bluuebunny/crossref_metadata_2025 huggingface dataset:
Adaptations and transformations of hunter-gatherers in forest environments: New archaeological and anthropological insights
Authors: Groß Daniel , Piezonka Henny , Corradini Erica , Schmölcke Ulrich , Zanon Marco , Dörfler Walter , Dreibrodt Stefan , Feeser Ingo , Krüger Sascha , Lübke Harald , Panning Diana , Wilken Dennis
Published: June 2019

Like any other living being, humans constantly influence their environment, be it intentionally or unintentionally. By extracting natural resources, they shape their environment and also that of plants and other animals. A great difference setting people apart from all other living beings is the ability to construct and develop their own niche intentionally, and the unique tool for this is cultural behaviour. Here, we discuss anthropogenic environmental changes of hunter-gatherers and present new palaeoecological and palynological data. The studies are framed with ethnoarchaeological data from Western Siberia to gain a better understanding of how different triggers lead to coping mechanisms. For archaeological implication, we use two Mesolithic case studies from Germany: One of them focuses on hazelnut economy around ancient Lake Duvensee, and the other broaches the issue of selective roe deer hunt and its consequences at the site of Friesack. We address the archaeological evidence from the perspective of active alteration and its consequences, starting our argumentation from a perspective of niche construction theory. This approach has rarely been applied to early Holocene hunter-gatherers in Northern Europe even though the available data render possible to discuss human–environment interaction from such a perspective. It is demonstrated that archaeological research has tools at hand that enables to detect anthropogenic niche construction. However, the ethnoarchaeological example shows limitations and archaeologically invisible triggers and consequent results of human adaptations. The critical revision of such perspectives based on empirical data provides a better understanding of social and environmental transformations in the early- and mid-Holocene.
The authoritarian surveillant assemblage: Authoritarian state surveillance in Turkey
Authors: Topak Özgün E
Published: June 2019

This article examines Turkey’s authoritarian state surveillance regime by developing the concept of the authoritarian surveillant assemblage (ASA), building on and expanding the concept of the surveillant assemblage (SA). Turkey’s ASA is the outcome of diverse surveillance systems, which continuously expand their reach, form new connections and incorporate new actors. These systems include a protest and dissent surveillance system, an internet surveillance system, a synoptic media surveillance system and an informant–collaborator surveillance system. Turkey’s ASA is controlled by the Turkish state and serves its repressive interests. Although pivotal in emphasizing the complexity of surveillance connections and increasing diversification of and collaboration among surveillance actors, the SA model of surveillance puts the main emphasis on decentralized, uncoordinated and multifaceted forms of surveillance, and does not offer sufficient analytical space to understand how an authoritarian state could coordinate diverse surveillance systems and use it for the overarching purpose of control. The article draws on Michael Mann’s theory of state power and the authoritarian state to address these limitations of the SA and conceptualize the ASA. It shows how the diverse systems of Turkey’s ASA work in concert with one another under the hierarchical command of Erdoğan’s Justice and Development Party (AKP) to control the population and suppress dissent.
Impact of therapeutic modalities on disease-specific survival in older adults with glioblastoma: A single-institution retrospective cohort study
Authors: Iskandar Andrew S , Kerr Wesley T , Hwang Andrew , Farrell Stephanie , Plaxe Steven C , Dasanu Constantin A
Published: June 2019

The standard first-line therapy for glioblastoma consists of maximal surgical resection, followed by concurrent chemoradiotherapy. Optimal management for older glioblastoma patients is unknown as they have not been extensively studied in clinical trials. We report data from a series of 156 consecutive glioblastoma patients treated at our institution from 2007 to 2017. Compared to glioblastoma patients aged 70 or less, the patients older than 70 were less likely to undergo surgical resection (34% vs. 64%; p = 0.0003), be treated with adjuvant chemotherapy (37% vs. 59%; p = 0.01) or radiation therapy (36% vs. 56%; p = 0.03). Disease-specific survival was significantly shorter in this age group (4.7 vs. 15.3 months; p = 0.002). Nonetheless, when older patients did undergo surgery or chemotherapy, the proportional improvement in cancer-specific survival was similar to the one recorded in younger patients, which is concordant with the findings of other published reports. A multidisciplinary input from neurosurgeons, medical and radiation oncologists, oncology pharmacists and geriatricians remain paramount for the optimal management of glioblastoma in patients older than 70.
Association of Systemic Inflammation and Fatigue in Osteoarthritis: 2007−2010 National Health and Nutrition Examination Survey
Authors: Hackney Alisha J. , Klinedinst N. Jennifer , Resnick Barbara , Johantgen Meg
Published: June 2019

Background/Purpose:

Mechanistic insight into osteoarthritis fatigue is needed as clinical management of this condition is nonspecific. Systemic inflammation is associated with fatigue in other chronic diseases. The purpose of this study was to explore the relationship between systemic inflammation and fatigue in osteoarthritis, while controlling for covariates.

