bluuebunny/crossref_metadata_2025 huggingface dataset:
Radiostereographic analysis of a shoulder surface replacement
Authors: Nuttall D. , Birch A. , Haines J. F.  , Trail I. A.
Published: August 2014

Resurfacing of the humeral head is commonly used within the UK to treat osteoarthritis (OA) of the shoulder. We present the results of a small prospective randomised study of this procedure using the Global CAP prosthesis with two different coatings, Porocoat and DuoFix hydroxyapatite (HA). We followed two groups of ten patients with OA of the shoulder for two years after insertion of the prosthesis with tantalum marker beads, recording pain, Constant–Murley and American Shoulder and Elbow Surgeons (ASES) outcome scores, and using radiostereometric analysis to assess migration. The outcomes were similar to those of other series, with significant reductions in pain (p = 0.003) and an improvement in the Constant (p = 0.001) and ASES scores (p = 0.006). The mean migration of the prosthesis three months post-operatively was 0.78 mm (0.51 to 1.69) and 0.72 mm (0.33 to 1.45) for the Porocoat and DuoFix groups, respectively. Analysis of variance indicated that the rate of migration reached a plateau after three months post-operatively in both groups. At follow-up of two years the mean migration was 1 mm (sd 1 (0.25 to 3.32)); in the Porocoat group and 0.8 mm (sd 0.4 (0.27 to 1.45)) in the DuoFix HA group. Significant migration of the prosthesis was seen in one patient who had received an anterior humeral bone graft. This prosthesis was later revised after 2.7 years.

The addition of a coating of HA to the sintered surface does not improve fixation of this prosthesis.

Cite this article: Bone Joint J 2014;96-B:1077–81.
Burnout and quality of life among orthopaedic trainees in a modern educational programme
Authors: van Vendeloo S. N. , Brand P. L. P. , Verheyen C. C. P. M.
Published: August 2014

We aimed to determine quality of life and burnout among Dutch orthopaedic trainees following a modern orthopaedic curriculum, with strict compliance to a 48-hour working week. We also evaluated the effect of the clinical climate of learning on their emotional well-being.

We assessed burnout, quality of life and the clinical climate of learning in 105 orthopaedic trainees using the Maslach Burnout Inventory, linear analogue scale self-assessments, and Dutch Residency Educational Climate Test (D-RECT), respectively.

A total of 19 trainees (18%) had poor quality of life and 49 (47%) were dissatisfied with the balance between their personal and professional life. Some symptoms of burnout were found in 29 trainees (28%). Higher D-RECT scores (indicating a better climate of learning) were associated with a better quality of life (r = 0.31, p = 0.001), more work-life balance satisfaction (r = 0.31, p = 0.002), fewer symptoms of emotional exhaustion (r = -0.21, p = 0.028) and depersonalisation (r = -0,28, p = 0.04).

A reduced quality of life with evidence of burnout were still seen in a significant proportion of orthopaedic trainees despite following a modern curriculum with strict compliance to a 48-hour working week. It is vital that further work is undertaken to improve the quality of life and reduce burnout in this cohort.

Cite this article: Bone Joint J 2014;96-B:1133–8.
Infusion-Related Reaction following Daptomycin Two-Minute Rapid Intravenous Administration
Authors: Caulder Celeste R. , Sloan Aaron , Ahmed Yasir , Bookstaver P. Brandon
Published: August 2014

Background

Erythroderma, or red man's syndrome, is a common infusion-related reaction following vancomycin administration. Erythroderma following daptomycin rapid infusion has not been documented.

Objective

To report a case of erythroderma following daptomycin 2-minute intravenous (IV) injection.

Case Report

A review of published literature suggests that this is the first published case of a flushing (nonallergic) reaction resulting from a 2-minute IV injection of daptomycin that is not present with standard IV infusion. A 69-year-old woman following right knee reconstructive surgery presented with right knee joint swelling, purulent discharge, and fever. Subsequently, she was diagnosed with a presumed postsurgical infection and was initiated on vancomycin therapy. Following removal of the infected hardware, the patient was discharged and continued outpatient vancomycin therapy. The patient's renal function began to decline and therapy was discontinued. Daptomycin 6 mg/kg every 48 hours was initiated via 2-minute IV push. On the initial dose, approximately 2 hours post IV infusion, the patient began to notice redness and a warm sensation on her face, neck, and upper part of the chest. Diphenhydramine 25 mg provided limited immediate relief, but all symptoms subsided within 3 to 4 hours. The patient received her next dose 48 hours later over a 40-minute IV infusion with no adverse effects. Subsequent infusions continued at the same dose over 30 minutes for 4 weeks with no further adverse effects.

