bluuebunny/crossref_metadata_2025 huggingface dataset:
c-Rel Promotes Invasion of Choriocarcinoma Cells via PI3K/AKT Signaling
Authors: Sekiya Yoko , Yamamoto Eiko , Niimi Kaoru , Nishino Kimihiro , Nakamura Kenichi , Kotani Tomomi , Kajiyama Hiroaki , Shibata Kiyosumi , Kikkawa Fumitaka
Published: March 2017

Objective: Choriocarcinoma is the most common epithelial cancer among gestational trophoblastic diseases (GTDs); the mechanism of trophoblastic carcinogenesis is unknown. This study aimed to examine the expression of NF-κB family proteins in GTDs and placental tissues as well as the roles of c-Rel in choriocarcinoma. Methods: We examined the expression of NF-κB family proteins in normal placenta and hydatidiform mole tissues as well as extravillous trophoblast (EVT) and choriocarcinoma cell lines by Western blot and immunohistochemistry. Immunoprecipitation was performed to determine which proteins can bind with c-Rel in choriocarcinoma cells. To investigate the roles of c-Rel in choriocarcinoma, we examined the effects of c-Rel knockdown and overexpression on cell proliferation, migration, and invasion using small interfering RNAs and gene activation plasmid. Results: The expression of c-Rel was strong in choriocarcinoma and EVTs, but very weak in villi of normal placenta and hydatidiform mole. Immunoprecipitation suggested that c-Rel heterodimerizes with p65 in choriocarcinoma. c-Rel knockdown reduced invasion, migration, and AKT phosphorylation in choriocarcinoma cells. c-Rel overexpression in choriocarcinoma increased migratory and invasive abilities, and the effect on invasion was inhibited by a PI3K inhibitor. Conclusion: These findings suggest that c-Rel might play a role in promoting the invasion of choriocarcinoma cells through PI3K/AKT signaling.
One-Year Outcomes of a Treat-and-Extend Regimen of Aflibercept for Exudative Age-Related Macular Degeneration
Authors: Yamamoto Akiko , Okada Annabelle A. , Nakayama Makiko , Yoshida Yumiko , Kobayashi Hiroaki
Published: March 2017

Purpose: The aim of this study was to investigate the 1-year outcomes of treat-and-extend aflibercept for exudative age-related macular degeneration (AMD) in Japan. Procedures: Clinical records of 67 patients (67 eyes) were reviewed. Monthly aflibercept was administered until resolution of exudation and maximal reduction of pigment epithelial detachment. Injection intervals were extended by 2-week units up to 12 weeks if no exudation was observed and shortened for recurrence. Results: Mean best-corrected visual acuity (logarithm of the minimum angle of resolution) improved from 0.29 to 0.14 at 12 months (p < 0.0001). Mean central retinal thickness decreased from 430 μm to 236 μm at 12 months (p < 0.0001). Fifty-nine eyes (88.0%) achieved a dry macula with a mean of 8.3 injections by study end. The injection interval was extended to 10 weeks in 44.8% and to 12 weeks in 17.9% of eyes. Conclusions: At 1 year, good outcomes were obtained using treat-and-extend aflibercept for exudative AMD in Japan.
Psoriatic Alopecia in a Patient with Systemic Lupus Erythematosus
Authors: Iamsumang Wimolsiri , Sriphojanart Tueboon , Suchonwanit Poonkiat
Published: March 2017

Psoriasis is a chronic, recurrent, and relatively common inflammatory dermatologic condition, which demonstrates various clinical manifestations including hair loss. It was once believed that alopecia was not a presentation of scalp psoriasis, but it is now widely accepted that psoriatic alopecia exists. Although the majority of patients get hair regrowth, it can potentially lead to permanent hair loss. Herein, we report a case of 26-year-old female patient with systemic lupus erythematosus who presented with scalp hair loss and nonpruritic scaly plaques on the scalp. Her clinical presentation, dermoscopic, and histopathologic findings were consistent with psoriatic alopecia. Additionally, we also described a novel scalp dermoscopic pattern of “patchy dotted vessels” which we detected in the lesion of scalp psoriasis.
Long-Term Prevention of Congenital Thrombotic Thrombocytopenic Purpura in ADAMTS13 Knockout Mice by Sleeping Beauty Transposon-Mediated Gene Therapy
Authors: Verhenne Sebastien , Vandeputte Nele , Pareyn Inge , Izsvák Zsuzsanna , Rottensteiner Hanspeter , Deckmyn Hans , De Meyer Simon F. , Vanhoorelbeke Karen
Published: March 2017

Objective—

Severe deficiency in the von Willebrand factor–cleaving protease ADAMTS13 (a disintegrin and metalloproteinase with thrombospondin type 1 motif, member 13) because of mutations in the
ADAMTS13
gene can lead to acute episodes of congenital thrombotic thrombocytopenic purpura (TTP), requiring prompt treatment. Current treatment consists of therapeutic or prophylactic infusions of fresh frozen plasma. However, lifelong treatment with plasma products is a stressful therapy for TTP patients. Here, we describe the use of the nonviral sleeping beauty (SB) transposon system as a gene therapeutic approach to realize lifelong expression of ADAMTS13 and subsequent protection against congenital TTP.