Method:

This secondary analysis with a cross-sectional, multiyear retrospective design used data from the 2007−2010 National Health and Nutrition Examination Survey. Adults with self-reported osteoarthritis who participated in an examination at a mobile center and had no comorbidities associated with fatigue or systemic inflammation were included ( n = 296). Complex sample analysis, independent samples t tests, and χ2 tests of independence were used to explore differences between nonfatigued and fatigued adults with osteoarthritis. Adjusted hierarchical logistic regression models were used to calculate odds of fatigue as a function of two systemic inflammatory markers, C-reactive protein (CRP), and white blood cell (WBC) count.

Results:

Fatigued adults with osteoarthritis had significantly higher CRP levels and WBC counts compared to nonfatigued adults with osteoarthritis. In adjusted logistic regression models, increased CRP was associated with higher odds of fatigue when controlling for age, days affected by pain, depressive symptoms, sleep quantity, and body mass index (Odds ratio [ OR] = 3.38, 95% CI [1.18, 9.69]). WBC count was not associated with higher odds of fatigue when controlling for these variables ( OR = 1.10, 95% CI [0.92, 1.32]).

Conclusion:

Systemic inflammation may have a relationship with fatigue in osteoarthritis. Future work is necessary to replicate these findings in more robust studies.
Lyme-associated uveitis: Clinical spectrum and review of literature
Authors: Bernard Alexia , Seve Pascal , Abukhashabh Amro , Roure-Sobas Chantal , Boibieux Andre , Denis Philippe , Broussolle Christiane , Mathis Thibaud , Kodjikian Laurent
Published: June 2019

Background:

Clinical presentation of Lyme-associated uveitis is poorly described. We reported here a case series of seven patients with uveitis related to Lyme disease and a review of the literature.

Methods:

A retrospective study in our university hospital between 1 May 2003 and 31 July 2016 on 1006 uveitis patients and review of Pubmed library.

Results:

Seven patients (71.4% male, mean age = 53 (38–70)) were diagnosed with a Lyme-associated uveitis. All anatomical types of uveitis were found (four intermediate, three anterior, and three posterior uveitis); most were unilateral (n = 6; 85.7%), one granulomatous and two with synechiae. Peripheral retinal vasculitis was present in four patients. They all had a risk of exposure or extra-ophthalmological symptoms. Antibiotic and steroid treatment was rapidly effective in all patients. Four patients presented recurrences of uveitis, of whom two received a second antibiotic treatment, which is quite common in literature. Persistent or recurrence of symptoms can be explained by three hypotheses: (1) reinfection, (2) relapse of original infection, and (3) autoimmune reaction.

Conclusion:

Lyme-associated uveitis appears varied. Hyalitis and involvement of the posterior segment and retinal vasculitis seem to be rather frequent. Its prognosis is mainly good, even if inflammation can be resistant or recurring.
First-line treatment algorithm and guidelines in center-involving diabetic macular edema
Authors: Kodjikian Laurent , Bellocq David , Bandello Francesco , Loewenstein Anat , Chakravarthy Usha , Koh Adrian , Augustin Albert , de Smet Marc D , Chhablani Jay , Tufail Adnan , García-Layana Alfredo , Sudhalkar Aditya , Mathis Thibaud
Published: June 2019

Management of center-involving diabetic macular edema represents a real therapeutic challenge. Diabetic macular edema is the leading cause of visual acuity impairment in diabetic patients. Since the advent of intravitreal drugs, management of diabetic macular edema has significantly evolved. The historical grid laser photocoagulation is no longer recommended as first-line treatment of diabetic macular edema owing to the findings of the pivotal randomized controlled trials, and anti-vascular endothelial growth factor therapy has emerged as first-line therapy. Steroids also represent a valid treatment option in the management of naïve diabetic macular edema and their efficacy has also been confirmed in several studies. The optimal treatment for diabetic macular edema should consider both general and ophthalmological comorbidities. Patient compliance and motivation should also be carefully evaluated as some treatments require monthly follow-up. Based on recent literature evidence, the present review provides clinicians with a first-line treatment algorithm for center-involving diabetic macular edema tailored to the patient’s individual characteristics.
Rewiring of the Transcription Factor Network in Acute Myeloid Leukemia
Authors: Assi Salam A , Bonifer Constanze , Cockerill Peter N
Published: June 2019

Acute myeloid leukemia (AML) is a highly heterogeneous cancer associated with different patterns of gene expression determined by the nature of their DNA mutations. These mutations mostly act to deregulate gene expression by various mechanisms at the level of the nucleus. By performing genome-wide epigenetic profiling of cis-regulatory elements, we found that AML encompasses different mutation-specific subclasses associated with the rewiring of the gene regulatory networks that drive differentiation into different directions away from normal myeloid development. By integrating epigenetic profiles with gene expression and chromatin conformation data, we defined pathways within gene regulation networks that were differentially rewired within each mutation-specific subclass of AML. This analysis revealed 2 major classes of AML: one class defined by mutations in signaling molecules that activate AP-1 via the mitogen-activated protein (MAP) kinase pathway and a second class defined by mutations within genes encoding transcription factors such as RUNX1/CBFβ and C/EBPα. By identifying specific DNA motifs protected from DNase I digestion at cis-regulatory elements, we were able to infer candidate transcription factors bound to these motifs. These integrated analyses allowed the identification of AML subtype-specific core regulatory networks that are required for AML development and maintenance, which could now be targeted in personalized therapies.
A Review of Studies Evaluating Insecticide Barrier Treatments for Mosquito Control From 1944 to 2018
Authors: Stoops Craig A , Qualls Whitney A , Nguyen Thuy-Vi T , Richards Stephanie L
Published: June 2019

Background and Purpose:

Barrier insecticide treatments have a long history in mosquito control programs but have been used more frequently in the United States in recent years for control of invasive “backyard” species (eg, Aedes albopictus) and increases in incidence of vector-borne diseases (eg, Zika).

