bluuebunny/crossref_metadata_2025 huggingface dataset:
Asking for it: BDSM sexual practice and the trouble of consent
Authors: Fanghanel Alexandra
Published: March 2019

This article explores issues of consent in the context of BDSM. I argue that consent is a complex expression which must be thought beyond the ‘yes means yes, no means no’ that proliferates mainstream debates around consent education. This article draws on qualitative interview data to examine how BDSM practitioners talk about consent and consent violations. It examines how these discussions about consent within a BDSM context interact with non-BDSM discussions and how they do, or do not, inform each other. Though consent is centralized in BDSM as a practice of community-building, sometimes consent violations are ignored or dismissed because this community-building also relies on neoliberal constructions of the autonomous self and heteronormative accounts of desire to explain them. These findings have serious implications for better understanding not only of consent within this subcultural practice, but how heteronormative values saturate contexts where unequal power relations or hierarchies manifest themselves outside of this. By insisting on this nuanced understanding of sexual consent, this article transforms existing debates about consensual sexual practice by exploring consent as a grey area, and where violations are experienced as abusive and where they are not. It also offers pertinent insights into how mobilizing an ethical consent praxis might better attend to questions of consent.
How to Assess Executive Functions in a Low-Educated and Multicultural Population Using a Switching Verbal Fluency Test (the TFA-93) in Neurodegenerative Diseases?
Authors: Narme Pauline , Maillet Didier , Palisson Juliette , Le Clésiau Hervé , Moroni Christine , Belin Catherine
Published: March 2019

Few neuropsychological tests are available to assess executive dysfunction in low-educated and multicultural populations. To address this issue, the TFA-93, a switching verbal fluency test to assess cognitive flexibility, was administered to 70 healthy controls, 57 patients with a clinical diagnosis of Alzheimer’s disease, and 21 with a clinical diagnosis of a neurodegenerative disease associated with frontal disorders. Most of the participants were low-educated and nonnative French speakers. The TFA-93 comprises 2 categorical fluency tasks (animals and fruits) and a fluency task in which participants have to switch between animals and fruits. Correct responses and errors were collected, and a flexibility index expressed the switching cost. Results showed that correct responses were lower, and the switching cost was greater in both patient groups. In low-educated and multicultural populations, the TFA-93 seems to be a good alternative to assess flexibility compared to the standard neuropsychological tools based on academic abilities.
Novel Use of Capturex Device and Reliant Balloon for Inferior Vena Cava Tumor Thrombectomy: A Case Report and Review of Literature
Authors: Ho Derek , Samarakoon Lasitha , Kai Tan Yih , Kum Steven , Lim Darryl
Published: March 2019

Introduction:

Most common tumor extending into the inferior vena cava (IVC) are renal carcinomas, such extension have been noted in nearly one-fifth of tumors. Tumor thrombectomy improves the prognosis of patients including those with extension of tumor as far as supra hepatic vena cava. In contrast, if radical nephrectomy is performed as the sole procedure, the prognosis is reduced drastically.

Case Presentation:

We present a case of a 42-year-old male who presented to us with renal cell carcinoma with tumor thrombus extending to IVC. We performed a hybrid endovascular and open procedure using novel surgical techniques to obtain proximal vena caval control and to remove the tumor thrombus—Capturex filter which was placed endovascularly 1 cm above the thrombus via the right internal jugular vein and reliant balloon was placed above the capturex below the hepatic veins. At this position, when the reliant balloon was inflated, it acted as a retro hepatic IVC control. Following vascular control, we proceeded to tumor thrombectomy and radical nephrectomy using transperitoneal approach. Patient made an uneventful recovery and was subsequently referred for medical oncology service for consideration of targeted therapy. Detailed description of the procedure is followed by the discussion of the literature.
The Eastern Partnership: Geopolitics and policy inertia
Authors: Crombois Jean
Published: March 2019

On the eve of its tenth anniversary, the EU’s Eastern Partnership seems to be drifting towards placing greater emphasis on differentiation and stabilisation than on reforms. This contrasts with the transformative ambitions displayed by the EU when it launched this new initiative in 2009. These ambitions have produced mixed results and were partly abandoned in the 2015 European Neighbourhood Policy Review. Since then, policy inertia seems to have prevailed. This exposes the EU to the risk that its relations with its eastern partners will become increasingly geopoliticised. This might lead the EU to lower its transformative ambitions even further. And this, in turn, could throw into question a fundamental aspect of its foreign policy identity, the EU’s role as a transformative power. In other words, such a development might not only weaken the EU’s role in its eastern neighbourhood but also undermine the added value of its foreign policy.
Knee Cartilage Defect Characteristics Vary among Symptomatic Recreational and Competitive Scholastic Athletes Eligible for Cartilage Restoration Surgery
Authors: Everhart Joshua S. , Boggs Zak , DiBartola Alex C. , Wright Brennan , Flanigan David C.
Published: March 2019

Objective

To determine whether there are differences by sport or competitive level in symptomatic knee cartilage defects among recreational, high school, or collegiate competitive athletes undergoing initial arthroscopic knee surgery who meet criteria for cartilage restoration surgery.

Design

Three hundred recreational ( n = 172) and high school or collegiate competitive athletes ( n = 128) younger than 40 years and body mass index (BMI) <35 kg/m2 (63% male, mean age 24.3 years, SD 7.1; mean BMI 25.7 kg/m2, SD 3.7) with Outerbridge grade 2 or higher symptomatic cartilage defects who underwent arthroscopic knee surgery were identified. The independent relationship between sporting activity or competitive level and cartilage defect location, size, severity, and symptom chronicity were assessed by multivariate regression analysis.