Approach and Results—

We demonstrated that hydrodynamic tail vein injection of the SB100X system expressing murine ADAMTS13 in
Adamts13
−/−
mice resulted in long-term expression of supraphysiological levels of transgene ADAMTS13 over a period of 25 weeks. Stably expressed ADAMTS13 efficiently removed the prothrombotic ultralarge von Willebrand factor multimers present in the circulation of
Adamts13
−/−
mice. Moreover, mice stably expressing ADAMTS13 were protected against TTP. The treated mice did not develop severe thrombocytopenia or did organ damage occur when triggered with recombinant von Willebrand factor, and this up to 20 weeks after gene transfer.

Conclusions—

These data demonstrate the feasibility of using SB100X-mediated gene therapy to achieve sustained expression of transgene ADAMTS13 and long-term prophylaxis against TTP in
Adamts13
−/−
mice.
Calling forth the change-makers
Authors: Davidson Debra J , Stedman Richard C
Published: March 2017

Reflexivity theory can contribute in important ways to our understanding of how societies contend with climate change. Avoiding the catastrophic effects of “dangerous climate change” will require substantial change, yet emissions continue to rise. Social scientific research on climate change mitigation is dominated by a relatively small number of macro-theoretical frameworks, plus a rather large and disparate empirical literature on individual cognitions, attitudes and behaviors. We apply Archer’s reflexivity theory to a survey sample drawn from Alberta, Canada, showing that unique predispositions toward reflexivity offer strong predictors of willingness to engage in climate-related mitigative behaviors.
A Case Report and Systematic Review of Eosinophilic Angiocentric Fibrosis of the Paranasal Sinuses
Authors: Heft Neal Molly E. , Rowan Nicholas R. , Willson Thomas J. , Wang Eric W. , Lee Stella E.
Published: March 2017

Objective:

There is a paucity of literature discussing prognostic factors or comparing outcomes in eosinophilic angiocentric fibrosis (EAF). This review aims to analyze tumor and patient characteristics as possible prognostic markers and compare surgical approaches.

Methods:

Systematic literature review and case report analyzing available cases of EAF located within the paranasal sinuses.

Results:

The literature search yielded 39 articles meeting criteria for a total of 59 cases (including 1 from our institution). Median patient age was 46 years. The most common presenting symptoms were nasal obstruction (69%, n = 41) and change in external nasal appearance (39%, n = 32). The majority of cases (85%) were treated with surgical resection alone or in combination with medication. Of surgical patients, 62% underwent a complete resection with a recurrence rate of 20%. Median follow-up duration was 2 years. Endoscopic approach showed a significant positive correlation with complete resection ( P = .045). Patient sex ( P = .6), tumor location (range, P = .32-.98), lateral rhinotomy ( P = .26), septoplasty ( P = .84), and external rhinoplasty ( P = .28) were not significantly correlated with total resection. Insufficient sample size precluded calculation of predictors of recurrence following surgery.

Conclusion:

This review suggests that an endoscopic approach to EAF tumor is a viable option, frequently yielding complete resection.
Nonoperative Management of Appendicitis
Authors: Scott Andrew , Lee Steven L. , DeUgarte Daniel A. , Shew Stephen B. , Dunn James C. Y. , Shekherdimian Shant
Published: March 2017

We evaluated the outcomes for nonoperative management (NOM) of all children with suspected nonperforated appendicitis, including those patients with an appendicolith. Parents of all children with suspected nonperforated appendicitis were offered NOM versus laparoscopic appendectomy. NOM included administration of intravenous antibiotics and hospital admission. If no improvement within 24 hours, laparoscopic appendectomy was performed. Primary outcomes were initial success rate and recurrence rate. Fifty patients selected NOM. The initial failure rate for NOM was 20%. Of the 10 who failed, 7 had complicated appendicitis. The recurrence rate was 13%. Overall, 34 (68%) patients avoided appendectomy. Patients with an appendicolith had a higher initial failure rate (37%) compared to patients without an appendicolith (10%; P < .05). NOM is feasible and effective in pediatric nonperforated appendicitis. The presence of an appendicolith was associated with a higher failure rate but is not an absolute contraindication for NOM.
The School Principal and Student Learning Capacity
Authors: Adams Curt M. , Olsen Jentre J. , Ware Jordan K.
Published: March 2017

