bluuebunny/crossref_metadata_2025 huggingface dataset:
Extended-Release Mesalamine Granules for Ulcerative Colitis
Authors: Love Bryan L , Miller April D
Published: November 2012

OBJECTIVE:

To evaluate the efficacy and safety of extended-release mesalamine granules in the maintenance of remission in ulcerative colitis (UC).

DATA SOURCES:

Literature was obtained through searches of MEDLINE (1990-June 2012) using the terms mesalamine granules, ulcerative colitis, Apriso, and Salofalk. Bibliographies from retrieved articles were searched for additional citations.

STUDY SELECTION AND DATA EXTRACTION:

All English-language articles reporting on use of extended-release mesalamine granules in humans identified through the search were evaluated and included.

DATA SYNTHESIS:

The preferred initial treatment for induction and maintenance of remission in mild to moderate UC is agents from the 5-aminosalicylate class (balsalazide, mesalamine, olsalazine, sulfasalazine). Mesalamine granules are available as an encapsulated product in the US and as a nonencapsulated formulation in Europe. Data evaluating encapsulated mesalamine granules for induction of remission are lacking; however, the European mesalamine granule formulation has been evaluated for induction of remission. Patients receiving mesalamine granules for induction achieved clinical and endoscopic remission more frequently than those receiving placebo. Two pivotal, randomized, double-blind, placebo-controlled, multicenter studies have evaluated encapsulated mesalamine granules for maintenance in 562 adults in remission from UC. In both studies, the proportion of patients who remained relapse-free at 6 months was higher for those receiving encapsulated mesalamine granules than placebo. Mesalamine granules are well tolerated, with headache, nausea, and upper respiratory infections being the most frequently reported adverse effects.

CONCLUSIONS:

Current evidence supports the use of extended-release mesalamine granules for maintenance of remission in mild to moderate UC. Further studies are necessary to examine the ideal dose and regimen of encapsulated mesalamine granules for induction of remission in UC.
Competitive Effects of Mass Customization
Authors: Loginova Oksana
Published: November 2012

The existing theoretical literature on mass customization maintains that customization reduces product differentiation and intensifies price competition. In contrast, operations management studies argue that customization serves primarily to differentiate a company from its competitors. Interactive involvement of the customer in product design creates an affective relationship with the firm, relaxing price competition. This paper provides a model that incorporates consumer involvement to explain the phenomena described in the operations management literature.Two firms on the Hotelling line compete for a continuum of consumers with heterogeneous brand preferences. An exogenously given fraction of consumers is potentially interested in customization. Consumer benefits from customization are the rewards from a special shopping experience and the value of product customization (a better fitting product); these benefits are higher for consumers located closer to the customizing brand. When a consumer purchases a customized product, he/she incurs waiting costs. Each firm simultaneously decides whether to offer standard products, customized products, or both, and then engage in price competition. I show that customization increases product differentiation, leading to less intense price competition. Depending on the parameter values, in equilibrium either both firms offer customized products, one firm offers customized products and the other standard and customized products, or one firm offers customized products and the other standard products. I perform comparative statics analysis with respect to the fraction of consumers interested in customization, the waiting costs, and the fixed cost of customization.
Heterogeneity in Number and Type of Sexual Contacts in a Gay Urban Cohort
Authors: Romero-Severson Ethan O. , Alam Shah Jamal , Volz Erik M. , Koopman James S.
Published: November 2012

HIV transmission models include heterogeneous individuals with different sexual behaviors including contact rates, mixing patterns, and sexual practices. However, heterogeneity can also exist within individuals over time. In this paper we analyze a two year prospective cohort of 882 gay men with observations at six month intervals focusing on heterogeneity both within and between individuals in sexual contact rates and sexual roles. The total number of sexual contacts made over the course of the study (mean 1.55 per month) are highly variable between individuals (standard deviation 9.82 per month) as expected. At the individual level, contacts were also heterogeneous over time. For a homogeneous count process the variance should scale with the mean; however, at the individual level the variance scaled with the square root of the mean implying the presence of heterogeneity within individuals over time. We also observed a high level of movement between dichotomous sexual roles (insertive/receptive, protected/unprotected, anal/oral, and HIV status of partners). On average periods of exclusively unprotected sexual contacted lasted 16 months. Our results suggest that future HIV models should consider heterogeneities both between and within individuals in sexual contact rates and sexual roles.
Degradation of channelopsin-2 in the absence of retinal and degradation resistance in certain mutants
Authors: Ullrich Sybille , Gueta Ronnie , Nagel Georg
Published: November 2012

Channelrhodopsin-2 is a light-gated cation channel from the green alga Chlamydomonas reinhardtii. It is functional in animal cells and therefore widely used for light-activated depolarization, especially in neurons. To achieve a fully functional protein, the chromophore all-trans-retinal is needed. It has not been investigated whether or not the apoprotein is stable without its cofactor until now. Here we show that channelopsin-2 (Chop2, protein without bound retinal) is much more prone to degradation than channelrhodopsin-2 (protein with retinal). Constructs of Chop2 fused to yellow fluorescent protein (Chop2::YFP) in the absence and presence of retinal confirm this observation by exhibiting strongly differing fluorescence. We present mutants of Chop2 with highly increased stability in the absence of retinal. Substitution of threonine 159 with aromatic amino acids causes enhanced resistance to degradation in the absence of retinal, which is confirmed by fluorescence intensity, the increase in photocurrents on the addition of retinal to previously expressed protein, and Western blot analysis. Exchanging threonine 159 with cysteine, however, increases photocurrents due to better binding of retinal, without obvious stabilization against degradation of the retinal-free opsin. We also show that the light-activated hyperpolarizing chloride pump halorhodopsin from Natronomonas pharaonis (NpHR) is not prone to retinal-dependent degradation.
Assessing rodent community responses in disturbed environments of the Chilean Patagonia
Authors: García Karla P. , Zapata Juan Carlos Ortiz , Aguayo Mauricio , D’Elia Guillermo
Published: November 2012