Results

Full-thickness defects were present in 24% of competitive athletes and 31% of recreational athletes ( P = 0.21). There was a trend toward an independent association with competitive level and high-grade (3 or 4) multicompartment disease (adjusted odds ratio [aOR] 3.99, 95% confidence interval 0.84-18.8; P = 0.08) or isolated anterior compartment defects (aOR 2.00, 95% CI 0.86-4.62, P = 0.10) but not isolated medial or lateral defects. High-grade defect size was similar among recreational and competitive athletes ( P = 0.71). High-grade lateral defect prevalence differed by sport (running 24%, basketball 23%, soccer 18%, football 5%; P = 0.02) but not medial or anterior defect prevalence.

Conclusions

Among recreational and high school or collegiate competitive athletes with symptomatic cartilage defects who meet criteria for cartilage restoration, competitive athletes may have higher risk of high-grade anterior and multicompartment defects but no difference in defect size.
Percutaneous cystolitholapaxy: A safe and effective alternative to open stone surgery for the management of complex bladder stones in patients with no urethral access
Authors: Goldsmith Louise , Neal Naomi , Briggs James , Tapping Charles , Boardman Phil , Turney Ben , Reynard John
Published: March 2019

Objectives:

Bladder stone management in patients with reconstructed bladders drained by Mitrofanoff catheterizable channels, with no urethral access, generates multiple challenges. Trans-Mitrofanoff access limits the size of endoscopic stone fragmenting devices, risking prolonged procedures, incomplete stone clearance and damage to the continent conduit. Access through previous surgical access sites risks bowel injury. This case series reports outcomes in patients undergoing percutaneous cystolitholapaxy (PCCL), using ultrasound-guided access and direct track closure, thereby limiting radiation exposure and avoiding suprapubic catheters (SPCs).

Patients and methods:

Seven PCCL procedures were performed in five patients with closed urethras. Average age 32 years, primary diagnoses: spina bifida, vertebrae, anus, trachea, esophagus, renal (VATER) syndrome, bladder exstrophy and traumatic brain injury. Four used Mitrofanoff stomas and one an SPC. Average largest stone was 18.57 mm (range 10–30 mm). Five procedures were for multiple stones (range 2–30 stones).

Results:

Each PCCL achieved complete stone clearance. Average operative time: 146 min (range 72–250 min). No intraoperative blood loss or bladder perforation. Postoperative median length of stay was 2 days.

Conclusion:

PCCL is a safe, minimally invasive alternative to open surgery for large and multiple bladder stones in individuals with complex lower urinary tract anatomy, specifically reconstructed bladders drained by Mitrofanoff catheterizable channels with no urethral access. Level of evidence: Level 4
Serial stab incision venous drainage technique for simple artery-only fingertip replantation
Authors: Kim Dong Hee , Yang Seongwook , Seo Kyu Bum , Kwak Sang Ho , Rhee Seung Joon , Ahn Tae Young , Lee Sang Hyun
Published: March 2019

Purpose:

Fingertip replantation is a challenging and technically demanding procedure. A variety of venous drainage techniques have been attempted for successful fingertip replantation. We present a new venous drainage technique, known as serial multifocal incision for fingertip replantation.

Methods:

Between 2006 and 2014, we performed 94 fingertip replantations without vein anastomosis. Eighty of the patients were male, and 14 were female, with an overall mean age of 42 years (range: 8–67 years). All patients suffered amputations distal to the distal phalanx joint (Ishikawa subzone I, II, or III). We performed only artery anastomosis. To relieve venous congestion, we incised the fingertip 2–3 mm using a number 11 scalpel blade and allowed the vein to drain naturally. We made small serial incisions every 2–3 days for 1 week.

Results:

The overall success rate for this procedure was 90%, with 85 surviving digits. Two patients with partial necrosis and nine patients with complete loss needed a second operation. Two patients received blood transfusions with an average of 1.5 units, but both had an accompanying injury at another site. No one complained of nail deformity or wound infection.

Conclusions:

Various external bleeding techniques have been reported to yield good results. The serial stab incision venous drainage technique is a modified fish-mouth external bleeding technique that overcomes the disadvantages of published methods. This technique is simple, allows for easy control of venous drainage, and reduces the need for blood transfusions compared to other venous drainage techniques that cause large amounts of bleeding. We propose a new method, the serial stab incision venous drainage technique, which is effective and associated with high rates of survival.
Arthroscopic Bankart repair following traumatic recurrent shoulder dislocation: A prospective review of 30 cases
Authors: Parmar RS , Kapoor Sanjeev , Sharma Bhanu
Published: March 2019

Background:

Literature on outcomes of arthroscopic Bankart repair at the intervening time intervals in traumatic recurrent dislocation of shoulder joint is limited.

Study Design:

Case series.

Subjects and methods:

A prospective review of 30 shoulders, aged 20–40 years with clinically and magnetic resonance imaging established findings that were treated with primary arthroscopic Bankart repair and followed up for a minimum of 2 years. Outcomes were evaluated using Rowe score and University of California at Los Angeles (UCLA) scoring system.

Results:

The mean age was 26.40 years. All patients had definite trauma history. Average number of dislocation was 13.77 + 18.435 (range: 3–100). Time duration from first dislocation to surgery was an average of 4.80 + 3.576 years. The average size of the lesion was approximately 31% of the glenoid circumference. The number of suture anchors used for fixation did not correlate significantly with any of the scores. The mean Rowe and UCLA scores were 94.16 ± 9.7 and 33.83 ± 3.32, respectively, at final follow-up. The average duration of hospital stay was 7 days. Of the 30 patients, 2 (6.66%) had dislocation events post-operatively. Returns to pre-injury level were available for 27 (90%) of 30 patients. Multivariate analysis of independent Variables: age; side and number of dislocations, time to surgery, duration of surgery, size of lesion, number of anchors, and concurrent Hill–Sachs lesion, shown to have no significant relationship to outcomes.