Methods:

We reviewed the published literature for studies investigating barrier treatments for mosquito control during the last 74 years (1944-2018). We searched databases such as PubMed, Web of Science, and Google Scholar to retrieve worldwide literature on barrier treatments.

Results:

Forty-four studies that evaluated 20 active ingredients (AIs) and 21 formulated products against multiple mosquito species are included. Insecticides investigated for efficacy included organochlorines (dichlorodiphenyltrichloroethane [DDT], β-hexachlorocyclohexane [BHC]), organophosphates (malathion), and pyrethroids (bifenthrin, deltamethrin, permethrin, lambda-cyhalothrin) as AIs. Study design varied with multiple methods used to evaluate effectiveness of barrier treatments. Barrier treatments were effective at lowering mosquito populations although there was variation between studies and for different mosquito species. Factors other than AI, such as exposure to rainfall and application equipment used, also influenced control efficacy.

Conclusions:

Many of the basic questions on the effectiveness of barrier insecticide applications have been answered, but several important details still must be investigated to improve precision and impact on vector-borne pathogen transmission. Recommendations are made to assist future evaluations of barrier treatments for mosquito control and to limit the potential development of insecticide resistance.
The refeudalization of modern capitalism
Authors: Neckel Sighard
Published: June 2019

Jürgen Habermas once investigated the structural transformation of the modern public using the term ‘refeudalization’. He reconstructed how, in the course of the development of economic monopolies, pre-bourgeois forms of power again penetrated the public sphere. It is not only the fact that the social sciences today speak again of a crisis of the public sphere, however, that gives Habermas’ concept of ‘refeudalization’ new relevance. On the contrary, a social change is taking place in numerous areas of present-day society which, in the course of a neoliberal modernization of the economy, is once again re-creating pre-modern social forms, hierarchies and power structures. This does not take place as a relapse into past social forms, but as a paradoxical result of social transformations that generate the old as the new and thereby produce ‘neo-feudal’ patterns in the distribution of wealth, recognition and power. In this paper ‘refeudalization’ is presented as a key concept for understanding the development of modern capitalist societies today. It will be shown that the dichotomy of ‘progressive’ and ‘regressive’ forms of transformation of capitalism must be complemented by more complex models of paradoxical social change.
“Our quality is a little bit different”: How family childcare providers who participate in a Quality Rating and Improvement System and receive childcare subsidy define quality
Authors: Hooper Alison , Hallam Rena , Skrobot Christine
Published: June 2019

This research uses focus group methodology to examine how a specific subset of family childcare providers—those participating in a voluntary quality rating and improvement system and serving a high percentage of children receiving childcare subsidy—define quality. The study builds on the limited existing research about family childcare quality, especially research focused on understanding quality from the perspective of the childcare provider. A total of 28 family childcare providers participated in three focus groups where they were asked to define quality and to describe high- and low-quality programs. Qualitative analysis revealed four themes: relationships, supporting children’s learning, the physical and temporal environment, and personal professionalism. These results can inform how quality improvement initiatives and professional development systems support and engage family childcare providers.
Movie scene segmentation using object detection and set theory
Authors: Haq Ijaz Ul , Muhammad Khan , Hussain Tanveer , Kwon Soonil , Sodanil Maleerat , Baik Sung Wook , Lee Mi Young
Published: June 2019

Movie data has a prominent role in the exponential growth of multimedia data over the Internet, and its analysis has become a hot topic with computer vision. The initial step towards movie analysis is scene segmentation. In this article, we investigated this problem through a novel intelligent Convolutional Neural Network (CNN) based three folded framework. The first fold segments the input movie into shots, the second fold detects objects in the segmented shots and the third fold performs object-based shots matching for detecting scene boundaries. Texture and shape features are fused for shots segmentation, and each shot is represented by a set of detected objects acquired from a light-weight CNN model. Finally, we apply set theory with the sliding window–based approach to integrate the same shots to decide scene boundaries. The experimental evaluation indicates that our proposed approach outran the existing movie scene segmentation approaches.
The ‘agitation bubble ‘contrast’’ technique: A technique for using intra-peritoneal free air as contrast for the diagnosis of organ perforation
Authors: Ward James , Samuels Theophilus , Andorka Matyas
Published: June 2019

