. Dafür gibt es heute eine Reihe therapeutischer Ansätze. Trotzdem ist die Erkrankung mit einer erhöhten Mortalität und einer relevanten Morbidität verbunden.
Frakturen, Rückenschmerzen, Lebensqualität und Compliance unter einer Teriparatid-Therapie bei Patientinnen mit postmenopausaler Osteoporose in Deutschland
Authors: Scharla S. , Oertel H. , Jakob F. , Petto H.
Published: August 2018

Ziel: Primäres Ziel der Beobachtungsstudie EFOS war die Erfassung der Inzidenz von klinischen vertebralen und nichtvertebralen Frakturen bei postmenopausalen Frauen mit Osteo porose während einer 18-monatigen Teriparatid-Behandlung und einer 18-monatigen Nachbeobachtung. Weiterhin wurden gesundheitsbezogene Lebensqualität (EQ-5D und EQ-visuelle Analogskala [VAS]) und Rückenschmerzen (Häufigkeit, Schweregrad, Aktivitätseinschränkungen, VAS) evaluiert.

Methode: Veränderungen der Frakturinzidenz in jeweils 6-Monats-Intervallen wurden mittels logistischer Regression mit wiederholten Messungen und Veränderungen der VASWerte mit einem gemischten Modell für wiederholte Messungen analysiert.

Ergebnisse: Von 385 deutschen Patientinnen erlitten 44 (11,4 %) im Studienverlauf 52 Frakturen (17 vertebrale, 35 nicht-vertebrale). Die Inzidenz von Frakturen wurde signifikant reduziert (ab Monat 24 bis < 30 vs. Monat 0 bis < 6). Die sekundären Variablen verbesserten sich im Studienverlauf. Die Veränderungen waren dabei gegenüber dem Studienbeginn zu allen Zeitpunkten signifikant.

Schlussfolgerung: Die Befunde sind bei diesem nicht kontrollierten Studiendesign mit den entsprechenden Einschränkungen zu werten.
Knochenverlust nach bariatrischen Eingriffen
Authors: Messner Z. , Kocijan A. , Kocijan R.
Published: August 2018

Bariatrische Chirurgie stellt eine effektive Behandlungsmethode für pathologische Adipositas dar. Neben den positiven kardiovaskulären Effekten kommt es jedoch zu zahlreichen negativen Effekten auf den Knochenmetabolismus. Die Genese des Knochenverlustes ist multifaktoriell und inkludiert Malabsorption, Vitamin D-Insuffizienz, Hypokalzämie, Hyperparathyreoidismus, “skeletal unloading” und einen erhöhten Knochenturnover. Das Resultat ist ein Verlust von Knochendichte und -struktur, sowohl im trabekulären als auch im kortikalen Bereich. Zusätzlich kommt es zu einem Abfall der Muskelmasse. Veränderungen im Knochenstoffwechsel normalisieren sich innerhalb von 2 Jahren. Der Knochendichteverlust dürfte jedoch anhalten. Die aktuelle Datenlage gibt Evidenz über ein erhöhtes Frakturrisiko bereits 2 Jahre nach bariatrischem Eingriff. Langzeitstudien haben jedoch eine weitere Zunahme des Frakturrisikos über 10 Jahre und mehr gezeigt. Frakturen treten sowohl an Osteoporose-typischen, als auch Osteoporose-untypischen Stellen auf. Eine Vitamin D-, Kalzium- und Proteinsubstitution scheint bereits präoperativ unerlässlich, um dem postoperativen Knochenmasseverlust entgegen zu wirken.
Management of Extrapulmonary Nontuberculous Mycobacterial Infections
Authors: Holt Michael , Kasperbauer Shannon
Published: August 2018