Conclusion:

Arthroscopic Bankart repair is an effective and safe technique for treating anterior glenohumeral instability in patients with recurrent traumatic shoulder dislocation.
Venous thromboembolism after hospital discharge in pelvic and acetabular fracture patients treated operatively
Authors: Dwyer Emma P , Moed Berton R
Published: March 2019

Purpose:

The purposes of this study were to determine the rate of venous thromboembolism (VTE) after discharge from the hospital in patients treated operatively with a pelvic ring or acetabular fracture and to define the main time frame in which VTE occurs within the 90-day period after hospital discharge.

Methods:

California and Florida State Inpatient Databases from 2005 to 2009 were used to identify patients with clinically significant VTEs within 90 days of hospital discharge. ICD-9 diagnosis codes identified patients with a pelvic ring or acetabular fracture and a VTE. Procedure codes distinguished patients having surgical fracture treatment. Deep vein thrombosis (DVT) and pulmonary embolus (PE) were included.

Results:

Overall, 13,589 patients had a pelvic ring or acetabular fracture and operative treatment. One hundred thirteen patients (0.83%) had a VTE within 90 days after hospital discharge: 0.51% had a DVT, 0.21% had a PE, and 0.12% had both. Twenty eight percent of DVTs and 23% of PEs occurred >35 days after discharge, being evenly distributed out to 90 days. Therefore, overall, <0.2% of patients developed a DVT and <0.1% were diagnosed with a PE (<0.01% fatal) >35 days after the index hospitalization.

Conclusions:

A substantial proportion of VTE events occur over 35 days after discharge; however, the overall risk is low with fatal PE being extremely low (<0.01%). Given the diminished VTE risk after 35 days, the decision to further extend antithrombotic drug therapy may be guided by patient-specific factors, such as prolonged immobility.
Secretory status of monoclonal immunoglobulin is related to the outcome of patients with myeloma: a retrospective study
Authors: Qin Xiao-Qi , An Gang , Li Zeng-Jun , Liu Lan-Ting , Xu Yan , Yang Lin-Hua , Ma Yan-Ping , Deng Shu-Hui , Sui Wei-Wei , Qin Yu , Feng Xiao-Yan , Zang Mei-Rong , Yang Wen-Juan , Zhang Yan-Ru , Yi Shu-Hua , Wang Ting-Yu , Lv Rui , Zou De-Hui , Zhao Yao-Zhong , Qiu Lu-Gui
Published: March 2019

The treatment of multiple myeloma (MM) with proteasome inhibitor (PI) bortezomib has significantly improved the survival of patients with MM. The 26S proteasome inhibitor targets the unfolded protein response (UPR) by inhibiting proteasome degradation of ubiquitinated paraprotein, subsequently leading to the lethal accumulation of paraprotein within the endoplasmic reticulum. According to secretory status of monoclonal immunoglobulin, newly diagnosed MM (NDMM) is divided into measurable and unmeasurable disease, which includes oligosecretory, nonsecretory, and nonproducer myeloma. The present study analyzed the clinical characteristics of 822 patients with NDMM who had either measurable or unmeasurable diseases and received bortezomib- or thalidomide-based therapies. Our results showed that the median progression-free survival (PFS) and overall survival (OS) of patients with MM was significantly longer in patients with measurable disease than those in oligosecretory, nonsecretory, and nonproducer MM (PFS: 27, 18, 19, and 2.0 months, respectively [P < .001]; OS: 51, 30, 22, and 2.0 months, respectively [P < .001]). Within the unmeasurable group, patients with nonproducer myeloma showed the shortest PFS and OS. Importantly, compared with thalidomide treatment, bortezomib significantly improved the PFS and OS of patients with MM with measurable disease (PFS: 25 and 33 months [P = .022], respectively; OS: 41 and 58 months [P < .001], respectively), but not those with unmeasurable disease (PFS: 18 and 16 months [P = .617], respectively; OS: 22 and 27 months [P = .743], respectively). Our results indicate that bortezomib-based therapy performed no better than thalidomide-based treatment in patients with unmeasurable MM. The results need to be confirmed in other patient cohorts, preferably in the context of a prospective trial.
Effectiveness of a volunteer befriending programme for patients with schizophrenia: randomised controlled trial
Authors: Priebe Stefan , Chevalier Agnes , Hamborg Thomas , Golden Eoin , King Michael , Pistrang Nancy
Published: March 2019

Background

Befriending by volunteers has the potential to reduce the frequent social isolation of patients with schizophrenia and thus improve health outcomes. However, trial-based evidence for its effectiveness is limited.

Aims

To conduct a randomised controlled trial of befriending for patients with schizophrenia or related disorders.

Method

Patients were randomised to a befriending programme for 1 year or to receive information about social activities only (trial registration: ISRCTN14021839). Outcomes were assessed masked to allocation at the end of the programme; at 12 months and at a 6-month follow-up. The primary outcome was daily time spent in activities (using the Time Use Survey (TUS)) with intention-to-treat analysis.

