bluuebunny/crossref_metadata_2025 huggingface dataset:
Smart materials activation analysis on example of nickel and titanium alloys
Authors: Wieczorek Bartosz , Kukla Mateusz , Warguła Łukasz , Waluś Konrad J. , Wiesner Klaudia
Published: March 2018

This paper is focused on research concerning activation time of elements made of Ni-Ti alloy (55/45% vol.) The activation time is a period of time required for alloy to reach it’s austenitic transformation (Af) temperature. For examined wire it reached values up to 60 °C. Heating of NiTi wire was conducted by retaining heat. In this paper the influence of wire length and electric current power on heating time is presented. This research allows to determine the correlation between the increase of temperature and time. For given electric current values. This data is useful for effective design of SMA actuators‥
Numerical computation of the damping and stiffness coefficients of the classical and magnetorheological squeeze film damper
Authors: Ferfecki Petr , Zapoměl Jaroslav , Šofer Michal , Pochylý František , Fialová Simona
Published: March 2018

Technological solution, frequently used to suppress vibrations in rotating machines, consists in adding damping devices between the rotor and its frame. This is enabled by dampers working on the principle of a squeezing thin classical or magnetorheological fluid film. The Navier-Stokes equations, Reynolds equation, and modified Navier-Stokes equations are used to determine the pressure distribution in the thin fluid film. The damping and stiffness coefficients are computed by the developed procedure presented in this paper. The proposed computational approach is based on the perturbation of the synchronous circular whirling motion. The carried-out computational simulations show that the investigated mathematical models of the squeeze film damper and magnetorheological squeeze film damper allowed computation of the damping and stiffness coefficients. It has been found that the stiffness coefficients computed by the proposed mathematical models may be different.
Parametric oscillations of the mechanical systems
Authors: Ftorek Branislav , Oršanský Pavol , Šamajová Helena
Published: March 2018

This paper deals with an approximative solution in the analytical form of some second order linear differential equation with time depend parameters. The analytic solution is compared with the numerical solution obtained by Runge-Kutta method and the conditions of the convergence of this analytical method are discussed.
Model calculations of posterior reliability indicators for the proposal of the maintenance system
Authors: Galliková Jana , Stuchlý Vladimír , Poprocký Roman , Volna Peter
Published: March 2018

Designing the content and scale of maintenance of machines and equipment by a priori and posterior reliability methods in considered crucial to reducing the cost of the machine's life cycle, maintaining high operational readiness and reducing the consequences of failures. In the presented paper, attention is paid to the analysis of the calculation methods of posterior reliability for calculation indicators of reliability and to the use of the specified Weibull model for reliability calculations. The obtained results are further developed for models of optimal process calculations to perform scheduled maintenance interventions. Calculations of the other RAMS (reliability, availability, maintainability and safety) indicators that are critical to the design of an optimal engineering design with regard to maintenance and which do not receive sufficient attention in technical practice are also assessed.
Load of the slipper-swash plate kinematic pair of an axial piston pump
Authors: Złoto Tadeusz , Kowalski Konrad
Published: March 2018

The paper presents problems related to the twisting moment of the slipper. The load of the slipper and the piston has been presented and the complex formula of twisting moment of the slipper has been established. Achieved results has been presented graphically. The conducted research has indicated that the value of the twisting moment relays on both the exploitation and geometrical parameters.
A genetic algorithm for the steel continuous casting with inter-sequence dependent setups and dedicated machines
Authors: Sbihi Abdelkader , Chemangui Makram
Published: March 2018

The steel continuous casting planning and scheduling problem namely SCC is a particular hybrid (flexible) flowshop that includes stages: (i) the converters (CV), (ii) the refining stands (RS) and (iii) the continuous casting (CC) stages. In this paper we study the SCC with inter-sequence dependent setups and dedicated machines at the last stage. The batch sequences are assumed to be pre-determined for one of the CC devices with a non preemptive scheduling process. The aim is to schedule the batches for each CC machine including the times setup between two successive sequences. We model the problem as a MILP where the objective is to minimize the makespan Cmax that we formulate as the largest completion time taking account of the setup times for each CC. Then, we propose an adapted genetic algorithm that we call Regeneration GA (RGA) to solve the problem. We use a randomly generated instances of several sizes to test the model and for which we do not know an optimal solution. The method is able to solve the problems in an acceptable time for medium and large instances while a commercial solver was able to solve only small size instances.
Synthesis of Cinacalcet Hydrochloride: A Case Study on the Impact of Agitation Speed on the Reaction Kinetics of Schiff’s Base during Scale-up
Authors: Jagtap Kunal , Shinde Gorakshanath , Niphade Navnath , Teldhune Ashish , Toche Raghunath , Mathad Vijayavitthal
Published: March 2018

During the process development of Cinacalcet hydrochloride, a calcimimetic agent, we encountered an unexpected substantial increase in the content of impurities in the product while scaling up the process in the pilot plant. Detailed investigation led to the conclusion that the agitation speed of the reaction mass impacted the reaction kinetics of Schiff’s base, leading to the formation of the impurities and lowering the product yield to ca. 40%. The present work reports details of an investigation carried out to control the formation of impurities to achieve an efficient and one-pot process for Cinacalcet hydrochloride with an overall yield of ca. 70%.
Effects of ligand functionalization on the photocatalytic properties of titanium-based MOF: A density functional theory study
Authors: Li Yi , Fu Yuqing , Ni Bilian , Ding Kaining , Chen Wenkai , Wu Kechen , Huang Xin , Zhang Yongfan
Published: March 2018