Purpose: The purpose of this study was to define student learning capacity and to examine the role of the school principal in nurturing it. Method: The study used cross-sectional data from 3,175 students in 70 schools located in a metropolitan area of a Southwestern city. We tested three hypotheses by following a conventional modeling building process in HLM 7.0: Hypothesis 1—Principal Support for Student Psychological Needs (PSSPN) is related to school differences in student-perceived autonomy-support; Hypothesis 2—PSSPN is related to school differences in student-perceived competence-support; Hypothesis 3—Student-perceived need-support mediates the relationship between PSSPN and grit. Results: Evidence aligns with our initial theorizing about student learning capacity and principal support for student psychological needs. Student-perceived need-support, as a social characteristic of capacity, manifests itself through teacher–student interactions in the learning process. Need-supporting interactions varied significantly across schools, and principals played a critical role in developing an instructional environment that students experienced as nurturing autonomy and competence. Implications: PSSPN highlights the transformative effects that regular principal–teacher social exchanges can have on instructional practices. School principals who interacted with teachers about student psychological needs and need-supporting instructional practices contributed to a learning environment that students experienced as autonomy-supporting and competence-supporting.
Outbreak of Drug-Resistant Mycobacterium tuberculosis Among Homeless People in Atlanta, Georgia, 2008-2015
Authors: Powell Krista M. , VanderEnde Daniel S. , Holland David P. , Haddad Maryam B. , Yarn Benjamin , Yamin Aliya S. , Mohamed Omar , Sales Rose-Marie F. , DiMiceli Lauren E. , Burns-Grant Gail , Reaves Erik J. , Gardner Tracie J. , Ray Susan M.
Published: March 2017

Objectives:

Our objective was to describe and determine the factors contributing to a recent drug-resistant tuberculosis (TB) outbreak in Georgia.

Methods:

We defined an outbreak case as TB diagnosed from March 2008 through December 2015 in a person residing in Georgia at the time of diagnosis and for whom (1) the genotype of the Mycobacterium tuberculosis isolate was consistent with the outbreak strain or (2) TB was diagnosed clinically without a genotyped isolate available and connections were established to another outbreak-associated patient. To determine factors contributing to transmission, we interviewed patients and reviewed health records, homeless facility overnight rosters, and local jail booking records. We also assessed infection control measures in the 6 homeless facilities involved in the outbreak.

Results:

Of 110 outbreak cases in Georgia, 86 (78%) were culture confirmed and isoniazid resistant, 41 (37%) occurred in people with human immunodeficiency virus coinfection (8 of whom were receiving antiretroviral treatment at the time of TB diagnosis), and 10 (9%) resulted in TB-related deaths. All but 8 outbreak-associated patients had stayed overnight or volunteered extensively in a homeless facility; all these facilities lacked infection control measures. At least 9 and up to 36 TB cases outside Georgia could be linked to this outbreak.

Conclusions:

This article highlights the ongoing potential for long-lasting and far-reaching TB outbreaks, particularly among populations with untreated human immunodeficiency virus infection, mental illness, substance abuse, and homelessness. To prevent and control TB outbreaks, health departments should work with overnight homeless facilities to implement infection control measures and maintain searchable overnight rosters.
Insider Ownership and Analyst Forecast Properties
Authors: Wang Jacqueline Wenjie , Yu Wayne W.
Published: March 2017

In this article, we investigate the effect of insider ownership on analyst forecast properties and find a significant nonlinear relationship between the two. Specifically, in the low to medium range, a rise in insider ownership improves analyst forecast properties (making them more accurate and less dispersed), but a further rise in insider ownership beyond moderate levels leads to deteriorating forecasts. We also find that this nonlinear relationship is attenuated for firms in countries with better investor protection. We interpret our findings as evidence that the role of insider ownership as an interest alignment or entrenchment mechanism is diminished in these countries due to their stronger investor protection.
Development and Validation of the Activities of Daily Living Short Form for Community-Dwelling Korean Stroke Survivors
Authors: Hong Ickpyo , Yoo Eun-Young , Kazley Abby Swanson , Lee Danbi , Li Chih-Ying , Reistetter Timothy A.
Published: March 2017

This study developed and validated a short form (SF) using activities of daily living (ADL) outcome measures from the Korea National Health and Nutrition Examination Survey (KNHANES) that can minimize survey administration burden for clinicians. This study utilized secondary data from the 2005 KNHANES with 422 community-dwelling stroke survivors. The KNHANES data were collected from April to June 2005 in South Korea. We created a 7-item SF from the 17 ADL questions in the survey using item response theory (IRT) methodologies. The precision and validity of the SF were compared to the full questionnaire of ADL items and the EuroQol-5D total score. Among the 17 ADL questions, 14 questions demonstrated unidimensional construct validity. Using IRT methodologies, a set of 7 items were selected from the full bank. The 7-item SF demonstrated good psychometric properties: high correlation with the full bank ( r = .975, p < .001), good internal consistency (Cronbach’s α = .93), and a high correlation with the EuroQol-5D total score ( r = .678, p < .001). These findings indicate that a well-developed SF can precisely measure ADL performance capacity for stroke survivors compared to the full item bank, which is expected to reduce the administration burden of the KNHANES.
Where There’s a Will: The Link Between Estate Planning and Disparities in Advance Care Planning by White and Black Older Adults
Authors: Koss Catheryn S. , Baker Tamara A.
Published: March 2017

Data from the Health and Retirement Study ( n = 6,946) were used to test whether differences in estate planning accounted for disparities in advance care planning between White and Black older adults. White participants were more likely to have advance directives after controlling for demographic, health, and financial variables. When estate planning was also controlled, the odds of having an advance directive were equal for White and Black participants. In contrast, Whites remained more likely to discuss end-of-life preferences after controlling for demographic, health, financial, and estate planning variables. White participants were almost four times as likely to have wills or trusts. Wealth, income, and home ownership were predictive of estate planning. Financial disparities contributed to lower rates of estate planning which in turn explained in large part why Black older adults were less likely to have advance directives but did not account for race disparities in advance care discussion.
Political reconciliation in postcolonial settler societies
Authors: Verdeja Ernesto
Published: March 2017

