bluuebunny/crossref_metadata_2025 huggingface dataset:
Amidino Thiourea as a Secondary Accelerator in the Sulphur Vulcanization of Natural Rubber Containing Fillers
Authors: Kurien Mary , Susamma A. P. , Kuriakose A. P.
Published: September 2018

As a part of our study on the mechanism of vulcanization we investigated a number of thiourea derivatives as secondary accelerators in the sulphur vulcanization of natural rubber. In the present study, the accelerator activity of a new binary accelerator system containing unsubstituted amidinothiourea viz. aminoiminomethyl thiourea (ATU) along with different primary accelerators has been examined. Different fillers like carbon black, silica and china clay are incorporated in these mixes under review. Various compositions of ATU are examined for the above vulcanization study. The optimum concentration of this secondary accelerator in different systems has also been derived. The mixes are examined for different cure characteristics and the vulcanizates are evaluated for their physical properties. In order to study the effect of the secondary accelerator on the temperature of vulcanization, these mixes are cured and evaluated at two different temperatures, viz. 120o and at 150oC. The correlation between physical properties and chemical cross links in the different vulcanizates is also examined by determining the cross link density values of the vulcanizates. These binary systems are found to be effective in the filled systems studied. The optimum cure time has been found to be reduced considerably by this secondary accelerator. At the lower temperature i.e., at 120°C, the reduction in cure time is found to be more significant with increase in the concentration of ATU especially when compared with systems containing thiourea. ATU being more nucleophilic than thiourea this points to a nucleophilic reaction mechanism in these vulcanization reactions. The tensile properties of the vulcanizates from these systems are better/comparable to those of the reference mixes. There is favourable increase in many of the physical properties like hardness, compression set, abrasion loss, tear strength etc. The crosslink density values evaluated also support the above conclusions. The non-toxic nature of ATU, which is used in pharmaceutical applications, is an added advantage in this context.
Sandwich Injection Moulding of Thermosetting Materials. Part I: Initial Experiments
Authors: Kiatmanaroj S. , Goodship V. , Smith G.F.
Published: September 2018

Thermoset co-injection moulding is a novel technology that might be an alternative for thermoset recycling. This paper describes some experiments on the sandwich moulding of two polyesters, a powder coating and a BMC using a new special design thermoset co-injection machine and manifold system. The first thermoset sandwich moulding has been made and a number of initial moulding problems are presented and discussed.
Regeneration of Carbon Black from Waste Automobile Tyres and its Use in Carcass Compound
Authors: Mandal Nilkanta , Gupta Saikat Das , Mukhopadhyaya R.
Published: September 2018

Post-consumer tyre provide a real challenge for recovery and re-use, since they must be disposed of in an environmentally sound and sustainable manner. Pyrolysis has proved an attractive method. The authors have already established a process of pyrolysis to regenerate the carbon black from waste tyres; it was elaborated in an earlier paper.

The regenerated blacks(RB) have now been characterized by various methods. They were mixed in a typical virgin carcass compound, the required properties of the mixed compounds were measured, and then the compounds were cured under standard conditions of time and temperature. The physico-mechanical properties of the cured specimens were measured and compared to those of samples made using virgin (VB) and heat-treated blacks (HTB). It was concluded that the regenerated black has a higher surface area, and gives a higher elongation at break, with a higher heat build up, lower cure rate and lower modulus than virgin blacks, but a comparable state of cure, dispersion, hardness, tensile strength, tear strength and high adhesion strength. It was also found that regenerated black had a slightly different structure and agglomerate size. Some polar groups were incorporated into the carbon black, either during pyrolysis or during heat treatment. The regenerated black gave better ageing properties than the virgin or heat-treated blacks.
Cure Characteristics and Mechanical Properties of NR/ SBR Blends Filled with Nano-sized CaCO3
Authors: Wan Chaoying , Zhang Yong , Zhu Yin , Zhang Yinxi
Published: September 2018

Four kinds of nano-sized calcium carbonate (CaCO3) surface-modified with stearic acid, aluminate, titanate and aluminate-titanate complex coupling agents, were used to reinforce natural rubber (NR)/styrene-butadiene rubber (SBR) blends. The effects of surface modification and CaCO3 content on the cure characteristics, swelling behaviour, and mechanical properties of NR/SBR blends were studied. The surface modification of CaCO3 improved the processing and mechanical properties, and the stearic acid coated CaCO3 (SA-CaCO3) had finer dispersion and produced a better reinforcement effect than the other modified CaCO3. Furthermore, a commercial high abrasion furnace carbon black (HAF) was used for comparison. The results showed that both CaCO3 and HAF increased the cure rate, reduced the optimum cure time and improved the mechanical properties of NR/SBR blends at appropriate filler contents. The tensile strength of filled NR/SBR composites reached its maximum value when the SA-CaCO3 content was 50 phr or the HAF content was 30 phr. The modulus at 200%, tear strength, and Shore A hardness of filled NR/SBR composites all increased with increasing filler content. The CaCO3 reinforced the NR/SBR blends to some extent, though it was still not as effective as HAF.
Yeast as Coupling Agent for Corn Filler in Tyre Tread Compound
Authors: Agrawal S.L. , Mandot S.K. , Mandal N. , Bandyopadhyay S. , Mukhopadhyay R. , Deuri A.S. , Mallik R. , Bhowmick A.K.
Published: September 2018

