bluuebunny/crossref_metadata_2025 huggingface dataset:
Novel Melano-Cortin-2-Receptor Gene Mutation Presenting With Infantile Cholestasis: A Case Report
Authors: Alsaedi Abdulaziz , Kamal Naglaa M , Bakkar Ayman , Althobaiti Enad , Naeem Muhammad , Kamal Mohamed
Published: April 2022

Introduction:

For many years, congenital panhypopituitarism has been recognized to cause infantile cholestasis. However, the isolated cortisol deficiency as a cause of cholestasis and liver failure was rarely reported.

Case description:

A 32-days old male infant presented to the hepatology clinic with infantile cholestasis. His initial workup revealed alanine transaminase (ALT) level of 138 U/L, aspartate transaminase level of 76 U/L, total bilirubin (T.Bil) of 103 mmol/L, direct bilirubin of (D.Bil) 83 mmol/L, gamma-glutamyl transpeptidase (GGT) level of 28 U/L with normal prothrombin time (PT) of 13 seconds. One week later, the patient developed severe bronchiolitis necessitating mechanical ventilation associated with acute liver failure and worsening cholestasis. His ALT increased to 303.5 U/L and direct bilirubin increased to 204 mmol/L with prolongation of PT to 18.9 seconds reflecting derangement in synthetic liver functions. There was associated hypoglycemia, hyponatremia and high normal potassium level with a picture of adrenal insufficiency. Hormonal workup and genetic testing revealed isolated cortisol deficiency with a novel homozygous mutation c.763_764delAT (p. Met255ValfsX17) in Melanocortin 2 receptor gene ( MC2R) and the patient was diagnosed as familial primary glucocorticoid deficiency. The patient was maintained on cortisol replacement therapy with the resolution of cholestasis and normalization of liver functions.

Conclusions:

Patients presenting with infantile cholestasis associated with documented hypoglycemia should alert pediatricians about the possibility of familial glucocorticoid deficiency and prompt investigation of adrenal function should be considered. Cortisol replacement therapy leads to the resolution of cholestasis.
Large Cystic Mass of the Pancreatico-Duodenal Region Revealing Duodenal Lymphatic Malformation: A Case Report
Authors: Belkouchi Lina , Saouab Rachida , Boualiten Khadija , Aourarh Benayad , Adioui Tarik , Essaoudi Mohamed Amine , Kessab Amine
Published: April 2022

Lymphatic malformations are benign tumors rarely located in the gastro-intestinal tract. They are usually asymptomatic; however, they can cause clinical discomfort when enlarged.

Imaging leads to diagnosis, but the confirmation can only be done through histology findings.

We report the case of a 59-year-old male patient, admitted in our ward for melena, to which esophago-gastroduodenoscopy showed budding formations in the second portion of the duodenum wall, with Magnetic Resonance Imaging features and histological examination confirming diagnosis of a duodenal lymphatic malformation.
Type B Interrupted Aortic Arch With a Very Large Right Subclavian Artery Aneurysm in an Adult
Authors: Shakerian Behnam , Jebelli Mohammad , Mandegar Mohammad Hossein
Published: April 2022

Interruption of the aortic arch and right subclavian artery aneurysm is a rare congenital malformation. Survival in adults depends on the formation of collaterals to supply the descending aorta. The interruption of the aortic arch must be taken into account, particularly in patients with hypertension and weak pulses in the lower extremities. We present a case of aortic arch interruption and a right subclavian artery aneurysm in a woman who survived to adulthood.
Structural damage detection by integrating robust PCA and classical PCA for handling environmental variations and imperfect measurement data
Authors: Xu Mingqiang , Li Jun , Wang Shuqing , Hao Hong , Tian Huiyuan , Han Jie
Published: April 2022

This paper proposes a vibration-based structural damage detection approach considering the effects of uncertainties, including environmental variations and random errors that possibly stem from measurement and automatic modal identification. The existing methods that only employ the classical Principle Component Analysis (PCA) have been demonstrated effective to remove the effects of environmental variations while extremely sensitive to random errors. Therefore, the robust PCA is firstly introduced to remove the random errors, especially outliers, that significantly corrupt the low-rank property of the stacked damage sensitive feature (DSF) matrix. Then, the classical PCA is used to extract the environmental variation-free residues, which are inherently damage-dependent and can be used to detect the existence of damage. The problem of missing data is also considered in this study. It is tackled by adding virtual random errors to the locations of missing entities and thus can be addressed by the introduced robust PCA. The advantages of the proposed approach include: (1) Handling the random error-contaminated DSF data regardless of the error’s amplitude, which is an intractable problem for the existing classical PCA-based methods to consider the environmental effects; (2) Damage detection process can be automatic since the missing data can be automatically predicted and the random errors are not required to be manually distinguished. The effectiveness and performance of the proposed method are demonstrated on a numerical beam structure and an experimentally tested wooden bridge model.
Cross-cultural engagement through translated news: A reception analysis
Authors: Scammell Claire , Bielsa Esperança
Published: April 2022

