bluuebunny/crossref_metadata_2025 huggingface dataset:
Oxford Nanopore MinION genome sequencer: performance characteristics, optimised analysis workflow, phylogenetic analysis and prediction of antimicrobial resistance in Neisseria gonorrhoeae
Authors: Golparian Daniel , Donà Valentina , Sánchez-Busó Leonor , Foerster Sunniva , Harris Simon R. , Endimiani Andrea , Low Nicola , Unemo Magnus
Published: June 2018

Antimicrobial resistant (AMR) Neisseria gonorrhoeae strains are common and compromise gonorrhoea treatment internationally. Rapid identification and characterisation of AMR gonococcal strains could ensure appropriate and even personalised treatment, and support identification and investigation of gonorrhoea outbreaks in nearly real-time. Whole-genome sequencing is ideal for investigation of the emergence and dissemination of AMR determinants that predict AMR in the gonococcal population and spread of AMR strains in the human population. The novel, rapid and revolutionary long-read sequencer MinION is a small hand-held device that can generate bacterial genomes within one day. However, the accuracy of MinION reads has been suboptimal for many objectives and the MinION has not been evaluated for gonococci. In this first MinION study for gonococci, we show that MinION-derived sequences analysed with existing open-access, web-based sequence analysis tools are not sufficiently accurate to identify key gonococcal AMR determinants. Nevertheless, using an in house-developed CLC Genomics Workbench, we show that ONT-derived sequences can be used for accurate prediction of decreased susceptibility or resistance to recommended therapeutic antimicrobials. We also show that the ONT-derived sequences can be useful for rapid phylogenomic-based molecular epidemiological investigations, and, in hybrid assemblies with Illumina sequences, for producing contiguous assemblies and finished reference genomes.
Legal Content and the Issues of Classification of Socio-economic Human Rights
Authors: BAZAROVA Gulmira S. , BIRMANOVA Axunkar I. , ALIYEVA Indira Z. , BALGIMBEKOVA Gulnara U. , AKHEMETOVA Nailya S.
Published: June 2018

The main feature of social and economic rights is that their implementation requires governmental assistance and control for realization. Therefore, the stance on the present category of rights and freedoms is quite ambiguous. Scientific analysis and generalization of actual variety of socio-economic rights are complicated with the fact the classification of considered categories of rights cannot be based on emphasizing one and only criterion. The main goal of this paper is the studying of legal content and issues of classification of social and economic rights of man. To reach this goal authors have used analysis methods. Having analyzed works of Belova-Ganeva G. it was elicited the essence of socio-economic rights lays in the fact ʽthey help to reduce unjustified social differences and provide individual with the possibility of getting benefits or services and having state supportʽ. The variety of rights’ content comprising the present group results in the situation when the same right, in virtue of various grounds, can be attributed to two or more classified groups. The difference between goals becomes visible within the process of normative setting of separate socio-economic rights and when subjects exercise them. Correspondingly, in the present work authors distinguish rights in the sphere of property and economic activity for one group, while the second group includes rights in the sphere of social security and social insurance.
Pre-Trial Insolvency Prevention: Economic and Legal Analysis
Authors: IZUYMOV Igor Vladimirovich , SADYKOVA Hadiya Nurgalievna , KORENKOVA Svetlana Ivanovna , KILIN Petr Martemjanovich , SAMOYLOVA Yana Victorovna , SHESTAKOVA Vera Ivanovna
Published: June 2018

This paper analyzes the nature of pre-trial insolvency prevention of a business entity, reveals the content of this phenomenon, and studies the possibilities of its use to prevent existing negative consequences of the court procedures on insolvency in the economy. The article discusses the features of pre-trial insolvency prevention (bankruptcy) of business entities conducting business abroad, analyzes the Russian and international practice of the legal regulation of pre-trial prevention of bankruptcy. It is proposed to regulate the activity of domestic entrepreneurs in the field of pre-trial insolvency prevention of business entities at the legislative level.
Counteraction to Illegal Drug Trafficking Using the Internet: Modern Problems and Contradictions
Authors: SIDOROV Anatoly S.
Published: June 2018

General characteristics of crimes related to illicit trafficking in drugs using the mass media or electronic or information and telecommunication networks, including the Internet network are presented. The main problems of detection and suppression of this type of crimes are considered, as well as the main contradictions in the international legal regulation of interaction issues between law enforcement agencies of various states that impede effective counteraction to drug traffic. In the course of the study, the state of regulatory and legal regulation of issues related to countering crimes related to illicit trafficking in narcotic drugs with electronic and information and telecommunication networks, including the Internet network, in the Russian Federation was analyzed. International cooperation in this field was assessed. The practice of investigating and prosecuting criminal cases related to drug trafficking has been studied.
Access of the Public to Environmental Information in the Republic of Kazakhstan
Authors: YEREZHEPKYZY Roza , TYNYBEKOV Serikkali , ABIKENOV Arkhat , ALDASHEV Sarsengali
Published: June 2018