Extrapulmonary disease occurs in a minority of nontuberculous mycobacterial (NTM) infections. The pattern of disease tends to be multifocal in immunocompromised individuals and localized in the immunocompetent. There is increasing recognition of disseminated Mycobacterium chimaera infection, as a complication of cardiac surgery, and focal infections due to rapidly growing mycobacteria. Microbiologic diagnosis requires detection of NTM in blood or tissue samples by microscopy, culture, or molecular methods. Management of extrapulmonary NTM infection requires prolonged, targeted multiple-drug therapy and, in some cases, aggressive surgical intervention. The optimal treatment approach is often unknown. Despite combined medical and surgical therapy, outcomes may be poor. A high degree of clinical suspicion and early diagnosis are required to maximize chances of a positive outcome.
Epidemiology of Nontuberculous Mycobacteriosis
Authors: Daniel-Wayman Shelby , Ricotta Emily , Prevots D. , Adjemian Jennifer
Published: August 2018

Annual prevalence estimates for pulmonary nontuberculous mycobacterial (PNTM) disease in the contiguous United States range from 1.4 to 13.9 per 100,000 persons, while one study found an annual prevalence of up to 44 per 100,000 persons in Hawaii. PNTM prevalence varies by region, sex, and race/ethnicity, with higher prevalence among women and persons of Asian ancestry, as well as in the Southern United States and Hawaii. Studies consistently indicate that PNTM prevalence is increasing, with estimates ranging from 2.5 to 8% per year. Most PNTM disease is associated with Mycobacterium avium complex (MAC), although the proportion of disease attributed to MAC varies by region. Host factors identified as influencing disease risk include structural lung disease, immunomodulatory medication, as well as variants in connective tissue, mucociliary clearance, and immune genes. Environmental variables including measures of atmospheric moisture and concentrations of certain soil factors have also been shown to correlate with higher PNTM prevalence. Prevalence of extrapulmonary NTM disease is lower, stable, and associated with different risk factors, including primary immune deficiencies or HIV infection.
Diagnosis of Nontuberculous Mycobacteria Lung Disease
Authors: Cowman Steven , Loebinger Michael
Published: August 2018

The diagnosis of pulmonary nontuberculous mycobacteria (NTM) disease may be challenging, as their presence alone does not necessarily indicate disease and diagnosis requires the integration of clinical, radiological, and microbiological findings. The first step is to suspect NTM disease; however, clinical manifestations of NTM are nonspecific and it may not be possible to separate them from those caused by underlying respiratory disease. The radiological appearance generally falls into two patterns, fibrocavitary disease and nodular-bronchiectatic disease; consolidation, infiltrates, and solitary nodules are also described. The isolation of NTM from clinical samples is fundamental to the diagnosis and they may be cultured from sputum, bronchoalveolar lavage fluid, or tissue specimens. If sputum is used, more than one isolate is required for diagnosis due to the propensity of NTM to contaminate clinical samples. The correct identification of NTM is vital, as their clinical relevance varies widely between species, and treatment is dictated by the identity of the isolated organism. This review covers the clinical presentation of NTM disease, the interpretation of radiological findings, and issues surrounding the isolation and identification of mycobacteria.
Der Stellenwert von Milch und Milchprodukten für die Knochengesundheit
Authors: Borner R.
Published: August 2018

Milch und Milchprodukte gehören in unserer westlichen Ernährungskultur zu den wichtigsten Kalziumlieferanten. Einzelne Inhaltsstoffe der Milch, wie beispielsweise Milchsäure, Laktose und Vitamin D, erhöhen außerdem die intestinale Absorption von Kalzium. Weitere positive Effekte der Milch zeigen sich hinsichtlich Knochenmineralgehalt und Knochengesundheit. Diese lassen sich auf die spezifischen Wirkungen der Milchproteine zurückführen. In Kindheit und Adoleszenz geht ein höherer Milchverzehr (gemäß den geltenden Empfehlungen der deutschsprachigen Fachgesellschaften) mit einer erhöhten Knochenmasse und Knochendichte einher. Ein direkter Zusammenhang von Milchkonsum und der Entstehung von Osteoporose bzw. Osteoporose bedingten Knochenbrüchen beim Erwachsenen, konnte bisher nicht gezeigt werden. Personen mit Laktoseintoleranz sollten nicht komplett auf Milch und Milchprodukte verzichten. Ohne Milchkonsum ist die Zufuhr der täglich empfohlenen Menge Kalzium nur schwer möglich. Wie eine Metaanalyse um Savaiano et al. gezeigt hat, verursachen einzelne Portionen von Milch und Milchprodukten über den Tag verteilt häufig noch keine Symptome. Viele Käsesorten sind außerdem von Natur aus laktosefrei. Bestimmte Ernährungstrends, die eine milchfreie Ernährung vorsehen, sind hinsichtlich ihrer Wirkung auf die Knochengesundheit derzeit noch unzureichend erforscht. Personen, die eine solche Ernährungsweise verfolgen, sollten die Unterstützung einer Ernährungsberaterin in Anspruch nehmen.
Treatment of Other Nontuberculous Mycobacteria
Authors: Basille Damien , Jounieaux Vincent , Andréjak Claire
Published: August 2018