Tyre manufacturers are continually developing energy efficient, low rolling resistance tyres, using more and more naturally occurring materials, with minimum depletion of petroleum/natural resources. Of all the components of a typical tyre, the tread component contributes most to rolling resistance properties. So continuous efforts are in progress around the globe to develop suitable tread compounds in order to fulfil the above criteria with different filler combinations, including treated fillers. In the present study, the effect of a naturally occurring coupling agent, yeast, was investigated in the context of a corn – carbon black filler system, and the results were compared with those for corn powder treated with a silane coupling agent – carbon black system in a radial passenger tyre tread compound. The yeast increased polymer-filler interaction significantly by modifying the corn surface, giving rise to optimum properties for the tread compound.
Use of Recycled Tyre Material in Natural Rubber based Tyre Tread Cap Compound: Part I (with Ground Crumb Rubber)
Authors: Bandyopadhyay S. , Dasgupta S. , Mandal N. , Agrawal S.L. , Mandot S.K. , Mukhopadhyay R. , Deuri A.S. , Ameta Suresh C.
Published: September 2018

For both environmental and economic reasons, there is a continuing broad-based interest in the recycling of scrap rubber and therefore in the development of recycling technologies. In the present work three different sizes of mechanically ground Indian crumb rubbers were used in a natural rubber (NR) based tyre tread cap compound. Varying doses of crumb rubber were used as an additional compounding ingredient. The minimum torque and Mooney viscosity values were marginally increased with increasing dose and mesh size of crumb rubber. In a Rubber Process Analyser (RPA) study, the Payne effect before curing was marginally higher for compounds containing crumb rubber, while, after curing a comparable Payne effect was observed with respect to the control compound without having crumb rubber. A marginal deterioration in tensile strength, fatigue to failure and abrasion properties was observed. At all levels of usage, the 100 mesh size ground crumb rubber retained the properties better than other lower mesh size crumb rubbers.
Studies on Synthesis and Characterisation of Zinc Butyl Xanthate and its Room Temperature Curing Property in Natural Rubber
Authors: Palaty Shiny , Joseph Rani
Published: September 2018

Zinc butyl xanthate [Zn(bxt)2] was prepared in the laboratory. It was purified by reprecipitation and was characterised by infrared spectroscopy (IR), Proton Magnetic Resonance spectroscopy (H-NMR) and thermogravimetric analysis (TGA) techniques. Gum and black filled natural rubber (NR) compounds were prepared using zinc butyl xanthate alone and zinc butyl xanthate in combination with zinc diethyl dithiocarbamate (ZDC) as accelerators and were cured at room temperature. The sheets were moulded and properties such as tensile strength, tear strength, crosslink density, elongation at break, compression set, abrasion resistance etc. were evaluated. NR latex was compounded using Zn(bxt)2/ZDC accelerator combination. It was prevulcanised at room temperature and properties like mechanical stability time (MST), pH, potassium hydroxide (KOH) number and Volatile fatty acid (VFA) number of the prevulcanised latex were measured. Sheets were prepared by casting and tensile properties were measured. The results showed that Zn(bxt)2 and Zn(bxt)2/ZDC combination were effective for the vulcanisation of NR and NR latex at room temperature.
Radiation-Cured Nanocomposites Based on Diene Rubber and Nanoclay
Authors: Cataldo Franco , Ursini Ornella , Angelini Giancarlo
Published: September 2018

SBR/BR-based rubber nanocomposites filled with carbon black (65 phr) and nanoclay (1 and 3 phr) were radiation-cured at 100, 200, 389 and 800 kGy from a 60Co γ radiation source and tested against a reference compound without nanoclay. For reference the same compounds where also sulfur cured. The nanoclay consisted of a layered silicate, a montmorillonite, treated with an alkylammonium salt. The nanoclay was added on top to a conventional carbon black-filled rubber compound during the first masterbatch preparation.

The spectacular reinforcement effect derived from the nanoclay addition to the composite has been observed both in the radiation-cured compounds and in the sulfur-cured compound. Although the sulfur-cured composite show a reduction in hysteresis after the nanoclay addition, the radiation-cured compounds show an opposite trend.
Short Glass Fiber Filled Waste Plastic (PE) Composites: Studies on Thermal and Mechanical Properties
Authors: Satapathy Sukanya , Jose Jobin , Nag Ahin , Nando Golok Bihari
Published: September 2018

