bluuebunny/crossref_metadata_2025 huggingface dataset:
Conceptual tendencies to analyze coal-gas system state under the hydroimpulsive effect
Authors: Sofiiskyi Kostiantyn , Zberovskyi Vasyl , Yalanskyi Anatolii , Yalanskyi Oleksii
Published: October 2019

The paper considers conceptual tendencies concerning the analysis of coal-gas system state within rock mass in front of a mine working stope in the context of hydroimpulsive effect on an outburst-prone coal seam. It has been shown that mining intensification is impossible without the improved efficiency of means indented to avoid gasdynamic phenomena taking into consideration the effect of technogenic factors on operation schedules. It has been determined that since grades of outburst-prone coal are of globular structure, its breakage may involve changes in molecular weight of coal substance and generation of methane and water molecules. In the context of a shear model of undermined rock mass, method of graphical analysis has been applied to determine areas of changes in border angles of demonstration of the initial and maximum deformation under the effect of rock bearing pressure. The determined dependences are described rather reliably by means of similar logarithmic curves which characterizes identity of their nature. Changes in filtration coal characteristics in the context of shear deformations have been considered. It has been proved experimentally that if injection pressure varies, periodically discontinuous fluid flow has initial, stable, and decaying stages being implemented in the forms of cavitation phenomena and high-frequency hydroimpulsive vibration. Sequence of methods to study parameters of hydroimpulsive action, evaluation of its efficiency, and control over a change in coal-gas system state of outburst-prone coal seams have been considered.
Selection of design alternatives in the formation of energy-saving programs at the enterprises of the mining and metallurgical complex of Ukraine
Authors: Trifonov Ivan , Sankov Petrо , Dikariev Kostiantyn , Kapshuk Olha
Published: October 2019

In the article, a method is proposed for making management decisions in the conditions of uncertainty when choosing project alternatives under the energy saving program at an enterprise of the mining and metallurgical complex (MMC) of Ukraine. The purpose of the article is to develop project practice for improving the feasibility of management decisions in the implementation of energy saving programs of the MMC of Ukraine, using the value criteria from the point of view of parties concerned at a ratio of the expected project results and resource constraints. At the same time, there is a need to measure the extent to which a particular project contributes to achieving a program goal. Therefore, the list of value criteria of the project results in the work was turned into an absolute measurement scale; this allowed evaluating each alternative project at the stage of developing a program to minimize the consumption of fuel and energy resources necessary for the production of products (services) of preset quality, with account of the degree of concerned parties’ satisfaction, limitedness of organization resources and risk factors. In the process of research, the following research methods were applied: survey, system analysis, and set theory. Based on the results obtained, it has been revealed that most of the problems in implementing the energy saving strategy are related to payback issues and a decrease in the loss of fuel and energy resources per 1 UAH of finished products. The overall assessment when ranking the goals of the energy saving program ranges from 1.2 to 2.6, which, in turn, is a prerequisite for the use of value-based management in the program formation.
Ecological and economic assessment of investment activities of mining enterprises
Authors: Stovpnyk Stanislav , Tkachuk Kostiantyn , Temchenko Oleksandr
Published: October 2019

The article deals with the problematic issues and features of further development of iron ore deposits at great depths (over 400 m). The necessity of wide application of innovative competitive technologies for ore mining by open method and an increase in the efficiency of mineral processing in the conditions of modern trends of sustainable development is substantiated. To solve this problem, a systematic approach is applied based on the consideration of all technological processes, taking into account the impact of mining operations on the environment as a single organizational and technological complex. It is proposed to use the Neumann-Gale model as an economic and mathematical model for assessing the investment activity of mining enterprises, which takes into account the influence of the environmental factor on the efficiency of their functioning. Approbation of the model was performed at the PJSC “Southern Mining Factory” as an example of production and economic activity. The priority measures are presented for the implementation of ecologically balanced strategies in terms of environmental protection for sustainable development at modern mining enterprises in difficult economic conditions and uncertainty of price characteristics in the markets of iron ore raw materials.
Adaptive control of ore mill charge
Authors: Morkun Natalia , Oliinyk Tetiana , Kasatkina Iryna , Rytsko Oleksandr
Published: October 2019

The system of mining operations does not enable long-lasting mining of single-type ores that causes instability of mineral materials intended for concentration. To solve the problem of controlling these processes on the basis of operating data on characteristics of processed raw materials, the method of controlling mill charge is suggested considering measurements of its output product. This method is based on correlation of the output product quantity and the rate of the mill charge. The process of the object’s operation is modeled, while time characteristics of the output controlled value and the mill charge are approximated to assess accuracy of the method of determining the mill charge. The possibility to use the discrete Kalman filter is studied in order to indentify the object’s characteristics under noises by measurement results. It is shown that application of the Kalman filter to controlling the mill charge enables not only solving the problem of filtration aimed to obtain data on the object’s current state, but also predicting its state.
Ensuring the sustainability of the motorway subgrade in the zones of underground mining operations
Authors: Balashova Yuliia , Demianenko Viktor , Tkach Nataliia , Karasev Hennadii
Published: October 2019