Nontuberculous mycobacteria (NTM) are numerous, and for the vast majority of them, randomized studies are lacking and data regarding optimal treatment are limited. When Mycobacterium avium complex (MAC) and M. abscessus are excluded, the main NTM are M. xenopi, M. kansasii, M. malmoense, M. szulgai, and M. simiae. Treatment is long (at least 12 months after culture conversion according to recommendations by scientific societies) and difficult (at least three drugs are required, each of which have potential adverse events). Moreover, optimal treatment is unknown for the vast majority of NTM and efficacy of treatment is not 100%. That is why, balance between benefit and risk is fundamental. For M. xenopi, the second most common NTM isolated in Europe, treatment is classically based on macrolides or fluoroquinolones, associated with ethambutol and rifampicin. For M. kansasii, the cornerstone of treatment is rifampicin, which should be associated with two other drugs: ethambutol plus isoniazid or clarithromycin. M. malmoense, which is common in Northern Europe, can be treated by rifampicin, ethambutol, and clarithromycin and/or fluoroquinolones.
Surgical Management of Pulmonary Mycobacterial Disease
Authors: Mitchell John
Published: August 2018

There is renewed interest in the use of adjuvant surgical resection in the treatment of pulmonary mycobacterial disease. For pulmonary Mycobacterium tuberculosis, the emergence of significant drug resistance has led clinicians to reconsider surgery in select cases, where a clear benefit in bacterial conversion and cure has been noted. Less data exist for the use of anatomic resection in the setting of pulmonary nontuberculous mycobacterial disease, although multiple reports have supported the use of surgery in select cases. Resection is generally well tolerated, and may often be performed through a minimally invasive approach. While medical treatment clearly remains the mainstay of therapy, more research is needed regarding the use of adjuvant resection in this patient population.
Management of Multidrug-Resistant Tuberculosis
Authors: Caminero Jose , Daley Charles
Published: August 2018

Drug-resistant strains of Mycobacterium tuberculosis pose a major threat to global tuberculosis control. Despite the availability of curative antituberculosis therapy for nearly half a century, inappropriate and inadequate treatment of tuberculosis, as well as unchecked transmission of M. tuberculosis, has resulted in alarming levels of drug-resistant tuberculosis. The World Health Organization (WHO) estimates that there were 600,000 cases of multidrug-resistant tuberculosis (MDR-TB)/rifampin-resistant (RR) tuberculosis in 2016, defined as strains that are resistant to at least isoniazid and rifampicin. Globally, WHO estimates that 4.1% of new tuberculosis cases and 19% of retreatment cases have MDR-TB. By the end of 2016, 123 countries had reported at least one case of extensively drug-resistant strains, which are MDR-TB strains that have acquired additional resistance to fluoroquinolones and at least one second-line injectable. It is estimated that only 22% of all MDR-TB cases are currently receiving therapy. This article reviews the management of MDR/RR-TB and updates recommendations regarding the use of shorter course regimens and new drugs.
Clinical Risk Factors for Postoperative Atrial Fibrillation among Patients after Cardiac Surgery
Authors: Yamashita Kennosuke , Hu Nan , Ranjan Ravi , Selzman Craig , Dosdall Derek
Published: August 2018

Background Postoperative atrial fibrillation (POAF) is a common arrhythmia following cardiac surgery and is associated with increased health-care costs, complications, and mortality. The etiology of POAF is incompletely understood and its prediction remains suboptimal. Using data from published studies, we performed a systemic review and meta-analysis to identify preoperative clinical risk factors associated with patients at increased risk of POAF.

