bluuebunny/crossref_metadata_2025 huggingface dataset:
Asymmetric Introgression in the Horticultural Living Fossil Cycas Sect. Asiorientales Using a Genome-Wide Scanning Approach
Authors: Chiang Yu-Chung , Huang Bing-Hong , Chang Chun-Wen , Wan Yu-Ting , Lai Shih-Jie , Huang Shong , Liao Pei-Chun
Published: April 2013

The Asian cycads are mostly allopatric, distributed in small population sizes. Hybridization between allopatric species provides clues in determining the mechanism of species divergence. Horticultural introduction provides the chance of interspecific gene flow between allopatric species. Two allopatrically eastern Asian Cycas sect. Asiorientales species, C. revoluta and C. taitungensis, which are widely distributed in Ryukyus and Fujian Province and endemic to Taiwan, respectively, were planted in eastern Taiwan for horticultural reason. Higher degrees of genetic admixture in cultivated samples than wild populations in both cycad species were detected based on multilocus scans by neutral AFLP markers. Furthermore, bidirectional but asymmetric introgression by horticultural introduction of C. revoluta is evidenced by the reanalyses of species associated loci, which are assumed to be diverged after species divergence. Partial loci introgressed from native cycad to the invaders were also detected at the loci of strong species association. Consistent results tested by all neutral loci, and the species-associated loci, specify the recent introgression from the paradox of sharing of ancestral polymorphisms. Phenomenon of introgression of cultivated cycads implies niche conservation among two geographic-isolated cycads, even though the habitats of the extant wild populations of two species are distinct.
Two Common Bean Genotypes with Contrasting Response to Phosphorus Deficiency Show Variations in the microRNA 399-Mediated PvPHO2 Regulation within the PvPHR1 Signaling Pathway
Authors: Ramírez Mario , Flores-Pacheco Gerardo , Reyes José , Luz Alvarez Ana , Drevon Jean , Girard Lourdes , Hernández Georgina
Published: April 2013

Crop production of the important legume, the common bean (Phaseolus vulgaris), is often limited by low phosphorus (P) in the soil. The genotypes, BAT477 and DOR364, of the common bean have contrasting responses to P starvation. Plants from the BAT477 P deficiency tolerant genotype showed higher phosphate content and root biomass as compared to the DOR364 plants under P starvation. The PvPHR1 transcription factor-signaling pathway plays an essential role in the response to P starvation. PvPHO2, a negative regulator of this pathway, encodes an ubiquitin E2 conjugase that promotes degradation of P-responsive proteins and is the target gene of PvmiR399. PvPHO2 is downregulated in BAT477 plants under P deficiency, while such a response is not observed in P-starved DOR364 plants. Five putative PvmiR399 binding sites were identified in the 5' UTR region in both genotypes. While four sites showed an identical DNA sequence, the fifth (binding site of PvPHO2 one) showed three base changes and higher complementarity scores in DOR364 as compared to BAT477. Modified 5'RACE experiments indicated that PvmiR399 binding and/or processing was affected in DOR364 P-starved plants. We propose that a less efficient cleavage of the PvPHO2 mRNA directed by PvmiR399 would result in a higher PvPHO2-mediated degradation of P-responsive proteins in the DOR364 genotype with decreased P deficiency tolerance.
Intercellular Signaling Pathway among Endothelia, Astrocytes and Neurons in Excitatory Neuronal Damage
Authors: Takemiya Takako , Yamagata Kanato
Published: April 2013

Neurons interact closely with astrocytes via glutamate; this neuron-glia circuit may play a pivotal role in synaptic transmission. On the other hand, astrocytes contact vascular endothelial cells with their end-feet. It is becoming obvious that non-neuronal cells play a critical role in regulating the neuronal activity in the brain. We find that kainic acid (KA) administration induces the expression of microsomal prostaglandin E synthase-1 (mPGES-1) in venous endothelial cells and the prostaglandin E2 (PGE2) receptor prostaglandin E receptor (EP)-3 on astrocytes. Endothelial mPGES-1 exacerbates KA-induced neuronal damage in in vivo experiments. In in vitro experiments, mPGES-1 produces PGE2, which enhances astrocytic Ca2+ levels via the EP3 receptor and increases Ca2+-dependent glutamate release, thus aggravating neuronal injury. This novel endothelium-astrocyte-neuron signaling pathway may be crucial for driving neuronal damage after repetitive seizures and could be a new therapeutic target for epilepsy and other brain disorders.
The Structure of European Food Law
Authors: Van der Meulen Bernd
Published: April 2013

This contribution lays bare the structure of EU food law as it appears from scholarly analysis at Wageningen University in the Netherlands. The structure of EU food law can be used as a framework for teaching, application, further analysis and comparison to food law approaches in other parts of the world. From this analysis, food law emerges as a functional area of law. Core elements are: (1) the objectives of EU food law to protect consumers’ interests; (2) the principles of risk analysis and precaution; (3) obligations on businesses regarding the products they place on the market, the processes they apply and their communication towards consumers; and (4) public powers of law enforcement and incident management.
Peak Detection Method Evaluation for Ion Mobility Spectrometry by Using Machine Learning Approaches
Authors: Hauschild Anne-Christin , Kopczynski Dominik , D'Addario Marianna , Baumbach Jörg , Rahmann Sven , Baumbach Jan
Published: April 2013