Scholars in journalism and media studies have reflected on the cosmopolitan potential of the media and of news in particular to facilitate cross-cultural engagement. However, the key mediating role that translation plays when the news crosses linguistic and cultural borders has remained largely unexamined. This article considers how different translation strategies can maximise or minimise the potential journalism holds to facilitate cross-cultural engagement and approaches the still widely unexplored area of the reception of translated news. It relates existing debates in the discipline of translation studies to current approaches to the domestication of news in journalism research, paving the way for synergetic research across traditional disciplinary boundaries. The article explores how the news has the potential to equip readers with the cultural competence they need in a world that they share with others they do not understand, but only if journalistic translation practices promote rather than prevent engagement with the foreign cultural context. It discusses the findings of an exploratory focus-group study that compares the response of readers to news reporting translated according to the current norm for domesticating translation strategies with the response of readers to the same reports translated using an experimental ‘foreignised’ approach. The focus-group investigation, which takes Reuters’ English-language reporting on news from France as a case study, finds indications that the foreignised approach, by exposing the reader to the foreign cultural specificity rather than domesticating the news information using terms available in the target culture and language, is successful in facilitating cross-cultural engagement.
Worker collectivity in child welfare: Mobilising action and commitment through team meetings
Authors: Skotte Pernille S
Published: April 2022

The burdens of working in the frontline of the child welfare and protection services are well documented. Studies have identified individual and organisational indicators that lead to burnout, turnover and retention. In this article, I direct attention to enacted local cultures in child welfare teams and explore how embedded social practices contribute to social workers’ coping. I apply the concept of worker collectivity to explore how informal social practices in regular team meetings mobilise action and commitment among the team members. The article draws on an ethnographic study of two Norwegian frontline child welfare offices, involving intermittent observation of everyday work practices for two years. My analysis suggests that the collectivity is a crucial condition in bearing the demands of child welfare work.
Thermal, mechanical, rheological and morphological properties of compatible poly(lactic acid)/ethylene vinyl acetate blends
Authors: Johar Munirah , Zarkasi Kamarul Zaman , Hashim Faiezah , Rusli Arjulizan
Published: April 2022

This paper examines the effects of poly (ethylene-co-vinyl acetate) (EVA) with 40% vinyl acetate content on thermal, mechanical, rheological, and morphological properties of polylactic acid (PLA) blends. Thermal analysis indicated improvement of crystallinity in the presence of more EVA. With 15% EVA, the impact strength of the binary blend increased significantly (37.80 KJ/m2) at an optimum elongation at break due to the compatibility of the blend and the formation of fibrils. In the presence of % EVA, complete phase separation with the formation of EVA droplets in the PLA continuous phase resulted in a reduction of impact strength and elongation at break. Changes in compatibility and morphology lead to variation in rheological properties. The complex viscosity (η*) decreased with increasing EVA content up to 10% EVA but slightly increased at 15% EVA due to optimum interphase interaction between components in the compatible blend. In the presence of more than 20% EVA, η* reduced again due to the occurrence of phase separation. The variations in the mechanical and rheological properties of PLA/EVA blends are directly related to the state of compatibility and morphology of the blends.
Development of zinc, silver, and hyaluronic acid mediated wet spun alginate fibers for potential wound care applications
Authors: Mahmood Urwa , Masood Rashid , Afzal Muhammad Ali , Raza Zulfiqar Ali , Abid Sharjeel , Zahir Abdul , Hussain Tanveer , Nazir Ahsan
Published: April 2022

Sodium alginate and hyaluronic acid are being used extensively in wound care applications for their exceptional properties, including gelation, biocompatibility, exudate absorption, and the ability to provide a moist environment to the wound bed that accelerates healing. This research work presents the potential of developing silver and zinc ions loaded bioactive fibers for wound care applications with improved absorption, swelling (gelling), and antibacterial properties. The effect of loading silver and zinc on alginate/hyaluronic acid biofiber absorption, swelling (gelation), tensile and antibacterial activity were analyzed. It was found that the addition of silver and zinc salts improved the absorption, tensile, and gelation properties of alginate/hyaluronic acid fibers. Zinc-containing fibers exhibited superior properties to silver-containing fibers. The presence of hyaluronic acid influenced the release of silver and zinc ions in various liquid media with a maximum of 26 g/g absorption was observed which suggested the good wound exudate absorption capacity of the developed fibers. The developed fibers showed good antibacterial activity against Staphylococcus aureus and Escherichia coli strains.
Extraction of keratin from wool and its use as biopolymer in film formation and in electrospinning for composite material processing
Authors: Goyal Sahil , Dotter Marius , Diestelhorst Elise , Storck Jan Lukas , Ehrmann Andrea , Mahltig Boris
Published: April 2022

Keratin is one of the most important protein materials and can act as a sustainable biopolymer for manifold applications. This paper reports on a sustainable extraction method for keratin from wool fiber materials. The use of this extracted keratin for polymer film preparation and preparation of nano-composite materials by electrospinning is investigated. The preparation of keratin films is done in combination with the both biopolymers alginate and pectin. Keratin nanofibers are prepared in combination with the polymer polyacrylonitrile PAN. A view on antibacterial properties of the prepared films is given. As further analytic methods, Fourier-transform infrared (FT-IR) spectroscopy, thermogravimetry, and scanning electron microscopy (SEM) are used. Finally, the preparation of new keratin containing materials is described, which may be used in future for biomedical applications.
Carbon Ion Induces Cell Death and G2/M Arrest Through pRb/E2F1Chk2/Cdc2 Signaling Pathway in X-ray Resistant B16F10 Melanoma Cells
Authors: Li Sha , Huang Hefa , Xing Mengjie , Qin Jin , Zhang Hong , Liu Yang , Zhang Liping , Zhang Chao , Tian Zhongze , Gao Xingxin , Zhao Rui , Mao Aihong
Published: April 2022