The article describes a variational method for calculating the motorway subgrade stability. The application of this method allows to quickly and accurately determine the most dangerous sliding surface with a minimum coefficient of stability. The purpose of the article is to improve the variational method for calculating the motorway subgrade stability. The article proposes to apply this method in the calculation of the transport earthwork structures, located in the area of mining operations, where there is a danger of failed subsidence. Underground mining operations have a significant impact on the vertical bent curves of a motorway, that leads to the modification of the subgrade geometric dimensions in the negative direction. This is the cause of sharp fluctuations in the values of local curvature and the radii of vertical curves. The use of variational method for calculating the motorway subgrade stability will allow to take into account the velocity of the saturated soil mass movement and the change in the geometric parameters caused by the underground mining operations. The advantages of this method include the possibility to consider the efforts from geosynthetic materials, recommended to use for strengthening the basement and slopes of the subgrade, the rheological properties of the soil, and the load from the vehicle moving along the surface. In the process of research, regulatory documents on the calculation of the stability of road structures reinforced with geosynthetic materials were studied. The identified shortcomings of the existing regulatory documents allowed to conclude that it is necessary to consider the velocity of the saturated soil mass movement caused by the underground mining operations when calculating the stability coefficient of soil structures.
Annual production enhancement at deep mining
Authors: Shvaher Nataliia , Komisarenko Tetiana , Chukharev Serhii , Panova Svitlana
Published: October 2019

The article aims at determining possible annual production considering mining and technical capabilities of the underground mine. Deepening of mining operations at Kryvyi Rih iron ore basin reduces considerably annual production of the useful mineral which results in increased mining costs. To maintain annual production, it is reasonable to build the second stage of opening the depth of which depends on production volumes. When determining the optimal depth of the first stage opening, it is necessary to apply a complex research method including the graphoanalytical one for determining the underground mine’s annual production and the industrial one for adjusting the methods considering technical conditions of the enterprise. It has been determined that annual production is influenced not only by mining and geological but also by mining and technical conditions. It has been proved that annual production of an underground mine decreases in direct proportion to the increased depth of mining. The speed of skips in the shaft is greatly impacted by the length of the main opening and its operating life. With the increase of the shaft operating life the skip speed decreases from 12 to 6 – 8 m/s. When designing the flowchart of further opening of underlying levels, it is necessary to consider both mining capabilities and technical conditions of the shaft and headgear, mining depth and the main opening operating life as well as the strategy of the mining enterprise. Consideration of the above mentioned factors enables maintaining the required annual production when mining iron ores at great depths. Under conditions of Kryvyi Rih iron ore basin, it has been determined reasonable to apply the main vertical shaft flowchart when mining reserves to the depth of 1650 m.
Improvement of open field development technology as a factor in the formation of quality and market value of reclaimed land
Authors: Litvinov Yurii , Terekhov Yevhen , Fenenko Volodymyr
Published: October 2019

An analysis of the results of the reproduction of land in an open development of a horizontal mineral deposit has been carried out. The interconnection of the method and the system of open development of the deposit with the qualitative and quantitative levels of land reclamation, as well as their monetary estimation according to the direction of use, is substantiated. The principle of this approach to the planning of land abandonment measures at a mining enterprise from the point of view of the subordination of the technological processes of mining of minerals to the results of the reproduction of land in previous periods is proposed, which allows to take into account the quality of reproduction of land for determining the extent of their violation. The technological scheme of organization of mining works and land reclamation works is shown, which involves synchronization of these processes in terms of disturbance and reproduction of lands, as well as formation of a more qualitative soil layer due to its selective displacement. The components and peculiarities of the formation of the economic effect are determined from the introduction of dynamic schemes for the development of a quarry field on their relation to the cost of land leakage in the development of horizontal mineral deposits in the stages of the life cycle of a quarry.
Digital survey in studying open pit wall deformations
Authors: Kalinichenko Vsevolod , Dolgikh Oleksandr , Dolgikh Liubov
Published: October 2019

The article highlights the topical problem of increasing efficiency of survey during monitoring of rock and earth surface displacement when studying various kinds of deformations caused by mining. To settle the problem, new methods based on use of new devices, programmes and technologies are applied along with traditional ones. The object of the study is an open-pit slide. As it is dangerous to stay on, remote monitoring methods become the most efficient ones, digital photogrammetric survey being one of them. Digital survey methods are being improved along with development of more sophisticated devices and software. The article deals with the method of open-pit slide monitoring involving digital ground survey with the Canon EOS1200D camera. Camera station reference was performed on the basis of GPS data and marker reference – by intersections.
How Connected Autonomous Vehicles Would Affect Our World? —— A Literature Review on the Impacts of CAV on Road Capacity, Environment and Public Attitude
Authors: Zong Shuya
Published: October 2019

With the rapid development of technology, connected autonomous vehicle (CAV) is getting close to the reality. The application of CAV causes changes to road capacity, gas emission, public attitude and other realms. Lots of efforts have been spent in quantifying the potential changes and this paper is an attempt to review the relevant researches. There will be three sections, presenting review of the impacts on road capacity, environment and public attitude respectively. There is a large amount of papers making models to predict future road capacity with various penetration rate of CAV and they obtain quite different interesting results. To predict the future condition more properly, more stochastic models should be proposed. In terms of influence on environment, it may be hard to conclude whether CAV will exacerbate or relieve global warming by looking at current researches. It would be valuable to conduct a quantitative analysis on this issue. For the public attitude, this paper mainly focus on whether people are willing to use CAV and future efforts that may help with the promotion of CAV.
Study on the Vibration Suppression Method of Urban Railway Vehicles Based on a Composite Dynamic Vibration Absorber
Authors: Sun Qian , Wen Yongpeng , Zou Yu
Published: October 2019

