bluuebunny/crossref_metadata_2025 huggingface dataset:
Macular Choroidal Small-Vessel Layer, Sattler’s Layer and Haller’s Layer Thicknesses: The Beijing Eye Study
Authors: Zhao Jing , Wang Ya Xing , Zhang Qi , Wei Wen Bin , Xu Liang , Jonas Jost B.
Published: March 2018

To study macular choroidal layer thickness, 3187 study participants from the population-based Beijing Eye Study underwent spectral-domain optical coherence tomography with enhanced depth imaging for thickness measurements of the macular small-vessel layer, including the choriocapillaris, medium-sized choroidal vessel layer (Sattler’s layer) and large choroidal vessel layer (Haller’s layer). In multivariate analysis, greater thickness of all three choroidal layers was associated (all P < 0.05) with higher prevalence of age-related macular degeneration (AMD) (except for geographic atrophy), while it was not significantly (all P > 0.05) associated with the prevalence of open-angle glaucoma or diabetic retinopathy. There was a tendency (0.07 > P > 0.02) toward thinner choroidal layers in chronic angle-closure glaucoma. The ratio of small-vessel layer thickness to total choroidal thickness increased (P < 0.001; multivariate analysis) with older age and longer axial length, while the ratios of Sattler’s layer and Haller’s layer thickness to total choroidal thickness decreased. A higher ratio of small-vessel layer thickness to total choroidal thickness was significantly associated with a lower prevalence of AMD (early type, intermediate type, late geographic type). Axial elongation-associated and aging-associated choroidal thinning affected Haller’s and Sattler’s layers more markedly than the small-vessel layer. Non-exudative and exudative AMD, except for geographic atrophy, was associated with slightly increased choroidal thickness.
The role of combining medroxyprogesterone 17-acetate with human menopausal gonadotropin in mouse ovarian follicular development
Authors: Wen Xiaowei , Xie Jun , Zhou Lixia , Fan Yong , Yu Baofeng , Chen Qiuju , Fu Yonglun , Yan Zheng , Guo Haiyan , Lyu Qifeng , Kuang Yanping , Chai Weiran
Published: March 2018

Medroxyprogesterone 17-acetate (MPA) combined with human menopausal gonadotropin (hMG) has been effectively used for ovarian stimulation in clinical practice. However, the molecular mechanism of MPA + hMG treatment in follicular development is poorly described. Here we performed a study to investigate the impact of MPA + hMG on ovarian stimulation utilizing a mouse model in vivo. Forty female BALB/C mice were randomly divided into four groups of 10 each and treated during ciestrus stage and continued for 5 days: control group, MPA group, hMG group, and MPA + hMG group. Morphological and molecular biology methods were used for detecting serum hormones and ovarian function. MPA + hMG group exhibited increasing follicle stimulating hormone (FSH), antral follicle, FSH receptor (FSHR) and phosphorylated mammal target of rapamycin (p-mTOR), and decreasing luteinizing hormone (LH), estradiol (E2), progesterone (P), corpus luteum, phosphoinositide 3-kinase (PI3K), Akt and mTOR compared with control group. In contrast, MPA + hMG group showed reduced FSH, LH, E2, P, corpus luteum, LH receptor (LHR), and activated PI3K,/Akt/mTOR pathway compared with hMG group (P < 0.05). Collectively, these data definitively established that MPA plus hMG may modulate the hormone, hormone receptor and PI3K/Akt/mTOR signaling pathway to influence follicular development in the mouse ovary. Our study provides overwhelming support for MPA + hMG as an effective treatment for infertility in women.
Chemical composition and hepatoprotective effect of free phenolic extract from barley during malting process
Authors: Quan Meiping , Li Qin , Zhao Pei , Tian Chengrui
Published: March 2018

In this study, No.Ganpi4 of barley was steeped and malted to investigate the changes of phenolic compounds during malting process. The free phenolic extract from raw barley (FPEB) was analyzed by HPLC and predominant compounds were (+)-catechin, protocatechuate and quercetin. The FPEB was evaluated for hepatoprotective effect in vivo and in vitro. Intragastric administration of FPEB (100, 200 and 400 mg/kg/bw) to mice significantly weakened the effects of hepatic damage induced by CCl4 toxicity on serum markers, including serum alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, total-bilirubin, total cholesterol and total triglycerides. FPEB administration also increased the hepatic levels of antioxidant enzymes, such as superoxide dismutase, catalase and glutathione peroxidase. Histopathological examinations further confirmed that FPEB could protect the liver from CCl4-induced damage. In vitro, the experimental results demonstrated that FPEB could reduce BRL hepatocyte apoptosis and damage induced by CCl4. These results suggest that FPEB exerts an effective protection for hepatic injury, and barley has the potential as a functional food to prevent hepatic injury.
Dual effect of PEG-PE micelle over the oligomerization and fibrillation of human islet amyloid polypeptide
Authors: Fang Xiaocui , Yousaf Maryam , Huang Qunxing , Yang Yanlian , Wang Chen
Published: March 2018

The oligomerization and fibrillation of human islet amyloid polypeptide (hIAPP) play a central role in the pathogenesis of type 2 diabetes. Strategies for remodelling the formation of hIAPP oligomers and fibrils have promising application potential in type 2 diabetes therapy. Herein, we demonstrated that PEG-PE micelle could inhibit hIAPP oligomerization and fibrillation through blocking the hydrophobic interaction and the conformational change from random coil to β-sheet structures of hIAPP. In addition, we also found that PEG-PE micelle could remodel the preformed hIAPP fibrils allowing the formation of short fibrils and co-aggregates. Taken together, PEG-PE micelle could rescue hIAPP-induced cytotoxicity by decreasing the content of hIAPP oligomers and fibrils that are related to the oxidative stress and cell membrane permeability. This study could be beneficial for the design and development of antiamyloidogenic agents.
Fluorescent polydopamine nanoparticles as a probe for zebrafish sensory hair cells targeted in vivo imaging
Authors: Gu Gyo Eun , Park Chul Soon , Cho Hyun-Ju , Ha Tai Hwan , Bae Joonwon , Kwon Oh Seok , Lee Jeong-Soo , Lee Chang-Soo
Published: March 2018

