bluuebunny/crossref_metadata_2025 huggingface dataset:
The Netherlands
Authors: Busch Danny
Published: September 2022

This chapter describes and discusses the liability the Dutch Authority for the Financial Markets (Stichting Autoriteit Financiële Markten or the AFM) and the Dutch Central Bank (De Nederlandsche Bank NV or DNB). Before 1 July 2012, there was no statutory provision which specifically addressed the liability of the AFM and DNB. This meant that their liability was governed by the general tort provisions in force at that time, especially Articles 6:162 and 6:163 of the Dutch Civil Code, in line with state liability in the Netherlands generally. In 2006, in the landmark case Vie d’Or, the Dutch Supreme Court held that the financial supervisors were subject to the unwritten standard of care that their conduct ‘must meet the requirements necessary for proper and careful supervision’. Whether or not a financial supervisor had exercised the required level of care depended on all the circumstances of the case, one of them being whether or not it was exercising a discretionary power. If the financial supervisor was exercising a discretionary power (and this was—and still is—usually the case), the courts had to respect that power and could subject the financial supervisor’s conduct only to a marginal review. Since 1 July 2012 the liability of both the AFM and DNB is subject to a statutory limitation. This limitation of liability is laid down in Section 1:25d Wft. It limits the liability of the AFM and DNB to cases in which the loss is to a significant extent due to a failure involving (1) intent (opzet) or (2) gross fault (grove schuld) (a) to perform their statutory duties properly or (b) to exercise their statutory powers properly. This standard is stricter than that which applied before 1 July 2012. The protection of Section 1:25d Wft extends to the activities of DNB as the designated national resolution authority (NRA) for banks within the Single Resolution Mechanism (SRM).
Ireland
Authors: Clarke Blanaid
Published: September 2022

This chapter describes and discusses the civil liability of the Irish Central Bank (CBI), the single financial services supervisor in Ireland. It examines the possible private law claims for damages. These are: (1) actions for breach of statutory duty simpliciter (i.e. irrespective of negligence); (2) actions based solely on the careless performance of a statutory duty in the absence of any other common law right of action; (3) actions based on a common law duty of care arising either from the imposition of the statutory duty or from the performance of it; and (4) misfeasance in public office. The chapter also examines the liability of the state for the actions or inactions of the CBI. Finally, it considers the circumstances in which statutory immunity may protect the state or the CBI from liability arising from a breach of EU or national law.
Hong Kong and Singapore
Authors: Booysen Sandra Annette
Published: September 2022

There are numerous circumstances in which a member of the public may be aggrieved by the conduct of the authorities who supervise the financial services sector. Claimants might include bank depositors who lose monies when a bank collapses, or the financial institution itself which is denied a licence or has its licence withdrawn. Recovery and resolution measures may similarly trigger grievances from the affected financial institution, or from adversely affected shareholders or creditors. In Hong Kong and Singapore, financial authorities are protected from civil claims by extensive immunity provisions. These provisions do not, however, protect from bad faith conduct, and the financial authorities can be sued for the tort of misfeasance in public office. There are also other limited avenues of recourse for claimants to challenge decisions, including judicial review.
United States of America
Authors: Broome Lissa Lamkin
Published: September 2022

In the United States there is limited liability for financial supervisors and resolution authorities. Although the Federal Tort Claims Act (FTCA) permits suit against the United States for certain torts to provide compensation for those injured by government wrongdoing, the statute has a significant exception for discretionary functions. This exception has been interpreted to cover most conduct of federal financial regulators. When a bank becomes insolvent, however, the Federal Deposit Insurance Corporation (FDIC) is appointed as its receiver and assumes all of the bank’s rights, including the ability to sue its former officers and directors for liability. In such suits, the officers and directors often assert affirmative defences based on the FDIC’s own conduct. The affirmative defences, if successful, only reduce the amount of the FDIC’s claims against the defendants and do not serve as a positive theory for recovery against the FDIC. Liability has been found, however, when the government promised the benefit of particular accounting practices to depository institutions that purchased failed thrifts but later enacted legislation that precluded the application of those accounting practices.
Global Sales and Contract Law
Authors: Schwenzer Ingeborg , Muñoz Edgardo
Published: September 2022

This book provides a comparative analysis of domestic laws on contracts and sales in over sixty countries to deliver a global view of domestic and international sales law. The book reports on the real practice of sales law, taking into account present-day problems. Complex questions on the obligations under a sales contract, the ways in which these are established, as well as the remedies following the breach of obligations, are all discussed. The book encompasses all aspects of a sale of goods transaction and takes a wide view of sale by including general contract law. Since the first edition, new case law and legislation have emerged changing the content of the law on contracts and sales in some countries, and changes to the law of contract have been implemented in Argentina, France, Hungary, and Japan. Additionally, there have been 16 further country adoptions of the CISG. The UNIDROIT PICC was updated in 2016, and the ICC released new editions of its INCOTERMS© and force majeure and hardship clauses in 2020. International or multilateral developments that were in prospect (and some which were not) when writing the original edition have now either evolved or disappeared. This new edition provides a fresh comparative analysis of domestic laws and international developments, whilst considering the new case law applying and interpreting uniform projects like the CISG and the UNIDROIT PICC, and the influence this may have in the domestic law on contracts and sales.
Development of Domestic Sales Laws
Authors: Schwenzer Ingeborg , Muñoz Edgardo
Published: September 2022