We report a case using a novel ultrasound technique to diagnose suspected bowel perforation in the presence of peritoneal fluid. Our technique removed the need for radiological confirmation and expedited surgical intervention. This highlights the potential for using this bedside ultrasonographic technique to detect free peritoneal gas in the presence of peritoneal fluid secondary to viscus perforation.
The efficacy of adding budesonide/formoterol to ipratropium plus theophylline in managing severe chronic obstructive pulmonary disease: an open-label, randomized study in China
Authors: Huang Kewu , Guo Yanfei , Kang Jian , An Li , Zheng Zeguang , Ma Lijun , Peng Liping , Wang Hongyang , Su Rong , Itoh Yohji , Wang Chen
Published: June 2019

Background:

Patients diagnosed with chronic obstructive pulmonary disease (COPD) in China are commonly prescribed ipratropium plus theophylline (I+T) therapy. Studies have shown that an inhaled corticosteroid (ICS)/long-acting β2-agonist (LABA) combination is also efficacious in reducing symptoms and exacerbations. This study evaluated the efficacy and tolerability of adding budesonide/formoterol (BUD/FORM) to I+T in Chinese patients with severe COPD.

Methods:

A randomized, parallel-group, open-label, multicenter phase IV study (Clinical Trials.gov identifier: NCT01415518) was conducted in China. Patients received either BUD/FORM (160/4.5 µg; two inhalations twice daily [bid] via Turbuhaler®) + I (20 µg per inhalation, two inhalations four times daily) + T (100 mg bid) or I+T alone for 12 weeks. The primary efficacy variable was change from baseline in predose forced expiratory volume in 1 s (FEV1).

Results:

A total of 584 patients were randomized equally between treatment groups. At the end of the study, the BUD/FORM plus I+T group displayed significant improvements in predose FEV1 versus the I+T group (between-group difference 6.9%; 95% confidence interval [CI]: 4.3, 9.6; p < 0.0001). Forced vital capacity, inspiratory capacity, peak expiratory flow and health-related quality of life (HRQoL) scores were significantly improved (all p < 0.0001) and exacerbation frequency was reduced (43.5% reduction; rate ratio 0.565, 95% CI 0.325, 0.981; p = 0.0425) with BUD/FORM plus I+T versus I+T alone.

Conclusion:

Patients with severe COPD in China treated with BUD/FORM plus I+T showed significant improvements in lung function and HRQoL and a reduction in exacerbations compared with I+T alone. Both treatments were well tolerated and no safety concerns were noted. The reviews of this paper are available via the supplemental material section.
Cicadamides A and B, N-Acetyldopamine Dimers From the Insect Periostracum cicadae
Authors: Liu Huan , Yan Yong-Ming , Liao Li , Wang Shao-Xiang , Zhang Yi , Cheng Yong-Xian
Published: June 2019

Two new N-acetyldopamine dimers, cicadamides A (1) and B (2), and 8 known compounds were isolated from the medicinal insect Periostracum cicadae. Their structures including absolute configurations were assigned by spectroscopic and computational methods. Biological activities of compounds 1, (+)-2, and (–)-2 toward human cancer cells BGC-823, HepG2, and A549 were evaluated.
Beneficial Effects on Cosmetic Activity by Optimizing the Calamondin Orange Extraction Process
Authors: Kim Yu M. , Seo Seung B.
Published: June 2019

This study expands the usage of Citrus madurensis ( Citrofortunella microcarpa), which is a good source of skin whitening and antioxidants activation in cosmetics. The goal of this study is to provide cosmeceutical activity data about the extraction yield and total polyphenol of calamondin orange by optimizing the focused high ultrasound (INEFU), ultrasound extraction (UE), and water extraction (WE) conditions. Under optimal extraction conditions, which consisted of 1800 W for 45 minutes (INEFU) and 500 W for 45 minutes (UE), 21.55% (w/w) and 13.27% (w/w) of the highest extractions yield and total polyphenol content was obtained. For the skin whitening activity, tyrosinase inhibitory activity was observed at 69.28% in the INEFU extracts, which was 69.24% higher than that of the UE extracts (58.82%). To reduce melanin production in Clone M-3 cells, 86.9% melanin production was observed following the addition of control, WE relative to the control without a sample, and 81.2% and 78.9% were found in the UE and INEFU conditions, respectively. The highest total phenol secretion was conclusively obtained under the optimal conditions and resulted in a significant improvement of the cosmetic activities of C. madurensis ( C. microcarpa)-based cosmeceutical ingredient.
I Earn It, But They Just Get It: Loyalty Program Customer Reactions to Unearned Preferential Treatment in the Social Servicescape
Authors: Kim Youngsun Sean , Baker Melissa A.
Published: June 2019