The effects of a perturbation gradient on a Patagonian rodent community were assessed over the course of a year by comparing the community parameters in natural and different disturbed environments in the central Chilean Patagonia. The studied habitat types were mature forest, second-growth forest, forest plantations, and agricultural grassland. We recorded eight species of sigmodontine rodents (
Polarised bovine endometrial epithelial cells vectorially secrete prostaglandins and chemotactic factors under physiological and pathological conditions
Authors: MacKintosh Siân B , Schuberth Hans-Joachim , Healy Laura L , Sheldon I Martin
Published: November 2012

Epithelial cells of the endometrium secrete prostaglandins to regulate the bovine oestrous cycle and form a functional barrier to microbes. However, bacterial infection of the endometrium commonly causes infertility in dairy cattle by disrupting endometrial physiology. Epithelial cell cultures are used to study the mechanisms of physiology and pathology, but 2D cultures may not reflect the 3D complexity of the epithelium. In this study, a polarised epithelial cell transwell culture was developed, using transepithelial resistance (TER), to monitor epithelial integrity. Polarised epithelial cells were treated with oxytocin and arachidonic acid to test physiological function and with lipopolysaccharide (LPS) to mimic bacterial infection. Supernatants were analysed for prostaglandin E2(PGE), prostaglandin F2α, the chemokine interleukin-8 (IL8) and the ability of supernatants to induce neutrophil migration. Confluent epithelial cells established polarity when TER was >1800 Ωcm2and predominantly released prostaglandins basolaterally. In contrast, IL8 from epithelial cells accumulated apically and the supernatants were highly chemotactic for neutrophils. The striking exception was when the epithelial cells were treated with LPS in the apical or basolateral compartment independently, which led to the release of IL8 towards the treated compartment. Although stromal cells also accumulated PGE and IL8 in response to treatment, co-culture of stromal cells in the well below polarised epithelial cells did not influence cellular responses. In conclusion, polarised endometrial epithelial cells vectorially released prostaglandins and chemokines to reflect their respective mechanistic roles in physiology and pathology.
Cardiovascular Disease in Pregnancy
Authors: Hill Alexandria J. , Pacheco Luis D.
Published: November 2012

Although cardiac lesions in pregnancy are often well tolerated, those that are not warrant a cardiac evaluation as well as careful management in the antepartum and peripartum periods. Congenital heart disease cases comprise the majority of pregnant cardiac patients, and the lesions can require careful monitoring. Women who have valvular disease often tolerate pregnancy well, but there are specific lesions that require close monitoring throughout the pregnancy. Finally, peripartum cardiomyopathy, although rare, is of great concern and must be managed quickly and appropriately. We will review concerns and treatment for pregnant women who have congenital heart disease, valvular lesions, and peripartum cardiomyopathy, as well as provide guidance for drug therapy in the pregnant patient who has cardiac disease.
Complementary and Alternative Medicine Use in a Large Pediatric Autism Sample
Authors: Perrin James M. , Coury Daniel L. , Hyman Susan L. , Cole Lynn , Reynolds Ann M. , Clemons Traci
Published: November 2012

BACKGROUND AND OBJECTIVE

Children and adolescents with autism spectrum disorder (ASD) often use complementary and alternative medicine (CAM), usually along with other medical care. This study aimed to determine associations of ASD diagnostic category, co-existing conditions, and use of medications with use of CAM.

METHODS

We used the Autism Speaks Autism Treatment Network patient registry, which collects information on CAM use, medical conditions, and psychotropic medication at enrollment. CAM was categorized as special diets versus “other” CAM; ASD was defined as autism, pervasive developmental disorder (PDD), or Asperger’s. Gastrointestinal symptoms, seizure disorders, sleep problems, and medication use were determined from parent report. Child Behavior Checklist (CBCL) scores were used to measure behavioral symptoms. Logistic regression was used to determine associations of diagnostic category, other medical conditions, and medication use with CAM treatments, controlling for demographic characteristics.

RESULTS

Of 3413 subjects in the registry as of April 2011, 3173 had complete data on CAM use: 896 (28%) reported any use; 548 (17%), special diets; and 643 (20%), other CAM. Higher rates of CAM use were associated with gastrointestinal symptoms (odds ratio [OR] = 1.88), seizures (OR = 1.58), and CBCL total score >70 (OR = 1.29). Children with PDD (OR = 0.62), Asperger’s (OR = 0.66), or using medications (0.69) had lower rates.