Results

A total of 124 patients were randomised (63 intervention, 61 active control) and 92 (74%) were followed up at 1 year. In the intervention group, 49 (78%) met a volunteer at least once and 31 (49%) had more than 12 meetings. At 1 year, mean TUS scores were more than three times higher in both groups with no significant difference between them (adjusted difference 8.9, 95% CI −40.7 to 58.5, P = 0.72). There were no significant differences in quality of life, symptoms or self-esteem. However, patients in the intervention group had significantly more social contacts than those in the control group at the end of the 12-month period. This difference held true at the follow-up 6 months later.

Conclusions

Although no difference was found on the primary outcome, the findings suggest that befriending may have a lasting effect on increasing social contacts. It may be used more widely to reduce the social isolation of patients with schizophrenia.
Mitochondrial plasticity in the cerebellum of two anoxia-tolerant sharks: contrasting responses to anoxia/reoxygenation
Authors: Devaux Jules B. L. , Hickey Anthony J. R. , Renshaw Gillian M. C.
Published: March 2019

Exposure to anoxia leads to rapid ATP depletion, alters metabolic pathways and exacerbates succinate accumulation. Upon re-oxygenation, the preferential oxidation of accumulated succinate most often impairs mitochondrial function. Few species can survive prolonged periods of hypoxia and anoxia at tropical temperatures and those that do may rely on mitochondria plasticity in response to disruptions to oxygen availability. Two carpet sharks, the epaulette shark (Hemiscyllium ocellatum; ES) and the grey carpet shark (Chiloscyllium punctatum; GCS) display different adaptive responses to prolonged anoxia: while the ES enters energy conserving metabolic depression, the GCS temporarily elevates its haematocrit prolonging oxygen delivery. High-resolution respirometry was used to investigate mitochondrial function in the cerebellum, a highly metabolically active organ that is oxygen sensitive and vulnerable to injury after anoxia/re-oxygenation (AR).

Succinate was titrated into cerebellar preparations in vitro, with or without pre-exposure to AR, then the activity of mitochondrial complexes was examined. Like most vertebrates, GCS mitochondria significantly increased succinate oxidation rates, with impaired complex I function post-AR. In contrast, ES mitochondria inhibited succinate oxidation rates and both complex I and II capacities were conserved, resulting in preservation of oxidative phosphorylation capacity post-AR.

Divergent mitochondrial plasticity elicited by elevated succinate post A/R parallels the inherently divergent physiological adaptations of these animals to prolonged anoxia, namely the absence (GCS) and presence of metabolic depression (ES). Since anoxia tolerance in these species also occurs at temperatures close to that of humans, examining their mitochondrial responses to AR could provide insights for novel interventions in clinical settings.
Cholesteatoma: multishot echo-planar vs non echo-planar diffusion-weighted MRI for the prediction of middle ear and mastoid cholesteatoma
Authors: Dudau Cristina , Draper Ashleigh , Gkagkanasiou Maria , Charles-Edwards Geoffrey , Pai Irumee , Connor Steve
Published: March 2019

Objective:

We aimed to compare a newer readout-segmented echoplanar imaging (RS-EPI) technique with the established single shot turbo spin echo (SS-TSE) non-EPI diffusion-weighted imaging (DWI) in detecting surgically validated cholesteatoma.

Methods:

We retrospectively reviewed 358 consecutive MRI studies in 285 patients in which both RS-EPI and non-EPI DWI sequences were performed. Each diffusion sequence was reviewed independently and scored negative, indeterminate or positive for cholesteatoma in isolation and after reviewing the T1W sequence. Average artefacts scores were evaluated and the lesion size measured as a distortion indicator. The imaging scores were correlated with surgical validation, clinical and imaging follow-up.

Results:

There were 239 middle ear and central mastoid tract and 34 peripheral mastoid lesions. 102 tympanomastoid operations were performed. The positive predictive value ( PPV), post-operative PPV, primary PPV, negative predictive value were 93%, 95%, 87.5%, 70% for RS-EPI and 92.5%, 93.6%, 90%, 79% for non-EPI DWI. There was good agreement between the two techniques (k = 0.75). Non-EPI DWI is less susceptible to skull base artefacts although the mean cholesteatoma measurement difference was only 0.53 mm.

Conclusion:

RS-EPI has comparable PPV with non-EPI DWI in both primary and post-operative cholesteatoma but slightly lower negative predictive value. When there is a mismatch, non-EPI DWI better predicts the presence of cholesteatoma. There is good agreement between the sequences for cholesteatoma diagnosis. The T1W sequence is very important in downgrading indeterminate DWI signal lesions to a negative score.

Advances in knowledge:

This is, to our knowledge, the first study to compare a multishot EPI DWI technique with the established non- EPI DWI in cholesteatoma diagnosis.
Combination bone marrow imaging using positron emission tomography (PET)-MRI in plasma cell dyscrasias: correlation with prognostic laboratory values and clinicopathological diagnosis
Authors: Tate Courtney J , Mollee Peter N , Miles Kenneth A
Published: March 2019

Objective:

This prospective observational study of positron emission tomography (PET)-MRI findings in 16 consecutive newly diagnosed patients with a plasma cell dyscrasia describes and compares MRI-detected myeloma lesions with18F-fludeoxyglucose PET-avid myeloma lesions, and correlates quantitative imaging findings to a range of biochemical and prognostic parameters.

Methods:

Simultaneously acquired whole body PET and MRI images were evaluated qualitatively for the presence of focal or generalised abnormalities of bone marrow (BM) on either modality. Quantitative analysis comprised mean standardised uptake values (SUVmean) and fractional water content of the BM measured from PET and chemical shift MRI images of the second to fourth lumbar vertebrae.