Hospitality and tourism firms use two different strategies in customer relationship management: rewarding loyalty program customers with earned rewards (earned preferential treatment) and delighting the nonprogram customers with surprise rewards (unearned preferential treatment). However, research overlooks the key impact of how these two customer relationship management strategies may negatively affect the observing loyalty program customers. To address these gaps, Study 1 finds that providing a nonprogram customer with a high-value unearned treatment significantly decreases perceptions of distributive justice, status, and loyalty among the observing loyalty program customers. No significant interaction effects of a firm’s explanation were found, suggesting that the practice of unearned preferential treatment cannot be justified simply by presenting a reason for the practice. Study 2 finds that compensating the affected program customers with tangible compensation is the only significant factor that enhances the observing loyalty program customers’ perceived trust, suggesting rebuilding customers’ trust as the key element in recovery. This research is grounded in social comparison and justice theory and builds upon the loyalty, social servicescape, and customer delight literature to explicitly examine the reward comparison stemming from the social presence of other customers.
Effect of Bisphosphonates on Bone Health in Adult Renal Transplant Patients: Beyond the First Year Posttransplant—A Systematic Review and Meta-Analysis
Authors: Lip Alyssa , Warias Ashley , Shamseddin M. Khaled , Thomson Benjamin , Wijeratne D. Thiwanka
Published: June 2019

Background:

Bone mineral density (BMD) decreases postrenal transplantation. Evidence demonstrating the effects of bisphosphonates on BMD and fracture risk beyond 1-year posttransplant is sparse in existing literature, but remains essential to enhance clinical outcomes in this population.

Objective:

Our study aimed to systematically review and meta-analyze the current literature on the use of any bisphosphonate in the adult renal transplant population beyond the first year of renal transplant to determine its effect on BMD and fracture incidence.

Design:

We conducted a systematic review and meta-analysis of primary research literature that included full-text, English-language, original randomized clinical trials (RCTs) and observational studies.

Setting:

Patient data were primarily captured in an outpatient setting across various studies.

Patients:

Our population of interest was patients older than 18 years who received deceased/living donor kidney transplantation and any bisphosphonate with a follow-up greater than 12 months posttransplantation.

Measurements:

The primary outcome was change in BMD from baseline. Secondary outcomes were the incidence of fractures and effects of other confounders on bone health.

Methods:

We included RCTs and observational studies that satisfied our inclusion criteria. Each study was analyzed for risk of bias and data were extrapolated to analyze for overall statistical significance accounting for heterogeneity of studies.

Results:

Sixteen studies (N = 1762) were analyzed. The follow-up ranged from 12 to 98 months. There was a nonsignificant improvement in BMD with bisphosphonate treatment persisting into the second and third years posttransplant at the lumbar spine. The calculated standardized mean BMD difference was −0.29 (−0.75 to 0.17), P = .22. Only 5 studies reported a total of 43 new fractures. Prednisone ( P < .01), low body weight ( P < .001), low body mass index ( P < .01), and male gender ( P < .05) correlated with reduced lumbar and femoral BMD.

Limitations:

Limitations of this review include the use of BMD as a surrogate outcome, the bias of the included studies, and the incomplete reporting data in numerous analyzed studies.

Conclusions:

We demonstrate no statistically significant benefit of bisphosphonate treatment on BMD beyond the first year postrenal transplantation. Despite heterogeneity of treatment, a differential nonsignificant improvement in lumbar spine BMD was consistent and may be clinically relevant.

Trial Registration:

PROSPERO CRD42019125593
No dynamic extrusion in medial meniscus root lesions - an ultrasound study
Authors: Karpinski Katrin , Petersen Wolf
Published: June 2019

Aims and Objectives:

Extrusion of the medial meniscus in MRI is an indirect radiological sign for a meniscus root tear. However, a recent study has shown that ultrasound-detectable dynamic extrusion is considered physiological in healthy volunteers. The aim of our study was to analyze the dynamic meniscal extrusion in patients with proven root injury in ultrasound. Our hypothesis was that dynamic extrusion is reduced in patients with root injury of the medial meniscus compared to healthy volunteers.

Materials and Methods:

Inclusion criteria for this prospective study were MRI signs for a root lesion of the medial meniscus (ghost sign, extrusion > 3 mm). An age matched group of healthy volunteers served as control. Exclusion criterion was osteoarthritis > II° of the medial compartment according to Kellgren & Lawrence. The extrusion of the medial meniscus (MME) of the affected knee was measured by ultrasound (US) in supine position and under full weight bearing.

Results:

25 patients with a medial root lesion were included in the study. The evaluation of the ultrasound results revealed a significant decreased dynamic medial displacement of the meniscus in patients with root injury. In the supine position, the mean medial meniscus extrusion was 3.60 mm (± 1.00 mm). In the standing position, the mean medial meniscus extrusion increased to 3.72 mm (± 0.96 mm). The mean delta-extrusion was 0.11 mm (± 0.17 mm). This difference was statistically not significant. In 14 patients, no dynamic extrusion was detectable at all. All patients belonging to the medial root tear group had a significant varus deformity (mechanical axis hits the tibial joint line more than 15 mm medially form the center). In the control group, the mean medial meniscus extrusion was 1.34 mm (± 0.37 mm) in supine position and 2.20 mm (± 0.34 mm) under full weight bearing. The mean delta-extrusion was 0.85 mm (± 0.30 mm). The difference in mean delta-extrusion between the root tear and control group was statistically significant.

