bluuebunny/crossref_metadata_2025 huggingface dataset:
Applicable Law in Investment Agreements
Authors: Titi Catharine
Published: March 2019

The law applicable to investment disputes is of paramount importance because it can be a determinant of the outcome of the dispute. Disputing parties can choose the law applicable to their dispute. This derives from the principle of party autonomy in international arbitration. The parties’ choice of the applicable law often takes place in tandem with or as part of their consent to arbitration. Treaty partners can insert a clause on applicable law in the investment treaty or indirectly incorporate the provisions on applicable law of various arbitration rules, such as when offering arbitration according to the Convention on the Settlement of Investment Disputes between States and Nationals of Other States (ICSID Convention) or the Arbitration Rules of the United Nations Commission on International Trade Law (UNCITRAL). When an investor accepts the host state’s offer to arbitrate, it also accepts its choice of applicable law as expressed in the treaty and/or in the arbitration rules under which the investor selects to bring the dispute. There are also other ways in which disputing parties can choose the applicable law. For instance, their choice of applicable law can be crystallized in a compromis drafted once a dispute has arisen. In the absence of an express choice of applicable law, the latter is determined on the basis of the default rules found in the arbitration rules which govern the dispute. As an illustration, Article 42(1) of the ICSID Convention provides that, if the parties do not agree on the applicable law, the tribunal shall apply the law of the host state, including its conflict of law rules, “and such rules of international law as may be applicable.” Debates about the identification of the applicable law have often revolved around the relative weight to be accorded to the municipal law of the host state and to international law. Sometimes the tribunal’s failure to apply primarily the investment treaty has been at the heart of debate. Failure to apply the proper law constitutes a ground for annulment under the ICSID Convention (as manifest excess of powers). In non-ICSID Convention arbitration, awards can also be set aside for failure to apply the applicable law (e.g., when the tribunal is perceived to overstep its mandate). However, such annulment or set-aside concerns the effect of failure to apply the applicable law. This is a separate issue and as such it is not covered in the present article.
Religion and Politics in Contemporary Africa
Authors: Haynes Jeffrey
Published: March 2019

This entry examines the relationship of religion and politics in Africa in the context of Democratization over time, with particular focus on the roles of religious leaders. Two main issues form its focus. The first is the relationship of senior religious figures to the state in Africa and the role of the former in the region’s recent attempts to democratize in the 1980s and 1990s. The second aim is to examine a more recent development: Islamic militancy in Africa in the 2000s, and its relationship with politics, political change, and democratization. During the 1980s and 1990s Africa experienced something it had not seen for decades: widespread popular calls for democratization, part of a wider package of demands for improved economic and political, including human, rights. Demands for democratization had both domestic and external roots. Domestically, demands for reform reflected an awakening—or reawakening—of an often long dormant political voice for various civil society groups, with trade union officials, higher education students, businesspeople, civil servants, and religious (mostly Christian) figures initially leading and coordinating popular demands for reform. Professional politicians later made such demands integral parts of their programs for election. The widespread expectation was that popular efforts would force long-entrenched, often venal governments from office. A second factor was that Africa’s democratization was the ‘road map’ for political change preferred by key external actors: Western governments who provided Africa with the bulk of its foreign aid. In sum, demands for democratization in Africa in the 1980s and 1990s are best explained through the interaction of domestic and international factors, with the former of most importance. During the 1980s and 1990s, religious figures, notably Christian leaders, added their voices to the clamor for fundamental political changes in Africa. Leading Catholics were frequently involved in national conferences on the political way forward in a number of French-speaking, mainly Christian, countries, including Congo-Brazzaville, Togo, Gabon, Zaire (now Democratic Republic of Congo), and Chad. In addition, in South Africa, apartheid rule came to an end in 1994 and a democratically elected government followed. And in Muslim-majority Niger and Mali new political leaders and democratically elected governments emerged. In sum, during the 1980s and 1990s involvement of religious leaders, including Catholic leaders in national democracy conferences and other means of democratization, reflected the fact that many religious figures became convinced of the need for democratically elected government in Africa.
Pediatric Intracavernous Sinus Lesions: A Single Institutional Surgical Case Series and Review of the Literature
Authors: Hoshide Reid , Rennert Robert C , Calayag Mark , Gonda David , Meltzer Hal , Crawford John R , Levy Michael L
Published: March 2019

BACKGROUND

Pediatric intracavernous sinus tumors are exceedingly rare and thus poorly characterized. Their neurosurgical management is challenging and diagnostic, and management guidelines are limited.

OBJECTIVE

To report our institutional experience with the surgical resection of pediatric intracavernous sinus tumors. We also compare and contrast our results with the 14 cases of pediatric intracavernous sinus lesions in the current literature.

METHODS

A retrospective descriptive analysis of consecutive pediatric patients (ages 0-18 yr) presenting to our institution with a diagnosis of an intracavernous sinus lesion was performed. From January 2012 to January 2017, 5 cases were identified. Eleven patients with secondary invasion of the cavernous sinus (2 meningiomas, 7 pituitary adenomas) or dermoid tumors involving the cavernous sinus (2) were not included in our review.