CONCLUSIONS

Children with ASD use more CAM when they have co-existing gastrointestinal symptoms, seizure disorders, and behavior problems. This study suggests the importance of asking about CAM use in children with ASD, especially those with complex symptoms.
Stomatologic complications of eating disorders
Authors: Resch Mária , Nagy Ágnes
Published: November 2012

Since the 1990s numerous international experts have reported about the somatic complications of eating disorders including those having a dental and stomatological nature. Several reports emphasised that deformations in the oral cavity resulting from this grave nutritional disease typical of the young generation could already appear in the early stage and, therefore, dentists are among the first to diagnose them. Dentists are still often unaware of the importance of their role in multidisciplinary treatment. Even if they knew what the disease was about and recognised it on the basis of deformations in the oral cavity in time, their advice that their patients should brush their teeth more often would fail to eliminate the root cause of the problem. Not only the earliest possible treatment of the complications of the bingeing-purging mechanism and the maintenance of oral hygiene are important, but controlling and curing pathological habits with active participation of psychiatrists are also required to ensure full recovery. Due to the multidisciplinary nature of the disease, manifold communication is required. For this reason, publishing the dental ramifications of organic and systemic diseases at dental conferences and in technical journals, as well as providing information about oral complications of eating disorders for general practitioners and specialists are particularly important. Orv. Hetil., 2012, 153, 1779–1786.
A Possible Tracemaker forArthrophycus Alleghaniensis
Authors: McCoy Victoria E. , Strother Paul K. , Briggs Derek E. G.
Published: November 2012

Arthrophycus alleghaniensisis a well-known trace fossil common in the lower Silurian of the Appalachian Basin, eastern U.S.A. Despite the distinctive morphology of this trace, with few exceptions, hypotheses about the nature of the tracemaker have not extended beyond that of a long-bodied, segmented organism. A single organic compression of a long-bodied arthropod discovered in shale interbedded with sandstones containingA. alleghaniensisin the Silurian (Llandovery) Tuscarora Formation at Mann Narrows, Pennsylvania is described. The specimen preserves evidence of two trunk tagmata: an anterior tagma with tergites extending into broad, rectangular pleurae, and a posterior tagma bearing long, curved spines. Head and appendages are not preserved. The new arthropod,Pleuralata spinosan. gen. n. sp., matches the size and general morphology required for anA. alleghaniensistracemaker. Precise systematic affinities of this new arthropod could not be determined. This discovery supports the conclusion that the tracemakers of variousArthrophycusichnospecies are likely poorly preserved, and presently unknown, members of the Ecdysozoa.
An Unusual Occurrence of Bashkirian (Pennsylvanian) Rugose Corals From the Sverdrup Basin, Arctic Canada
Authors: Fedorowski Jerzy , Bamber E. Wayne , Baranova Darya V.
Published: November 2012

The oldest known Carboniferous rugose coral fauna in the Canadian Arctic Islands was collected in the Yelverton Inlet area of northern Ellesmere Island, from Bashkirian carbonates of the lower Nansen and Otto Fiord formations. It includes the generaDibunophyllumThomson and Nicholson,LonsdaleiaMcCoy,PalaeosmiliaMilne-Edwards and Haime andTizraia? Said and Rodríguez. Such a generic assemblage is unknown elsewhere above the Serpukhovian. An upper? Bashkirian specimen ofParaheritschioidesSando, collected above the main fauna, is the oldest known representative of that genus. Faunal comparisons suggest Novaya Zemlya or northern Timan as the most likely source areas for the Yelverton Inlet fauna.
A New Early Danian Gastropod Assemblage From Northern Patagonia, Río Negro Province, Argentina
Authors: del Rio Claudia Julia
Published: November 2012

A new early Danian gastropod assemblage contained in the Roca Formation of Río Negro Province was analyzed. Eleven species are described and illustrated, the new genusRocalariais created, and six new species are recognized:Gyroscala daniana, Heteroterma carmeloi, Microfulgur concheyroae, Sulcobuccinum prominentum, Cidarina lenzaniyeuensis, andRocalaria alani. The present research includes the first mention ofSulcobuccinumd'Orbigny, 1850,PriscoficusConrad, 1866,CavoscalaWhitfield, 1892,MicrofulgurFinlay and Marwick, 1937, andCidarinaDall, 1909, for the Danian of Southern South America; the new record ofAustrophaeraFurque and Camacho, 1949,FusinusRafinesque, 1815 andHeterotermaGabb, 1869 in northern Patagonia; and the oldest Paleogene record for the genusGyroscalade Boury, 1887. The presence of the study assemblage in northern Patagonia indicates a more complex paleobiogeographic pattern for the area than previously thought, as shown by the record of endemic genera, cosmopolitan taxa, elements with Tethyan/ Indo-Pacific affinities, and genera related with “Wangaloan” faunas of the Paleocene of New Zealand.
Ontogeny ofHypselocrinus Hoveyi, Mississippian Cladid Crinoid From Indiana
Authors: Ausich William I. , Wood Troy E.
Published: November 2012

A very early juvenile specimen ofHypselocrinus hoveyiwith arms and partial column attached is utilized to examine the growth in this Mississippian advanced cladid crinoid. The aboral cup height of this specimen is 4 mm. In contrast to results reported in previous studies of crinoids,Hypselocrinus hoveyigrew with a combination of allometric and isometric growth. Different plates of the aboral cup grew with a combination of growth modes, and arms grew with allometric growth or relative change in shape that was not strict allometry.
New Tethyan Apiocrinitidae (Crinoidea, Articulata) From the Jurassic of Israel
Authors: Ausich William I. , Wilson Mark A.
Published: November 2012