Plastics used in the form of carry bags, pouches, sheets and various other shapes discarded into the Municipal Solid Waste (MSW) is a major concern of environmental pollution these days. In India synthetic textiles from the garment industry and from the rubber industry also goes to the MSW stream. The objective of this paper is to combine the stiffness and strength of the short synthetic fibers with the waste polyethylene matrix to form useful products. In this study glass fibers have been chosen from the tyre industry and chopped to short fibers before mixing with waste plastics. The composites of Short glass fiber (GF) reinforced Waste Polyethylene (WPE) and neat High Density Polyethylene (HDPE) were prepared separately by melt-mixing technique in a Brabender plasticorder under optimum process conditions. Physico-mechanical properties of the composites at different fiber loadings were determined using standard methods. Thermal stability of the composites was determined using a thermo gravimetric analyzer. It was observed that the strength properties improved with the fiber loading up to 50 wt% of the short glass fibers; beyond which it reduced due to dilution effect. The effect of Maleic anhydride (MAH) grafting onto the waste polyethylene improved the fiber-matrix adhesion significantly. The effect of Ethylene methacrylic acid (EMA) copolymer as a matrix modifier improves the adhesion with the glass fibers. The Waste Polyethylene composites were compared with those of neat HDPE glass fiber reinforced composites, for its strength and thermal stability. Thermal stability of the composites improved as expected. The results were supplemented by fracture studies by SEM.
Thermal Behaviour of Recyclable Short Nylon Fibre Reinforced PP Composite
Authors: Abraham Thomas N. , George K.E.
Published: September 2018

The thermal and crystallisation behaviour of short nylon fibre reinforced PP composites was studied by thermogravimetry (TG) and differential scanning calorimetry (DSC). Dynamic paramteres such as storage modulus, loss modulus and loss factor or damping efficiency (tan δ) were determined in a resonant frequency mode over a wide range of temperatures using dynamic mechanical analysis (DMA). Attempts were made to improve the interfacial adhesion using styrene maleic anhydride–grafted PP. The thermal properties of the composites were analysed by TG analysis. It was found that modified matrix composites show superior properties compared to the unmodified system. DSC measurements exhibited an increase in the crystallisation temperature and crystallinity, upon the addition of fibres to the PP matrix. This is attributed to the nucleating effects of the fibre surfaces. DMA of the composite shows higher dynamic stress than the neat matrix material with increase in storage modulus and decrease in loss factor.
Studies on the Biodegradability of Linear Low-Density Polyethylene–Dextrin Blends using Vibrios from the Benthic Environment
Authors: Hamza Zeena P. , Dilfi K.F. Anna , Kurian Thomas , Bhat Saritha G.
Published: September 2018

Linear low-density polyethylene (LLDPE) was blended with dextrin of different particle sizes (100, 200, and 300 mesh). Various compositions were prepared, and mechanical and thermal studies were carried out. The biodegradability of these samples was verified using culture medium containing vibrios (amylase-producing bacteria) which were isolated from the marine benthic environment. Soil burial tests of these samples were also conducted. Biodegradability tests on these blends indicate that they are partially biodegradable.
A Concealed “Natural Orifice”: Umbilicus Anatomy for Minimally Invasive Surgery
Authors: Asakuma Mitsuhiro , Komeda Koji , Yamamoto Masashi , Shimizu Tetsunosuke , Iida Ryo , Taniguchi Kohei , Inoue Yoshihiro , Hirokawa Fumitoshi , Hayashi Michihiro , Okuda Junji , Kondo Yoichi , Uchiyama Kazuhisa
Published: September 2018

Introduction. A recent development in minimally invasive surgery (MIS) is single-port surgery, where a single large multiport trocar is placed in the umbilicus. All medical schools require that students complete an anatomy course as part of the medical curriculum. However, there is limited instruction regarding the detailed parts of the “umbilicus.” In several famous anatomy atlases, the umbilicus is not dissected at all and is merely represented as a button. Until now, the true nature of the umbilicus has not been anatomically demonstrated. Methods. Five cadavers were obtained from the Osaka Medical College medical student anatomy class. The umbilicus was dissected in the anatomy laboratory, to demonstrate all the layers. A detailed dissection was performed, focusing on the exact center of the umbilicus, in order to ascertain whether there exists a “natural orifice” or a fascial defect. Results. In all cadavers, a small defect of fascia was identified just below the center of the umbilicus. Yellow fatty tissue was present just below the skin in the exact center of the umbilicus. A probe placed exactly in the middle of this defect passes easily through into the abdominal cavity. Conclusions. With the widespread use of MIS, umbilical incision is commonly used to reduce pain and improve cosmetic results. This study consistently revealed a natural defect of fascia in the center of the umbilicus. Therefore, the umbilicus can be called a concealed “natural orifice.” It is important to recognize and utilize this defect effectively to minimize unnecessary tissue trauma during MIS.
A Comparison of Locking Plates and Intramedullary Pinning for Fixation of Metacarpal Shaft Fractures
Authors: Dreyfuss Daniel , Allon Raviv , Izacson Nufar , Hutt Dan
Published: September 2018

