bluuebunny/crossref_metadata_2025 huggingface dataset:
Qualitative Methods Used to Generate Questionnaire Items: A Systematic Review
Authors: Ricci Laetitia , Lanfranchi Jean-Baptiste , Lemetayer Fabienne , Rotonda Christine , Guillemin Francis , Coste Joël , Spitz Elisabeth
Published: June 2018

A systematic review of articles using qualitative methods to generate questionnaire items identified in MEDLINE and PsycINFO from 2000 to 2014 was carried out. Articles were analyzed for (a) year of publication and journal domain, (b) qualitative data collection methods, (c) method of data content analysis, (d) professional experts’ input in item generation, and (e) debriefing of the newly developed items. In total, 371 articles were included and results showed (a) an acceleration of published articles, (b) individual interviews and focus groups were common ways of generating items and no emergent approach was identified, (c) the content analysis was usually not described (43% of articles), (d) experts were involved in eliciting concepts in less than a third of articles, (e) 61% of articles involved a step of further submission of newly developed items to the population of interest. This review showed an insufficient reporting of qualitative methods used to generate new questionnaires despite previous recommendations.
Macroscopic Evaluation of the Trimmed Frozen Block Is a Helpful Tool for Intraoperative Assessment of Resection Margins of Breast Cancer Specimens
Authors: Trippel Mafalda , Slotta-Huspenina Julia , Becker Karen , Rau Tilman , Paepke Stefan , Maurer-Marti Franziska , Langer Rupert
Published: June 2018

Introduction. The evaluation of the trimming surfaces (TS) of tissue blocks from frozen sections may serve as a supplementary examination tool for the intraoperative determination of resection margins of breast cancer specimens. This study aimed at the investigation of the feasibility and reliability of this technique, which has been described only very rarely in literature. Methods. Two observers assessed digital images from TS obtained from 57 resection margins. Findings were correlated with the diagnosis of the frozen section (FS) alone and the final diagnosis on formalin-fixed paraffin-embedded (FFPE) material. Results. The determination of the resection margin on TS was estimated as feasible for all cases. Interobserver congruence rate for TS was 96% (κ = 0.81), which was lower compared with FFPE (100%, κ = 1.0) but superior to FS (89%, κ = 0.67). Intraobserver congruence of the 2 reviewers was 96.5% and 93.0% between TS and FFPE, and 91.1% and 92.5% between FS and FFPE, respectively. The combination of both intraoperative consultation techniques showed similar congruence but a slight improvement for the sensitivity (0.75 to 0.875) for the diagnosis of tumor at the resection margin in FFPE for Reviewer 1 but was unchanged for Reviewer 2. Conclusion. The additional evaluation of TS can be a helpful additional tool for intraoperative margin assessment of breast cancer specimens, in particular, when processing artifacts of FS are encountered.
Endometrioid Endometrial Carcinoma With Spindle Cells–Aberrant p16 and p53 Expression
Authors: Sonawane Snehal , Elfituri Osama , Zhang Yanmin , Yordan Edgardo , Ree Nicholas
Published: June 2018

Endometrioid carcinoma is known for its diverse morphology and may pose a diagnostic dilemma when it presents with a spindle cell component. We present a case of a 65-year-old woman with postmenopausal bleeding. Physical examination showed a mass protruding from the external cervical os. The patient underwent biopsy followed by hysterectomy. Pathologic examination showed an endometrioid endometrial carcinoma with spindle cell differentiation arising in an endometrial polyp, which raised a variety of differential diagnoses. Prior reports of this tumor type showed nonaberrant immunohistochemical expression of p16 and p53. However, this case showed p16 and p53 overexpression indicating that there is a spectrum of these tumors.
Foot Width Changes Following Hallux Valgus Surgery
Authors: Tenenbaum Shay A. , Herman Amir , Bruck Nathan , Bariteau Jason T. , Thein Ran , Coifman Oded
Published: June 2018

Background:

Hallux valgus (HV) adversely affects quality of life. Patients frequently express concerns regarding postoperative foot appearance, foot width and footwear anticipations. However, only scarce data are available regarding postoperative foot width.

Materials and Methods:

Seventy-one cases with moderate to severe HV treated with scarf osteotomy were included. The average age was 55.7 years (range, 20-76), with average follow-up of 20.7 months (range, 6-96). Patients’ medical records were reviewed for demographic, operative, and radiographic data. Foot width was assessed radiographically by measuring both bone (distance between the first and fifth metatarsal heads) and soft tissue width (maximal distance of the soft tissue outline).

Results:

Preoperative HV deformity (mean hallux valgus angle [HVA] 35.8 degrees, intermetatarsal angle [IMA] 14.1 degrees, and distal metatarsal articular angle [DMAA] 15.2 degrees) was successfully corrected (postoperative mean HVA 13.7 degrees, IMA 6.9 degrees, and DMAA 7.7 degrees). Overall bony foot width was reduced by 5% and soft tissue foot width by 2%. Further analysis showed that 13 feet (18.3%) had increased (>5%) bone width, 26 feet (36.6%) with no change (±5%), and 32 feet (45.1%) for which the width decreased (>5%) postoperatively. Angular deformity (HVA, IMA, and DMAA) showed low correlation with postsurgery foot width.

Conclusion:

HV surgery effect on foot width was very limited, overall reducing foot width by 2%. Furthermore, in only about half of the patients, the postoperative foot width decreased, regardless of angular deformity magnitude. Patients with the widest feet had a decrease in foot width following surgery, whereas patients with the narrowest feet had an increase in foot width.

