bluuebunny/crossref_metadata_2025 huggingface dataset:
The risk factors associated with colonic injury during percutaneous renal stone surgery – a literature review
Authors: Burns H , Nalagatla S
Published: March 2019

Objective:

A focused literature review was conducted of colonic injuries occurring during percutaneous nephrolithotomy (PCNL) procedures to determine the importance of patient position, identifiable risk factors and methods to avoid colonic injury.

Method:

A MEDLINE literature search was performed from PubMed and Scopus databases to retrieve all articles relating to colonic injuries occurring during PCNL. Incidence of colonic injury, patient management, position, side of stone and recognised risk factors were compiled for analysis.

Results:

Of the 35,054 PCNLs carried out, 87 colonic perforations were identified, which results in a 0.25% chance of perforation. A total of 65.5% (57/87) of colonic perforations occurred during left-hand punctures, and 54.0% (47/87) occurred in the prone position. Retrorenal colon, posterior colon, previous renal tract surgery, horseshoe kidney and mobile kidneys were the most common risk factors identified.

Discussion:

The risk of colonic perforation during PCNL was 0.25% across these studies. It more commonly occurred in the prone position and on the left-hand side. Only four perforations were noted to be in the supine position. A retrorenal colon is implicated as the most common identifiable risk factor. Careful preoperative work-up, planning and intraoperative use of ultrasound combined with fluoroscopy is the best method of preventing a colonic injury.

Level of evidence:

Not applicable for this multicentre audit.
The Multiple Sclerosis Severity Score: fluctuations and prognostic ability in a longitudinal cohort of patients with MS
Authors: Gross RH , Sillau SH , Miller AE , Farrell C , Krieger SC
Published: March 2019

Background

The Multiple Sclerosis Severity Score (MSSS), combining the Expanded Disability Status Scale (EDSS) and disease duration, attempts to stratify multiple sclerosis (MS) patients based on their rate of progression. Its prognostic ability in the individual patient remains unproven.

Objectives

To assess the stability of MSSS within individual persons with MS in a longitudinal cohort, to evaluate whether certain factors influence MSSS variability, and to explore the ability of MSSS to predict future ambulatory function.

Methods

A single-center retrospective review was performed of patients following a single provider for at least 8 years. Mixed model regression modeled MSSS over time. A Kaplan–Meier survival plot was fitted, using change of baseline MSSS by at least one decile as the event. Cox modeling assessed the influence of baseline clinical and demographic factors on the hazard of changing MSSS by at least one decile. Linear models evaluated the impact of baseline EDSS, baseline MSSS, and other factors on the Timed 25-Foot Walk (T25FW).

Results

Out of 122 patients, 68 (55.7%) deviated from baseline MSSS by at least one decile. Final T25FW had slightly weaker correlation to baseline MSSS than to baseline EDSS, which was moderately strongly correlated with future log T25FW.

Conclusion

Individual MSSS scores often vary over time. Clinicians should exercise caution when using MSSS to prognosticate.
Investigating the feasibility and acceptability of real-time visual feedback in reducing compensatory motions during self-administered stroke rehabilitation exercises: A pilot study with chronic stroke survivors
Authors: Lin Shayne , Mann Jotvarinder , Mansfield Avril , Wang Rosalie H , Harris Jocelyn E , Taati Babak
Published: March 2019

Introduction

Homework-based rehabilitation programs can help stroke survivors restore upper extremity function. However, compensatory motions can develop without therapist supervision, leading to sub-optimal recovery. We developed a visual feedback system using a live video feed or an avatar reflecting users' movements so users are aware of compensations. This pilot study aimed to evaluate validity (how well the avatar characterizes different types of compensations) and acceptability of the system.

Methods

Ten participants with chronic stroke performed upper-extremity exercises under three feedback conditions: none, video, and avatar. Validity was evaluated by comparing agreement on compensations annotated using video and avatar images. A usability survey was administered to participants after the experiment to obtain information on acceptability.