Background: Metacarpal shaft fractures that necessitate surgery are frequently fixated with either intramedullary pins or plates and screws. This study compared outcome measurements of these two techniques. Methods: Patients operated on for closed shaft fractures of metacarpals 2-5 were examined at least 1 year after injury. All fractures were fixated by pinning between years 2013 and 2015 and by locking plates and screws between 2016 and 2017. Evaluation included range of motion measurements for all fingers compared with the contralateral hand; comparison of grip strength; finger alignment and rotation; Disabilities of the Arm, Shoulder and Hand (DASH) score; and radiographic measurements of fracture reduction and healing. Results: Thirty patients with 39 fractured metacarpals treated by pinning were compared with 29 patients with 35 fractured metacarpals treated by locking plate and screws. Both groups had similar characteristics and preoperative fracture patterns on radiograph. Patients in the plate group were found to have significantly improved outcomes in total range of motion of the operated digits (loss of 4° extension, 10° flexion, and 14° total vs 10° extension, 19° flexion, and 29° total), grip strength (93% vs 83% of contralateral hand), rotational deformity (5 digits, 1° vs 15 digits, 6°), and DASH score (10.5 vs 15.6). Radiographic bone healing time (59 vs 50 days) and operative time (58 vs 41 minutes) were both significantly longer in fractures fixated by plates. Conclusions: Fixation with locking plates allows earlier mobilization without need for splinting. Our study supports the use of this method over intramedullary pinning for metacarpal shaft fractures.
Optimal LDR to Protect the Kidney From Diabetes: Whole-Body Exposure to 25 mGy X-rays Weekly for 8 Weeks Efficiently Attenuates Renal Damage in Diabetic Mice
Authors: Cheng Jie , Li Fengsheng , Wang Guanjun , Guo Weiying , Huang Shan , Wang Brian , Li Cai , Jiang Qisheng , Cai Lu , Cui Jiuwei
Published: September 2018

To explore an optimal frequency of whole-body low-dose radiation (LDR) to protect the kidney from diabetes, type 1 diabetic mice were induced with multiple injections of low-dose streptozotocin in male C57BL/6J mice. Diabetic or age-matched normal mice received whole-body exposure to 12.5 or 25 mGy either every other day or weekly for 4 or 8 weeks. Diabetes decreased the urinary creatinine and increased the microalbumin in urine, renal accumulation of 3-nitrotyrosine and 4-hydroxynonenal, and renal expression of collagen IV and fibronectin. All these renal pathological and functional changes in diabetic mice were significantly attenuated by exposure to LDR at all regimens. However, whole-body exposure of diabetic mice to 25 mGy weekly and to 12.5 mGy every other day for 8 weeks provided a better prevention of diabetic nephropathy than other LDR regimens. Furthermore, whole-body exposure to 25 mGy weekly for 8 weeks showed no detectable effect on the kidney of normal mice, but whole-body exposure to normal mice at 12.5 mGy every other day for 8 weeks increased urinary microalbumin and renal expression of collagen IV and fibronectin. These results suggest that whole-body exposure to LDR at 25 mGy weekly is the optimal condition of LDR to protect the kidney from diabetes.
Endovascular repair of an acute symptomatic carotid artery dissection through the false dissecting carotid lumen
Authors: Befera Nicholas , Griffin Andrew S , Hauck Erik F
Published: September 2018

A 48-year-old woman presented with an acute ischemic stroke (National Institutes of Health Stroke Scale (NIHSS) 21) six hours after symptom onset. Workup revealed a left cervical internal carotid artery (ICA) occlusive dissection, which was emergently reconstructed with a flow-diverting stent. A routine Duplex scan one hour later suggested reocclusion of the ICA, confirmed by angiography. The true lumen of the ICA could not be accessed and therefore the “false lumen” of the ICA dissection was entered proximally. The true lumen and ultimately the flow-diverting stent were accessed via the false lumen. In analogy to the subintimal arterial flossing with antegrade-retrograde intervention technique described for peripheral vascular disease, several stents were placed in telescoping fashion from the true common carotid lumen through the “false dissecting” lumen of the proximal ICA into the distal true lumen. The stent construct remained patent, and the patient recovered clinically to an NIHSS of 1.
Damage identification in welded structures using symmetric excitation of Lamb waves
Authors: He Jian , Yang Liang , Sun Xiaodan , Hu Muping
Published: September 2018

Damage monitoring systems based on Lamb wave health monitoring technology have attracted considerable attention for scientific research and industrial applications. In this article, two types of single-mode Lamb waves are obtained using symmetric and anti-symmetric methods, respectively, to determine a crack identification signal. A numerical simulation of a welded steel plate model was conducted using the ABAQUS/EXPLICIT module, which is a dynamic solver. The propagation process and the corresponding effect of the Lamb waves over the complete and damaged models are simulated. According to the propagation characteristics and with the assistance of the ellipse localization method with MATLAB, the location of crack damage is simulated by the amplitude addition method and the crack damage location is determined. The results show that the simulation results are in good agreement with the actual crack damage. Furthermore, the received signals are compared and analyzed from an energy perspective. Two types of single-mode Lamb wave monitoring methods are also compared. In addition, it is demonstrated that a symmetric excitation can simplify the received waves and recognize crack damage in plates in welded steel structures from an experimental perspective of this work.
Establishing healthy pharmaceutical regulations on statutory exclusivity: Lessons from the experience in the European Union, Canada, South Korea, Australia, and the United States
Authors: Son Kyung-Bok
Published: September 2018

Abstracts

Objectives

Recent international trade agreements require member countries a prolonged statutory exclusivity for biologics, and domestic legislation guarantees various forms of exclusivity for specific drugs, indications, or studies. This study notes prolonged exclusivity provisions for biologics in the United States and international trade agreements. We aim to review various exclusivity systems, including chemical entities, in selected high-income countries and to suggest implications for establishing the system specifically relevant for biologics in low- and middle-income countries.