Methods A systematic search of PubMed, MEDLINE, and EMBASE databases was performed.

Results Twenty-four studies that reported univariate analysis results regarding POAF risk factors, published from 2001 to May 2017, were included in this meta-analysis with a total number of 36,834 subjects. Eighteen studies were performed in the United States and Europe and 16 studies were prospective cohort studies. The standardized mean difference (SMD) between POAF and non-POAF groups was significantly different (reported as [SMD: 95% confidence interval, CI]) for age (0.55: 0.47–0.63), left atrial diameter (0.45: 0.15–0.75), and left ventricular ejection fraction (0.30: 0.14–0.47). The pooled odds ratios (ORs) (reported as [OR: 95% CI]) demonstrated that heart failure (1.56: 1.31–1.96), chronic obstructive pulmonary disease (1.36: 1.13–1.64), hypertension (1.29: 1.12–1.48), and myocardial infarction (1.18: 1.05–1.34) were significant predictors of POAF incidence, while diabetes was marginally significant (1.06: 1.00–1.13).

Conclusion The present analysis suggested that older age and history of heart failure were significant risk factors for POAF consistently whether the included studies were prospective or retrospective datasets.
Analysis of Endoscopy Intervention in Postesophagectomy Anastomotic Leak: A Retrospective Study
Authors: Ma Han , Wang Jun , Xi Qinhua , Shi Dongtao , Zheng Shiying , Ma Haitao , Ge Jinfeng
Published: August 2018

Background Anastomotic leak after esophagectomy is one of the most challenging complications resulting in a high morbidity and mortality and prolonged hospitalization. The aim of this retrospective study was to access the impact of endoscopy intervention in anastomotic leak.

Methods A retrospective review was conducted at our hospital from January 2008 to December 2016. In total, 263 patients who were diagnosed with an anastomotic leak after esophagectomy and underwent endoscopy examination were included in this study. First, all patients were divided into two groups based on a single criteria—whether they received endoscopy intervention or not—and comparisons were conducted between the two groups. Second, we categorized all patients into three groups based on the diameter of the anastomotic leak (group I: <5 mm; group II: 5–15 mm; group III: >15 mm). Detailed analyses were made for each group. Factors we considered included demographic factors, the length of postoperative hospital stay, the amount of medical expenditure, limited days of oral intake, and the incurrence of complications. Data relating to those factors were collected and then analyzed using standard statistic tools.

Results In general, the difference between endoscopy intervention and conservative measure was significant. Moreover, the hospital stay (p < 0.001; p = 0.018), medical expenditure (p < 0.001; p = 0.003), limited days of oral intake (p < 0.001; p = 0.019), and postoperative complications such as hemorrhage (p < 0.001; p = 0.036), tracheoesophageal fistula (p = 0.002; p = 0.017), and anastomosis stricture (p = 0.03; p = 0.026) were significantly lower among patients who received endoscopy intervention in groups II and III. However, no significant difference was identified between endoscopy intervention and conservative measure in group I.

Conclusions Endoscopy intervention is safe and effective in the diagnosis and treatment of postesophagectomy anastomotic leak. Especially for patients with a diameter of anastomotic leaks greater than 5 mm, the advantages of endoscopy intervention should not be neglected.
Early Clinical Experience with Double Ring Implantation for Aortic and Mitral Valve Repair
Authors: Russo M. , Andreas M. , Rankin S. J. , Maisano F. , Weber A.
Published: August 2018