Conclusion

A 2-minute intravenous injection of daptomycin in this patient yielded a reaction that was not present on rechallenge with standard, extended infusion.
Dapagliflozin
Authors: Cada Dennis J. , Levien Terri L. , Baker Danial E.
Published: August 2014

Each month, subscribers to The Formulary Monograph Service receive 5 to 6 well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to Pharmacy & Therapeutics Committees. Subscribers also receive monthly 1-page summary monographs on agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation/medication use evaluation (DUE/MUE) is also provided each month. With a subscription, the monographs are sent in print and are also available on-line. Monographs can be customized to meet the needs of a facility. A drug class review is now published monthly with The Formulary Monograph Service. Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. For more information about The Formulary Monograph Service, call The Formulary at 800–322–4349. The July 2014 monograph topics are albiglutide, ramucirumab, short ragweed pollen allergen extract, timothy grass pollen allergen extract, and isavuconazole. The DUE/MUE is on albiglutide.
Heirs through Fear
Authors: Caterine Darryl V.
Published: August 2014

Beginning with nineteenth-century Indian curse rhetoric as a national jeremiad, and continuing into the twentieth century through Puritan-derived landscapes in fiction by Howard Philips Lovecraft and Jay Anson, Indian curses and accursed lands stand apart from other paranormal beliefs in the explicit voice they give to Euro-American anxieties over cultural authority. By imagining themselves as living in Indian terrains, accursed though they are, white Americans lay claim to the land, articulating an indigenized myth of national origin. Since the 1970s, neo-charismatic Protestants have taken a keen interest in Lovecraft-inspired religions and Indian curse lore, engaging in various deliverance ministries to exorcise individuals and landscapes, and to symbolically claim the nation for themselves.
When the Veil is Thin
Authors: Feltmate David
Published: August 2014

Researching the paranormal frequently involves the study of how people discuss paranormal phenomena’s significance in popular culture. Using Victor Turner’s concept of the liminoid, in this article I survey The Simpsons’ annual “Treehouse of Horror” episodes and suggest that thinking with these episodes can help scholars re-envision the academic construction of religion and the paranormal. I will argue that scholars should collapse the distinction between “religion” and “the paranormal” in academic and popular discussions.
Stop, Words
Authors: Rosenberg Daniel
Published: August 2014

The stop list, a list of words excluded from computer processing, is a characteristic artifact of recent times, and its logic is one of the implicit structures of the everyday epistemology of the late twentieth century.
SNPs in Genes Functional in Starch-Sugar Interconversion Associate with Natural Variation of Tuber Starch and Sugar Content of Potato (Solanum tuberosumL.)
Authors: Schreiber Lena , Nader-Nieto Anna Camila , Schönhals Elske Maria , Walkemeier Birgit , Gebhardt Christiane
Published: August 2014

Starch accumulation and breakdown are vital processes in plant storage organs such as seeds, roots, and tubers. In tubers of potato (Solanum tuberosum L.) a small fraction of starch is converted into the reducing sugars glucose and fructose. Reducing sugars accumulate in response to cold temperatures. Even small quantities of reducing sugars affect negatively the quality of processed products such as chips and French fries. Tuber starch and sugar content are inversely correlated complex traits that are controlled by multiple genetic and environmental factors. Based on in silico annotation of the potato genome sequence, 123 loci are involved in starch-sugar interconversion, approximately half of which have been previously cloned and characterized. By means of candidate gene association mapping, we identified single-nucleotide polymorphisms (SNPs) in eight genes known to have key functions in starch-sugar interconversion, which were diagnostic for increased tuber starch and/or decreased sugar content and vice versa. Most positive or negative effects of SNPs on tuber-reducing sugar content were reproducible in two different collections of potato cultivars. The diagnostic SNP markers are useful for breeding applications. An allele of the plastidic starch phosphorylase PHO1a associated with increased tuber starch content was cloned as full-length cDNA and characterized. The PHO1a-HA allele has several amino acid changes, one of which is unique among all known starch/glycogen phosphorylases. This mutation might cause reduced enzyme activity due to impaired formation of the active dimers, thereby limiting starch breakdown.
NICU Follow-up Care: The Developmental and Advocacy Perspectives
Authors: Andrews Bree , Myers Patrick , Osterhout Paula , Pellerite Matthew , Zimmerman Amy , Msall Michael
Published: August 2014

The responsibility for the medical and developmental care of the premature infant falls to the neonatologist, the general practitioner, subspecialists, and therapists, as well as the family and available community resources. This article reviews the landscape of developmental delays among former premature infants and offers a framework for screening and addressing these delays in infancy and early childhood. A holistic approach to developmental delays, especially with regard to public benefits can mobilize resources early to assist families and shape the environment for the child both at home and at school. The medical and developmental team working together can improve the developmental trajectory of a child.
Neurodevelopmental Outcomes for Infants Born With Congenital Heart Disease
Authors: Chock Valerie , Lee Henry C.
Published: August 2014

Owing to advances in the care of infants with congenital heart disease, more patients are surviving not only infancy, but into adulthood. Therefore, there is a growing emphasis on the potential for long-term disability and quality of life in these patients. Follow-up studies have shown an increased risk for adverse neurodevelopmental outcomes. Unlike some patients who may have one underlying risk for neurologic disability, patients with congenital heart disease often have multiple risk factors, which may be inherent to the patient’s condition or may be potentially modifiable. Recent advances in neuroimaging, surgical techniques, and perioperative care may help to inform our evaluation and treatment of infants with congenital heart disease so as to optimize outcomes.
Introduction: The Solar Corridor Concept
Authors: Kremer Robert J. , Deichman C. LeRoy
Published: August 2014