Methods

We conducted a review of a comprehensive range of literature to develop the framework. Then, a comparative legal analysis was conducted to analyze the deviations among the systems in the European Union, Canada, South Korea, Australia, and the United States.

Results

There is constructive ambiguity in international trade agreements, specifically for provisions regarding biologics. Furthermore, the selected countries operate different statutory exclusivity systems in terms of eligibility for statutory exclusivity, specific measures for exclusivity, and other elements of exclusivity. In addition, market exclusivity, which is distinguished from data exclusivity, is not available in Korea and Australia. There are also various forms of statutory exclusivity for specific drugs, indications, or studies requested by the marketing authority.

Conclusions

Given constructive ambiguities in international agreements and variations in the manner of implementations of the systems in selected countries, statutory exclusivity for biologics could be established with cautions to mediate the harms. In this study, we suggest several solutions and alternatives for low- and middle-income countries.
On the behavior of slackline webbings under dynamic loads and the simulation of leash falls
Authors: Athanasiadis Panos J
Published: September 2018

Slackline is a new and rapidly expanding sport, which has had minimal research published on it in terms of sport physics and engineering. Slackline dynamics strongly depend upon the elastic response of used webbing, typically made of polyester or nylon. Depending on the stress and strain rates applied, polymers are known to exhibit a visco-elastic behavior characterized by hysteresis effects. Through a series of carefully executed experiments, this study examined the behavior of slackline webbing under dynamic loads to determine the departures from the respective static response (stress–strain curves). Such knowledge is fundamental for the accurate simulation of slackline dynamics, so as to predict peak forces and aid safe rigging. The results demonstrate that the effective modulus during leash falls was significantly higher than the slope of the respective stress–strain curve, indicating a stiffer response. Also, the effective modulus increased with the applied pretension. Using the moduli determined experimentally for the rigged slacklines with different types of webbing, the respective leash falls were simulated numerically with high accuracy. A standardized test is proposed, to be adopted by the International Slackline Association and slackline webbing manufacturers, is proposed in order to provide key information on the response of each webbing available in the market under typical dynamic loads, similar to the “impact force” test designed for dynamic ropes by the International Climbing and Mountaineering Federation.
Practical aspects of extended half-life products for the treatment of haemophilia
Authors: Lambert Thierry , Benson Gary , Dolan Gerry , Hermans Cedric , Jiménez-Yuste Victor , Ljung Rolf , Morfini Massimo , Zupančić-Šalek Silva , Santagostino Elena
Published: September 2018

Haemophilia A and haemophilia B are congenital X-linked bleeding disorders caused by deficiency of coagulation factor VIII (FVIII) and IX (FIX), respectively. The preferred treatment option for patients with haemophilia is replacement therapy. For patients with severe disease, prophylactic replacement of coagulation factor is the treatment of choice; this has been shown to reduce arthropathy significantly, reduce the frequency of bleeds and improve patients’ quality of life. Prophylaxis with standard recombinant factor requires regular intravenous infusion at least two (FIX) to three (FVIII) times a week. Recombinant FVIII and FIX products with an extended half-life are in development, or have been recently licensed. With reported mean half-life extensions of 1.5–1.8 times that of standard products for FVIII and 3–5 times that of standard products for FIX, these products have the potential to address many of the unmet needs of patients currently treated with standard factor concentrates. For example, they may encourage patients to switch from on-demand treatment to prophylaxis and improve the quality of life of patients receiving prophylaxis. Indeed, extended half-life products have the potential to reduce the burden of frequent intravenous injections, reducing the need for central venous lines in children, promote adherence, improve outcomes, potentially allow for more active lifestyles and, depending on the dosing regimen, increase factor trough levels. Members of the Zürich Haemophilia Forum convened for their 19th meeting to discuss the practicalities of incorporating new treatments into the management of people with haemophilia. This review of extended half-life products considers their introduction in haemophilia treatment, including the appropriate dose and schedule of infusions, laboratory monitoring, patient selection, safety considerations, and the economic aspects of care.
Examining discursive formations in early childhood media research: A genealogical analysis
Authors: Henward Allison Sterling
Published: September 2018

The study of popular culture and children has a long and intimate relationship in many fields within the humanities and social sciences, yet in the applied field of Early Childhood Education and Care, the relationship is rather fraught. Employing a Foucauldian genealogical approach, I trace the ways in which intellectual traditions and discourses (i.e. history, politics, and sacrosanct values of European aesthetics and childhood innocence) have shaped contemporary understandings and debates in the field. With attention to Foucault’s concepts of power/knowledge couplet, and discursive archives, my focus in on how these axiomatic “myths” have assembled as “regimes of truth.” I thus argue for the need for the field of Early Childhood Education and Care to engage in and consider more contextualized, nuanced, and empirically oriented studies of young children and their engagement with consumer culture.
Treatment of Odontoid Fractures: Recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU)
Authors: Gonschorek Oliver , Vordemvenne Thomas , Blattert Thomas , Katscher Sebastian , Schnake Klaus John ,   the Spine Section of the German Society for Orthopaedics and Trauma
Published: September 2018

Study Design:

Narrative review.