In the present work, a comprehensive legal analysis of public access to information in the field of environmental protection and the use of natural resources in the Republic of Kazakhstan has been conducted, and the legal basis for securing, implementing and protecting the public's right to access to environmental information has been examined. Particular attention is paid to the problems of direct implementation of environmental information provision, as well as to the role of the public in participation in decision-making in the Republic of Kazakhstan, legal problems of judicial protection of legitimate rights and interests of the public and citizens in this field. The theoretical conclusions and recommendations on improving the legislation are substantiated, based on the requirements for the implementation of the norms of the Convention on Access to Information, Public Participation in Decision-making and Access to Justice in Environmental Matters in National Legislation.
Hibás kommunikációs panelek perinatalis veszteség esetén
Authors: Monostori Dóra , Dombi Edina , Zelena András
Published: June 2018

Abstract:

In the case of obstetrics and intensive child care, the members of the medical team are the first to communicate with mourning parents about their pre- and perinatal loss. According to the national law, only doctors are allowed to report death. Our aim is to emphasize the complexity and specificity of this communication process by presenting a short case study, in which we highlight how improper, incorrect and sometimes misleading this communication can be regardless on the pain of the mourning parents. The mourning period is characterized by the vulnerability of families and very often accompanied with impulsive reactions. Tipical consolatory phrases in the post-mortem communication such as “No problem, you are able to get pregnant again and you will have a child soon!” can be especially traumatogenic. Through the presented case description we would like to emphasize how effective support can be provided by a trained specialist, and what aspects should be taken into consideration. In order to benefit from the supporting communication we collected some national and international guidelines. Orv Hetil. 2018; 159(12): 1033–1036.
Analysis of errors identified in the implementation and management of the real estate cadastre
Authors: Sinenko V A , Volnova A N , Pichuzhkina M V , Shiyapov T I
Published: June 2018

One of the most common reasons for the suspension of the procedure for state cadastral registration, or state registration of rights to real estate are errors that are contained in the information of the real estate cadastre. The presence of errors in the Unified state register of real estate, including mistakes in title documents for real estate, is the basis for the suspension and refusal in the state cadastral registration and further registration of rights to real estate. In such circumstances, the applicant is compelled to prove violation of his rights. If there is an error in the information of the real estate cadastre regarding the real estate object, such errors are automatically exported to various databases and as a consequence lead to a large number of errors in the information of the real estate cadastre as well as various registers and cadastres. With the enactment of the Federal Law of 13.07.2015 No. 218 On State registration of real estate the procedure for correcting mistakes in the Unified state register of real estate has been substantially simplified. In their article, the authors analyze the current situation of the real estate cadastre databases and give examples of the most common in practice technical errors in the management and implementation of the real estate cadastre.
Morphobiological features of buck lambs by using high protein extruded food
Authors: Chamurliev N G , Mandzhieva M V
Published: June 2018

The development of internal organs and the morphological composition of carcasses of the sheeps ox of Volgograd breeds when feeding them grain extruded forages with the use of dry beer pellets (EKKO-PD-SM) and pumpkin cake (EKKO-PC-SM) in combination with natural sulfur and methionine. Studies have established that sheep of experimental groups by the mass of internal organs were superior to the peers of the control group. Thus, the animals of the I and II-experimental groups had an advantage in comparison with the control peers: by weight of the leaked blood 9.24 and 11.54% (P ˂ 0.05); by weight of heart 12,41 and 16,47% (Р ˂ 0,05); by weight of lungs 8.60 and 11.34% (P ˂ 0.05); by weight of the liver 8,40 and 10,93% (Р ˂ 0,05); by weight of spleen 22,06 and 24,11% (Р ˂ 0,05) respectively. By the mass of the kidneys, there is no reliable difference in the compared groups, although the tendency of its increase in the animals of the experimental groups was noted. Buck lambs of I and II-experimental groups exceeded the control peer by weight of the stomach without contents by 8.04 and 10.57% (P ˂ 0.05), by weight of the small intestine by 9.07 and 12.29% (P ˂ 0.05), by weight of carcass (by 10.78-14.66%), by weight of pulp (by 17.19-22.81%), respectively.
Pengklasifikasian Grade Telur Ayam Negeri menggunakan Klasifikasi K-Nearest Neighbor berbasis Android
Authors: IBRAHIM NUR , BACHERAMSYAH TASYA FIKRIYAH , HIDAYAT BAMBANG , DARANA SJAFRIL
Published: June 2018

ABSTRAKTelur ayam negeri yang dibeli oleh masyarakat Indonesia di toko swalayan, pasar, ataupun di peternakan memiliki grade yang berbeda-beda. Pada penelitian sebelumnya, telah dilakukan pembuatan sistem pengklasifikasian telur ayam dengan berbasis Windows, namun belum dapat digunakan secara praktis oleh masyarakat. Penelitian ini dilakukan agar masyarakat dapat menggunakannya di lapangan dalam mengklasifikasikan grade telur ayam negeri, dimana pengklasifikasian grade pada telur ayam negeri ini menggunakan klasifikasi KNearest Neighbor (K-NN) yang berbasis android. Berdasarkan hasil pengujian, sistem ini dapat mengklasifikasikan grade telur ayam negeri dengan tingkat akurasi sebesar 80% (dibandingkan menggunakan Haugh Unit Micrometer) menggunakan parameter layer 4 (grayscale), metode penghitungan jarak cosine, dan nilai k=1 dimana jumlah tetangga yang dibandingkan pada algoritma K-NN adalah 1.Kata kunci: K-NN, telur ayam negeri, android.ABSTRACTChicken eggs purchased by Indonesian people in supermarkets, markets, or farms have different grades. In the previous research, the classification system of chicken eggs has been done in the windows platform, but it cannot be used practically by the people. This research was made so the people can use it on the field to classify chicken eggs grade, using the classification of K-Nearest Neighbor (K-NN) based on android. Based on testing results of this system, can classify eggs grade chicken with an accuracy of 80% (compared with Haugh Unit Micrometer) using layer 4 (grayscale), cosine distance method, and value of k=1 which is the total of compared neighborhood in K-NN algorithm is 1.Keywords: K-NN, chicken egg, android.
The Victim, the Villain and the Rescuer
Authors: Faulkner Elizabeth
Published: June 2018