The first principle calculations have been performed to investigate the geometries, band structures and optical absorptions of a series of MIL-125 MOFs, in which the 1,4-benzenedicarboxylate (BDC) linkers are modified by different types and amounts of chemical groups, including NH2, OH, and NO2. Our results indicate that new energy bands will appear in the band gap of pristine MIL-125 after introducing new group into BDC linker, but the components of these band gap states and the valence band edge position are sensitive to the type of functional group as well as the corresponding amount. Especially, only the incorporation of amino group can obviously decrease the band gap of MIL-125, and the further reduction of the band gap can be observed if the amount of NH2 is increased. Although MIL-125 functionalized by NH2 group exhibits relatively weak or no activity for the photocatalytic O2 evolution by splitting water, such ligand modification can effectively improve the efficiency in H2 production because now the optical absorption in the visible light region is significantly enhanced. Furthermore, the adsorption of water molecule becomes more favorable after introducing of amino group, which is also beneficial for the water-splitting reaction. The present study can provide theoretical insights to design new photocatalysts based on MIL-125.
The effect of explosive percentage on underwater explosion energy release of hexanitrohexaazaisowurtzitane and octogen based aluminized explosives
Authors: Jiao Qingjie , Wang Qiushi , Nie Jianxin , Guo Xueyong , Zhang Wei , Fan Wenqi
Published: March 2018

To control the explosion energy output by optimizing explosive components is a key requirement in a number of different application areas. The effect of different Al/O Ratio on underwater explosion of aluminized explosives has been studied detailedly. However, the effect of explosive percentage in the same Al/O Ratio is rarely researched, especially for Hexanitrohexaazaisowurtzitane (CL-20) based aluminized explosives. In this study, we performed the underwater explosion experiments with 1.2-kilogram explosives in order to investigate the explosion energy released from CL-20 and Octogen (HMX) based aluminized explosives. The percentage of the explosive varied from 5% to 30% and it is shown that: the shockwave peak pressure (pm) grows gradually; shock wave energy (Es) continues increasing, bubble energy (Eb) increases then decreases peaking at 15% for both formulas, and the total energy (E) and energy release rate (η) peak at 20% for CL-20 and 15% for HMX. This paper outlines the physical mechanism of Eb change under the influence of an aluminium initial reaction temperature and reaction active detonation product percentage coupling. The result shows that CL-20 is superior as a new high explosive and has promising application prospects in the regulation of explosive energy output for underwater explosives.
An inverse design approach finds interactions that drive designer multicomponent self-assembly
Authors: Cockbill Louisa
Published: March 2018

The concept of using inverse design for multicomponent assemblies is demonstrated through the adaptation and extension of a coarse-graining computer simulation technique.
Optimal discrete measures for Riesz potentials
Authors: Borodachov S. , Hardin D. , Reznikov A. , Saff E.
Published: March 2018

For weighted Riesz potentials of the form

K
(
x
,
y
)
=
w
(
x
,
y
)

/

K(x,y)=w(x,y)/

|

x
−
y

|

s

|x-y|^s

, we investigate

N
N

-point configurations

x
1

,

x
2

,
…
,

x
N

x_1,x_2, \ldots , x_N

on a

d
d

-dimensional compact subset

A
A

of

R

p

\mathbb {R}^p

for which the minimum of

∑

j
=
1

N

K
(
x
,

x
j

)

\sum _{j=1}^NK(x,x_j)

on

A
A

is maximal. Such quantities are called

N
N

-point Riesz

s
s

-polarization (or Chebyshev) constants. For

s
⩾
d

s\geqslant d

, we obtain the dominant term as

N
→
∞

N\to \infty

of such constants for a class of

d
d

-rectifiable subsets of

R

p

\mathbb {R}^p

. This class includes compact subsets of

d
d

-dimensional

C
1

C^1

manifolds whose boundary relative to the manifold has

d
d

-dimensional Hausdorff measure zero, as well as finite unions of such sets when their pairwise intersections have measure zero. We also explicitly determine the weak-star limit distribution of asymptotically optimal

N
N

-point configurations for weighted

s
s

-polarization as

N
→
∞

N\to \infty

.
The dynamic Atg13-free conformation of the Atg1 EAT domain is required for phagophore expansion
Authors: Lin Mary G. , Schöneberg Johannes , Davies Christopher W. , Ren Xuefeng , Hurley James H.
Published: March 2018

Yeast macroautophagy begins with the de novo formation of a double-membrane phagophore at the preautophagosomal structure/phagophore assembly site (PAS), followed by its expansion into the autophagosome responsible for cargo engulfment. The kinase Atg1 is recruited to the PAS by Atg13 through interactions between the EAT domain of the former and the tMIM motif of the latter. Mass-spectrometry data have shown that, in the absence of Atg13, the EAT domain structure is strikingly dynamic, but the function of this Atg13-free dynamic state has been unclear. We used structure-based mutational analysis and quantitative and superresolution microscopy to show that Atg1 is present on autophagic puncta at, on average, twice the stoichiometry of Atg13. Moreover, Atg1 colocalizes with the expanding autophagosome in a manner dependent on Atg8 but not Atg13. We used isothermal titration calorimetry and crystal structure information to design an EAT domain mutant allele ATG1DD that selectively perturbs the function of the Atg13-free state. Atg1DD shows reduced PAS formation and does not support phagophore expansion, showing that the EAT domain has an essential function that is separate from its Atg13-dependent role in autophagy initiation.
A biosensor for MAPK-dependent Lin28 signaling
Authors: Oldach Laurel M. , Gorshkov Kirill , Mills William T. , Zhang Jin , Meffert Mollie K.
Published: March 2018