This chapter expounds on the domestic sales laws across the world. It cites the differences and peculiarities of the Uniform Commercial Code in the US, Code Civil in France, codifications of the Germanic legal systems and Ibero-American legal systems, and the jurisdictions of the African legal systems. Additionally, the chapter explores the main influences of Middle Eastern, Arab, and Asian laws. It highlights how no comparative work on sales and contract law would not include its respective historical development. The chapter notes that the foundation of Continental European systems is Roman law after it was preserved in Western Europe.
Modern Practice of International Sales Law
Authors: Schwenzer Ingeborg , Muñoz Edgardo
Published: September 2022

This chapter explores the modern practice of international sales law. It notes the booming trend of international trade since 2008. Most surveys on how the law interacted with international trade are limited to the geographical approach, the number of respondents, and empirical research. The chapter highlights the Global Sales Law survey conducted by the United Nations Commission on International Trade Law (UNCITRAL). It also includes the significance of CISG in international sales law. The increase in international trade is reflected by a comparable increase in sales law litigation and arbitration.
The Concept of Goods
Authors: Schwenzer Ingeborg , Muñoz Edgardo
Published: September 2022

This chapter explores the concept of goods. Goods are generally referred to as the object of a sales contract. The majority of civil law jurisdictions do not restrict the definition of goods to tangible goods from the onset. Res extra commercium is declared when the notion of goods is outside the matters of commerce. Additionally, The Sales of Goods Acts and CISG do not include money from its statutory definition of goods. The chapter then discusses the examples and specificities of tangible goods and intangible goods. The modern issue of all jurisdictions concerns software, stocks, and shares.
Electronic Communications
Authors: Schwenzer Ingeborg , Muñoz Edgardo
Published: September 2022

This chapter focuses on electronic communications. It highlights the significance of electronic communication in modern international trade transactions. Unification and harmonization efforts were made to ensure legal framework and legal systems modernize their laws in line with cross-border transactions. The chapter discusses the principle of equality in line with contract formation over electronic communications by referencing the process of offer and acceptance in a website. Moreover, an information system is designated if the recipient has used the address of this information system in business communications. Many of the modern rules on electronic communication include special definitions for the dispatch and receipt of declarations as well.
Modification of Contract
Authors: Schwenzer Ingeborg , Muñoz Edgardo
Published: September 2022

This chapter explicates the modification of contacts. The general principles of freedom, statutory form requirements, and contract formation are applied when it comes to modifying contracts. Severe restrictions on modifications could be found in common law legal systems. Moreover, the chapter lists waiver, practical benefit, and abandoning consideration requirements as variations of contracts. Parties regularly agree on a no-oral medication clause in the recent commercial practice. The chapter notes the possible approach of protecting a party’s reasonable reliance on the modification, which is found in the common law legal systems.
Consequences of Mistake, Fraud, and Duress
Authors: Schwenzer Ingeborg , Muñoz Edgardo
Published: September 2022

This chapter notes the consequences of mistake, fraud, and duress in contracts. The principal remedy for mistake, fraud, and duress is similar which is the victim’s right to render the contract void ab initio. Unlike fraud and duress, remedies for mistakes can be contractually waived in many legal systems. The chapter clarifies the right to rescind should not be confused with the right to avoid being accosted with a breach of contract. Moreover, rescission is subject to confirmation and expiration of time. The chapter also explains the process of restitution. It highlights the importance of checking the damage following the deed.
Excessive Benefits and Unfair Advantages
Authors: Schwenzer Ingeborg , Muñoz Edgardo
Published: September 2022

This chapter explores excessive benefits and unfair advantages. All jurisdictions with a market economy struggle to regulate contracts with substantial contractual injustice. The chapter explains how gross disparity focuses on civil law jurisdictions, whereas unconscionability primarily examines common law jurisdictions. Gross disparity refers to an unusually significant difference between the obligations assumed by each party at the time of the conclusion of the contract. Meanwhile, some jurisdictions need the additional element of some kind of abusive conduct or blameworthy behavior. The chapter notes adaptation of the contract is another solution against gross disparity. It explains unconscionability is a concept that needs a high level of moral obloquy.
Form Requirements
Authors: Schwenzer Ingeborg , Muñoz Edgardo
Published: September 2022

This chapter discusses form requirements. Form requirements are typically used as a means to protect consumers, or as an attempt to assist dispute determination by way of evidentiary rules. Additionally, statutory form requirements are used for a variety of purposes, such as the goods to be sold, the parties to the contract, or the value of the contract. The formal validity of the contract has traditionally been distinguished by the law of the place where the contract was concluded. Moreover, the in writing formal requirement is imposed by law. The chapter also notes the form required for initial contract and alteration.
General Remarks on Pre-Contractual Liability
Authors: Schwenzer Ingeborg , Muñoz Edgardo
Published: September 2022