This article presents a theory of reconciliation for postcolonial settler societies. It asks: what are the scope, substance and limitations of a normative theory of political reconciliation for historical wrongs in these societies? The article begins with an assessment of communitarian and agonistic theories and then outlines an alternative based on mutual respect, which includes three core elements: critical reflection, symbolic and material recognition, and political participation. The case of the United States and Native Americans is used to illustrate this alternative theory.
Environmental Control of Allergens
Authors: Corey Jacquelynne P.
Published: March 2017

Allergy therapy properly consists of three possible treatment methods that can be used singly or in combination: environmental control (avoidance), pharmacotherapy, and immunotherapy. What allergens are effectively treated by environmental control? There are several broad groups of allergens with which we are concerned: indoor allergens such as dust, animal dander, molds (indoor), and cockroach; and outdoor allergens such as trees, grasses, weeds, and molds (outdoor); and, lastly, foods. The largest body of work has been collected regarding the effectiveness of indoor allergens, especially dust mites and cat. Scientifically proven measures exist for dust mites, cats, and infant formulas. Practical advice for controlling the environment for other furred animals, cockroaches, molds, and pollens are summarized. More research on effective avoidance measures for these other allergens is needed to help our patients control their environment effectively.
Therapeutic Advances in the Management of Allergic Rhinitis and Urticaria
Authors: Krause Helen F.
Published: March 2017

Therapy for patients with allergic rhinitis and urticaria has undergone considerable change in recent years because the mechanisms of these diseases have been more clearly elucidated. Both appear to have marked inflammatory components. A review of the recent literature reveals that clinical studies of both classic and new nonsedating H1‐receptor antagonists, H2‐receptor antagonists, a variety of intranasal medications, and mast‐cell stabilizers demonstrate variable roles in the management of these diseases. Because allergic rhinitis has early‐and late‐phase reactions, therapy must be directed toward control of both responses. There are a number of types of urticaria; therapy for each may vary.
Aortic assessment of bicuspid aortic valve patients and their first-degree relatives
Authors: Straneo Pablo , Parma Gabriel , Lluberas Natalia , Marichal Alvaro , Soca Gerardo , Cura Leandro , Paganini Juan J , Brusich Daniel , Florio Lucia , Dayan Victor
Published: March 2017

Background

Bicuspid aortic valve patients have an increased risk of aortic dilatation. A deficit of nitric oxide synthase has been proposed as the causative factor. No correlation between flow-mediated dilation and aortic diameter has been performed in patients with bicuspid aortic valves and normal aortic diameters. Being a hereditary disease, we compared echocardiographic features and endothelial function in these patients and their first-degree relatives.

Methods

Comprehensive physical examinations, routine laboratory tests, transthoracic echocardiography, and measurements of endothelium-dependent and non-dependent flow-mediated vasodilatation were performed in 18 bicuspid aortic valve patients (14 type 1 and 4 type 2) and 19 of their first-degree relatives.

Results

The first-degree relatives were younger (36.7 ± 18.8 vs. 50.5 ± 13.9 years, p = 0.019) with higher ejection fractions (64.6% ± 1.7% vs. 58.4% ± 9.5%, p = 0.015). Aortic diameters indexed to body surface area were similar in both groups, the except the tubular aorta which was larger in bicuspid aortic valve patients (19.3 ± 2.7 vs. 17.4 ± 2.2 mm·m−2, p = 0.033). Flow-dependent vasodilation was similar in both groups. A significant inverse correlation was found between non-flow-dependent vasodilation and aortic root diameter in patients with bicuspid aortic valve ( R = −0.57, p = 0.05).

Conclusions

Bicuspid aortic valve patients without aortopathy have larger ascending aortic diameters than their first-degree relatives. Endothelial function is similar in both groups, and there is no correlation with ascending aorta diameter. Nonetheless, an inverse correlation exists between non-endothelial-dependent dilation and aortic root diameter in bicuspid aortic valve patients.
Modelling and analysis of acoustic field in a rectangular enclosure bounded by elastic plates under the excitation of different point force
Authors: Cui Huaifeng , Hu Rufu , Chen Nan
Published: March 2017

The coupled acoustic field of fully elastic plate model is described by the modal analysis method. The acoustic potential energy resonance peaks of the fully elastic plate model are significantly more than that of the one elastic plate model due to the influence of the vibration of multi elastic plates. The acoustic field characteristics of the fully elastic plate model are analyzed when the primary excitation source is applied on the different elastic plates. The results show that the coupled acoustic field of the fully elastic plate model is dominated by the structural mode of the elastic plate with primary excitation, and the acoustic mode of the enclosure, and the structural-acoustic coupling between the plate and the enclosure; the structure modes of the other elastic plates have less effects on the acoustic field in the enclosure except the first ones of them.
Fantastical materializations: Interoceanic infrastructures in the Ecuadorian Amazon
Authors: Wilson Japhy , Bayón Manuel
Published: March 2017