Intracellular levels of the RNA-binding protein and pluripotency factor, Lin28a, are tightly controlled to govern cellular and organismal growth. Lin28a is extensively regulated at the posttranscriptional level, and can undergo mitogen-activated protein kinase (MAPK)–mediated elevation from low basal levels in differentiated cells by phosphorylation-dependent stabilizing interaction with the RNA-silencing factor HIV TAR RNA-binding protein (TRBP). However, molecular and spatiotemporal details of this critical control mechanism remained unknown. In this work, we dissect the interacting regions of Lin28a and TRBP proteins and develop biosensors to visualize this interaction. We identify truncated domains of Lin28a and of TRBP that are sufficient to support coassociation and mutual elevation of protein levels, and a requirement for MAPK-dependent phosphorylation of TRBP at putative Erk-target serine 152, as well as Lin28a serine 200 phosphorylation, in mediating the increase of Lin28a protein by TRBP. The phosphorylation-dependent association of Lin28a and TRBP truncated constructs is leveraged to develop fluorescence resonance energy transfer (FRET)-based sensors for dynamic monitoring of Lin28a and TRBP interaction. We demonstrate the response of bimolecular and unimolecular FRET sensors to growth factor stimulation in living cells, with coimaging of Erk activation to achieve further understanding of the role of MAPK signaling in Lin28a regulation.
CoABind: a novel algorithm for Coenzyme A (CoA)- and CoA derivatives-binding residues prediction
Authors: Meng Qiaozhen , Peng Zhenling , Yang Jianyi
Published: March 2018

Motivation

Coenzyme A (CoA)-protein binding plays an important role in various cellular functions and metabolic pathways. However, no computational methods can be employed for CoA-binding residues prediction.

Results

We developed three methods for the prediction of CoA- and CoA derivatives-binding residues, including an ab initio method SVMpred, a template-based method TemPred and a consensus-based method CoABind. In SVMpred, a comprehensive set of features are designed from two complementary sequence profiles and the predicted secondary structure and solvent accessibility. The engine for classification in SVMpred is selected as the support vector machine. For TemPred, the prediction is transferred from homologous templates in the training set, which are detected by the program HHsearch. The assessment on an independent test set consisting of 73 proteins shows that SVMpred and TemPred achieve Matthews correlation coefficient (MCC) of 0.438 and 0.481, respectively. Analysis on the predictions by SVMpred and TemPred shows that these two methods are complementary to each other. Therefore, we combined them together, forming the third method CoABind, which further improves the MCC to 0.489 on the same set. Experiments demonstrate that the proposed methods significantly outperform the state-of-the-art general-purpose ligand-binding residues prediction algorithm COACH. As the first-of-its-kind method, we anticipate CoABind to be helpful for studying CoA-protein interaction.

Availability and implementation

http://yanglab.nankai.edu.cn/CoABind

Supplementary information

Supplementary data are available at Bioinformatics online.
Loss of Proprietary Interest in an Asset
Authors: Raczynska Magda
Published: March 2018

This chapter examines the circumstances in which title-based interests and security interests are lost in assets in which they were originally held. It first explains how tangible assets subject to proprietary interests may be lost through physical or deemed destruction, as a result of goods becoming a fixture on land, or an accession or a product resulting from a manufacture. It then considers whether the law allows any proprietary protection to a party who loses his/her proprietary interest, with a particular focus on the principle of nemo dat quod non habet (no one can pass a greater interest in property than they have) and the notion of a disposition, including disposition in circumstances triggering possession-based defences. The chapter concludes with a discussion of loss of a proprietary interest through disposition by a third party.
Default Rules in the Absence of an Agreement
Authors: Raczynska Magda
Published: March 2018

This chapter examines the default rules in English law with respect to the extent to which a holder of security interest or a title-based interest can assert a proprietary claim to a new or derived asset in cases where the agreement is silent as to such asset. It asks whether one who holds the proprietary interest in an asset can automatically assert rights in derived assets, particularly proceeds and fruits. The chapter first considers the ‘principle of substitutions and accretions’ in Buhr v Barclays Bank before discussing the question of whether a secured creditor has, by virtue of its interest, an automatic right to accretions, substitutes and fruits. It shows that there is no general principle in English law whereby security interests extend automatically to substitutes. In relation to fruits, the claims of secured creditors or holders of title-based interests depend primarily on their right to possess.
The Law of Private Investment Funds
Authors: Spangler Timothy
Published: March 2018