Fluorescent polydopamine nanoparticles (FPNPs) are prepared via the ethylenediamine (EDA)-induced degradation of as-prepared non-fluorescent polydopamine (PDA) and used for targeted bioimaging. The reductive treatment of PDA in the presence of EDA yields fluorescent precipitates, inspiring us to seek various biological approaches to preparing FPNPs with excellent optical and biocompatible properties. Moreover, we firstly found that FPNPs selectively label neuromast hair cells in the lateral line of zebrafish, their applications as a reliable fluorescent indicator to investigate the neuromast hair cells, to in turn determine the viability of hair cells, was demonstrated. FPNPs also provided a minimal toxicity enable to assay the number of functional hair cells per neuromast in live animals as development proceeds. Upon combined incubation with TO-PRO-3, a well-established hair cell marker, all hair cells that were rapidly labeled with FPNPs were observed to be also completely labeled with the TO-PRO-3, labeling hair cells in neuromasts positioned in the supraorbital, otic and occipital lateral line as well as in posterior lateral line of living zebrafish larvae. Their potential efficacy for biological applications was demonstrated by their excellent optical and biocompatible properties, offering new opportunities in cancer research, real-time monitoring of stem cell transplantation and other cell-based therapies.
A Possible Role of Dust in Resolving the Holocene Temperature Conundrum
Authors: Liu Yonggang , Zhang Ming , Liu Zhengyu , Xia Yan , Huang Yi , Peng Yiran , Zhu Jiang
Published: March 2018

Climate models generally fail to produce a warmer (by as much as 0.5 °C) early to mid-Holocene than the pre-industrial in the global annual temperature, which has been termed the Holocene temperature conundrum. Here we use a fully coupled atmosphere-ocean general circulation model to test whether the conundrum can be partially resolved by considering the fact that atmospheric dust loading was much reduced during the early to mid-Holocene. Our experiments show that the global annual mean surface temperature increases by 0.30 °C and 0.23 °C for the mid-Holocene (6 ka) and early Holocene (9 ka), respectively, if the dust is completely removed. The temperature increase scales almost linearly with the fraction of dust being removed, with the 50% dust reduction experiment for the 6 ka being the only one deviating from the linear trend. The indirect effect of dust, which is highly uncertain and is not included in the model, may further enhance the warming. Therefore, the neglect of dust reduction in the Holocene in climate models could contribute significantly to the model-data discrepancy, especially in the Northern Hemisphere.
Dynamic mapping of spontaneously produced H2S in the entire cell space and in live animals using a rationally designed molecular switch
Authors: Yang Linlin , Zhao Jun , Yu Xinling , Zhang Ruilong , Han Guangmei , Liu Renyong , Liu Zhengjie , Zhao Tingting , Han Ming-Yong , Zhang Zhongping
Published: March 2018

A rationally designed molecular switch created to detect and dynamically map spontaneous production of H2S in whole cells and the organs of live zebrafish.
Fe3O4-decorated graphene assembled porous carbon nanocomposite for ammonia sensing: study using an optical fiber Fabry–Perot interferometer
Authors: Pawar Dnyandeo , Rao B. V. Bhaskara , Kale S. N.
Published: March 2018

Fe3O4 nanoparticles embedded in porous graphene structures, juxtaposed with optical fiber technology to yield explicit, highly-sensitive ammonia sensor.
The evolution of size, shape, and surface morphology of gold nanorods
Authors: Tong Wenming , Katz-Boon Hadas , Walsh Michael J. , Weyland Matthew , Etheridge Joanne , Funston Alison M.
Published: March 2018

The transformation of single crystal gold nanorods over extended growth times shows smoothing of surface morphology and reduction and convergence of aspect ratios across AgNO3 concentrations. The final aspect ratio has little dependence on the AgNO3 concentration.
Electro-nucleation of water nano-droplets in No Man's Land to fault-free ice Ic
Authors: Nandi Prithwish K. , Burnham Christian J. , English Niall J.
Published: March 2018

Externally-applied static electric fields on aggressively-quench-frozen water nanodroplets yields morphological stretching and realises near-perfect cubic ice.
Inertial manipulation of bubbles in rectangular microfluidic channels
Authors: Hadikhani Pooria , Hashemi S. Mohammad H. , Balestra Gioele , Zhu Lailai , Modestino Miguel A. , Gallaire François , Psaltis Demetri
Published: March 2018

The position of bubbles in rectangular microchannels can be controlled by tuning the balance of forces acting on them.
Electrically controlled rapid release of actives encapsulated in double-emulsion droplets
Authors: Jia Yankai , Ren Yukun , Hou Likai , Liu Weiyu , Jiang Tianyi , Deng Xiaokang , Tao Ye , Jiang Hongyuan
Published: March 2018

We utilize electric fields to trigger the on-demand release of different cargos that are encapsulated in water-in-oil-in-water (W/O/W) double-emulsion droplets.
Octadentate flexible ligands as a platform for a variety of homo and heterometallic complexes containing diphenoxido and phenoxido/azido bridging groups: synthesis, structure and magnetic properties
Authors: Pramanik Koushik , Malpaharia Pijush , Colacio Enrique , Das Babulal , Chandra Swapan K.
Published: March 2018