Reconstruction of cardiac valves is associated with reduced mortality, including in multiple valve surgery. However, multiple valve repair is still considered a challenge, even with established techniques. Recently, internal aortic ring annuloplasty has been introduced and could simplify multiple valve reconstruction. This study reports early results with double ring aortic and mitral valve repair. Three patients with bivalvular degenerative regurgitation were managed with combined aortic and mitral valve repair using double rings. Mean (±SD) age was 41 ± 21 years, preoperative left ventricular end-diastolic volume was 119 ± 53 mL/m2, and ejection fraction was 0.50 ± 0.07. Mean aortic ring diameter was 21 mm, and mitral rings averaged 32 mm. No operative mortalities or major complications were observed. No valve-related events occurred. Postoperative echo showed complete resolution of mitral and aortic regurgitation. Postoperative left ventricular end-diastolic volume decreased to 98 ± 10 mL/m2; no left ventricular outflow tract obstruction or significant transvalvular gradients were observed. Postoperative cardiac CTs showed an optimal three-dimensional configuration of aortic and mitral annuloplasty devices. This initial series demonstrated the feasibility and safety of combined aortic and mitral repair with double rings. Clinical and hemodynamic results were promising. Increasing application and more clinical experience with combined aortic and mitral double ring repair seems indicated.
Multispectral medical image fusion scheme based on hybrid contourlet and shearlet transform domains
Authors: Bhateja Vikrant , Srivastava Anuja , Moin Aisha , Lay-Ekuakille Aimé
Published: August 2018

Multimodal medical image sensor fusion has revolutionized the medical analysis by improving the precision of computer assisted diagnosis. This is incorporated by highlighting the complementary information while minimizing the redundant content in the fused images from various biomedical sensors like MRI, Computed Tomography, and Positron Emission Tomography/Single-Photon Emission Computerized Tomography. Multispectral image fusion is a special case of multimodal fusion which serves to encompass both spatial and spectral details in the fused image. This paper presents a hybrid sub-band decomposition scheme for multispectral image fusion comprising of non-subsampled contourlet transform and shearlet transform domains. The pre-processing stage involves color transformation of an input multispectral image from red-green-blue to YIQ color space. Thereafter, both the source images (i.e., panchromatic and multispectral images) after sub-band decomposition are processed via the application of contrast enhancement, weighted-principal component analysis, and max-max algorithms. The low frequency coefficients are processed via phase congruency whereas a combination of directive contrast and normalized Shannon entropy is applied to high frequency coefficients. The objective assessment of image quality has been carried out using various reference and no-reference based performance metrics. The distinguishing fusion response of the proposed hybrid scheme has been validated by the comparisons done with the other fusion approaches.
Implementation of a Wollaston interferometry diagnostic on OMEGA EP
Authors: Howard A. , Haberberger D. , Boni R. , Brown R. , Froula D. H.
Published: August 2018

A Wollaston interferometer is presented for use in measuring the electron density of plasma plumes created in experiments on the OMEGA EP laser system. The diagnostic is installed as an additional arm on the 4ω probe system, a suite of diagnostics that share a 10 ps pulse of 263 nm laser light captured by an imaging system at f/4. The interferometer utilizes a Wollaston prism to create two angularly separated beams from a single input probe beam, split at any angle between 0° and 90°. This configuration is implemented uniquely such that fringe spacing may be altered independently of field of view, magnification, and imaging resolution, from a range of 17 to 76 μm/fringe. The region of overlap between the two beams forms a total field of view of approximately 1.2 × 1.6 mm at the target chamber center with an imaging resolution of 5 μm. Using this configuration, here it is shown that plasma density may be accurately characterized over a range of 3 × 1018–1 × 1020 cm−3.
Implementation of a 1-2 keV point-projection x-ray spectrometer on the National Ignition Facility
Authors: King J. A. , Opachich Y. P. , Huffman E. J. , Knight R. , Heeter R. F. , Ahmed M. , Liedahl D. A. , Schneider M. B. , Thompson N. B. , Johns H. M. , Dodd E. , Flippo K. A. , Kline J. L. , Lopez F. E. , Archuleta T. N. , Perry T. S.
Published: August 2018