This chapter explains the pre-contractual phase. It recognizes the grey area when the parties have started to negotiate a contract since they are no longer strangers under tort law. As a consequence of the freedom of contract principle, parties to determine the structure of their negotiation process first. Applicable law usually handles how most negotiations precede sale contracts. Explicit rules on pre-contractual liability are rarely found, even in civil law legal systems with a comprehensive civil code. Legislators around the world introduced statutory rules providing for a general liability resulting from culpa in contrahendo. However, the CISG does not have any culpa in contrahendo provision at the international level.
Interpretation and Supplementation
Authors: Schwenzer Ingeborg , Muñoz Edgardo
Published: September 2022

This chapter explicates interpretation and supplementation. It clarifies how it does not encompass the interpretation of the statutory law. The sources for rules on interpretation and supplementation differ among legal systems. Additionally, both uniform law and projects contain provisions on interpretation at the international level. The chapter highlights the importance of the contract’s wording. It cites the possible approaches of interpretations: subjective, objective, and uniform approaches. All legal systems agree that there is no right and no duty for adjudicators to rewrite a contract. The chapter then clarifies how the interpretation of statements should not be mixed with the subsequent modifications of concluded contracts.
Practices and Usages
Authors: Schwenzer Ingeborg , Muñoz Edgardo
Published: September 2022

This chapter discusses the role of practices and usages. Practices and usages are the most common factors to be taken into account when interpreting declarations or contracts as they supplement possible gaps left by parties in a contract. Legal systems typically acknowledge the relevance of practices and usages for interpreting party conduct and contracts and determining the content of the contract. The chapter also notes how practices and usages are also found in commercial codes, civil codes, and codes of obligation at the domestic level, while uniform laws and projects take over practices and usages at the international level.
Delivery
Authors: Schwenzer Ingeborg , Muñoz Edgardo
Published: September 2022

This chapter tackles the concept behind the act of delivering. It refers to how delivery is the obligation of the seller. Legal systems have developed two further subcategories to the notion of delivery: symbolic delivery and deemed delivery. Moreover, categories of delivery fall under the rubric of legal delivery which the applicable law determines. The chapter discusses the internal and external effects of the act of delivering. It adds how non-conformity versus non-delivery have different legal consequences as well. Then, the chapter expounds on how the process of delivery is a contractual agreement.
Examination and Notice
Authors: Schwenzer Ingeborg , Muñoz Edgardo
Published: September 2022

This chapter explores examination and notice. The failure of the buyer to examine the goods and notify the seller of any non-conformities discovered does not give rise to any liability on the part of the buyer. The obligations of examination and notice do not compare to the obligation of payment of the purchased price. Many civil law legal systems traditionally operate with a very strict notice requirement, most of which are in line with commercial transactions. The chapter then highlights the determination of the period for examinations and notices. The general consequences mostly fall into the loss of remedies or exclusion of non-conformities.
General Remarks on Buyer’s Obligations
Authors: Schwenzer Ingeborg , Muñoz Edgardo
Published: September 2022

This chapter tackles the obligations of buyers. The obligations of the seller and buyer are symbiotic in the sense of blatant interplay. The payment of the price is a characteristic obligation of the buyer under a sales contract. One of the characteristic obligations includes the assumption of possession of goods. However, the obligations of buyers are limited in line with applicable law. The chapter notes the additional obligations of buyers such as sources, confidentiality, and competition. Similar to seller’s obligations, it is easier to find nearly all obligations of the buyer in one piece of legislation from the common law systems.
Passing of Risk
Authors: Schwenzer Ingeborg , Muñoz Edgardo
Published: September 2022

This chapter notes the notions of risks. Price risk is the risk of having to bear the cost of damage to the goods, wherein the buyer is still obligated to pay for purchase price since the damage was neither of the parties’ fault. The rules on the passing of risk are only relevant where neither party can be considered responsible for the loss or the circumstances. The chapter narrates the number of consequences following the passing of risks. Under the general principle of freedom of contract, parties need to make provision for the allocation of risk in their contract. Trade terms are used to specify obligations under the contract.
Taking Delivery
Authors: Schwenzer Ingeborg , Muñoz Edgardo
Published: September 2022

This chapter explicates the obligation of buyers to take delivery of goods. Taking delivery is in line with taking control over and bearing responsibility for the goods. Common law legal systems impose a positive duty to accept the goods in accordance with the terms of the contract of sale. However, the duty to accept goods is not clearly defined. Affirmative communication, inconsistent ownership, and delayed rejection of goods are the three methods for effective acceptance. Meanwhile, the two acts of taking delivery are divided between taking over the goods and assisting with the modalities of delivery.
General Remarks about Remedies
Authors: Schwenzer Ingeborg , Muñoz Edgardo
Published: September 2022

This chapter focuses on remedies of contract breaches. It mentions how clauses establishing, modifying, and excluding remedies are among the most common features in sales contracts. The cause-oriented approach is followed by structured civil law legal systems wherein remedial systems are structured in a way so that each cause for the disturbance in the performance determines the available remedy. Moreover, the impossibility impacted the validity of contracts. On the other hand, the breach-of-contract approach is traditionally followed by common law jurisdictions. The chapter lists the consequences of breaches such as damages, specific performance, and avoidance. CISG had been a notable proponent in building a modern approach to remedies.
Exemption
Authors: Schwenzer Ingeborg , Muñoz Edgardo
Published: September 2022