Level of Evidence:

Level III, comparative series.
Implementation of a text message intervention to promote behavioural change and weight loss among overweight and obese Brazilian primary care patients
Authors: Gusmão Lorenn L , Ribeiro Antonio L , Souza-Silva Maíra Viana Rego , Gomes Paulo R , Beleigoli Alline M , Cardoso Clareci S , Santo Karla , de Sousa Lidiane P , Marcolino Milena S
Published: June 2018

Introduction

Mobile-technology-based interventions are promising strategies for promoting behavioural change in obese patients. The aims of this study were to evaluate the feasibility of implementing a text message intervention, and to assess the effects of the intervention on body mass index (BMI) and self-reported behavioural change.

Methods

TELEFIT was a three-phase feasibility study comprising the following stages: (a) the development of text messages; (b) testing; and (c) a quasi-experimental pilot study in which patients who were engaged in obesity/overweight educational groups in public primary care centres in Belo Horizonte, Brazil, were recruited. A bank of text messages was drafted and reviewed by an expert panel, text message delivery software was developed and tested, and a pilot study assessed patients before and after receiving the intervention using validated questionnaires and body measures. The data were analysed using the Wilcoxon test.

Results

A total of 46 patients completed the follow-up; 93.5% were women and the median age was 42 years (interquartile range (IQR) 34–52 years). At four months, participants had a significant reduction in BMI (median 31.3 (IQR 28.2–34.6) vs. 29.9 (IQR 27.2–34.6) kg/m2, p < 0.001), systolic (median 125 (IQR 120–132) vs. 120 (IQR 110–130) mmHg, p = 0.013) and diastolic blood pressure (median 80 (IQR 70–100) vs. 80 (IQR 70–80) mmHg, p = 0.006), when compared to baseline. All patients reported to be satisfied and willing to continue receiving the intervention, and 93.3% felt that the intervention helped them change their behaviours.

Discussion

This study has shown that a text message intervention to promote behavioural change and weight loss was feasible and effective in a short-term period. Participants were satisfied and willing to continue receiving the SMS messages.
Cycle behaviour of precast composite wall with different ecological filled blocks
Authors: Li Bin , Huang Wei , Luo Bin , Chen Guoxin
Published: June 2018

This article aims at experimentally investigating a cycle behaviour of a new lateral force-resisting structural system, that is, precast composite walls with ecological filled blocks. For this purpose, a total of five low cyclic loading tests were conducted for the 1:2-scaled precast composite wall specimens with five different kinds of ecological filled blocks, namely, the wheat straw fibre raw soil–based block, the recycled expanded polystyrene lightweight concrete block, the wheat straw fibre cement–based block, the autoclaved aerated concrete block and the cotton straw block. In the test, the failure patterns, hysteretic loops, characteristic points, skeleton curves, ductility and relative deformation, stiffness degradation and energy dissipation capacity of the tested specimens were obtained and further analysed. The test results show that (1) the failure modes and mechanisms of the tested specimens are primarily affected by the strength of the filled blocks and the connection performance of the concrete ribbed grids; (2) the filled blocks, ribbed grids and the concealed frame can work cooperatively and interact and they play roles in the three stages of elastic, elastic–plastic, and ultimate destruction in turn; (3) the compressive strength, crack resistance, modulus of elasticity of filled blocks and bonding capacity with the ribbed grids are the main factors affecting the characteristic point, displacement ductility, stiffness degradation and other seismic performance index of the precast composite wall; (4) the five wall specimens have different energy dissipation capacities with the increase of displacement and also have the strong ability to resist collapse, which reflect the precast composite walls’ good behaviour in terms of earthquake resistance.
Citizen Support for Domestic Drone Use and Regulation
Authors: West Jonathan P. , Klofstad Casey A. , Uscinski Joseph E. , Connolly Jennifer M.
Published: June 2018

Recently, governments, commercial firms, and individuals have increased their use of unmanned aerial vehicles (i.e., “drones”). As with many new technologies, drone use has outpaced government oversight. Attempts to regulate the technology have been met with intense public backlash. Therefore, governments need to understand the public’s preferences for a regulatory regime. Analyzing national survey data, we address two questions: (a) What policies do Americans prefer for the regulation of drones? and (b) Does the public believe the federal, state, or local government or nongovernmental actors should be responsible for regulating drone use? Public preferences are one of several important inputs affecting policymaking; therefore, our results provide an important overview of current public opinion toward drone policy, as well as a theoretical blueprint for understanding how such opinions might fluctuate overtime.
IL-33 Promotes the Development of Colorectal Cancer Through Inducing Tumor-Infiltrating ST2L+ Regulatory T Cells in Mice
Authors: Zhou Yaxing , Ji Yong , Wang Honggang , Zhang Hai , Zhou Haihua
Published: June 2018