A point-projection soft X-ray Opacity Spectrometer (OpSpec) has been implemented to measure X-ray spectra from ∼1 to 2 keV on the National Ignition Facility (NIF). Measurement of such soft X-rays with open-aperture point-projection detectors is challenging because only very thin filters may be used to shield the detector from the hostile environment. OpSpec diffracts X-rays from 540 to 2100 eV off a potassium (or rubidium) acid phthalate (KAP or RbAP) crystal onto either image plates or, most recently, X-ray films. A “sacrificial front filter” strategy is used to prevent crystal damage, while 2 or 3 rear filters protect the data. Since May 2017, OpSpec has been recording X-ray transmission data for iron-magnesium plasmas on the NIF, at “Anchor 1” plasma conditions (temperature ∼150 eV, density ∼7 × 1021 e−/cm3). Upgrades improved OpSpec’s performance on 6 NIF shots in August and December 2017, with reduced backgrounds and 100% data return using filter stacks as thin as 2.9 μm (total). Photometric noise is beginning to meet requirements, and further work will reduce systematic errors.
The investigations of phase transitions in the (1-x)PbZrO3-xBiFeO3 nanocrystals using differential scanning calorimetry and Raman spectroscopy
Authors: Podgórna M. , Ptak M. , Chrunik M. , Jankowska-Sumara I. , Piecha J. , Zasada D.
Published: August 2018

Polycrystalline powders of PbZrO3, 0.98PbZrO3–0.02BiFeO3, and 0.96PbZrO3–0.04BiFeO3 were synthesised by means of a molten salt synthesis route. Their structure and morphology were studied using X-ray powder diffraction and scanning electron microscopy, respectively. The frequencies of the Raman lines were analysed and discussed in terms of the sequence of structural phase transitions. The measurements revealed the existence of a new intermediate phase observed below the Curie point (Tc) and an additional temperature anomaly above Tc, most likely connected with magnetic transition originating from BiFeO3 contribution. The addition of multiferroic BiFeO3 into the structure of antiferroelectric PbZrO3 suggests that the obtained solid solutions form multiferroic systems even at low BiFeO3 content. The Raman measurements were supplemented by dielectric studies and differential scanning calorimetry measurements. An excellent agreement for transition temperatures obtained by means of these three techniques suggests that BiFeO3 is uniformly distributed in the synthesised powder materials.
Rotational manipulation by acoustic radiation torque of high-order vortex beams generated by an artificial structured plate
Authors: Li Weiping , Ke Manzhu , Peng Shasha , Liu Fengming , Qiu Chunyin , Liu Zhengyou
Published: August 2018

As a nondestructive and contactless method of rotational manipulation on objects, acoustic radiation torque has attracted much attention in recent years. Here, we propose an effective way to generate high-order acoustic vortex beams simply by a structured plate and demonstrate flexible rotational manipulations on objects with different shapes such as disks or small balls or sticks by the generated vortex beams. Two structural plates carved with one set or two sets of Archimedean spiral gratings on a single side are fabricated to get the first-order and second-order acoustic vortex beams at the same frequency, respectively, acoustic radiation torque of which is experimentally analyzed through the rotational manipulation of a standard acoustic absorption disk. Furthermore, we extend the rotational manipulation on different objects such as small balls and sticks, which gives an intuitive picture of angular momentum transfer from vortex beams to absorption materials. We believe that the present work will pave a way to potential applications in acoustic and biomedical fields.
Diamond-defect magnetometry gets ready for the field
Authors: Miller Johanna L.
Published: August 2018

A frequency-locking scheme endows the sensors with the necessary robustness to make practical measurements.
Will doubling magnetic field strength halve the time to fusion energy?
Authors: Kramer David
Published: August 2018

Magnets built with high-temperature superconductors are at the heart of efforts to demonstrate a burning plasma in a compact device.
Corrigendum to: The use of energy-protein supplement increases performance of high-yielding dairy cows and improves health-promoting properties of milk
Authors: Brzozowska Anna Malgorzata , Micek Piotr , Kuczynska Beata , Lukaszewicz Marek , Oprzadek Jolanta M.
Published: August 2018