This chapter discusses exemptions, impediments, hardships, and obligee’s behavior. All legal systems envisage some possibility to relieve the obligor from the obligation to pay damages after a breach of contract has occurred. However, legal systems vary in responding to these. The civil law system’s natural solutions around the absence of fault, while the common law system takes a strict liability approach. The critical distinction between impediment and hardship is that performance does not need to be impossible under hardship. Obligee’s behavior plays a vital role in questions of whether an obligor should be exempted from either its responsibility or damages for a failure to perform.
Unwinding of the Contract
Authors: Schwenzer Ingeborg , Muñoz Edgardo
Published: September 2022

This chapter tackles the unwinding of contracts. Contracts may be invalid from the outset because requirements for the formation of the contract have been lacking despite the efforts of parties to do their respective obligations. The chapter lists the possible reasons for the failure of a contract such as the lack of capacity, authority, agent, mistake, fraud, illegality, or initial impossibility. Property law, unjust enrichment, and tort law usually cover the unwinding of a contract. However, cases of avoidance are handled differently. The chapter then discusses the impact of a contract’s conclusion.
Limitation of Actions
Authors: Schwenzer Ingeborg , Muñoz Edgardo
Published: September 2022

This chapter looks into the limitation of actions. All legal systems recognize the need to impose limitations or prescription periods. Also, many legal systems have statutory amendments to the law on limitations of actions at a more general level. The three principle policy reasons behind the imposition of a limitation period are unfair considerations, improperly enforced claims, and time reducing the availability of evidence. The chapter then discusses the extent of contract breaches in terms of traditional civil law, common law, and modern approaches. It includes the renewal and extension of limitation periods.
The Alethic Platitudes, Deflationism, and Adverbial Quantification
Authors: Armour-Garb Bradley , Woodbridge James A
Published: September 2022

Alethic pluralists often claim that accommodating certain alethic platitudes motivates rejecting deflationism in favour of a pluralist inflationism about truth. Deflationists claim that the logical role of the truth predicate, viz providing something equivalent to variables for sentence-in-use positions and quantifiers governing them, is sufficient to account for the appeal to truth in the alethic platitudes. Surprisingly, however, most deflationists face an insufficiently acknowledged problem with respect to explaining how this mode of generalizing works. The standard substitutional or higher-order interpretations of sentential quantifiers and variables do not meet two desiderata that we claim any adequate account of them must satisfy. To address this issue, we review and extend A. N. Prior's adverbial understanding of sentential quantification, explain how it satisfies the desiderata, and respond to some objections. This shows that deflationists can accommodate and account for the alethic platitudes by applying this non-nominal understanding of generalizing on sentence positions.
Phospholipid-grafted PLLA electrospun micro/nanofibers immobilized with small extracellular vesicles from rat adipose mesenchymal stem cells promote wound healing in diabetic rats
Authors: Li Jing , Yan Shunshun , Han Weiju , Dong Zixuan , Li Junliang , Wu Qi , Fu Xiaoling
Published: September 2022

Small extracellular vesicles (sEVs) derived from mesenchymal stem cells (MSCs) can deliver a variety of bioactive factors to create a favorable local microenvironment, thereby holding huge potential in chronic wound repair. However, free sEVs administrated intravenously or locally are usually cleared rapidly, resulting in an insufficient duration of the efficacy. Thus, strategies that enable optimized retention and release profiles of sEVs at wound sites are desirable. Herein, we fabricated novel functional phosphoethanolamine phospholipid-grafted poly-l-lactic acid micro/nanofibers (DSPE-PLLA) to carry and retain sEVs from rat adipose MSCs, enabling the slow local release of sEVs. Our results showed that sEVs@DSPE-PLLA promoted the proliferation, migration and gene expression (Col I, Col III, TGF-β, α-SMA, HIF-1α) of fibroblasts. It also promoted keratinocyte proliferation. In addition, sEVs@DSPE-PLLA helped polarize macrophages toward the M2 phenotype by increasing the expression of anti-inflammatory genes (Arginase 1, CD 206, IL-10) and inhibiting the expression of pro-inflammatory genes (IL-1β, TNF-α). Further in vivo study in diabetic rat models showed that sEVs@DSPE-PLLA improved the wound-healing process by alleviating the inflammatory responses, stimulating cell proliferation, collagen deposition and angiogenesis. These results highlight the potential of using DSPE-grafted scaffolds for extracellular vesicle immobilization and suggest sEVs@DSPE-PLLA micro/nanofibers as promising functional wound dressings for diabetic wounds.
ON THE PLACEMENT OF APRON DOSEMETERS AND DOSE ASSESSMENT IN INTERVENTIONAL CARDIOLOGY PROCEDURES: PRELIMINARY RESULTS
Authors: Ferrari P , Becker F , Campani L , Jansen J , Jovanović Z , Krstić D , Mariotti F , Teles P , Venturi G
Published: September 2022