Results:

Final diagnoses comprised symptomatic myeloma (n = 10), asymptomatic myeloma (n = 4) and monoclonal gammopathy of uncertain significance (n = 2). 8/10 patients with symptomatic myeloma demonstrated BM abnormalities on qualitative assessment of MRI compared to 4/10 on PET. BM SUVmean inversely correlated with serum albumin (r = 0.57, p = 0.017). BM water fraction correlated with trephine cellularity and blood platelet count (r = 0.78, p = 0.00039 and r = 0.61, p = 0.0013 respectively). BM water fraction correlated with SUVmean in patients with low plasma cell burden (r = 0.91, p = 0.0015) but not in patients with high plasma cell burden (r = 0.18, p = 0.61).

Conclusion:

PET-MRI shows promise in both morphological and functional multiparametric quantitative assessment of myeloma.

Advances in knowledge:

For the first time, multiparametric imaging in myeloma has been shown to predict BM abnormalities and correlate with known biochemical prognostic markers, moving PET-MRI beyond simple diagnostic applications into potential prognostic and treatment selection applications.
Biopsy of palliative lesions following radiotherapy
Authors: Fujita Shiro , Masago Katsuhiro , Yatabe Yasushi
Published: March 2019

Objective:

Definite radiotherapy and/or chemoradiotherapy is often conducted for the treatment of non-small cell lung cancer. However, there is a potential concern regarding the mutagenic effects on tumor cells derived from the therapies, and genomic information regarding cancer cells that survived definitive radiotherapy/chemoradiotherapy is lacking. To evaluate the mutagenic effect of radiotherapy/chemoradiotherapy, we compared genomic signatures of recurrent non-small cell lung cancer tissue with those of pre-treatment.

Methods:

We evaluated seven specimens from three patients who developed disease recurrence after definite radiotherapy/chemoradiotherapy, and we ranked the mutations according to the Combined Annotation-Dependent Depletion score.

Results:

Some mutations remained in the post-therapy state, and others, including driver mutations, either newly occurred or disappeared during the course of disease. Of the four specimens obtained in the post-radiation period, 21 variants were detected. Compared with single nucleotide substitution (5, 23.8%), substantial number of deletions (16, 76.2%) was observed in specimens obtained after definite radiotherapy/chemoradiotherapy.

Conclusion:

Radiotherapy/chemoradiotherapy effects on tumor cells have a wide spectrum, and resequencing of a recurrent lesion is always recommended to discuss the best course of therapy for recurrent non-small cell lung cancer after definitive radiotherapy/chemoradiotherapy.

Advances in knowledge:

With regard to cancer cells that survived definitive radiotherapy/chemoradiotherapy, some mutations remained in the post-therapy state, and others, including driver mutations, either newly occurred or disappeared during the course of disease. Compared with single nucleotide substitution, substantial number of deletions was observed in specimens obtained after definite radiotherapy/chemoradiotherapy.
Dosimetric evaluation of the gantry sag effect in clinical SRS plans
Authors: Borzov Egor , Nevelsky Alex , Bar-Deroma Rachel , Orion Itzhak
Published: March 2019

Objectives:

The gantry sag introduces a largely reproducible variation of the radiation field center around the radiation isocenter. The purpose of this work is to assess the change of the dose distribution caused by the gantry sag in clinical stereotactic plans.

Methods:

Brain stereotactic radio surgery treatment plans were evaluated and grouped according to radiation therapy planning technique. Group 1 was planned with volumetric arc therapy technique using coplanar arcs while Group 2—non-coplanar arcs. To simulate the gantry sag effect in the treatment planning system, the original plan segments were divided into four groups according to corresponding gantry angles: upper, lower, left and right quadrants. Then, isocenter of the upper quadrant was shifted towards “Gun”, isocenter of the lower quadrant was shifted towards “Target” and isocenter of the left and right quadrants was left at its original positions. The magnitude of the shift was 0.5, 1 and 1.5 mm in each direction, corresponding to 1, 2 and 3 mm of gantry isocenter diameter. To estimate the changes in dose distribution between the original and modified plans, the following dose–volume metrics were tracked: planning target volume (PTV) coverage (V99;PTV), hotspot dose in PTV (DPTV;0.015cc)), coldspot doses in PTV (DPTV;(V-0.015cc)), conformity and gradient indexes, maximum point doses in organs at risk (OAR, DOAR;0.015cc) and outside PTV (DoutsidePTV;0,015cc). For the second group of patients volume of brain receiving 12 Gy (V12Gy) was analyzed.

Results:

The mean relative change of all metrics was within −2%/+2.5% range for both techniques for isocenter diameter up to 2 mm. Isocenter diameter of 3 mm causes significant changes in V99;PTV,conformity and gradient indexes for coplanar, and additionally in DPTV;(V-0.015cc)for non-coplanar plans. The largest increase of maximum point dose in OAR was 1.1, 2.1 and 3.2% for ±0.5, ±1 and ±1.5 mm shift, respectively.

Conclusion:

The results demonstrate dosimetric effect of gantry sag depending on its value. By itself, the gantry sag effect does not produce clinically perceptible dose changes neither for PTV nor for OARs for shift ranges up to ±1 mm, both for coplanar and non-coplanar delivery techniques. For the larger gantry sag magnitude dosimetric changes can become significant, especially for non-coplanar plans. It indicates that 2 mm diameter tolerance of gantry isocenter postulated in TG-142 is reasonable, as variations in excess of this value start to affect the overall dosimetric and spatial uncertainty.