To reduce the bounce and the pitch vibration of carbody, a vertical dynamic model for urban rail vehicles is established to analyze the vibration response of the carbody in the low frequency range. In this paper, different methods of single-degree-of-freedom dynamic vibration absorber to suppress the vibration for carbody are investigated. The limits of single-degree-of-freedom dynamic vibration absorber to the vibration reduction effect of carbody are pointed out. After that, the design of a composite dynamic vibration absorber including a double oscillator structure is introduced. A vibration discreteness index is used to evaluate dynamic vibration absorbers with various designs for the vibration damping performance. Finally, the vibration reduction performance of the composite dynamic vibration absorber is verified by Sperling’s riding index. The results demonstrate that the performance of the single degree of freedom dynamic vibration absorber attached to a carbody may increase the vibration within a partial scope, when the peak frequency of vibration is far away from the design frequency. The installation of the composite dynamic vibration absorber vibration provides gentler running experience for passengers.
Endoscopic full-thickness resection using an endoluminal-suturing device: a proof-of-concept study
Authors: Huberty Vincent , Leclercq Loulia , Hiernaux Martin , Verset Laurine , Sandersen Charlotte , Beyna Thorsten , Neuhaus Horst , Deviere Jacques
Published: October 2019

Background and study aims Endoscopic full-thickness resection (EFTR) is used to achieve R0 resection in difficult situations and as a way to overcome the limitations of endoscopic submucosal dissection. Multiple techniques have been described but adequate tools are still under evaluation. In this study, we evaluated the safety and feasibility of non-exposed endoscopic full-thickness resection using a novel endoscopic suturing device.

Materials and methods Full-thickness resections of gastric predetermined lesions were performed on five pigs using the Endomina platform. After creating virtual lesion > 20 mm, sutures were placed around it using this triangulation platform. After tightening the knots, the bulging lesion, internalized into the gastric lumen, was cut with a needle knife.

Results R0 resections of large lesions (42 to 60 mm) were achieved in all cases. One perforation occurred and prompted us to improve the procedure by shortening the sutures for more maneuverability and reinforcing the suture line before section. Procedure duration dropped by 50 % between the first case and the fourth case. Histological analysis confirmed successful full-thickness resection of all resected specimens.

Conclusion EFTR using this triangulation platform seems feasible for lesions > 20 mm. Additional possible improvements were identified to simplify the procedure before moving to human trials.
Schwere Schocksymptomatik infolge anaphylaktoider Reaktion auf Ticagrelor
Authors: Schittek Gregor A. , Simonis Holger , Fischer Matthias , Soukup Jens
Published: October 2019

Die Kasuistik beschreibt den ersten dokumentierten Fall mit einer klinisch gesicherten schweren Anaphylaxie nach Ticagrelor bei einem 76-jährigen männlichen Patienten mit ST-Hebungs-Myokardinfarkt (STEMI).
Endoscopic clipping prior to GVO vs. GVO in IGV1 bleeding: a multicenter retrospective clinical trial
Authors: Li Huixian , Ye Dong , Li Ping , Kong Derun
Published: October 2019

Background and study aims Bleeding from isolated gastric varices type I (IGV1) is more dangerous and fatal than other types of esophageal variceal hemorrhages. However, optimum treatment for bleeding from IGV1 remains undefined. This retrospective study compared the efficacy of endoscopic clipping prior to N-butyl-2-cyanoacrylate injection (GVO) and only GVO for treatment of IGV1.

Patients and methods Data were collected retrospectively at three medical centers. Ninety-six patients were enrolled between March 2015 and April 2017 and divided into two groups: group I (patients with endoscopic clipping prior to GVO, n = 46) and group II (patients with only GVO, n = 50). Computed tomography angiography (CTA) was performed to evaluate the status of gastrorenal shunts (GRS).

Results GRS was found in 59 of 66 patients (59/66). The groups did not differ in baseline characteristics. Initial hemostasis was successfully achieved in all patients. There was a significant difference in volume of N-butyl-2-cyanoacrylate administered (3.39 ± 1.20 mL in group I versus 2.53 ± 1.05 mL in group II (P = 0.03). Rebleeding occurred in 4.35% of patients in group I and 18.00 % in group II (P = 0.007). Variceal obliteration was achieved in all patients in group I and 72 % in group II (P < 0.001) with only one session. Rate of complications was similar in both the groups with the exception of one patient in group II who developed ectopic cerebral embolism.

Conclusions Endoscopic clipping prior to GVO may be an appropriate alternative to GVO as a treatment modality for IGV1 bleeding.
Role of EUS-FNA for gallbladder mass lesions with biliary obstruction: a large single-center experience
Authors: Singla Vikas , Agarwal Rachit , Anikhindi Shrihari Anil , Puri Pankaj , Kumar Mandhir , Ranjan Piyush , Kumar Ashish , Sharma Praveen , Bansal Naresh , Bakshi Pooja , Verma Kusum , Arora Anil
Published: October 2019

Background and study aims Although endoscopic ultrasound (EUS)-guided fine-needle aspiration (EUS-FNA) is an established modality for pathological sampling of pancreatic and biliary lesions, limited data are available on the diagnostic value of EUS-FNA for evaluation of gallbladder mass lesions, a common cause of obstructive jaundice. We aimed to evaluate the usefulness of EUS-FNA for diagnosis of gallbladder mass lesions presenting with biliary obstruction.

