bluuebunny/crossref_metadata_2025 huggingface dataset:
The Changing Narrative of Security Discourse: From State Security to Human Security in South Asia?
Authors: Lahiry Sujit
Published: May 2020

Security discourse has radically changed over the years, especially since the Post–Cold War period. The traditional concept focuses on state security and national security, and is essentially based on realist and neo‐realist paradigms. However, in 1994, the United Nations Human Development Report for the first time elaborated the notion of human security and the associated Human Development Index (HDI). Human security advocates a people‐centric approach to security. The two foundational principles on which human security is based are “freedom from fear” and “freedom from want.” I evaluate the notions of state security versus human security and examine how South Asian countries have fared regarding the human security indices. I conclude that, despite advances in some areas, various HDI parameters show that the human security record is still rather dismal in South Asia. There remains a critical need to improve it.
Sign effects in spoken word learning by oral deaf and hard-of-hearing children, and by hearing children
Authors: van Berkel-van Hoof Lian , Hermans Daan , Knoors Harry , Verhoeven Ludo
Published: May 2020

Previous research found a beneficial effect of augmentative signs (signs from a sign language used alongside speech) on spoken word learning by signing deaf and hard-of-hearing (DHH) children. The present study compared oral DHH children, and hearing children in a condition with babble noise in order to investigate whether prolonged experience with limited auditory access is required for a sign effect to occur. Nine- to 11-year-old children participated in a word learning task in which half of the words were presented with an augmentative sign. Non-signing DHH children ( N = 19) were trained in normal sound, whereas a control group of hearing peers ( N = 38) were trained in multi-speaker babble noise. The researchers also measured verbal short-term memory (STM). For the DHH children, there was a sign effect on speed of spoken word recognition, but not accuracy, and no interaction between the sign effect in reaction times and verbal STM. The hearing children showed no sign effect for either speed or accuracy. These results suggest that not necessarily sign language knowledge, but rather prolonged experience with limited auditory access is required for children to benefit from signs for spoken word learning regardless of children’s verbal STM.
Comparison of three autotransfusion devices for utilization in the pediatric population
Authors: Melchior Richard W , Dreher Molly , Shade Brandon , Chappell Alexander , Fisher Douglas , Rosenthal Tami
Published: May 2020

Introduction:

A device that may help attenuate the amount of homologous blood product given to pediatric cardiac surgical patients is the autotransfusion device. Three separate autotransfusion devices were selected for evaluation. The Sorin Xtra, Fresenius Continuous Autotransfusion System Plus (CATS*plus), and the Fresenius Continuous Autotransfusion System Smart (CATSmart) were evaluated based on the mechanical processes of each device, hematocrit value of the salvaged packed red cell product, time of processing, and the advantageous accessories with each device.

Methods:

Each of the autotransfusion devices were used to collect salvageable blood from the surgical field as well as to process residual blood from the cardiopulmonary bypass circuit after decannulation. The cell salvage process was performed in accordance with the manufacturer’s instructions for use and the recommended settings for processing and washing. The Sorin Xtra device had the 55 mL bowl set up for all cases, while the Fresenius continuous autotransfusion systems utilized the standard disposable for each device.

Results:

Each cell salvage device was employed during 30 pediatric cardiac surgery procedures, and data for each device, was broken down into four groups based on patient weight (0-10, 10-20, 20-40, and >40 kg). For all patient sizes, the Sorin Xtra tended to produce the greatest volume of cell saver product (55-825 mL) as compared to the CATS*plus and CATSmart devices (7-550 mL and 0-860 mL, respectively). The Continuous Autotransfusion System Smart tended to produce the highest hematocrit product, ranging from 44 to 81%.

Discussion:

Through this evaluation, it was determined the continuous autotransfusion systems provided the highest hematocrit with the lowest recovered packed red cell volume, while the Sorin Xtra packed red cell product showed to have a lower hematocrit with a larger packed red cell volume. Each device proved effective within our pediatric population.
Human resourcefulness in a time of diminishing resources
Authors: Seabrook Jeremy
Published: May 2020

In a powerful polemic, the author explains how the ‘moral’ dimension of progress is no longer defensible. In fact, material improvement, he argues, is a substitute for moral progress as rich societies devour the planet and teach the world that consumption = civilisation. The present crisis is not merely of our climate but also of our social, moral and spiritual futures. There is, he contends, no damage to the earth which does not have its counterpart in the inner landscapes of humanity. Affluence, consumption and the market ensure that social goods are sequestered from social evils – so that they appear to have different origins. He calls for a regeneration of human resourcefulness where we relearn to meet what are real needs.
Ruptured cerebral mycotic aneurysm in a left ventricular assist device patient with bacteremia
Authors: Fisher Bryant , Seese Laura , Mathier Michael A , Sultan Ibrahim , Kilic Arman
Published: May 2020