Conclusion:

Ultrasonography is a diagnostic tool to detect the dynamic extrusion of the medial meniscus. Lack of dynamic extrusion (“dead meniscus sign”) may serve as an indicator for medial root injury.
Clinical 2 years results after implantation of patient-specific mini-metal implants in middle-aged patients alfter previous frustrane cartilage surgery
Authors: Kösters Clemens , Glasbrenner Johannes , Raschke Michael J.
Published: June 2019

Aims and Objectives:

The treatment of focal (osteo-)chondral lesions of the knee in middle-aged patients with previous frustane cartilage regeneration is challenging. This prospective study presents clinical 2 years results after implantation of patient-specific mini-metal implants.

Materials and Methods:

Based on a three dimensional MRI planing 7 patient-specific mini-metal implants (Episealer, Episurf, Stockholm, Sweden) were produced for 4 patients (2 men, 2 women). In one patient a single implant was implanted to the trochlea, the other 3 patients received each a trochlea and a medial condyle implant. Corresponding cartilage lesions in the tibia plateau or retropatellar surface were excluded by a detailed specific MRI resulting in a so called “damage report”. MRI data was used to manufacture patient-specific implants and guide instruments, to fit the unique anatomy of each individual knee. Demographic, operative and clinical scores (VAS of pain and patient satisfaction, KOOS and Forgotten Joint Score) were collected preop and at 6 months, 1 and 2 years postoperatively.

Results:

Mean age was 51.5 (47-57) years. All patients had failed previous cartilage surgery. All mean KOOS domain scores were improved at 1 and 2 years. Mean preoperative aggregated KOOS (35) improved to 60 at 12 months and remained at 60 also at 24 months. Mean VAS score (pain) improved from 7.4 preoperatively to 2.1 at 24 months, mean VAS score (patient satisfaction) improved from 3.1 to 8.5 postoperatively at 24 months. The forgotten joint score reached a mean of 24 points. No revisions or complications were detected.

Conclusion:

Despite a very small patient number and leck of statistical power the new patient-spedific mini-metal implant seems to be a good options fort he treatment of middle-aged patients who already underwent frustane cartilage surgery. In these relatively rare caes early unicompartimental arthroplasty can be prevented. Further clinical studies with larger patient collectives have to prove the effectiveness of this new technique.
General, regional and combination anesthesia in knee arthroplasty: A multicenter cohort-study of 15326 cases analyzing patient satisfaction and perioperative pain management
Authors: Greimel Felix , Maderbach Günther , Baier Clemens , Keshmiri Armin , Schwarz Timo , Zeman Florian , Meissner Winfried , Grifka Joachim , Benditz Achim
Published: June 2019

Aims and Objectives:

In recent years, a steadily increasing number of total knee arthroplasty implants have been reported. After having ameliorated operation techniques and material, pain management and anesthetic methods have come into focus. Various anesthesia procedures for the surgical procedure itself as well as pain management programs have been developed. One of the main goals is to reduce postoperative pain and enable better and faster mobilization in the postoperative period. The present study aims to compare the use of general and regional anesthesia and their combination in terms of perioperative pain management and patient satisfaction.

Materials and Methods:

In the present cohort study, 15.326 patients were examined in 46 orthopedic departments after knee replacement surgery from 2009-2015. The parameters were analyzed on the first postoperative day as part of the project “QUIPS - Quality Improvement in Postoperative Pain Management”, an initiative to compare the outcome parameters in participating hospitals. Primary outcome values were pain levels (activity, minimum and maximum pain, and pain management satisfaction) on a NRS scale. Pain medication necessity was analyzed using the WHO pain ladder classification. Parameters were compared between the types of anesthesia used: general, regional and combination anesthesia.

Results:

Pain scores and pain management satisfaction were significantly better in the groups of either spinal or peripheral anesthesia combined with general anesthesia (p0.001, respectively). Patients who received the combination of general and spinal anesthesia were associated with the lowest need for opioids (p0.001).

Conclusion:

The use of a combined general and spinal anesthesia as well as using a combination of general and peripheral anesthesia in knee arthroplasty was associated with a highly significant advantage to other anesthetic techniques regarding perioperative pain management in daily clinical practice, but maybe below clinical relevance. Furthermore they were associated with positive tendency considering side effects and subjective well-being parameters.
The irreducible knee-luxation after low-velocity trauma
Authors: Fehske Kai , Jordan Martin , Meffert Rainer
Published: June 2019

Aims and Objectives:

Knee-luxations are severe and rare injuries. Within the last years there is an incline on low velocity trauma leading to a nee-luxation. The luxated knee should be reduced immediately to minimize collateral damage to soft-tissue structures, nerves, vessels, etc.

Materials and Methods:

We report about a 87-year old man who was brought to our emergency room after he fell out of his bed. He showed a to the lateral side luxated tibial-head, which could not be reduced in analog sedation. The foot pulses could be measured with the Doppler, the patient was under massive pain so we decided to perform an immediate operative intervention. Even under maximum relaxtion the knee stayed in medial luxation.

Results:

The open reposition showed the destruction of all medial structures including the subcutaneous fat. The medial condyle was completely uncovered. The sartorious fascia, the ruptured M. vastus medialis and fibres of the medial collateral ligament have been trapped in the medial tibial joint line. The reposition was made possible by incision of the sartorious fascia. The tibially ruptured acl was refixated in a modified canula technique, the medial structures were adapted with sutures and additionally stabilized with ligament bracing for the medial collateral ligament. Postoperatively, the knee was immobilized in an external fixation for two week. Afterward we started with functional rehabilitation. The postoperatively obtained CT-angiography showed now traumatic vascular damage. This case is completely foto-documented.