Objective:

To establish recommendations for the treatment of odontoid fractures based on current literature and the knowledge of the experts of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU).

Methods:

Narrative review of the literature. Analyzing treatment algorithms of German trauma and spine centers as members of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU).

Results:

There are many influencing factors leading to appropriate treatment of odontoid fractures such as age, bone quality, arthrosis, classification, and type of the fracture. Conservative nonoperative treatment is appropriate for stable undislocated displaced odontoid fractures. Anterior osteosynthesis with 1 or 2 screws leads to good results in the classical unstable type II odontoid fracture in patients with good bone quality. However, modifiers have been identified by the working group leading to higher complication and failure rates. For these cases, more stable constructs and/or posterior approaches are indicated.

Conclusions:

Operation seems to be standard treatment for odontoid fractures. However, in the aged population, conservative treatment should be considered as morbidity and mortality rise significantly in the group of >75 years. Conservative treatment may also be started within stable nondislocated fractures, but then regular controls have to be performed. If operation is indicated, many influencing factors have to be considered for appropriate approach and technique. The classification of Anderson and D’Alonzo is still standard. To create an adequate treatment algorithm, dislocation displacement and instability have to be identified. Stable odontoid fractures are treated conservatively non-operatively, but if so regular controls have to be performed. Unstable and/or dislocated displaced odontoid fractures are treated by anterior osteosynthesis with 1 or 2 screws. The technique is demanding and leads to elevated complication and failure rates if modifiers are apparent. In these cases, posterior instrumentation or fusion of C1 and C2 is favorable. In the aged population (>80 years), operative therapy is critical as postoperative morbidity complication and mortality rates rise significantly. As there is still some bias in the treatment algorithms, the working group recommends establishment of a prospective study to result in more objective statements.
Complications and Risk Factors Using Structural Allograft Versus Synthetic Cage: Analysis 17 783 Anterior Cervical Discectomy and Fusions Using a National Registry
Authors: Goz Vadim , Buser Zorica , D’Oro Anthony , Wang Christopher , Yoon S. Tim , Park Jong-Beom , Youssef Jim A. , Meisel Hans-Joerg , Wang Jeffrey C. , Brodke Darrel S.
Published: September 2018

Study Design:

Retrospective cohort study.

Objective:

To determine the rates of perioperative complications in patients undergoing anterior cervical discectomy and fusion (ACDF) with allograft versus synthetic cage.

Methods:

A large national administrative health care database was queried for ACDF procedures performed between 2007 and 2014 using ICD-9 (International Statistical Classification of Diseases, 9th revision) and CPT (Current Procedural Terminology) codes. Cases that utilized structural allograft and synthetic cages were identified via CPT codes. Gender, age, frequency of obesity, cigarette use, diabetes, and number of levels fused were compared between the 2 cohorts using χ2 test. Complications within 90 days were identified via ICD-9 codes and compared between the 2 cohorts. Revision rates within 2 years were noted.

Results:

A total of 10 648 ACDF cases using synthetic cages and 7135 ACDFs using structural allograft were identified. The demographics between the 2 cohorts were similar. Overall complication rate was 8.71% in the synthetic cage group compared with 7.76% in the structural allograft group ( P < .01). Use of synthetic cage was associated with higher rate of respiratory complications, 0.57% compared with 0.31% in the structural allograft cohort ( P = .03), while use of structural allograft was associated with a higher rate of dysphagia, 0.64% compared with 0.33% ( P < .01). Revision rate at 2 years was 0.50% and 0.56% in the synthetic cage and allograft groups, respectively ( P = .03).

Conclusions:

This data suggests that synthetic cages are associated with a marginally higher overall rate of complications with similar revision rates.
Scrapping the Bell Curve: A Practitioner’s Review of Reinvented Performance Management System
Authors: Chillakuri Bharat
Published: September 2018

Conventional methods of performance management followed the bell curve or the relative ranking of employees. This resulted in counterproductive outcomes such as stress and disengagement. In recent years, a paradigm shift has occurred in performance management practices. This article describes a new performance management system, currently being practised in multinational companies including Deloitte LLP, a Big Four accounting and consulting firm. The model, with such features as touch points and regular coaching discussions, aims at providing feedback at regular intervals and implementing course correction activities, if necessary, more immediately and frequently. The model and the expected outcomes are discussed in detail.
Diabetic Foot Ulcers and Vitamin D Status: A Literature Review
Authors: Macido Antony
Published: September 2018