Results

There was substantial agreement between video and avatar images for shoulder elevation and hip extension (Cohen's κ: 0.6–0.8) and almost perfect agreement for trunk rotation and flexion (κ: 0.80–1). Acceptability was low due to lack of corrective prompts and occasional noise with the avatar display. Most participants suggested that an automatic compensation detection feature with visual and auditory cuing would improve the system.

Conclusion

The avatar characterized four types of compensations well. Future work will involve increasing sensitivity for shoulder elevation and implementing a method to detect compensations.
Winning on Social Media: Candidate Social-Mediated Communication and Voting During the 2016 US Presidential Election
Authors: Macafee Timothy , McLaughlin Bryan , Rodriguez Nathian Shae
Published: March 2019

The 2016 US Presidential Election provided an opportunity to examine how political candidates’ use of social media can affect voting intentions. This study considers how political candidates can use social media to increase potential supporters’ perceptions that they will win the election, providing them extra motivation to go out and vote. Results from a two-wave survey provide evidence that following the in-group candidate (Trump or Clinton) relates to voting intentions through the increased belief that the candidate would win. However, this mediation effect occurs for only supporters of Trump or Clinton, but not for partisans of the opposing party.
Digital Disobedience and the Limits of Persuasion: Social Media Activism in Hong Kong’s 2014 Umbrella Movement
Authors: Agur Colin , Frisch Nicholas
Published: March 2019

This article probes the catalytic features of social media in civic participation and mass civil disobedience in Hong Kong’s 2014 protests, and conceptualizes digital activism in terms of mobilization, organization, and persuasion. It makes use of in-depth interviews, in English, Mandarin, and Cantonese, with 40 of the leading users of social media during the protests. These included, first and foremost, student activists, as well as opposition figures and journalists who reported on the protests. The article finds that the velocity and scale of social media have strengthened protesters’ ability to mobilize and organize, on the Internet and in the streets. Yet, these advantages have not carried over into persuasion of previously uncommitted individuals. Protesters encountered two main obstacles to persuasion via social media: the multitude of messages enabled by social media and the age segmentation of media. As a result, the movement’s social media efforts generated new attention and created digital space for activism, but did not persuade a durable majority of Hongkongers of the movement’s legitimacy. The Umbrella Movement may not have persuaded Hongkongers that their movement and tactics were valid or wise, but the existence of social media allowed protest leaders to document their motivations and conduct, and blunt less flattering narratives in legacy media.
Social Media Bullshit: What We Don’t Know About facebook.com/peace and Why We Should Care
Authors: John Nicholas A.
Published: March 2019

If we live in media, then our knowledge of our social lives must, at least partly, come from those media. It is in this context that I analyze www.facebook.com/peace , a page that claims to show “how many new friendships formed just yesterday” between Facebook users from the opposing sides of three different protracted conflicts. However, the numbers seem unfeasible, leading to a series of attempts to try and evaluate them independently, as well as to ask Facebook if they could explain them. This article presents these failed efforts to verify the numbers published by Facebook, and the subsequent conclusion that they are, technically speaking, bullshit, and more specifically, social media bullshit. It is in reaching this conclusion that the article contributes to theoretical discussions around data, social media, and knowledge.
The mediating role of political talk and political efficacy in the effects of news use on expressive and collective participation
Authors: Park Chang Sup
Published: March 2019

This study examines how media use for news can relate to expressive and collective participation through the mediating role of political talk and internal and external political efficacy. Based on two cross-sectional analyses and one autoregressive analyses of the data obtained from a two-wave panel survey during the 2012 presidential campaign in South Korea, this study finds that political talk and internal political efficacy mediate the association between news attention and expressive participation, while external political efficacy does not. Political talk and internal political efficacy jointly mediate the impact of news attention on expressive participation. The analysis also reveals that social media news attention and internal political efficacy play a bigger role in connecting news attention and political participation than traditional news attention, external political efficacy, and political talk.
Metformin inhibits both oleic acid-induced and CB1R receptor agonist-induced lipid accumulation in Hep3B cells: The preliminary report
Authors: Szuster-Ciesielska Agnieszka , Zwolak Agnieszka , Daniluk Jadwiga , Kandefer-Szerszeń Martyna
Published: March 2019