Homometallic (M2 and M4) and heterometallic (Ni4Cu) complexes were assembled from octadentate Schiff-base ligands, transition metal ions and ancillary ligands.
Structures and single crystal to single crystal transformations of cadmium frameworks using a flexible tripodal ligand
Authors: Zhang Zongyao , Xu Lijin , Cao Rui
Published: March 2018

Various cadmium coordination polymers were constructed using a flexible tris-imidazole ligand and they showed single crystal to single crystal transformations during anion exchange.
Coalescence driven self-organization of growing nanodroplets around a microcap
Authors: Dyett Brendan , Hao Hao , Lohse Detlef , Zhang Xuehua
Published: March 2018

The coalescence between growing droplets is important for the surface coverage and spatial arrangements of droplets on surfaces.
An ultrasensitive photoelectrochemical bioanalysis strategy for tumor markers based on the significantly enhanced signal of a bismuth oxyiodine microsphere/graphitic carbon nitride composite
Authors: Wang Shurui , Tu Wenwen , Dai Zhihui
Published: March 2018

An ultrasensitive PEC bioanalysis strategy was designed based on the significantly enhanced signal of BiOI/g-C3N4 and amplified signal variation of CuS NPs.
How Mg2+ ions lower the SN2@P barrier in enzymatic triphosphate hydrolysis
Authors: van Bochove Marc A. , Roos Goedele , Fonseca Guerra Célia , Hamlin Trevor A. , Bickelhaupt F. Matthias
Published: March 2018

Our activation strain analyses highlight the key role of Mg2+ ions during enzymatic triphosphate hydrolysis associated with DNA replication.
Light-triggered self-assembly of a cyanostilbene-conjugated glutamide from nanobelts to nanotoroids and inversion of circularly polarized luminescence
Authors: Jin Xue , Yang Dong , Jiang Yuqian , Duan Pengfei , Liu Minghua
Published: March 2018

UV irradiation regulated transformation of chiral nanostructures and inversion of circularly polarized luminescence.
Theory of diffusioosmosis in a charged nanochannel
Authors: Jing Haoyuan , Das Siddhartha
Published: March 2018

We probe the diffusioosmotic transport in a charged nanofluidic channel in the presence of an applied tangential salt concentration gradient.
NMR spectroscopic identification of Ni(ii) species formed upon activation of (α-diimine)NiBr2 polymerization catalysts with MAO and MMAO
Authors: Soshnikov Igor E. , Semikolenova Nina V. , Bryliakov Konstantin P. , Antonov Artem A. , Zakharov Vladimir A. , Talsi Evgenii P.
Published: March 2018

The ion pair [LNiII(μ-Me)2AlMe2]+[MeMAO]− is formed at the initial stage of LNiBr2 activation with MAO, whereas [LNiII–tBu]+[MeMMAO]− prevails in the LNiBr2/MMAO system.
Correction: Novel valdecoxib derivatives by ruthenium(ii)-promoted 1,3-dipolar cycloaddition of nitrile oxides with alkynes – synthesis and COX-2 inhibition activity
Authors: Roscales Silvia , Bechmann Nicole , Weiss Daniel Holger , Köckerling Martin , Pietzsch Jens , Kniess Torsten
Published: March 2018

Correction for ‘Novel valdecoxib derivatives by ruthenium(ii)-promoted 1,3-dipolar cycloaddition of nitrile oxides with alkynes – synthesis and COX-2 inhibition activity’ by Silvia Roscales et al., Med. Chem. Commun., 2018, DOI: 10.1039/c7md00575j.
Dicarbohydrazide based chemosensors for copper and cyanide ions via a displacement approach
Authors: Yadav Neetu , Singh Ashok Kumar
Published: March 2018

Ligands attached to pyridine dicarbohydrazide were synthesized and characterized using NMR, FT-IR, elemental analysis, UV-visible spectroscopy, mass spectrophotometry, emission spectra and single crystal X-ray diffraction, and were assessed for their ability to sense copper and cyanide ions.
From pirates and killers: does metabolite diversity drive bacterial competition?
Authors: Szamosvári Dávid , Rütschlin Sina , Böttcher Thomas
Published: March 2018

This article discusses interspecies competition by sets of closely related metabolites with significantly different biological activities.
Metal-catalyzed direct heteroarylation of C–H (meso) bonds in porphyrins: facile synthesis and photophysical properties of novel meso-heteroaromatic appended porphyrins
Authors: Khandagale Santosh B. , Pilania Meenakshi , Arun V. , Kumar Dalip
Published: March 2018

A MW-assisted rapid and versatile synthesis of diverse meso-heteroaromatic appended porphyrins 7a-kNi.
Reentrant phase behavior and coexistence in asymmetric block copolymer electrolytes
Authors: Loo Whitney S. , Jiang Xi , Maslyn Jacqueline A. , Oh Hee Jeung , Zhu Chenhui , Downing Kenneth H. , Balsara Nitash P.
Published: March 2018

Reentrant phase transitions and coexisting ordered phases of the same lattice type are observed in block copolymer electrolytes.
Synthesis of ultrathin two-dimensional organic–inorganic hybrid perovskite nanosheets for polymer field-effect transistors
Authors: Zhu Lijie , Zhang Huaye , Lu Qipeng , Wang Yue , Deng Zhenbo , Hu Yufeng , Lou Zhidong , Cui Qiuhong , Hou Yanbing , Teng Feng
Published: March 2018

The (PEA)2PbX4(PEA = C8H9NH3, X = Cl, Br, I) nanosheets: P3HT composite films were prepared as channel layers for high performance field-effect transistors.
Performance modelling of a multirate loss system with batched Poisson arrivals under a probabilistic threshold policy
Authors: Moscholios Ioannis D. , Vassilakis Vassilios G. , Sarigiannidis Panagiotis G.
Published: March 2018