This book provides a clear and concise dual US/UK and pan-asset analysis on the legal and regulatory issues that arise in connection with private investment funds. The book advises on the structuring, formation, and operation of a range of asset classes, including hedge funds, private equity funds, real estate funds, and other non-retail collective investment vehicles. This edition has been revised to reflect the numerous and significant developments in financial services regulation on both sides of the Atlantic since the publication of the second edition. More elements of the Dodd Frank financial regulatory reforms, which increased the scope and reach of regulation applicable to private funds, have been implemented and commented on in this edition. In relation to European regulation, the impact of the commencement of the Alternative Investment Fund Managers Directive (AIFMD) has also now been analysed. The US/UK approach is maintained, but this edition now also includes consideration of third countries, particularly the Middle East and Asia. An entirely new chapter is dedicated to litigation and regulatory enforcement, and some treatment is given to the effects of the global financial crisis, in particular the regulatory response and the changes to negotiating leverage of fund managers and fund investors. The potential impact of ‘Brexit’ on the United Kingdom private funds industry and the future of the AIMFD and European private funds is also examined.
Governance Issues in Partnerships used as Private Investment Funds
Authors: Spangler Timothy
Published: March 2018

This chapter examines issues of governance arising from partnerships used as private investment funds. A limited partnership has two categories of partner: general partners and limited partners. The chapter first considers the role and duties of general partners and limited partners before discussing the English law vs Delaware law on limited partnerships, focusing on the advantages and disadvantages of Delaware law. It then looks at the UK legal reform on limited partnership and how the limited partnership agreement can be used to address the governance challenge presented by private investment funds. It also explains the duties of partners with respect to the governance challenge, taking into account the fiduciary duty in Delaware partnerships, the fiduciary duty of the board of directors under Delaware law, the Delaware Court of Chancery’s ruling in USA Cafes, and developments following USA Cafes.
Governance Issues in Offshore Companies Used as Private Investment Funds
Authors: Spangler Timothy
Published: March 2018

This chapter examines issues of governance arising from the use of offshore companies as private investment funds. Funds established in offshore jurisdictions are often structured as limited companies that issue shares to investors. Governance issues can arise in offshore companies when voting rights are separated from economic participation. The chapter first considers the role of the board of directors in private investment funds before discussing taxation issues affecting offshore companies used as private investment funds in the UK and in the United States. It then explains the duties of directors under Cayman Islands law, including fiduciary duty, duty of care, diligence, and skill, and duty of confidentiality. It also describes the composition of the board of directors, its meetings, relationship with the fund manager, and responsibility for approval of fund documentation.
US and EU Regulatory Responses to The Global Financial Crisis
Authors: Spangler Timothy
Published: March 2018

This chapter examines the impact of the 2007–08 global financial crisis on the regulation of private investment funds in the United States and in the European Union. It begins with a review of Dodd-Frank, which can be seen as the U.S. movement towards the international consensus that private fund managers should be directly regulated by the national financial regulator. It then considers Dodd-Frank’s repeal of the so-called ‘private adviser exemption’ previously found in the Investment Advisers Act of 1940, along with its exemption of ‘foreign private advisers’ from registration. It also explains the distinction between ‘US advisers’ and ‘non-US advisers’, Dodd-Frank’s compliance requirements for various types of investment advisers, and Rule 204(b)-1, jointly approved by the Securities and Exchange Commission and the Commodity Futures Trading Commission under the Investment Advisers Act. The chapter concludes with an analysis of the Alternative Investment Fund Managers Directive (AIFMD) and future outlook for Dodd-Frank.
Regional peacekeeping and enforcement action
Authors: Gray Christine
Published: March 2018

This final chapter examines the role of regional peacekeeping, the limitations on what may be expected from it, and the uncertainties about the applicable law that remained at the end of the Cold War. The UN Secretary General, in his 1991 Agenda for Peace, argued that the regional organizations possessed a potential that should be used for preventive diplomacy, peacekeeping, peacemaking, and post-conflict peace building. Since then the UN has increased its cooperation with regional organizations in the sphere of peacekeeping. The Brahimi Report and the 2015 High-level Panel Report made recommendations on the division of labour between the UN and regional organizations in the light of their comparative advantages. Today, regional organizations, and particularly the African Union, operate as ‘first responders’ when the UN is not willing or able to take swift action in situations of ongoing conflict.
Structural changes in the hot Algol OGLE-LMC-DPV-097 and its disc related to its long cycle
Authors: Garcés L J , Mennickent R E , Djurašević G , Poleski R , Soszyński I
Published: March 2018

Double Periodic Variables (DPVs) are hot Algols showing a long photometric cycle of uncertain origin. We report the discovery of changes in the orbital light curve of OGLE-LMC-DPV-097 which depend on the phase of its long photometric cycle. During the ascending branch of the long cycle the brightness at the first quadrature is larger than during the second quadrature, during the maximum of the long cycle the brightness is basically the same at both quadratures, during the descending branch the brightness at the second quadrature is larger than during the first quadrature, and during the minimum of the long cycle the secondary minimum disappears. We model the light curve at different phases of the long cycle and find that the data are consistent with changes in the properties of the accretion disc and two disc spots. The disc’s size and temperature change with the long-cycle period. We find a smaller and hotter disc at minimum, and larger and cooler disc at maximum. The spot temperatures, locations, and angular sizes also show variability during the long cycle.
Degree of Housing Instability Shows Independent “Dose-Response” With Virologic Suppression Rates Among People Living With Human Immunodeficiency Virus
Authors: Clemenzi-Allen Angelo , Geng Elvin , Christopoulos Katerina , Hammer Hali , Buchbinder Susan , Havlir Diane , Gandhi Monica
Published: March 2018