To explore the effect of high-LET carbon ion (C-ion) radiation on malignant melanoma, we systematically compared the radiobiological effects of C-ion with that of X-rays in B16F10 melanoma cells. Results showed that C-ion radiation statistically inhibited clonogenic survival capacity of B16F10 melanoma cells. The RBE was 3.7 at D10 levels, meaning 1.0 Gy C-ion should cause the same biological effect as ≥ 3.0 Gy X-rays. In addition, we also observed a stronger proliferation-inhibiting and higher ratio of cell apoptosis and necrosis in B16F10 cells treated with C-ion than X-rays. Moreover, C-ion radiation exhibited stronger and long-lasting G2/M arrest than X-rays. As an underlying mechanism, we speculated that C-ion radiation-induced G2/M block through activating pRb/E2F1/Chk2 pathway. With these results, we highlighted the potential of C-ion in treatment of cutaneous melanoma. Further, in vitro experiments as well as clinical trials are needed to further evaluate the effect of carbon ion radiotherapy in melanoma.
A Response Surface Analysis of the Combination of Dexmedetomidine and Sufentanil for Attenuating the Haemodynamic Response to Endotracheal Intubation
Authors: Su Peng , Li Zheng , Jia Xiaoqian , Peng Xiaoling , Liu Daiqiang , Xiao Jing , Tu Ye , Gao Feng
Published: April 2022

Purpose

Dexmedetomidine combined with opioids has been extensively used to blunt cardiovascular responses to endotracheal intubation. To determine their interaction, we aimed to develop a response surface model between dexmedetomidine and sufentanil.

Methods

One hundred and twenty patients undergoing scheduled gynaecological surgery were recruited. According to a simulation of slice design, patients received different dose pairs of dexmedetomidine (0 to 1.1 μg/kg) and sufentanil (.1 to .5 μg/kg). The mean arterial blood pressure and heart rate of patients were recorded just before endotracheal intubation, immediately after intubation, and during the first 3 min after intubation. The primary outcomes were haemodynamic changes. The full dose–response relationship between dexmedetomidine and sufentanil was analysed using a logit model.

Results

This response surface model revealed that the interaction between dexmedetomidine and sufentanil was additive. The dose pairs that could effectively attenuate the haemodynamic response to endotracheal intubation primarily ranged from .3 to .4 μg/kg and .5 to 1.1 μg/kg for sufentanil and dexmedetomidine, respectively.

Conclusion

When used propofol as the main hypnotic drug during anaesthesia induction, dexmedetomidine could effectively reduce the requirement of sufentanil in an additive manner. However, it is not an effective drug for ablating the cardiovascular response to endotracheal intubation when used alone. The clinical trial registry. The trial registry name: Chinese Clinical Trial Registry. Registration number: ChiCTR1800015273. URL: http://www.chictr.org.cn
Moving From Co-Design to Co-Research: Engaging Youth Participation in Guided Qualitative Inquiry
Authors: Clark Adam T. , Ahmed Ishrat , Metzger Stefania , Walker Erin , Wylie Ruth
Published: April 2022

The inclusion of community voices in research is important. Over the years, research training programs have continued to emphasize that engagement with communities at the focus of research can promote thoughtful, sensitive designs ( Rivera et al., 2004 ). In this paper, we discuss a method for youth participation in the research process. In an attempt to move beyond “staged and superficial” participation in gathering youth perspectives, we advocate for including co-researchers in the development and modification of fundamental aspects of the research process, from data analysis to the development of additional research questions and collection methods ( Guishard & Tuck, 2013 ). In the course of a study designed to enroll middle school students in participatory co-design sessions ( Cahill, 2007 ) to aid in the development of educational technologies, it became apparent that our youth participants, as co-researchers, could also aid in the development, analysis, and coding of anonymized interview transcripts; development of themes; and creation of models for behaviors found in the transcripts ( Docan-Morgan, 2010 ; Luchtenberg et al., 2020 ). Thus, this paper presents a practical example of a co-research process that includes youth participants, with an emphasis on training in qualitative coding and the fundamentals of research design.
Courtroom Ethnography in the Context of Terrorism: A Multi-Level Approach
Authors: Bögelein Nicole , Eppert Kerstin , Roth Viktoria , Schmidt-Kleinert Anja
Published: April 2022

This paper addresses terrorism trials as sites of research and proposes an approach for the analysis of ethnographic data collected during these trials. The suggested approach offers multi-level analytical access, it centers around interactionist conceptions and knowledge discourses. The conceptual framework we suggest is spelled out in terms of how to observe and being sensitive of (re-)production of power structures inside the courtroom as well as in regard to relations imported into the courtroom. For this purpose, we integrate (i) the micro-level of courtroom interactions and (ii) (self-)presentation, (iii) the meso-level of knowledge (re)production and the establishment of knowledge orders and (iv) an intersectional perspective on gender, race, and class in knowledge discourses. By applying a multi-level approach, we open up new explanatory avenues to understand the constitution of terrorism as a socio-legal object. The methodical framework connects hitherto unconnected elements, that is, participants’ interactions and negotiation, their (self-)representations, ascriptions and narrative performances, and knowledge (re-)production in order to establish or maintain political and social orders.
Studies on heat transfer characteristics of vapor chamber under periodic-pulsed heat source
Authors: Ma Tengyue , Wang Baosheng , Tang Xiuhuan , Hu Pan , Ma Zhenhui , Jiang Xinbiao , Guo Huiping
Published: April 2022