Patients and methods This study was a retrospective analysis of data from patients who had undergone EUS-FNA for gallbladder mass lesions. FNA was performed on either a gallbladder mass, metastatic node or liver lesions. Outcome measures were diagnostic yield of EUS FNA and adverse events.

Results From April 2011 to August 2018, 101 patients with gallbladder mass lesions with biliary obstruction underwent EUS-FNA. The final diagnosis was malignancy in 98, benign disease in one, and two patients were lost to follow-up. EUS-FNA confirmed the diagnosis in 89 of 98 patients with malignancy (sensitivity 90.81 %); was false negative in nine of 98 cases with malignancy; and was truly negative in the solitary patient with benign disease (specificity 100 %). Positive predictive value, negative predictive value (NPV), and accuracy were 100 %, 10 %, and 90.90 %, respectively. Two patients had self-limiting pain.

Conclusion EUS-FNA is a sensitive tool for evaluation of gallbladder mass lesions presenting with obstructive jaundice. However, because of low NPV, lesions in which FNA is negative should be further evaluated.
EUS-guided biliary drainage is equivalent to ERCP for primary treatment of malignant distal biliary obstruction: a systematic review and meta-analysis
Authors: Hathorn Kelly E. , Bazarbashi Ahmad Najdat , Sack Jordan S. , McCarty Thomas R. , Wang Thomas J. , Chan Walter W. , Thompson Christopher C. , Ryou Marvin
Published: October 2019

Background and study aims Although endoscopic retrograde cholangiopancreatography (ERCP) is standard of care for malignant biliary obstruction, endoscopic ultrasound-guided biliary drainage (EUS-BD) as a primary treatment has become increasingly utilized. The aim of this study was to perform a systematic review and meta-analysis to evaluate the effectiveness and safety of EUS-BD for primary treatment of malignant biliary obstruction and comparison to traditional ERCP.

Methods Individualized search strategies were developed through November 2018 using PRISMA and MOOSE guidelines. A cumulative meta-analysis was performed by calculating pooled proportions. Subgroup analysis was performed for studies comparing EUS-BD versus ERCP. Heterogeneity was assessed with Cochran Q test or I
2 statistics, and publication bias by funnel plot and Egger’s tests.

Results Seven studies (n = 193 patients; 57.5 % males) evaluating primary EUS-BD for malignant biliary obstruction were included. Mean age was 67.4 years (2.3) followed an average of 5.4 months (1.0). For primary EUS-BD, pooled technical success, clinical success, and adverse event (AE) rates were 95 % (95 % CI 91 – 98), 97 % (95 % CI 93 – 100), and 19 % (95 % CI 11 – 29), respectively. Among EUS-BD and ERCP comparator studies, technical and clinical success, and total AEs were not different with lower rates of post-ERCP pancreatitis and reintervention among the EUS-BD group.

Conclusion Primary EUS-BD is an effective treatment with few AE. Comparing EUS-BD versus ERCP, EUS-BD has comparable efficacy and improved safety as a primary treatment for malignant biliary obstruction. Further randomized trials should be performed to identify patient populations and clinical scenarios in which primary EUS-BD would be most appropriate.
IMPlementing split Regimen OVEr Single dose using a Plan-Do-Study-Act approach (IMPROVES study)
Authors: Vanella Giuseppe , Hassan Cesare , De Bellis Mario , Giardini Maxemiliano , Grasso Enrico , Laterza Francesco , Tarantino Ottaviano , Di Giulio Emilio
Published: October 2019

Background and aims A split-dose regimen for colonoscopy is recommended by international guidelines, but its adoption is still suboptimal. Our aim was to assess whether a Plan-Do-Study-Act approach (PDSA), a scientific method promoting quality improvement, would be able to improve adherence to a split-dose regimen, and to identify factors influencing its adoption.

Methods This study consisted of three phases: Cycle 1: a cross-sectional assessment of split-dose adherence in consecutive outpatients/inpatients undergoing colonoscopies in 74 Italian centers; Educational intervention: regional meetings with literature review, analysis of Cycle 1 data, and discussion on corrective measures; local diffusion of educational material and tools for improvement; Cycle 2: reassessment of split-dose adherence after spontaneous local interventions. Demographic, clinical, and procedural variables were systematically collected. Multivariate logistic regression was used to identify predictors of split-dose adoption.

Results In total, 8213 patients (mean age = 60.29 years (SD = 13.58), men = 54 %, outpatients = 88.4 %) were enrolled between 2013 and 2016 (Cycle 1 = 4189 patients and Cycle 2 = 4024 patients). Split-dose adoption rose from 29.1 % in Cycle 1 to 51.1 % in Cycle 2 (P < 0.0001), and being enrolled in Cycle 2 independently predicted split-dose adherence (OR = 2.9; 95 %CI 2.6 – 3.3). The adoption improved in all time slots, including colonoscopies scheduled before 0930. The main corrective measures were: rescheduling of colonoscopies after 0930 (between 0930 and 1130: OR = 2.6; 95 %CI 2.3 – 3.1; after 1130: OR = 7; 95 %CI 5.9 – 8.4); the cleansing regimen communicated by the Endoscopy unit (via form: OR = 1.6; 95 %CI 1.3 – 1.9; via visit: OR = 2.1; 95 %CI 1.7 – 2.5); a decrease in the use of deep sedation (OR = 2; 95 %CI 1.7 – 2.5).