A 50-year-old male with a history of nonischemic dilated cardiomyopathy presented in cardiogenic shock and ultimately underwent durable left ventricular assist device implantation. He recovered well initially but developed persistent bacteremia. His indwelling pacemaker leads were extracted due to evidence of vegetation. Shortly thereafter, around 3 months post–left ventricular assist device, he succumbed to a massive intracranial hemorrhage due to ruptured cerebral mycotic aneurysm. This case highlights the potential importance of brain imaging in left ventricular assist device patients with persistent bacteremia to avoid this likely catastrophic complication.
Characterisation and material flow analysis of end-of-life portable batteries and lithium-based batteries in different waste streams in Austria
Authors: Nigl Thomas , Schwarz Therese Elisabeth , Walch Cornelia , Baldauf Mirjam , Rutrecht Bettina , Pomberger Roland
Published: May 2020

Although separate collection systems for portable batteries (PBs) have been installed years ago, high amounts of batteries still do not enter the collection systems of the member states of the European Union (EU). In Austria, the collection rate has recently dropped to the EU target value of 45%. For the purposes of this study, a comprehensive survey was conducted to identify the destinations of the other end-of-life batteries. A literature survey and an assessment of different waste streams (WSs) were followed by sampling and sorting campaigns for highly relevant WSs (residual waste, lightweight packaging waste, metal packaging waste, and small waste electrical and electronic equipment). The results underwent material flow analysis, showing that more than 800 metric tonnes of portable batteries are misplaced into non-battery-specific collection systems, 718 metric tonnes of them entering residual waste collection. Considerable amounts of batteries are stockpiled, stored or hoarded in Austrian households. Lithium-based batteries, representing a serious risk of fire to the waste industry and making up for 30% of the marketed amount, are still scarcely arriving in waste management systems.
“Protect someone, become yourself”: How the Japanese military reinvents childhood for the 21st century
Authors: Frühstück Sabine
Published: May 2020

Military establishments the world over invest in multi-faceted and paradoxical relationships to children and childhood. This article aims to examine how the Japanese military today engages children and childhood in order to mold their public image, legitimize their missions, appease parents, and recruit the young.
Angiotensin-converting enzyme insertion/deletion polymorphism and susceptibility to pediatric asthma: A meta-analysis
Authors: Shao Zhengyang , Jin Haili , Sun Hong , Dong Chenxia , Xu Binbin , Zhan Lu
Published: May 2020

Objective:

The correlation of the angiotensin-converting enzyme ( ACE) insertion/deletion (I/D) polymorphism with pediatric asthma risk was assessed in this meta-analysis.

Methods:

PubMed, Web of Science, Embase and CNKI databases were systematically searched for relevant literature, followed by application of odds ratios (OR) along with 95% confidence interval (CI) for determining the strength of relationship.

Results:

Seven articles with 802 cases and 632 controls fulfilled the inclusion criteria. As a result, the ACE I/D polymorphism was related to elevated pediatric asthma risk (D vs I: OR = 1.87, 95% CI = 1.59–2.20; dominant model: OR =1.53, 95% CI = 1.28–1.81; recessive model: OR =1.54, 95% CI = 1.28–1.85; DD vs II: OR =2.95, 95% CI = 2.19–3.98; DI vs II: OR = 0.96, 95% CI = 0.78–1.19). Subgroup analysis stratified by race revealed significant interrelation in Asians.

Conclusion:

This meta-analysis demonstrated that the ACE I/D polymorphism might be related to the risk of pediatric asthma.
Adaptive trajectory tracking control strategy of intelligent vehicle
Authors: Zhang Shuo , Zhao Xuan , Zhu Guohua , Shi Peilong , Hao Yue , Kong Lingchen
Published: May 2020

The trajectory tracking control strategy for intelligent vehicle is proposed in this article. Considering the parameters perturbations and external disturbances of the vehicle system, based on the vehicle dynamics and the preview follower theory, the lateral preview deviation dynamics model of the vehicle system is established which uses lateral preview position deviation, lateral preview velocity deviation, lateral preview attitude angle deviation, and lateral preview attitude angle velocity deviation as the tracking state variables. For this uncertain system, the adaptive sliding mode control algorithm is adopted to design the preview controller to eliminate the effects of uncertainties and realize high accuracy of the target trajectory tracking. According to the real-time deviations of lateral position and lateral attitude angle, the feedback controller is designed based on the fuzzy control algorithm. For improving the adaptability to the multiple dynamic states, the extension theory is introduced to design the coordination controller to adjusting the control proportions of the preview controller and the feedback controller to the front wheel steering angle. Simulation results verify the adaptability, robustness, accuracy of the control strategy under which the intelligent vehicle has good handling stability.
Optimal policy for composite sensing with crowdsourcing
Authors: Zhao Bei , Zheng Siwen , Zhang Jianhui
Published: May 2020