In a high-power microwave device, the intense electron beam causes a high-heat-flux on the collector’s inner surface which results in an instant temperature increase which eventually causes the output power to drop. The vapor chamber is one of the passive cooling devices effective for high-heat-flux heat dissipation. To study the heat dissipation capacity and the surface temperature control effect of the vapor chamber, a numerical heat transfer model of the vapor chamber is proposed based on the effective thermal conductivity method. The accuracy of the steady-state heat transfer analysis and the applicability of the transient simulation are verified by comparing with experimental data, and the heat transfer are calculated under the condition of periodic pulsed heat sources. Lastly, the transient performance of a vapor chamber relative to a copper heat spreader of the same external dimensions is investigated as a function of the wick effective thermal conductivity, pulsed heat flux, and pulse duration. The transient behavior of the vapor chambers are examined to find a performance threshold to determine if the performance is superior to that of a copper heat spreader. The present work provides a basis to understand the advantages and limitations of metal heat spreader in pulse mode operation of vapor chamber and plays a vital role in the design of improving transient performance.
Predictions of three-dimensional contact stresses of a radial truck tire under different driving modes
Authors: Tang Xu , Xie Jun , Xie Hao , Zhang Haijun
Published: April 2022

In pavement design, vehicle load is typically simplified as vertical circular uniform loading. Due to the vehicle dynamic effect and deformation of a tire, non-uniform three-dimensional contact stresses are produced at the contact interface between the tire and pavement under different driving modes. For this paper, an 11R22.5 truck radial tire was selected. Considering the geometric nonlinearity and large deformation of the tire and nonlinear characteristics of tire-pavement contact, the Neo-Hookean and Rebar models are used to simulate the hyperelastic rubber material and rubber-cord composite material, respectively. The three-dimensional contact stress distribution under static, free rolling, acceleration, braking, and cornering modes was simulated and analyzed. The results show that inflation pressure, axle load, and friction coefficient of the tire significantly affect the three-dimensional contact stress distribution. Further, three-dimensional stresses are non-uniformly distributed, rather than in the traditional simplified circular uniform load. The three-dimensional stress distribution of tire-pavement in different driving modes is also significantly different. The vertical and lateral stresses in the state of cornering are the largest, the longitudinal stress in the state of braking is the largest as well. The research results provide reference for future pavement design and pavement damage analysis.
Acute dissection into a large abdominal aortic aneurysm in a patient with Marfan syndrome
Authors: Jim Jeffrey , Maijub John , Cook Jason R
Published: April 2022

Objectives

Synchronous aortic dissection (AD) with involvement of pre-existing infrarenal abdominal aortic aneurysms (AAAs) are fortunately rare. Extension of the dissection flap to involve the aneurysm is particularly dangerous with pressurization of the false lumen within a diseased aortic wall. The aim of this article is to present a unique case of an acute AD with extension to involve a large AAA in a patient with an underlying connective tissue disorder

Methods

A 24-year-old male Marfan syndrome patient with prior type A dissection repair presented with a descending thoracic AD and a separate 7.0-cm infrarenal AAA. He was initially medically managed but developed acute extension of the dissection flap to involve the large aneurysm.

Results

The patient was initially treated with open infrarenal aortic replacement under left atrialfemoral artery bypass. Three years later, he developed degeneration of the residual aorta and underwent a two-stage hybrid repair. He underwent an additional stent graft for a distal anastomotic leak. At 5 years of follow-up, there was positive aneurysm remodeling and sac regression.

Conclusion

This case illustrates the challenges in treating a patient with synchronous aortic processes. False lumen pressurization of a large aneurysm wall is fortunately rare but can be lethal. Prompt intervention is required but the presence of an underlying connective tissue disorder may limit endovascular treatment options. Careful case planning is mandatory and multiple interventions should be anticipated.
Serum sortilin as a predictor of stroke in patients with intermediate carotid artery stenosis
Authors: Şimsek Zeki , Alizade Elnur , Abdurahmanova İlahe , Güner Ahmet , Zehir Regayip , Pala Selçuk
Published: April 2022

Background

Sortilin was an important molecular protein involved in the pathogenesis of atherosclerosis. Besides, serum sortilin was associated with adverse cerebrovascular events. Atherosclerotic stenosis in the carotid artery is a major etiology for ischemic stroke. The risk of stroke in patients with intermediate carotid artery stenosis (CAS) was unknown. Hence, the aim of the present study was to evaluate the relationship between serum sortilin levels and stroke in patients with intermediate CAS.

Methods

A total of 195 intermediate CAS patients were included in this cross-sectional study. The patients were divided into two groups as symptomatic ( N = 95) and asymptomatic ( N = 100) patients. Patients with a transient ischemic attack (TIA), retinal ischemic event, or ischemic stroke resulting from the narrowed carotid artery were considered to be symptomatic. Serum sortilin concentrations were measured using the enzyme-linked immunosorbent assay.