Conclusions An educational intervention with observation-driven corrections through a PDSA approach was able to substantially increase the adoption of a split-dose regimen.
Update Breast Cancer 2019 Part 5 – Diagnostic and Therapeutic Challenges of New, Personalised Therapies in Patients with Advanced Breast Cancer
Authors: Welslau Manfred , Hartkopf Andreas D. , Müller Volkmar , Wöckel Achim , Lux Michael P. , Janni Wolfgang , Ettl Johannes , Lüftner Diana , Belleville Erik , Schütz Florian , Fasching Peter A. , Kolberg Hans-Christian , Nabieva Naiba , Overkamp Friedrich , Taran Florin-Andrei , Brucker Sara Y. , Wallwiener Markus , Tesch Hans , Schneeweiss Andreas , Fehm Tanja N.
Published: October 2019

Significant advancements have been made in recent years in advanced breast cancer and nearly all of them have been in the field of targeted therapy. Pertuzumab and trastuzumab-emtansine (T-DM1) have been able to be introduced in HER2-positive breast cancer. Now other anti-HER2 therapies are being developed (e.g. margetuximab, DS-8201a, pyrotinib) which can overcome other resistance mechanisms in the HER2 signalling pathway. In the field of hormone-receptor-positive breast cancer, an mTOR inhibitor and CDK4/6 inhibitors were introduced in the past. Now the introduction of the first PI3K inhibitor is forthcoming and this inhibitor will involve genetic testing of the tumour for a mutation in the PIK3CA gene. There are also significant advancements in triple-negative breast cancer: By combining chemotherapy and immunotherapy, an advantage for overall survival was able to be demonstrated in a subgroup (immune cells PD-L1-positive). The PARP inhibitor therapy for HER2-negative patients with a germ line mutation in BRCA1 or BRCA2 was also associated with an improved overall survival in a subgroup. These promising new study results are summarised in this review.
Freude an der Chirurgie – Einblicke gewähren, Begeisterung wecken
Authors: Kauffels-Sprenger Anne , Lehmann Wolfgang , Kutschka Ingo , Trojan Lutz , Ghadimi Michael
Published: October 2019

Der „Göttinger Aufschneidertag“ wurde ins Leben gerufen, um im Rahmen eines Ganztagesprogramms mit praktischen Kursen und der Möglichkeit des direkten Austauschs zwischen Studierenden und Dozierenden die Begeisterung für die Chirurgie zu wecken. In Workshops aus insgesamt 4 chirurgischen Disziplinen werden den Teilnehmern Einblicke in das Handwerk der Chirurgie gewährt. Das Ziel ist es, in den Studierenden bereits zu einem frühen Zeitpunkt des Studiums Interesse für die Chirurgie zu wecken und ihnen die Freude am Beruf näherzubringen.
MiR-214 Attenuates the Osteogenic Effects of Mechanical Loading on Osteoblasts
Authors: Yuan Yu , Guo Jianmin , Zhang Lingli , Tong Xiaoyang , Zhang Shihua , Zhou Xuchang , Zhang Miao , Chen Xi , Lei Le , Li Hui , Liu Timon Cheng Yi , Xu Jiake , Zou Jun
Published: October 2019

Exercise is an effective way to prevent osteoporosis, but its mechanism remains unclear. MicroRNAs (miRNAs) play an essential role in bone metabolism. Recently, mechanical loading was reported to induce changes in miRNA expression in osteoblasts. However, the role of miRNAs in bone under exercise and its underlining mechanisms of action still remain unknown. MiR-214 was reported to regulate the process of osteogenesis and is considered a biomarker of osteoporosis. In this study, we aimed to investigate whether exercise could induce changes in miRNA expression in bone and to study the effects of miR-214 on mechanical loading-induced osteogenesis in osteoblasts. The results showed that miR-214 was down-regulated in both tibia from C57BL/6 mice after exercise in vivo and in osteoblasts after mechanical strain in vitro. Mechanical strain could enhance the ALP activity, promote matrix mineralization, up-regulate the expression of osteogenic factors such as ATF4, Osterix, ALP and β-catenin, and down-regulate RANKL and RANK expression. Over-expression of miR-214 not only inhibited the expression of these osteogenic factors but also attenuated mechanical strain-enhanced osteogenesis in osteoblasts. Collectively, our results indicated that miR-214 could attenuate the osteogenic effects of mechanical loading on osteoblasts, suggesting that inhibition of miR-214 may be one of the ways in which exercise prevents osteoporosis.
Healthcare Costs for Older Patients Before and After Inpatient
Rehabilitation: A Retrospective and Prospective Longitudinal Cohort
Study
Authors: Bachmann Stefan , Pfaundler Nubio , Oesch Peter , Kool Jan Pieter
Published: October 2019

Background Little is known about the costs incurred over the 12 months
before and after inpatient geriatric rehabilitation in Switzerland.