The mobile crowdsourcing technology has been widely researched and applied with the wide popularity of smartphones in recent years. In the applications, the smartphone and its user act as a whole, which called as the composite node in this article. Since smartphone is usually under the operation of its user, the user’s participation cannot be excluded out the applications. But there are a few works noticed that humans and their smartphones depend on each other. In this article, we first present the relation between the smartphone and its user as the conditional decision and sensing. Under this relation, the composite node performs the sensing decision of the smartphone which based on its user’s decision. Then, this article studies the performance of the composite sensing process under the scenario which composes of an application server, some objects, and users. In the progress of the composite sensing, users report their sensing results to the server. Then, the server returns rewards to some users to maximize the overall reward. Under this scenario, this article maps the composite sensing process as the partially observable Markov decision process, and designs a composite sensing solution for the process to maximize the overall reward. The solution includes optimal and myopic policies. Besides, we provide necessary theoretical analysis, which ensures the optimality of the optimal algorithm. In the end, we conduct some experiments to evaluate the performance of our two policies in terms of the average quality, the sensing ratio, the success report ratio, and the approximate ratio. In addition, the delay and the progress proportion of optimal policy are analyzed. In all, the experiments show that both policies we provide are obviously superior to the random policy.
Evaluation of Pancreatic Lesions With Endoscopic Ultrasound and Fine Needle Aspiration
Authors: Luk Yan , She Wong Hoi , Chow Felix Che Lok , Ma Ka Wing , Tsang Simon Hing Yin , Dai Wing Chiu , Cheung Tan To , Lo Chung Mau
Published: May 2020

Background. Endoscopic ultrasound (EUS) and fine-needle aspiration (FNA) are commonly used for assessing pancreatic lesions. This study aimed to evaluate the diagnostic yield and accuracy of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in a single tertiary institution. Methods. Consecutive patients who underwent EUS-FNA of the pancreas at Queen Mary Hospital, Hong Kong, from January 2015 to March 2016 were retrospectively reviewed. Endoscopic findings and FNA results were analysed. For patients who subsequently underwent surgical resection of pancreatic lesion, EUS-FNA diagnoses were compared to histopathological findings of surgical specimens to determine its diagnostic accuracy. Results. One hundred twelve EUS-FNA were performed in 99 patients within the study time period and were included for analysis. Sixty-six (66.7%) pancreatic lesions were solid in nature and 33 (33.3%) were cystic. The overall diagnostic yield of EUS-FNA was 70.5% (n = 79). On multivariate analysis, more passes of needle were associated with a higher diagnostic yield (odds ratio = 2.000, P = .049). 57.1% (n = 64) of EUS-FNA results had an impact on management. Sixteen patients with diagnostic EUS-FNA subsequently underwent surgery for resection of the pancreatic lesion. Upon correlation to the histopathological findings of surgical specimens, there were 12 true-positive, 2 true-negative, 0 false-positive, and 2 false-negative cases. Sensitivity was 85.7%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 50%. The diagnostic accuracy of EUS-FNA was 87.5%. Conclusion. EUS-FNA is accurate and reliable for diagnosing pancreatic lesions.
How to Stage Airflow Limitation in Stable Chronic Obstructive Pulmonary Disease Male Patients?
Authors: Anane Ichraf , Guezguez Fatma , Knaz Hend , Ben Saad Helmi
Published: May 2020

No study has evaluated the utility of different classifications of chronic obstructive pulmonary disease (COPD) airflow limitation (AFL) in terms of the refined “ABCD” classification of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) or in terms of the impacts on quality of life. This study aimed to compare some relevant health outcomes (i.e., GOLD classification and quality-of-life scores) between COPD patients having “light” and “severe” AFL according to five COPD AFL classifications. It was a cross-sectional prospective study including 55 stable COPD male patients. The COPD assessment test (CAT), the VQ11 quality-of-life questionnaire, a spirometry, and a bronchodilator test were performed. The patients were divided into GOLD “A/B” and “C/D.” The following five classifications of AFL severity, based on different post-bronchodilator forced expiratory volume in 1 s (FEV1) expressions, were applied: FEV1%pred: “light” (≥50), “severe” (<50); FEV1z-score: “light” (≥−3), “severe” (<−3); FEV1/height2: “light” (≥0.40), “severe” (<0.40); FEV1/height3: “light” (≥0.29), “severe” (<0.29); and FEV1Quotient: “light” (≥2.50), “severe” (<2.50). The percentages of the patients with “severe” AFL were significantly influenced by the applied classification of the AFL severity (89.1 [FEV1z-score], 63.6 [FEV1%pred], 41.8 [FEV1/height3], 40.0 [FEV1Quotient], and 25.4 [FEV1/height2]; Cochrane test = 91.49, df = 4). The CAT and VQ11 scores were significantly different between the patients having “light” and “severe” AFL. In GOLD “C/D” patients, only the FEV1Quotient was able to distinguish between the two AFL severities. To conclude, the five classifications of COPD AFL were not similar when compared with regard to some relevant health outcomes.
Global Lifestyle Medicine: For People Who Need It the Most but Have It the Least
Authors: Ezinwa Ngozi Margarete
Published: May 2020