The solar corridor crop system (SCCS) is a method to improve crop yields by rearranging the spatial positioning of plants in an alternative crop architecture designed to maximize the capture of solar radiation and to improve crop growth. The SCCS is an advancement of strip intercropping based on cultivating two or more crops simultaneously in different strips across the field for greater use of solar radiation, water, and nutrients compared with either of the component crops grown in monoculture. A properly developed SCCS offers the potential to increase sustainable corn (Zea mays L.) yields. Understanding the various physiological and cultural factors that contribute to grain yield and soil conservation benefits of the SCCS is needed as a foundation for implementing long‐term and replicated field studies to validate this production system. This need was the impetus for two International American Society of Agronomy symposia: “The Solar Corridor Concept” (2011) and “The Solar Corridor's Potential to Increase Solar Radiation Use Efficiency” (2012). Articles in this special Agronomy Journal section address key symposia themes including physiological indices developed to describe the response of crops to growth factors; cultural practices for enhancing effects of physiological factors in crop growth; and field assessments of the SCCS for agronomic performance and soil quality effects. Thus, an up‐to‐date understanding of the physiological, cultural, and soil quality factors that are basic to the solar corridor is provided, which is an important and critical aid for future evaluation necessary for practical development of the SCCS as an option for corn production.
Vernalization Duration Requirement in Soft Winter Wheat is Associated with Variation at the VRN‐B1 Locus
Authors: Guedira Mohammed , Maloney Peter , Xiong Mai , Petersen Stine , Murphy J. Paul , Marshall David , Johnson Jerry , Harrison Steve , Brown‐Guedira Gina
Published: August 2014

Genetic variation in the factors controlling flowering in wheat (Triticum aestivum L.) allow it to be grown in a wide range of environments. The aim of this study was to identify genetic determinants of flowering time in winter wheat cultivars adapted to regions of the United States differing in latitude and the duration of cold temperatures during winter. Quantitative trait locus (QTL) analysis was performed in a recombinant inbred line (RIL) population from the cross between cultivars NC‐Neuse and AGS 2000 that are adapted to the Mid‐Atlantic and Southeastern regions, respectively. We identified a QTL for heading date (HD) in the greenhouse after 4 wk of vernalization, designated Qvdr.nc‐5BL, which also had a large effect on winter dormancy release and HD when the population was evaluated in the field at locations in North Carolina, Georgia, and Louisiana during 2012 and North Carolina during 2013. However, Qvdr.nc‐5BL did not have a significant effect on HD in greenhouse grown plants vernalized for 8 wk or in plants grown in the field at Raleigh, NC during 2011. In those environments where Qvdr.nc‐5BL was not significant, a region on chromosome 2B, probably associated with the Ppd‐B1 locus, was determined to have a HD effect. Interrogation of the population with gene‐based markers for Vrn‐B1 and Ppd‐B1 suggests that these loci are major determinants of HD in winter wheat and are important for adaptation to diverse growing environments.
The Reflective Plant Breeding Paradigm: A Robust System of Germplasm Development to Support Strategic Diversification of Agroecosystems
Authors: Runck Bryan C. , Kantar Michael B. , Jordan Nicholas R. , Anderson James A. , Wyse Donald L. , Eckberg James O. , Barnes Richard J. , Lehman Clarence L. , DeHaan Lee R. , Stupar Robert M. , Sheaffer Craig C. , Porter Paul M.
Published: August 2014

Over the last half‐century, crop breeding and agronomic advances have dramatically enhanced yields in temperate summer‐annual cropping systems. Now, diversification of these cropping systems is emerging as a strategy for sustainable intensification, potentially increasing both crop production and resource conservation. In temperate zones, diversification is largely based on the introduction of winter‐annual and perennial crops at spatial and temporal locations in annual‐crop production systems that efficiently increase production and resource conservation. Germplasm development will be critical to this strategy, but we contend that to be feasible and efficient, germplasm improvement must be closely integrated with commercialization of these crops. To accomplish this integration, we propose a novel approach to germplasm development: the reflective plant breeding paradigm (RPBP). Our approach is enabled by developments in genomics, agroecosystem management, and innovation theory and practice. These developments and new plant‐breeding technologies (e.g., low‐cost sequencing, phenotyping, and spatial modeling of agroecosystems) now enable germplasm development to proceed on a time scale that enables close coordination of breeding and commercialization (i.e, development of cost‐effective production systems and supply–value chains for end‐use markets). The RPBP approach is based on close coordination of germplasm development with enterprise development. In addition to supporting strategic diversification of current annual‐cropping systems, the RPBP may be useful in rapid adaptation of agriculture to climate change. Finally, the RPBP may offer a novel and distinctive pathway for future development of the public plant‐breeding programs of land‐grant universities with implications for graduate education for public‐ and private‐sector plant breeders.
The Myth of Rigorous Accounting Research
Authors: Williams Paul F.
Published: August 2014