Objectives To compare direct healthcare costs for elderly patients over a
period of 12 months before and after inpatient rehabilitation and to determine
predictive factors for costs after discharge.

Design Retrospective and prospective cohort study.

Patients and Methods Elderly patients referred for inpatient
rehabilitation to the rehabilitation centre Walenstadtberg of Kliniken Valens,
Switzerland, were included. Cost data were collected from healthcare insurance
providers. Comparisons of costs before and after discharge from rehabilitation
were performed. The effect of patient characteristics (Multimorbidity,
Health-related quality of life, Age, Vulnerability, Independence in activities
of daily living, Sex, and Mobility) on costs 12 months before and after
rehabilitation was evaluated with regression analysis.

Results A total of 210 patients were enrolled, and 136 completed the
clinical follow-up. Seventy-five patients were included in the cost analysis.
Total mean healthcare costs per person in the 12-month period before discharge
were CHF 24 429, compared with CHF 18 154 in the 12-month period
after discharge. After rehabilitation lower costs were reported for hospital
admissions, while costs for drugs and therapy were significantly higher.
Multimorbidity and health-related quality of life were predictors of costs
before rehabilitation (adjusted R-square 0.183). Higher costs after
rehabilitation were predicted by higher multimorbidity (adjusted R-square 0.09),
lower independence in activities of daily living (adjusted R-square 0.04) and
lower health-related quality of life (adjusted R-square 0.03).

Conclusion The mean total costs before geriatric rehabilitation were
significantly higher compared with the mean costs after discharge from geriatric
rehabilitation. In particular, the mean costs for hospitalizations were lower
after rehabilitation. Multimorbidity and lower health-related quality of life
predicted higher costs before and after rehabilitation.
Stereoselective Synthesis of the A,E-Ring Bicyclic Core of Calyciphylline B-Type Alkaloids
Authors: Kumar Balagani Satish , Raghavan Sadagopan
Published: October 2019

A stereoselective synthesis of the bicyclic unit constituting the A and E rings of calyciphylline B-type alkaloids is disclosed. The propionate ester of (1R)-cyclohex-2-en-1-ol, obtained by enzymatic resolution, is subjected to an Ireland–Claisen rearrangement. Subsequent reduction of the acid, Mitsunobu reaction to introduce a nitrogen functionality, oxidative cleavage to a dialdehyde, and intramolecular aldol and aza-Michael reactions afford the bicyclic subunit.
Chronic Inflammatory Demyelinating Polyradiculoneuropathy
Authors: Shije Jeffrey , Brannagan Thomas H.
Published: October 2019

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a relatively common autoimmune disorder affecting the peripheral nerves and nerve roots, often causing progressive or recurrent weakness with diminished reflexes. Electrodiagnostic (EDx) studies, cerebral spinal fluid (CSF) analysis, and nerve biopsy may help provide supportive evidence for the diagnosis. Most cases have a favorable response to one of the three first-line treatments: corticosteroids, IV immunoglobulin (IVIG) and plasmapheresis. Responses to these treatments may vary among individual patients. There is evidence that a small percentage of CIDP patients with IgG class 4 (IgG4) autoantibodies to paranodal proteins have characteristic clinical features and poorer response to IVIG. Chemotherapy and other immunomodulatory agents, as well as hematopoietic stem cell transplantation, may be considered in refractory cases. The degree of disability varies, and most patients require ongoing treatment to maintain stable disease, although long-term remission or cure may be achieved in some patients.
Singing Style, Vocal Habits, and General Health of Professional Singers
Authors: Santos Sabrina Silva , Montagner Thaynara , Bastilha Gabriele Rodrigues , Frigo Letícia Fernandez , Cielo Carla Aparecida
Published: October 2019

Introduction For the singer, the voice is a medium used to express feelings that capture the listener. Every singing style has specific demands, and a vocal alteration may prevent the singer from meeting them.

Objective To compare the singing style, the vocal habits, and the general health data of professional singers.

Methods Cross-sectional, quantitative and retrospective study of a survey database. Data on the singing style, the vocal habits, and the health conditions and history of 57 professional singers, 31 female singers and 26 male singers, aged from 19 to 57 years old (average of 32 years old), from a mid-sized town were analyzed

Results There was a prevalence of female (54 ± 2%) popular singers (91 ± 2%), in the adult age (51 ± 2%), nonsmokers (89 ± 2%), nonusers of alcohol (77 ± 2%), with respiratory problems (53 ± 2%), mainly rhinitis (23 ± 2%), and without other health problems. There was a significant use of alcohol in males (p = 0.010); among the alcohol users, there was a significant presence of respiratory problems (p = 0.046), of pharyngitis/tonsillitis (p = 0.003), and of gastroesophageal reflux (GER) (p = 0.043); there was a significant presence of GER in subjects reporting endocrine problems (p = 0.023), of gastritis (p = 0.023), and of pharyngitis/tonsillitis (p = 0.030).

Conclusion There was a predominance of adult professional popular female singers, with complaints of respiratory issues (with a higher prevalence of rhinitis), without other general health issues, of nonsmokers, and of nonusers of alcohol.
The Influence of Dietary Salt on the Osseointegration of Implants in Aging Rats
Authors: Baldisserotto Julio , Padilha Dalva Maria Pereira , Amenábar José Miguel
Published: October 2019

Introduction The bone-implant interface has been studied extensively, but only few papers focused on the nutritional aspects that may affect bone quality, especially salt intake.