This paper explores the entanglement of dreams and reality in the production of economic infrastructures. It focuses on the Manta-Manaus multimodal transport corridor, which is currently being constructed between the Pacific coast of Ecuador and the Atlantic coast of Brazil, with the aim of integrating the Amazon into global production networks. Drawing on extensive field research conducted in Ecuador, we develop a fantastical materialism, as a theoretical and methodological approach to the intertwining of fantasy and materiality through which the spaces of capital are conceived, constructed, and brought to ruin. Manta-Manaus is revealed not only as a technocratic accumulation strategy, but also as a seductive dream of planetary integration and geographical freedom. This dream has become ensnarled in the material dynamics of uneven geographical development, and its infrastructures have been repurposed for the expansion of the oil frontier. The Real of Capital thus advances through the creative destruction of its own fantasies.
Child-rearing values: The impact of intergenerational class mobility
Authors: Sieben Inge
Published: March 2017

This study contrasts two theoretical perspectives on the relationship between intergenerational class mobility and child-rearing values. According to the dissociative thesis, which describes social mobility as a disruptive experience leading to insecurity, social isolation, stress and frustration, socially mobile individuals less often prefer community-oriented qualities such as tolerance and respect for other people, unselfishness, good manners and obedience. The beneficiary thesis, on the other hand, predicts that socially mobile individuals have a stronger preference for individual-based values such as hard work, determination, responsibility, independence and thrift. In both cases, these mobility effects are thought to be stronger for more extremely mobile individuals and for downwardly mobile compared with upwardly mobile individuals. However, using Dutch data from the European Values Study 2008, hardly any significant intergenerational mobility effects are found. Maybe intergenerational mobility is not such an extraordinary experience as mobility theory would lead us to believe, or mobile individuals adjust themselves very quickly to their new situation.
Disentangling bias: national capabilities, regime type, and international conflict mediation
Authors: Chen Frederick R.
Published: March 2017

Existing literature on bias and third-party conflict management mainly focuses on the dichotomy of whether the mediator’s bias as a whole can contribute to mediation onset and outcomes. I argue that we need more specific and disaggregated research on the mediator’s bias because the side on which a prospective mediator’s bias lies may significantly affect the likelihood of mediation onset. Why are some biased mediations initiated by third parties while others are not? By disentangling the mediator’s bias and by distinguishing between different levels of bias, I find that the likelihood of mediation onset tends to increase if the potential mediator shares a closer political relationship with a conflicting state that has greater national capabilities or that is more authoritarian than the counterparty. However, the effect is largely conditional on the levels of the mediator’s bias, where a more obvious level of bias is more likely to facilitate mediation initiation. This article advances our understanding of bias and international conflict mediation.
Robust functional regression model for marginal mean and subject-specific inferences
Authors: Cao Chunzheng , Shi Jian Qing , Lee Youngjo
Published: March 2017

We introduce flexible robust functional regression models, using various heavy-tailed processes, including a Student t-process. We propose efficient algorithms in estimating parameters for the marginal mean inferences and in predicting conditional means as well as interpolation and extrapolation for the subject-specific inferences. We develop bootstrap prediction intervals (PIs) for conditional mean curves. Numerical studies show that the proposed model provides a robust approach against data contamination or distribution misspecification, and the proposed PIs maintain the nominal confidence levels. A real data application is presented as an illustrative example.
Intra-product Specialisation and the Innovation Ability of the High-technology Industry in China
Authors: Cao Hongjian , Zhang Hui , Li Jun , Liu Yumin
Published: March 2017

The purpose of this paper is to analyse the influence of intra-product specialisation on the innovation ability of the high-technology industry in China. To achieve this research goal, we use the generalised method of moments (GMM) with a dynamic panel data model in our empirical research. Total factor productivity (TFP) and its decomposition variables are used to measure the innovation ability. The Malmquist index is employed to calculate TFP and its decomposition variables, namely, technology progress, technical efficiency and scale efficiency. Previous studies show that intra-product specialisation can raise TFP, but our empirical results reveal that the impact of the intra-product specialisation on the TFP is uncertain: it decreases TFP in the initial period but increases it in the lag period. Results also indicate that an increase in the proportion of state-owned property rights exerts a positive influence on TFP and the change in pure technical efficiency. Technical efficiency is greatly influenced by intra-product specialisation, whereas intra-product specialisation exerts a slight influence on technological progress. The capital investment in research and development (R&D) has a positive effect on TFP, and the contribution rate of R&D labour input to TFP is relatively low. The main conclusion is that China need to improve the degree of intra-product specialisation, accelerate the evolution of industry technical standards and reduce the coordination cost of intra-product specialisation to enhance the innovation ability of the high-technology industry.
A Mnemonic for Pharmacists to Ensure Optimal Monitoring and Safety of Total Parenteral Nutrition: I AM FULL
Authors: Bohl Chris J. , Parks Ann
Published: March 2017