SYNOPSIS

In this brief paper, I provide an argument that the rigor that allegedly characterizes contemporary mainstream accounting research is a myth. Expanding on arguments provided by West (2003), Gillies (2004), and Williams (1989), I show that the numbers utilized extensively to construct the statistical models that are the central defining feature of rigorous accounting research are, in many cases, not adequate to the task. These numbers are operational numbers that cannot be construed as measures or quantities of any kind of stable property. Constructing elaborate calculative models using operational numbers leads to equations whose results are not clearly decipherable. The rigorous nature of certain preferred forms of accounting research is, thus, largely a matter of appearance and not a substantive quality of the research mode that we habitually label “rigorous.” Thus, the policy recommendations implied by the results of rigorous accounting research may be viewed with considerable skepticism.
Influence of No-Ferrule and No-Post Buildup Design on the Fatigue Resistance of Endodontically Treated Molars Restored With Resin Nanoceramic CAD/CAM Crowns
Authors: Magne P , Carvalho AO , Bruzi G , Anderson RE , Maia HP , Giannini M
Published: August 2014

Objectives

To evaluate the influence of adhesive core buildup designs—4-mm buildup, 2-mm buildup, and no buildup (endocrown)—on the fatigue resistance and failure mode of endodontically treated molar teeth restored with resin nanoceramic (RNC) CAD/CAM complete crowns placed with self-adhesive resin cement.

Methods and Materials

Forty-five extracted molars were decoronated at the level of the cementoenamel junction, and the roots were endodontically treated. Specimens received different Filtek Z100 adhesive core buildups (4-mm buildup, 2-mm buildup, and no buildup, endocrown preparation) and were restored with Cerec 3 CAD/CAM RNC crowns (Lava Ultimate). Restorations (n=15) and prepared teeth were treated with airborne-particle abrasion, followed by cementation with RelyX Unicem 2 Automix. Specimens were then subjected to cyclic isometric loading at 10 Hz, beginning with a load of 200 N (for 5000 cycles), followed by stages of 400, 600, 800, 1000, 1200, and 1400 N at a maximum of 30,000 cycles each. Specimens were loaded until failure or to a maximum of 185,000 cycles (10-mm-diameter composite resin sphere antagonist). The failure mode was assessed: “catastrophic” (tooth/root fracture that would require tooth extraction), “possibly reparable” (cohesive/adhesive failure with fragment and minor damage, chip or crack, of underlying tooth structure), or “reparable” fracture (cohesive or cohesive/adhesive fracture of restoration only). Groups were compared using the life table survival analysis. Intact specimens were loaded to failure and compared with one-way analysis of variance.

Results

All specimens survived the fatigue test until the 800 N-step. The survival rates for 4-mm, 2-mm, and no buildup (endocrown) were 53%, 87%, and 87%, respectively, and were not statistically different even though crowns with 2-mm buildups only started to fail at 1200 N. Minor cohesive chips were detected in many samples despite having survived all 185,000 cycles. Postfatigue load-to-failure ranged from 2969 N with 4-mm buildup (eight specimens), 2794 N for 2-mm buildup (13 specimens), and 2606 N for endocrowns (13 specimens) and were also not statistically different. There were only two catastrophic failures during the fatigue test and small subgingival delamination fractures and cracks (only with 4-mm buildup). All specimens in the load-to-failure test exhibited nonrestorable catastrophic fractures.

Conclusions

There was no influence of the buildup design on the performance of endodontically treated molars restored with RNC CAD/CAM complete crowns placed with self-adhesive cement. All restoration designs survived the normal range of masticatory forces. Failure mode tended to be more favorable with the 2-mm buildup or no buildup (endocrown).
Resistive Inspiratory Muscle Training in People With Spinal Cord Injury During Inpatient Rehabilitation: A Randomized Controlled Trial
Authors: Postma Karin , Haisma Janneke A. , Hopman Maria T.E. , Bergen Michael P. , Stam Henk J. , Bussmann Johannes B.
Published: August 2014

Background

People with spinal cord injury (SCI) may benefit from resistive inspiratory muscle training (RIMT). Current evidence is weak, and little is known about the effect on functional outcomes and long-term effects.

Objective

The purpose of this study was to assess immediate and long-term effects of RIMT in people with SCI.

Design

This was a single-blinded randomized controlled trial.

Setting

The study was conducted at 4 specialized SCI units in the Netherlands.

Patients

The study participants were 40 people with SCI (15 with motor complete tetraplegia, 16 with incomplete tetraplegia, 8 with motor complete paraplegia, and 1 with incomplete paraplegia) who had impaired pulmonary function and were admitted for initial inpatient rehabilitation.

Intervention

Study participants were randomized to an RIMT group or a control group. All participants received usual rehabilitation care. In addition, participants in the intervention group performed RIMT with a threshold trainer.

Measurements

Measurements were performed at baseline, after 8 weeks of intervention, 8 weeks later, and 1 year after discharge from inpatient rehabilitation. Primary outcome measures were: respiratory muscle function, lung volumes and flows, and perceived respiratory function. Secondary outcome measures concerned patient functioning, which included health-related quality of life, limitations in daily life due to respiratory problems, and respiratory complications.

Results

During the intervention period, maximum inspiratory pressure (MIP) improved more in the RIMT group than in the control group (11.7 cm H2O, 95% confidence interval=4.3 to 19.0). At follow-up, this effect was no longer significant. No effect on other primary or secondary outcome measures was found except for an immediate effect on mental health.

Limitations

The sample size was insufficient to study effects on respiratory complications.