Colorectal cancer, one of the most commonly diagnosed and lethal cancers worldwide, is accompanied by the disorders of immune system. However, the underlying mechanism is still not fully understood. In this study, our goal was to determine whether interleukin 33 promotes tumorigenesis and progression of colorectal cancer through increased recruitment of tumor-infiltrating ST2+ regulatory T cells in CT26 tumor-bearing mice. We found that the mRNA or protein levels of interleukin 33, soluble ST2, and membrane ST2 were elevated in the serum of tumor-bearing mice when compared to WT mice. The mRNA levels of interleukin 33, soluble ST2, and membrane ST2 were also elevated in the tissue of tumor-bearing mice when compared to surrounding nontumor muscular tissues. In addition, the frequency of ST2L+ regulatory T cells was significantly increased in both tumor tissue and spleen of tumor-bearing mice. Higher protein levels of interleukin-4, -10, and -13 were also observed in the serum or the tumor homogenates of tumor-bearing mice. We found exogenously administered recombinant mouse interleukin 33 promoted tumor size and induced tumor-infiltrating ST2L+ regulatory T cells in tumor-bearing mice while neutralizing interleukin-33 or ST2L inhibited tumor size and decreased ST2L+ regulatory T cells. Furthermore, ST2L+ regulatory T cells from tumor tissue were also able to suppress CD4+CD25−T cell proliferation and interferon γ production. Altogether, our findings demonstrate the critical roles of interleukin 33 in promoting colorectal cancer development through inducing tumor-infiltrating ST2L+ regulatory T cells, and inhibition of interleukin-33/ST2L signaling maybe a potential target for the prevention of colorectal cancer.
High TSTA3 Expression as a Candidate Biomarker for Poor Prognosis of Patients With ESCC
Authors: Yang Jie , Kong Pengzhou , Yang Jian , Jia Zhiwu , Hu Xiaoling , Wang Zianyi , Cui Heyang , Bi Yanghui , Qian Yu , Li Hongyi , Wang Fang , Yang Bin , Yan Ting , Ma Yanchun , Zhang Ling , Cheng Caixia , Song Bin , Li Yaoping , Xu Enwei , Liu Haiyan , Gao Wei , Wang Juan , Liu Yiqian , Zhai Yuanfang , Chang Lu , Wang Yi , Zhang Yingchun , Shi Ruyi , Liu Jing , Wang Qi , Cheng Xiaolong , Cui Yongping
Published: June 2018

Esophageal squamous cell carcinoma is the sixth most lethal cancer worldwide and the fourth most lethal cancer in China. Tissue-specific transplantation antigen P35B codifies the enzyme GDP-d-mannose-4,6-dehydratase, which participates in the biosynthesis of GDP-l-fucose. GDP-l-fucose is an important substrate involved in the biosynthesis of many glycoproteins. Cancer cells are often accompanied by the changes in glycoprotein structure, which affects the adhesion, invasion, and metastasis of cells. It is not clear whether tissue-specific transplantation antigen P35B has any effect on the development of esophageal squamous cell carcinoma. We used an immunohistochemical method to assess the expression of tissue-specific transplantation antigen P35B in 104 esophageal squamous cell carcinoma samples. The results showed tissue-specific transplantation antigen P35B expression was associated with some clinical features in patients, such as age ( P = .017), clinical stage ( P = .010), and lymph node metastasis ( P = .043). Kaplan-Meier analysis and log-rank test showed that patients with esophageal squamous cell carcinoma having high tissue-specific transplantation antigen P35B expression had a worse prognosis compared to the patients with low expression ( P = .048). Multivariate Cox proportional hazards regression model showed that high expression of tissue-specific transplantation antigen P35B could predict poor prognosis for patients with esophageal squamous cell carcinoma independently. In conclusion, abnormal fucosylation might participate in the progress of esophageal squamous cell carcinoma and tissue-specific transplantation antigen P35B may serve as a novel biomarker for prognosis of patients with esophageal squamous cell carcinoma.
Investigating the cross-cultural dimensions of educational Web 2.0 acceptance: the case of Moroccan and American university students
Authors: Amzaourou Oulaid , Oubaha Driss
Published: June 2018

As a response to scholars’ growing calls for new and more cross-cultural perspectives in the study of educational technology acceptance, this study examined the moderating effect of Moroccan ( n = 200) and American ( n = 200) university students’ psycho-cultural values, as conceptualized by Hofstede’s multidimensional matrix, on their acceptance and use of Web 2.0 for learning. Data were collected using an extended version of the unified theory of acceptance and use of technology (UTAUT). The findings, in addition to validating the UTAUT in two culturally divergent higher education contexts, have uncovered how students’ cultural values of individualism/collectivism and power distance significantly affect their Web 2.0 acceptance profiles. Thus, for example, while Moroccan students’ acceptance of Web 2.0 is determined by social influence, performance expectancy and behavioral intention were the primary determinant factors for their American counterparts.
Educational gaps and their impact on Iraqi refugee students’ secondary schooling in the Greater Detroit, Michigan Area
Authors: Bang Hyeyoung , Collet Bruce A
Published: June 2018

In this piece we examine educational gaps among Iraqi refugee students while living in Iraq and while in transitional countries, challenges resulting from those educational gaps since they have arrived in the United States, and Iraqi students’ needs to overcome their challenges for school adjustment. Thirty Chaldean Iraqi refugees who attended various high schools in the greater Detroit area, their parents, and their teachers participated in interviews and focus groups. Educational gaps in Iraq are due to precarious conditions involved in access to schooling, and threats and dangers experienced as Chaldean religious minorities. Gaps in transitional countries are due to lack of access to schooling due to residency restrictions, discriminatory treatment, and financial difficulties. Iraqi students are highly anxious about academic failure and their ability to obtain a high school diploma. We recommend educational policies and practices that might best address the serious problem of educational gaps.
Concentrations of Intact Insulin Concurs With FDA and EMA Standards When Measured by HPLC in Different Parts of the Distribution Cold Chain
Authors: Moses Alan , Bjerrum Jesper , Hach Morten , Wæhrens Lars Holm , Toft Anders Dyhr
Published: June 2018

Background:

The article by Carter and Heinemann raised serious concerns about the concentrations of insulin in vials being sold in US pharmacies. To study the claims made in the manuscript, we reviewed Novo Nordisk data on insulin concentration.