A new species ofApiocrinitesis described from the Middle Jurassic (Callovian) Matmor Formation of the Negev, Israel.Apiocrinites negevensisis from the tropical latitudes in the Tethys, in contrast to all other reported species of this genus. With a narrow radial facet and adjacent arms not in lateral contact and large aboral cup plates,A. negevensisis quite unusual for this genus.
A New Primitive Species of the Flat-Headed PeccaryPlatygonus(Tayassuidae, Artiodactyla, Mammalia) From the Late Miocene of the High Plains
Authors: Prothero Donald R. , Grenader Jessica
Published: November 2012

A new species of the Pliocene–Pleistocene flat-headed peccary,Platygonus pollenae, has been recovered latest Hemphillian (latest Miocene) localities from Nebraska, Kansas, Colorado, and Texas. It can be distinguished from other tayassuids by its distally rounded wing-like zygomatic process, and its subzygodont cheek teeth. In contrast to more derived species ofPlatygonus, it is much smaller in size, its molars are relatively more bunodont, the talon and talonid cusps are retained on the premolars of most individuals, and the mandibular symphysis lacks a median keel on the chin. In these characters, it is the earliest and the most primitive species ofPlatygonusknown. It is more primitive than the typical Blancan species, or any of the species from the Pleistocene, and demonstrates the origin of this important Pleistocene mammal in the latest Miocene.
Adaptation to climate change: the coastal zone of Barbados
Authors: Mycoo Michelle , Chadwick Andrew
Published: November 2012

Unsustainable development in the Caribbean has reduced the effectiveness of coastal ecosystems as ecological buffers against climate variability, climate change, extreme weather events, and sea level rise. Using Barbados as a case study, the research conducted first examined ecosystem degradation. Second, an analysis of adaptation options for climate change and rising sea levels was undertaken. Based on the study conducted, conclusions were drawn on the implementation challenges of adaptation measures and approaches, and areas for future research. The research found that hard engineering is highly prioritised because of the vulnerability of settlements, infrastructure, and beaches to erosion. Beach protection in particular receives significant attention because beach tourism is economically significant. Additionally, beach nourishment is popular in alleviating erosion. A major finding is that reactive and standalone protective efforts are less effective, so that hard and soft engineering measures, though economically costly, are combined responses. On the other hand, retreat and relocation are controversial given limited space, and are economically and politically costly.
From the archives – the building of the Tyne piers
Authors: Cooper Nicholas J.
Published: November 2012

This article summarises a paper produced in 1958 by Raymond B. Porter, the then Chairman of the Northern Counties Association of the Institution of Civil Engineers. Porter's paper presented detailed information on the building of the Tyne piers. The relevance of key aspects of his paper to contemporary maritime civil engineers is discussed within this paper.
Non-Peptidic GnRH Receptor Antagonists
Authors: Armer Richard E. , Smelt Kathryn H.
Published: November 2012

Gonadotropin-releasing hormone (GnRH) or luteinizing hormone-releasing hormone (LHRH) is a decapeptide (pGlu-His-Trp-Ser-Tyr-Gly-Leu-Arg-Pro-Gly-NH2) hypothalamic hormone that acts upon 7-trans membrane spanning GnRH receptors in the pituitary. This action leads to the secretion of the gonadotropins, luteinizing hormone (LH) and follicle-stimulating hormone (FSH) that in turn act on the reproductive organs regulating gonadal steroid production, spermatogenesis and follicular development. Peptidic agonists of the GnRH receptor have been known for many years and are currently employed therapeutically in the treatment of prostate and breast tumours, uterine fibroids, precocious puberty, endometriosis, premenstrual syndrome, contraception and infertility. Peptidic antagonists to date have only been employed commercially in the treatment of infertility during assisted reproductive therapy; however, many peptidic antagonists are currently in late stage development for many of the aforementioned indications. Whilst peptidic agonists and antagonists of the GnRH receptor have been discovered and exploited clinically, they are limited to predominantly parenteral administration due to their poor oral bioavaila bility. Recently, several small molecule GnRH antagonist series have been discovered offering the prospect of orally active therapeutics based on GnRH receptor antagonism. This article will review the current medicinal chemistry literature and structure activity relationships known for non-peptidic GnRH receptor antagonists.
Remineralization of Eroded Enamel Lesions by Simulated Saliva In Vitro
Authors: Karlinsey Robert L , Mackey Allen C , Blanken Douglas D , Schwandt Craig S
Published: November 2012

Purpose:

The purpose of this study was to evaluate the effects of two simulated saliva (SS) remineralization solutions comprising different calcium-inorganic phosphate (Ca/Pi) ratios on eroded enamel.

Methods:

3 mm diameter enamel cores were extracted from bovine teeth, mounted in acrylic rods, ground and polished,and initially demineralized with either 0.3% (120 minutes) or 1.0% (30 minutes) citric acid solutions (pH 3.8). Both sets of initially eroded specimens were evaluated for surface microhardness (N=10) and treated with either 0.3 or 1.6 Ca/Pi ratio SS. Groups were first exposed to a seven-day remineralization period and then were cycled in a three-day regimen consisting daily of three rounds of two-hour plus overnight SS treatments and three 10-minute static immersions in demineralization solution. Specimens were assessed using surface microhardness and scanning electron microscopy.