The authors consider a link accommodating batched Poisson arriving calls of different service classes. A batch of generally distributed number of calls arrive to the link at exponentially distributed time‐points. Each call is treated separately from the rest, and its acceptance is decided, according to the available link bandwidth (partial batch blocking discipline). For congestion control, if the number of in‐service calls of a service class exceeds a threshold (dedicated to the service class), a new call of the same service class is accepted with a probability, dependent on the system state (probabilistic threshold policy). The link is analysed as a multirate loss system, via a reversible Markov chain. The latter leads to a product form solution (PFS) for the steady‐state distribution. Based on the PFS, the authors propose models for the accurate determination of time and call congestion probabilities and link utilisation. Comparison against other existing models under the complete sharing or the bandwidth reservation policy reveals the necessity and consistency of the proposed models.
Research on three‐phase four‐leg matrix converter based more electric aircraft wing ice protection system
Authors: Huang Songtao , Xu Lie , Guo Yougui , Li Yongdong , Deng Wenlang
Published: March 2018

In this study, a new three‐phase four‐leg matrix converter (TFMC) topology is proposed, and the three‐dimensional space vector modulation (3DSVM) strategy is used to realise the output with the three‐phase unbalanced load. Aiming at the situation that the icing area of the more electric aircraft on the wing is larger than the icing area in the belly, wing ice protection system is constructed by using the TFMC. Through the real‐time detection of the heating element temperature and icing condition by the sensor installed in the wing and belly position, working temperature and three‐phase output power of TFMC can be set reasonably. In order to save fuel consumption and reduce operating costs, the key point is to reduce the power transmission in belly position. Finally, simulation and experiment verify the correctness of the proposed 3DSVM strategy and realise the TFMC output with unbalanced three‐phase load.
Cumulative risks of stent migration and gastrointestinal bleeding in patients with lumen-apposing metal stents
Authors: Garcia-Alonso Francisco , Sanchez-Ocana Ramón , Peñas-Herrero Irene , Law Ryan , Sevilla-Ribota Sergio , Torres-Yuste Raúl , Gil-Simón Paula , de la Serna Higuera Carlos , Perez-Miranda Manuel
Published: March 2018

Background: Delayed gastrointestinal (GI) bleeding and stent migration are known adverse events which may occur following placement of lumen-apposing metal stents (LAMSs).

Methods: All consecutive patients who underwent LAMS placement between May 2011 and June 2017 at a single tertiary medical center were included. Demographics and procedural details were prospectively collected. Post-procedure follow-up and outcome measures were retrospectively collected. The cumulative risks of migration and LAMS-related GI bleeding were estimated using the life-table method. Risk predictors were assessed using Cox proportional hazards models.

Results: We analyzed 250 patients (64.8 % men; median age 71.6 [interquartile range (IQR) 57.9 – 83.6]). Median follow-up was 78.5 days (IQR 31 – 246.5 days). Thirty-four stent migrations (13.6 %) occurred (5 symptomatic). On multivariable analysis, associations with migration included nasocystic drains (hazard ratio [HR] 6.5, 95 % confidence interval [CI] 2.2 – 19.3), pancreatic fluid collections (PFCs; HR 4.2, 95 %CI 1.8 – 10.1), and double-pigtail stents (HR 2.4, 95 %CI 1.2 – 4.9). Migration risk at 12 months was 25.5 % (95 %CI 17.9 % – 35.7 %) and was higher for PFCs 48.9 % (33.4 % – 66.9 %) than other indications 8.4 % (4.9 % – 17.5 %; P < 0.001). LAMSs placed for longer durations (i. e. enteral anastomoses, biliary and gallbladder drainage) presented an 8.4 % cumulative risk at 2 years. There were 13 LAMS-related GI hemorrhages (5.2 %), two of them fatal, presenting a median of 3 days (IQR 1 – 9 days) after deployment. The cumulative risk of bleeding at 12 months was 6.9 % (3.6 % – 12.7 %).

Conclusions: LAMS migration occurs in 1 out of 7 cases and is most common when treating PFCs. Bleeding related to LAMS placement occurs much less commonly but can be life-threatening.
Electrophilic Aromatic Formylation with Difluoro(phenylsulfanyl) methane
Authors: Betterley Nolan , Kongsriprapan Sopanat , Chaturonrutsamee Suppisak , Deelertpaiboon Pramchai , Surawatanawong Panida , Pohmakotr Manat , Soorukram Darunee , Reutrakul Vichai , Kuhakarn Chutima
Published: March 2018

Difluoro(phenylsulfanyl)methane (PhSCF2H) was found to undergo a reaction with aromatic compounds mediated by SnCl4, through a thionium intermediate characterized by NMR and TD-DFT analyses, leading to the formation of a mixture of S,S′-diphenyl dithioacetal and aromatic aldehyde which, after oxidative hydrolysis, provides the aromatic aldehyde in good to excellent yields. The salient feature of the present work is the reaction of activated aromatic compounds containing a deactivating ester functional group, leading to the formylated products in good yields.
A Convenient Synthesis for HBED-CC-tris(tert-butyl ester)
Authors: Makarem Ata , Konrad Moritz , Liolios Christos , Kopka Klaus
Published: March 2018