Ion mobility spectrometry with pre-separation by multi-capillary columns (MCC/IMS) has become an established inexpensive, non-invasive bioanalytics technology for detecting volatile organic compounds (VOCs) with various metabolomics applications in medical research. To pave the way for this technology towards daily usage in medical practice, different steps still have to be taken. With respect to modern biomarker research, one of the most important tasks is the automatic classification of patient-specific data sets into different groups, healthy or not, for instance. Although sophisticated machine learning methods exist, an inevitable preprocessing step is reliable and robust peak detection without manual intervention. In this work we evaluate four state-of-the-art approaches for automated IMS-based peak detection: local maxima search, watershed transformation with IPHEx, region-merging with VisualNow, and peak model estimation (PME).We manually generated Metabolites 2013, 3 278 a gold standard with the aid of a domain expert (manual) and compare the performance of the four peak calling methods with respect to two distinct criteria. We first utilize established machine learning methods and systematically study their classification performance based on the four peak detectors’ results. Second, we investigate the classification variance and robustness regarding perturbation and overfitting. Our main finding is that the power of the classification accuracy is almost equally good for all methods, the manually created gold standard as well as the four automatic peak finding methods. In addition, we note that all tools, manual and automatic, are similarly robust against perturbations. However, the classification performance is more robust against overfitting when using the PME as peak calling preprocessor. In summary, we conclude that all methods, though small differences exist, are largely reliable and enable a wide spectrum of real-world biomedical applications.
Chemical Constituents from the Leaves of Annona reticulata and Their Inhibitory Effects on NO Production
Authors: Thang Tran , Kuo Ping-Chung , Huang Guan-Jhong , Hung Nguyen , Huang Bow-Shin , Yang Mei-Lin , Luong Ngo , Wu Tian-Shung
Published: April 2013

In the present study, the chemical investigation of the leaves of Annona reticulata has resulted in the identification of nine compounds, including annonaretin A, (1), a new triterpenoid. The purified compounds were subjected to the examination of their effects on NO inhibition in LPS-activated mouse peritoneal macrophages and most of them exhibited significant NO inhibition, with IC50 values in the range of 48.6 ± 1.2 and 99.8 ± 0.4 μM.
A Sample-Based Forest Monitoring Strategy Using Landsat, AVHRR and MODIS Data to Estimate Gross Forest Cover Loss in Malaysia between 1990 and 2005
Authors: Giree Namita , Stehman Stephen , Potapov Peter , Hansen Matthew
Published: April 2013

Insular Southeast Asia is a hotspot of humid tropical forest cover loss. A sample-based monitoring approach quantifying forest cover loss from Landsat imagery was implemented to estimate gross forest cover loss for two eras, 1990–2000 and 2000–2005. For each time interval, a probability sample of 18.5 km × 18.5 km blocks was selected, and pairs of Landsat images acquired per sample block were interpreted to quantify forest cover area and gross forest cover loss. Stratified random sampling was implemented for 2000–2005 with MODIS-derived forest cover loss used to define the strata. A probability proportional to x (πpx) design was implemented for 1990–2000 with AVHRR-derived forest cover loss used as the x variable to increase the likelihood of including forest loss area in the sample. The estimated annual gross forest cover loss for Malaysia was 0.43 Mha/yr (SE = 0.04) during 1990–2000 and 0.64 Mha/yr (SE = 0.055) during 2000–2005. Our use of the πpx sampling design represents a first practical trial of this design for sampling satellite imagery. Although the design performed adequately in this study, a thorough comparative investigation of the πpx design relative to other sampling strategies is needed before general design recommendations can be put forth.
Early Detection of Bark Beetle Green Attack Using TerraSAR-X and RapidEye Data
Authors: Ortiz Sonia , Breidenbach Johannes , Kändler Gerald
Published: April 2013

Bark beetles cause widespread damages in the coniferous-dominated forests of central Europe and North America. In the future, areas affected by bark beetles may further increase due to climate change. However, the early detection of the bark beetle green attack can guide management decisions to prevent larger damages. For this reason, a field-based bark beetle monitoring program is currently implemented in Germany. The combination of remote sensing and field data may help minimizing the reaction time and reducing costs of monitoring programs covering large forested areas. In this case study, RapidEye and TerraSAR-X data were analyzed separately and in combination to detect bark beetle green attack. The remote sensing data were acquired in May 2009 for a study site in south-west Germany. In order to distinguish healthy areas and areas affected by bark beetle green attack, three statistical approaches were compared: generalized linear models (GLM), maximum entropy (ME) and random forest (RF). The spatial scale (minimum mapping unit) was 78.5 m2. TerraSAR-X data resulted in fair classification accuracy with a cross-validated Cohen’s Kappa Coefficient (kappa) of 0.23. RapidEye data resulted in moderate classification accuracy with a kappa of 0.51. The highest classification accuracy was obtained by combining the TerraSAR-X and RapidEye data, resulting in a kappa of 0.74. The accuracy of ME models was considerably higher than the accuracy of GLM and RF models.
Optimization of Hydrogen Peroxide Detection for a Methyl Mercaptan Biosensor
Authors: Li Zhan-Hong , Guedri Houssemeddine , Viguier Bruno , Sun Shi-Gang , Marty Jean-Louis
Published: April 2013