RESULTS

Surgical resection via a frontotemporal orbitozygomatic approach was performed in all cases by a single senior neurosurgeon (M.L.). There were no perioperative or postoperative complications attributable to the surgery or approach. Four of 5 patients remained neurologically stable throughout the perioperative and postoperative period. The fifth patient had a complete resolution of their cranial neuropathies postoperatively. A pathological diagnosis that guided long-term management was obtained in all cases.

CONCLUSION

Neurosurgical management of pediatric cavernous sinus lesions can be safely performed and critically guide future therapies. Surgeon familiarity with cavernous sinus and skull-base anatomy is critical to the successful management of these patients. The benefits of surgery should be balanced against the potential complications and need for a tissue diagnosis in children. The senior author had a significant experience with cavernous sinus approaches in adults prior to initiating use of the approach in the pediatric population.
Worker Power and Class Polarization in Intra-Year Work Hour Volatility
Authors: LaBriola Joe , Schneider Daniel
Published: March 2019

Precarious work, which has become more prevalent in the United States in recent decades, is disproportionately experienced by workers of lower socio-economic classes, and research suggests that the erosion of worker power has contributed to this class polarization in precarity. One dimension of precarious work of growing interest to scholars and policymakers is instability faced by workers in the amount and regularity of their work hours. However, we know little about the magnitude of month-to-month or week-to-week (intra-year) volatility in hours worked, the extent of class-based polarization in this measure of job quality, and whether worker power moderates this polarization. In this paper, we make novel use of the panel nature of the nationally-representative Current Population Survey (CPS) to estimate intra-year volatility in the actual hours respondents report working in the previous week across four consecutive survey months. Using this new measure, we then show that, net of demographic characteristics and controls for occupation and industry, low-wage workers experience disproportionately greater work hour volatility. Finally, we find evidence that reductions in marketplace bargaining power—as measured by higher state-level unemployment rates—increase wage- and education-based polarization in work hour volatility, while increases in associational power—as measured by union coverage—reduce wage-based polarization in work hour volatility.
The Tad Pilus Apparatus of ‘CandidatusLiberibacter asiaticus’ and Its Regulation by VisNR
Authors: Andrade Maxuel , Wang Nian
Published: March 2019

Citrus huanglongbing (HLB) is one of the most destructive diseases affecting citrus plants. ‘Candidatus Liberibacter asiaticus’, an uncultivated α-proteobacteria, is the most widely spread causal agent of HLB and is transmitted by the Asian citrus psyllid Diaphorina citri. ‘Ca. L. asiaticus’ attachment to the psyllid midgut is believed to be critical to further infect other organs, including the salivary gland. In this study, the type IVc tight adherence (Tad) pilus locus encoded by ‘Ca. L. asiaticus’ was characterized. The Tad loci are conserved among members of Rhizobiaceae, including ‘Ca. L. asiaticus’ and Agrobacterium spp. Ectopic expression of the ‘Ca. L. asiaticus’ cpaF gene, an ATPase essential for the biogenesis and secretion of the Tad pilus, restored the adherence phenotype in cpaF mutant of A. tumefaciens, indicating CpaF of ‘Ca. L. asiaticus’ was functional and critical for bacterial adherence mediated by Tad pilus. Quantitative reverse transcription PCR (qRT-PCR) analysis revealed that ‘Ca. L. asiaticus’ Tad pilus-encoding genes and ‘Ca. L. asiaticus’ pilin gene flp3 were upregulated in psyllids compared with in planta. A bacterial one-hybrid assay showed that ‘Ca. L. asiaticus’ VisN and VisR, members of the LuxR transcriptional factor family, were bound to the flp3 promoter. VisNR regulate flp3. Negative regulation of the flp3 promoter by both VisN and VisR was demonstrated using a shuttle strategy, with analysis of the phenotypes and immunoblotting together with quantification of the expression of the flp3 promoter fused to the β-galactosidase reporter gene. Comparative expression analysis confirmed that ‘Ca. L. asiaticus’ visNR was less expressed in the psyllid than in the plant host. Further, motility and biofilm phenotypes of the visNR mutant of A. tumefaciens were fully complemented by expressing ‘Ca. L. asiaticus’ visNR together. The physical interaction between VisN and VisR was confirmed by pull-down and stability assays. The interaction of the flp3 promoter with VisR was verified by electrophoretic mobility shift assay. Taken together, the results revealed the contribution of the Tad pilus apparatus in the colonization of the insect vector by ‘Ca. L. asiaticus’ and shed light on the involvement of VisNR in regulation of the Tad locus.
Approaching Impact Meaningfully in Medical Education Research
Authors: Friesen Farah , Baker Lindsay R. , Ziegler Carolyn , Dionne Amy , Ng Stella L.
Published: March 2019