Approximately 15% of patients with diabetes mellitus (DM) are prone to developing diabetic foot ulcers (DFU) in their lifetime. The term vitamin D status or 25-hydroxyvitamin D (25(OH)D) levels is used interchangeably to represent the status of vitamin D in individuals throughout this article. Evidence suggests a relationship between 25(OH)D levels and DFU. However, very minimal data are available on the association between DFU and vitamin D deficiency. After a careful review of the literature, it was inferred that vitamin D could be associated with DFU and diabetic foot infections. Available evidence on vitamin D and DFU suggests a negative correlation between 25(OH)D levels and the presence of DFU. Evidence also supports a negative relationship between 25(OH)D levels and diabetic foot infections. Further large-scale randomized controlled studies need to be done to confirm the relationship between 25(OH)D levels and DFU including the use of vitamin D in the management of DFU and diabetic foot infections.
How do we prevent the burden of extremely harmful and clinically nonbeneficial drug–drug interactions among chronic kidney disease patients?
Authors: Fasipe Olumuyiwa John , Olayemi Sunday Olufemi , Akinyede Akinwumi Akinyinka , Osho Patrick Olanrewaju , Ibiyemi-Fasipe Oluwatosin Beatrice , Osho Evelyn Salewa
Published: September 2018

The chronic intake of different medications by chronic kidney disease (CKD) patients predisposes them to extremely harmful and clinically nonbeneficial drug–drug interactions (DDIs) which can ultimately lead to increase in morbidity, mortality, healthcare cost, and frequency and length of hospitalization. This produces a negative deteriorating and counter-efficient outcome on the health, quality of life and treatment response of these patients. This was an 18-month prospective descriptive study that reviewed the medical case records of consented adult CKD patients attending the Nephrology medical outpatient clinic of a Nigerian Tertiary Healthcare Centre from January 2015 to June 2016. The Medscape drug reference database was used to evaluate patients’ medications for extremely harmful, clinically nonbeneficial DDIs. This study involved 123 consented adult CKD patients comprising of 82 (66.67%) males and 41 (33.33%) females with a mean age of 53.81 ± 16.03 years. In this study, the prevalence of extremely harmful, clinically nonbeneficial DDIs (type D or type X interaction categories only) was 24.4%, while the overall prevalence for all the observed DDIs was 95.9%. The most frequent extremely harmful, clinically nonbeneficial DDIs in this study was between α-methyldopa and metoclopramide: 16 (0.9%) interactions in eight (6.5%) patients. Furthermore, α-methyldopa decreases the antiemetic effects of metoclopramide by pharmacodynamics antagonism at the chemoreceptor trigger zone site D2-receptors (type X; pharmacodynamics). In addition, metoclopramide decreases the level of α-methyldopa by inhibition of gastrointestinal tract (GIT) absorption, as this applies to only oral formulations of both agents (type D; pharmacokinetic). The occurrence and burden of extremely harmful, clinically nonbeneficial DDIs is significantly high among these CKD patients. There is also a critical need to minimize the number of prescribed medications for these patients in order to optimize their care.
Enhancing immunotherapy of STING agonist for lymphoma in preclinical models
Authors: Sallets Adrienne , Robinson Sophie , Kardosh Adel , Levy Ronald
Published: September 2018

Key Points

The immunotherapeutic property of STING agonists is more potent to clear lymphoma than its cytotoxic property. In situ vaccination with STING agonist can be enhanced by agents that improve APC or T-cell function such as anti-GITR and anti-PD-1.
Integrated turning-ray and reflection tomography for velocity model building in foothill areas
Authors: Jun Tian , Gengxin Peng , Jiao Junru , Yan Grace (Yan) , Zhu Xianhuai
Published: September 2018

A special challenge for land seismic exploration is estimating velocities, in part due to complex near-surface structures, and in some instances because of rugose topography over foothills. We have developed an integrated turning-ray and reflection-tomographic method to face this challenge. First, turning-ray tomography is performed to derive a near-surface velocity-depth model. Then, we combine the near-surface model with the initial-subsurface model. Taking the combined model as starting model, we go through a reflection tomographic process to build the model for imaging. During reflection tomography, the near-surface model and subsurface models are jointly updated. Our method has been successfully applied to a 2D complex synthetic data example and a 3D field data example. The results demonstrate that our method derives a very decent model even when there is no reflection information available in a few hundred meters underneath the surface. Joint tomography can lead to geologic plausible models and produce subsurface images with high fidelity.
Liaison psychiatry services in Wales
Authors: Tahir Tayyeb A. , Watkins Adam , Slack Philip , Chick Phil , Lee William , Gray Andrea
Published: September 2018

Aims and method

Recent funding from Welsh Government for mental health has helped to develop liaison psychiatry services in Wales. Systematic data collection was undertaken to map the liaison psychiatry services in Wales in collaboration with the Royal College of Psychiatrists in Wales and Public Health Wales 1000 Lives Improvement. A questionnaire was designed and circulated to all the health boards in Wales to gather information to map liaison psychiatry services in Wales. Up-to-date information was confirmed in January 2018, via email.

Results

Over the past 2 years, liaison psychiatry services have been set up in six out of seven health boards in Wales. Staffing levels have increased and the remit of services has broadened.

Clinical implications

Mapping has highlighted that liaison psychiatry services in Wales continue to evolve. It will be important to continue to monitor these developments and their effects. Comparison with services in England will provide a useful comparison of service provision. A particular challenge will be to establish and monitor liaison psychiatry standards in Wales.