Fatty liver is characterized by excessive accumulation of triglycerides within hepatocytes. Recent findings indicate that natural history of nonalcoholic fatty liver is regulated, in part, by endogenous cannabinoids. Metformin is an oral hypoglycemic medication which inhibits gluconeogenesis and glycogenolysis in hepatocytes and limits lipid storage in the liver through the inhibition of free fatty acid formation via induction of activated protein kinase activity (AMPK). Both endocannabinoids and metformin may modulate hepatosteatosis; therefore, it was interesting to examine whether metformin may affect lipid accumulation in hepatocytes by acting on cannabinoid receptors, CB1 and CB2, in in vitro study. Hep3B cells were incubated with or without metformin (Met), phosphatidylcholine (PC), and oleic acid (OA). Cells without any of the examined substances served as negative control. Cells treated only with OA served as positive control. The quantity of intracellular lipids was assessed using Oil-Red-O staining. Selective CB1R agonist, arachidonyl-2-chloromethylamide (ACEA), and CB2R agonist, AM1241 (2-iodo-5-nitrophenyl)-[1-(methylpiperidin-2-ylmethyl)-1 H-indol-3-yl]methanone, were also used to treat Hep3B cells. In some experiments, antagonist for CB1R, AM6545, or SR144528 as selective antagonist of CB2R were used. In the study, Met decreased lipid accumulation in cells treated with OA and inhibited CB1R agonist–induced lipid accumulation in hepatocytes. The CB2R agonist–induced hepatic lipid accumulation was not inhibited by metformin. The results indicate that metformin may interact with endocannabinoid system in the liver by inhibiting CB1R agonist–stimulated fat accumulation in hepatocytes.
Abdominal wall endometriosis: A monocentric continuous series and review of the literature
Authors: Goksever Celik Hale , Karacan Tolga , Kaya Cihan , Uhri Mehmet , Savkli Ayse Ozge , Yalcin Bahat Pinar , Altintas Tansu , Usta Taner , Polat Ibrahim , Gorgen Husnu , Oral Engin
Published: March 2019

Introduction:

Endometriosis is characterized by the presence of endometrial cells anywhere outside the uterine cavity. Endometriosis has been encountered on surgical scars especially resulting from a cesarean section recently. Our aim was to investigate the patients with abdominal wall endometriosis in our clinics where all the patients having this disease are managed via surgical resection. We also compared them with the patients presented in the literature.

Methods:

A study was conducted on the patients with histopathological diagnosis of abdominal wall endometriosis as a case series. All the subjects were analyzed through a comprehensive medical assessment including documentation of the detailed history and physical and gynecological examination based on the patients’ medical records.

Results:

A total of 53 patients diagnosed with abdominal wall endometriosis were included in this study. The mean age and the mean body mass index of the patients were 32.6 ± 6.5 years and 25.2 ± 3.5 kg/m2, respectively. A total of 49 patients had at least one operation history, mainly cesarean section. The most common sites for abdominal wall endometriosis were skin and the region containing the rectus abdominis muscle and rectus sheath, 56.6% and 18.9% respectively. The main symptom was the pain getting worse during menstruation and the presence of a mass in all patients. The main diagnostic tools in all patients were detailed history and physical examination, ultrasonography, and then histopathological confirmation after surgical excision.

Conclusion:

Abdominal wall endometriosis is a common diagnosis mainly due to increased cesarean section rate. Clinical suspicion has the most important place in correct diagnosis and management of abdominal wall endometriosis.
Salter osteotomy without open reduction in the Tönnis type II developmental hip dysplasia: A retrospective clinical study
Authors: Gurger Murat , Demir Sukru , Yilmaz Mehmet , Once Gokhan
Published: March 2019

Purpose:

We aimed to evaluate the clinical and radiological outcomes of children older than 18 months who were treated with Salter osteotomy without open reduction for Tönnis type II hip dysplasia.