Conclusion:

The irreducible knee-luxations are rare complications. So far there are 4 cases published. In all cases there has been an interposition of the musculus vastus medialis an the surrounding structures. An immediate open intervenvtion to reposition the knee has to be performed to avoid severe damage to. Especially the elderly patient benefits from a single-staged procedure to reconstruct the ruptured ligaments. To realize the best outcome early functional rehabilitation under close supervision of the surgeon is necessary.
Smritichitre: The Memoirs of a Spirited Wife
Authors: Richard H. L.
Published: June 2019

This article reviews a new translation of a classic work of Marathi literature, the autobiography of Lakshmibai Tilak, which tells the story of her life with the great Christian poet Narayan Vaman Tilak. Three English translations of the autobiography are compared, and the story of the Tilaks is summarized. The meaning of discipleship to Jesus in Hindu contexts is explored. The challenge of translation is apparent, and appeal is made for further mining of Marathi original writings to bring out in yet deeper ways the genius and significance of Tilak.
Novel Targets for Fast Antidepressant Responses: Possible Role of Endogenous Neuromodulators
Authors: Camargo Anderson , Rodrigues Ana Lúcia S.
Published: June 2019

The available medications for the treatment of major depressive disorder have limitations, particularly their limited efficacy, delayed therapeutic effects, and the side effects associated with treatment. These issues highlight the need for better therapeutic agents that provide more efficacious and faster effects for the management of this disorder. Ketamine, an N-methyl-D-aspartate receptor antagonist, is the prototype for novel glutamate-based antidepressants that has been shown to cause a rapid and sustained antidepressant effect even in severe refractory depressive patients. Considering the importance of these findings, several studies have been conducted to elucidate the molecular targets for ketamine’s effect. In addition, efforts are under way to characterize ketamine-like drugs. This review focuses particularly on evidence that endogenous glutamatergic neuromodulators may be able to modulate mood and to elicit fast antidepressant responses. Among these molecules, agmatine and creatine stand out as those with more published evidence of similarities with ketamine, but guanosine and ascorbic acid have also provided promising results. The possibility that these neuromodulators and ketamine have common neurobiological mechanisms, mainly the ability to activate mechanistic target of rapamycin and brain-derived neurotrophic factor signaling, and synthesis of synaptic proteins in the prefrontal cortex and/or hippocampus is presented and discussed.
The Role of Informal Local Institutions in Food Security of Rural Households in Southwest Ethiopia
Authors: Negera Chimdessa Uma , Bekele Adugna Eneyew , Wondimagegnehu Beneberu Assefa
Published: June 2019

Among sub-Saharan countries, Ethiopia is known for its dominant informal institutions and chronic problem of food insecurity. However, the role of local institutions in households' food security in Ethiopia is less understood. Thus, the aim of the study was to identify local informal institutions and their roles in household food security. Mixed methods research was used to collect and analyse data relating to membership in local institutions and their food consumption. A logit model was employed to identify the role of local institutions in households' food security. The result showed that 45.1 per cent of households were food insecure. Rural households' membership in Iddir, Equib, Debo and Jarsumma strongly helped them escape food insecurity. On the one hand, participation in women's associations and Jiga did not significantly contribute to their food security. On the other hand, Dado was found to reduce their food security. We conclude that the programmes and policies that target food security should provide support to those informal institutions that successfully contributed to hunger reduction.
Cost Effectiveness of Multigene Panel Sequencing for Patients With Advanced Non–Small-Cell Lung Cancer
Authors: Steuten Lotte , Goulart Bernardo , Meropol Neal J. , Pritchard Daryl , Ramsey Scott D.
Published: June 2019

PURPOSE

Compared with single-marker genetic testing (SMGT), multigene panel sequencing (MGPS) has the potential to identify more patients with cancer who could benefit from targeted therapies, but the effects on outcome and total cost of care are uncertain. Our goal was to estimate the clinical and cost effectiveness of MGPS versus SMGT among patients with advanced non–small-cell lung cancer (aNSCLC).

METHODS

Patients with aNSCLC—stage IIIB or metastatic—who were diagnosed between 2011 and 2016 were identified from the Flatiron Health database. After stratifying patients into MGPS or SMGT cohorts, we analyzed the percentage of patients who received targeted treatment, survival, and total costs of care. SMGT included epidermal growth factor receptor ( EGFR) and anaplastic lymphoma kinase testing. MGPS also allowed for the detection of BRAF, RET, ROS1, HER2, and MET mutations. Cost data sources were the Centers for Medicare & Medicaid Services Fee Schedule and 2017 average sales price drug cost. We estimated the incremental cost-effectiveness ratio from a US payer perspective over a lifetime horizon using a decision model.