Advances in knowledge:

Dosimetric evaluation of the gantry sag effect in clinical stereotactic radio surgery plans is presented for the first time.
Clinical features of bone metastasis with extraosseous soft-tissue mass in prostate cancer patients
Authors: Kawaguchi Masaya , Kato Hiroki , Nakano Masahiro , Goshima Satoshi , Matsuo Masayuki
Published: March 2019

Objective:

This study aimed to compare the differences in the clinical features of prostate cancer (PC) bone metastases (PCBMs) with and without extraosseous soft-tissue masses (ESTMs).

Methods:

Among 720 consecutive patients with histopathologically or clinically diagnosed PC, PCBMs were identified in 48 (7%) patients at initial diagnosis before receiving treatment. CT images of PCBMs were assessed and classified into two groups: PCBMs with and without ESTMs. Clinical features of PCBMs with and without ESTMs were compared.

Results:

We found ESTMs in 15 (31%) patients diagnosed with PCBMs, and 33 (69%) patients diagnosed with PCBMs did not have ESTMs. The initial prostate-specific antigen (PSA) levels (median, 1031 vs 247 ng ml−1; p < 0.05) and PSA reduction rates (median, 99.97 vs 99.40 %; p < 0.05) were significantly greater in PCBMs with ESTMs than in PCBMs without ESTMs. No significant differences were observed in terms of age, Gleason sum score, PSA nadir, time from the initiation of therapy to PSA nadir, PSA doubling time, PSA progression-free survival, or overall survival between patients having PCBMs with and without ESTMs.

Conclusion:

Both initial PSA levels and PSA reduction rates were higher in PCBMs with ESTMs than in PCBMs without ESTMs; however, no significant differences were observed in other clinical features.

Advances in knowledge:

ESTMs in patients with PCBMs were not a poor prognostic factor.
Comparison of the McGrath video laryngoscope and macintosh direct laryngoscope in obstetric patients: A randomized controlled trial
Authors: Toker Melike Korkmaz , Altıparmak Basak , Karabay Ayse Gul
Published: March 2019

Objective: In obstetric patients’ airway, guidelines have recommended the availability of advanced airway equipment. Our aim was to compare the larynx visualization provided by the Macintosh direct laryngoscope and McGrath video laryngoscope and the intubation time of patients undergoing cesarean section.

Methods: This study was conducted at a private obstetrics and gynecology hospital during one month between June and July 2018. A hundred patients scheduled for elective cesarean section under general anesthesia were randomized into two different group’s as intubated using either McGrath VL or Macintosh DL. The intubation times, Cormack–Lehane grade, percentage of glottic opening, mean arterial blood pressure, and heart rates before and after intubation were compared among the groups.

Results: The McGrath VL significantly reduced the intubation time compared to the Macintosh DL. In the McGrath VL group, better glottic view set the time of tracheal intubation as assessed using the Cormack-Lehane classification system and POGO scores were recorded. After intubation, hemodynamic parameters were significantly higher in the Macintosh DL group than in the McGrath VL group.

Conclusion: The McGrath VL significantly lowered intubation time relative to the Macintosh DL, which may be a critical finding considering the importance of maintaining the mother’s airway for the health of both mother and baby.

How to cite this:Toker MK, Altıparmak B, Karabay AG. Comparison of the McGrath video laryngoscope and macintosh direct laryngoscope in obstetric patients: A randomized controlled trial. Pak J Med Sci. 2019;35(2):342-347. doi: https://doi.org/10.12669/pjms.35.2.646

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
A comparative study on short-term therapeutic effects of percutaneous transforaminal endoscopic discectomy and microendoscopic discectomy on lumbar disc herniation
Authors: Wang Fei , Guo Dong , Sun Tiansheng , Guan Kai
Published: March 2019

Objective: To find out the short-term effects of percutaneous transforaminal endoscopic discectomy (PTED) and microendoscopic discectomy (MED) on lumbar disc herniation (LDH).

Methods: Ninety LDH patients treated in PLA Army General Hospital from July 2015 to July 2016 were selected and randomly divided into an MED group and a PTED group. Length of incision, amount of intraoperative bleeding, surgical time, number of times using intraoperative fluoroscopy, postoperative bedridden time, hospital stay, together with visual analogue scale (VAS) and Oswestry disability index (ODI) scores before surgery, three days, three months and six months after surgery were analyzed.

Results: As regards the length of surgical incision, amount of bleeding, postoperative bedridden time and hospital stay, the PTED group was significantly superior to the MED group ((P=0.000, 0.000, 0.000, 0.001, respectively)). Compared with the PTED group, the MED group used less fluoroscopy and had shorter surgical time (P=0.001, 0.000, respectively). The postoperative VAS and ODI scores of both groups were significantly improved compared with those before surgery (P<0.000, 0.000, respectively). The short-term postoperative low back pain (LBP) VAS score of PTED group was lower than that of MED group (P=0.001). The two groups had similar leg pain (LP) VAS score three and six months after surgery, postoperative and follow-up LP VAS and ODI scores, and surgical improvement rate (P=0.093, 0.097, respectively).

Conclusion: LDH was effectively treated by both PTED and MED. Compared with MED, PTED had less trauma, less blood loss, and faster recovery after surgery.