A term as morally and politically loaded as ‘modern day slave trade’ inevitably provokes strong and emotive responses. From the current Secretary General of the United Nations (UN) (António Guterres) to the Prime Minister of the United Kingdom (Theresa May) world leaders have identified human trafficking and slavery as an issue of pressing international concern. The legal understanding of migration (whether legal or illegal, across national borders or internally) has, the article maintains, been constructed in a specific way, serving specific interests. The current ‘migration crisis’ in Europe demonstrates how the key actors are the same, namely, the victim, villain and the rescuer. The purpose of this paper is to critique the influence of The New Abolitionists movement on contemporary responses to female migration; and through applying a gender lens to the movement it will investigate whether their narratives further drives the gender inequalities that plague the migration framework.
Access to Social Protection Minimum Floors as a tool to end early marriage in Mozambique
Authors: Mamad Farida , Foubert Petra
Published: June 2018

Mozambique has the seventh highest early marriage prevalence rate in the world, notwithstanding there being a legal ban. Early marriage generally affects girls who are the least educated, poor and living in rural areas. This situation is a reflection of the gendered socialization process in Mozambique, which places girls in caregiving and reproductive roles. Recently, legal research on early marriage has gained importance in Mozambique. This article demonstrates that social protection floors (SPFs) can be a tool to empower girls. SPFs should be designed to capture substantive inequality in the household and increase protection for girls, inorder to reduce early marriage rates.
The Recognition of the Right to Cultural Identity under (and beyond) international Human Rights law
Authors: Ferri Marcella
Published: June 2018

After summarising the range of reflections by legal scholars on Cultural Rights, this article scrutinises the principle interpretations of the right to take part in cultural life – by the Committee on Economic, Social and Cultural Rights, and the Committee on the Rights of the Child. Due to the evolving interpretations adopted, these bodies have come to define both a right to cultural identity and a right to cultural heritage that is both nuanced and direct. Moreover, they open the door to more extensive attempts at defining customary state obligations, for instance, to respect cultural heritage as recently demonstrated by the decision of the International Criminal Court in the well-known Prosecutor v. Ahmad Al Faqi Al Mahdi case (2016). This article underlines the importance of this ruling in identifying the human dimension to cultural heritage. It established that the human perspective of  cultural heritage is not a prerogative of human rights bodies only, but is beginning to be recognised and valued by other international agencies and organs.
China's Political Economy of Public Communication
Authors: Ni Chen
Published: June 2018

In China, public information and media is a dimension of political communication and subject to political management. Understanding the function and complexity of information-based public discourse in China is important in understanding the conditions for cultural rights. The aim of this article is to offer an insight into the complex role of information in China, and why ‘cultural rights’ cannot be assumed to be a single category of inquiry. Indeed, any form of rights in regard to cultural expression, production and distribution, needs to be understood in the context of the changing political imaginary of the Chinese nation-state – an emerging nationalism based not on imperialist militarism and territorial expansion but on cultural self-determination. This article constructs an historical-critical narrative on the emergence, and major instances, of the growing political management of public communication as a strategy of nation-building through cultural revival.
The Polar® OH1 Optical Heart Rate Sensor is Valid during Moderate-Vigorous Exercise
Authors: Schubert Matthew , Clark Amy , De La Rosa Annie
Published: June 2018

Purpose Traditional heart-rate monitoring through the use of electrocardiograms or chest-worn heart rate sensors can be challenging in certain sports or in field settings. New technologies, such as photoplethysmography (PPG), have enabled heart-rate monitoring at alternate sites. However, to date, the accuracy and validity of various PPG sensors has not been examined in detail. The purpose of the present investigation was to determine the validity of an arm-worn PPG sensor during yoga sequences.

Methods Fifteen college-aged men and women participated in a ~45 min power vinyasa yoga class. During the class, participants wore Polar® H7 chest straps and RCX3 receivers (criterion) and Polar® OH1 arm bands on their upper right arm (practical). Mean differences were compared via a paired t-test, heart rate during yoga using a time*device repeated measures ANOVA, and agreement assessed with Bland-Altman analysis.

Results Mean heart rates during yoga were not different (mean difference=0.76, 95% CI: –0.54 to 2.06; p=0.229). Yoga created a main effect of time on heart rate (p<0.0001), but there was no difference between devices (p=0.86) or interaction (p=0.90). Mean bias±95% limits of agreement was 0.76±1.30 bpm, with a typical error of 2.42±1.49 bpm and a coefficient of variation of 1.8±1.5%.