HBED-CC is a bifunctional complexing agent that, at ambient temperature, tightly chelates the trivalent radiometal 68Ga (T1/2 = 68 min). This complexing agent has attracted a lot of interest in tumor imaging applications. Depending on the chemical structure, different HBED-CC variants may be employed as radiolabeling precursor for the synthesis of desired radiopharmaceuticals. In this context, HBED-CC-tris(tert-butyl ester) is the only known monovalent variant of HBED-CC which is used for the synthesis of non-symmetric HBED-CC-based radiopharmaceuticals. Commercial HBED-CC-tris(tert-butyl ester) is very ­expensive, with limited availability. Nevertheless, no synthetic procedure for this useful product has been reported to date. This work introduces a convenient and comparatively cost-efficient method for the preparation of HBED-CC-tris(tert-butyl ester).
Synthesis of 1,2-Fused Bicyclic Imidazolidin-4-ones by Redox-Neutral Cyclization Reaction of Cyclic Amines and α-Ketoamides
Authors: Wu Jiashou , Liu Yi , Jin Zhengneng , Jiang Huajiang
Published: March 2018

A redox annulation reaction of cyclic amines and α-ketoamides was developed. A variety of 1,2-fused bicyclic imidazolidin-4-ones were synthesized in moderate to good yields from cyclic amines by ­redox-neutral α-C–H functionalization.
A Synthesis of Spirocyclic Oxazinoisoquinolines and Oxazinoquinolines Bearing Thiazolopyrimidine Moieties
Authors: Yavari Issa , Hojati Mahniya , Azad Leila , Halvagar Mohammad
Published: March 2018

The reaction of isoquinoline or quinoline with dialkyl acetylenedicarboxylates in the presence of alkyl 2-{3,5-dioxo-5H-thiazolo[3,2-a]pyrimidin-2(3H)-ylidene}acetates (generated in situ from acetylenedicarboxylates and 2-thiouracils) led to dialkyl 2-(2-alkoxy-2-oxoethylidene)-5-oxo-2H,5H,11b′H-spiro{thiazolo[3,2-a]pyrimidine-3,2′-[1,3]oxazino[2,3-a]isoquinoline}-3′,4′-dicarboxylates or dialkyl 2-(2-alkoxy-2-oxoethylidene)-5-oxo-2H,4a′H,5H-spiro{thiazolo[3,2-a]pyrimidine-3,2′-[1,3]oxazino[3,2-a]quinoline}-1′,2′-dicarboxylates in good yields. The structure of the target compounds was confirmed by X-ray diffraction study.
Is Rotational Thromboelastometry the Answer for Rapid Prediction of Coagulopathy on Extracorporeal Membrane Oxygenation?
Authors: Karanjkar Ameya , Bhardwaj Vandana , Kapoor Poonam Malhotra
Published: March 2018

Extracorporeal membrane oxygenation (ECMO) induces a variety of changes in hemostatic system due to various reasons such as exposure to the extracorporeal circuit, activation of the coagulation and complement pathways, consumption of platelets, activation of various mediators of inflammation, and imbalance between clot formation and resorption. Giving cryoprecipitate and platelet concentrates is more important than adding whole blood in these patients. EXTEM CT and FIBTEM A5 give results within a few minutes and shortened turnaround time brings imported results.
Extracorporeal Membrane Oxygenation in Critical Care: Past, Present, and Future
Authors: Conrad Steven A. , Rycus Peter T.
Published: March 2018

Extracorporeal membrane oxygenation (ECMO) provides support for cardiac and pulmonary failure, and it was introduced into clinical practice over 40 years ago. The translation of surgical extracorporeal circulation into long-term support was enabled by the development of efficient, biocompatible artificial lungs and blood pumps. Early clinical trials in adult patients did not support clinical benefit in acute respiratory failure, but they were plagued by lack of center experience, older approaches to management, and lack of understanding of ventilator-induced lung injury. Recent clinical trials and retrospective studies, however, suggest a benefit in selected patients. Three neonatal trials for respiratory failure led to ECMO as a standard of care in this population, as well as in the pediatric population despite lack of controlled trials. Cardiac support with ECMO took a foothold in the management of pediatric congenital heart disease in the perioperative period, and subsequently expanded to adult cardiac failure for both perioperative and nonsurgical indications. Presently, ECMO is used to support a variety of etiologies of cardiac and pulmonary failure in all age groups. Expanding indications include support of septic shock, cardiopulmonary arrest, and donation after cardiac death, as well as bridging patients with chronic disease to transplant or long-term support devices. The future is focused on developing integrated support systems, overcoming the requirement for anticoagulation, and perfecting long-term implantable or paracorporeal pulmonary support systems.
Extracorporeal Circulatory/Life Support: An Update
Authors: Swanevelder Justiaan L. C. , Firmin Richard K.
Published: March 2018

The evolution of extracorporeal life support technology has added a new advanced dimension to intensive care management of acute cardiac and/or respiratory failure in neonatal, pediatric, and adult patients who fail conventional treatment. ECMO has been a controversial subject within the intensive care community for many years. Perceptions have, however, changed positively over the past decade due to a need for improved management of these groups of patients, technological advances, and evolving evidence. As is common with many emerging therapies, its optimal use is currently not fully backed by quality evidence.
Thromboelastography in Venovenous Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome
Authors: Singh Sarvesh Pal , Solanki Yogesh , Kapoor Poonam Malhotra
Published: March 2018

The authors hereby report the case of a 16-year-old girl who was put on venovenous extracorporeal membrane oxygenation (ECMO) for refractory acute respiratory distress syndrome. Use of thromboelastography as a supplement to conventional hemostatic investigations is highlighted to achieve an optimal anticoagulation state during the ECMO.
Extracorporeal Membrane Oxygenation for Cardiotoxic Drug Overdose—A Lifesaving Intervention
Authors: Subash Sundar Singh , Nandakumar Madhusoodhanan Nandanam , Placid Siroraj Alphonse , Cherian Vijay Thomas , Palangadan Shaji , Kumar Suresh
Published: March 2018