Lipid additives are of particular importance in the diet of high-yielding dairy cows. The aim of this study was to determine the effects of a specially designed energy-protein supplement on dairy cows' performance and milk composition. The experiment was conducted on 24 Polish Holstein-Friesian cows fed total mixed ration. Two kilograms of energy-protein supplement/cow.day were added to the ration for one group of cows whereas the other was fed solely the total mixed ration. The supplement consisted of whole flax seeds, wheat bran, flaxseed and fish oils, and rapeseed cake and its composition is protected by a patent. Feed intake and daily milk yield were recorded automatically for each cow. Gross milk composition and fatty acid profile of milk were determined. An ANOVA was performed to determine the influence of the supplement on performance traits and milk composition. Energy-protein supplement had a positive impact on dry matter intake and milk yield of cows. It had a little effect on the gross milk composition and somatic cell count. The effect of the additive on fatty acids in milk was beneficial, therefore its use in high-yielding dairy cows nutrition is recommended to improve health-promoting properties of milk.
The role of progenesis in the diversification of the interstitial annelid lineage Psammodrilidae
Authors: Worsaae Katrine , Giribet Gonzalo , Martínez Alejandro
Published: August 2018

Psammodrilidae constitutes a family of understudied, nearly completely ciliated, small-sized annelids, whose systematic position in Annelida remains unsettled and whose internal phylogeny is here investigated for the first time. Psammodrilids possess hooked chaetae typical of macroscopic tube-dwelling semi-sessile annelids, such as Arenicolidae. Yet, several minute members resemble, with their conspicuous gliding by ciliary motion and vagile lifestyle, interstitial fauna, adapted to move between sand grains. Moreover, psammodrilids exhibit a range of unique features, for example, bendable aciculae, a collar region with polygonal unciliated cells, and a muscular pumping pharynx. We here present a combined phylogeny of Psammodrilidae including molecular and morphological data of all eight described species (two described herein as Psammodrilus didomenicoi, sp. nov. and P. norenburgi, sp. nov.) as well as four undescribed species. Ancestral character state reconstruction suggests the ancestor of Psammodrilidae was a semi-sessile larger form. Miniaturisation seems to have occurred multiple times independently within Psammodrilidae, possibly through progenesis, yielding small species with resemblance to a juvenile stage of the larger species. We find several new cryptic species and generally reveal an unexpected diversity and distribution of this small family. This success may be favoured by their adaptive morphology, here indicated to be genetically susceptible to progenesis.
World English and World Englishes: perspectives from English language learners in Iran
Authors: Tamimi Sa’d Seyyed Hatam
Published: August 2018

The global spread of English has led to the emergence of non-native varieties of English in the world and this has, as a consequence, prompted many scholars to discuss and acknowledge World Englishes (WEs, i.e., non-native varieties of English) in addition to World English (WE; i.e., English as an international language). The present study set out to assess Iranian English as a foreign language (EFL) learners’ attitudes toward WE and WEs using a questionnaire, adopted from previous relevant research, and focus-group interviews. The participants consisted of 38 EFL learners. The results revealed the remarkably positive attitudes of the participants toward WE but not toward WEs nor to “Iranian English” (i.e., “Expanding Circle”). The findings therefore indicated that Iranian language learners perceive the Standard English spoken in English speaking countries such as the US and UK (i.e., “Inner Circle”) as the only legitimate reference group.
On bounds of homological dimensions in Nakayama algebras
Authors: Madsen Dag , Marczinzik René
Published: August 2018

Let

A
A

be a Nakayama algebra with

n
n

simple modules and a simple module

S
S

of even projective dimension. Choose

m
m

minimal such that a simple

A
A

-module with projective dimension

2
m

2m

exists. Then we show that the global dimension of

A
A

is bounded by

n
+
m
−
1

n+m-1

. This gives a combined generalisation of results of Gustafson [J. Algebra 97 (1985), pp. 14–16] and Madsen [Projective dimensions and Nakayama algebras, Amer. Math. Soc., Providence, RI, 2005]. In [Comm. Algebra 22 (1994), pp. 1271–1280], Brown proved that the global dimension of quasi-hereditary Nakayama algebras with

n
n

simple modules is bounded by

n
n

. Using our result on the bounds of global dimensions of Nakayama algebras, we give a short new proof of this result and generalise Brown’s result from quasi-hereditary to standardly stratified Nakayama algebras, where the global dimension is replaced with the finitistic dimension.
US Latina/os and the White Imagination
Authors: Bebout Lee
Published: August 2018

There is no singular manifestation of Latina/os in the white imagination. Rather, Latina/os occupy various, competing, and interdependent forms of representation. Latina/os are depicted as perpetually foreign and as the future of conservative American values. They are cast as lazy drains on society and as people who outwork Americans and take their jobs. Latinas are rendered as sexy señoritas who desire US white men and as hyper-fertile producers of “anchor babies” in the United States. And these are just a few of the ways in which US whiteness imagines Latina/os. These representations find expression in stereotypes, discursive tropes, and racial scripts—beliefs that explicitly or implicitly take narrative form. As a product of the white imagination, these depictions of Latina/os find expression in a wide array of discursive locations, from film and literature to journalism and political speech, to name a few.