Medical education research faces increasing pressure to demonstrate impact and utility. These pressures arise amidst a climate of accountability and within a culture of outcome measurement. Conventional metrics for assessing research impact such as citation analysis have been adopted in medical education, despite researchers’ assertion that these quantitative measures insufficiently reflect the value of their work. Every knowledge community has its own definitions of what counts as knowledge, how that knowledge should be produced, and how the quality of that knowledge production should be evaluated. Definitions of impact and knowledge shape and constrain researchers’ foci and endeavors. Therefore, metrics that meaningfully evaluate the knowledge outputs of researchers need to be defined within each field. It is time for medical education research, as a field, to examine how to measure research impact and carefully consider the broader implications these measures may have. The authors discuss developments in research metrics more broadly, then critically examine impact metrics currently used in the medical education field and propose alternatives to more meaningfully track and represent impact in medical education research. Grey metrics and narrative impact stories to more fully capture the richness and nuanced nature of impact in medical education research are introduced. The authors advocate for a continual examination of how impact is defined, eschewing unquestioned use of conventional metrics. A new conversation is needed, as well as a research agenda to help medical education conceptualize and study metrics more appropriate for the field.
Beyond the United States Medical Licensing Examination Score: Assessing Competence for Entering Residency
Authors: Radabaugh Carrie L. , Hawkins Richard E. , Welcher Catherine M. , Mejicano George C. , Aparicio Alejandro , Kirk Lynne M. , Skochelak Susan E.
Published: March 2019

Assessments of physician learners during the transition from undergraduate to graduate medical education generate information that may inform their learning and improvement needs, determine readiness to move along the medical education continuum, and predict success in their residency programs. To achieve a constructive transition for the learner, residency program, and patients, high-quality assessments should provide meaningful information regarding applicant characteristics, academic achievement, and competence that lead to a suitable match between the learner and the residency program’s culture and focus.

The authors discuss alternative assessment models that may correlate with resident physician clinical performance and patient care outcomes. Currently, passing the United States Medical Licensing Examination Step examinations provides one element of reliable assessment data that could inform judgments about a learner’s likelihood for success in residency. Yet, learner capabilities in areas beyond those traditionally valued in future physicians, such as life experiences, community engagement, language skills, and leadership attributes, are not afforded the same level of influence when candidate selections are made.

While promising new methods of screening and assessment—such as objective structured clinical examinations, holistic assessments, and competency-based assessments—have attracted increased attention in the medical education community, currently they may be expensive, be less psychometrically sound, lack a national comparison group, or be complicated to administer. Future research and experimentation are needed to establish measures that can best meet the needs of programs, faculty, staff, students, and, more importantly, patients.
Effect of Serious Adverse Events on Health-related Quality of Life Measures Following Surgery for Adult Symptomatic Lumbar Scoliosis
Authors: Smith Justin S. , Shaffrey Christopher I. , Kelly Michael P. , Yanik Elizabeth L. , Lurie Jon D. , Baldus Christine R. , Edwards Charles , Glassman Steven D. , Lenke Lawrence G. , Boachie-Adjei Oheneba , Buchowski Jacob M. , Carreon Leah Y. , Crawford Charles H. , Errico Thomas J. , Lewis Stephen J. , Koski Tyler , Parent Stefan , Kim Han Jo , Ames Christopher P. , Bess Shay , Schwab Frank J. , Bridwell Keith H.
Published: March 2019

Study Design.

Secondary analysis of prospective multicenter cohort.

Objective.

To assess effect of serious adverse events (SAEs) on 2- and 4-year patient-reported outcomes measures (PROMs) in patients surgically treated for adult symptomatic lumbar scoliosis (ASLS).

Summary of Background Data.

Operative treatment for ASLS can improve health-related quality of life, but has high rates of SAEs. How these SAEs effect health-related quality of life remain unclear.

Methods.

The ASLS study assessed operative versus nonoperative ASLS treatment, with randomized and observational arms. Patients were 40- to 80-years-old with ASLS, defined as lumbar coronal Cobb ≥30° and Oswestry Disability Index (ODI) ≥20 or Scoliosis Research Society-22 (SRS-22) ≤4.0 in pain, function, and/or self-image domains. SRS-22 subscore and ODI were compared between operative patients with and without a related SAE and nonoperative patients using an as-treated analysis combining randomized and observational cohorts.

Results.

Two hundred eighty-six patients were enrolled, and 2- and 4-year follow-up rates were 90% and 81%, respectively, although at the time of data extraction not all patients were eligible for 4-year follow-up. A total of 97 SAEs were reported among 173 operatively treated patients. The most common were implant failure/pseudarthrosis (n = 25), proximal junctional kyphosis/failure (n = 10), and minor motor deficit (n = 8). At 2 years patients with an SAE improved less than those without an SAE based on SRS-22 (0.52 vs. 0.79, P = 0.004) and ODI (−11.59 vs. −17.34, P = 0.021). These differences were maintained at 4-years for both SRS-22 (0.51 vs. 0.86, P = 0.001) and ODI (−10.73 vs. −16.69, P = 0.012). Despite this effect, patients sustaining an operative SAE had greater PROM improvement than nonoperative patients (P<0.001).

Conclusion.

Patients affected by SAEs following surgery for ASLS had significantly less improvement of PROMs at 2- and 4-year follow-ups versus those without an SAE. Regardless of SAE occurrence, operatively treated patients had significantly greater improvement in PROMs than those treated nonoperatively.