Conclusions

Resistive inspiratory muscle training has a positive short-term effect on inspiratory muscle function in people with SCI who have impaired pulmonary function during inpatient rehabilitation.
Holospinal epidural abscess of the spinal axis: two illustrative cases with review of treatment strategies and surgical techniques
Authors: Smith Gabriel A. , Kochar Arshneel S. , Manjila Sunil , Onwuzulike Kaine , Geertman Robert T. , Anderson James S. , Steinmetz Michael P.
Published: August 2014

Despite the increasing prevalence of spinal infections, the subcategory of holospinal epidural abscesses (HEAs) is extremely infrequent and requires unique management. Panspinal imaging (preferably MRI), modern aggressive antibiotic therapy, and prompt surgical intervention remain the standard of care for all spinal axis infections including HEAs; however, the surgical decision making on timing and extent of the procedure still remain ill defined for HEAs. Decompression including skip laminectomies or laminoplasties is described, with varied clinical outcomes. In this review the authors present the illustrative cases of 2 patients with HEAs who were treated using skip laminectomies and epidural catheter irrigation techniques. The discussion highlights different management strategies including the role of conservative (nonsurgical) management in these lesions, especially with an already identified pathogen and the absence of mass effect on MRI or significant neurological defects.

Among fewer than 25 case reports of HEA published in the past 25 years, the most important aspect in deciding a role for surgery is the neurological examination. Nearly 20% were treated successfully with medical therapy alone if neurologically intact. None of the reported cases had an associated cranial infection with HEA, because the dural adhesion around the foramen magnum prevented rostral spread of infection. Traditionally a posterior approach to the epidural space with irrigation is performed, unless an extensive focal ventral collection is causing cord compression. Surgical intervention for HEA should be an adjuvant treatment strategy for all acutely deteriorating patients, whereas aspiration of other infected sites like a psoas abscess can determine an infective pathogen, and appropriate antibiotic treatment may avoid surgical intervention in the neurologically intact patient.
Perioperative morbidity and mortality comparison in circumferential cervical fusion for osteomyelitis versus cervical spondylotic myelopathy
Authors: Wadhwa Rishi , Mummaneni Praveen V. , Lau Darryl , Le Hai , Chou Dean , Dhall Sanjay S.
Published: August 2014

Object

The most common indications for circumferential cervical decompression and fusion are cervical spondylotic myelopathy (CSM) and cervical osteomyelitis (COM). Currently, the informed consent process prior to circumferential cervical fusion surgery is not different for these two groups of patients, as details of their diagnosis-specific risk profiles have not been quantified. The authors compared two patient cohorts with either CSM or COM treated using circumferential fusion. They sought to quantify perioperative morbidity and postoperative mortality in these two groups to assist with a diagnosis-specific informed consent process for future patients undergoing this type of surgery.

Methods

Perioperative and follow-up data from two cohorts of patients who had undergone circumferential cervical decompression and fusion were analyzed. Estimated blood loss (EBL), length of stay (LOS), perioperative complications, hospital readmission, 30-day reoperation rates, change in Nurick grade, and mortality were compared between the two groups.

Results

Twenty-two patients were in the COM cohort, and 24 were in the CSM cohort. Complications, hospital readmission, 30-day reoperation rates, EBL, and mortality were not statistically different, although patients with COM trended higher in each of these categories. There was a significantly greater LOS (p < 0.001) in the COM group and greater improvement in Nurick grade in the CSM group (p < 0.001).

Conclusions

When advising patients undergoing circumferential fusion about perioperative risk factors, it is important for those with COM to know that they are likely to have a higher rate of complications and mortality than those with CSM who are undergoing similar surgery. Furthermore, COM patients have less neurological improvement than CSM patients after surgery. This information may be useful to surgeons and patients in providing appropriate informed consent during preoperative planning.
Timing in the surgical evacuation of spinal epidural abscesses
Authors: Ghobrial George M. , Beygi Sara , Viereck Matthew J. , Maulucci Christopher M. , Sharan Ashwini , Heller Joshua , Jallo Jack , Prasad Srinivas , Harrop James S.
Published: August 2014

Object

One often overlooked aspect of spinal epidural abscesses (SEAs) is the timing of surgical management. Limited evidence is available correlating earlier intervention with outcomes. Spinal epidural abscesses, once a rare diagnosis carrying a poor prognosis, are steadily becoming more common, with one recent inpatient meta-analysis citing an approximate incidence of 1 in 10,000 admissions with a mortality approaching 16%. One key issue of contention is the benefit of rapid surgical management of SEA to maximize outcomes. Timing of surgical management is definitely one overlooked aspect of care in spinal infections. Therefore, the authors performed a retrospective analysis in which they evaluated patients who underwent early (evacuation within 24 hours) versus delayed surgical intervention (> 24 hours) from the point of diagnosis, in an attempt to test the hypothesis that earlier surgery results in improved outcomes.

Methods

A retrospective review of a prospectively maintained adult neurosurgical database from 2009 to 2011 was conducted for patients with the diagnostic heading: epidural abscess, infection, osteomyelitis, osteodiscitis, spondylodiscitis, and abscess. The primary end point for each patient was neurological grade, measured as an American Spinal Injury Association Impairment Scale grade using hospital inpatient records on admission and discharge. Patients were divided into early surgical (< 24 hours) and delayed surgical cohorts.