In many low- and middle-income countries, chronic or noncommunicable disease is rising exponentially leading to high rates of death and disability. Many low-resource countries also still have high rates of infectious disease, leading to a double burden. As demographics shift and people are able to afford higher calorie convenience foods there can be concomitant obesity and malnutrition. Lifestyle medicine can prevent and reverse these diseases, but the concepts of lifestyle medicine are not reaching the people who need them the most. Lifestyle medicine’s unique contribution to the fight against noncommunicable disease is well trained providers who can reach people, really hear their stories, and provide tools for them on their journey, which can affect individuals, communities, and the planet. Providers all over the world are realizing this and joining together in the Lifestyle Medicine Global Alliance (LMGA) to build a network of providers; share best practices, educational resources, and research initiatives; and to advocate on the global stage. The contribution lifestyle medicine has to offer in synergy with public health efforts has been recognized by the World Health Organization, and the Lifestyle Medicine Global Alliance has been invited to partner with them to reduce noncommunicable disease by 30% by 2030.
Examining the appropriateness and reliability of the strategy of the Kenyan Comprehensive School Health Program
Authors: Tomokawa Sachi , Asakura Takashi , Njenga Sammy M. , Njomo Doris Wairimu , Takeuch Rie , Akiyama Takeshi , Kazama Haruki , Mutua Alex , Barnett Walema , Henzan Hanae , Shimada Masaaki , Ichinose Yoshio , Kamiya Yasuhiko , Kaneko Satoshi , Miyake Kimihiro , Kobayashi Jun
Published: May 2020

The Kenyan government established the Kenyan Comprehensive School Health Program (KCSHP) on the basis of Kenyan National School Health Policy. A KCSHP pilot project was carried out in eight primary schools in Mbita Sub-County of Homa Bay County in the Nyanza Region from 2012 to 2017. This pilot project provided health facilities and support for evaluation with a school health checklist, and organized teacher training on health education, a child health club, and school-based health check-ups. The present study aimed to examine the appropriateness and reliability of the strategy of the second KCSHP pilot project in Kenya. We analyzed data from self-administered questionnaires targeted at pupils in seventh-grade in the eight primary schools. The questionnaire consisted of questions on health-related knowledge, attitudes and practices, self-evaluated physical and mental health status, self-awareness of health control, subjective happiness, recognition on the importance of learning about health in school, absenteeism, and sense of school belongingness. The project contributed to improving health-related knowledge, attitudes and practices, self-evaluated health status, sense of school belongingness, recognition on the importance of learning about health in school, self-awareness of health control, and absenteeism. On the contrary, subjective happiness did not improve significantly.
BlaBlaCar: Value creation on a digital platform
Authors: Saxena Deepak , Muzellec Laurent , Trabucchi Daniel
Published: May 2020

From its humble origin in 2003, BlaBlaCar has become a preferred ride-sharing platform for the passengers across Europe. BlaBlaCar is an online marketplace that connects drivers and passengers and helps them share the costs of journeys. In so doing, it creates value for both sides of the platform. Drivers save money of the cost of the trip, and passengers get a low-cost option to reach their destination. The case follows the company from the inception to its growth and current challenges. The case helps the students in understanding the business of digital platforms as it relates to value creation for the customers, matching the value proposition for two sides, revenue and pricing strategies, and the crucial role of trust in sharing economy.
Mapping of predictors of the disengagement of the descending inhibitory pain modulation system in fibromyalgia: an exploratory study
Authors: Soldatelli Matheus Dorigatti , Siepmann Timo , Illigens Ben Min-Woo , Souza dos Santos Vinicius , Lucena da S Torres Iraci , Fregni Felipe , Caumo Wolnei
Published: May 2020

Background:

The main symptoms of fibromyalgia comprise diffuse pain, disability, depressive symptoms, catastrophizing, sleep disruption and fatigue, associated with dysfunction of the descending pain-modulating system (DPMS).

Objectives:

We aimed to identify patterns of main symptoms of fibromyalgia and neuroplasticity biomarkers (i.e. brain-derived neurotrophic factor (BDNF) and S100B protein) in non-responders to the conditioned pain modulation task (CPM-task) induced by immersion of hand in cold water (0–1°C). Furthermore, we evaluated if these patterns predict responsiveness to CPM-task.

Methods:

This cross-sectional study included 117 women with fibromyalgia (( n = 60) non-responders and ( n = 57) responders), with age ranging from 30 to 65 years old. We analysed changes in numerical pain scale (NPS-10) during the CPM-task using a standardized protocol.

Results:

A hierarchical multivariate logistic regression analysis was used to construct a propensity score-adjusted index to identify non-responders compared to responders to CPM-task. The following variables were retained in the models: analgesic use four or more times per week, heat pain threshold (HPT), poor sleep quality, pain catastrophizing, serum levels of BDNF, number of psychiatric diagnoses and the impact of symptoms of fibromyalgia on quality of life. Receiver operator characteristics (ROC) analysis showed non-responders can be discriminated from responders by a composite index of more frequent symptoms of fibromyalgia and neuroplasticity markers (area under the curve (AUC) = 0.83, sensitivity = 100% and specificity = 98%).

Conclusion:

Patterns of fibromyalgia symptoms and neuroplasticity markers may be helpful to predict responsiveness to the CPM-task which might help personalize treatment and thereby contribute to the care of patients with fibromyalgia.
Lived experiences of informal caregivers of people with chronic musculoskeletal pain: a systematic review and meta-ethnography
Authors: Smith Toby , Fletcher Jessica , Lister Sarah
Published: May 2020

Background:

People with chronic pain often seek support from friends and family for everyday tasks. These individuals are termed informal caregivers. There remains uncertainty regarding the lived experiences of these people who care for individuals with chronic musculoskeletal pain. The aim of this article is to synthase the evidence on the lived experiences of informal caregivers providing care to people with chronic musculoskeletal pain.