Objective: To present a guideline-derived mnemonic that provides a systematic monitoring process to increase pharmacists’ confidence in total parenteral nutrition (TPN) monitoring and improve safety and efficacy of TPN use. Data Sources: The American Society for Parenteral and Enteral Nutrition (ASPEN) guidelines were reviewed. Additional resources included a literature search of PubMed (1980 to May 2016) using the search terms: total parenteral nutrition, mnemonic, indications, allergy, macronutrients, micronutrients, fluid, comorbidities, labs, peripheral line, and central line. Articles (English-language only) were evaluated for content, and additional references were identified from a review of literature citations. Study Selection and Data Extraction: All English-language observational studies, review articles, meta-analyses, guidelines, and randomized trials assessing monitoring parameters of TPN were evaluated. Data Synthesis: The ASPEN guidelines were referenced to develop key components of the mnemonic. Review articles, observational trials, meta-analyses, and randomized trials were reviewed in cases where guidelines did not adequately address these components. Conclusions: A guideline-derived mnemonic was developed to systematically and safely manage TPN therapy. The mnemonic combines 7 essential components of TPN use and monitoring: Indications, Allergies, Macro/Micro nutrients, Fluid, Underlying comorbidities, Labs, and Line type.
Flexor Hallucis Longus Tendon Transfer for Hallux Claw Toe Deformity and Vertical Instability of the Metatarsophalangeal Joint
Authors: Steensma Matthew R. , Jabara Michael , Anderson John G. , Bohay Donald R.
Published: March 2017

Background: Historically, operative treatment of hallux claw toe deformity has been the Jones procedure or one of its modifications. Review of the literature confirms its ability to maintain alignment and achieve patient satisfaction; however, several complications have been reported. Many of these are related to altered biomechanics across the metatarsophalangeal (MTP) joint. A similar approach to this clinical problem involves restoration of the flexion moment across the MTP joint without an interphalangeal (IP) joint arthrodesis. Methods: We conducted a retrospective review of 10 patients who had a flexor hallucis longus (FHL) tendon transfer to the proximal phalanx of the great toe for hallux claw toe deformity, as well as for symptomatic vertical instability. Four patients had a positive drawer test indicating vertical instability without static deformity. Two patients with vertical instability were found to have a dynamic deformity. Mean followup was 24 (SD 15.2) months. Results: All deformities were corrected and alignment was maintained at the time of followup. Pain under the first metatarsal head was reliably improved in symptomatic patients ( p < 0.05). Patient satisfaction also was assessed. All six patients treated for hallux claw deformity were satisfied with their outcomes. Two of the four patients treated for vertical instability were satisfied. The other two patients expressed dissatisfaction because of persistent pain that occurred during strenuous exercise. Their symptoms during routine activity were improved, however. Conclusion: Based on initial results, the FHL transfer to the proximal phalanx appears to be a viable treatment option for hallux claw deformity in terms of deformity correction, pain relief, and patient satisfaction. Further evaluation is warranted regarding the indication of vertical instability.
Thromboembolic Disease after Foot and Ankle Surgery
Authors: Hanslow Sarah S. , Grujic Les , Slater Henry K. , Chen Darren
Published: March 2017

Background: The incidence and potential life-threatening complications of thromboembolic disease after major orthopaedic surgery has been extensively studied. However, there are two studies pertaining to the incidence of thromboembolic disease after foot and ankle surgery, the findings of which suggest that the incidence is too low to justify routine thromboprophylaxis. Methods: This is a retrospective study identifying the incidence of thromboembolic disease after foot and ankle surgery in the practices of two foot and ankle specialists. The purpose of the study was to evaluate the risk factors for the development of thromboembolic disease and to examine the issue of routine thromboprophylaxis. Six hundred and two patients were included in this study. Results: There was a 4% incidence (24 patients) of postoperative thromboembolic complications. Risk factors identified for postoperative thromboembolic disease were a history of rheumatoid arthritis, a recent history of air travel, previous deep vein thrombosis or pulmonary embolism, and limb immobilization. Conclusions: The incidence of thromboembolic disease after foot and ankle surgery could be higher than that previously reported particularly if a patient has certain risk factors. Prospective randomized clinical trials are needed to establish the true incidence of thromboembolic disease after foot and ankle surgery and to define the indications for routine thromboprophylaxis.
Diagnosis and Treatment of Malignant Melanoma of the Foot
Authors: Gray Richard J. , Pockaj Barbara A. , Vega Miriam L. , Connolly Suzanne M. , DiCaudo David J. , Kile Todd A. , Buchel Edward W.
Published: March 2017