Several kinds of modified carbon screen printed electrodes (CSPEs) for amperometric detection of hydrogen peroxide (H2O2) are presented in order to propose a methyl mercaptan (MM) biosensor. Unmodified, carbon nanotubes (CNTs), cobalt phthalocyanine (CoPC), Prussian blue (PB), and Os-wired HRP modified CSPE sensors were fabricated and tested to detect H2O2, applying a potential of +0.6 V, +0.6 V, +0.4 V, −0.2 V and −0.1 V (versus Ag/AgCl), respectively. The limits of detection of these electrodes for H2O2 were 3.1 μM, 1.3 μM, 71 nM, 1.3 μM, 13.7 nM, respectively. The results demonstrated that the Os-wired HRP modified CSPEs gives the lowest limit of detection (LOD) for H2O2 at a working potential as low as −0.1 V. Os-wired HRP is the optimum choice for establishment of a MM biosensor and gives a detection limit of 0.5 μM.
Community Perceptions of Criminality: The Case of the Maltese Walled City of Bormla
Authors: Cutajar JosAnn , Formosa Saviour , Calafato Trevor
Published: April 2013

This paper explores the situational factors that explain why crime in Bormla occurs in certain areas and not others. Bormla, one of the oldest cities in Malta, is the fifth crime hotspot on the Maltese Islands. The objective of this paper is to find out whether socio-demographic aspects and/or other contextual aspects are linked with the rate and type of crime that takes place within this city. A multi-method approach was adopted for the purposes of this paper. Statistics issued by the Malta police were analysed to find out which criminal offences occur there, and in which location. This analysis took place with the help of Geographic Information System (GIS) software. Qualitative and quantitative data collected through a needs assessment exercise conducted with a sample of Bormla respondents in 2009 and 2010 was also analysed to find out whether residents concurred with this official picture of what type of crime takes place there, and where it occurs. Residents were also asked whether they felt safe living in this crime hotspot, when and where they felt safe, and why.
Mountain Pine Beetles, Salvage Logging, and Hydrologic Change: Predicting Wet Ground Areas
Authors: Rex John , Dubé Stéphane , Foord Vanessa
Published: April 2013

The mountain pine beetle epidemic in British Columbia has covered 18.1 million hectares of forest land showing the potential for exceptionally large-scale disturbance to influence watershed hydrology. Pine stands killed by the epidemic can experience reduced levels of evapotranspiration and precipitation interception, which can translate into an increase in soil moisture as observed by some forest practitioners during salvage logging in the epicenter of the outbreak. They reported the replacement of summer ground, dry firm soil areas, with winter ground areas identified by having wetter, less firm soils upon which forestry equipment operation is difficult or impossible before winter freeze-up. To decrease the likelihood of soil disturbance from harvesting, a set of hazard indicators was developed to predict wet ground areas in areas heavily infested by the mountain pine beetle. Hazard indicators were based on available GIS data, aerial photographs, and local knowledge. Indicators were selected by an iterative process that began with office-based selection of potential indicators, model development and prediction, field verification, and model refinement to select those indicators that explained most field data variability. Findings indicate that the most effective indicators were lodgepole pine content, understory, drainage density, soil texture, and the topographic index.
Introducing the Adherence Strategy Engineering Framework (ASEF)
Authors: Toftegaard T. S. , Bertelsen O. W. , Wagner S.
Published: April 2013

Background: Patients performing self-care in the unsupervised setting do not always adhere to the instructions they were initially provided with. As a consequence, a patient’s ability to successfully comply with the treatment plan cannot be verified by the treating healthcare professional, possibly resulting in reduced data quality and suboptimal treatment.

Objectives: The aim of this paper is to introduce the Adherence Strategy Engineering Framework (ASEF) as a method for developing novel technology-based adherence strategies to assess and improve patient adherence levels in the unsupervised setting.

Methods: Key concepts related to self-care and adherence were defined, discussed, and implemented as part of the ASEF framework.

ASEF was applied to seven self-care case studies, and the perceived usefulness and feasibility of ASEF was evaluated in a questionnaire study by the case study participants. Finally, we reviewed the individual case studies usage of ASEF.

Results: A range of central self-care concepts were defined and the ASEF methodological framework was introduced. ASEF was successfully used in seven case studies with a total of 25 participants. Of these, 16 provided answers in the questionnaire study reporting ASEF as useful and feasible. Case study reviews illustrated the potential of using context-aware technologies to support self-care in the unsupervised setting as well as ASEF’s ability to support this.

Conclusion: Challenges associated with moving healthcare to the unsupervised setting can be overcome by applying novel context-aware technology using the ASEF method. This could lead to better treatment outcomes and reduce healthcare expenditures.
A Comprehensive E-prescribing Model to Allow Representing, Comparing, and Analyzing Available Systems
Authors: Mazzola L. , Bonacina S. , Tarquini P. , Donzelli P. , Pinciroli F. , Marceglia S.
Published: April 2013

Background: Even though ePrescribing systems are now available in many healthcare systems and have been a crucial milestone of the roadmaps towards eHealth in the last years, there is still a large heterogeneity among functionalities and performances of different systems.

Objective: In this paper, we propose an updated comprehensive model for the ePre-scribing process able to represent, analyze, and compare current systems and to support the design of new, more general, systems suitable also to sustain the ePrescription process in National Healthcare Systems.