Methods:

A systematic literature review was undertaken of published and unpublished literature databases including EMBASE, MEDLINE, CINAHL, PubMed, the WHO International Clinical Trial Registry and ClinicalTrials.gov registry (to September 2019). Qualitative studies exploring the lived experiences of informal caregivers of people with chronic musculoskeletal pain were included. Data were synthesised using a meta-ethnography approach. Evidence was evaluated using the Critical Appraisal Skills Programme qualitative appraisal tool.

Results:

From 534 citations, 10 studies were eligible (360 participants: 171 informal caregivers of 189 care recipients). The evidence was moderate quality. Seven themes arose: the relationship of caregivers to healthcare professionals; role reversal with care recipients; acting the confidant to the care recipient; a constant burden in caregiving; legitimising care recipient’s condition; knowledge and skills to provide caregiving; and the perception of other family members and wider society to the caregiver/care recipient dyad.

Conclusion:

The lived experiences of caregivers of people with chronic musculoskeletal pain is complex and dynamic. There is an inter-connected relationship between caregivers, care recipients and healthcare professionals. Exploring how these experiences can be modified to improve a caregiving dyad’s lived experience is now warranted.
Successful Outcome Following Bilateral Dual-Mobility Total Hip Arthroplasty For Neglected Developmental Dysplasia Of The Hip – A Case Report
Authors: M.Asyraf AH , Ahmad AR , Solayar GN
Published: May 2020

Objectives:

Developmental dysplasia of hip (DDH) is a disorder of abnormal development of dislocation of hip secondary to casular laxity and mechanical factor. Arthroplasty maybe challenging with acetabular dysmorphia affecting cup placement which may increase the risk of dislocation post procedure

Results:

We describe a case of 60 years old lady that with history of difficulty in walking since childhood but not taken any definitive treatment. She presented with complaint of pain in both hips for last 5 years ago. On examination, patient was walking with waddling gait. All hip movements were painfully restricted. 3 cm shortening was present on left side. Radiological examination, Radiographs of the pelvis revealed proximally migrated dysplastic head of femur with dysplastic shallow empty acetabulum. Patient was underwent for right dual-mobility total hip arthroplasty (THA) first with acetabular shelf grafting. Following successful results, she opted for a similar implant on the left side. Harris Hip Score was used to evaluate the functional outcome of hip. Prior of operation, the score was 40, then after operation, the score was 80. The patient is currently two years from her surgery and ambulating with one stick

Conclusion:

In untreated developmental dysplasia of hip, concentric reduction of prosthetic hip is technically demanding. Cup coverage and restoration of normal hip biomechanics remain the most important issues. Acetabulum is hypoplastic with narrow femoral medullary canal. Dual-mobility arthroplasty is an option with potentially reduced wear rates and improved articulating stability; particularly in cases of DDH where placement maybe sub-optimally placed due to existing acetabular dysmorphia. This case highlights success in treating patients with DDH using dual-mobility arthroplasty. In untreated developmental dysplasia of hip, concentric reduction of prosthetic hip is technically demanding. Cup coverage and restoration of normal hip biomechanics remain the most important issues. Acetabulum is hypoplastic with narrow femoral medullary canal. Dual-mobility arthroplasty is an option with potentially reduced wear rates and improved articulating stability; particularly in cases of DDH where placement maybe sub-optimally placed due to existing acetabular dysmorphia. This case highlights success in treating patients with DDH using dual-mobility arthroplasty.
Immediate Donor Site Complications after Anterior Cruciate Ligament Reconstruction with Bone-Patellar Tendon-Bone Autograft: 2 Case Reports
Authors: Liu Hsuan-Chih , Lin Ching-Wei , Wu Chung-Ta
Published: May 2020

With the increasing number of anterior cruciate ligament reconstructions (ACL-R), complications after reconstruction are likely to become more frequent. Patellar fracture is a rare but significant complication following ACL reconstruction when using a bone-patellar tendon-bone (BPTB) autograft. This case report presents 1 simple patellar fracture, 1 patellar comminuted fracture with associated patellar tendon rupture which occurred acutely after ACL reconstruction using BPTB graft.

Methods:

Case 1: 17-year-old female. Nondisplaced linear lateral pole patellar fracture was first noticed at post-op 6 weeks followed-up. There was no subjectively complaint issued by the patient after the operation. She was managed conservatively with closed follow up until the fracture had healed. Case 2: 37-year-old woman, 6 weeks after operation. The patient slipped on a wet floor and injured the operated knee joint. Patellar lower pole comminuted fracture with complete patella tendon tear was diagnosed. Open reduction and internal fixation of the fracture and patella tendon repair were performed.

Results:

Case 1: She achieved full fracture union at 3 months, is 76 months post-operatively. She is currently active in sports activities without any problem. Case 2: The fracture healed at 2 months; she has had full, active knee joint extension and full ROM of the knee joint at 3 months post-operatively. She is now 9 months after the primary ACL-R surgery, is well on track with our ACL-R rehabilitation program.