Housing instability negatively impacts outcomes in people living with human immunodeficiency virus (PLHIV), yet the effect of diverse living arrangements has not previously been evaluated. Using 6 dwelling types to measure housing status, we found a strong inverse association between housing instability and viral suppression across a spectrum of unstable housing arrangements.
Rapid Detection of Ustilaginoidea virens from Rice using Loop-Mediated Isothermal Amplification Assay
Authors: Yang Xue , Al-Attala Mohamed N. , Zhang Yong , Zhang Ai-Fang , Zang Hao-Yu , Gu Chun-Yan , Gao Tong-Chun , Chen Yu , Al-Attala Mohamed N. , Ali Farman , Li Yun-Fei , Yao Jian , Zhu Jin-Guo
Published: March 2018

Ustilaginoidea virens is an important fungus that causes rice false smut disease. This disease significantly reduces both grain yield and quality. Various methods have been developed for the detection of U. virens but most of these methods need sophisticated equipment such as a thermal cycler. Here, we present a loop-mediated isothermal amplification (LAMP) assay for the specific detection of U. virens. This assay used a specific region of the UvG-β1 gene (212-bp region) to design six LAMP primers. The LAMP assay was optimized by the combination of rapidity, simplicity, and high sensitivity for the detection of about 1 pg of target genomic DNA in the reaction whereas, with polymerase chain reaction (PCR), there was no amplification of DNA with concentrations less than 1 ng. Among the genomic DNA of 22 fungus species and two strains of U. virens, only the tube containing the DNA of U. virens changed to yellowish green with SYBR Green I. The color change was indicative of DNA amplification. No DNA was amplified from either the other 22 fungus species or the negative control. Moreover, 20 spikelets and 22 rice seed samples were used for the detection of rice false smut via LAMP. The results were comparable with conventional PCR. We conclude that gene UvG-β1 coupled with LAMP assay, can be used for the detection and identification of U. virens gene via LAMP.
Repeal and Replace? A Note of Caution for Medical School Curriculum Reformers
Authors: Stevens Carl D.
Published: March 2018

The sudden, dramatic collapse of the seven-year struggle in Congress to repeal and replace the Affordable Care Act holds important lessons for all would-be reformers, including those advocating fundamental changes in medical education. In this Invited Commentary, the author draws parallels between reform initiatives in health policy and those in medical education, highlighting that, in both settings, stakeholders rarely support “repeal” in the absence of a superior replacement, even when they view the status quo as deeply flawed.

For more than three decades, reformers have worked to overhaul the preclerkship medical school curriculum. The author compares two broad categories of these reform initiatives. First, pedagogical reforms largely preserve existing curricular content, instead seeking to maximize active learning principles from educational psychology. By contrast, content reformers attribute the traditional curriculum’s shortcomings mainly to what students are taught, rather than how they learn, and seek to swap out significant portions of the existing basic science curriculum to make room for more clinically relevant material. While pedagogical innovations currently dominate reform efforts, few medical education research studies have rigorously proved the impact of different teaching strategies on the outcome of greatest interest to future patients and the public at large: Do new teaching methods yield better doctors?

The persistent reliance of residency programs on United States Medical Licensing Examination Step 1 scores in the resident selection process constitutes the single greatest barrier to fundamental paradigm shifts in undergraduate medical education. The author concludes by proposing a solution to overcome this barrier.
Hyperinsulinemic Normoglycemia during Cardiac Surgery Reduces a Composite of 30-day Mortality and Serious In-hospital Complications
Authors: Duncan Andra E. , Sessler Daniel I. , Sato Hiroaki , Sato Tamaki , Nakazawa Keisuke , Carvalho George , Hatzakorzian Roupen , Codere-Maruyama Takumi , Abd-Elsayed Alaa , Bose Somnath , Said Tamer , Mendoza-Cuartas Maria , Chowdary Hyndhavi , Mascha Edward J. , Yang Dongsheng , Gillinov A. Marc , Schricker Thomas
Published: March 2018

Background

Hyperinsulinemic normoglycemia augments myocardial glucose uptake and utilization. We tested the hypothesis that hyperinsulinemic normoglycemia reduces 30-day mortality and morbidity after cardiac surgery.

Methods

This dual-center, parallel-group, superiority trial randomized cardiac surgical patients between August 2007 and March 2015 at the Cleveland Clinic, Cleveland, Ohio, and Royal Victoria Hospital, Montreal, Canada, to intraoperative glycemic management with (1) hyperinsulinemic normoglycemia, a fixed high-dose insulin and concomitant variable glucose infusion titrated to glucose concentrations of 80 to 110 mg · dl–1; or (2) standard glycemic management, low-dose insulin infusion targeting glucose greater than 150 mg · dl–1. The primary outcome was a composite of 30-day mortality, mechanical circulatory support, infection, renal or neurologic morbidity. Interim analyses were planned at each 12.5% enrollment of a maximum 2,790 patients.