Conclusions Results of the present investigation revealed that the Polar® OH1 is a valid measure of heart rate during moderate-vigorous exercise. Future validation studies should consider other exercise modes and participant characteristics.
Influence of Serum Incubation Conditions on Asolectin Thromboplastin Generation Results
Authors: Seaman Arthur J. , Karlsen Karen-Marie
Published: June 2018

Thromboplastin generation in a system employing Asolectin, a soybean phosphatide, suspension as a platelet substitute is greatly influenced by the time and temperature of serum incubation.

Reproducible results and good separation of populations of normal and PTC deficient sera were obtained in the asolectin TGT system when test sera were incubated for 1 hour at 20° C prior to the thromboplastin generation test. Longer time or higher temperatures of serum incubation resulted in progressively less reliable, separation of pathologic and normal populations in asolectin TGT systems than in fresh platelet TGT systems. Cephalin suspension was shown in a smaller number of tests to behave similarly to asolectin suspension when used as a platelet substitute in TGT systems.

The 0.14 M sodium citrate eluate of citrated normal or Hemophilia B sera (incubated 1 hour at 37° C) had the ability to shorten the prolonged asolectin TGT minimal time of “over-incubated” normal sera to values obtained with the same sera in fresh platelet TGT systems. This correction, however, was probably non-specific since Hemophilia B sera results were sometimes similarly normalized. Citrated (but not oxalated) plasma incubated at 37° C for 24 hours, then recalcified to manufacture serum, and incubated an additional hour at 20° C showed no loss of the fresh 1 hour 20° C serum activity in asolectin thromboplastin generation, further suggesting that the thermolabile component of normal serum influencing asolectin TGT is a reaction product evolved during clotting.
Heparin Resistance, Measured by the Plasma Heparin Thrombin Time, in Patients on Long-term Anticoagulant Therapy with Phenylindanedione Following Coronary Occlusion
Authors: Holger-Madsen T , Schioler M
Published: June 2018

Of 74 patients with a history of coronary occlusion 42 received anticoagulant (phenylindanedione) therapy, while 32 were untreated. Both groups were investigated in a comparative study of prothrombin determination, heparin tolerance test, and plasma heparin thrombin time. By the latter method the clotting time with thrombin is determined on heparinized, platelet-poor citrated plasma. In several patients on anticoagulant therapy whose prothrombin-proconvertin level was well adjusted and whose heparin clotting time, as measured by the heparin tolerance test, was definitely prolonged in relation to normal, an increased heparin resistance might still be demonstrated in the form of a distinct shortening of the heparin thrombin time. In the majority of the treated patients the anticoagulant therapy had entailed a prolongation of the heparin clotting time as measured by the heparin tolerance test. As measured by the heparin thrombin time, however, the treatment was found to have had no influence on the heparin resistance, there being no difference between the frequency of shortened heparin thrombin time in the treated and in the untreated group.
A Rapid Quantitative Assay of Factor VIII (AHG) Without the Use of Haemophilia A Plasma
Authors: Jung Ernst G.
Published: June 2018

A new method for the quantitative determination of factor VIII (AHG) without using haemophilia A plasma as test substrate has been described. The comparison to Geiger et al. shows a good concordance. The normal range of factor VIII in adults is 50—150% (normal plasma taken as 100%) and the average value of healthy newborns is 78%. This is compared to the average values of the other clotting factors in newborns. Factor VIII is not affected by deficient vitamin K resorption.
Biophysical Studies on Platelet Cofactor I Preparations
Authors: Shulman Sidney , Landaburu Ricardo H. , Seegers Walter H.
Published: June 2018

Preparations of bovine platelet cofactor I have been examined according to biophysical methods. In the ultracentrifuge the patterns reveal a major component comprising 86% of the total and two faster moving minor components. The sedimentation constants are 6.65, 10.0, and 21.2 Svedberg units. The diffusion constant is 3.30 × 10−7 cm2 sec−1. Associating this value with the main constituent, the molecular weight is found to be 196,000. A molecular axial ratio of 12 is also obtained from these data. An axial ratio of 8 is indicated from viscosity data. The extinction coefficient at 2800 Å is 14.8.
Viscous Metamorphosis Produced by Chilling and by Clotting Failure to Find Specific Defect of Viscous Metamorphosis in PTA Syndrome
Authors: Zucker Marjorie B. , Borrelli Jennie
Published: June 2018

Development of platelet clumps, fusion (VM) and fibrin was studied when an aliquot of platelet-rich plasma (PRP), prepared in siliconed glassware without anticoagulant, was transferred to a glass or siliconed tube and shaken at 37° C.

When PRP was not chilled prior to shaking at 37° C in a siliconed tube, clots rarely formed for 12 minutes. Platelet clumps either developed about 1 minute before the clot or did not form at all. If PRP was chilled before shaking, some samples developed platelet clumps within a minute, long before clotting occurred. Either the platelets in these clumps did not fuse, and the clumps disappeared as the sample became warm, or fusion occurred and the clumps persisted.