Results

Eighty-seven consecutive patients were identified (25 females; mean age 55.5 years, age range 18–87 years). Fifty-four patients received surgery within 24 hours of admission (mean time from admission to incision, 11.2 hours), and 33 underwent surgery longer than 24 hours (mean 59 hours) after admission. Of the 54 patients undergoing early surgery 45 (85%) had a neurological deficit, whereas in the delayed surgical group 21 (64%) of 33 patients presented with a neurological deficit (p = 0.09). Patients in the delayed surgery cohort were significantly older by 10 years (59.6 vs 51.8 years, p = 0.01). With regard to history of prior revision, body mass index, intravenous drug abuse, tobacco use, prior radiation therapy, diabetes, chronic systemic infection, and prior osteomyelitis, there were no significant differences. There was no significant difference between early and delayed surgery groups in neurological grade on presentation, discharge, or location of epidural abscess. The most common organism isolated was Staphylococcus aureus (n = 51, 59.3%). The incidence of methicillin-resistant S. aureus was 21% (18 of 87).

Conclusions

Evacuation within 24 hours appeared to have a relative advantage over delayed surgery with regard to discharge neurological grade. However, due to a limited, variable sample size, a significant benefit could not be shown. Further subgroup analyses with larger populations are required.
Medical and surgical management of spinal epidural abscess: a systematic review
Authors: Arko Leopold , Quach Eric , Nguyen Vincent , Chang Daniel , Sukul Vishad , Kim Bong-Soo
Published: August 2014

Object

Spinal epidural abscess (SEA) is a rare condition that has previously been treated with urgent surgical decompression and antibiotics. Recent availability of MRI makes early diagnosis possible and allows for the nonoperative treatment of SEA in select patients. The first retrospective review of medically and surgically managed SEA was published in 1999, and since that time several other retrospective institutional reports have been published. This study reviews these published reports and compares pooled data with historical treatment data.

Methods

A PubMed keyword and Boolean search using (“spinal epidural abscess” OR “spinal epidural abscesses” AND [management OR treatment]) returned 429 results. Filters for the English language and publications after 1999 were applied, as the first study comparing operative and nonoperative management was published that year. Articles comparing operative to nonoperative treatment strategies for SEA were identified, and the references were further reviewed for additional articles. Studies involving at least 10 adult patients (older than 18 years) were included. Case reports, studies reporting either medical or surgical management only, studies not reporting indications for conservative management, or studies examining SEA as a result of a specific pathogen were excluded.

Results

Twelve articles directly comparing surgical to nonsurgical management of SEA were obtained. These articles reported on a total of 1099 patients. The average age of treated patients was 57.24 years, and 62.5% of treated patients were male. The most common pathogens found in blood and wound cultures were Staphylococcus aureus (63.6%) and Streptococcus species (6.8%). The initial treatment was surgery in 59.7% of cases and medical therapy in 40.3%. This represented a significant increase in the proportion of medically managed patients in comparison with the historical control prior to 1999 (p < 0.05). Patients with no neurological deficits were significantly more likely to be treated medically than surgically (p < 0.05). There was no statistically significant difference overall between surgical and nonsurgical management, although several risk factors may predict failure of medical management.

Conclusions

. Since the first reports of nonoperative treatment of SEA, there has been a substantial trend toward treating neurologically intact patients with medical management. Nevertheless, medical therapy fails in a fair number of cases involving patients with specific risk factors, and patients with these risk factors should be closely observed in consideration for surgery. Further research may help identify patients at greater risk for failure of medical therapy.
An institutional series and contemporary review of bacterial spinal epidural abscess: current status and future directions
Authors: Shweikeh Faris , Saeed Kashif , Bukavina Laura , Zyck Stephanie , Drazin Doniel , Steinmetz Michael P.
Published: August 2014

Object

Over the past decade, the incidence of bacterial spinal epidural abscess (SEA) has been increasing. In recent years, studies on this condition have been rampant in the literature. The authors present an 11-year institutional experience with SEA patients. Additionally, through an analysis of the contemporary literature, they provide an update on the challenging and controversial nature of this increasingly encountered condition.

Methods

An electronic medical record database was used to retrospectively analyze patients admitted with SEA from January 2001 through February 2012. Presenting symptoms, concurrent conditions, microorganisms, diagnostic modalities, treatments, and outcomes were examined. For the literature search, PubMed was used as the search engine. Studies published from January 1, 2000, through December 31, 2013, were critically reviewed. Data from articles on methodology, demographics, treatments, and outcomes were recorded.

Results

A total of 106 patients with bacterial SEA were identified. The mean ± SD age of patients was 63.3 ± 13.7 years, and 65.1% of patients were male. Common presenting signs and symptoms were back pain (47.1%) and focal neurological deficits (47.1%). Over 75% of SEAs were in the thoracolumbar spine, and over 50% were ventral. Approximately 34% had an infectious origin. Concurrent conditions included diabetes mellitus (35.8%), vascular conditions (31.3%), and renal insufficiency/dialysis (30.2%). The most commonly isolated organism was Staphylococcus aureus (70.7%), followed by Streptococcus spp. (6.6%). Surgery along with antibiotics was the treatment for 63 (59.4%) patients. Surgery involved spinal fusion for 19 (30.2%), discectomy for 14 (22.2%), and corpectomy for 9 (14.3%). Outcomes were reported objectively; at a mean ± SD follow-up time of 8.4 ± 26 weeks (range 0–192 weeks), outcome was good for 60.7% of patients and poor for 39.3%. The literature search yielded 40 articles, and the authors discuss the result of these studies.