Methods: After a preliminary literature review, we identified six main phases of the ePrescribing process, namely Assign, Transmit, Dispense, Administer, Monitor, and Analysis & Decision. Each phase produces a digital object characterized by formal properties that ensure the collection of appropriate data and information and works as input for the next one. The impact, in terms of benefits, of ePrescribing on governance, drug sur -veillance, and quality of care at the individual, territorial, and governmental levels are related to the formal properties of the digital objects created at the end of each phase.

Results and Conclusions: The model-based implementation of each phase has an impact on the quality of care, the access to care, and the effectiveness of care delivery. The model does not cover cost evaluation, but the benefits identified can be used as basis for cost-benefit or cost-effectiveness analysis of heterogeneous systems.
Prototyping Sensor Network System for Automatic Vital Signs Collection
Authors: Noma H. , Naito C. , Tada M. , Yamanaka H. , Takemura T. , Nin K. , Yoshihara H. , Kuroda T.
Published: April 2013

Objective: Development of a clinical sensor network system that automatically collects vital sign and its supplemental data, and evaluation the effect of automatic vital sensor value assignment to patients based on locations of sensors.

Methods: The sensor network estimates the data-source, a target patient, from the position of a vital sign sensor obtained from a newly developed proximity sensing system. The proximity sensing system estimates the positions of the devices using a Bluetooth inquiry process. Using Bluetooth access points and the positioning system newly developed in this project, the sensor network collects vital sign and its 4W (who, where, what, and when) supplemental data from any Blue-tooth ready vital sign sensors such as Continua-ready devices. The prototype was evaluated in a pseudo clinical setting at Kyoto University Hospital using a cyclic paired comparison and statistical analysis.

Results: The result of the cyclic paired analysis shows the subjects evaluated the proposed system is more effective and safer than POCS as well as paper-based operation. It halves the times for vital signs input and eliminates input errors. On the other hand, the prototype failed in its position estimation for 12.6% of all attempts, and the nurses overlooked half of the errors. A detailed investigation clears that an advanced interface to show the system’s “confidence”, i.e. the probability of estimation error, must be effective to reduce the oversights.

Conclusions: This paper proposed a clinical sensor network system that relieves nurses from vital signs input tasks. The result clearly shows that the proposed system increases the efficiency and safety of the nursing process both subjectively and objectively. It is a step toward new generation of point of nursing care systems where sensors take over the tasks of data input from the nurses.
Evaluation of methicillin-resistant Staphylococcus aureus nasal carriage in Malagasy patients
Authors: Rasamiravaka Tsiry , Rasoanandrasana Saida , Zafindraibe Norosoa Julie Julie , Rakoto Alson Aimee Olivat , Rasamindrakotroka Andry
Published: April 2013

Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) is an important cause of infections. It is well recognized that nasal carriage of S. aureus represents a potent and increasingly prevalent risk factor for subsequent S. aureus infection. However, in Madagascar no data exist concerning this nasal carriage of S. aureus. Methodology: Nasal swabs from 304 different patients attending the Laboratory of Training and Research in Medical Biology of Madagascar were cultured for methicillin sensitive (MSSA) and MRSA. Results: One hundred and sixteen patients had S. aureus in their noses (38.16 ± 5.46%) of whom 45 (14.80 ± 3.99%) had MRSA.  A risk factor for MSSA nasal carriage included a history of hospitalization when antibiotics were administered (odds ratio [OR] 2.25, 1.09 - 4.64). Among MRSA nasal isolates, high rate of resistance to other antibiotics was observed, particularly for trimethoprim-sulfamethoxazole (68.89%), erythromycin (66.67%) and ofloxacin (53.33%). Conclusion: Our data showed a high rate of MRSA nasal carriage and a high rate of multidrug resistance. A strategic policy against the spread of multidrug resistant strains is desirable.
Multi-drug resistance profiles and the genetic features of Acinetobacter baumannii isolates from Bolivia
Authors: Lopes Bruno Silvester , Gallego Lucia , Amyes Sebastian Giles Becket
Published: April 2013

Introduction: Acinetobacter baumannii is opportunistic in debilitated hospitalised patients. Because information from some South American countries was previously lacking, this study examined the emergence of multi-resistant A. baumannii in three hospitals in Cochabamba, Bolivia, from 2008 to 2009. Methodology: Multiplex PCR was used to identify the main resistance genes in 15 multi-resistant A. baumannii isolates. RT-PCR was used to measure gene expression. The genetic environment of these genes was also analysed by PCR amplification and sequencing. Minimum inhibitory concentrations were determined for key antibiotics and some were determined in the presence of an efflux pump inhibitor, 1-(1-napthylmethyl) piperazine. Results: Fourteen strains were found to be multi-resistant. Each strain was found to have the blaOXA-58 gene with the ISAba3-like element upstream, responsible for over-expression of the latter and subsequent carbapenem resistance. Similarly, ISAba1, upstream of the blaADC gene caused over-expression of the latter and cephalosporin resistance; mutations in the gyrA(Ser83 to Leu) and parC (Ser-80 to Phe) genes were commensurate with fluoroquinolone resistance. In addition, the adeA, adeB efflux genes were over-expressed. All 15 isolates were positive for at least two aminoglycoside resistance genes. Conclusion: This is one of the first reports analyzing the multi-drug resistance profile of A. baumannii strains isolated in Bolivia and shows that the over-expression of theblaOXA-58, blaADC and efflux genes together with aminoglycoside modifying enzymes and mutations in DNA topoisomerases are responsible for the multi-resistance of the bacteria and the subsequent difficulty in treating infections caused by them.
Pathogenesis of Hendra and Nipah virus infection in humans
Authors: Escaffre Olivier , Borisevich Viktoriya , Rockx Barry
Published: April 2013