Personnel involved in interventional practices are likely to be exposed to higher radiation doses than other workers in the medical field. Personnel monitoring and radiation protection measures play a crucial role in keeping these doses below the limits. EURADOS (European Radiation Dosimetry Group) Working Group 12 performed a series of investigations showing how the complexity of the scattered field reaching the operators can influence the doses to the operators. The present work was aimed at determining the possible effects on the registered doses of the scattered field and the actual position of a dosemeter on apron. This study has been performed through Monte Carlo simulations and it was validated through measurements. It does not claim to identify the ‘best’ position for the dosemeter, but to assess the variability of its response, showing how a variability of the order of +/− 30% to 40 should be taken into account.
It is time to abolish the clock change and adopt permanent standard time in the United States: a Sleep Research Society position statement
Authors: Malow Beth A
Published: September 2022

Daylight saving time (DST) refers to the practice of advancing clock time by 1 h each spring, with a return (setting back) to standard time (ST) each fall. Numerous sleep and circadian societies other than the Sleep Research Society have published statements in support of permanent ST, and permanent ST has also received support from multiple medical societies and organizations. This perspective discusses the positive and negative health and economic consequences of permanent DST, permanent ST, and maintaining the status quo (DST for part of the year). After a thorough review of the existing literature, the SRS advocates the adoption of permanent ST.
Evaluation of the Uptake, Metabolism, and Secretion of Toxicants by Zebrafish Larvae
Authors: Achenbach John C , Hui Joseph P M , Berrue Fabrice , Woodland Cindy , Ellis Lee D
Published: September 2022

Zebrafish larvae have classically been used as a high-throughput model with which to test both the bioactivity and toxicity of known and novel compounds, making them a promising whole organism New Approach Method in the context of the international momentum to eliminate animal testing. Larvae are generally exposed to the chemicals being tested in a static environment and the concentration-response patterns are calculated based on the initial bath concentrations of the compounds. This approach rarely takes into account the absorption, distribution, metabolism, and excretion of the compounds being tested, which can have a significant effect on the toxicokinetic profiles of the compounds and thus impact the predictive ability of the model. In this study, we have evaluated the toxicokinetic profile of 5 known toxicants, 3 phenolic compounds, along with thiabendazole and 3,4-dicholoronalanine, at 6, 8, 24, 72, and 120 h postfertilization in order to match the exposure timelines of a standard in vitro fish embryo toxicity test. It was revealed that in addition to bioaccumulation effects, the compounds were all actively metabolized and excreted by the larvae. Importantly, comparisons between the toxicants revealed that the patterns of uptake and metabolism were varied and could often partially explain the differences in their concentration-response patterns. The findings of this study are significant as they highlight the requirement for an assessment of the stability and toxicokinetic profile of chemicals tested using standard zebrafish larval toxicity assays in order to better understand and compare their toxicity profiles.
Transcriptional Regulation of Human Arylamine N-Acetyltransferase 2 Gene by Glucose and Insulin in Liver Cancer Cell Lines
Authors: Hong Kyung U , Salazar-González Raúl A , Walls Kennedy M , Hein David W
Published: September 2022

Arylamine N-acetyltransferase 2 (NAT2) is well-known for its role in phase II metabolism of xenobiotics and drugs. More recently, genome wide association studies and murine models implicated NAT2 in regulation of insulin sensitivity and plasma lipid levels. However, the mechanism remains unknown. Transcript levels of human NAT2 varied dynamically in HepG2 (hepatocellular) cells, depending on the nutrient status of the culture media. Culturing the cells in the presence of glucose induced NAT2 mRNA expression as well as its N-acetyltransferase activity significantly. In addition, insulin or acetate treatment also significantly induced NAT2 mRNA. We examined and compared the glucose- and acetate-dependent changes in NAT2 expression to those of genes involved in glucose and lipid metabolism, including FABP1, CPT1A, ACACA, SCD, CD36, FASN, ACLY, G6PC, and PCK1. Genes that are involved in fatty acid transport and lipogenesis, such as FABP1 and CD36, shared a similar pattern of expression with NAT2. In silico analysis of genes co-expressed with NAT2 revealed an enrichment of biological processes involved in lipid and cholesterol biosynthesis and transport. Among these, A1CF (APOBEC1 complementation factor) showed the highest correlation with NAT2 in terms of its expression in normal human tissues. The current study shows, for the first time, that human NAT2 is transcriptionally regulated by glucose and insulin in liver cancer cell lines and that the gene expression pattern of NAT2 is similar to that of genes involved in lipid metabolism and transport.
Pararectus Approach in Acetabular Fractures in Patients Older Than 65 years. Is it Possible to Improve the Technique?
Authors: Cano-Luís Pedro , García-Mendoza Abraham , Giráldez-Sánchez Miguel , Andrés-Cano Pablo
Published: September 2022

Objectives:

Review clinical results of the treatment for acetabular fractures using the pararectus approach and analyze surgical variations of the traditional approach.

Design:

Retrospective.

Setting:

Tertiary referral hospital.