Results:

Initial erosion from 0.3% citric acid led to elliptical-shaped pore openings several microns in length and in depth and contrasted significantly with respect to 1% citric acid. The greatest remineralization was observed from the 0.3 Ca/Pi SS, while the 1.6 Ca/Pi SS produced the least.

Conclusions:

This study demonstrated the nature of remineralization of eroded enamel depends on both initial erosive conditions and the Ca/Pi ratio of simulated saliva.
Ozone and UV254 Radiation for Municipal Wastewater Disinfection
Authors: Blatchley Ernest R. , Weng ShihChi , Afifi Mehrnaz Zare , Chiu Hsiao‐Han , Reichlin Douglas B. , Jousset Stéphane , Erhardt Richard S.
Published: November 2012

Bench‐scale experiments were conducted with municipal wastewater effluent samples to examine the feasibility of combined application of ozone and ultraviolet (UV) radiation for disinfection. Effluent samples displayed rapid initial ozone demand, which promotes ozone transfer but diminishes disinfection efficacy. Ozone doses up to 10 mg/L yielded only trace quantities of residual ozone; despite the fact that initial ozone demand was never exceeded, quantifiable (though variable) inactivation of E. coli was observed, along with modest improvements of UV transmittance. Results from collimated beam experiments demonstrated that compliance with effluent discharge permit limitations could be achieved consistently with a UV254 dose of 12.4 mJ/cm2 at a pre‐ozonation dose of 2 to 3 mg/L. In the absence of pre‐ozonation, consistent compliance was observed at a UV dose of 16.5 mJ/cm2. No evidence of synergism between ozone and UV254 radiation was found in the measured inactivation responses of E. coli.
Fate of Florfenicol in a Simulated Aquatic Ecosystem and Effects on Sediment Microflora
Authors: Sun Yongxue , Dai Zhenqing , Xiong Wenguang , Luo Xuelian , Zou Mengjia
Published: November 2012

ABSTRACT  Four controlled microcosms were prepared, one of which served as control, whereas the other three received treatments of 10, 50, and 150 mg/L of florfenicol, an antibacterial drug developed initially for aquaculture applications. Water and sediment samples were collected according to a pre‐set time schedule to determine its fate in the aquatic environment. The results demonstrated that florfenicol amine was not detectable in any treatment groups. The half‐life of florfenicol in pond water was 30.76, 52.92, and 51.48 hours for the 10, 50, and 150 mg/L treatment groups, respectively; the corresponding half‐lives in sediment were 25.42, 38.40, and 53.59 days. Further, the 50 and 150 mg/L florfenicol treatment groups inhibited alkaline protease activity; however, all treatment groups inhibited sediment microflora structural diversity.
Non-genericity phenomena in ordered Fraïssé classes
Authors: Slutsky Konstantin
Published: November 2012

We show that every two-dimensional class of topological similarity, and hence every diagonal conjugacy class of pairs, is meager in the group of order preserving bijections of the rationale and in the group of automorphisms of the ordered rational Urysohn space.
Ossifying chondrolipoma of the tongue
Authors: Tasic Desanka , Pavlovic Milorad , Stankovic Dragan , Dimov Irena , Stanojevic Goran , Dimov Dragan
Published: November 2012

Introduction. Chondrolipomas and osteolipomas are uncommon variants of
lipomatous tumors. Case report. We presented a 60-year-old woman with
ossifying chondrolipoma of the tongue. Clinical examination revealed a firm
nodular mass, located in the midline of the posterior region on the dorsal
surface of the tongue. Histologically, the lesion was well-delimited showing
areas of mature adipocytes arranged in lobules and separated by fibrous
connective tissue septa, islands of mature cartilaginous tissue and osseous
metaplasia. Trabeculae of lamellar bone within a fibro-fatty background were
visible throughout the tumor. The cartilaginous areas merging centrally with
bone formation and fatty marrow tissue were present, as well as the
hematopoietic elements in the fatty marrow. The bone forming was found to be
through both membranous and enchondral mechanisms. Conclusion. Ossifying
chrondrolipoma with hematopoietic elements is extremely unusual lesion. This
interesting entity should be kept in mind in the differential diagnosis of
lingual lesions.
Application of alternative medicine in gastrointestinal cancer patients
Authors: Nikolic Ivan , Smiljenic Dragana , Kukic Biljana , Bogdanovic Bogdan , Petrovic Tomislav , Ivkovic-Kapicl Tatjana , Kozarski Dejan , Djan Igor
Published: November 2012

Bacground/Aim. Alternative medicine is a set of therapeutic procedures which
are no part of official practice. At present, the use of alternative medicine
among cancer patients is significant and the purpose of this study was to get
more information on the methods and products of alternative medicine. Thus,
the aim of the study was to determine the frequency of the use of alternative
medicine among gastrointestinal cancer patients. Methods. The research was
conducted using an anonymous questionnaire in writing. We included 205
patients with the diagnosis of gastrointestinal malignancy in the study but
the questionnaire was fulfilled by 193 patients and the presented data were
based on their answers. The questions were about the sociodemographic
characteristics of the patients, the reasons for their use of alternative
medicine, and their information sources about alternative medicine. We
divided existing alternative therapies into 6 categories: herbal therapy,
special diets, psychotherapy, body-mind therapy, spiritual therapy, and other
supplements. Results. A total of 48 (24.9%) patients did not use any type of
alternative therapy; 145 (75.1%) patients used at least one product and 124
(64.25%) patients used herbal preparations (beetroot juice was consumed by
110 [56.99%] patients); 136 (70.5%) patients were informed about alternative
therapies by other patients.; 145 (75.1% ) used alternative medicine to
increase the chances for cure; 88 (45.6%) of interviewed patients would like
to participate in future research in this field. Conclusion. The use of
alternative medicine is evidently significant among cancer patients. Further
research should be conducted in order to find out interactions of these
products with other drugs and potential advantages and disadvantages of this
form of treatment.
Hemodynamic stability in total intravenous propofol anesthesia with midazolam coinduction versus general balanced anaesthesia in laparoscopic cholecystectomy
Authors: Surbatovic Maja , Vesic Zoran , Djordjevic Dragan , Radakovic Sonja , Zeba Snjezana , Jovanovic Dusko , Novakovic Marijan
Published: November 2012