These manifestations of Latinas/os in the white imagination stretch across US history from the late 18th century to the 21st century. These representations have been shaped by and met the exigencies of US whites’ national and racial projects. As such, depictions of Latina/os reveal crucial aspects of US whiteness within a given historical moment and across time. While there are numerous, often contradictory elements of these depictions, they are also interdependent and work together to meet the needs of whiteness. Critically, however, Latinas/os have not been imagined by whiteness without response. Rather, throughout this history, Latinas/os have actively negotiated these dominant racial scripts—from claiming whiteness and citizenship to asserting indigenous heritage or pride in ethnic heritage—in order to meet their own needs.
Literary Perspectives on Asian Americans in the South
Authors: Cha Frank
Published: August 2018

The continued growth of the Asian American population in the US South has redefined the region in terms of its economy, culture, and identity. While the literature associated with the region predominantly focuses on whites and African Americans, several narratives explore the experiences of Asian Americans. These texts span a variety of genres, including memoirs, young adult fiction, and historical analyses. From Chinese immigrant laborers who migrated to the Mississippi Delta during Reconstruction to second-generation Korean Americans growing up in the suburbs of northern Virginia, Asian Americans in the South engender more nuanced interpretations of concepts like race, region, and place-based identities. Writers of Asian descent like Monique Truong and Cynthia Kadohata as well as non-Asian writers like Cynthia Shearer and Robert Olen Butler illustrate the ways in which Asian immigration complicates long-standing notions of Southern culture and identity. Some of their works address the ambiguities of segregation-era racial politics as those defined as neither white nor African American struggle to navigate their place along the color line. These texts feature local-born southerners who perceive Asians as outsiders and in turn, establish both overt and subtler forms of exclusion and surveillance to maintain control. However, the growing visibility of Asians in the region also hints at the possibility of new multiracial and multiethnic coalitions and new communal identities centered on the shared struggle against economic, political, and social inequalities. Several narratives set in the post-Jim Crow South underscore the global networks that connect the South to the rest of the world. Writers have used and continue to employ the Asian American figure as a means to destabilize the white–black racial binary that has long characterized the Southern literary tradition and position the South in a broader, more global context. The emergence of Asian Americans in addition to Latinos and indigenous populations on the Southern literary landscape highlights the diverse cultures and histories that mark the South not as a monolith but rather as a region experiencing constant transformation.
Archipelagoes and Oceania in Asian American and Pacific Islander Literary Studies
Authors: Suarez Harrod J.
Published: August 2018

What is the difference between studying an archipelago and studying archipelagically? As research in literary critical studies has shown, the difference is significant and what results from each profoundly distinct and possibly at odds with each other. If one approaches the archipelago as an empirical entity—that is, as a chain of islands—there has been the tendency to regard it as smaller and more isolated than other geographic formations, which then determines its marginalization even when working with the advent of transnational and postcolonial rubrics. On the other hand, if the archipelago, following Édouard Glissant and others, is conceptualized as a mode of analysis, then studying different landscapes, histories, narratives, and cultures becomes an altogether different endeavor. Using such approaches to animate the relationship between Oceania and Asian American and Pacific Islander literary studies has been the focus of numerous critics working at the intersections of these and other fields. A controversy that received national media attention framed certain of the stakes involved in the effort to address Oceania, a moment of representational crisis that produced rich responses and galvanized efforts to deal rigorously with the field’s heterogeneity, hybridity, and multiplicity. The resulting epistemological pursuits seem to emphasize the need to study archipelagically, opening up new frameworks and problematics crucial for reimagining the place of Oceania in diverse fields.