Objective To study the osseointegration of implants in salt-loaded rats with low mineral bone content.

Methods A total of 60 4-month-old male rats were divided in 2 groups (n = 30), being these groups divided in 2 periods, (2 and 4 months). The control group received a normal diet, while the test group received a diet supplemented with 1% sodium chloride (NaCl). Implants were placed in the tibia of both groups. A total of 15 animals of each group were sacrificed at the 2nd month of the experiment, while the remaining animals were sacrificed at the 4th month.

Results No statistically significant difference was found in food intake between the groups on any experimental period, but a statistically significant difference was found in the liquid intake in the saline group in both periods. For all groups, osseointegration was observed in both groups. The mean percentage of osseointegration in the cortical bone, in the trabecular bone, and in the total osseointegrated surface between the control (46.38 ± 16.17%) and saline (49.13 ± 11.52%) groups at 2 months was not statistically different (p = 0.61). The total osseointegration areas of the control (53.98 ± 12.06%) and saline (51.40 ± 13.01%) groups at the 4th month of the study were not statistically (p = 0.61).

Conclusion Ingestion of salt did not affect directly the osseointegration process during the period of the experiment. The results suggest that mineral losses may not affect the achievement of good osseointegration in aging rats.
The Use of Osteotomies in Nasal Profileplasty
Authors: Berkhout Maaike Cornelia , Menger Dirk Jan
Published: October 2019

In rhinoplasty, osteotomies are performed to manipulate the bony nasal vault to improve the function and/or the aesthetics of the nose. This article provides an overview of the instruments used for osteotomies, as well as the indications and techniques for osteotomies in nasal profileplasty.
A Retrospective Analysis of Peroperative Risk Factors Associated with Posttonsillectomy Reactionary Hemorrhage in a Teaching Hospital
Authors: Manimaran Vinoth , Mohanty Sanjeev , Jayagandhi Satish Kumar , Umamaheshwaran Preethi , Jeyabalakrishnan Shivapriya
Published: October 2019

Introduction Tonsillectomy is one of the most common otolaryngology procedures performed worldwide. It is also one of the first procedures learnt by residents during their training period. Although tonsillectomy is viewed relatively as a low-risk procedure, it can be potentially harmful because of the chance of posttonsillectomy hemorrhage.

Objective The objective of the present study is to analyze the effects of peroperative factors and experience of the surgeon on the incidence and pattern of posttonsillectomy reactionary hemorrhage.

Methods A retrospective review of medical charts was performed from 2014 to 2017 in a tertiary care hospital. A total of 1,284 patients who underwent tonsillectomy and adenoidectomy were included in the study. The parameters assessed were experience of the surgeon, operating time, intraoperative blood loss, difference in mean arterial pressure (MAP) and pulse rate.

Results A total of 23 (1.79%) out of the 1,284 patients had reactionary hemorrhage. Out of those 23, 16 (69.5%) patients had been operated on by trainees, while 7 (30.5%) had been operated on by consultants (p = 0.033, odds ratio [OR] = 0.04). Operating time, intraoperative blood loss, difference in MAP and pulse rate were significantly higher in the reactionary hemorrhage group, and showed a positive association with risk of hemorrhage (p < 0.05; OR >1). Re-exploration to control the bleeding was required in 10 (76.9%) out of the 23 cases.

Conclusion The experience of the surgeon experience and peroperative factors have an association with posttonsillectomy hemorrhage. Close surveillance and monitoring of the aforementioned peroperative factors will help in the identification of patients at risk of hemorrhage.
Thoracoscopic Esophagectomy for a Huge Leiomyosarcoma
Authors: Manipadam John Mathew , Bains Satinder Pal Singh , Mahesh S. , Emmanuel Ami Maria , Ramesh H.
Published: October 2019

Esophageal leiomyosarcoma is the commonest of all esophageal sarcomas but yet has a very low incidence. These tumors have been resected by the open approach so far. We describe the steps and challenges involved in the thoracoscopic excision of a huge leiomyosarcoma of the esophagus.
Severe Subglottic Tracheal Stenosis Dictates Intercontinental Transfer of a 2-Year-Old Child with Tracheostomy Tube In Situ
Authors: Sahu Manoj Kumar , Chalattil Bipin , Karanjkar Ameya , Singh Sarvesh Pal , Rajashekar Palleti , Devagouru V. , Saxena Anita , Choudhary Shiv
Published: October 2019

Atrioventricular septal defect (AVSD) is the most common congenital cardiac anomaly associated with Down’s syndrome. Children with AVSD develop pulmonary arterial hypertension and often require extensive therapy with pulmonary vasodilators in the postoperative period. The postoperative management is complicated by prolonged mechanical ventilation through endotracheal tube or tracheostomy tube. This artificial airway may trigger various airway complications including subglottic tracheal stenosis. The incidence and severity of subglottic tracheal stenosis is high in children with congenital syndromes. Inability to extubate or decannulate trachea and rapid respiratory compromise while attempting to do so directs toward a diagnosis of subglottic tracheal stenosis. The following case report discusses a 2–year-old boy from Nigeria who was discharged with tracheostomy tube in situ due to severe subglottic tracheal stenosis and surgical tracheoplasty could not be done at his present age. The implications of prolonged tracheostomy tube in situ and the hazards thereof during transfer of the child are being described.
A Prospective Randomized Clinical Trial of Efficacy of Algorithm-Based Point of Care Guided Hemostatic Therapy in Cyanotic Congenital Heart Disease Surgical Patients
Authors: Karanjkar Ameya , Kapoor Poonam Malhotra , Sharan Sandeep , Bhardwaj Vandana , Malik Vishwas , Hasija Suruchi , Choudhury Arindam , Chowdhury Ujjwal Kumar , Rajashekar P.
Published: October 2019