Background/Aim. Laparoscopic cholecystectomy can be a greater challenge for
anesthesiologist than for surgeon if the patient is ASA III with concomitant
cardiovascular diseases. The aim of our study was to compare the effect of
total intravenous anesthesia (TIVA - propofol with midazolam) and general
balanced anesthesia (GBA - midazolam, thiopenton, nitrous oxide and O2) on
hemodynamic stability in the ASA III patients who underwent laparoscopic
cholecystectomy. Methods. In our study, 60 patients were randomized into two
groups depending on whether they received TIVA or GBA. Heart rate, systolic,
diastolic and mean arterial pressure were monitored continuously and recorded
in five time intervals. Results. Statistical analysis showed that TIVA with
propofol provides better hemodynamic stability (less than 10% deviation from
basal values for each measured parameter) then GBA group (p < 0.01).
Conclusion. Total intravenous anesthesia with propofol provides better
hemodynamic stability for ASA III patients with concomitant cardiovascular
diseases then GBA.
PTT Functional Recovery in Early Stage II PTTD After Tendon Balancing and Calcaneal Lengthening Osteotomy
Authors: Brilhault Jean , Noël Vincent
Published: November 2012

Background: The decision to offer surgery for Stage II posterior tibial tendon deficiency (PTTD) is a difficult one since orthotic treatment has been documented to be a viable alternative to surgery at this stage. Taking this into consideration we limited our treatment to bony realignment by a lengthening calcaneus Evans osteotomy and tendon balancing. The goal of the study was to clinically evaluate PTT functional recovery with this procedure. Method: The patient population included 17 feet in 13 patients. Inclusion was limited to early Stage II PTTD flatfeet with grossly intact but deficient PTT. Deficiency was assessed by the lack of hindfoot inversion during single heel rise test. The surgical procedure included an Evans calcaneal opening wedge osteotomy with triceps surae and peroneus brevis tendon lengthening. PTT function at follow up was evaluated by an independent examiner. Evaluation was performed at an average of 4 (range, 2 to 6.3) years. Results: One case presented postoperative subtalar pain that required subtalar fusion. Every foot could perform a single heel rise with 13 feet having active inversion of the hindfoot during elevation. Conclusions: The results of this study provide evidence of PTT functional recovery without augmentation in early Stage II. It challenges our understanding of early Stage II PTTD as well as the surgical guidelines recommending PTT augmentation at this specific stage.

Level of Evidence: IV, Retrospective Case Series
Open Ankle Dislocations without Associated Fracture
Authors: Uçar Bekir Yavuz , Necmioglu Serdar , Bulut Mehmet , Azboy Ibrahim , Demirtaş Abdullah
Published: November 2012

Background: This study aimed to clarify the intermediate followup results of reduction without soft tissue repair in open ankle dislocations without fracture. Methods: We retrospectively reviewed cases of open isolated ankle dislocations without associated fracture. Five male patients treated between January 2005 and July 2009 were enrolled in this study. Debridement and reduction with primary wound closure of the skin were performed without suture of the capsule or repair of the ligaments. The outcome was evaluated by the American Orthopaedic Foot & Ankle Society score (AOFAS). The time period for returning to previous level of activity was also recorded. Results: The average age of the patients was 34 (range, 27 to 44) years, and the average followup was 4 (range, 2 to 6) years. The average of the last control AOFAS score was 90 (range, 84 to 98) points. Two ankles were rated as excellent, and the other three were rated as good. Patients returned to their previous levels of physical activity at an average of 9 weeks. Conclusion: Favorable long-term results were obtained for reduction without ligament repair in pure ankle dislocations.

Level of Evidence: IV, Retrospective Case Study
Role of External Prophylactic Support in Restricting Accessory Ankle Motion after Exercise
Authors: Miller Heather , Needle Alan R. , Swanik C. Buz , Gustavsen Geoffrey A. , Kaminski Thomas W.
Published: November 2012