Declaration of interest

None.
Temporal Trends and Geographic Patterns of Lung Cancer Incidence by Histology in Thailand, 1990 to 2014
Authors: Chang Joanne T. , Jeon Jihyoun , Sriplung Hutcha , Yeesoonsang Seesai , Bilheem Surichai , Rozek Laura , Chitapanarux Imjai , Pongnikorn Donsuk , Daoprasert Karnchana , Vatanasapt Patravoot , Suwanrungruang Krittika , Meza Rafael
Published: September 2018

Purpose

Lung cancer is one of the most common cancers worldwide and in Thailand. We characterize and forecast region-specific patterns of lung cancer incidence by histology and sex.

Methods

We analyzed lung cancer incidence trends in Thailand by histology (adenocarcinoma [AdC]; squamous cell carcinoma [SCC]; and large-cell, small-cell, and other carcinomas) from 1990 to 2014 in four cancer registries in three regions (north, Chiang Mai Province and Lampang Province; northeast: Khon Kaen Province; south: Songkhla Province). Annual percent change (APC) was calculated to quantify the incidence rate trends using joinpoint regression. Age-period-cohort models were used to examine the temporal trends of AdC and SCC by age, calendar year, and birth cohort. We projected the incidence of AdC and SCC up to 2030 using three independent approaches: joinpoint, age-period-cohort, and Nordpred models.

Results

AdC incidence significantly increased from 1990 to 2012 in Chiang Mai males (APC, 1.3%), Songkhla males from 2004 to 2014 (APC, 2.5%), Songkhla females from 1990 to 2014 (APC, 5.9%), and Khon Kaen females from 2005 to 2014 (APC, 3.1%). Conversely, SCC incidence significantly decreased from 1990 to 2012 in Chiang Mai males and females (APC, −1.2% and −4.8%, respectively), Lampang males and females from 1993 to 2014 (APC, −5.4% and −5.2%, respectively), and Songkhla females from 1990 to 2014 (APC, −2.1%). In general, trends of AdC and SCC correlated more with birth cohort than with calendar year. Three projection models suggested that incidence rates of AdC in Songkhla may continue to increase until 2030.

Conclusion

Temporal trends of lung cancer by histology varied among regions in Thailand. Reduction of lung cancer incidence in Thailand likely will require prevention strategies tailored to each specific region.
Pupillary Pain Index Changes After a Standardized Bolus of Alfentanil Under Sevoflurane Anesthesia: First Evaluation of a New Pupillometric Index to Assess the Level of Analgesia During General Anesthesia
Authors: Sabourdin Nada , Diarra Coumba , Wolk Risa , Piat Véronique , Louvet Nicolas , Constant Isabelle
Published: September 2018

BACKGROUND:

The pupillary pain index (PPI) is a novel pupillometric index, designed to assess intraoperative analgesia. It is based on the evaluation of the pupillary response to electrical stimuli of increasing intensity. It ranges from 1 (low level of pupillary reactivity, high level of analgesia) to 10 (high level of pupillary reactivity, low level of analgesia). In this first evaluation of the PPI, our objective was to investigate the PPI changes after a bolus of 10 µg·kg−1 of alfentanil in children under sevoflurane general anesthesia.

METHODS:

After ethics committee approval and informed consent, 20 healthy children (9 ± 5 years) undergoing elective surgery under general anesthesia were included in this prospective, open, registered pilot study (NCT02646592). Anesthetic induction was standardized with sevoflurane 6% and propofol 1 mg·kg−1. After tracheal intubation, sevoflurane concentration was maintained at 2% for 10 minutes. A first PPI measurement was performed (PPI-1), and a bolus of 10 µg·kg−1 was administered. Two minutes after this bolus, a second PPI measurement was performed (PPI-2). Heart rate, blood pressure, and bispectral index were recorded before and after each PPI measurement. Resting pupillary diameter was recorded before each PPI measurement. PPI scores before and after the bolus of alfentanil were compared using a Wilcoxon signed rank test.

RESULTS:

PPI scores decreased after administration of a bolus of alfentanil (median difference: −3 [95% confidence interval, −4 to −2]). The median (quartiles) of PPI-1 (baseline, before alfentanil) was 6 (4, 7), and the median (quartiles) of PPI-2 (after alfentanil) was 2 (2, 3) (P < .001). No difference was found in resting pupillary diameter before PPI-1 and PPI-2 (2.2 ± 0.2 and 2.2 ± 0.3 mm, respectively; P = .86). There were no significant changes in heart rate or blood pressure after PPI measurements (P = .46 and .49, respectively). Bispectral index was slightly increased after PPI measurements (P = .01; mean bispectral index increase <5%). No withdrawal movements occurred during PPI measurements.

CONCLUSIONS:

There was a significant decrease in PPI after alfentanil administration. The results of this pilot study suggest that PPI score decreases when the level of analgesia increases. PPI measurement was not associated with a clinical or hemodynamic nociceptive response. This new index might provide useful information to individually adapt opioid administration before nociceptive stimuli under general anesthesia.