Hendra virus (HeV) and Nipah virus (NiV) are emerging zoonotic viruses that cause severe and often lethal respiratory illness and encephalitis in humans. Henipaviruses can infect a wide range of species and human-to-human transmission has been observed for NiV. While the exact route of transmission in humans is not known, experimental infection in different animal species suggests that infection can be efficiently initiated after respiratory challenge. The limited data on histopathological changes in fatal human cases of HeV and NiV suggest that endothelial cells are an important target during the terminal stage of infection; however, it is unknown where these viruses initially establish infection and how the virus disseminates from the respiratory tract to the central nervous system and other organs. Here we review the current concepts in henipavirus pathogenesis in humans.
Safety of Abatacept Administered Intravenously in Treatment of Rheumatoid Arthritis: Integrated Analyses of up to 8 Years of Treatment from the Abatacept Clinical Trial Program
Authors: Weinblatt Michael E. , Moreland Larry W. , Westhovens Rene , Cohen Roger B. , Kelly Sheila M. , Khan Nader , Pappu Ramesh , Delaet Ingrid , Luo Allison , Gujrathi Sheila , Hochberg Marc C.
Published: April 2013

Objective.

To assess the overall safety, including rare events, of intravenous (IV) abatacept treatment in rheumatoid arthritis (RA).

Methods.

Data from 8 clinical trials of IV abatacept in RA were pooled. Safety events were assessed during the short-term (duration ≤ 12 months) and cumulative (short-term plus longterm extensions) abatacept treatment periods. Incidence rates per 100 patient-years were calculated. Standardized incidence ratios (SIR) for hospitalized infections and malignancies were compared with external RA cohorts and, for malignancies, with the US general population.

Results.

There were 3173 IV abatacept-treated patients with 2331 patient-years of exposure in the short-term periods, and 4149 IV abatacept-treated patients with 12,132 patient-years of exposure in the cumulative period. Incidence rates for serious infections were low and consistent over time (3.68 for abatacept vs 2.60 for placebo during the short-term, and 2.87 for abatacept during the cumulative period). Hospitalized infections were generally similar to external RA patient cohorts and were consistent over time. Incidence rates of malignancies were similar for abatacept- and placebo-treated patients during the short-term period (0.73 vs 0.59) and remained low during the abatacept cumulative period (0.73). SIR of some tissue-specific malignancies (e.g., colorectal and breast) in the cumulative period tended to be lower, while others (lymphoma and lung) tended to be higher, compared with the general population; however, incidence rates were comparable with RA cohorts. Autoimmune events were rare and infusion reactions uncommon.

Conclusion.

Longterm safety of IV abatacept was consistent with the short-term, with no unexpected events and low incidence rates of serious infections, malignancies, and autoimmune events.
Operative Treatment of Communited Olecranon Fractures Using Tension-band Wiring and Miniplate Augmentation
Authors: Oh Hyoung Keun , Choo Suk Kyu , Lee Chang Soo , Song Jae Gwang
Published: April 2013

Olecranon fractures are intra-articular injuries that require anatomic restoration of the articular surface. For most simple noncomminuted transverse olecranon fractures, tension band wire fixation can provide a stable construct to allow for early joint range of motion. However, in comminuted olecranon fractures, it is difficult to provide a sufficient buttress for impacted articular fragments using tension band wire fixation. Therefore, plate fixation is the standard fixation method, but wide skin exposure and symptomatic plate irritation on the skin are common complications. The authors’ technique uses tension band wire fixation with miniplate augmentation for patients with comminuted olecranon fractures.
Safety of Fondaparinux Versus Enoxaparin After TKA in Japanese Patients
Authors: Hosaka Kunihiro , Saito Shu , Ishii Takao , Sumino Takanobu , Ryu Keinosuke , Suzuki Gen , Suzuki Takashi , Tokuhashi Yasuaki
Published: April 2013

Fondaparinux and enoxaparin are useful for preventing venous thromboembolism after total knee arthroplasty (TKA), but both drugs have associated complications. The purpose of this study was to clarify the risks associated with use of these drugs in Japanese patients who underwent TKA.

A total of 575 patients (935 knees) underwent TKA and were retrospectively reviewed; 277 patients (454 knees) were treated with fondaparinux and 298 patients (481 knees) were treated with enoxaparin. The authors investigated the incidences of deep venous thrombosis of the lower limbs and pulmonary embolism to evaluate venous thromboembolism, knee enlargement compared with the preoperative size, incidence of subcutaneous knee hematoma, and other complications. No significant differences were observed between the 2 drugs regarding the incidences of deep venous thrombosis and pulmonary embolism. However, fondaparinux use resulted in knee enlargement (
P
<.0005) and subcutaneous hematoma of the knee (
P
=.035) significantly more often than enoxaparin use. Conversely, enoxaparin use significantly caused the elevation of alanine aminotransferase (one of the liver enzymes) at a higher rate than fondaparinux (30.1% vs 8.3%, respectively;
P
<.0001). However, the increased alanine aminotransferase levels were transient, and no patient exhibited symptoms of abnormal liver function, such as jaundice or cutaneous pruritus.