Methods:

Thirty-two type II hips of 24 patients were included in the study. The mean age was 43.22 (18–108) months. The mean follow-up period was 50 (24–142) months. Seven patients had left sided, nine had right sided, and eight had bilateral developmental dysplasia of the hip. All patients underwent closed reduction and Salter osteotomy. Preoperative and postoperative radiographs were assessed by measuring the center-edge (CE) angle of Wiberg, Smith’s c/b and h/b ratio, and acetabular index (AI). Patients were evaluated clinically according to McKay’s criteria and radiologically according to Severin criteria. The Kalamchi and MacEwen criteria were used in the evaluation of avascular necrosis.

Results:

The mean preoperative AI, CE angle, c/b, and h/b ratio were 36.7° (±4.1), 7.2° (±5.9), 0.9 (±0.08), and 0.05 (±0.04), respectively. The mean latest follow-up AI, CE angle, c/b, and h/b ratio were 18.2° (±1.7), 38.8° (±5.4), 0.6 (±0.03), and 0.19 (±0.04), respectively. The comparison of preoperative and postoperative radiological values revealed statistically significant improvement ( p < 0.01). On the latest physical examinations of the patients, 25 (78.1%) hips were rated excellent, and 7 (21.9%) were rated good according to the McKay criteria. The Severin classification determined 25 (78.1%) hips were grade I and 7 (21.9%) hips were grade II. Type I avascular necrosis (AVN) was seen in four (12.5%) hips. Three of these four hips were more superolateral in preoperative radiographs (c/b > 1 and h/b < 0.05).

Conclusions:

Salter osteotomy without open reduction is a good surgery option for Tönnis type II hip dysplasia, in which closed reduction can be performed. However, the risk of AVN should be kept in mind in more superolateral type 2 hips.
A Novel Arthroscopic Classification of Degenerative Medial Meniscus Posterior Root Tears Based on the Tear Gap
Authors: Kim Jae-Young , Bin Seong-Il , Kim Jong-Min , Lee Bum-Sik , Oh Sung-Mok , Cho Won-Joon
Published: March 2019

Background:

Degenerative medial meniscus posterior root tears (MMPRTs) are reportedly associated with medial compartment osteoarthritis and meniscal extrusion with a displaced gap from the root insertion. However, degenerative MMPRTs have not yet been clearly classified according to arthroscopic findings.

Purpose:

To classify degenerative MMPRTs according to the tear gap and to investigate how the classification could reflect the joint condition properly.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Patients who underwent arthroscopic surgery, performed by a single orthopaedic surgeon, for degenerative MMPRTs between August 2006 and February 2017 were included. MMPRTs were classified according to tear patterns observed during arthroscopic surgery (type 1, incomplete root tear; types 2-5, complete root tears), with each type further divided by the size of the tear gap, defined as the degree of tear displacement from the root (type 2, no gap or overlapped; type 3, gap of 1-3 mm; type 4, gap of 4-6 mm; type 5, gap of ≥7 mm). We compared preoperative factors, including the Kellgren-Lawrence (K-L) grade, absolute extrusion, relative percentage of extrusion (RPE), tear gap on magnetic resonance imaging (MRI), and mechanical alignment, as well as intraoperative factors, including chondral wear at surgery, between each MMPRT type.

Results:

A total of 116 root tears were categorized according to this classification: type 1, 16.4% (19 knees); type 2, 9.5% (11 knees); type 3, 40.5% (47 knees); type 4, 25.0% (29 knees); and type 5, 8.6% (10 knees). Chondral wear of the medial femoral condyle (MFC) ( P = .001), K-L grade ( P = .001), meniscal extrusion ( P = .001), and tear gap on MRI ( P = .001) showed a tendency to increase with a higher tear type. Chondral wear (ρ for MFC = 0.388; ρ for MTP = 0.311), K-L grade (ρ = 0.390), and meniscal extrusion (ρ for absolute extrusion = 0.500; ρ for RPE = 0.451) showed a moderate correlation with tear type, whereas tear gap on MRI (ρ = 0.907) showed a strong correlation with tear type.