Results

Serum sortilin level was significantly higher in the symptomatic group than in the severe asymptomatic group (1.53 ± 0.25 ng/mL vs 1.34 ± 0.19 ng/mL, p < 0.001). Besides, high serum sortilin levels (odds ratio = 4.91, 95% confidence intervals 1.24–19.51, p = 0.023) were identified as independent predictors of symptomatic carotid plaque. In the receiver operating characteristic curve analysis, serum sortilin levels higher than 1.34 ng/mL predicted stroke/TIA with a sensitivity of 66.3% and a specificity of 67% (AUC = 0.725, p < 0.001).

Conclusions

Serum sortilin level is increased in the presence of symptomatic intermediate CAS and may have clinical value in the management of patients with carotid artery disease.
Daxx ameliorates abdominal aortic aneurysm through inhibiting the TGF-β1-mediated PI3K/AKT/ID2 signaling pathway
Authors: Chen Jie , Xiong Guo-zuo , Luo Dong-yang , Zou Qing-qing , Wang Yang-yi-jing , Bi Guo-shan
Published: April 2022

Background

Abdominal aortic aneurysm (AAA) is a potentially life-threatening vascular abnormality, that, if ruptured, is almost universally fatal without repair, and is associated with up to 50% mortality even if repaired in hospital. To date, there is no drug therapy that has clinically proven benefit to reduce or prevent expansion of AAA. The aim of this study was to investigate whether Daxx could affect AAA through inhibiting the PI3K/AKT/ID2 signaling pathway mediated by transforming growth factor β-1 (TGFβ1).

Methods

The AAA model was constructed by injecting angiotensin Ⅱ (Ang-Ⅱ) into rats, and the Daxx lentivirus vector was constructed. Hematoxylin and eosin (HE) staining was used to detect the wall thickness of the abdominal aorta in rats. The gene and protein expressions in abdominal aortic tissues were detected utilizing western blot, immunohistochemistry (IHC) and fluorescence quantitative real-time polymerase chain reaction (qRT-PCR). Finally, the concentration of TGF-β1 in abdominal aortic tissue was determined by ELISA.

Results

The abdominal aortic wall thickness was decreased in the Daxx expression group (by HE staining), and Daxx overexpression markedly reduced the protein expression levels of MMP2 and MMP9. Proteins related to the PI3K/AKT/ID2 signaling pathway were highly enhanced in the aneurysm wall of rats, but were reduced following Daxx addition. Moreover, Daxx reduced the damage to elastin (by IHC), and the expression levels of α-SMA and SM22α were up-regulated by Daxx (by qRT-PCR). The concentration of TGF-β1 was correlated with the activation of the PI3K/AKT/ID2 signaling pathway (by ELISA), whereas AKT overexpression weakened the inhibitory effect of Daxx.

Conclusion

Daxx ameliorated several mechanisms that contributed to expansion of AAA suppressing the tissue concentration of TGF-β1, thereby inhibiting the activation of the PI3K/AKT/ID2 signaling pathway. This evidence might form the basis to develop a therapeutic target for AAA.
Clinical characteristics and prognostic factors of fibrotic nonspecific interstitial pneumonia
Authors: Cho Hyun Kyu , Chung Man Pyo , Soo Lee Kyung , Chung Myung Jin , Han Joungho , Kwon O Jung , Yoo Hongseok
Published: April 2022

Aim:

Several studies have reported favorable outcomes of nonspecific interstitial pneumonia (NSIP); however, its prognosis and prognostic factors remain unclear. This study aimed to determine the outcomes of fibrotic NSIP and the prognostic factors for progression, relapse, and survival.

Methods:

In this retrospective study, we reviewed the clinical data of 204 patients diagnosed with fibrotic NSIP by surgical lung biopsy at Samsung Medical Center. The factors associated with survival and disease progression or relapse were determined using Cox proportional hazard analysis.

Results:

The median age of patients was 54 years and 67 (33%) patients were male. Also, 47 patients (23%) were current or ex-smokers. In all, 141 (69%) patients were diagnosed with idiopathic NSIP, while 63 (31%) patients were associated with connective tissue diseases. Progression or relapse was observed in 100 (49%) patients. The 5-year and 10-year survival rates were 94.6% and 90.4%, respectively. The factors associated with disease progression and relapse were diffusing capacity for carbon monoxide (DLco) <60% [adjusted hazard ratio (HR), 1.739; 95% confidence interval (CI), 1.036–2.921; p = 0.036], bronchoalveolar lavage (BAL) lymphocyte >15% (adjusted HR, 0.592; 95% CI, 0.352–0.994; p = 0.047), and treatment with corticosteroid and azathioprine (adjusted HR, 0.556; 95% CI, 0.311–0.955; p = 0.048). Disease progression or relapse was associated with mortality (adjusted HR, 7.135; 95% CI, 1.499–33.971; p = 0.014).