Methods:

Insulin concentrations within vials from three different sources along the distribution chain were evaluated utilizing currently accepted US Pharmacopeia methodology: (1) insulin content and stability based on production batches covering 7 years of insulin production, (2) insulin content in samples returned to Novo Nordisk over the last three years in the United States, and (3) data from eight years of independent EMA testing.

Results:

The data demonstrated that without exception (1) insulin quality based on stability data was maintained, even in scenarios that stressed the normal recommendations for temperature storage conditions, (2) insulin content from the last three years of samples returned to Novo Nordisk from patients in the United States (233 vials) was within USP requirements recognized by FDA, and (3) ten years of independent EMA sampling of products obtained at wholesalers and pharmacies across the EU confirmed compliance (n = 43).

Conclusions:

The study by Carter and Heinemann utilized an LC-MS technique, which has not been validated for the quantification of insulin in pharmaceutical preparations. It appears likely that their findings are the result of the method utilized and not due to decreased insulin content in samples. However, recognizing the importance of maintaining Insulin content from production to the patient, Novo Nordisk supports continued evaluation of insulin distributed to pharmacies and patients utilizing validated techniques compliant with international pharmacopeias.
Editor’s Choice- Pathophysiology, diagnosis and management of MINOCA: an update
Authors: Scalone Giancarla , Niccoli Giampaolo , Crea Filippo
Published: June 2018

Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a syndrome with different causes, characterised by clinical evidence of myocardial infarction with normal or near-normal coronary arteries on angiography. Its prevalence ranges between 5% and 25% of all myocardial infarction. The prognosis is extremely variable, depending on the cause of MINOCA. The key principle in the management of this syndrome is to clarify the underlying individual mechanisms to achieve patient-specific treatments. Clinical history, electrocardiogram, cardiac enzymes, echocardiography, coronary angiography and left ventricular angiography represent the first level diagnostic investigations to identify the causes of MINOCA. Regional wall motion abnormalities at left ventricular angiography limited to a single epicardial coronary artery territory identify an ‘epicardial pattern’whereas regional wall motion abnormalities extended beyond a single epicardial coronary artery territory identify a ‘microvascular pattern’. The most common causes of MINOCA are represented by coronary plaque disease, coronary dissection, coronary artery spasm, coronary microvascular spasm, Takotsubo cardiomyopathy, myocarditis, coronary thromboembolism, other forms of type 2 myocardial infarction and MINOCA of uncertain aetiology. This review aims at summarising the diagnosis and management of MINOCA, according to the underlying physiopathology.
Long‐term changes in liver elasticity in hepatitis C virus‐infected patients with sustained virologic response after treatment with direct‐acting antivirals
Authors: Pietsch Veronika , Deterding Katja , Attia Dina , Ringe Kristina Imeen , Heidrich Benjamin , Cornberg Markus , Gebel Michael , Manns Michael Peter , Wedemeyer Heiner , Potthoff Andrej
Published: June 2018

Background

The use of interferon‐free direct‐acting antiviral agents (DAAs) is associated with a rapid short‐term decrease in liver stiffness in chronic hepatitis C‐infected patients with sustained virologic response (SVR).

Objective

The objective of this article is to evaluate long‐term changes in liver elasticity in hepatitis C patients with SVR using transient elastography (TE), FIB‐4 and APRI.

Methods

A total of 143 patients were treated with DAAs and reached SVR. Patients received TE measurement (median (range)) at treatment start (baseline), follow‐up week 24 (FU24) and follow‐up week 96 (FU96). Laboratory data were examined at each date and FIB‐4 and APRI were calculated.

Results

Liver elasticity showed a significant decrease from baseline to FU24 (13.1 (3.1–75) kPa to 9.3 (2.9–69.1) kPa; p < 0.0001) and declined further until FU96 (7.9 (2.4–59.3) kPa; p < 0.0001). Liver inflammation and liver function parameters normalised during long‐term follow‐up. Progression of liver stiffness between FU24 to FU96 despite viral clearance was observed in 24 patients (17%). Long‐term liver stiffness progression was associated with aspartate aminotransferase levels and TE change from baseline to FU24.

Conclusion

During long‐term follow‐up, the majority of patients with SVR had further improved liver stiffness values. Still, a significant proportion of patients may show long‐term liver stiffness progression and thus continued TE follow‐up is recommended.
Comparison of anti-inflammatory effect between β-patchoulene epoxide and β-patchoulene in LPS-stimulated RAW264.7 macrophages
Authors: Wu Xue , Liang Jia-Li , Liu Yu-Hong , Wu Jia-Zhen , Huang Qiong-Hui , Li Yu-Cui , Xie Qing-Feng
Published: June 2018

β-patchoulene (β-PAE) is one of the essential tricyclic sesquiterpenes of patchouli oil while β-patchoulene epoxide (β-PAO) is the oxidative product of β-PAE which can only be found in the oil with long storage period. Our previous researches demonstrated that both β-PAE and β-PAO exert potent anti-inflammatory activity in vivo, but which one is more valuable still remains uncertain. Therefore, this study adopts the model of LPS-stimulated RAW264.7 macrophages to compare β-PAO with β-PAE on the anti-inflammatory activity. According to our results, β-PAO was superior to β-PAE on anti-inflammation as evidence by lowering the protein and mRNA expressions of several pro-inflammatory cytokines including tumor necrosis factor-α (TNF-α), interleukin-12 (IL-12), interleukin-1β (IL-1β), and monocyte chemotactic protein-1 (MCP-1). β-PAO was also better than β-PAE in reducing the productions of nitric oxide (NO) and prostaglandin E2 (PGE2) through inhibiting inducible nitric oxide synthase (iNOS) and cyclooxygenase (COX)-2 signaling pathway. The results above provided experimental basis for the conclusion that β-PAO was more potent than β-PAE in anti-inflammatory activity in vitro.
Support Programs for Women Survivors of Sexualized Gender-Based Violence From African Conflict Zones: A Contextual Review
Authors: Okeke-Ihejirika Philomina , Yohani Sophie , McMenemy Claire
Published: June 2018