Discussion:

Case 1 fracture was believed to happen at the time of graft harvesting without our noticing. Case 2 had a fall and caused a more complicated donor site problem. Though rare, these complications cause major post-operative and rehabilitation problems. Closed follow-up, early detection with immediate intervention should be warranted after ACL-R surgeries.
GUNSHOT INDUCED HUMERUS FRACTURE TREATED USING THE MASQUELET TECHNIQUE
Authors: Terence MD , Abdul Razak KA , Jagjoth S , Tan WL
Published: May 2020

Humerus fractures secondary to gunshot injury are slow to unite and may require multiple surgeries to obtain union. 1We report a gunshot induced humerus fracture treated via the Masquelet technique.

Report:

A 27-year old gentleman had a shotgun injury to his left arm exposing the humerus bone. He underwent debridement and external fixator and a 4cm segmental bone loss was noted. The following debridement, a humeral nail and 3cm acute shortening was done, as well as the 1st stage Masquelet (Figure 1). After 6 weeks, the 2nd stage Masquelet was performed (Figure 2). At 1 year follow up, radiographical union was noted (Figure 3). [Figure: see text][Figure: see text][Figure: see text]

Discussion:

Masquelet technique consists of cement spacer insertion which is then exchanged with autologous cancellous bone graft packed into an induced membrane. 2To our knowledge, there have not been reported cases of Masquelet technique used to treat shotgun induced open humerus fractures. The use of an external fixator is proposed by many authors1. The key to success is a thorough debridement of the fracture3.

Conclusion:

The Masquelet technique is a reliable tool in the surgeon’s armamentarium in the management of humeral segmental bone defects2.

Reference:

Management of shotgun induced open fractures of the humerus with Ilizarov fixator;2015 The Masquelet Technique for Thumb Metacarpal Reconstruction Following Trauma ; JBJS; 2018 Muscle reconstruction in reconstructive surgery: soft tissue repair and long bone reconstruction; 2003
Therapeutic effect of Intra-articular normal saline and lidocaine injection after Arthrocentesis for Knee Hemarthrosis post traumatic injury in RS Muhammadiyah Palembang (RSMP): A Case Report
Authors: Afifurrahman MD
Published: May 2020

Female 22 years old, come to RSMP with pain and swollen in the right knee after fall down from stairs 2 days ago. In Physical Examination found bruising around the knee with no sign of crepitation nor abnormality during ligament test. Patient than given initial treatment (analgesic and antifibrinolytic) for 1 week and X-ray examination of knee. One week later patient come with decreased but persisted pain and swollen knee. X-ray Examination suggests joint effusion. The Patient than admitted for arthrocentesis followed by Intra-articular normal saline and lidocaine injection.

Bleeding into a joint is referred to as hemarthrosis and is an important cause of monoarticular joint pain and swelling. Its can be suspected based on patient history, physical exam, and multiple imaging modalities, however the best way to diagnose hemarthrosis is with arthrocentesis with synovial fluid analysis. Traumatic injury is the most common cause and the knee is a frequent site of hemarthrosis. Initial treatment of any acute hemarthrosis includes immobilization, ice, and compression. Analgesia for pain control may be required in the acute period. Arthrocentesis with aspiration from a joint can be both diagnostic and therapeutic by reducing pressure from the effusion.

Intra-articular normal saline (IA-NS) injections have been utilized as a placebo in a number of researches pertaining to the management of joints problem such as knee osteoarthritis (OA). It is believed that these IA-NS injections may have a therapeutic effect that has not been quantified in the literature. Lidocaine have some mild anti-inflammatory effect during its relatively short halflife of 1.5 hours. The prompt effect of the local anesthetic providing temporary relief of symptoms can help confirm proper placement of the injection and support that the site injected was the source of the pain.
POSTERO-MEDIAL TIBIAL PLATEAU (MOORE’S TYPE) FRACTURE AND THE IMPORTANCE OF COMPUTER TOMOGRAPHY IN DIAGNOSIS: A CASE REPORT
Authors: Mohd Yunus R , Solayar G.N , Ahmad A. R
Published: May 2020

Moore type I posteromedial split fracturedislocation of proximal tibia are relatively uncommon. It is a specific fracture pattern that is not well described by the AO (41B2.2/B3.2) or Schatzker (IV) classification system because these systems do not differentiate when the medial fragment is primarily posterior and associated with a dislocation as the Moore system does. 1The additional use of computed tomography scans in the assessment of tibial plateau fracture may improve surgeon’s agreement that lead to the final decision and optimization of treatment. 2Galla and Lobenhoffer described a direct posteromedial approach for managing Moore type I tibial plateau fracture1.

Report:

A 48 years old malay gentlemen was alleged motor-vehicle accident, sustained closed fracture tibial plateau of right knee. Initially patient was diagnosed with right tibial fracture schatzker IV based on right knee anterior-posterior and lateral view xray. But CT scan had done, show the proximal tibial fracture transversing medial aspect with coronal spliting. Patient was treated with posteromedial locking compression plate with Lobenhoffer approach. Intraoperatively, diagnosis was confirmed with Hohl & Moore classification type I, there is coronal split fracture extending to posteromedially. The importance of computerised tomography scans when dealing with intra-articular fracture of tibial plateau may improve regarding localisation of fracture lines, depression zone, comminution, and the surgical treatment plan. 2Alexander et al. reported after addition of computerised tomography scans significantly improved to “good” in all classification. The features of Moore’s type I fracture which is coronal split fracture dominantly posterior column, coronal view from CT scans is more useful compare than sagital view. Galla and Lobenhoffer have introduce a direct postero-medial approach that minimizes soft tissue injury while allowing excellent fracture visualization, reduction, and fixations. 1This technique protect the neurovascular bundle and requires only suboeriosteal elevation of the popliteus to obtain full exposure. Furthermore, because of the protecting posterior soft tissues, skin closure and wound healing are reliable.