Fondaparinux and enoxaparin were both effective in preventing venous thromboembolism in Japanese patients undergoing elective TKA. However, both drugs had some adverse effects. It is important to be aware of these potential risks when prescribing these drugs.
Bifid Median Nerve Causing Carpal Tunnel Syndrome: MRI and Surgical Correlation
Authors: Bagatur A. Erdem , Yalcinkaya Merter , Atca Ali Onder
Published: April 2013

Carpal tunnel syndrome can be secondary in some patients, and vascular anomalies (usually a persistent median artery), median nerve variations, or both are among the etiologic factors. High division of the median nerve proximal to the carpal tunnel (known as a bifid median nerve) is a median nerve anomaly that has an incidence rate of 2.8%. This rare entity is often associated with various abnormalities that are clinically relevant, such as vascular malformations (persistent median artery), aberrant muscles, and carpal tunnel syndrome. The bifid median nerve is one cause of carpal tunnel syndrome because of its relatively higher cross-sectional area compared with a nonbifid median nerve. Obtaining magnetic resonance imaging and ultrasounds of bifid median nerves has helped surgeons avoid potential surgical hazards.

This article describes 3 men with 4 bifid median nerves associated with a persistent median artery. Mean patient age was 38 years (range, 37–40 years). Mean follow-up was 7 years (range, 3–11 years). Patients were diagnosed with carpal tunnel syndrome and underwent open carpal tunnel release. To reveal a morphological etiology in patients in whom it the possibility of having idiopathic carpal tunnel syndrome is unlikely, preoperative imaging studies should be obtained. Bifid median nerves associated with a persistent median artery in the carpal tunnel are important to understand for their clinical and surgical significance. A secondary nature should be suspected in patients with unilateral symptoms, especially those with a history of symptoms and when the symptomatic hand shows severe neurophysiologic impairment but the contralateral hand is neurophysiologically intact. Inadvertent injury to the median nerve during carpal tunnel surgery can be minimized if the variations of the median nerve are recognized.
T1 Intralaminar Screws: An Anatomic, Morphologic Study
Authors: Weaver John , Seipel Shane , Eubanks Jason
Published: April 2013

In some scenarios, such as complex revisions or tumor cases, intralaminar screw placement in the upper thoracic spine can be used to supplement or replace traditional pedicle screw placement. Despite the theortic feasibility of placing these screws, no thorough anatomic study has evaluated the morphology of the T1 lamina for screw placement.

Anatomic data of the T1 lamina, including height, width (the upper, middle, and lower one-third segments), and length (with and without penetration of the facet articulation) were analyzed for 112 T1 vertebrae. The placement of screws with widths of 3.5 or 4 mm and screws with lengths of 24 or 26 mm in the T1 lamina was feasible in all of the laminas measured with the exception of 2 outliers. Furthermore, relationships were found between T1 lamina size and patient height and between T1 lamina size and sex, but no relationship was found between T1 lamina size and race.

The morphology of the T1 lamina allows for the simple and safe placement of common screw diameters and is a viable salvage or alternative to the traditional pedicle screw.
Lateral Mass Versus Hybrid Construct for Cervical Laminectomy and Fusion
Authors: Regan Conor M. , Emmanuel Steven , Hornik Christoph , Weinhold Paul , Lim Moe R.
Published: April 2013

Spine stabilization after C3–C7 laminectomy can be accomplished with many instrumentation options. A hybrid construct using lateral mass screws from C3 to C5 and pedicle screws at C7 can potentially maximize strength and solve the spatial constraints introduced by the placement of C6 lateral mass screws and C7 pedicle screws. Seven cadaveric cervical spines from C2 to T2 were potted in a custom testing apparatus. Differential variable reluctance transducers were placed on C6 and C7 to measure linear displacement. Specimens were loaded in flexion, extension, lateral bending, and axial torque at 1.5 Nm. A wide laminectomy was then performed, and specimens were randomized to first receive either the bilateral C3–C7 lateral mass screw construct or a hybrid construct with C3–C5 lateral mass screws and C7 pedicle screws. All specimens were tested with both constructs. Normalized deformation (mean±SD) for the lateral mass screw vs the hybrid pedicle screw constructs in the sagittal plane was 7.46%±5.48% vs 5.68%±3.67%, respectively (
P
=.237). Coronal deformation for lateral mass screw vs the hybrid pedicle screw constructs was 19.2%±10.9% vs 13.6%±9.53% (
P
=.237). Axial rotation deformation for lateral mass vs pedical screw constructs was 85.9%±83.3% vs 74.7%±58.1%, respectively (
P
=.868). Despite data reported in the literature indicating a higher pullout strength of pedicle screws and improved strength of hybrid pedicle screw constructs compared with lateral mass screw constructs, a hybrid construct taking spatial constraints and increased danger of pedicle screw placement above C7 into account showed no improvement in motion compared with a lateral mass screw construct.
Comparison of Lumbar Interbody Fusion Performed with Unilateral or Bilateral Pedicle Screw
Authors: Mao Lu , Chen Guang-Dong , Xu Xiao-Min , Guo Zhe , Yang Hui-Lin
Published: April 2013

Currently, bilateral pedicle screw fixation is the standard of instrumentation, providing rigid fixation and an increased fusion rate. However, due to the excessive rigidity of the system, this instrumentation has been suspected to cause degeneration of adjacent segments. Alternatively, less rigid unilateral pedicle fixation is considered to be as effective as bilateral constructs. Few studies have compared unilateral and bilateral constructs in the treatment of lumbar degenerative disease. The purpose of this retrospective study was to evaluate possible differences between unilateral and bilateral pedicle screw fixation for single-level lumbar degenerative disease.