The increasing attention paid to sexualized gender-based violence (GBV) against women in African conflict zones by the international community is a welcome development to many stakeholders, including scholars, policy makers, human rights advocates, international organizations, and nongovernmental organizations. Little is known, however, about the experiences of survivors who end up in Western host countries, such as Canada, as newcomers. Much less is known about their interactions with Western-based mental health care intervention models and the assumptions and understandings they hold about survivors’ histories and life circumstances before, during, and after migration. We argue, therefore, for studies that place the experiences of survivors in a broader social and political context—as one crucial facet of culturally effective interventions. This review of the state of knowledge reveals the gaps in literature, identifies areas for future research, and contributes to the search for effective intervention measures that could enhance survivors’ transition and integration into Western societies.
Foreigners to Kristeva: Refashioning Orientalism and the Limits of Love
Authors: Ibrahim Hanan M.
Published: June 2018

Julia Kristeva, an influential 20th- and 21st-century thinker, adopts an approach to religion that distinguishes between Islamic and Christian belief systems. She argues that, unlike the Christian God, the God of Islam is preeminent and abstracted from worldly affairs and human experience. This thesis reinforces a general notion that Europeans typically defend Western culture against the assumed assault of others/Muslims. This article examines Kristeva’s acclaimed universal and ethical positions and their relevance to other cultures, particularly Islamic cultures. Notwithstanding the fact that Kristeva’s approach is informed by postmodern psychological and religious terms, she continues to refashion an orientalist discourse that colonial powers utilized in the era of high colonialism to rule and disempower others/Muslims. The inconsistencies in many of her statements show that the transcendentalism she unfavorably attributes to Islam is germane to many aspects of her thought.
Effect of Self-Monitoring on Personal Hygiene Among Individuals With Developmental Disabilities Attending Postsecondary Education
Authors: Gushanas Christina M. , Thompson Julie L.
Published: June 2018

Research indicates that employers rate personal hygiene as the number one barrier to employment among individuals with developmental disabilities. However, there is limited literature on improving personal hygiene in preparation for employment among individuals with developmental disabilities. Using a multiple-baseline across-participants design, this study examined the effect of self-monitoring on personal hygiene among five individuals with developmental disabilities, ages 19 to 22 years, attending a postsecondary education program. A functional relation was demonstrated between self-monitoring and reduced distracting body odor. Limitations, suggestions for future research, and practical applications are provided.
Efficacy and Tolerability of Peritendinous Hyaluronic Acid in Patients with Supraspinatus Tendinopathy
Authors: Álvarez Rey G , Balius Matas R , Buil Bellver MA , Cano Herrera C , Varela Sende L , Flores Lozano C
Published: June 2018

Introduction:

Physical therapy and peritendinous hyaluronic acid (HA) injections have both shown promising results in the treatment of shoulder tendinopathies. However, the superiority of treatment combining physical therapy and HA is unclear.

Objectives:

In this parallel-group, randomized, controlled trial, we investigated the efficacy and safety of peritendinous injection of HA in patients with persistent supraspinatus tendinopathy. To this end, we compared the therapeutic outcome of treatment with HA as an adjuvant to physical therapy with that of physical therapy as sole therapeutic intervention.

Methods:

84 Patients with ultrasound-confirmed supraspinatus tendinopathy were randomized to receive either physical therapy + subacromial HA injections or physical therapy only. Treatment efficacy was assessed using a Visual Analog Scale (VAS) for pain and an Activities of Daily Living (ADL) scale. Other measures were the number of rehabilitation sessions and days needed for recovery, the Tampa Scale for Kinesiophobia (TSK), and the physician and patient’s perception of efficacy and tolerability. Patients were followed up for 90 days.

Results:

Overall, VAS and ADL scores showed a progressive decrease during the follow-up ( P<0.01 at all visits for both groups), without significant differences between groups. The TSK score decreased significantly more in the HA group than in the control group (3.6 vs. 2.4; P<0.001). Patients in the control group needed more rehabilitation sessions (28 vs. 22 in the HA group; P=0.006) and more days for returning to their pre-injury activity (32 vs. 20 in the HA group; P=0.013). Both patients and investigators perceived higher efficacy in the HA group than in the control group ( P=0.034). Both treatments were safe and well tolerated.

Conclusion:

Subacromial HA injections combined with physical therapy have high efficacy in the treatment of supraspinatus tendinopathy, leading to an earlier return to pre-injury activity and the need for fewer rehabilitation sessions, which may benefit both patients and the healthcare system.
Fracture of the Medial Sesamoid Bone in a professional soccer player
Authors: Gastaldi Llorens GM , Gastaldi Orquin E
Published: June 2018

The incidence of medial sesamoid bone fracture is rare. Clinically they are often misdiagnosed as soft tissue injuries and often missed. Thus generates an important morbidity for the patient.

Objectives:

We present a case of turf-toe injury: plantar-plate rupture with medial sesamoid bone fracture in a contact athlete.