Level of Evidence: 2
PHQ-9 Score Predicts Postoperative Outcomes Following Minimally Invasive Transforaminal Lumbar Interbody Fusion
Authors: Patel Dil V. , Yoo Joon S. , Khechen Benjamin , Haws Brittany E. , Block Andrew M. , Lamoutte Eric H. , Karmarkar Sailee S. , Singh Kern
Published: March 2019

Study Design:

This was a retrospective cohort study.

Objective:

This study evaluates if an association exists between preoperative depression and postoperative outcomes following minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).

Summary of Background Data:

Few studies have quantified preoperative depression symptoms using Patient Health Questionnaire-9 (PHQ-9) to predict postoperative outcomes after lumbar fusion, especially MIS TLIF.

Methods:

A surgical database of patients undergoing primary, single-level MIS TLIF was retrospectively reviewed. Patients were stratified by predefined preoperative PHQ-9 scores: no depression (<5), mild depression (5–9), and moderate to severe depression (≥10). Inpatient pain scores and narcotics use were recorded. Oswestry Disability Index, Veterans RAND-12 Mental Component Score and Physical Component Score, and Visual Analog Scale (VAS) back and leg pain scores were collected preoperatively and at 6-week, 12-week, and 6-month follow-up. One-way analysis of variance and χ2 analysis determined if an association existed between PHQ-9 subgroups and baseline characteristics or perioperative outcomes. Multivariate linear regression assessed for an association between PHQ-9 and postoperative patient-reported outcomes.

Results:

In total, 94 patients were included. Patients with higher PHQ-9 scores were younger, obese, and carried workers’ compensation insurance. Higher PHQ-9 scores were associated with worse preoperative Oswestry Disability Index, Veterans RAND-12 Mental Component Score and Physical Component Score, and VAS back and leg pain scores. Patients with higher PHQ-9 reported greater inpatient VAS pain scores on postoperative day 0 and 1 and demonstrated greater hourly narcotics consumption on postoperative day 0. Furthermore, higher PHQ-9 scores exhibited less improvement in all patient-reported outcomes.

Conclusions:

Patients with severe depression symptoms reported greater pain, increased narcotics consumption, and less clinical improvement after MIS TLIF. Therefore, patients with greater PHQ-9 scores should be monitored more closely and may benefit from additional counseling with regard to postoperative outcomes to better manage pain control and expectations of recovery.
Side effects of immunotherapy: a constant challenge for oncologists
Authors: Scotté Florian , Ratta Raffaele , Beuzeboc Philippe
Published: March 2019

Purpose of review

Immunotherapeutic strategies have become the new paradigm of cancer care, through their new targeting and safety profile approach, and, de facto, their new monitoring and safety management challenges.

Recent findings

Generalities and specificities of the toxicity management related to immune checkpoint inhibitors (ICIs) are highlighted. Predictive factors of safety are issue of research and the challenge of prevention as well as monitoring are huge to alleviate toxicities and enhance safety and efficacy. Particular situations like steroids association and cost-effectiveness approach are summarized.

Patients as well as general practitioners, including health-caregivers, should be informed before ICI initiation of the different alert symptoms which should precede immune-related adverse events.
Prevalence and Severity of Child Impairment in a US Sample of Child Maltreatment Investigations
Authors: Helton Jesse J. , Lightfoot Elizabeth , Fu Q. John , Bruhn Christina M.
Published: March 2019

Objectives:

Although there is agreement that childhood disability is both a risk and result of maltreatment, the extent of disability in the child welfare system remains unclear. Our objective is to determine the prevalence and severity of child impairment in a national sample of child abuse and neglect investigations in the United States.

Methods:

We used data from the National Survey of Child and Adolescent Well-Being II, a study of 2644 children older than 3 years who were subjects of child abuse and neglect investigations. Groups of children were identified by latent profile analysis using continuous standardized measures of intelligence, emotional or behavioral impairments, adaptive behaviors, and social skills.

Results:

Whether the child remained in home or was removed to foster care after an investigation, 3 classes of children were identified: (1) slightly over one-tenth were in an intellectual disability subgroup characterized by marked intellectual impairments alongside delays in daily living functioning, (2) over one-third were in an emotional or behavioral impairment subgroup characterized by both frequent and severe internalizing and externalizing behaviors, and (3) slightly over half were in a typically developing subgroup.

Conclusion:

When using standardized measures of disability, nearly half of the children investigated by child protection in the United States are not typically developing. These findings suggest that those working for the child welfare system need to be attentive to the complex needs of children with intellectual disabilities and emotional or behavioral impairments and their families, many of whom are under significant stress.
The influence of leadership facilitation on relational coordination among primary care team members of accountable care organizations
Authors: Huber Thomas P. , Rodriguez Hector P. , Shortell Stephen M.
Published: March 2019

Background

Teamwork is a central aspect of integrated care delivery and increasingly critical to primary care practices of accountable care organizations. Although the importance of leadership facilitation in implementing organizational change is well documented, less is known about the extent to which strong leadership facilitation can positively influence relational coordination among primary care team members.