The distinction between clumps caused by chilling and those produced just prior to coagulation, presumably by thrombin, was even clearer in PRP from patients with prolonged clotting times caused by AHF, PTC and PTA deficiency than it was in normal PRP. Chilled samples usually developed early clumps even though clotting was delayed. In unchilled samples, clumping was delayed as well as clotting; this was attributed to sluggish thrombin evolution.

When EDTA1 PRP was chilled for several hours and shaken at 37° C in the presence of a physiologic excess of magnesium, clumps formed and the platelets often underwent fusion or VM. No relationship could be found between this type of clumping and the coagulation mechanism, although mercuric chloride and benadryl inhibited both VM produced by cold and that caused by clotting.
Performance determinants of fixed gear cycling during criteriums
Authors: Babault Nicolas , Poisson Maxime , Cimadoro Guiseppe , Cometti Carole , Païzis Christos
Published: June 2018

Nowadays, fixed gear competitions on outdoor circuits such as criteriums are regularly organized worldwide. To date, no study has investigated this alternative form of cycling. The purpose of the present study was to examine fixed gear performance indexes and to characterize physiological determinants of fixed gear cyclists. This study was carried out in two parts. Part 1 (n = 36) examined correlations between performance indexes obtained during a real fixed gear criterium (time trial, fastest laps, averaged lap time during races, fatigue indexes) and during a sprint track time trial. Part 2 (n = 9) examined correlations between the recorded performance indexes and some aerobic and anaerobic performance outputs (VO2max, maximal aerobic power, knee extensor and knee flexor maximal voluntary torque, vertical jump height and performance during a modified Wingate test). Results from Part 1 indicated significant correlations between fixed gear final performance (i.e. average lap time during the finals) and single lap time (time trial, fastest lap during races and sprint track time trial). In addition, results from Part 2 revealed significant correlations between fixed gear performance and aerobic indicators (VO2max and maximal aerobic power). However, no significant relationship was obtained between fixed gear cycling and anaerobic qualities such as strength. Similarly to traditional cycling disciplines, we concluded that fixed gear cycling is mainly limited by aerobic capacity, particularly criteriums final performance. However, specific skills including technical competency should be considered.
Different Effects of Social Support on Adolescent Smoking and the Mediation by Smartphone Dependence
Authors: Dancoine Pierre-François , Gentina Elodie
Published: June 2018

Background and aims:

This study examines the relationship between social support (from parents and peers) and cigarette use, through the mediating effect of smartphone dependence, among adolescents.

Study design:

Prospective cohort study.

Methods:

A survey, conducted among 472 adolescents (average age = 16.2 years) attending classes in 3 schools in Lille, France, provides the data. The theoretical model features social support (parental and peer) and cigarette use, with smartphone dependence as a mediator, such that the authors simultaneously examine direct (support → cigarette use) and indirect (eg, peer support → smartphone dependence → cigarette use) paths.

Results:

The results illustrate that both parental support and peer support discourage cigarette use, but the indirect effect through smartphone dependence is positive. That is, smartphone dependence mediates the relationship between peer support and cigarette use. Parental support and peer support shape adolescents’ cigarette use and smartphone dependence differently, depending on the adolescents’ gender.

Conclusions:

Policy makers should acknowledge the positive effects of social support, the negative effect of smartphone dependence, and the importance of gender when developing anti-smoking policies and campaigns.
Percutaneous Versus Open Treatment of Posterior Pelvic Ring Injuries: Changes in Practice Patterns Over Time
Authors: Gire Jacob D. , Jiang Sam Y. , Gardner Michael J. , Bishop Julius A.
Published: June 2018

Objective:

To determine how the utilization of open versus percutaneous treatment of posterior pelvic ring injuries in early-career orthopaedic surgeons has changed over time.

Methods:

Case log data from surgeons testing in the trauma subspecialty for part II of the American Board of Orthopaedic Surgery examination from 2003 to 2015 were evaluated. Current procedural terminology codes for percutaneous fixation (27216) and open fixation (27218) of the posterior pelvic ring were evaluated using a regression analysis.

Results:

A total of 377 candidates performed 2095 posterior ring stabilization procedures (1626 percutaneous, 469 open). Total case volume was stable over time [β = −1.7 (1.1), P = 0.14]. There was no significant change in the number of posterior pelvic ring fracture surgery cases performed per candidate per test year [β = 0.1 (0.1), P = 0.50]. The proportion of posterior pelvic ring cases performed percutaneously increased significantly from 49% in 2003 to 79% in 2015 [β = 1.0 (0.4), P = 0.03]. There was a significant decrease in the number of open cases reported per candidate [β = −0.07 (0.03), P = 0.008].