Methods:

A 19-year-old professional soccer player injured his left toe when he planted his foot during a sprint. He had an hyperextension and axial overload traumatism in his toe. On physical examination he had pain, swollen, ecchymosis, instability and loss of plantar-flexion strength. Radiographs showed a transverse medial sesamoid bone fracture with retraction > 3 mm. Magnetic resonance imaging confirmed a subluxation of the proximal phalange and a plantar plate disruption. Because of the completely deficient flexion, the sesamoid retraction, and the articular subluxation, surgery was recommended to restore the MTPJ anatomy. Reduction of the fracture and Repair of the plantar plate was performed using non-absorbable 2-0 Fiber wire sutures through a medial approach. Postoperatively, the patient was placed in a cast, for a total of 2 weeks. After that he began a rehabilitation program.

Results:

The patient had a complete recovery. He returned to participation in his team at 3 months. At final follow-up, his dorsiflexion ROM was 60 in the involved toe.

Conclusion:

Turf-toe and disorders of the sesamoid complex is an important injury, often misdiagnosed and usually undertreated. They had an incidence of 25% to 50% of residual pain and limited dorsiflexion in those cases. Despite the incidence of surgical treatment of 2%, we have found hopeful results with the open reduction and internal fixation of the fracture. Accurate and timely diagnosis and treatment can allow for full return to activity for these athletes.
Hamstring Graft Preparation Techniques for Anterior Cruciate Ligament Reconstruction
Authors: Vinagre Gustavo , Kennedy Nicholas , Cinque Mark , Hussain Zaamin , Olesen Morten , Chahla Jorge , LaPrade Robert
Published: June 2018

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Introduction:

Anterior Cruciate Ligament (ACL) tears are one of the most frequent injuries in young athletes. Given the importance of its biomechanical function in knee stability, ACL tears are treated surgically whenever there is sports activities demand. There are key factors in the ACL reconstruction such as graft choice, tunnel positioning, and graft diameter. Grafts less than 8 mm in diameter are a risk factor for re-rupture and relapse. This is especially important if hamstring grafts are used in female patients younger than 20 years old.

Objectives:

To describe in detail different hamstring graft preparation techniques to obtain an optimal and individualized graft according to patient´s anatomy and the ideal diameter and length for the reconstruction of the ACL.

Methods:

In the surgical lab, different hamstring graft preparation techniques with allografts, Endobutton femoral cortical suspension device (Smith and Nephew), FiberWire # 2 and FiberLoop # 2 (Arthrex) braided suture were prepare above the graft preparation station.

Results:

Different techniques of hamstring graft preparation were described in detail: Two-Strand with one tendon; Three-Strand with one tendon; Four-Strand with one and with two tendons; Five-Strand with two tendons; Six-Strand with two tendons and Eight-Strand with two tendons.

Conclusion:

It is essential to master the different hamstring graft preparation techniques in order to obtain an individualized graft with the appropriate diameter and length according to the patient´s anatomy, height and physical demand.
Fiscal decentralisation and local government efficiency: Does relative deprivation matter?
Authors: Alonso Jose M , Andrews Rhys
Published: June 2018

Fiscal decentralisation arguably improves government efficiency because it enhances responsiveness to local policy issues and incentivises fiscal discipline. However, critics suggest that central control over local spending is necessary to equalise fiscal outcomes between prosperous and deprived areas. Using a two-stage analysis, we investigate the validity of these arguments by analysing the separate and combined effects of fiscal decentralisation and socio-economic deprivation on the productive efficiency of English local governments during 2002–2008. The results suggest that decentralisation is positively related to productive efficiency and that there is a negative relationship between socio-economic deprivation and efficiency. Further analysis reveals that deprivation weakens the positive decentralisation–efficiency relationship, calling into question simplistic proposals for fiscal decentralisation.
Thrombolytic Treatment in Thailand
Authors: Suwanwela Nijasri C. , Chutinet Aurauma , Kijpaisalratana Naruchorn
Published: June 2018

Thrombolytic treatment has been available for stroke treatment in Thailand since 1996. The use of intravenous thrombolysis in Thailand has dramatically increased during the past 10 years. This is mainly due to the stroke fast track program that has been implemented throughout the country. The “stroke fast track” program is designed for medical triage personnel at the hospital to identify stroke patients who presented early in order to immediately notify the stroke team for further investigation and management. The establishment of a telestroke network will be the next step to increase the accessibility of stroke patients to a better medical care as well as to decrease the rate of thrombolysis.
New minerals tsangpoite Ca5(PO4)2(SiO4) and matyhite Ca9(Ca0.5□0.5)Fe(PO4)7 from the D'Orbigny angrite
Authors: Hwang Shyh-Lung , Shen Pouyan , Chu Hao-Tsu , Yui Tzen-Fu , Varela Maria-Euginia , Iizuka Yoshiyuki
Published: June 2018