Purpose

The aim of this study was to examine the association of leadership facilitation of change and relational coordination among primary care teams of accountable care organization-affiliated practices and explore the role of team participation and solidarity culture as mediators of the relationship between leadership facilitation and relational coordination among team members.

Methodology/Approach

Survey responses of primary care clinicians and staff (n = 764) were analyzed. Multilevel linear regression estimated the relationships among leadership facilitation, team participation, group solidarity, and relational coordination controlling for age, time, occupation, gender, team tenure, and team size. Models included practice site random effects to account for the clustering of respondents within practices.

Results

Leadership facilitation (β = 0.19, p < .001) and team participation (β = 0.18, p < .001) were positively associated with relational coordination, but solidarity culture was not associated. The association of leadership facilitation and relational coordination was only partially mediated (9%) by team participation.

Conclusions

Leadership facilitation of change is positively associated with relational coordination of primary care team members. The relationship is only partially explained by better team participation, indicating that leadership facilitation has a strong direct effect on relational coordination. Greater solidarity was not associated with better relational coordination and may not contribute to better team task coordination.

Practice Implications

Leadership facilitation of change may have a positive and direct impact on high relational coordination among primary care team members.
The effectiveness of teaching chest compression first in a standardized public cardiopulmonary resuscitation training program
Authors: Hsu Shou-Chien , Kuo Chan-Wei , Weng Yi-Ming , Lin Chi-Chun , Chen Jih-Chang
Published: March 2019

Effectiveness of bystander cardiopulmonary resuscitation (CPR) is known to provide emergency medical services which reduce the number of deaths in patients with out-of-hospital cardiac arrest. The survival at these patients is affected by the training level of the bystander, but the best format of CPR training is unclear. In this pilot study, we aimed to examine whether the sequence of CPR instruction improves learning retention on the course materials.

A total of 95 participants were recruited and divided into 2 groups; Group 1: 49 participants were taught firstly how to recognize a cardiac arrest and activate the emergency response system, and Group 2: 46 participants were taught chest compression first. The performance of participants was observed and evaluated, the results from 1 pre-test and 2 post-tests between 2 groups were then compared.

There was a significantly better improvement of participants in Group 2 regarding the recognition of a cardiac arrest and the activation of the emergency response system than of those in Group 1. At the post-test, participants in Group 2 had an improvement in chest compression compared to those in Group 1, but the difference was not statistically significant.

Our study had revealed that teaching CPR first in a standardized public education program had improved the ability of participants to recognize cardiac arrest and to activate the emergency response system.
Comparison between paclitaxel-coated balloon and standard uncoated balloon in the treatment of femoropopliteal long lesions in diabetics
Authors: Du Xin , Wang Feng , Wu Dan-ming , Zhang Min-hong , Jia Xin , Zhang Ji-wei , Zhuang Bai-xi , Zhao Yu , Guo Ping-fan , Bi Wei , Fu Wei-guo , Guo Wei , Wang Shen-ming
Published: March 2019

Atherosclerotic diseases may include femoropopliteal artery stenosis or occlusion. Percutaneous transluminal angioplasty (PTA) is an effective and minimally invasive treatment strategy for atherosclerotic femoropopliteal artery stenosis/occlusion disease. Balloon angioplasty is a widely used technique in the management of occlusive disease in almost all arterial segments.

We enrolled 111 diabetics with long femoropopliteal lesions, among which 54 received PTA with paclitaxel-coated balloon (the Paclitaxel group), and 57 with standard balloon catheters (the Control group).

The primary outcome was set as angiographic late lumen loss (LLL) within 6 months; the secondary angiographic outcome was binary restenosis. Clinical outcomes included Rutherford clarification, ankle-brachial index (ABI) and rate of clinically driven target lesion revascularization (TLR). Two groups had similar basal clinical features, angiographic and procedural characteristics. Compared to controls, the Paclitaxel group had a significantly lower 6-month LLL rate, 12-month binary restenosis rate, 12-month TLR, lower Rutherford grades at 3 and 6 months, and higher ABI at 3 months. For all factors which might influence outcomes, fasting blood glucose was negatively correlated with ABI; the blood urea nitrogen (BUN) was positively related with the Rutherford clarification grades. In addition, the coronary heart disease (CHD) and smoking histories were positively correlated with residual stenosis after treatment.

Collectively, the paclitaxel-coated balloon angioplasty can yield more favorable angiographic and clinical outcomes than standard uncoated balloon angioplasty, even in the more challenging lesions (the long and occlusive femoropopliteal lesions) in diabetics, when it had a similar safety profile to the traditional balloon. Blood glucose, BUN, CHD, and smoking imply poor curative effects.
Comparison of hemodynamic changes and prognosis between stenting and standardized medical treatment in patients with symptomatic moderate to severe vertebral artery origin stenosis
Authors: Shao Jia-Xin , Ling Yun-Ao , Du Hua-Ping , Zhai Guo-Jie , Xu Yuan , Cao Yong-Jun
Published: March 2019

This study aimed to compare the clinical efficacy of stenting compared with standardized medical treatment in patients with moderate to severe vertebral artery origin stenosis (VAOS).