Discussion and Conclusion:

Early-career orthopaedic surgeons are performing more percutaneous fixation of the posterior pelvic ring and less open surgery. The impact of this change in volume on surgeon proficiency is unknown and warrants additional research.
A Novel Biportal Full Endoscopy Technique for Lumbar Lateral Recess Stenosis
Authors: Liu Xinchun
Published: June 2018

Full endoscopy spine surgery is one of the minimally invasive procedures for lumbar spine disease and is especially popular in East Asia. As for the interlaminar approach, lumbar recess stenosis can be manipulated through a uniportal bigger diameter working channel spinal endoscope or a smaller one, or a biportal arthroscope. Each kind of procedure has its advantages and shortcomings. Here, a novel experience in biportal interlaminar approach for lumbar recess stenosis is presented. A smaller uniportal spinal endoscope is adopted for biportal procedures rather than the arthroscope. Briefly, 2 spinal endoscope working tubes are placed onto the interlaminar window of the target segment. Both of the 2 working tubes can serve as either a viewing or working channel, which means that more flexible visual fields and instrument manipulation can be used during the procedures. Bigger surgical instruments can be used directly through one working tube, and the visual field can be provided by the spinal endoscope in the other working tube. Smaller surgical instruments can be used at the same time through the working channel of the endoscope. The 2 working tubes can change their roles according to the surgeon’s needs. This paper will describe the surgical technique and perioperative management.
A Prospective Study Investigating Fistula Rate Following Primary Palatoplasty Using Acellular Dermal Matrix
Authors: Gilardino Mirko S. , Aldekhayel Salah , Govshievich Alexander
Published: June 2018

Background:

Acellular dermal matrix (ADM) has been described as an adjunct in primary cleft palate repair to reduce the fistula rate in several retrospective studies (level III or lower); however, current data are insufficient to definitively conclude its efficacy for this purpose. The goal of the present study was to provide prospective, higher level of evidence data investigating the effect of ADM on fistula rate following primary palatoplasty.

Methods:

A prospective clinical trial was conducted in which ADM was used uniformly in all primary cleft palate repairs that met inclusion criteria. For comparison, a matched control group was identified (retrospectively) from the same center/surgeon’s database. Primary outcome was the rate of palatal fistula formation. Secondary outcomes included bleeding, infection, and delayed healing.

Results:

A total of 130 patients were included in the analysis consisting of 65 in both the study and control groups. There were no statistically significant differences in patient demographics or cleft /surgical characteristics. The results demonstrated a fistula rate of 1.5% in the study group versus 12.3% in the control group (P = 0.03). The other complications (infection, bleeding, delayed healing) were similar between the groups.

Conclusion:

The study provides the highest level of evidence currently available (level II, prospective data) investigating the effect of ADM on fistula rate following primary palatoplasty. The results demonstrate a low overall fistula rate (1.5%) and suggest there may be a clinically significant reduction in fistula formation associated with the routine use of ADM in all primary palate repairs.
Aortic Valve-in-Valve in Externally Mounted Bioprosthesis
Authors: Cheung Anson W. , Ye Jian , Dvir Danny , Wood David A. , Webb John G.
Published: June 2018

Objective

Aortic valve-in-valve implantation for prosthetic valve dysfunction is a good alternative to reoperative valve replacement. There are some limitations to this approach including the risk of coronary occlusion, patient prosthesis mismatch, and valve malposition. The incidence of coronary occlusion is higher in aortic valve-in-valve than de novo aortic stenosis cases. Multiple factors can contribute to this complication, and the type of bioprosthesis has been implicated.

Methods

We examined our experience of 80 aortic valve-in-valve cases with internally and externally mounted leaflet valves.

Results

Procedural success was achieved in 95% of cases with an overall 30-day mortality of 1.3%. Clinical and procedural outcomes were similar in the both cohorts.

Conclusions

Our data suggest that aortic valve-in-valve implantation can be safely performed in carefully selected patient with internally and externally mounted leaflet bioprosthesis.
Homograft versus Conventional Prosthesis for Surgical Management of Aortic Valve Infective Endocarditis
Authors: Yanagawa Bobby , Mazine Amine , Tam Derrick Y. , Jüni Peter , Bhatt Deepak L. , Spindel Stephen , Puskas John D. , Verma Subodh , Friedrich Jan O.
Published: June 2018

Objective

Surgical management of aortic valve infective endocarditis (IE) with cryopreserved homograft has been associated with lower risk of recurrent IE, but there is equipoise with regard to the optimal prosthesis. This systematic review and meta-analysis were performed to compare outcomes between homograft and conventional prosthesis for aortic valve IE.

Methods

We searched MEDLINE database to September 2017 for studies comparing homograft versus conventional prosthesis. The main outcomes were all-cause mortality, recurrent IE, and reoperation.

Results

There were 18 included comparative observational studies with 2232 patients (median follow up = 5 [interquartile range: 2–7] years, 30% prosthetic valve endocarditis); four studies were adjusted for baseline differences. There were no differences in perioperative mortality or stroke despite a greater proportion of staphylococcal endocarditis, abscess, and root replacements but less multivalve involvement in the homograft group. Long-term outcomes of all-cause mortality [incidence rate ratio (IRR) = 1.03, 95% confidence interval (CI) = 0.81–1.31, P = 0.83, for unmatched, and IRR = 0.82, 95% CI = 0.36–1.84, P = 0.63, for matched studies], recurrent endocarditis (IRR = 1.01, 95% CI = 0.53–1.93, P = 0.96, for unmatched, and IRR = 1.04, 95% CI = 0.49–2.19, P = 0.92, for matched studies), and reoperation (IRR = 1.60, 95% CI = 0.80–3.21, P = 0.18, for unmatched, and IRR = 3.17, 95% CI = 0.52–19.44, P = 0.21, for matched studies) were not different comparing homograft versus conventional prosthesis. There was a significantly increased need for reoperation with homograft versus mechanical prosthetic valves, but this comparison was based on limited data.