Conclusion:

Preserved lung function, BAL lymphocytosis, and treatment with corticosteroids and azathioprine were associated with lower risks of disease progression and relapse, which were risk factors for mortality.
Interplay between European Union criminal law and administrative sanctions: Constituent elements of transposing punitive administrative sanctions into national law
Authors: Kärner Markus
Published: April 2022

The post-Lisbon punitive sanctioning law of the EU is divided between criminal and non-criminal sanctions. The legislator has preferred non-criminal sanctions for reasons of ultima ratio but more recently also for reasons of efficiency. In the search for efficiency, the regulation on such sanctions has become increasingly precise, and the legislator has started to refer to the administrative nature of such sanctions. This can limit the discretion of the Member States in finding the most suitable way to transpose such sanctions, and it could amount to a prohibition on resorting to criminal law (a negative harmonisation of criminal law). When EU law prescribes specific requirements on administrative sanctioning systems, fundamental aspects of national sanctioning systems might be affected, and this can also bring about a lower protection for procedural guarantees. This article explores the interplay between EU criminal law and administrative sanctions to ascertain whether there is a coherent understanding of what the term administrative refers to in EU law. Based on this evaluation, this article analyses whether the EU legislation allows for conclusions to be made on the minimum requirements of transposing sanctions that are labelled as administrative into national law (the constituent elements) and whether this labelling interferes with the use of criminal law.
Knowledge About Dementia Among Family Caregivers With a Turkish or Moroccan Immigrant Background: Development and Validation of a Dementia Knowledge Scale
Authors: Wezel Nienke van , van der Heide Iris , Devillé Walter L.J.M. , Blom Marco M. , Hoopman Rianne , Francke Anneke L.
Published: April 2022

Objective:

To describe the development and validation of the Dementia Knowledge Scale (DKS) among family caregivers with a Turkish or Moroccan immigrant background.

Methods:

The 11 items of the DKS, selected by professionals and people with a Turkish or Moroccan background, were translated and adapted in Turkish and Dutch. The feasibility, comprehensibility and appropriateness of the 2 language versions were examined. Subsequently, both languages were assessed among caregivers from these groups. The internal consistency of both language versions was determined by calculating Cronbach’s α. The known group validity was determined by comparing mean scores between subgroups.

Results:

Both language versions of the DKS were considered feasible, comprehensible, and appropriate. A total of 117 caregivers with a Turkish background completed the Turkish version of the DKS and 110 with a Moroccan background the Dutch version. The Turkish version showed adequate internal consistency but the Dutch version did not. No differences were found in mean scores between those with a low level of education versus those with a higher level; those who frequently provided care versus those who did so less frequently; and those who lived together with a person with dementia versus those who did not.

Conclusions:

The DKS is feasible, comprehensible and reliable and can be used among groups with an immigrant background.

Practice Implications:

The DKS provides insight into various aspects of dementia knowledge, including knowledge about risk factors and symptoms, among caregivers with a Turkish or Moroccan background, and thereby supports the development of tailored education for these groups.
Mechanism of the Mitogen-Activated Protein Kinases/Mammalian Target of Rapamycin Pathway in the Process of Cartilage Endplate Stem Cell Degeneration Induced by Tension Load
Authors: Zhang Yu , Liu Chen , Li Yu , Xu Hongguang
Published: April 2022

Study Design

Basic Research.

Objective

Intervertebral disc degeneration (IVDD) is caused by the cartilage endplate (CEP). Cartilage endplate stem cell (CESC) is involved in the recovery of CEP degeneration. Tension load (TL) contributes a lot to the initiation and progression of IVDD. This study aims to investigate the regulatory mechanism of the Mitogen-activated protein kinases/Mammalian target of rapamycin (MAPK/mTOR) pathway during TL-induced CESC degeneration.

Methods

CESCs were isolated from New Zealand big-eared white female rabbits (6 months old). FX-4000T cell stress loading system was applied to establish a TL-induced degeneration model of CESCs. Western blotting was used to detect the level of mTOR pathway-related proteins and autophagy markers LC3-Ⅱ, Beclin-1, and p62 in degenerative CESCs. The expression of MAPK pathway-related proteins JNK and extracellular signal-regulated kinases (ERK) in degenerated CESCs was inhibited by cell transfection to explore whether JNK and ERK play a regulatory role in TL-induced autophagy in CESCs.

Results

In the CESC degeneration model, the mTOR pathway was activated. After inhibition of mTOR, the autophagy level of CESCs was increased, and the degeneration of CESCs was alleviated. The MAPK pathway was also activated in the CESC degeneration model. Inhibition of JNK expression may alleviate TL-induced CEP degeneration by inhibiting Raptor phosphorylation and activating autophagy. Inhibition of ERK expression may alleviate TL-induced CEP degeneration by inhibiting mTOR phosphorylation and activating autophagy.

Conclusion

Inhibition of JNK and ERK in the MAPK signaling family alleviated TL-induced CESC degeneration by inhibiting the phosphorylation of Raptor and mTOR in the mTOR pathway.
The Effect of Preoperative Cervical Spondylosis on Heterotopic Ossification After Cervical Disc Replacement
Authors: Shen Yi-Wei , Yang Yi , Liu Hao , Wang Bei-Yu , Ding Chen , Meng Yang , Rong Xin , Hong Ying
Published: April 2022

Study Design

Retrospective cohort study.

Objectives

This study aimed to explore the effect of preoperative cervical spondylosis on the heterotopic ossification (HO) formation in different locations after cervical disc replacement (CDR).

Methods

The degree of preoperative cervical spondylosis was evaluated radiologically, including the intervertebral disc, uncovertebral joints, facet joints and ligaments. The effects of cervical spondylosis on the HO formation after CDR were analyzed according to the location of HO. Multivariate logistic regression was performed to identify the independent factors.