Conclusion:

Our study introduces a new classification based on the tear gap that can concisely describe a degenerative MMPRT. The classification system demonstrated that a higher tear type (increasing displacement of the tear gap in arthroscopic surgery) is associated with higher meniscal extrusion, severe chondral wear, and greater severity of arthritis.
Effects of Tinnitus on Cochlear Implant Programming
Authors: Pierzycki Robert H. , Corner Charlotte , Fielden Claire A. , Kitterick Pádraig T.
Published: March 2019

Clinical observations suggest that tinnitus may interfere with programming cochlear implants (CIs), the process of optimizing the transmission of acoustic information to support speech perception with a CI. Despite tinnitus being highly prevalent among CI users, its effects and impact on CI programming are obscure. This study characterized the nature, time-course, and impact of tinnitus effects encountered by audiologists and patients during programming appointments. Semistructured interviews with six CI audiologists were analyzed thematically to identify tinnitus effects on programming and related coping strategies. Cross-sectional surveys with 67 adult CI patients with tinnitus and 20 CI audiologists in the United Kingdom examined the prevalence and time-course of those effects. Programming parameters established at CI activation appointments of 10 patients with tinnitus were compared with those of 10 patients without tinnitus. On average, 80% of audiologists and 45% of patients reported that tinnitus makes measurements of threshold (T) levels more difficult because patients confuse their tinnitus with CI stimulation. Difficulties appeared most common at CI activation appointments, at which T levels were significantly higher in patients with tinnitus. On average, 26% of patients reported being afraid of “loud” CI stimulation worsening tinnitus, affecting measurements of loudest comfortable (C) stimulation levels, and 34% of audiologists reported observing similar effects. Patients and audiologists reported that tinnitus makes programming appointments more difficult and tiresome for patients. The findings suggest that specific programming strategies may be needed during CI programming with tinnitus, but further research is required to assess the potential impact on outcomes including speech perception.
Comparative Couple Stability: Same-sex and Male-female Unions in the United States
Authors: Ketcham Eric , Bennett Neil G.
Published: March 2019

Findings on comparative couple stability between same-sex and male-female unions vary, with some studies finding similar dissolution rates among same-sex and male-female unions and others finding higher rates of dissolution among same-sex unions. The authors extend previous research by examining the association between gender composition of couples and dissolution patterns, distinguishing between cohabitational and formal unions. Using data from the How Couples Meet and Stay Together survey, a nationally representative longitudinal survey of coupled individuals including an oversample of gay-, lesbian-, and bisexual-identified individuals, the authors conduct event-history analyses to estimate the hazard of dissolution of cohabiting and formalized unions. The findings suggest that dissolution rates are indistinguishable among cohabiting unions of all gender compositions and that formalized female-female unions may have a higher risk of union dissolution than the formalized unions of their male-male and male-female peers. The authors explore possible mechanisms underlying this observed risk differential.
Mumbai North: Contemporary Aerial Photographs of Mumbai’s Suburbs
Authors: Stephens Robert D.
Published: March 2019

‘Mumbai North’ features black-and-white aerial photographs of the city’s suburban ecologies—social and natural. Spanning from Sanjay Gandhi National Park to Gorai Creek, and from Bhiwandi’s Waral Lake to Powai, the series visually engages with the ecosystems of Mumbai. Juxtaposed against each photograph are excerpts from archival publications, such as the 1964 Report on the Development Plan for Greater Bombay and the 1965 Marg publication, Bombay, Planning and Dreaming. Together, these two art forms are interwoven into a photo-literary tapestry spanning decades, providing historical insight as to how policies and development plans of the past have shaped urban forms of the present. Air pollution levels, as monitored by the Maharashtra Pollution Control Board, record the contents of atmospheric contaminants such as sulphur dioxide, nitrogen dioxide and respirable suspended particulate matter. This photo-essay integrates multiple layers of information—visual, historical and anthropogenic—as a contemporary means of a new civic survey.
Responding to Harm: The Challenge of Children’s Perspectives
Authors: Haines Kevin , Charles Anthony
Published: March 2019