Conclusion:

Moore’s type I fracture managed with postero-medial approach has better post operative outcome, improved reliability and shows good reproducibility when classified with computerised tomography scans.

References:

Johannes K.MF, et al,. Optimizing the Management of Moore Type I Postero-Medial Split Fracture Dislocations of the Tibial Head: Description of the Lobenhoffer Approach. J Orthop Trauma 2007;21:330-336 Alexander B, et al. Classification system for tibial plateau fractures: Does computed tomography scanning improve their reliability? Injury, Int. J. Care Injured 41 (2010) 173-178
Functional and Radiological Comparison of Umbilical Cord Mesenchymal Stem Cells, Somatotropin, and Hyaluronic Acid Injection for Cartilage Repair in Early Osteoarthritis of the Knee: A Randomized Controlled Trial
Authors: Fiolin J , Dilogo IH , Lubis AMT , Pawitan JA , Liem IK , Pandelaki J , Hanitya AL , Feby CA
Published: May 2020

The umbilical cord-mesenchymal stem cells (UC-MSC) has been shown to improve the viability of degenerated chondrocytes in knee osteoarthritis (KOA) in cellular level. Additional somatotropin injection also shown clinical improvement in patients. The present trial is conducted to assess the efficacy of umbilical cord mesenchymal stem cells (UC-MSC) in comparison to somatotropin and hyaluronic acid (HA) injection to treat and slow the progression of knee osteoarthritis.

Methods:

This study was conducted from January 2016 to April 2018 in Cipto Mangunkusumo General Hospital. A total of 28 knees from 15 patients with early KOA Kellgren Lawrence I-II were randomized into three groups. Group A was treated with 1x106 units of intra-articular UC-MSCs + 2 ml HA followed with 2 consecutive weeks of HA injection; group B was treated with the same dose of HA with additional 8 IU of Somatotropin; group C was treated as control. The International Knee Documentation Committee (IKDC) score, The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analogue score (VAS), were assessed on the 1st and 3rd month, then every 3rd month until 12 months. Cartilage evaluation using MRI cartigram were performed at pre-implantation, and after the 6th and 12th month after implantation

Results:

General improvement were observed in all groups after 6 and 12 months. The IKDC score improved significantly among groups after 12 months (69.43 [48.3-89.66], 79.31 [51.72-90.08], and 75.9 [67.82-97.7] in group A, B, and C, respectively, p =0.005). We did not find a significant difference between groups in VAS and WOMAC results. However, we observed a medial T2 improvement in group A (39.55 [32.65-67.85] initially and 45.64 [38.12-70.65] 12 months after implantation).

Conclusion:

Injection of UC-MSC could improve knee function and cartilage profile in early KOA. However, further multicenter studies with larger samples are required to investigate the efficacy of such treatment for treating knee osteoarthritis.
Crab bite causing shewanella putrefaciens infection: Introduction to a possibly deadly and emerging threat
Authors: Razak Kamarul Arifin Abdul , Dass Terence Michal , Liang Tan Weng , Nadeson Yogeshwarran , Kaur Karenjit
Published: May 2020

Shewanella species are gram-negative bacteria found in warm, temperate regions and are normal microflora of the marine environment1. Human infections are unusual and have a restricted geographic distribution.

Presentation:

A 45 years old lady was bitten by a crab while preparing to cook it. She developed fever and swelling of the right thumb with hemoserous discharge and blackish discolouration.Upon examination, the thumb was erythematous and swollen with a hematoma filled blister formation over the dorsal aspect. Deblistering was done and fluid samples were sent for culture and sensitivity which later returned as Shewanella Putrefaciens. Empirically she was started on IV Augmentin.

Discussion:

Most common clinical manifestation associated with Shewanella spp are superficial soft tissue infection1. Other reported clinical features are primary and secondary bacteremia, hepatobiliary, bone, joint and CNS infection, endocarditis, eye, ear and respiratory infection2. Antibiotics susceptibility includes aminoglycosides, 3rd and 4th generation cephalosporins, carbapenems and fluoroquinolones1. About 79% of patients have underlying conditions such as diabetes mellitus, venous congestion and heart failure; they are immunocompromised, as is our patient3.

Conclusion:

Proper handling of seafood during preparation should be encouraged as a simple bite may turn deadly. Initiation of antibiotics according to suspected organisms should be performed to prevent worsening of soft tissue infections.