Conclusions

Homografts and conventional prostheses offer similar survival and freedom from recurrent endocarditis and reoperation for aortic valve IE. Homografts may be associated with greater risk of reoperation compared with mechanical valves.
Maintenance Ketamine Therapy for Treatment-Resistant Depression
Authors: Archer Shaina , Chrenek Carson , Swainson Jennifer
Published: June 2018

Background

Previous studies have demonstrated ketamine to have a rapid antidepressant effect in some patients with treatment-resistant depression (TRD), but the effect is unfortunately not sustained in the long term. In this study, we report on the clinical use of ongoing maintenance ketamine infusions in a group of patients with TRD, beyond an acute course of 6 to 8 ketamine infusions.

Methods

This retrospective case series reports on 11 patients with TRD who received maintenance ketamine infusions, defined as treatments beyond an initial series of up to 8 infusions. Charts were reviewed to collect data on response to treatment and side effects.

Results

All 11 patients in this case series were noted to have a reduction in their Beck Depression Inventory II (BDI-II) score after an acute course of treatment and a lower median BDI-II during their maintenance treatments than their baseline BDI-II. At the study end point, 4 patients were continuing maintenance ketamine and 1 patient had transitioned to maintenance intranasal ketamine. Four patients discontinued ketamine due to loss of effect and 1 due to side effects, and the reason for discontinuation was not noted for the remaining 2 patients. No major adverse events were noted in these patients receiving maintenance treatments, and it was well tolerated overall.

Conclusions

Maintenance ketamine treatments may be an effective way of maintaining treatment response in some ketamine responders. Future research is required to determine optimal length of treatment in those who respond to ketamine and to track adverse effects over a longer time.
Idiopathic Sudden Sensorineural Hearing Loss Is Not a Sentinel Event for Acute Myocardial Infarction
Authors: Crowson Matthew G. , Mulder Hillary , Cyr Derek D. , Langman Alan W. , Lee Walter T. , Parham Kourosh , Pynnonen Melissa A. , Schulz Kristine , Shin Jennifer J. , Witsell David , Vambutas Andrea
Published: June 2018

Objective:

Given ongoing debate about the suggested association, the primary objective was to determine if idiopathic sudden sensorineural hearing loss (ISSNHL) was a sentinel event for acute myocardial infarction (AMI) in adults.

Study Design:

Case-control study.

Setting:

United States MarketScan administrative health claims database.

Patients:

Aged 18 years or older, had a diagnosis of ISSNHL on or after January 1st, 2011 and had sufficient follow-up data available to assess for AMI occurrence.

Intervention:

N/A.

Main Outcome Measures:

Incidence rates (per 1,000 patient years) of AMI for cases and controls were computed. Adjusted and unadjusted Cox proportional hazards models were created to explore possible associations between ISSNHL and initial AMI.

Results:

A total of 10,749 ISSNHL cases and 10,749 matched controls were included. There were no significant differences in the incidence rate of AMI between ISSNHL cases (8.29 events/1,000 person-years) and controls (9.25 events/1,000 person-years), nor were there differences within age groups, sex, or comorbidity status (overall incidence rate ratio 0.90; 95% confidence interval [CI] 0.70–1.15 p = 0.39). The unadjusted and adjusted Cox proportional hazards models did not demonstrate an association between ISSNHL and initial AMI (hazard ratio [HR]: 0.90, 95% CI: 0.70–1.15; HR: 0.86, 95% CI: 0.67–1.10, respectively).

Conclusions:

ISSNHL is not a predictor of an initial AMI in adult patients from the United States. Considerable inconsistencies in associations between cardiovascular risk factors and ISSNHL exist in the literature. Further work is needed to confirm or refute direct associations between cardiovascular disease risk factors and ISSNHL before definitive mechanistic conclusions can be made.
Inadequate Hepatocellular Carcinoma Screening in Patients With Nonalcoholic Steatohepatitis Cirrhosis
Authors: Aby Elizabeth , Phan Jennifer , Truong Emily , Grotts Jonathan , Saab Sammy
Published: June 2018

Background:

Nonalcoholic steatohepatitis (NASH) is a common cause of liver disease which can progress to cirrhosis and hepatocellular carcinoma (HCC). American Association for the Study of Liver Diseases (AASLD) guidelines recommend abdominal ultrasound, with or without serum alpha-fetoprotein, every 6 months for HCC surveillance in cirrhotic patients.

Goals:

Describe HCC surveillance rates in NASH cirrhosis compared with hepatitis C (HCV) cirrhosis and the impact of surveillance on tumor size, treatment, and mortality.

Study:

Adults with NASH and HCV cirrhosis diagnosed with HCC from 2009 to 2016 were retrospectively evaluated. Patients were categorized into 3 mutually exclusive disease screening groups based on abdominal imaging with or without serum alpha-fetoprotein testing before HCC diagnosis.