How to cite this:Wang F, Guo D, Sun T, Guan K. A comparative study on short-term therapeutic effects of percutaneous transforaminal endoscopic discectomy and microendoscopic discectomy on lumbar disc herniation. Pak J Med Sci. 2019;35(2):426-431.  doi: https://doi.org/10.12669/pjms.35.2.650

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Hydrometeorological support of navigation
Authors: Сухин Михаил , Suhin Mihail , Белокур Геннадий , Belokur Gennadiy , Головко Александр , Golovko Aleksandr
Published: March 2019

Training manual is intended for students studying in the direction of 26.00.00 "Engineering and technology of shipbuilding and water transport", specialty 26.05.05 "Navigation", for the development of knowledge and practical skills in the disciplines of "Hydrometeorological support of navigation" and "Meteorology and Oceanography".
The allowance can also be used for training in matters of seafaring cadets of higher naval schools of navigational and other specialties, whose responsibilities included performing duties|akhtanova officer of the watch to the Navigator.
Autologous bone marrow clot as an alternative to autograft for bone defect healing
Authors: Lim Z. X. H. , Rai B. , Tan T. C. , Ramruttun A. K. , Hui J. H. , Nurcombe V. , Teoh S. H. , Cool S. M.
Published: March 2019

Objectives

Long bone defects often require surgical intervention for functional restoration. The ‘gold standard’ treatment is autologous bone graft (ABG), usually from the patient’s iliac crest. However, autograft is plagued by complications including limited supply, donor site morbidity, and the need for an additional surgery. Thus, alternative therapies are being actively investigated. Autologous bone marrow (BM) is considered as a candidate due to the presence of both endogenous reparative cells and growth factors. We aimed to compare the therapeutic potentials of autologous bone marrow aspirate (BMA) and ABG, which has not previously been done.

Methods

We compared the efficacy of coagulated autologous BMA and ABG for the repair of ulnar defects in New Zealand White rabbits. Segmental defects (14 mm) were filled with autologous clotted BM or morcellized autograft, and healing was assessed four and 12 weeks postoperatively. Harvested ulnas were subjected to radiological, micro-CT, histological, and mechanical analyses.

Results

Comparable results were obtained with autologous BMA clot and ABG, except for the quantification of new bone by micro-CT. Significantly more bone was found in the ABG-treated ulnar defects than in those treated with autologous BMA clot. This is possibly due to the remnants of necrotic autograft fragments that persisted within the healing defects at week 12 post-surgery.

Conclusion

As similar treatment outcomes were achieved by the two strategies, the preferred treatment would be one that is associated with a lower risk of complications. Hence, these results demonstrate that coagulated BMA can be considered as an alternative autogenous therapy for long bone healing. Cite this article: Z. X. H. Lim, B. Rai, T. C. Tan, A. K. Ramruttun, J. H. Hui, V. Nurcombe, S. H. Teoh, S. M. Cool. Autologous bone marrow clot as an alternative to autograft for bone defect healing. Bone Joint Res 2019;8:107–117. DOI: 10.1302/2046-3758.83.BJR-2018-0096.R1.
Pentagamaboronon-0 Fructose Inhibited Migration and Overexpression of Matrix Metalloproteinases 9 on MCF-7/HER2 Breast Cancer Cells
Authors: Hairunisa Indah , Utomo Rohmad Yudi , Ertanto Yogi , Jenie Riris Istighfari , Meiyanto Edy
Published: March 2019

The incidence of Breast Cancer Metastasis (MBC) can be categorized in stage IV as well as being the leading cause of death in cases of breast cancer. MBC prognosis is known to be weak, frequent recurrent, and MBC patients have only a survival rate of about 5 years. One of the proteins that causes breast cancer metastasis is Human Epidermal Growth Factor 2 (HER2). Pentagamaboron-0 (PGB-0), a newly curcumin analogue performed cytotoxic effect on HER2-positive breast cancer cells but it is practically water-insoluble. The aims of this study are to determine anti-metastatic activity of a more soluble form of PGB-0 namely PGB-0 fructose complex (PGB-0-F) toward HER2 positive cancer (MCF-7/HER2) cells. PGB-0-F was obtained from Cancer Chemoprevention Research Centre Faculty of Pharmacy Universitas Gadjah Mada. Based on scratch wound healing assay result, PGB-0-F inhibited cell migration especially in combination with doxorubicin at the concentration 15 μM. Under gelatin zymography assay, PGB-0-F in combination with doxorubicin decreased Matrix Metalloproteinases 9 (MMP-9) expression compare to the doxorubicin. Hence, PGB-0-F has a potency to be developed as anti-metastatic agent on HER2 overexpression breast cancer.Keywords : HER2, MCF-7/HER2, PGB-0-F, Metastasis
EFFECTS OF PROGRESSIVE MUSCLE RELAXATION INTERVENTION WITH MUSIC AND AROMATHERAPY ON DECREASING STRESS LEVEL AMONG TEACHERS
Authors: Dewi Claudia Fariday
Published: March 2019

Introduction: Stress among teachers has a significant relationship with the psychosomatic and depressive symptoms. Community nurses need to make efforts in preventing the adverse effects of stress on teachers. Progressive muscle relaxation with music and aromatherapy is an alternative intervention which can be practiced to reduce the level of stress among teachers. This study aimed to investigate the effects of progressive muscle relaxation which was combined with music and aromatherapy on decreasing the level of stress in teachers.Methods:This study employed a pre-post test quasi-experimental design with a control group. The samples were 46 teachers recruited by purposive sampling and were assigned to the intervention group (n=23) and the control group (n=23). The intervention of progressive muscle relaxation with music and aromatherapy was given to the intervention group for four sessions in four days; each session lasted for 20 minutes. The data were analyzed using the t-test to know the effects of the intervention on decreasing the stress level.Results:The results showed that the average level of stress of the teachers in the intervention group decreased from 50.65 ± 3.761 to 32.78 ± 8.426 after the intervention. Meanwhile, in the control group, the average stress level slightly decreased from 49.87 ± 3.348 to 49.17 ± 4.868. The result of the t-test obtained a p-value of 0.000 (<0.,05), indicating that there were significant differences in the stress levels between the intervention and the control group.Conclusion:Progressive muscle relaxation with music and aromatherapy could reduce the level of stress in school teachers. Based on the findings, it is recommended that the school teachers perform this relaxation therapy to decrease the stress level. The teachers could practice the therapy by the help of training from the community nurses.
Pengujian Pengeringan Garam Briket Skala Laboratorium
Authors: Kiono Berkah Fajar Tamtomo , Sony Severianus
Published: March 2019