Patients:

46 patients over 65 years of age who sustained an acetabular fracture and underwent surgery using the pararectus approach.

Intervention:

Fractures were treated using a pararectus approach. Three variations of the original technique were performed: (1) Ligature of the deep iliac circumflex artery and vein, (2) separation of the psoas and iliacus muscles, and (3) isolation of the spermatic cord in men and round ligament in women together with the iliac and epigastric vessels.

Main Outcome Measurements:

Outcomes measures included surgical, demographic, and clinical data, and information related to follow-up.

Results:

Duration of surgery, 125 minutes (95–210). Quality of reduction on postoperative computed tomography (CT) scan; anatomic in 22 patients (47.8%), incomplete in 16 (34.8%), and poor in 8 (17.4%). In patients in whom the hip was preserved (n = 41), functional status was excellent in 15 patients (36.5%), good in 17 (41.4%), fair in 6 (14.7%), and poor in 3 (7.4%), with mean functional score of 16 points (7–18). Seven patients (15.2%) developed posttraumatic osteoarthritis and 4 of these patients underwent total hip replacement.

Conclusions:

This study reports positive outcomes in fracture reduction and clinical outcomes with low complications in older patients who suffered acetabular fractures and were treated using a pararectus approach. Small variations in the technique, such as those proposed in this study, may help to widen access to the surgical site and simplify the technique.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Tackling Gynecologic Cancer Disparities: An Assessment of 2 Interventions for Improving Information Exchange With Racial/Ethnic Communities
Authors: Adebayo Nihmotallahi , Dunne Will , Dean Julie Robin , O’Brian Catherine , Dahdouh Rabih , Simon Melissa
Published: September 2022

Racial health disparities continue to greatly impact the incidence and mortality rates of gynecologic cancers. Although there are many drivers for these disparities, limited inclusion of vulnerable populations in clinical research and narrowed medical knowledge of patients are large contributors that disproportionately affect racial/ethnic communities. To mitigate these disparities, we must look for avenues that connect patients from these communities to cancer researchers. In this review, we summarize 2 projects that can serve as models for future interventions that promote education and engagement in clinical research for populations most impacted by gynecologic cancer disparities.
How State Perinatal Quality Collaboratives Can Improve Rural Maternity Care
Authors: MAIN ELLIOTT K. , SAKOWSKI CHRISTA
Published: September 2022

Perinatal Quality Collaboratives (PQCs) are now present in nearly all states and provide important tools and strategies for improving maternal outcomes. State PQCs can focus their strengths to address rural maternal health challenges using support groups of rural hospitals, of tertiary facilities that network with them, and of other PQCs to share best practices for rural hospitals to: (1) Support networks of care and telehealth; (2) Support remote education and training; (3) Implement rural appropriate versions of National Safety Bundles; (4) Engage and support providers beyond obstetricians; and (5) Engage community members and resources.
Investigating the mechanism of action of Danhong injection and its components against myocardial ischemia-reperfusion injury
Authors: Lei Peng , Mwangi Charity Ngina , Cao Yuanlin , Chen Jingrui , Huang Yuting , Wang Yuefei , Zhu Yan , Fan Guanwei , Jiang Miaomiao
Published: September 2022

Objective:

The surgical treatment of myocardial infarction often causes myocardial ischemia-reperfusion injury (MI/RI). Danhong injection (DHI) has curative effects on coronary heart disease and angina pectoris. However, its therapeutic effects on MI/RI still require further validation. This study aims to investigate the components involved and mechanism of action of DHI against MI/RI.

Methods:

Primary metabolites (PM) and secondary metabolites (SM) were isolated from DHI. We established a rat model of MI/RI by administering PM, SM, and DHI. Cardiac morphology and functional parameters were evaluated using cardiac ultrasound. The metabolic effects of PM, SM, and DHI in the serum and myocardial tissue on MI/RI were investigated using 1H-NMR.

Results:

Our study showed that DHI, PM, and SM could improve cardiac function by correcting the dilated cardiac structure, alleviating inflammation by downregulating complement C2 expression, reducing reactive oxygen species (ROS) production by upregulating cyclooxygenase (COX) expression, and restoring normal energy supply by inhibiting fatty acid metabolism and stimulating glycometabolism. In addition, DHI and SM could attenuate the calcium overload and trigger an inflammatory response and oxidative stress by downregulating Ca2+/calmodulin-dependent protein kinase II (CaMKII) expression.

Conclusions:

This study suggests that DHI and its components exerts resistance against MI/RI by ameliorating cardiac dysfunction, energy metabolism, and oxidative stress.
Safety and Efficacy of Direct Oral Anticoagulants for Treatment of Venous Thromboembolism in Pediatric Oncology Patients
Authors: Scheuermann Amanda , Liegl Melodee , Simpson Pippa , Branchford Brian , Malec Lynn
Published: September 2022

Background/Objectives:

Children with cancer have an increased risk for developing a venous thromboembolism (VTE) during their treatment course. Direct oral anticoagulants (DOACs) represent a relatively new class of oral medications to treat VTE; however, data are limited to support use in this patient group. Given the safety and efficacy data from numerous perspective adult studies, providers now consider off-label use in select children.