Results:

In total, 99 patients with NASH cirrhosis and 162 patients with HCV cirrhosis were evaluated. In total, 51.5% of NASH cirrhosis patients and 25.9% of HCV cirrhosis patients had no screening before HCC diagnosis. Patients with HCV cirrhosis were significantly more likely to undergo surveillance compared with patients with NASH cirrhosis (P=0.002). NASH cirrhosis patients who underwent complete screening had smaller tumors compared with those with incomplete screening and no screening (P=0.006). There were no differences in number of tumors at diagnosis or mortality between screening groups in patients with NASH cirrhosis (P=0.281 and 0.468, respectively).

Conclusions:

There is suboptimal HCC surveillance in NASH and HCV cirrhotic patients, with a greater proportion of patients with NASH cirrhosis not undergoing surveillance. Patients with NASH cirrhosis who had complete surveillance had smaller tumors at diagnosis, but there were no differences in treatment outcomes or mortality.
Role of Cholecystectomy After Endoscopic Sphincterotomy in the Management of Choledocholithiasis in High-risk Patients
Authors: Khan Muhammad Ali , Khan Zubair , Tombazzi Claudio R. , Gadiparthi Chiranjeevi , Lee Wade , Wilcox C. Mel
Published: June 2018

Background:

Endoscopic retrograde cholangiography and endoscopic sphincterotomy (ES) with subsequent cholecystectomy is the standard of care for the management of patients with choledocholithiasis. There is conflicting evidence in terms of mortality reduction, prevention of complications specifically biliary pancreatitis and cholangitis with the use of early cholecystectomy particularly in high-risk surgical and elderly patients.

Aims:

We conducted this systematic review and meta-analysis of randomized controlled trials to compare the early cholecystectomy versus wait and watch strategy after ES.

Methods:

We searched Medline, Scopus, Web of Science, and Cochrane database for randomized controlled trials comparing the 2 strategies in the management of choledocholithiasis after ES. Our primary outcome of interest was difference in mortality. We evaluated several secondary outcomes including difference in development of acute pancreatitis, biliary colic and cholecystitis, cholangitis and recurrent jaundice, nonbiliary adverse events, and length of hospital stay. Risk ratios (RR) were calculated for categorical variables and difference in means was calculated for continuous variables. These were pooled using random effects model.

Results:

Seven studies with 916 patients (455 cholecystectomy group and 461 wait and watch group) were included in the meta-analysis. Pooled RR with 95% confidence interval for mortality was 1.43 (0.93-2.18), I
2=9%. In the high-risk patient group, pooled RR was 1.39 (0.64-3.03) and in low-risk population pooled RR was 1.53 (0.79-2.96). Pooled RR for acute pancreatitis was 1.64 (0.46-5.81) with no heterogeneity. There was no difference in the rate of acute pancreatitis patients based on high-risk versus low-risk patients. Pooled RR for occurrence of biliary colic and cholecystitis during follow-up was 9.82 (4.27-22.59), I
2=0%. Pooled RR for cholangitis and recurrent jaundice was 2.16 (1.14-4.07), I
2=0%. However, there was no difference in the rate of cholangitis between the 2 groups in low-risk patients. Length of stay was shorter in the wait and watch group with a pooled mean difference was −2.70 (−4.71, −0.70) with substantial heterogeneity.

Conclusions:

Although we found no difference in mortality between the 2 strategies after ES, laparoscopic cholecystectomy should be recommended as it is associated with lower rates of subsequent recurrent cholecystitis, cholangitis, and biliary colic down the road even in high-risk surgical patients.
Assessing Quality of Precut Sphincterotomy in Patients With Difficult Biliary Access
Authors: Chen Jie , Wan Jian Hua , Wu Dang Yan , Shu Wen Qing , Xia Liang , Lu Nong Hua
Published: June 2018

Background:

It is generally accepted that precut sphincterotomy during endoscopic retrograde cholangiopancreatography (ERCP) increases the risk of pancreatitis. However, patients with difficult biliary access may be different. We implemented a meta-analysis to explore the effects of early and delayed precut sphincterotomy on post-ERCP pancreatitis in patients with difficult biliary access.

Methods:

We searched studies in PubMed, EMBASE, and the Cochrane Central Register of Randomized Controlled Trials for meeting requirement in which precut sphincterotomy was compared with persistent standard cannulation during ERCP. The primary outcomes included the overall cannulation success rate and the incidence of post-ERCP pancreatitis. The secondary outcomes included primary cannulation success and the overall complication rate.

Results:

Six studies (898 patients) were included. The present meta-analysis found no significant difference in overall cannulation success rate and overall complication rate between early precut sphincterotomy and persistent standard cannulation. However, early precut sphincterotomy not only increased the primary cannulation success rate [Mantel Haenszel test relative risk, 1.87; 95% confidence interval (CI), 1.15-3.04] but also decreased the overall risk of pancreatitis (Peto odds ratio, 0.49; 95% CI, 0.30-0.80). For persistent standard cannulation, no significant difference was observed in the pancreatitis rate between no salvage precut and delayed salvage precut sphincterotomy (Peto odds ratio, 0.96; 95% CI, 0.49-1.85).

Conclusions:

Compared with persistent standard cannulation, an early precut sphincterotomy exhibited a reduced risk of pancreatitis. In addition, a delayed precut sphincterotomy after persistent attempts did not increase the occurrence of pancreatitis and this is the first meta-analysis to present this conclusion.