Between October 2006 and October 2010, sixty consecutive patients were treated with unilateral pedicle screw fixation (28 patients) or bilateral pedicle screw fixation (32 patients) at the authors’ institution. Oswestry Disability Index and visual analog scale scores showed a statistical difference between preoperative values and 3- and 6-month postoperative values (
P
<.05). Unilateral fixation resulted in shorter operative times and less intraoperative blood loss. No significant difference was found between the 2 fixation methods in terms of fusion rate and complication rate (
P
>.05).

Lumbar interbody fusion with unilateral pedicle screw fixation was an effective and convenient method of treatment of single-level lumbar degenerative disease, with little surgical trauma.
Factors Affecting Kyphotic Angle Reduction in Osteoporotic Vertebral Compression Fractures with Kyphoplasty
Authors: Shen Minjie , Wang Heng , Chen Guangdong , Gan Minfeng , Yuan Quan , Wang Zhidong , Liu Ling , Yang Huilin
Published: April 2013

This article describes the independent factors that affect kyphotic angle reduction in the treatment of osteoporotic vertebral compression fractures with kyphoplasty. Between January 2008 and September 2011, one hundred twenty-six patients with a single-level osteoporotic compression fracture who underwent kyphoplasty were evaluated for a minimum of 1 year postoperatively. Nine independent variables related to patient characteristics (age, sex, bone mineral density [BMD], and body mass index), fracture characteristics (fracture level, fracture age, and preoperative kyphotic angle), and surgical variables (total injected cement volume and cement leakage) were assessed. Kyphotic angle reduction was the dependent variable. Univariate and multivariate linear regression analyses were used to determine the factors associated with kyphotic angle reduction.

Significant improvements occurred in mean anterior vertebral height variation, middle vertebral height variation, kyphotic angle, and visual analog scale and Oswestry Disability Index scores immediate postoperatively and at final follow-up compared with the preoperative values. Univariate analyses indicated correlations between kyphotic angle reduction with BMD, fracture age, preoperative kyphotic angle, and cement volume. The final multiple linear regression model resulted in a formula that accounted for 23.3% of the variability in kyphotic angle reduction: preoperative kyphotic angle (b=0.260;
P
=.002), BMD (b=−0.249;
P
=.004), and fracture age (b=−0.226;
P
=.009). Kyphoplasty is a safe and effective treatment for osteoporotic compression fractures.
Severe Persistent Synovitis After Cobalt-chromium Total Knee Arthroplasty Requiring Revision
Authors: Thakur Raman R. , Ast Michael P. , McGraw Michael , Bostrom Mathias P. , Rodriguez Jose A. , Parks Michael L.
Published: April 2013

Implant-related hypersensitivity is a well-established cause of failure after total hip arthroplasty but is a rare complication after total knee arthroplasty (TKA). It remains a relatively unpredictable and poorly understood cause of implant-related failure. This article describes 5 patients (6 knees) who presented with persistent pain and hypertrophic synovitis after TKA using a cobalt-chromium component. Extensive perioperative workup, including white blood cell count, erythrocyte sedimentation rate, C-reactive protein, joint aspiration, and intraoperative cultures, ruled out infection as a cause of the symptoms. All knees demonstrated appropriate ligamentous balance and were well aligned, with all components noted to be well fixed at revision. In all patients, the clinical condition improved dramatically after revision to zirconium femoral and titanium metal-backed tibial components. Pain and functional outcome scores improved in all patients. Intraoperative histopathology revealed a thickened synovium with either a predominantly lymphocytic or histiocytic monocellular response. Final pathology confirmed that no infection was present in any patient. The goal of TKA is to produce a well-performing, pain-free joint. When patients present with recurrent pain and synovitis after TKA, infection must be excluded. When infection and instability have been excluded, metal hypersensitivity should be considered as a cause of primary TKA failure. In these patients, revision to a zirconium femoral component can provide predictable and effective clinical improvement.
Metal Sensitivity After TKA Presenting With Systemic Dermatitis and Hair Loss
Authors: Post Zachary D. , Orozco Fabio R. , Ong Alvin C.
Published: April 2013

Recent problems with metal-on-metal bearings in total hip arthroplasty have highlighted a connection between metal particles and allergic responses. Metal sensitivity associated with total knee arthroplasty (TKA) is less understood and poorly characterized. However, metal sensitivity can lead to TKA failure. Accurate and reliable testing for this phenomenon is elusive; therefore, the diagnosis of metal sensitivity remains one of exclusion. Only skin testing and lymphocyte transformation testing are commonly available to assess hypersensitivity, and neither test is reliable.

This article describes a woman who presented with severe whole-body dermatitis and hair loss. After prolonged pain and progressive stiffness, including failed manipulation while under anesthesia and open synovectomy, the patient had a positive skin test, but the lymphocyte transformation test was negative. She was treated for metal sensitivity with TKA revision to nonallergenic components, and all symptoms resolved. One year after revision, she had good range of motion, complete dermatitis resolution, and hair loss restoration.