Results

At the third interim analysis (n = 1,439; hyperinsulinemic normoglycemia, 709, standard glycemic management, 730; 52% of planned maximum), the efficacy boundary was crossed and study stopped per protocol. Time-weighted average glucose concentration (means ± SDs) with hyperinsulinemic normoglycemia was 108 ± 20 versus 150 ± 33 mg · dl–1 with standard glycemic management, P < 0.001. At least one component of the composite outcome occurred in 49 (6.9%) patients receiving hyperinsulinemic normoglycemia versus 82 (11.2%) receiving standard glucose management (P < efficacy boundary 0.0085); estimated relative risk (95% interim-adjusted CI) 0.62 (0.39 to 0.97), P = 0.0043. There was a treatment-by-site interaction (P = 0.063); relative risk for the composite outcome was 0.49 (0.26 to 0.91, P = 0.0007, n = 921) at Royal Victoria Hospital, but 0.96 (0.41 to 2.24, P = 0.89, n = 518) at the Cleveland Clinic. Severe hypoglycemia (less than 40 mg · dl–1) occurred in 6 (0.9%) patients.

Conclusions

Intraoperative hyperinsulinemic normoglycemia reduced mortality and morbidity after cardiac surgery. Providing exogenous glucose while targeting normoglycemia may be preferable to simply normalizing glucose concentrations.
Morphology and Clinical Relevance of Vertebral Endplate Changes Following Limited Lumbar Discectomy With or Without Bone-anchored Annular Closure
Authors: Kuršumović Adisa , Kienzler Jenny C. , Bouma Gerrit J. , Bostelmann Richard , Heggeness Michael , Thomé Claudius , Miller Larry E. , Barth Martin
Published: March 2018

Study Design.

Post hoc analysis of a randomized controlled trial.

Objective.

To characterize the morphology and clinical relevance of vertebral endplate changes (VEPC) following limited lumbar discectomy with or without implantation of a bone-anchored annular closure device (ACD).

Summary of Background Data.

Implantation of an ACD following limited lumbar discectomy has shown promise in reducing the risk of recurrent herniation in patients with large annular defects. However, the interaction between the ACD and the lumbar endplate over time is not well understood.

Methods.

Patients undergoing limited lumbar discectomy with large postsurgical annular defects were randomized intraoperatively to receive additional ACD implantation or limited lumbar discectomy only (Controls). VEPC morphology, area, and volume were assessed with low-dose computed tomography preoperatively and at 1 and 2 years follow-up.

Results.

Of 554 randomized patients, the as-treated population consisted of 550 patients (267 ACD, 283 Controls). VEPC were preoperatively identified in 18% of patients in the ACD group and in 15% of Controls. At 2 years, VEPC frequency increased to 85% with ACD and 33% in Controls. Device- or procedure-related serious adverse event (8% vs. 17%, P = 0.001) and secondary surgical intervention (5% vs. 13%, P < 0.001) favored the ACD group over Controls. In the ACD group, clinical outcomes were comparable in patients with and without VEPC at 2 years follow-up. In the Control group, patients with VEPC at 2 years had higher risk of symptomatic reherniation versus patients without VEPC (35% vs. 19%, P < 0.01)

Conclusion.

In patients with large annular defects following limited lumbar discectomy, additional implantation with a bone-anchored ACD reduces risk of postoperative complications despite a greater frequency of VEPC. VEPC were associated with higher risk of symptomatic reherniation in patients treated with limited lumbar discectomy, but not in those who received additional ACD implantation.

Level of Evidence: 2
Update on Predicting Fracture Risk: What’s New, What’s Old, What’s Accurate
Authors: Damron Timothy A.
Published: March 2018

Until recently, there had been few advances in the science of predicting fracture risk in the setting of metastatic cancer from the early days of orthopedic oncology. Numerous rules based on clinical and plain film radiographic criteria evolved into Mirels scoring and Carnesale’s “conventional” definition, as well as its variation, the L-cort >30 mm rule, and then nothing new appeared for many years. Within the last few years, however, much has been published regarding CT-based techniques, particularly CT-based structural rigidity analysis (CTRA). Other techniques such as finite element modeling (FEM) and fludeoxyglucose positron emission tomography/computerized tomography (FDG PET/CT) continue to evolve. In addition, techniques that combine imaging with demographic and oncologic characteristics, similar to what has been done to predict fractures in osteoporosis using the World Health Organization’s (WHO) Fracture Risk Assessment Tool (FRAX), merit consideration. At this point, albeit improved from 30 years ago, precise, practical, and widely available prediction of impending fractures in patients with metastatic lesions remains elusive and warrants further prospective evaluation. In addition, although it would seem intuitively obvious that preventing a pathologic fracture is important, literature supporting this is lacking, and evaluation of the clinical and financial benefit of such preventative testing requires more investigation.
Characteristics of Treatment Decisions to Address Challenging Behaviors in Children with Autism Spectrum Disorder
Authors: Anixt Julia S. , Meinzen-Derr Jareen , Estridge Halley , Smith Laura , Brinkman William B.
Published: March 2018

Objective:

To describe the characteristics of treatment decisions to address challenging behaviors in children with autism spectrum disorder (ASD).

Methods:

Parents of children aged 4 to 15 years with ASD seen in a developmental behavioral pediatric (DBP) clinic completed validated measures to characterize their child's behaviors and their own level of stress. Parents reported their treatment priority before the visit. During the visit, we assessed shared decision making (SDM) using the Observing Patient Involvement (OPTION) scale and alignment of the clinician's treatment plan with the parent's priority. Before and after the visit, parents rated their uncertainty about the treatment plan using the Decisional Conflict Scale (DCS). We calculated descriptive statistics for the measures.