Tsangpoite, ideally Ca5(PO4)2(SiO4), the hexagonal polymorph of silicocarnotite, and matyhite, ideally Ca9(Ca0.5□0.5)Fe(PO4)7, the Fe-analogue of Ca-merrillite, were identified from the D'Orbigny angrite meteorite by electron probe microanalysis, electron microscopy and micro-Raman spectroscopy. On the basis of electron diffraction, the symmetry of tsangpoite was shown to be hexagonal,P63/morP63, witha= 9.489(4) Å,c= 6.991(6) Å,V= 545.1(6) Å3andZ= 2 for 12 oxygen atoms per formula unit, and that of matyhite was shown to be trigonal,R3c, witha= 10.456 (7) Å,c= 37.408(34) Å,V= 3541.6 (4.8) Å3andZ= 6 for 28 oxygen atoms per formula unit. On the basis of their constant association with the grain-boundary assemblage: Fe sulfide + ulvöspinel + Al–Ti-bearing hedenbergite + fayalite–kirschsteinite intergrowth, the formation of tsangpoite and matyhite, along with kuratite (the Fe-analogue of rhönite), can be readily rationalised as crystallisation from residue magmas at the final stage of the D'Orbigny meteorite formation. Alternatively, the close petrographic relations between tsangpoite/matyhite and the resorbed Fe sulfide rimmed by fayalite + kirschsteinite symplectite, such as the nucleation of tsangpoite in association with magnetite ± other phases within Fe sulfide and the common outward growth of needle-like tsangpoite or plate-like matyhite from the fayalite–kirschsteinite symplectic rim of Fe sulfide into hedenbergite, infer that these new minerals and the grain-boundary assemblage might represent metasomatic products resulting from reactions between an intruding metasomatic agent and the porous olivine–plagioclase plate + fayalite-kirschsteinite overgrowth + augite + Fe sulfide aggregates. Still further thermochemical and kinetics evidence is required to clarify the exact formation mechanisms/conditions of the euhedral tsangpoite, matyhite and kuratite at the grain boundary of the D'Orbigny angrite.
PPM1D-truncating mutations confer resistance to chemotherapy and sensitivity to PPM1D inhibition in hematopoietic cells
Authors: Kahn Josephine D. , Miller Peter G. , Silver Alexander J. , Sellar Rob S. , Bhatt Shruti , Gibson Christopher , McConkey Marie , Adams Dylan , Mar Brenton , Mertins Philipp , Fereshetian Shaunt , Krug Karsten , Zhu Haoling , Letai Anthony , Carr Steven A. , Doench John , Jaiswal Siddhartha , Ebert Benjamin L.
Published: June 2018

Key Points

Truncating PPM1D mutations confer chemotherapy resistance, leading to the selective expansion of PPM1D-mutant cells in vitro and in vivo. PPM1D inhibitor treatment reverses the chemotherapy-resistance phenotype and selectively kills PPM1D-mutant cells.
Lower DHEA-S levels predict disease and worse outcomes in post-menopausal women with idiopathic, connective tissue disease- and congenital heart disease-associated pulmonary arterial hypertension
Authors: Baird Grayson L. , Archer-Chicko Christine , Barr R. Graham , Bluemke David A. , Foderaro Andrew E. , Fritz Jason S. , Hill Nicholas S. , Kawut Steven M. , Klinger James R. , Lima Joao A.C. , Mullin Christopher J. , Ouyang Pamela , Palevsky Harold I. , Palmisicano Amy J. , Pinder Diane , Preston Ioana R. , Roberts Kari E. , Smith K. Akaya , Walsh Thomas , Whittenhall Mary , Ventetuolo Corey E.
Published: June 2018

High oestradiol (E2) and low dehydroepiandrosterone-sulfate (DHEA-S) levels are risk factors for pulmonary arterial hypertension (PAH) in men, but whether sex hormones are related to PAH in women is unknown.

Post-menopausal women aged ≥55 years with PAH were matched by age and body mass index to women without cardiovascular disease. Plasma sex hormone levels were measured by immunoassay.

Lower levels of DHEA-S (p<0.001) and higher levels of E2 (p=0.02) were associated with PAH. In PAH cases (n=112), lower DHEA-S levels were associated with worse haemodynamics (all p<0.01) and more right ventricular dilatation and dysfunction (both p=0.001). Lower DHEA-S levels were associated with shorter 6-min walking distance (6MWD) (p=0.01) and worse functional class (p=0.004). Each Ln(1 µg·dL−1) decrease in DHEA-S was associated with a doubling in the risk of death (hazard ratio 2.0, 95% CI 1.5–2.7; p<0.001). Higher levels of E2 were associated with shorter 6MWD (p=0.03) and worse functional class (p=0.01).

High E2 and low DHEA-S levels are associated with the risk and severity of PAH in post-menopausal women. Hormonal modulation should be studied as a treatment strategy in PAH.
Students’ Conception of Genetic Phenomena and Its Effect on Their Ability to Understand the Underlying Mechanism
Authors: Haskel-Ittah Michal , Yarden Anat
Published: June 2018

Understanding genetic mechanisms affords the ability to provide causal explanations for genetic phenomena. These mechanisms are difficult to teach and learn. It has been shown that students sometimes conceive of genes as traits or as trait-bearing particles. We termed these “nonmechanistic” conceptions of genetic phenomena because they do not allow the space required for a mechanism to exist in the learner’s mind. In this study, we investigated how ninth- and 12th-grade students’ conceptions of genetic phenomena affect their ability to learn the underlying mechanisms. We found that ninth- and 12th-grade students with nonmechanistic conceptions are less successful at learning the mechanisms leading from gene to trait than students with mechanistic conceptions. Our results suggest that nonmechanistic conceptions of a phenomenon may create a barrier to learning the underlying mechanism. These findings suggest that an initial description of a phenomenon should hint at a mechanism even if the mechanism would be learned only later.
Clozapine rapid retitration in the community: an assertive approach can prevent admissions
Authors: Nikolić Nikola , Kilbride Kevin , Preston Patrick
Published: June 2018

Rapid retitration of clozapine may be necessary to reduce the known high risk of mental state destabilisation in patients who have had a 48 h treatment break. It may carry a high risk of complications, including seizures and myocarditis. We reflect on the literature on standard and rapid retitration and present a case of rapid retitration in the community. In this case, of a 54-year-old homeless man with treatment-resistant schizophrenia and polysubstance misuse, we safely retitrated clozapine in a community setting four times during a 6-month period; each retitration was completed over 4 days. We used a specific protocol based on his psychiatric history. We are now more confident in delivering clozapine retitration to other patients, thus preventing unnecessary admissions.