Methods:

We performed a single-center, retrospective review of children 0 to 20 years of age from 2012 to 2020 with malignancy and confirmed VTE, with the objective to evaluate the hypothesis that the safety and the efficacy of DOACs are noninferior to enoxaparin in this population. The primary composite efficacy outcome comprises symptomatic recurrent VTE, death due to VTE, and thrombus progression. The principal safety outcome is a combination of major and clinically relevant nonmajor bleeding.

Results:

The safety and efficacy outcomes collected revealed that DOAC use was equivalent when compared with the enoxaparin group for treatment of VTE. One patient in the DOAC group had clinically relevant, nonmajor bleeding compared with 2 patients in the enoxaparin group. No treatment failures were observed.

Conclusions:

This single-center study suggests that DOACs are both safe and efficacious for the treatment of VTE in children with cancer. It also highlights the need for larger studies to address this clinical question.
Hermansky-Pudlak Syndrome: Spectrum in Oman
Authors: Nazir Hanan F. , AL Sukaiti Nashat , Khater Doaa , Elbeshlawy Ismail , Hassanein Nehad
Published: September 2022

Hermansky-Pudlak syndrome (HPS) is a rare autosomal recessive disorder, characterized by oculocutaneous albinism, a hemorrhagic diathesis secondary to storage pool-deficient platelets, and in some patients’ pulmonary fibrosis, granulomatous colitis, and immunodeficiency. To date, 11 different types of Hermansky-Pudlak syndrome were identified. HPS type 2 is distinctively characterized by severe neutropenia and recurrent sinopulmonary infections. HPS is more common in Puerto Rico, and this is the first report deciphering the genotypic spectrum of HPS in Oman. Between 2001 and 2021, 8 Omani cases with HPS (3 HPS type 2, 1 HPS type 3, and 4 HPS type 6) had been suspected clinically and confirmed through genetic mutation analysis. Patients had mild hemorrhagic phenotype, and variable platelet aggregation defects with different platelet agonists. All patients had characteristic eye manifestations. In addition, patients with HPS type 2 had severe neutropenia. Novel mutations in AP3B1(c.205-1G>C, c.12_13delTA (p.Asn4Lysfs*6) and HPS6 (c.19_20delCT (p. Leu7Alafs*168) were not reported in population variant databases. Diagnosis of HPS had markedly improved in Oman; however, increased clinician awareness is needed. A high index of suspicion and early referral for diagnosis and initiation of proper treatment might help improve outcomes.
Are there other muscle fibers on the orbicularis oris muscle in the upper lip?
Authors: Park Jung-Ah , Rho Nark Kyung , Lee Hye-In , Yeo In-Seung , Koh Ki-Seok , Song Wu-Chul
Published: September 2022

Background:

The elevator muscles of the upper lip are the levator labii superioris alaeque nasi, levator labii superioris, and zygomaticus minor muscles, which function via their insertions into the skin of the upper lip. However, many textbooks and journal articles state that no muscle fibers are present on the orbicularis oris muscle (OOr) in the upper lip. We attempted to determine if there is a superficial muscle layer additional to the OOr in the upper lip.

Methods:

We performed gross dissections of ten formalin-fixed cadavers and applied micro-computed tomography (microCT) to six formalin-fixed cadavers. The fine dissection of the upper lip was performed in a layer-by-layer manner that elucidated its muscle layers. The entire layer of the upper lip was separated and pretreated with phosphotungstic acid for microCT. The samples used for microCT were repurposed for use in histology. An ultrasonography study was also performed.

Results:

The presence of a muscle layer on the OOr was confirmed in all samples. The elevator muscle fibers of the upper lip formed a layer by combining with connective tissue. MicroCT indicated lower terminal insertions of the elevator muscles throughout the upper lip. All parts of the upper lip skin were inserted into the OOr. The histologic findings were similar to those of microCT.

Conclusions:

Our findings could be used to improve aesthetic and surgical procedures performed on the upper lip, such as correction of gummy smile and transverse upper labial crease, or postresection reconstruction of the upper lip.
Breast Shielding Combined With an Optimized Computed Tomography Pulmonary Angiography Pregnancy Protocol
Authors: Gillespie Ciara D. , Yates Andrew , Murphy Mark C. , Hughes Mark , Ewins Karl , NíAinle Fionnuala , Bolster Ferdia , Rowan Michael , Foley Shane , MacMahon Peter J.
Published: September 2022

Objectives:

To determine the impact of breast shields on breast dose and image quality when combined with a low-dose computed tomography pulmonary angiography (CTPA) protocol for pregnancy.

Methods:

A low-dose CTPA protocol, with and without breast shields, was evaluated by anthropomorphic phantom and 20 prospectively recruited pregnant participants from January to October 2019. Thermoluminescent dosimeters measured surface and absorbed breast dose in the phantom and surface breast dose in participants. The Monte-Carlo method estimated the absorbed breast dose in participants. Image quality was assessed quantitatively by regions of interest analysis and subjectively by the Likert scale. Doses and image quality for CTPA alone were compared with CTPA with breast shields.