Extracorporeal membrane oxygenation (ECMO) use in cardiotoxic drug overdose is increasing. Calcium channel blockers along with β-blockers constitute more than 65% of deaths from cardiovascular medications. The authors report here a case of ECMO use for amlodipine and telmisartan tablet overdose, where ECMO was used to salvage the patient’s life as a life-saving intervention.
One-Stage Arthroscopic Reduction Combined with Multiligament Reconstruction or Repair for Irreducible Posterolateral Knee Dislocation: A Retrospective Case Series with Minimum 2-Year Follow-Up
Authors: Hongwu Zhuo , Li Jian
Published: March 2018

The purpose of this study was to evaluate the clinical outcomes after arthroscopic management of irreducible posterolateral knee dislocation. Twenty-one patients with irreducible posterolateral knee dislocation were treated in our institution from January 2009 to May 2014. Inclusion criteria were as follows: (1) patients who underwent one-stage arthroscopic reduction combined with multiligament reconstruction or repair and (2) patients with a minimum 2-year follow-up. Knee stability was assessed using physical examination and side-to-side differences (SSD) determined with a KT-1000 arthrometer and Telos stress device. Other assessments included the International Knee Documentation Committee (IKDC) subjective score, Lysholm score, Tegner score, and patient satisfaction rate. Thirteen of the 21 patients (8 males and 5 females) met our inclusion criteria and were included in this analysis. The mean age was 37.8 years (range, 27–56 years). The mean time from injury to surgery was 1.84 days (range, 1–3 days). The mean follow-up period was 32.6 months (range, 24–46 months). At the final follow-up, with the exception of one patient who had an abnormal valgus stress test, all patients achieved normal or nearly normal Lachman test, pivot shift test, posterior drawer test, and varus and valgus stress tests. The mean SSD of total anterior–posterior translation and isolated anterior translation determined with a KT-1000 arthrometer were 2.15 ± 1.57 mm (range, 0–6 mm) and 1.61 ± 0.86 mm (range, 1–4 mm), respectively. The mean SSD of anterior translation, posterior translation, and medial and lateral joint gapping determined with a Telos stress device were 2.23 ± 0.92 mm (range, 1–4 mm), 3.23 ± 1.16 mm (range, 2–5 mm), 1.77 ± 1.87 mm (range, 0–7 mm), and 0.46 ± 0.52 mm (range, 0–2 mm), respectively. The IKDC subjective score, Lysholm score, and Tegner score improved significantly postoperatively (p = 0.001) with a satisfaction rate of 84.6%. One-stage arthroscopic reduction combined with multiligament reconstruction or repair was an effective, reliable treatment for irreducible posterolateral knee dislocation. This is a case series with level of evidence as IV.
A Retrospective Database Analysis of Neonatal Morbidities to Evaluate a Composite Endpoint for Use in Preterm Labor Clinical Trials
Authors: Pimenta Jeanne , Ebeling Myla , Montague Timothy , Beach Kathleen , Abell Jill , O'Shea Michael , Powell Marcy , Hulsey Thomas
Published: March 2018

Objective To propose and assess a composite endpoint (CE) of neonatal benefit based on neonatal mortality and morbidities by gestational age (GA) for use in preterm labor clinical trials.

Study Design A descriptive, retrospective analysis of the Medical University of South Carolina Perinatal Information System database was conducted. Neonatal morbidities were assessed for inclusion in the CE based on clinical significance/risk of childhood neurodevelopmental impairment, frequency, and association with GA in a mother–neonate linked cohort, comprising women with uncomplicated singleton pregnancies delivered at ≥24 weeks' GA.

Results Among 17,912 mother–neonate pairs, neonates were at a risk of numerous severe but infrequent morbidities. Clinically important, predominantly rare events were combined into a CE comprising neonatal mortality and morbidities, which decreased in frequency with increasing GA. The highest CE frequency occurred at <31 weeks. High frequency of respiratory distress syndrome, bronchopulmonary dysplasia, and sepsis drove the CE. Median length of hospital stay was longer at all GAs in those with the CE compared with those without.

Conclusions Descriptive epidemiological assessment and clinical input were used to develop a CE to measure neonatal benefit, comprising clinically meaningful outcomes. These empirical data and CE allowed trials investigating tocolytics to be sized appropriately.
Patellofemoral Imbalance in a Balanced Total Knee Arthroplasty: How Does it Occur?
Authors: Lenz Nathan , Laster Scott , Sheth Neil , Schwarzkopf Ran , Evangelista Perry
Published: March 2018

Despite the overall successful outcomes following primary total knee arthroplasty (TKA) and the concept that a well-balanced TKA yields a more successful result, concerns still remain in the reported literature regarding the patellofemoral joint. Diminished outcomes have been associated with poorly balanced or placed patella implants. The effect of different techniques to achieve flexion–extension balance and the use of posterior stabilized (PS) versus cruciate retaining (CR) implant designs on patellofemoral balancing has not been previously studied. The purpose of this study is to utilize a validated computational analysis software to simulate the effects of varying implant positions and sizes of femoral components. The patellofemoral retinaculum (PFR) load was significantly affected by some conditions, while others did not reach significance. The proximal-distal implant position with knee flexion angle (p < 0.001), the implant size (p < 0.001), and the implant bearing type (CR/PS) (p < 0.05) were significant. For the proximal-distal implant position and knee flexion angle, a more proximal implant position (elevating the joint line) increased the PFR load from 15 to 30°, and a more proximal implant position reduced retinaculum load from 60 to 135°. However, at 45°, implant position does not affect retinaculum load. Achieving the appropriate balance between the dynamic nature of both the tibiofemoral and the patellofemoral interaction in TKA has proven to be complex and challenging to manage. Balancing of a TKA is essential to the proper functioning and overall longevity of the implant. These results demonstrate that patellofemoral balance is affected by implant size and position during flexion–extension gap balancing.
Transient Neonatal Diabetes Mellitus in a Very Preterm Infant due to ABCC8 Mutation
Authors: Piccini Barbara , Coviello Caterina , Drovandi Livia , Rosangela Artuso , Monzali Francesca , Casalini Emilio , Giglio Sabrina , Toni Sonia , Dani Carlo
Published: March 2018