DECLARATION OF INTEREST

N. N. has received honoraria from Janssen Pharmaceuticals.
Chat- and internet-based cognitive–behavioural therapy in treatment of adolescent depression: randomised controlled trial
Authors: Topooco Naira , Berg Matilda , Johansson Sofie , Liljethörn Lina , Radvogin Ella , Vlaescu George , Nordgren Lise Bergman , Zetterqvist Maria , Andersson Gerhard
Published: June 2018

Background

Depression is a major contributor to the burden of disease in the adolescent population. Internet-based interventions can increase access to treatment.

Aims

To evaluate the efficacy of internet-based cognitive–behavioural therapy (iCBT), including therapist chat communication, in treatment of adolescent depression.

Method

Seventy adolescents, 15–19 years of age and presenting with depressive symptoms, were randomised to iCBT or attention control. The primary outcome was the Beck Depression Inventory II (BDI-II).

Results

Significant reductions in depressive symptoms were found, favouring iCBT over the control condition (F(1,67) = 6.18, P < 0.05). The between-group effect size was Cohen's d = 0.71 (95% CI 0.22–1.19). A significantly higher proportion of iCBT participants (42.4%) than controls (13.5%) showed a 50% decrease in BDI-II score post-treatment (P < 0.01). The improvement for the iCBT group was maintained at 6 months.

Conclusions

The intervention appears to effectively reduce symptoms of depression in adolescents and may be helpful in overcoming barriers to care among young people.

Declaration of interest

N.T. and G.A. designed the programme. N.T. authored the treatment material. The web platform used for treatment is owned by Linköping University and run on a non-for-profit basis. None of the authors receives any income from the programme.
Potent Inactivation-Dependent Inhibition of Adult and Neonatal NaV1.5 Channels by Lidocaine and Levobupivacaine
Authors: Elajnaf Taha , Baptista-Hon Daniel T. , Hales Tim G.
Published: June 2018

BACKGROUND:

Cardiotoxic effects of local anesthetics (LAs) involve inhibition of NaV1.5 voltage-gated Na+ channels. Metastatic breast and colon cancer cells also express NaV1.5, predominantly the neonatal splice variant (nNaV1.5) and their inhibition by LAs reduces invasion and migration. It may be advantageous to target cancer cells while sparing cardiac function through selective blockade of nNaV1.5 and/or by preferentially affecting inactivated NaV1.5, which predominate in cancer cells. We tested the hypotheses that lidocaine and levobupivacaine differentially affect (1) adult (aNaV1.5) and nNaV1.5 and (2) the resting and inactivated states of NaV1.5.

METHODS:

The whole-cell voltage-clamp technique was used to evaluate the actions of lidocaine and levobupivacaine on recombinant NaV1.5 channels expressed in HEK-293 cells. Cells were transiently transfected with cDNAs encoding either aNaV1.5 or nNaV1.5. Voltage protocols were applied to determine depolarizing potentials that either activated or inactivated 50% of maximum conductance (V½ activation and V½ inactivation, respectively).

RESULTS:

Lidocaine and levobupivacaine potently inhibited aNaV1.5 (IC50 mean [SD]: 20 [22] and 1 [0.6] μM, respectively) and nNaV1.5 (IC50 mean [SD]: 17 [10] and 3 [1.6] μM, respectively) at a holding potential of −80 mV. IC50s differed significantly between lidocaine and levobupivacaine with no influence of splice variant. Levobupivacaine induced a statistically significant depolarizing shift in the V½ activation for aNaV1.5 (mean [SD] from −32 [4.6] mV to −26 [8.1] mV) but had no effect on the voltage dependence of activation of nNaV1.5. Lidocaine had no effect on V½ activation of either variant but caused a significantly greater depression of maximum current mediated by nNaV1.5 compared to aNaV1.5. Similar statistically significant shifts in the V½ inactivation (approximately −10 mV) occurred for both LAs and NaV1.5 variants. Levobupivacaine (1 μM) caused a significantly greater slowing of recovery from inactivation of both variants than did lidocaine (10 μM). Both LAs caused approximately 50% tonic inhibition of aNaV1.5 or nNaV1.5 when holding at −80 mV. Neither LA caused tonic block at a holding potential of either −90 or −120 mV, voltages at which there was little steady-state inactivation. Higher concentrations of either lidocaine (300 μM) or levobupivacaine (100 μM) caused significantly more tonic block at −120 mV.

CONCLUSIONS:

These data demonstrate that low concentrations of the LAs exhibit inactivation-dependent block of NaV1.5, which may provide a rationale for their use to safely inhibit migration and invasion by metastatic cancer cells without cardiotoxicity.
Export Markets and Labor Allocation in a Low-Income Country
Authors: McCaig Brian , Pavcnik Nina
Published: June 2018

We study the effects of a positive export shock on labor allocation between the informal, microenterprise sector and the formal firm sector in a low-income country. The United States-Vietnam Bilateral Trade Agreement led to large reductions in US tariffs on Vietnamese exports. We find that the share of manufacturing workers in Vietnam in the formal sector increased by 5 percentage points in response to the US tariff reductions. The reallocation was greater for workers in more internationally integrated provinces and for younger cohorts. We estimate the gap in labor productivity within manufacturing across the informal and formal sectors. This gap and the aggregate labor productivity gain from the export-induced reallocation of workers across the two sectors are reduced when we account for worker heterogeneity, measurement error, and differences in labor intensity of production. (JEL F16, J24, O14, O17, O19, P23, P33)