References:

Diaz, J.H, Lopez, F.A Skin, Soft Tissue and Systemic Bacterial Infections Following Aquatic Injuries and Exposures. The American Journal of the Medical Sciences, 349(3), 269275 Finkelstein,R, Oren,I. Soft Tissue Infections Caused by Marine Bacterial Pathogens: Epidemiology, Diagnosis, and Management. Current Infectious Disease Report (2011)13(5):470–477 N. Vignier et al; Human Infection with Shewanella putrefaciens and S. algae: Report of 16 Cases in Martinique and Review of the Literature; Am. J. Trop. Med. Hyg., 89(1), 2013, pp. 151–156
Femoral Shaft Bowing Angle in The Coronal Plane Affects Distal Femoral Valgus Cutting Angle: A Radiographic Study
Authors: Suvarly Prettysia , Sindunata Nyoman Aditya , Aditya Rio , Muljadi Rusli , Butarbutar John
Published: May 2020

Postoperative limb alignment is important for successful total knee arthroplasty (TKA). Femoral shaft bowing angle (FBA) in coronal plane may influence distal femoral valgus cutting angle (DFVCA) and 5±2º may not perpendicular to mechanical axis.

Methods:

Sixty-six lower extremity long film x-ray of osteoarthritic knees were collected and analyzed with IntstaRISPACS (digital radiography software). The correlation and linear regression between FBA and DFVCAwere measured using SPSS 24.

Results:

Our study shows a strong correlation between FBA and DFVCA. Lateral FBA tends to present with DFVCA outside 7º as shown in linear regression test, vice versa.

Conclusion:

Since DFVCA is influenced by FBA, we recommend preoperative femoral x-ray in all knee replacement candidates.

References:

Rezende FC, Carneiro M. Is it safe the empirical distal femoral resection angle of 5° to 6°of valgus in the Brazilian geriatric population? Rev Bras Orthop. 2013; 48(5): 421-6. Kim CW, Lee CR. Effects of femoral lateral bowing on coronal alignment and component position after total knee arthroplasty: a comparison of conventional and navigation-assisted surgery. Knee Surg Relat Res. 2018 Mar; 30(1): 64–73. Kim JM, Hong SH, Kim JM, Lee BS, Kim DE, Kim KA, Bin et al. Femoral shaft bowing in the carinal plane has more significant effect on the coronal alignment of TKA than proximal or distal variations of femoral shape. Knee Surg Sports Traumatol Arthrosc. 2015;23(7):1936-42
NECROTISING FASCIITIS : PREVELANCE AND DISTRIBUTION OF CAUSATIVE MICROORGANISM IN A MALAYSIA TERTIARY HOSPITAL - A 2 YEAR STUDY
Authors: M.Asyraf A.H , Ashraf- Fareeq S , Zulfahrizzat S , Arvinder-Singh HS , Neela Vasantha Kumari , Abdul-Rauf A , Sanjiv-Rampal
Published: May 2020

The objective of this study was to evaluate the prevalence of microorganism isolates types, antibiotic usage preference, the prevalence of diabetic amputations in necrotizing fasciitis (NF) and predicitive factors of amputation.

Methodology:

This study was a cross-sectional study conducted by looking at medical records ttraced from Hospital Seremban identifying all necrotizing fasciits admissions in the year of 2017/2018. The researchers first traced all medical records via electronic medical records. All case records were reviewed and identifiers were removed. Patients with missing notes/medico-legal cases were excluded from this study.

Results:

A total of 159 records were traced of which none met the exclusion criteria. The mean age of patients were 56.09 (SD:12.20), mean days stayed at hospital 25.09 (17.70) and the mean number of days patients were on at least one antibiotic was 18.87 (41.78). From the total, 145 (91.2%) were suffered at the lower limbs, 68 (42.8%) suffered an amputation [of which 31 were above-knee-amputations], 97 (61.0%) suffered from sepsis and 19 (11.9%) suffered mortality. 139 (87.4%) of the patients were diabetics, 105 (66.0%) were hypertensives and 87 (54.7%) were immunocompramised. The majority were caused by unknown aetiology [103 (64.8%)], 131 (82.4%) presented with erythema/cellulitis and 116 (73.0%) had good prognosis. The commonest type of NF was type 2 [103 (64.8%)]. The top 3 commonest isolates were Pseudomonas aeruginosa (15.7%), Klebsiella pneumoniae (12.6%) and β haemolytic Group B Streptococcus (10.7%). The 3 commonest antibiotics started were ampicillin/sulbactam combination (69.8%), ceftazidime (9.4%) and amoxycillin/clavulanate (4.4%). The mean LRINEC score was 7.72 (SD:2.31). Among the 139 diabetics, 68 (48.9%) ended up with an amputation. Among the 102 patients having both diabetes and hypertension (n=102), 50% suffered an amputation. A cross tabulation done showed that Klebsiella pneumoniae (17.2%), β haemolytic Group B Streptococcus (15.5%) and Proteus mirabillis (13.8%) were the common causative organisms in an amputation. A regression analysis done to identify predictive variables for an amputation showed no statistical significant variables.

Conclusion:

Proper handling of seafood during preparation should be encouraged as a simple bite may turn deadly. Initiation of antibiotics according to suspected organisms should be performed to prevent worsening of soft tissue infections.

Conclusion:

From this study, we concluded that the commonest type of isolates at our centre was Pseudomonas aeruginosa and the commonest antibiotic choice was the ampicillin/sulbactam combination and nearly half of diabetics with NF ended up with an amputation. There were no predictive factors for an amputation among the collected variables