Neonatal diabetes mellitus (NDM) is a monogenic form of diabetes occurring within 6 months from birth. NDM can be permanent or transient (TNDM). We report the case of a preterm infant with TNDM due to an ABCC8 mutation identified by next-generation sequencing. The pancreatic adenosine triphosphate (ATP)-sensitive K+ (K-ATP) channel is a key regulator of insulin secretion. Gain-of-function mutations in the genes encoding the Kir6.2 (KCNJ11) and SUR1 (ABCC8) subunits of the channel cause neonatal diabetes. The patient was successfully managed with insulin lispro at a 1:100 dilution, drawn up in an insulin pen injector with a 4-mm needle. The insulin lispro dilution allowed administration of the exact insulin doses, obtaining a good glycemic control and minimizing the burden of injections. At 2 months, corrected age insulin doses were progressively decreased until discontinuation.
The Relationship between Soft-Tissue Balance and Intraoperative Kinematics of Guided Motion Total Knee Arthroplasty
Authors: Taketomi Shuji , Yamagami Ryota , Shirakawa Nobuyuki , Kawaguchi Kouhei , Tanaka Sakae , Inui Hiroshi
Published: March 2018

A new design of the so-called “guided-motion” total knee arthroplasty (TKA) is expected to produce normal-like kinematics. The implant behaves strictly as a mechanically constraint-guided motion system. However, no previous reports have demonstrated the most appropriate surgical technique or soft-tissue balance that would reproduce ideal kinematics. The purpose of this study was to clarify the relationship between soft-tissue balance and the intraoperative kinematics of guided-motion TKA. In this study, intraoperative kinematics of 95 patients whose TKA was performed with a guided-motion prosthesis (Journey II BCS Smith and Nephew) were measured using the computed tomography (CT)-free navigation system. All procedures were performed via the same soft-tissue balancing technique, which focused on the medial compartment because guided-motion TKA must acquire medial stability to induce medial pivot motion. We measured the extension and flexion osteotomy gaps using a force-controlled compartment-specific ligament tensioner with a distraction force of 80 N for each compartment and divided patients into three groups based on the relationship between extension and flexion joint osteotomy gaps of the medial compartment: group1– loose flexion gap, group 2–equal joint gap, and group 3–tight flexion gap. We compared the preoperative demographic characteristics, implant alignment, and intraoperative kinematics among the three groups. There was no difference between the preoperative demographic characteristics and postoperative implant alignment in the three groups. The relative tibial internal rotational angles in groups 1 and 2 were significantly larger than that in group 3 at 60°, 90°, and maximum flexion (p < 0.05). The appropriate soft-tissue balance of the medial compartment for guided-motion TKA was an equal joint osteotomy gap or a larger flexion than extension gap. A tight flexion gap should be avoided.
Comparison of Techniques for Preimplantation Treatment of Osteochondral Allograft Bone
Authors: Baumann Charles , Baumann John , Bozynski Chantelle , Stoker Aaron , Stannard James , Cook James
Published: March 2018

Articular defects are a major problem with few effective treatment options. Osteochondral allograft (OCA) transplantation can be an effective treatment; however, lack of OCA bone integration can cause failure. This controlled laboratory study was designed to compare clinically applicable methods for marrow element removal and enhanced delivery of bone marrow aspirate concentrate (BMC) to OCA bone. We hypothesized that compressed carbon dioxide (CO2) treatment of OCA bone would result in significantly better marrow element removal, significantly more retention and distribution of viable osteoprogenitor cells, and significantly higher osteoinductive protein elution from OCAs compared with other preimplantation treatments. Fresh humeral heads (n = 24) were harvested and stored for 14 days, then randomly assigned to treatment based on marrow element removal and bone treatment: (standard of care [SOC]) (n = 4) – SOC high-pulse saline lavage, no BMC; (BMC) (n = 5) – saline lavage then canine BMC; (Drill + BMC) (n = 5) – 1.1 mm drill-hole immediately subchondral then saline lavage then BMC injection through drill hole; (Carb + BMC) (n = 5) – saline lavage then CO2 then BMC; or (Saline-Carb + BMC) (n = 5) – saline lavage and CO2 together then BMC. Treated OCAs were cultured for 14 days. On day 3, media were collected, centrifuged to isolate cells, and replaced. Cells were cultured for 11 days for colony forming unit (CFU) determination. OCA media were collected on days 7 and 14 of culture for analysis. On day 14, each graft was assessed for viable cell retention and distribution, and bone marrow element removal. BMC had significantly higher (p = 0.001) viable cell distribution compared with the SOC, Drill + BMC, Carb + BMC, and Saline-Carb + BMC groups. BMC and Drill + BMC had significantly higher (p < 0.05) CFUs than SOC, Carb + BMC, and Saline-Carb + BMC. Drill + BMC and Carb + BMC had the highest media concentrations of the osteoinductive biomarkers. The Carb + BMC and Saline-Carb + BMC groups were associated with significantly superior marrow element removal (p < 0.02) compared with the SOC, Drill + BMC, and BMC groups. Saline irrigation plus saturation with autogenous BMC appears to be the most advantageous preimplantation treatment for OCA transplantation.
Contemporary Surgical Trends in the Management of Symptomatic Meniscal Tears among United States Military Servicemembers from 2010 to 2015
Authors: Pekari Timothy , Wang Kevin , Cotter Eric , Kusnezov Nicholas , Waterman Brian
Published: March 2018