To the authors’ knowledge, this is the only report that describes hair loss as a symptom of metal sensitivity secondary to TKA and hair regrowth after revision. The authors now include metal sensitivity in a differential of causes of pain and other unusual symptoms after TKA that are otherwise unexplained.
Validation of the Self-Assessment of Nursing Informatics Competencies Scale Among Undergraduate and Graduate Nursing Students
Authors: Choi Jeungok , Bakken Suzanne
Published: April 2013

This study investigated the psychometrics of the Self-Assessment of Nursing Informatics Competencies Scale for nursing students in undergraduate (
n
= 131) and graduate (
n
= 171) programs. The scale had a valid five-factor structure, accounting for 69.38% of the variance, high internal consistency reliabilities (0.96 for the total scale and 0.84 to 0.94 for subscales), and good responsiveness (standardized response mean = 0.99), as well as significantly improved scores in nursing students with diverse demographic and educational backgrounds after taking an informatics course. Our factor structure was similar to the original scale, differing slightly in four items’ loadings. This difference may reflect current informatics practice or the greater diversity of our sample. Further research is needed on the factor, data/information management skills, and related item loadings. This scale could be used to assess informatics competencies and develop educational strategies that prepare nursing students as informatics-competent graduates in information technology–rich environments. [
J Nurs Educ.
2013;52(5):275–282.]
Focus Group Study of Siblings of Individuals with Psychosis: Views on Designing an Online Psychoeducational Resource
Authors: Sin Jacqueline
Published: April 2013

Despite the strong evidence base for psychoeducation for families and caregivers, specific interventions targeting siblings of individuals affected by psychosis are lacking. A small but coherent body of research has identified that siblings often play an active role in their brother’s or sister’s care and recovery from psychosis, and siblings need robust and flexible psychoeducational resources. This study used focus groups involving 14 siblings to explore their views on the optimal content and design of such a resource using online delivery. Siblings suggested a number of content items for information giving, some similar to those identified from the wider literature on conventional psychoeducational intervention, whereas others are unique to siblings’ needs. Focus group participants also highly valued an interactive peer discussion and support forum despite some concerns over its security and moderation. Considerations over delivery and logistics issues integral to the resource were highlighted as crucial in facilitating access and usage by siblings. When caring for people with psychosis, nurses should assess if the service users have siblings involved in their care and recovery plans and signpost siblings for resources and support.
Localized Changes in Stromal Reflectivity After Corneal Collagen Cross-Linking Observed With Different Imaging Techniques
Authors: Wittig-Silva Christine , Chan Elsie , Pollock Graeme , Snibson Grant R.
Published: April 2013

PURPOSE:

To report changes observed in the corneal stroma using confocal microscopy and Scheimpflug imaging following epithelium-off collagen cross-linking (CXL) in cases of progressive keratoconus.

METHODS:

Fifteen eyes of 14 patients were examined before and after CXL using slit-lamp biomicroscopy, Scheimpflug imaging, and confocal microscopy. A subset of patients also had optical coherence tomography imaging performed.

RESULTS:

After CXL, confocal microscopy revealed a discrete layer of increased reflectivity in the mid to deep stroma. This layer was visible from as early as 1 week following treatment with patchy changes persisting until 12 months. This posterior reflective zone was found to consist of numerous linear or striate reflective structures (intrastromal striate reflections [ISRs]). ISRs were not observed in any of the eyes before the CXL procedure. High-resolution Scheimpflug and optical coherence tomography images also demonstrated a narrow zone of increased reflectivity at a similar depth. A layer-by-layer match was possible between the confocal and Scheimpflug images. The location of the ISR layer appears to correlate with a zone of increased reflectivity visible on postoperative slit-lamp examinations.

CONCLUSION:

Altered stromal reflectivity after CXL can be observed with modern diagnostic imaging technologies. These findings seem to correlate not only among the different devices but also with biomicroscopic observations and could potentially provide a non-invasive tool to monitor the cross-linking effect in individual corneas.

[
J Refract Surg.
2013;29(6):410–416.]
El «momento mutualista» en la formulación de un sistema de protección social en Argentina: socorro mutuo y prevención subsidiada a comienzos del siglo XX
Authors: González Bernaldo de Quirós Pilar
Published: April 2013

Este trabajo está destinado a estudiar las prácticas de socorro mutuo de los extranjeros y su papel en la difusión de un pensamiento solidarista que proporcionará un conjunto de herramientas conceptuales y técnicas esenciales para las reivindicaciones de protección por parte de los trabajadores así como para la formulación de los primeros proyectos de creación de un sistema nacional de seguro social. Ello me permite destacar la dimensión transnacional de la construcción del campo de la protección social. La primera parte del artículo está destinada a dar cuenta de esta realidad empírica a partir de un trabajo de fuentes cuantitativas y cualitativas y de archivos públicos y privados. La segunda pone en evidencia los mecanismos concretos de la circulación de saberes. El artículo analiza en particular los diferentes congresos mutualistas que se organizan en Buenos Aires durante las dos primeras décadas del siglo XX y el impacto de la visita de Léopold Mabilleau, intelectual francés, experto en mutualidades y «apóstol» del solidarismo.