Background: To both prevent and accelerate recovery and return-to-play from ankle sprains, clinicians frequently employ the use of external prophylactic support (EPS), such as taping and bracing, to provide mechanical support to the ankle joint. While common practice clinically, research has been inconclusive in demonstrating the effectiveness of EPS in restricting accessory motion (laxity) throughout activity, as well as its efficacy in restricting laxity in patients with complaints of ankle instability, and patients with a history of ankle sprain. The purpose of this study was to investigate the effectiveness of EPS type (None, Tape, Brace) on ankle laxity before and after exercise in subjects with varying degrees of previous ankle injury. Methods: Ankles from 24 participants (age, 20.6 ± 1.6 years; height, 173.6 ± 8.3 cm; mass, 72.8 ± 12.2 kg) were placed into one of three groups: healthy control (CON), potential coper (COP), and functionally unstable (UNS). Ankle laxity was assessed using an ankle arthrometer at 4 points in time; prior to EPS application, immediately following EPS application, following a 20-minute functional exercise protocol with EPS, and following removal of EPS. Peak ankle anterior displacement (ANT), inversion rotation (INV), and eversion rotation (EVR) were compared between groups and across conditions using a three-way ANOVA. Results: Taping and bracing each decreased laxity from pre-application to pre-exercise and post-exercise. Tape provided greater restriction post-exercise in inversion and eversion rotation. Additionally, the UNS group demonstrated significantly greater anterior displacement post-exercise following removal of the brace compared to other groups. Conclusion: Compared to pre-application and post-removal, EPS significantly decreased ankle laxity before and after physical activity, with taping providing better restriction in inversion and eversion rotation throughout exercise. Clinical Relevance: Following EPS removal, bracing revealed a greater increase in post-exercise laxity in subjects with ankle instability, suggesting tape may be more beneficial for controlling laxity in these patients.
Role of Collateral Ligaments in Metatarsophalangeal Stability: A Cadaver Study
Authors: Barg Alexej , Courville Xan F. , Nickisch Florian , Bachus Kent N. , Saltzman Charles L.
Published: November 2012

Background: Lesser metatarsophalangeal joint (MTPJ) instability is a common complaint. The role each of the collateral structures play in maintaining joint stability is unknown. Methods: Twenty-six fresh-frozen cadaver lesser MTPJ's were tested for instability with the amount of force necessary to translate the joint 3 mm dorsally. Specimens were tested with 1) intact collateral ligaments, 2) transected accessory collateral or proper collateral ligaments (ACL or PCL), 3) repaired ACL or PCL, 4) transected ACL and PCL, 5) repaired ACL and PCL, and 6) transferred interosseous (IO) tendon. Student t-tests were performed to test for statistical significance ( p value less than 0.05). Results: The mean force required for 3 mm of dorsal displacement was 25 ± 13 N (range, 11 to 52 N) in the 26 specimens. Transecting either the ACL alone or the ACL and PCL led to the most instability versus transecting the PCL alone. Repairing both ligaments improved stability. The IO tendon transfer was comparable to the direct repair of the PCL but was inferior to the direct repair of the ACL. Conclusion: Both ACL and PCL have a stabilizing effect on the MTPJ. However, the ACL was more important since primary transection of the ACL led to more instability and additional transection of the PCL in an ACL deficient model did not lead to significantly more instability. Clinical Relevance: Direct repairs of both structures improved the stability of the joint but not back to normal. IO tendon transfer is a possible adjunct to collateral ligament repairs, but in itself is not sufficient to restore stability.
Quantification of Posterior Ankle Exposure through an Achilles Tendon-Splitting versus Posterolateral Approach
Authors: Patzkowski Jeanne C. , Kirk Kevin L. , Orr Justin D. , Waterman Brian R. , Kirby Jess M. , Hsu Joseph R.
Published: November 2012

Background: The optimal surgical exposure to the posterior ankle for trauma and reconstruction is a source of debate. We hypothesized that the Achilles tendon-splitting approach would provide greater exposure to the posterior ankle than the posterolateral approach. Methods: Forty surgical approaches were performed from twenty fresh-frozen cadavers. Achilles tendon-splitting and posterolateral approaches were performed using a randomized crossover design for surgical sequence. Six landmarks (medial malleolus, ankle joint, subtalar joint, incisura fibularis, lateral malleolus and medial gutter) were identified by direct visualization or palpation. A calibrated digital photograph was taken and Image J ( http://rsb.info.nih.gov/ij/ ) was used to calculate the surface area of the distal tibia and talus exposed in neutral and dorsiflexion. Results: Using a posterolateral approach, the average distal tibia exposed was 11.3cm2 in neutral and 10.2 cm2 in dorsiflexion. The average talus exposed was 2.0 cm2 in neutral and 2.4 cm2 in dorsiflexion. Using an Achilles tendon-splitting approach, the average exposed distal tibia was 33% more (15.0 cm2) in neutral and 43% more (14.6 cm2) in dorsiflexion. The average talus exposed was 47% more (3.0 cm2) in neutral and 76% more (4.2 cm2) in dorsiflexion. All increases in exposure were statistically significant. The medial malleolus was visualized in 19 tendon-splitting and six posterolateral approaches. The medial gutter was visualized in 20 tendon-splitting and 13 posterolateral approaches. These differences were statistically significant. All other landmarks could be visualized through both approaches. Conclusion: The Achilles tendon-splitting approach provided significantly greater exposure of the posterior distal tibia and talus compared to the posterolateral approach. Clinical Relevance: Prospective studies will help determine if the tendon-splitting approach is a safe and clinically useful approach for surgeries in which direct access to the entire posterior ankle and subtalar joint are required.
Tendoscopic Resection of Low-lying Muscle Belly of Peroneus Brevis or Quartus
Authors: Lui T.H.
Published: November 2012

Level of Evidence: V, Expert Opinion
University of California, Los Angeles, surgical time-out process: evolution, challenges, and future perspective
Authors: McLaughlin Nancy , Winograd Deborah , Chung Hallie R. , Van de Wiele Barbara , Martin Neil A.
Published: November 2012