Tingginya konsumsi garam beryodium di Indonesia, membuat pemerintah membuat dan mendorong UMKM untuk memproduksi garam beryodium pada jumlah besar. Salah satu provinsi yang mempunyai jumlah UMKM garam yang banyak adalah Provinsi Jawa Tengah. Daerah terbesar produksi garam beryodium adalah Kabupaten Pati. Namun untuk memiliki produktivitas yang tinggi, pabrik garam beryodium yang ada di Pati harus mengganti alat pengeringnya dengan alat pengering yang tepat. Salah satu alat pengering yang harus diganti adalah alat pengering untuk garam briket. Dalam mendesain suatu alat pengering untuk garam briket, perlu dilakukan penelitian mengenai pengeringan garam briket skala laboratorium untuk mengetahui parameter-parameter untuk pengeringan garam. Penelitian ini dilakukan dengan menggunakan oven. Garam dikeringkan dengan menggunakan 1 heater dan 2 heater. Variasi temperatur oven dengan mengubah bukaan damper. Bukaan damper diatur setengah bukaan dan bukaan penuh (WOT/Wide Opening Throttle).  Temperatur oven bervariasi dari 120oC sampai 190oC, sedangkan temperatur garam maksimum adalah 108oC.Titik didih garam sangat tingi yaitu 801,1oC, sedangkan titik didih Yodium adalah 184,4oC. Pengujian ini mendapatkan hasil pengeringan berturut-turut sebagai berikut, dengan suhu udara akhir 120oC membutuhkan waktu pengeringan selama 221 menit, sedangkan untuk suhu 130oC waktu pengeringannya adalah 200 menit, dengan suhu akhir 176oC adalah 55 menit, dan pengeringan dengan suhu akhir 200oC adalah 55 menit. Proses pengeringan optimum garam pada suhu 170-180oC dengan waktu pengeringan 19 menit.
Redesign Portable Resistance Welding dengan Fungsi Brazing dan Soldering Skala Industri Rumahan
Authors: Yurianto Yurianto , Rahman Aulia , S. Frandy Alensius , S. Harun Firman Putra , Munthe Marthin
Published: March 2019

Dalam dunia fabrikasi, las tahanan (resistance welding/ spot welding) dibutuhkan dalam berbagai kegiatan penyambungan plat tipis yang umumnya mahal, sehingga untuk industri skala rumahan harganya tidak terjangkau (mahal). Untuk mendukung kegiatan industri rumahan tersebut perlu las titik skala kecil multi fungsi biaya murah dan compact, ringan dan bersifat portable (bisa dipindah sesuai kebutuhan). Rumusan masalah dalam perencanaan ini adalah “Bagaimana membuat mesin las titik multi fungsi untuk proses brazing dan soldering dengan daya 900 watts yang compact ?. Adapun tujuan dan manfaat perancanan mesin las ini adalah redesign dan memodifikasi model yang lebih compact dari mesin las titik dengan fungsi brazing dan soldering untuk industri rumahan portable, dan mesin ini dirancang mampu menyambung plat baja dengan ketebalan maksimum 1 mm dengan daya maksimum 900 watts. Metode yang digunakan adalah melakukan observasi kebutuhan/ design, perancangan mesin las titik multi fungsi dan menghasilkan produk yang memenuhi kebutuhan perancangan. Hasil perancangan dan modifikasi menunjukkan bentuk mesin yang lebih compact (dibanding hasil sebelumnya), dan mesin memerlukan daya 900 watts dengan pemasangan elektrode dilakukan dengan tangan sehingga mudah difungsikan sebagai soldering dan brazing.
Analisa Parameter Hidrodinamika Remotely Operated Vehicle (ROV) Kelas Obervasi
Authors: Satria Dhimas , Wiryadinata Romi , Caturwati Ni Ketut , Haryadi Haryadi , Rosyadi Imron
Published: March 2019

Remotely Operated Vehicle (ROV) teknologi observasi bawah laut di perairan selat Sunda yang telah dikembangkan memiliki keterbatasan dari segi manuver, yaitu hanya dapat bergerak vertical dengan kedalaman yang terbatas. Penelitian ini bertujuan untuk mendapatkan parameter hidrodinamika yang terbaik, yaitu matriks inersia, matrik coriolis, dan redaman hidrodinamika. Metode penelitian yang digunakan adalah metode fixed mesh, dimana diasumsikan fluida bergerak pada kecepatan dimana ROV bergerak dan model ROV diam (statik). Representasi gerak ROV dengan mengubah kemiringan ROV terhadap arah aliran fluida. Hasil dari penelitian adalah parameter hidrodinamika, yaitu  (matriks inersia benda tega ROV),  (Matriks koefisien untuk benda tega Coriolis),  (inersia hidrodinamika),  (matriks koefisien untuk hidrodinamika dengan Coriolis dan nilai sentripetal) memberikan koefisien inersia badan ROV kerangka rotasi terhadap titik pusat bumi. Sedangkan parameter hidrodinamika yaitu redaman hidrodiniamika menggambarkan gaya redaman hidrodinamika dan momen berkerja terhadap gerak relatif antara badan kendaraan dengan fluida