The purpose of this investigation is to report on trends over time in the treatment of meniscal pathology among military orthopaedic surgeons, as well as to evaluate the impact of patient demographics and concomitant procedure on the type of meniscal procedure performed. We performed a retrospective analysis of all active-duty United States military servicemembers who underwent a meniscal procedure from 2010 to 2015 within the Military Health System. Patient demographics and surgical variables were extracted from the electronic medical record. Treatments were categorized by location and by type of intervention (i.e., repair or debridement). Chi-square and linear regression analyses were performed to identify temporal trends in meniscal procedures and factors that were correlated with the type of meniscal procedure performed. Out of 29,571 meniscal procedures analyzed, partial meniscectomy was performed in 81.3% (n = 24,343) of cases, meniscal repair in 20.3% (n = 6,073), and meniscus allograft transplantation (MAT) in 0.7% (n = 206). The rates of debridement, repair, and concomitant surgeries did not demonstrate any significant temporal trends, whereas MAT demonstrated a significant decrease in overall utilization. Nearly two-thirds of all meniscal procedures were performed in the medial compartment. MAT occurred equally between the medial and lateral compartments. Lateral meniscal lesions demonstrated significantly higher rates of debridement. With each year of advancing age, there was a 3.7% increasing likelihood of meniscectomy and 6.5% decreasing likelihood of repair. Females were more likely to undergo meniscal repair than males. Patients in the military population were more likely to undergo meniscal repair compared with previously reported rates in the civilian population. In this physically active cohort of nearly 30,000 military patients, 1 in 5 meniscal tears were treated with meniscal repair. Meniscal repairs were performed at a higher rate for all age groups compared with previously reported rates in the civilian population. Further research is required to elucidate the causative factors behind these differences and the effect on postoperative outcomes.

Level of Evidence: IV, cross-sectional study.
Venous Thromboembolism Prophylaxis after Total Knee Arthroplasty
Authors: Box Hayden , Shahrestani Sean , Huo Michael
Published: March 2018

Venous thromboembolic disease (VTED) is a major cause of morbidity and mortality after total knee arthroplasty (TKA). Current VTED prophylaxis protocols consist of early mobilization, mechanical compression devices, and pharmacologic agents. Venous phasic flow-regulated below-knee devices are generally favored, but the optimal duration and method of mechanical prophylaxis is unknown. Risk stratification models have been developed to guide pharmacologic prophylaxis. For patients with standard VTED risk profile, aspirin has become increasingly popular. Recent studies have validated the efficacy, relatively low bleeding risks, and cost-effectiveness of aspirin in the patients with standard risk profile. Current evidence suggests that the newer oral anticoagulants, including the factor Xa and the direct thrombin inhibitors, are effective for the reduction of postoperative VTED but may be associated with increased bleeding and wound complication rates.
Impact of Intravenous Acetaminophen on Lengths of Stay and Discharge Status after Total Knee Arthroplasty
Authors: Barrington John , Hansen Ryan , Lovelace Belinda , Böing Elaine , Chughtai Morad , Newman Jared , Pham An , Khlopas Anton , Sodhi Nipun , Sultan Assem , Mont Michael
Published: March 2018

Postoperative pain remains difficult to control after total knee arthroplasty (TKA). While various modalities have been used, they have been associated with several side effects. For example, opioids have many side effects including: sedation, dizziness, nausea, vomiting, constipation, respiratory depression, and can lead to dependency. Recently, intravenous (IV) acetaminophen has been introduced as a method to manage postoperative pain. Therefore, the purpose of this study was to compare the postoperative outcomes of TKA patients who received oral acetaminophen versus IV acetaminophen. Specifically, this study evaluated: (1) the hospital lengths of stay (LOS) and (2) discharge dispositions. The Premier Database was used to review patients who underwent TKA from 2012 to 2015. A total of 134,216 TKA patients received oral acetaminophen, whereas 56,475 TKA patients received IV acetaminophen postoperatively. LOS were calculated as the number of days from the date of hospital admission to the date of discharge, and the discharge disposition was categorized as to home or to a skilled nursing facility (SNF). Compared with the oral group, the IV acetaminophen group had a 0.14 days shorter LOS (95% confidence interval [CI], –0.15 to –0.13; p < 0.001) and 22% higher chance of being discharged home (odds ratio [OR] = 1.22; 95% CI, 1.19–1.25; p < 0.001). Also, compared with the oral group, the IV group had a 13% lower chance of being discharged to a SNF (OR = 0.87; 95% CI, 0.85–0.90; p < 0.001). This study demonstrated that TKA patients who received IV acetaminophen were associated with a significantly shorter hospital LOS as well as being discharged home and fewer patients had to go to SNF. This may lead to a reduction in the total cost of health care, while, at the same time, decreasing the resource use in patients who undergo TKA.
Proximal Tibial Fractures in the Pediatric Population
Authors: Tileston Kali , Frick Steven
Published: March 2018

Injuries about the proximal tibia are quite common in children. Understanding the mechanisms of injury and treatment strategies is imperative for practitioners caring for these patients. Similarly, appreciating the anatomy of the proximal tibia and the adjacent neurovascular structures can assist a practitioner in recognizing the potential associated risks following fracture. Patients with injuries about the proximal tibia require long-term follow-up, and knowledge of the natural history of these fractures is imperative.