Since the development of the WHO Safe Surgery Saves Lives initiative and Surgical Safety Checklist, numerous hospitals across the globe have adopted the use of a surgical checklist. The UCLA Health System developed its first extended Surgical Safety Checklist in 2008. Authors of the present paper describe how the time-out checklist used before skin incision was implemented and how it progressed to its current form. Compliance with the most recent version of the checklist has been closely monitored via documentation and observance audits. In addition, the surgical team's appreciation of the current time-out has been assessed. Cultural, practice, and human resource challenges are discussed, as are potential future avenues for innovations in the emerging field of the surgical checklist in neurosurgery.
Intraoperative neurophysiological monitoring in spine surgery: indications, efficacy, and role of the preoperative checklist
Authors: Lall Rishi R. , Lall Rohan R. , Hauptman Jason S. , Munoz Carlos , Cybulski George R. , Koski Tyler , Ganju Aruna , Fessler Richard G. , Smith Zachary A.
Published: November 2012

Spine surgery carries an inherent risk of damage to critical neural structures. Intraoperative neurophysiological monitoring (IONM) is frequently used to improve the safety of spine surgery by providing real-time assessment of neural structures at risk. Evidence-based guidelines for safe and efficacious use of IONM are lacking and its use is largely driven by surgeon preference and medicolegal issues. Due to this lack of standardization, the preoperative sign-in serves as a critical opportunity for 3-way discussion between the neurosurgeon, anesthesiologist, and neuromonitoring team regarding the necessity for and goals of IONM in the ensuing case. This analysis contains a review of commonly used IONM modalities including somatosensory evoked potentials, motor evoked potentials, spontaneous or free-running electromyography, triggered electromyography, and combined multimodal IONM. For each modality the methodology, interpretation, and reported sensitivity and specificity for neurological injury are addressed. This is followed by a discussion of important IONM-related issues to include in the preoperative checklist, including anesthetic protocol, warning criteria for possible neurological injury, and consideration of what steps to take in response to a positive alarm. The authors conclude with a cost-effectiveness analysis of IONM, and offer recommendations for IONM use during various forms of spine surgery, including both complex spine and minimally invasive procedures, as well as lower-risk spinal operations.
Application of an aviation model of incident reporting and investigation to the neurosurgical scenario: method and preliminary data
Authors: Ferroli Paolo , Caldiroli Dario , Acerbi Francesco , Scholtze Maurizio , Piro Alfonso , Schiariti Marco , Orena Eleonora F. , Castiglione Melina , Broggi Morgan , Perin Alessandro , DiMeco Francesco
Published: November 2012

Object

Incident reporting systems are universally recognized as important tools for quality improvement in all complex adaptive systems, including the operating room. Nevertheless, introducing a safety culture among neurosurgeons is a slow process, and few studies are available in the literature regarding the implementation of an incident reporting system within a neurosurgical department. The authors describe the institution of an aviation model of incident reporting and investigation in neurosurgery, focusing on the method they have used and presenting some preliminary results.

Methods

In 2010, the Inpatient Safety On-Board project was developed through cooperation between a team of human factor and safety specialists with aviation backgrounds (DgSky team) and the general manager of the Fondazione Istituto Neurologico Carlo Besta. In 2011, after specific training in safety culture, the authors implemented an aviation-derived prototype of incident reporting within the Department of Neurosurgery. They then developed an experimental protocol to track, analyze, and categorize any near misses that happened in the operating room. This project officially started in January 2012, when a dedicated team of assessors was established. All members of the neurosurgical department were asked to report near misses on a voluntary, confidential, and protected form (Patient Incident Reporting System form, Besta Safety Management Programme). Reports were entered into an online database and analyzed by a dedicated team of assessors with the help of a facilitator, and an aviation-derived root cause analysis was performed.

Results

Since January 2012, 14 near misses were analyzed and classified. The near-miss contributing factors were mainly related to human factors (9 of 14 cases), technology (1 of 14 cases), organizational factors (3 of 14 cases), or procedural factors (1 of 14 cases).

Conclusions

Implementing an incident reporting system is quite demanding; the process should involve all of the people who work within the environment under study. Persistence and strong commitment are required to enact the culture change essential in shifting from a paradigm of infallible operators to the philosophy of errare humanum est. For this paradigm shift to be successful, contributions from aviation and human factor experts are critical.
Neurosurgical checklists: a review
Authors: Zuckerman Scott L. , Green Cain S. , Carr Kevin R. , Dewan Michael C. , Morone Peter J. , Mocco J
Published: November 2012

Morbidity due to avoidable medical errors is a crippling reality intrinsic to health care. In particular, iatrogenic surgical errors lead to significant morbidity, decreased quality of life, and attendant costs. In recent decades there has been an increased focus on health care quality improvement, with a concomitant focus on mitigating avoidable medical errors. The most notable tool developed to this end is the surgical checklist. Checklists have been implemented in various operating rooms internationally, with overwhelmingly positive results. Comparatively, the field of neurosurgery has only minimally addressed the utility of checklists as a health care improvement measure. Literature on the use of checklists in this field has been sparse. Considering the widespread efficacy of this tool in other fields, the authors seek to raise neurosurgical awareness regarding checklists by reviewing the current literature.