Conclusions

Bacterial SEA is an ominous condition that calls for early recognition. Neurological status at the time of presentation is a key factor in decision making and patient outcome. In recent years, surgical treatment has been advocated for patients with neurological deficits and failed response to medical therapy. Surgery should be performed immediately and before 36–72 hours from onset of neurological sequelae. However, the decision between medical or surgical intervention entails individual patient considerations including age, concurrent conditions, and objective findings. An evidence-based algorithm for diagnosis and treatment is suggested.
Mechanical yield of the lumbar annulus: a possible contributor to instability
Authors: Stemper Brian D. , Baisden Jamie L. , Yoganandan Narayan , Shender Barry S. , Maiman Dennis J.
Published: August 2014

Object

Segmental instability in the lumbar spine can result from a number of mechanisms including intervertebral disc degeneration and facet joint degradation. Under traumatic circumstances, elevated loading may lead to mechanical yield of the annular fibers, which can decrease load-carrying capacity and contribute to instability. The purpose of this study was to quantify the biomechanics of intervertebral annular yield during tensile loading with respect to spinal level and anatomical region within the intervertebral disc.

Methods

This laboratory-based study incorporated isolated lumbar spine annular specimens from younger and normal or mildly degenerated intervertebral discs. Specimens were quasi-statically distracted to failure in an environmentally controlled chamber. Stress and strain associated with yield and ultimate failure were quantified, as was stiffness in the elastic and postyield regions. Analysis of variance was used to determine statistically significant differences based on lumbar spine level, radial position, and anatomical region of the disc.

Results

Annular specimens demonstrated a nonlinear response consisting of the following: toe region, linear elastic region, yield point, postyield region, and ultimate failure point. Regional dependency was identified between deep and superficial fibers. Mechanical yield was evident prior to ultimate failure in 98% of the specimens and occurred at approximately 80% and 74% of the stress and strain, respectively, to ultimate failure. Fiber modulus decreased by 34% following yield.

Conclusions

Data in this study demonstrated that yielding of intervertebral disc fibers occurs relatively early in the mechanical response of the tissues and that stiffness is considerably decreased following yield. Therefore, yielding of annular fibers may result in decreased segmental stability, contributing to accelerated degeneration of bony components and possible idiopathic pain.
Pelvic reconstruction after subtotal sacrectomy for sacral chondrosarcoma using cadaveric and vascularized fibula autograft
Authors: Gillis Christopher C. , Street John T. , Boyd Michael C. , Fisher Charles G.
Published: August 2014

A novel method of spinopelvic ring reconstruction after partial sacrectomy for a chondrosarcoma is described. Chondrosarcoma is one of the most common primary malignant bone tumors, and en bloc resection is the mainstay of treatment. Involvement of the pelvis as well as the sacrum and lumbar spine can result in a technically difficult challenge for en bloc resection and for achievement of appropriate load-bearing reconstruction.

After en bloc resection in their patient, the authors achieved reconstruction with a rod and screw construct including vascularized fibula graft as the main strut from the lumbar spine to the pelvis. Additionally, a cadaveric allograft strut was used as an adjunct for the pelvic ring. This is similar to a modified Galveston technique with vascularized fibula in place of the Galveston rods. The vascularized fibula provided appropriate biomechanical support, allowing the patient to return to independent ambulation. There was no tumor recurrence; neurological status remained stable; and the allograft construct integrated well and even increased in size on CT scans and radiographs in the course of a follow-up longer than 7 years.
Development of a de novo arteriovenous malformation after severe traumatic brain injury
Authors: Miller Brandon A. , Bass David I. , Chern Joshua J.
Published: August 2014

Arteriovenous malformations (AVMs) are typically considered congenital lesions, although there is growing evidence for de novo formation of these lesions as well. The authors present the case of an AVM in the same cerebral cortex that had been affected by a severe traumatic brain injury (TBI) more than 6 years earlier. To the best of the authors' knowledge, this is the first report attributing the formation of an AVM directly to TBI.
Bioethics Teaching and Assessment: My Experience of Three Institutes
Authors: Rafique Zoheb
Published: August 2014

This paper describes my experience of teaching bioethics in different institutes and degree courses at undergraduate level. Bioethics is being taught to improve the understanding of the ethical issues in the field of medicine. The students are being trained in bioethics to recognize and resolve different ethical dilemmas and also to combat the situations where ethical analysis is needed. This paper also focuses on teaching and assessment methods for undergraduate courses. DOI: http://dx.doi.org/10.3329/bioethics.v5i2.19577 Bangladesh Journal of Bioethics 2014; 5(2):44-48
The Nijmegen Method of Case Deliberation and Clinical Decision in a Multicultural Society
Authors: Kazeem Fayemi Ademola
Published: August 2014