Patients diagnosed with moderate to severe VAOS and indicated to undergo vertebral artery stenting were enrolled. Patients were divided into stenting group and standardized medical treatment group. All patients underwent transcranial Doppler (TCD) before and after treatment. Incidence of new cerebral infarction, transient ischemic attack (TIA), improvement of clinical symptoms, and National Institutes of Health Stroke Scale (NIHSS) score were observed.

A total of 98 patients were enrolled. Vertebral artery stenting implant was accepted by 43 patients. Two weeks after treatment, the NIHSS score in the stenting group decreased significantly compared to that in the standardized medical treatment group. The modified Rankin Scale (mRS) score in the stenting group at three months was significantly lower than that in the medical treatment group (P = .044). The extent of vascular stenosis in the stent group decreased significantly (76.5 ± 10.0% vs. 13.7 ± 5.9%, t = 35.878, P = .000). The adverse events occurred in 9 (16.4%) patients in the medical treatment group and 5 (11.6%) in the stenting group (P = .506). There was one case with new cerebral infarction in the stenting group, whereas the medical treatment group showed 1 case with TIA and three with new cerebral infarction during follow-up after 3 months. The peak systolic velocity (PSV), end diastolic velocity (EDV), pulsatility index (PI) of stenosis vertebral artery, and PSV of basilar artery were significantly higher in the stent group than those in the standardized medical group (P < .05).

Stenting for VAOS, rather than standardized medical treatment, can effectively relieve vascular stenosis, alter vertebral-basilar artery hemodynamics, and improve neurological function, with low perioperative complications.
Traditional Chinese medicine on treating diabetic mellitus erectile dysfunction
Authors: Yu Xudong D. , Wang Jisheng S. , Zuo Guang , Wang Xin , Ge Fuxing , Wu Songli , Lim Jingyang , Shang Jianwei , Zhang Yaosheng
Published: March 2019

Background:

Diabetic mellitus erectile dysfunction (DMED) refers to erectile dysfunction (ED) secondary to diabetes. As people's lifestyle changes and the population ages, the incidence of DMED continues to increase. Many clinical trials have proven that Chinese medicine has a significant effect in the treatment of DMED. In this systematic review, we aim to evaluate the effectiveness and safety of traditional Chinese medicine (TCM) for DMED.

Methods:

We will search PubMed, Cochrane Library, AMED, EMbase, WorldSciNet; Nature, Science online and China Journal Full-text Database, China Biomedical Literature CD-ROM Database, and related randomized controlled trials included in the China Resources Database. The time is limited from the construction of the library to February, 2019.We will use the criteria provided by Cochrane 5.1.0 for quality assessment and risk assessment of the included studies, and use the Revman 5.3 and Stata13.0 software for meta-analysis of the effectiveness, recurrence rate, and symptom scores of DMED.

Ethics and dissemination:

This systematic review will evaluate the efficacy and safety of TCM for treating Diabetic mellitus erectile dysfunction. Because all of the data used in this systematic review and meta-analysis has been published, this review does not require ethical approval. Furthermore, all data will be analyzed anonymously during the review process trial.
Periprosthetic femoral fractures around tumor endoprostheses treated with limited revision surgery combined with allograft
Authors: Wu Jianhua , Zhu Dengfeng , Wang Jianjun , Wang Jie , Liu Yongguo , Lei Jun
Published: March 2019

Rationale:

Old periprosthetic femoral fractures (OPFFs) around a tumor prosthesis of the knee present formidable problems for orthopedic oncologists; large bone defects and inappropriate biomechanics of the revision implant design can impair successful reconstruction. Limited literature is available on the reconstruction of OPFFs using revision combined with massive allograft following resection of a bone tumor around the knee joint. In this study, we present the first reported case in the English literature of a limited revision followed by several segmental allografts for the reconstruction of the knee joint.

Patient concerns:

This case involved a 45-year-old female who was treated for a malignant fibrous histiocytoma (MFH) of the knee joint with surgical excision of the lesion and replacement of the defect using endoprosthetic reconstruction when she was 25 years old. Her surgical history was remarkable for a left tumoral knee prosthesis implanted 20 years ago. Nine years before revision, the patient had fall damage; however, she was able to walk independently and with moderate pain. In the 9-year period, prosthesis malfunction caused progressive left lower extremity shortening and a persistent swelling pain in the left thigh.

Diagnoses:

According to her clinical history, imaging results and physical examination, we confirmed the diagnosis of OPFFs potentially due to aseptic loosening and trauma injury.

Interventions:

In this study, we present the first case of OPFFs around a tumor endoprosthesis that was successfully treated using limited revision combined with a massive allograft.

Outcomes:

At 80 months after revision surgery, the patient had made a sufficient recovery from her symptoms. The bone union was complete without tumor recurrence or implant failure.