Results

149 patients with a total of 196 arthroplasty segments were involved in this study. HO, anterior HO (AHO), and posterior HO (PHO) developed in 59.69%, 22.96%, and 41.84% levels, respectively. The significant factors in univariate analysis for PHO after CDR included the disc height loss, anterior osteophytes, preoperative uncovertebral joint osteophytes and facet joint degeneration. The incidence of adjacent segment degeneration (ASD) was significantly higher in the PHO group compared to that without PHO at the last follow-up ( P = .003). The disc height loss in high-grade HO was significantly more than that in low-grade group ( P = .039). Multivariate analysis identified disc height loss was the only independent factor for PHO ( P = .009). No significant degenerative factors related to the formation of AHO were found.

Conclusions

Preoperative cervical spondylosis predominantly affected the HO formation in the posterior disc space after CDR. The disc height loss was an independent risk factor for PHO formation. Rigorous criteria for the extent of preoperative disc height loss should be used when selecting appropriate candidates for CDR.
Institutionalisation and Processes of Grassroots Innovations: Evidence from the Literature
Authors: Parwez Sazzad
Published: April 2022

This study tries to conceptualise the ontology of grassroots innovations (GIs) and the enabling institutional processes. It follows an extensive literature review approach to understand the phenomenon. GIs tend to emerge in the informal economy and rural setting, and they tend to face several socio-political–cultural–economic–technological limitations. GIs are the outcome of prevailing disparity and an environment that has not provided enough opportunities for a better standard of living. This study offers a contextual understanding of the GI movement and processes of institutionalisation. The finding suggests that institutionalisation of GIs is the outcome of the grassroots movement, networking, learning processes, acceptance of innovation, and diffusion processes. GIs have emerged as an effective tool developed by uneducated people to solve local problems.
Nerve Complications after Regional Anesthesia in Foot and Ankle Surgery Avoiding the Popliteal Fossa
Authors: Bartholomew Ania , Ciesa Michael , Slone Tyler , Cheney Nicholas A. , Clark Brian C.
Published: April 2022

Category:

Ankle; Arthroscopy; Hindfoot; Lesser Toes; Midfoot/Forefoot; Other

Introduction/Purpose:

Popliteal nerve blocks are a common procedure employed by anesthesiologists to augment intraoperative anesthesia as well as provide postoperative pain control. Unfortunately, these can be associated with unintended complications. These complications may be sensory or motor including pain, numbness, and foot drop, sometimes without clear resolution. Studies suggest complications higher than previously reported, Lauf (2020). Our study looked to address the complication rates from an alternative anesthetic procedure, a distal ankle nerve block which involves anesthesia to the five nerve(s) more intimately involved in the surgical procedure. This alternative technique may provide equivalent anesthetic properties and pain relief as the popliteal blocks, with less motor and sensory complications for many patients across various demographics.

Methods:

We retrospectively reviewed patient charts and messaging from 2019 to 2021 that received a distal ankle field block for various surgical procedures including ankle arthroscopy, ankle fractures, and lateral ankle stabilizations. The five nerves anesthetized in the distal ankle nerve block included the tibial, superficial and deep peroneal, sural, and saphenous. Thus far, 90 surgeries have been reviewed and analyzed for neuropathic complications and confirmed via EMG.

Results:

Of the 90 patients analyzed, 3 patients were found to have a superficial peroneal neuropathy that included dorsal numbness as a result of the distal ankle block, resulting in a 3.33% complication rate. 1 patient required a rescue block to be performed post-operatively for pain. The remaining 87 patients recovered appropriately and without complications. No motor complications have been found from patients receiving distal ankle nerve blocks, as performed by the senior author.

Conclusion:

With the absence of motor complications and markedly reduced incidence of sensory complications, distal ankle nerve blocks may be a beneficial alternative to popliteal nerve blocks for various foot and ankle orthopedic surgeries. As motor complications can result in life altering disability, an anesthetic procedure with reduced negative motor outcomes can improve surgery and recovery prognosis. Future directions for this study include adding more patients to increase the sample size, as well as continuing to follow current patients, monitoring symptoms or complications.
Investigating the Presence of Connective Tissue Progenitor Cells within the Retrocalcaneal Bursa
Authors: Jorgensen Anna , Jorgensen Anna , Karsmarski Owen P. , Hawthorne Benjamin C. , McCarthy Mary Beth , Zeng Francine , Mazzocca Jillian L. , Geaney Lauren E.
Published: April 2022

Category:

Ankle; Basic Sciences/Biologics; Other

Introduction/Purpose:

The purpose of this study was to evaluate the presence of connective tissue progenitor cells within the retrocalcaneal bursa. The study evaluation included an assessment of the viability of connective tissue progenitor cells, their proliferative potential, and their ability to differentiate into osteoblasts, adipocytes, and chondrocytes.

Methods:

The retrocalcaneal bursa samples were excised from 10 patients (age: 51.5 +- 10.8 years) undergoing Achilles surgery in which the retrocalcaneal bursa is routinely excised. Bursal tissue was processed by digesting cells with collagenase and obtaining nucleated cell counts and cellular concentrations. The cells were cultured, and differentiated into osteoblasts, adipocytes, and chondrocytes. Analysis of bursal derived cells consisted of fluorescent activated cell sorting (FACS) analysis, cellular proliferation and viability assay, and analysis of differentiation into osteoblasts, adipocytes, and chondrocytes. The CTP differentiation was confirmed using histology staining to qualitatively express differentiation, and qPCR to quantify gene expression.