Background: Patients diagnosed with melanoma of the foot have been reported to have a poor prognosis. We reviewed our experience at a tertiary-care medical clinic to determine the disease course in patients diagnosed with melanoma of the foot. Methods: A retrospective review was performed of 38 patients with a diagnosis of primary or locally recurrent melanoma of the foot treated between January, 1988, and July, 2004. The main outcome measures included methods of diagnosis, clinical and histopathologic features, and patterns of recurrence. Results: The mean age at diagnosis was 61 years; most were women (58%) and Caucasian (95%). The average time to diagnosis was 17 months. Initial clinical diagnosis had been considered benign in 12 (32%). The median Breslow thickness was 1.75 mm, T1 lesions were the most common, and acral lentiginous melanoma accounted for 42%. Thirteen patients (34%) had ulcerated lesions. Sentinel lymph node biopsy specimens of 25 patients identified four (16%) with metastatic disease. Surgical complications occurred in 12 patients, usually after skin graft or soft-tissue flap reconstruction. Systemic recurrence developed in six patients, four of whom also had regional recurrence. Conclusions: Most patients were elderly Caucasian women and most presented with early-stage disease, but diagnosis can be difficult and a subgroup presented with thick melanomas. Reconstructive surgical procedures had a high rate of complications; however, overall functional outcomes were good. Stage of cancer at diagnosis was associated with systemic metastases.
A Cotton Batting Compression Dressing and Fiberglass Cast used Safely in the Immediate Postoperative Period After Hindfoot or Ankle Surgery
Authors: Eagan Michael , SooHoo Nelson F. , Cracchiolo Andrea
Published: March 2017

Background: Patients undergoing surgery on the foot and ankle who require immobilization are typically placed in splints or soft compression dressings after surgery to avoid complications associated with swelling. As swelling subsides, this temporary immobilization is removed and replaced with a short-leg cast, making an additional office visit necessary, which adds to the cost as well as patient discomfort. Methods: We apply a cast in the operating room using a special padding technique to accommodate postoperative swelling. It is supportive enough that it does not need to be replaced shortly after surgery. This cast was applied to 38 patients having surgery on the hindfoot or ankle between March, 2003, and February, 2004. Results: All patients tolerated the cast during the initial 2 weeks after surgery, and there were no complications. Conclusion: The purpose of this study was to describe the casting technique and document its safety for use immediately after surgery on the hindfoot and ankle.
Midline Posterior Approach to the Ankle and Hindfoot
Authors: Hammit Matthew D. , Hobgood Edward R. , Tarquinio Thom A.
Published: March 2017

Background: The posterior approach to the ankle and hindfoot can be used for fixation of fractures, fusions, or osteotomies and is especially useful in patients with poor soft tissue anteriorly, medially, or laterally. However, a high rate of wound complications has been reported with standard posterolateral and posteromedial approaches. Because of local wound problems with the standard approaches, we have used a midline posterior approach and a longitudinal midline splitting of the Achilles tendon. This approach provides excellent exposure while minimizing wound healing complications. This approach provides dissection between angiosomes, which should optimize preservation of the blood supply to the skin flaps. Methods: We retrospectively evaluated wound healing in 33 consecutive patients who had surgery using the modified midline posterior approach. The mean age of the patients was 48 (range 16 to 83) years. The mean followup was 24 (range 12 to 73) months. Surgical procedures included ankle and pantalar arthrodeses (primary and revision), talectomies with tibiocalcaneal arthrodesis, repairs of fracture nonunions, reconstruction of a chronic Achilles rupture, and hardware removal with multiple debridements of chronic osteomyelitis. Results: There were no instances of skin flap necrosis. One patient with diabetic neuropathic arthropathy developed a small superficial wound eschar that healed with dressing changes alone. Four patients developed deep infections; two of these had a history of deep infection and the other two had significant comorbidities. Conclusions: The modified midline posterior approach to the distal tibia, ankle, and hindfoot has a low primary wound complication rate without sacrificing exposure. This approach can be used for any procedure requiring posterior access to the distal tibia, ankle joint, or subtalar joint.
Instant 99mTc-Ciprofloxacin Scintigraphy for the Diagnosis of Osteomyelitis in the Diabetic Foot
Authors: Dutta Pinaki , Bhansali Anil , Mittal Bhagwant R. , Singh Baljnder , Masoodi Sariq R.
Published: March 2017

Background: The diagnosis of osteomyelitis of the foot in patients with diabetes mellitus remains a challenge. This study was conducted to evaluate bone infections using scintigraphy with instantly prepared single-vial kit, radio-labeled ciprofloxacin (Diagnobact TM) in comparison to a bacterial culture taken from the involved site. Methods: Twenty-five patients with type 2 diabetes mellitus having foot ulcers, including six with superficial ulcers and positive 99mTc-methylene diphosphonate (MDP) bone scan as a control, were subjected to 99mTc-ciprofloxacin scan and subsequent bacteriological culture. Results: 99mTc-ciprofloxacin scan was positive in 13 patients and negative in 12 patients, including the six with superficial ulcers. Bacterial culture was positive in 18 patients and negative in seven, including one with osteomyelitis on bone biopsy only. 99mTc-ciprofloxacin scan showed “true positive” results in 12, “true negative” in six, “false positive” in one, and “false negative” in six. The specificity and sensitivity of the test were 66.7% and 85.7%, respectively. The positive and negative predictive values and an accuracy of 92.8%, 50% and 72%, respectively. Staphylococcus aureus and Escherichia coli were the most frequently isolated organisms. Conclusion: 99mTc-ciprofloxacin is a sensitive and specific marker to diagnose bone infection in patients with diabetes mellitus, but care must be taken in case of fastidious organisms and ciprofloxacin-resistant bacterial flora in which false results may be obtained.
Effect of administration rate on propofol requirement in cats
Authors: Oliveira Renato LS , Moreira Clarissa MR , Barcellos Myla CB , Silva Camile PP , Teixeira Jorge GC , Souza Heloisa JM
Published: March 2017

Objectives

The objective of this study was to determine the effect of administration rate on propofol dose for induction of anesthesia and the effect of methadone on this dose.