Lessons:

We propose that if prosthesis fracture is detected, revision surgery should be attempted as early as possible, and for patients with OPFFs, the use of limited revision combined with massive allografts may be useful for safely and adequately reconstructing OPFFs around the knee joint. However, patients should be followed-up closely after surgical treatment because of the high risk of revision.
Treatment of uterine high-grade endometrial stromal sarcoma with apatinib combined with chemotherapy
Authors: Zhang Ying , Chen Chen , Ren Meng , Cong Xiaofeng , Li Zhi , Yang Lei
Published: March 2019

Rationale:

The standard treatment for uterine high-grade endometrial stromal sarcoma (HGESS) is chemotherapy after surgery. However, the traditional combination chemotherapy has certain limitation, for example, the cancer cells will quickly become resistant to the chemotherapy drugs. Apatinib is a small-molecule antiangiogenic agent which has shown promising therapeutic effect against diverse tumor, but it still remains unknown whether apatinib has an antitumor effect in patients with endometrial stromal sarcoma (ESS). Here, we report a case of pulmonary metastasis from uterine HGESS successfully treated with apatinib combined with chemotherapy. We also review relevant literature discussing treatment of ESS.

Patients concerns:

A 54-years-old Chinese woman complained of intermittent pain in the waist and abdomen for 4 months. The patient was diagnosed as uterine fibroids before operation. The surgeon performed a total hysterectomy with bilateral salpingo-oophorectomy, resection of peritoneal disseminated lesions, and the pathological examination revealed a HGESS.

Diagnosis:

Uterine HGESS stage IV with lung metastases.

Interventions:

The patient underwent surgery, chemotherapy, chemotherapy combined with apatinib, apatinib maintenance therapy, and radioactive particle implantation for lung metastasis.

Outcomes:

The patient experienced the above interventions and achieved good results. And continue oral apatinib (500 mg daily) as maintenance therapy. It has been 16 months since the initial diagnosis, and the patient is still in follow-up.

Lessons:

Apatinib combined with chemotherapy and apatinib monotherapy as maintenance therapy could be a new therapeutic strategy for ESS.
The trends and associated factors of preterm deliveries from 2001 to 2011 in Taiwan
Authors: Chen Kou-Huang , Chen I-Chu , Yang Yi-Chieh , Chen Kow-Tong
Published: March 2019

The rate of preterm birth has been increasing worldwide. Most preterm babies are at increased risk of central nervous system impairments as well as respiratory and gastrointestinal complications. The aim of this study was to investigate the trends in preterm birth and associated factors contributing to preterm delivery in Taiwan. Information on obstetric antecedents and risk factors of preterm birth of pregnant women was obtained from the Taiwan National Medical Birth Register database. All live births from 2001 to 2011 in Taiwan were included in this study. A total of 2,334,532 live births from 2001 to 2011 were included in this study. Overall, the proportion of preterm deliveries increased by 11.1% (from 8.2% in 2001 to 9.1% in 2011). Multiple logistic regression analyses showed that nulliparity, multiple births, maternal medical complications, maternal age <20 years or ≥40 years, and medical indication for earlier delivery were positively associated with an increased risk of preterm delivery. Nulliparous women aged younger than 20 years and older than 40 years should be recognized as at-risk for preterm birth.
Risk Factors for Recurrent Acute Kidney Injury in Children Who Undergo Multiple Cardiac Surgeries: A Retrospective Analysis
Authors: Hasson Denise C. , Brinton John T. , Cowherd Ellen , Soranno Danielle E. , Gist Katja M.
Published: March 2019

Objectives:

Determine the risk factors for repeated episodes of acute kidney injury in children who undergo multiple cardiac surgical procedures.

Design:

Single-center retrospective chart review.

Setting:

Cardiac ICU at a quaternary pediatric care center.

Patients:

Birth to 18 years who underwent at least two cardiac surgical procedures with cardiopulmonary bypass.

Interventions:

None.

Measurements and Main Results:

One-hundred eighty patients underwent two cardiac surgical procedures and 89 underwent three. Acute kidney injury was defined by the Kidney Disease: Improving Global Outcomes serum creatinine criteria. Acute kidney injury frequency was 26% (n = 46) after surgery 1, 20% (n = 36) after surgery 2, and 24% (n = 21) after surgery 3, with most acute kidney injury occurring on postoperative days 1 and 2. The proportion of patients with severe acute kidney injury increased from surgery 1 to surgery 3. Patients with acute kidney injury had a significantly longer duration of ventilation and length of stay after each surgery. The odds of acute kidney injury after surgery 3 was 2.40 times greater if acute kidney injury was present after surgery 1 or 2 (95% CI, 1.26–4.56; p = 0.008) after adjusting for confounders. The time between surgeries was not significantly associated with acute kidney injury (p = 0.85).