Objective Point of care (POC) testing-based algorithm-guided hemostatic therapy has been used in adult as well as pediatric cardiac surgical patients to administer blood components. The authors hypothesized that implementation of POC-based algorithm in pediatric cyanotic congenital surgical patients would reduce the exposure to blood component therapy and improve the clinical outcome.

Design Prospective randomized control trial.

Setting Single-center academic institute.

Participants One hundred seventy pediatric congenital cyanotic surgical patients.

Intervention Implementation of POC and conventional tests-based algorithms.

Measurements and Main Results Algorithm-based blood component therapy was administered in each group. There were no group differences regarding the demographic, clinical, and laboratory characteristics. Amount of packed red blood cells (PRBCs), fresh frozen plasma (FFP), platelets, and cryoprecipitate (primary outcomes) administered was significantly lower in POC group than that in the conventional group (p < 0.001). Among the secondary outcomes, the chest drain output at 6, 12, and 24 hours and number of re-explorations was comparable among both the groups. The duration of mechanical ventilation, duration of intensive care unit (ICU) stay, and hospital stay was significantly short in POC group (p = 0.008, <0.001 and 0.019, respectively).

Conclusion Implementation of POC-based algorithm-guided hemostatic therapy reduced the exposure to blood and blood component therapy and was associated with reduced ICU and hospital stay in pediatric congenital cyanotic surgical patients.
International Council for Standardization in Haematology Recommendations for Hemostasis Critical Values, Tests, and Reporting
Authors: Gosselin Robert C. , Adcock Dorothy , Dorgalaleh Akbar , Favaloro Emmanuel J. , Lippi Giuseppe , Pego João M. , Regan Irene , Siguret Virginie
Published: October 2019

This guidance document was prepared on behalf of the International Council for Standardization in Haematology (ICSH), the aim of which is to provide hemostasis-related guidance documents for clinical laboratories. The current ICSH document was developed by an ad hoc committee, comprising an international collection of both clinical and laboratory experts. The purpose of this ICSH document is to provide laboratory guidance for (1) identifying hemostasis (coagulation) tests that have potential patient risk based on analysis, test result, and patient presentations, (2) critical result thresholds, (3) acceptable reporting and documenting mechanisms, and (4) developing laboratory policies. The basis for these recommendations was derived from published data, expert opinion, and good laboratory practice. The committee realizes that regional and local regulations, institutional stakeholders (e.g., physicians, laboratory personnel, hospital managers), and patient types (e.g., adults, pediatric, surgical) will be additional confounders for a given laboratory in generating a critical test list, critical value thresholds, and policy. Nevertheless, we expect this guidance document will be helpful as a framework for local practice.
Forehead/Brow Reduction or Augmentation with Custom Implants for Enhanced Facial Profileplasty
Authors: Eppley Barry L.
Published: October 2019

After studying this article, the reader should be able to understand the basic concepts of aesthetic reshaping of the forehead and the different methods to make those upper facial contour changes. The operative techniques for bony forehead and brow bone reduction and biomaterials for forehead and brow bone augmentation are described. Innovations in bony reduction and implant augmentation methods are emphasized.
Chordoma of the Craniocervical Junction: Endoscopic Endonasal Approach
Authors: Voormolen Eduard H. , Champagne Pierre Olivier , Froelich Sebastien
Published: October 2019

Objective This study was aimed to achieve gross-total removal of a chordoma of the craniocervical junction via an endonasal approach (Fig. 1).

Design The present study is a case report.

Setting The study was conducted at neurosurgical clinic of university hospital.

Participant A 40-year-old male, with normal neurologic exam and no prior medical history, presented with a 2-year history of cervicalgia. On preoperative imaging, a midline lesion, with image characteristics of chordoma, was seen in the lower clivus and odontoid. It had limited lateral extension.

Main Outcome Measures This study measures postoperative neurological deficits and postoperative tumor volume on magnetic resonance imaging (MRI).

Results A binostril approach to the upper nasopharynx was performed using endoscope at 30- and 45-degree angles. Subsequently, a heart-shaped mucosal flap was made and the clivus was drilled to expose the lesion (Fig. 2). After initial debulking, the ring of C1 was slightly drilled to reach the tumor in and around the odontoid. Postoperative MRI showed that a gross-total resection was achieved. The patient had no neurologic deficits postoperatively. Pathologic examination revealed a chordoma of the classical type.

Conclusion An endoscopic endonasal approach, utilizing the heart-shaped flap and angled endoscopes and instruments, can be considered for resection of select cases of craniocervical junction chordoma with limited lateral expansion.

The link to the video can be found at: https://youtu.be/rwVoZJRBIEo.