Methods

This was a prospective, randomized, blinded clinical study. Forty male cats (mean ± SD age 1.5 ± 0.8 years) were admitted for orchiectomy. Cats were randomly allocated to receive acepromazine (0.05 mg/kg) with either methadone (MET; 0.3 mg/kg) or saline (SAL; 0.03 ml/kg). Each premedication group then received anesthetic induction with propofol at 5 (F) or 1.5 mg/kg/min (S), resulting in the following four groups: MET-F, SAL-F, MET-S and SAL-S. Sedation scores were assigned at 15 and 30 mins after premedication using a simple descriptive scale (SDS) and a visual analog scale (VAS). After assignment of sedation scores, respiratory frequency ( fR) was recorded, and anesthetic induction began and was continued until cats lost their palpebral reflexes and jaw tone, and the eye globe rotated ventromedially. The time for induction and the total amount of propofol needed was recorded, and intubation was then performed. After intubation, fR was also recorded.

Results

SDS and VAS sedation scores were low at 15 and 30 mins after premedication. There was no significant difference in sedation scores by time or between the groups at any time on any scale. The amount of propofol needed to achieve anesthetic induction was 5.3 ± 1.1 mg/kg in group MET-F, which was statistically lower when compared with the other three groups, which demonstrated no difference among them.

Conclusions and relevance

Premedication with acepromazine and methadone was not able to produce adequate sedation in healthy cats. The slow induction rate is not adequate for use in cats considering that all of the animals demonstrated excitement during anesthetic induction. The fast administration rate was able to produce adequate induction of anesthesia and reduce the amount of propofol needed to achieve intubation only when using methadone.
A story of identity: a cautionary tale
Authors: Lewis Patrick J
Published: March 2017

This is a personal narrative drawing upon the multi-dimensionality of narrative and storytelling to make sense of lived-experience. The article is an experience that deals with Indigenous Identity fraud in the academy in the moment of Reconciliation with Indigenous People and the people of Canada. It is a story of White settler claims to being Indigenous so as to reposition themselves within university discourse of Indigenisation. The narrative weaves through the structures and practices of colonisation, the complexities of identity and racialisation, and the restraint of universities to take up Indigenisation in a meaningful and authentic way. A restraint that may actually contribute to the continued erasure of Indigeneity.
Gender equality in Swedish film policy: Radical interpretations and ‘unruly’ women
Authors: Jansson Maria
Published: March 2017

Gender quotas have been a crucial part of Swedish film policy since 2006 and have resulted in an increasing number of films with women directors, producers and screenwriters. However, films with women directors are still likely to have smaller budgets and less money for marketing and distribution than films with men directors. This article suggests that, in the context of film governance, gender quotas are discursively constructed in ways that circumscribe the opportunities to change current gender relations. Nevertheless, gender quotas have been used as a springboard for more radical interpretations to improve women’s conditions and challenge the foundation of the governance regime. The article also explores the idea that bottom-up representational claims are necessary to ensure that quotas and the inclusion of women result in women’s voices being heard. Such measures require the governance regime to be sensitive to voices that deviate from the norm.
Causal attributions of mental health problems and depressive symptoms among older Somali refugees in Finland
Authors: Kuittinen Saija , Mölsä Mulki , Punamäki Raija-Leena , Tiilikainen Marja , Honkasalo Marja-Liisa
Published: March 2017

Causal attributions of mental health problems play a crucial role in shaping and differentiating illness experience in different sociocultural and ethnic groups. The aims of this study were (a) to analyze older Somali refugees’ causal attributions of mental health problems; (b) to examine the associations between demographic and diagnostic characteristics, proxy indicators of acculturation, and causal attributions; and (c) to analyze the connections between causal attributions and the manifestation of somatic-affective and cognitive depressive symptoms. A sample of 128 Somali refugees aged 50–80 years living in Finland were asked to list the top three causes of mental health problems. Depressive symptoms were analyzed using the Beck Depression Inventory (BDI). The results showed that the most commonly endorsed causal attributions of mental health problems were jinn, jealousy related to polygamous relationships, and various life problems. We identified five attribution categories: (a) somatic, (b) interpersonal, (c) psychological, (d) life experiences, and (e) religious causes. The most common causal attribution categories were life experiences and interpersonal causes of mental health problems. Men tended to attribute mental health problems to somatic and psychological causes, and women to interpersonal and religious causes. Age and proxy indicators of acculturation were not associated with causal attributions. Participants with a psychiatric diagnosis and/or treatment history reported more somatic and psychological attributions than other participants. Finally, those who attributed mental health problems to life experiences (e.g., war) reported marginally fewer cognitive depressive symptoms (e.g., guilt) than those who did not. The results are discussed in relation to biomedical models of mental health, service use, immigration experiences, and culturally relevant patterns of symptom manifestation.