Results:

Cell migration at 3 weeks on average was found to be 3.84x107 nucleated cells/gram of tissue and nucleated cellular concentration on average was found to be 6.28x105 cells/mL of suspension. The proliferation data showed high levels of proliferation on average of 1.72 +-0.58. The FACS analysis showed a high percentage of positive surface markers for CTPs measuring greater than 96% (CD105, CD90, CD73) and measuring < 1.1% for negative surface markers (CD45 and CD31). Differentiation into osteoblasts, adipocytes, and chondrocytes were stained appropriately displaying differentiation.

Conclusion:

The retrocalcaneal bursa is a novel source of connective tissue progenitor cells. This is the first study to our knowledge analyzing the retrocalcaneal bursa as a novel source for CTPs, making it a potential augment to expedite the healing process of the Achilles tendon. Overall, it is unclear what the role of the CTPs within the bursa is, however, they may help to reduce the extensive healing time for the Achilles tendon thereby returning patients with Achilles tendon pathology back to functional status more promptly.
Realignment Surgery for Failed Osteochondral Autologous Transplantation in Osteochondral Lesions of the Talus Associated With Malalignment
Authors: Kim Jaeyoung , Aspang Jesse Seilern und , Ji-Beom Kim , Day Jonathan , Gagné Oliver , Lee Woo-Chun
Published: April 2022

Category:

Ankle Arthritis; Sports

Introduction/Purpose:

While osteochondral autograft transplantation (OAT) offers favorable results in most patients with osteochondral lesions of the talus (OLT), some patients continue to experience persistent pain following the procedure. Information regarding the etiology of this pain and outcomes of revision surgery are limited. This study aimed to report results of revision surgery with realignment procedures in patients with failed OAT who demonstrated concomitant malalignment at the distal tibia or hindfoot.

Methods:

Eight ankles with persistent pain following OAT underwent revision surgery with realignment procedures. All patients underwent primary OAT for treatment of medial OLTs. Patients were divided into two groups based on the main location of deformity; the Supramalleolar realignment group (SRG, five ankles) and the Hindfoot realignment group (HRG, three ankles). No direct procedure was performed on the osteochondral lesion at the time of revision surgery. Ankle and hindfoot alignment were evaluated using six parameters in weightbearing radiographs. Computed tomography (CT) was used to assess for medial gutter narrowing, spur formation, and cyst volume around transplanted osteochondral plug pre-and postoperatively. Clinical outcomes were assessed using foot function index and visual analogue scale.

Results:

All patients had medial gutter narrowing or spur formation, which are early signs of ankle arthritis. The SRG had varus distal tibial alignment with a median medial distal tibial angle of 85.7 degrees (Interquartile range [IQR], 3.2). The HRG had valgus hindfoot alignment and a lower medial longitudinal arch with a median hindfoot moment arm of 8.4 mm (IQR, 6.1) and a median Meary angle of 11.8 degrees (IQR, 1.4). Spontaneous restoration of the osteochondral lesion was observed after realignment surgery, with cyst volume decreasing from 0.2592cm3 to 0.0873cm3 (p<0.05, Figure 1 and Figure 2). Clinical scores improved in all patients.

Conclusion:

The current study shows the effectiveness of realignment surgery in a selected patient group in whom OAT has failed. Our study provides evidence for the role of realignment procedures in these cases, with results suggesting improved patient-reported outcomes and spontaneous restoration of osteochondral lesions.
Intra and Interobserver Reliability of the New Classification System of Progressive Collapsing Foot Deformity
Authors: Young Lee Hee , Mansur Nacime S. , Lalevée Matthieu , Dibbern Kevin N. , Myerson Mark S. , Ellis Scott J. , Femino John E. , de Cesar Netto Cesar
Published: April 2022

Category:

Other

Introduction/Purpose:

Historical concept of flatfoot as posterior tibial tendon dysfunction (PTTD) has been questioned. Recently, the consensus group published a new classification system and recommended renaming PTTD to Progressive Collapsing Foot Deformity (PCFD). The new PCFD classification could be effective in providing comprehensive information on the deformity. To date, there has been no study reporting intra- and interobserver reliability and the frequency of each class in PCFD classification.

Methods:

This was a single-center, retrospective study conducted from prospectively collected registry data. A consecutive cohort of PCFD patients evaluated from February 2015 to October 2020 was included, consisting of 92 feet in 84 patients. Classification of each patient was made utilizing characteristic clinical and radiographic findings by three independent observers. Frequencies of each class and subclass were assessed. Intraobserver and interobserver reliabilities were analyzed with Cohen's Kappa and Fleiss' kappa, respectively.

Results:

Mean sample age was 54.4, 38% was male and 62% were female. 1ABC (25.4%) was most common subclass followed by 1AC (8.7%) and 1ABCD (6.9%). Only small percentage of patients had isolated deformity. Class A was the most frequent component (89.5%), followed by C in 86.2% of the cases. Moderate interobserver reliability (Fleiss` Kappa=0.561, p<0.001, 95% CI 0.528-0.594) was found for overall classification. Very good intraobserver reliability was found (Cohen`s Kappa=0.851, P<0.001, 95% CI 0.777-0.926).

Conclusion:

Predominantly, 49.3% of patients had a presentation dominantly involving the hindfoot (A) with various combinations of midfoot and/or forefoot deformity (B), (C) with or without subtalar joint involvement (D). Despite limitations due to inherent subjectivity which may account for moderate interobserver agreement, the new system may potentially cover all possible combinations of the PCFD, providing a comprehensive description and guiding treatment in a systematic and individualized manner.