RESULTS

We identified 5,688 patients with aNSCLC who received MGPS (n = 875) or SMGT (n = 4,813), of which 22% tested positive for epidermal growth factor receptor (18.5% MGPS; 17.3% SMGT) or anaplastic lymphoma kinase (3.59% MGPS; 3.78% SMGT). Among MGPS-tested patients, an additional 8% were found to have BRAF, RET, ROS1, HER2, or MET mutations. Of MGPS-tested patients, 21% received treatments that were targeted to the specific mutations versus 19% with SMGT. Expected survival was 1.14 life years (LYs) in SMGT versus 1.20 LYs in MGPS. Lifetime total costs were $8,814 higher per patient for MGPS. The incremental cost-effectiveness ratio of MGPS versus SMGT was $148,478 per LY gained.

CONCLUSION

On the basis of data from a nationwide oncology patient database, MGPS is shown to have moderate cost effectiveness compared with SMGT in patients with aNSCLC.
Effect of Rifaximin Treatment on Endotoxemia and Insulin Sensitivity in Humans
Authors: Finlin Brian S , Zhu Beibei , Boyechko Tania , Westgate Philip M , Chia Chee W , Egan Josephine M , Kern Philip A
Published: June 2019

Context

The gut microbiome is a source of inflammatory factors such as lipopolysaccharide (LPS; endotoxin) that influence metabolic homeostasis. Rifaximin is a well-tolerated antibiotic that may reduce LPS.

Objective

We sought to develop a method to accurately assess postprandial endotoxemia and to determine whether rifaximin treatment improves metabolic homeostasis in obese humans with metabolic syndrome.

Design and Setting

Plasma LPS, adipose inflammation, glucose and lipid metabolism, and insulin sensitivity were evaluated in a clinical research setting.

Participants

Twelve obese human research participants with prediabetes or three features of metabolic syndrome participated.

Intervention

The research participants were randomized to placebo control or rifaximin soluble solid dispersion (80 mg/d) treatment groups and treated for 12 weeks.

Outcome Measures

We evaluated changes in insulin sensitivity with a euglycemic clamp; changes in lipid and glucose metabolism with oral lipid and glucose tolerance tests; changes in plasma LPS during the lipid tolerance test; and changes in adipose tissue and systemic inflammation by measuring inflammatory cytokines.

Results

Rifaximin treatment slightly worsened insulin sensitivity (P = 0.03), did not improve glucose or lipid homeostasis, and did not significantly improve adipose tissue inflammation. Our efforts to accurately assess plasma LPS using limulus amebocyte lysate assays revealed that the majority of LPS is masked from detection by limulus amebocyte lysate assays, but can be unmasked using a pretreatment step with protease. Unmasked LPS increases during the lipid tolerance test, but rifaximin treatment did not reduce this.

Conclusions

Rifaximin treatment did not lower plasma LPS or improve metabolic homeostasis in obese humans.
The Political Legacy of Entertainment TV
Authors: Durante Ruben , Pinotti Paolo , Tesei Andrea
Published: June 2019

We study the political impact of commercial television in Italy exploiting the staggered introduction of Berlusconi’s private TV network, Mediaset, in the early 1980s. We find that individuals with early access to Mediaset all-entertainment content were more likely to vote for Berlusconi’s party in 1994, when he first ran for office. The effect persists for five elections and is driven by heavy TV viewers, namely the very young and the elderly. Regarding possible mechanisms, we find that individuals exposed to entertainment TV as children were less cognitively sophisticated and civic-minded as adults, and ultimately more vulnerable to Berlusconi’s populist rhetoric. (JEL D72, L82, M31, Z13)
Cross-sectional study of IgG antibody levels to invasive nontyphoidal Salmonella LPS O-antigen with age in Uganda
Authors: Stockdale Lisa , Nalwoga Angela , Nash Stephen , Elias Sean , Asiki Gershim , Kusemererwa Sylvia , Gilchrist James J. , Newton Robert , MacLennan Calman A.
Published: June 2019

Invasive nontyphoidal Salmonella (iNTS) disease is a major cause of deaths among children and HIV-infected individuals in sub-Saharan Africa. Acquisition of IgG to iNTS lipopolysaccharide (LPS) O-antigen in Malawi in early childhood corresponds with a fall in cases of iNTS disease suggesting that vaccines able to induce such antibodies could confer protection. To better understand the acquisition of IgG to iNTS in other African settings, we performed a cross-sectional seroepidemiological study using sera from 1090 Ugandan individuals aged from infancy to old age. Sera were analysed for IgG to LPS O-antigen of S. Typhimurium and S. Enteritidis using an in-house ELISA. Below 18 months of age, most children lacked IgG to both serovars. Thereafter, specific IgG levels increased with age, peaking in adulthood, and did not wane noticeably in old age. There was no clear difference in antibody levels between the sexes and the few HIV-infected individuals in the study did not have obviously different levels from uninfected subjects. While IgG to iNTS is acquired at a younger age in Malawian compared with Ugandan children, it is not clear whether this is due to differences in the populations themselves, their exposure to iNTS, or variations between assays used. In conclusion, there is a need to develop a harmonised method and standards for measuring antibodies to iNTS across studies and to investigate acquisition of such antibodies with age across different sites in sub-Saharan Africa.