Results:

Fifty-four families participated. Children were a mean (SD) age of 8.8 (3.3) years, and 87% were male. Children had a variety of behavioral challenges, and parents reported high levels of stress. Commonly reported parent treatment priorities were hyperactivity, tantrums, anxiety, and poor social skills. Levels of SDM were low, with a mean (SD) OPTION score of 24.5 (9.7). Parent priorities were addressed in 65% of treatment plans. Approximately 69% of parents had elevated DCS scores before the visit. Although levels of decisional conflict were lower after the visit compared with before the visit (p < 0.03), 46% of parents continued to report high scores on the DCS.

Conclusion:

Parents leave DBP visits with feelings of uncertainty about treatment decisions and with treatment plans that do not always address their priorities. SDM interventions hold promise to improve the quality of ASD treatment decisions.
Staged Prosthetic Reconstruction with Fat Grafting for Severe Depressive Breast Deformation after Breast-conserving Therapy
Authors: Fujiwara Takashi , Yano Kenji , Tanji Yoshio , Nomura Masaya
Published: March 2018

Breast-conserving therapy, where radiotherapy is performed after partial mastectomy, is a widely used surgical method that can preserve most of the breast tissue without increasing the recurrence rate of breast cancer. However, without reconstruction, asymmetry of the breast occurs due to the tissue defect and radiation fibrosis, producing in poor cosmetic results. In this case study, we performed staged prosthetic breast reconstruction combined with fat grafting for severe depressive deformation of the breast after breast-conserving therapy. The first surgery involved insertion of a tissue expander and fat grafting, second surgery was the reduction of injected saline volume and fat grafting, and third surgery involved exchange for an implant and fat grafting. The skin in the depressed area, which had atrophied, became soft and flexible; deformation was also improved, and the patient was satisfied with the aesthetic outcome. It is expected that fat grafting will fertilize and qualitatively improve the damaged tissue due to irradiation, reducing the complications related to the tissue expander and implant. We believe that it will be possible to correct a breast deformity after breast-conserving therapy using a tissue expander and implant, which had not been considered as a solution. The results showed that the present method can be an option for delayed reconstruction after breast-conserving therapy.
Prevention and Management of Stroke in Obstetrics and Gynecology
Authors: BARGHOUTHI TAMARA , BUSHNELL CHERYL
Published: March 2018

Stroke risk is 3 times higher in pregnancy than in the general young adult population and carries high morbidity and mortality risks. The recognition of signs and symptoms of stroke and other serious cerebrovascular disorders in pregnant and postpartum patients is important for the obstetrician to be able to initiate urgent evaluation and management. The objective of this review is to provide an evidence-based summary of stroke incidence, risk factors, prevention, and treatment of stroke in pregnancy. The impact of postpartum contraceptive use can on stroke risk is summarized.
Short article: Switching to a infliximab biosimilar: short-term results of clinical monitoring in patients with inflammatory bowel disease
Authors: Binkhorst Lisette , Sobels Annemieke , Stuyt Rogier , Westerman Elsbeth M. , West Rachel L.
Published: March 2018

Objective

Currently, a biosimilar of Remicade is available (CT-P13). Switching patients from Remicade to a biosimilar is still under debate, especially for patients with inflammatory bowel disease (IBD). In a retrospective study, we investigated the feasibility and safety of switching patients with IBD from Remicade to a biosimilar infliximab.

Patients and methods

At two large general hospitals in The Netherlands, adult patients with a diagnosis of Crohn’s disease or ulcerative colitis being treated with Remicade were asked to switch to the biosimilar infliximab (CT-P13). After switching, patients were closely monitored by assessing disease activity and evaluating disease-specific measures (serum C-reactive protein and fecal calprotectin). Adverse effects were recorded and serum infliximab concentrations measured. All parameters were assessed at baseline (t=0) and after two infusions with biosimilar infliximab (±week 16).

Results

Among 197 patients with IBD switched to the biosimilar infliximab (∼77%), and no difference in disease activity was observed. Disease-specific measures did not differ between baseline and after two infusions with the biosimilar. Apart from one infusion-related reaction, no serious or unexpected adverse reactions were reported. Serum trough concentrations did not differ between baseline and after switching [median: 4.1 µg/ml (range: 0.03–22 µg/ml) vs. 4.6 µg/ml (range: 0.03–22 µg/ml); P=0.08, n=98].

Conclusion

These data suggest that switching patients with IBD to the biosimilar infliximab is safe in clinical practice. After the switch, no clinically relevant differences were observed in disease activity, adverse effects, and serum infliximab concentrations.
The Long-Term Clinical Outcome of Posttraumatic Stress Disorder With Impaired Coronary Distensibility
Authors: Ahmadi Naser , Hajsadeghi Fereshteh , Nabavi Volker , Olango Garth , Molla Mohammed , Budoff Matthew , Vaidya Nutan , Quintana Javier , Pynoos Robert , Hauser Peter , Yehuda Rachel
Published: March 2018

Objective

Coronary Distensibility Index (CDI) impairments reflect endothelial-dependent process associated with vulnerable-plaque composition. This study investigated the relation of impaired CDI with posttraumatic stress disorder (PTSD) and their predictive value for major adverse cardiovascular events (MACE).