Results:

Mean surface and absorbed breast dose for CTPA alone were 1.3±0.4 and 2.8±1.5 mGy in participants, and 1.5±0.7 and 1.6±0.6 mGy in the phantom. Shielding reduced surface breast dose to 0.5±0.3 and 0.7±0.2 mGy in the phantom (66%) and study participants (48%), respectively. Absorbed breast dose reduced to 0.9±0.5 mGy (46%) in the phantom.

Noise increased with breast shields at lower kV settings (80 to 100 kV) in the phantom; however, in study participants there was no significant difference between shield and no-shield groups for main pulmonary artery noise (no-shield: 34±9.8, shield: 36.3±7.2, P=0.56), SNR (no-shield: 11.2±3.7, shield: 10.8±2.6, P=0.74) or contrast-to-noise ratio (no-shield: 10.0±3.3, shield: 9.3±2.4, P=0.6). Median subjective image quality scores were comparable (no-shield: 4.0, interquartile range: 3.5 to 4.4, shield: 4.3, interquartile range: 4.0 to 4.5).

Conclusion:

Combining low-dose CTPA with breast shields confers additional breast-dose savings without impacting image quality and yields breast doses approaching those of low-dose scintigraphy, suggesting breast shields play a role in protocol optimization for select groups.
Acellular Dermal Matrix Mimicking a New Retroareolar Mass After Central Pillar Neonipple Reconstruction
Authors: Gherlone Nicole , Sowa Patrick , Osipova Maria , Walton Robert
Published: September 2022

Acellular dermal matrix (ADM) is an increasingly popular alloplastic cadaveric dermis used to enhance postmastectomy reconstruction. Acellular dermal matrix can be used as a nipple-shaped cylinder in central pillar nipple reconstruction to help maintain long-term projection. We report a unique presentation of ADM mimicking a retroareolar mass after central pillar neonipple reconstruction. A 49-year-old woman with a history of invasive ductal carcinoma underwent delayed nipple reconstruction after lumpectomy and oncoplastic closure using an inframammary V-Y advancement flap.

The nipple reconstruction was performed using pretattoo and articulated tab flaps. A rolled tube of acellular dermal matrix was placed in the central aspect of the neonipple reconstruction for projection. At 4 months postoperative, a screening mammogram and ultrasound noted a new retroareolar mass classified as BIRADS 4 necessitating a breast biopsy. Biopsy revealed portions of fibrous connective tissue consistent with partially incorporated acellular dermal matrix allograft. There was no evidence of malignancy. To mitigate the risk of future radiographic or clinical misinterpretation of ADM in nipple reconstruction, the placement of radiopaque markers such as microclips on the ADM implant could be a useful adjunct. Radiologists and surgeons should include ADM artifact in their differential diagnosis of radiologic imaging when evaluating a new mass in the proximity of prior ADM placement in neonipple reconstruction of the breast.
Subnormothermic Ex Vivo Porcine Kidney Perfusion Improves Energy Metabolism: Analysis Using 31P Magnetic Resonance Spectroscopic Imaging
Authors: Agius Thomas , Songeon Julien , Klauser Antoine , Allagnat Florent , Longchamp Grégoire , Ruttimann Raphael , Lyon Arnaud , Ivaniesevic Julijana , Meier Raphael , Déglise Sébastien , Markmann James F. , Uygun Korkut , Buhler Leo , Toso Christian , Corpataux Jean-Marc , Lazeyras Francois , Longchamp Alban
Published: September 2022

Background.

The ideal preservation temperature for donation after circulatory death kidney grafts is unknown. We investigated whether subnormothermic (22 °C) ex vivo kidney machine perfusion could improve kidney metabolism and reduce ischemia-reperfusion injury.

Methods.

To mimic donation after circulatory death procurement, kidneys from 45-kg pigs underwent 60 min of warm ischemia. Kidneys were then perfused ex vivo for 4 h with Belzer machine perfusion solution UW at 22 °C or at 4 °C before transplantation. Magnetic resonance spectroscopic imaging coupled with LCModel fitting was used to assess energy metabolites. Kidney perfusion was evaluated with dynamic-contrast enhanced MRI. Renal biopsies were collected at various time points for histopathologic analysis.

Results.

Total adenosine triphosphate content was 4 times higher during ex vivo perfusion at 22 °C than at 4 °C perfusion. At 22 °C, adenosine triphosphate levels increased during the first hours of perfusion but declined afterward. Similarly, phosphomonoesters, containing adenosine monophosphate, were increased at 22 °C and then slowly consumed over time. Compared with 4 °C, ex vivo perfusion at 22 °C improved cortical and medullary perfusion. Finally, kidney perfusion at 22 °C reduced histological lesions after transplantation (injury score: 22 °C: 10.5 ± 3.5; 4 °C: 18 ± 2.25 over 30).

Conclusions.

Ex vivo kidney perfusion at 22°C improved graft metabolism and protected from ischemia-reperfusion injuries upon transplantation. Future clinical studies will need to define the benefits of subnormothermic perfusion in improving kidney graft function and patient’s survival.