The Nijmegen method of ethical case deliberation is one of the ways of reflecting, clarifying, evaluating and making decisions about moral problems, conflicts and dilemmas in the clinical settings. It is a hybrid concentration of relevant ideas from different normative ethical traditions applied to the clinical practices. As a team multidisciplinary based deliberation, the method involves a professional ethicist serving as both a critical tutor and a facilitator in the process of deliberating and arriving at most ethical decision in clinical dilemmas. In such process, the Nijmegen method is not a democratic replacement of the decision and responsibility of the healthcare team. Rather it helps to motivate rational decision and reasoned responsibility in healthcare through consensus building which does not attenuate moral uprightness. The Nijmegen method is part of the healthcare process and aims at improving communication among patient, family and the healthcare team as well as enriching the decision making process. It is a promising method in resolving moral dilemmas in healthcare especially in multicultural societies. Besides enhancing the quality and transparency of the decision making process, ethical case deliberation on the ward using the Nijmegen method has prospect of serving as a baseline in guiding through similar dilemmas in the future. DOI: http://dx.doi.org/10.3329/bioethics.v5i2.19618 Bangladesh Journal of Bioethics 2014 Vol.5(2):73-79
BBS News Vol.5(2)
Authors: Lasker Shamima Parvin
Published: August 2014

DOI: http://dx.doi.org/10.3329/bioethics.v5i2.19622
Efficacy of Some Antibiotics used for the Treatment of Diseased Koi (Anabas Testudineus) Fish
Authors: Rashid Md Mamnur , Ali Muhammad Forhad , Rahman Muhammad Mamunur , Saha Ashish Kumar
Published: August 2014

Naturally diseased climbing perch Anabas testudineus was confirmed to be caused by Aeromonas hydrophila bacteria by aeromonas isolation medium (AIM), 0/129 vibriostatic agent and esculin hydrolysis. Such naturally diseased koi fish weretreated with four antibiotics: captor (chlortetracycline hydrochloride BP 45%), renamox 15% -Vet (amoxicillin trihydrate BP), oxy-Dox-F (oxytetracycline 20% and + doxycycline 10%), renaquine 20% -Vet (flumequine) at lower, recommended and higher doses were performed to examine the efficacy of the drugs. Captor was given at doses of 0.8, 1.0 and 1.2 g/3 litres of water separately. Doses of renamox 15% -Vet were given at 0.8, 1.0 and 1.2 g/litre of water. Doses of oxy-Dox-F were 0.8, 1.0 and 1.5 g/Kg body weight and doses of renaquine were 10, 12, and 15 mg/Kg body weight. Among the four antibiotics, effect of captor and renaquine at recommended dose showed the best result where 100% fish were recovered. However, renamox and oxy-Dox-F showed best result at higher dose. DOI: http://dx.doi.org/10.3329/mh.v3i1.19770 Microbes and Health, June 2014. 3(1): 7-8
Prevalence and Characterization of Escherichia coli from Rectal Swab of Apparently Healthy Cattle in Mymensingh, Bangladesh
Authors: Hassan Jayedul , Parvej Md Shafiullah , Rahman Md Bahanur , Khan Md Shahidur Rahman , Rahman Md Tanvir , Kamal Tazrin , Nazir KHM Nazmul Hussain
Published: August 2014

Cattle are considered as one of the sources of pathogenic E. coli worldwide. The present study was designed to determine the prevalence and identification of the E. coli isolated from rectal swab of apparently healthy cattle in Mymensingh, Bangladesh. A total of 128 rectal swab samples were assessed by cultural, morphological and biochemical examination followed by Polymerase Chain Reaction (PCR) using primers ECO-1 and ECO-2 that are specific for E. coli 16S rRNA gene. Data obtained from this study were analyzed based on the age, sex, breed and management systems of cattle. This study revealed a 75% prevalence of E. coli in the rectal swab of cattle. Higher prevalence was found in female cattle of unorganized farming systems, and in cattle ?3 years of age. From this study, it may be concluded that, irrespective of age, sex, breed and management system, E. coli is prevailing in the rectal swab of apparently healthy cattle. DOI: http://dx.doi.org/10.3329/mh.v3i1.19775 Microbes and Health, June 2014. 3(1): 12-14
Pedaling Through the Past: Sport Heritage, Tourism Development, and the Tour of Flanders
Authors: Ramshaw Gregory , Bottelberghe Tim
Published: August 2014

Sport and heritage, individually, are widely viewed as important catalysts in tourism development. However, the potential role that combining sport and heritage could have in tourism development initiatives is little understood. This article considers the tourism development potential
of sport heritage via the Tour of Flanders—a nearly century-old 1-day cycling race held each spring in the Flanders region of Belgium—by discussing the role of heritage in cycling tourism, the background of the race, current local tourism challenges surrounding the race, and potential
avenues for developing heritage sport tourism year round in the region. It is argued that the Tour of Flanders case suggests that sport heritage could be a potentially important avenue for tourism development, although it may need to be combined with other forms of local non-sport heritage
to reach a broader, international audience. Furthermore, it is speculated that developing a sport heritage emphasis may also positively contribute to addressing other tourism challenges, such as place promotion. The article concludes that further testing and evaluation is required to demonstrate
the link between sport heritage and tourism development, particularly as demonstrated through the Tour of Flanders.