Methods

This study involved 246 patients (age = 63 [10] years, 12% women) with (n = 50) and without (n = 196) PTSD, who underwent computed tomography angiography to determine coronary artery disease and CDI. Extent of coronary artery disease was defined as normal, nonobstructive (<50% luminal stenosis), and obstructive (>50%). Incidence of MACE, defined as myocardial infarction or cardiovascular death, was documented during a mean follow-up of 50 months. Survival regression was employed to assess the longitudinal association of impaired CDI and PTSD with MACE.

Results

A significant inverse correlation between CDI and Clinical Global Impression Severity scale of PTSD symptoms was noted (r
2 = .81, p = .001). CDI was significantly lower in patients with PTSD (3.3 [0.2]) compared with those without PTSD (4.5 [0.3]), a finding that was more robust in women (p < .05). Covariate-adjusted analyses revealed that the relative risk of MACE was higher in patients with PTSD (hazard ratio [HR] = 1.56, 95% CI = 1.34–3.14) and those with impaired CDI (HR = 1.95, 95% CI = 1.27–3.01, per standard deviation lower CDI value). There was also a significant interaction between PTSD and impaired CDI (HR = 3.24, 95% CI = 2.02–5.53).

Conclusions

Impaired CDI is strongly associated with the severity of PTSD symptoms. Both impaired CDI and PTSD were independently associated with an increased risk of MACE during follow-up, and evidence indicated an interaction between these two factors. These findings highlight the important role of CDI in identifying individuals with PTSD at risk for MACE.
Risk Factors for Transfusions Following Total Joint Arthroplasty in Patients With Rheumatoid Arthritis
Authors: Salt Elizabeth , Wiggins Amanda T. , Rayens Mary Kay , Brown Katelyn , Eckmann Kate , Johannemann Andrew , Wright Raymond D. , Crofford Leslie J.
Published: March 2018

Background/Objective

Despite effective therapies, rheumatoid arthritis (RA) can result in joint destruction requiring total joint arthroplasty to maintain patient function. An estimated 16% to 70% of those undergoing total joint arthroplasty of the hip or knee will receive a blood transfusion. Few studies have described risk factors for blood transfusion following total joint arthroplasty in patients with RA. The aim of this study was to identify demographic and clinical risk factors associated with receiving a blood transfusion following total joint arthroplasty among patients with RA.

Methods

A retrospective study (n = 3270) was conducted using deidentified patient health claims information from a commercially insured, US data set (2007–2009). Data analysis included descriptive statistics and multivariate logistic regression.

Results

Females were more likely to receive a blood transfusion (odds ratio [OR], 1.48; 95% confidence interval [CI], 1.16–1.87; p = 0.001). When compared with those in the South, patients residing the Midwest were less likely to receive a blood transfusion following total joint arthroplasty (OR, 0.56; 95% CI, 0.44–0.71). Relative to those receiving total knee arthroplasty, patients who underwent total hip arthroplasty were more likely to receive a blood transfusion (OR, 1.39; 95% CI, 1.14–1.70), and patients who underwent a total shoulder arthroplasty were less likely to receive a blood transfusion (OR, 0.14; 95% CI, 0.05–0.38; p < 0.001). Patients with a history of anemia were more likely to receive a blood transfusion compared with those who did not have this diagnosis (OR, 3.30; 95% CI, 2.62–4.14; p < 0.001).

Conclusions

Risk factors for the receipt of blood transfusions among RA patients who have undergone total joint arthroplasty were identified.
Situs Inversus Totalis and Cholangiocarcinoma of the Gallbladder Detected by 18F-FDG PET/CT
Authors: Calabria Ferdinando F. , Leporace Mario , Bagnato Antonio
Published: March 2018

A 72-year-old woman was examined by 18F-FDG PET/CT, showing pathologic tracer uptake in the gallbladder. PET/CT also depicted condition of situs inversus totalis, with dextrocardia, liver on the left side and spleen on the right side of the body. These findings were essential to plan and develop laparoscopic cholecystectomy, which diagnosed cholangiocarcinoma. The recognition of anatomical variants and abnormalities by means of hybrid PET/CT imaging is essential in order to plan the best therapeutic approach.
Adalimumab-Induced Epstein-Barr Virus–Related Lymphoproliferative Disorder on FDG PET/CT
Authors: Ward John , Noy Ariela , Ulaner Gary , Riedl Christopher
Published: March 2018

Adalimumab is a fully human chimeric tumor necrosis factor inhibitor used to treat immune-mediated disorders such as psoriatic arthritis. We present a 51-year-old woman with psoriatic arthritis on methotrexate and infliximab for 12 years. Adalimumab replaced infliximab because of worsening symptoms. Following 3 doses administered 1 week apart, rapidly enlarging cervical lymph nodes developed. Biopsy revealed Epstein-Barr virus–related polymorphic lymphoproliferative disorder. 18F-FDG PET/CT demonstrated widespread hypermetabolic lymphadenopathy; follow-up at 5 weeks off adalimumab revealed almost complete resolution of this adenopathy. This is most consistent with Epstein-Barr virus–related lymphoproliferative disorder secondary to tumor necrosis factor α inhibition.