Conclusions:

In a heterogeneous population of pediatric patients with congenital heart disease undergoing multiple cardiopulmonary bypass surgeries, odds of acute kidney injury after a third surgery was increased by the presence of acute kidney injury after prior procedures. Time between surgery did not play a role in increasing odds of acute kidney injury. Further studies in a larger multicenter investigation are necessary to confirm these findings.
Current Approach to the Management of Forearm and Elbow Dislocations in Children
Authors: Gottlieb Michael , Suleiman Linda I.
Published: March 2019

Pediatric orthopedic injuries are a common reason for presentation to the emergency department. This article sequentially discusses 2 important upper extremity injuries that require prompt management in the emergency department. Radial head subluxations are discussed with a focus on current evidence for imaging, reduction techniques, and follow-up. Elbow dislocations, although less common than radial head subluxations, are also addressed, highlighting imaging, reduction, immobilization, and follow-up recommendations.
Development and Validation of a Nipple-Specific Scale for the BREAST-Q to Assess Patient-Reported Outcomes following Nipple-Sparing Mastectomy
Authors: Peled Anne Warren , Amara Dominic , Piper Merisa L. , Klassen Anne F. , Tsangaris Elena , Pusic Andrea L.
Published: March 2019

Background:

Nipple-sparing mastectomy and immediate reconstruction has become increasingly popular for prophylactic and therapeutic indications. Patient-reported outcomes instruments such as the BREAST-Q provide important information regarding patient satisfaction and aesthetic and functional outcomes. However, a validated patient-reported outcomes scale specifically addressing nipple-related outcomes following nipple-sparing mastectomy is not currently available.

Methods:

The authors developed a new scale measuring nipple outcomes by adapting nipple reconstruction questions from the BREAST-Q breast reconstruction module. Patients completed the questions using the think-aloud method and underwent semistructured cognitive interviews to discuss their nipple-sparing mastectomy experience to elicit new concepts. Interviews were coded and additional questions were added based on this analysis after receiving additional input from a multidisciplinary group of breast cancer providers. The final scale was distributed electronically to a larger group with solicitation for any issues that were not addressed in the question set.

Results:

Ten patients completed the initial questionnaire. Analysis of the cognitive interviews identified nipple sensation, position, projection, scarring, symmetry, and surgical expectations as key content areas. After revising the questionnaire, an additional 35 patients completed it electronically. All respondents felt the questions were clear and no additional issues needed to be addressed. Feedback was used to clarify the instructions for how to respond to the questions if bilateral nipple-sparing mastectomy had been performed.

Conclusions:

Through qualitative patient interviews and adaptation of existing BREAST-Q questions, appropriate nipple-focused questions were developed to assess outcomes following nipple-sparing mastectomy. Incorporating these questions into patient-reported outcomes assessment of patients undergoing nipple-sparing mastectomy can help improve future techniques and optimize outcomes.
The Esthetic Difference of Chinese Beauty Evaluated by Two Different Human Races Based on Three-Dimensional Average Face Analysis
Authors: Chen Cong , Chen Yutong , Li Qingyi , Kau Chung How
Published: March 2019

Purpose:

The aim of this study was to establish a new method of facial soft tissue analysis based on 3dMDface system and to find the different esthetic preferences of Chinese beauties from the Chinese and Indian evaluators perspective.

Methods:

Three-dimensional facial images of 242 females and 168 males were evaluated and ranked by 8 Chinese and nine Indians using a 10-point visual analog scale (VAS). Total 120 subjects in 2 panels (from Chinese perspective and Indian perspective) including 30 male and 30 female faces with top 30 scores were analyzed with the “average face” method respectively. Then 17 linear measurements, 13 curve measurements and 14 ratios of 4 average faces were calculated and compared with the divine proportion.

Results:

Distinct differences were founded based on the average face analysis. Similar total facial types were preferred by both Chinese and Indian evaluators, while Indian evaluators preferred a wider male face with a protrusive lower lip. Delicate noses with lower nose ridge but protrusive lower lips in females were more acceptable by Indian evaluators. The differences of linear measurements were limited in 2.0 mm except the facial width, lower facial width, upper facial height and forehead height while curve measurements differ distinctly as the table shows. No ratios equal to the divine proportion were founded.

Conclusion:

The 3D Average face based on stereophotogrammetry is a feasible method to analyze the facial characters and discrepancy of esthetic preferences. Chinese and Indian evaluators have some certain differences when judging beauties. Attractive faces have some certain ratios but not the divine proportion.
Telescoping With Multiple Revolution Cranial Osteotomies in Patients With Simple Craniosynostosis
Authors: Caycedo Diego José , Betancourt Nadia Patricia , Cabal Marcela , Devia Rodriguez Raul , Santacruz Luís Fernando
Published: March 2019

Simple craniosynostosis is a cranial disease characterized by the premature closure of the cranial sutures, it develops during the first years of life and affects 1 in every 2000 to 2500 births worldwide (1). The cranial growth alteration occurs as parallel flattening to the compromised sutured with compensatory bulging in a perpendicular vector. Currently, The Suturectomy is the gold validated surgical treatment, that besides the dynamic Cranioplasties of multiples revolutions allows the design of bone flaps and therefore the correction of the secondary deformities caused by the synostosis. This multicenter descriptive study assessed a 20 series of cases (6 Plagiocephaly, 13 Scaphocephaly, 1 Brachycephaly) obtained in Cali, Colombia, that underwent surgery between January of 2014 and December of 2017, applying a Suturectomy surgery with additional telescoping of multiple revolution cranial osteotomies. The authors observe no clinical complications in the recruited patients regarding postoperative period of the described surgical technique (1, 90, and 180 days), thereby obtaining excellent outcomes on the maintained suture distraction focused on the assessment of the 3D reconstruction computed tomography scans.