This article draws upon research undertaken in South Wales to understand children’s views concerning what it means to be a ‘victim’ of crime and their experiences, in that context, of engaging with the criminal justice system. Significantly, and moving beyond traditional policy and service provision concerns, child participants argued passionately that not only did adults fail to provide them with appropriate advice and support, but that their understandings of victimhood were inaccurate. Rather, children articulated an almost zemiological understanding of ‘harm’ which was the basis for an alternative way of understanding what it was to be a ‘victim’. Furthermore, children suggested that they were not taken seriously by an adult-led criminal justice system and that the operation of that system did not address their needs. Reflections are offered in this article concerning children’s views, and the profound implications that their alternative discourse pose for criminal justice policymakers and practitioners.
Analysis of cardiovascular and arteriothrombotic adverse events in chronic-phase CML patients after frontline TKIs
Authors: Jain Preetesh , Kantarjian Hagop , Boddu Prajwal C. , Nogueras-González Graciela M. , Verstovsek Srdan , Garcia-Manero Guillermo , Borthakur Gautam , Sasaki Koji , Kadia Tapan M. , Sam Princy , Ahaneku Hycienth , O’Brien Susan , Estrov Zeev , Ravandi Farhad , Jabbour Elias , Cortes Jorge E.
Published: March 2019

Cardiovascular or arteriothrombotic adverse events (CV- or AT-AEs) are reported in chronic myeloid leukemia (CML) patients treated with tyrosine kinase inhibitors (TKIs). The incidence and characteristics across different TKI have not been systematically analyzed. We analyzed 531 patients treated with frontline TKIs in different prospective trials: imatinib 400 mg (n = 71) and 800 mg (n = 203), nilotinib (n = 108), dasatinib (n = 106), and ponatinib (n = 43). Characteristics and incidence of new-onset CV-AEs and AT-AEs were analyzed. Poisson regression models assessed factors associated with AE incidence. Median follow-up was 94 months (range, 2-195). Overall, 237 patients (45%) developed CV-AEs and 46 (9%) developed AT-AEs. Hypertension was the most common AE seen in 175 patients (33%; grade 3/4 in 17%). CV-AE and AT-AE incidence ratios (IRs) with 95% confidence intervals (CIs) were 8.6 (7.6-9.8) and 1.7 (1.2-2.2) per 100 person-years. Among the TKIs, ponatinib showed the highest IR (95% CI) for CV-AEs and AT-AEs at 40.7 (27.9-59.4) and 9.0 (4.1-20.1). In multivariate analysis, ponatinib therapy was associated with increased incidence rate ratio (IRR) for CV-AEs (4.62; 95% CI, 2.7-7.7; P < .0001) and AT-AEs (6.38; 95% CI, 1.8-21.8; P < .0001) compared with imatinib 400. In summary, there is an increased risk of CV-AEs (except hypertension) and AT-AEs in CML patients treated with newer TKIs, particularly with ponatinib. Patients on TKIs must be informed and closely monitored for vascular AEs. These studies were registered at www.clinicaltrials.gov as #NCT00048672, #NCT00038649, #NCT00050531, #NCT00254423, #NCT00129740, and #NCT01570868.
Stem cell transplantation for osteopetrosis in patients beyond the age of 5 years
Authors: Stepensky Polina , Grisariu Sigal , Avni Batia , Zaidman Irina , Shadur Bella , Elpeleg Orly , Sirin Mehtap , Hoenig Manfred , Schuetz Catharina , Furlan Ingrid , Beer Meinrad , von Harsdorf Stephanie , Bunjes Donald , Debatin Klaus-Michael , Schulz Ansgar S.
Published: March 2019

Osteopetrosis (OP) is a rare disease caused by defective osteoclast differentiation or function. Hematopoietic stem cell transplantation (HSCT) is the only curative treatment available in the infantile “malignant” form of OP. Improved clinical and genetic diagnosis of OP has seen the emergence of a cohort of patients with less severe and heterogeneous clinical presentations. This intermediate form of OP does not call for urgent intervention, but patients accumulate debilitating skeletal complications over years and decades, which are severe enough to require curative treatment and may also require intermittent transfusion of blood products. Here we present data from 7 patients with intermediate OP caused by mutations in TCIRG1 (n = 2), CLCN7 (n = 2), RANK (n = 1), SNX10 (n = 1), and CA2 (n = 1), who were transplanted between the ages of 5 to 30 years (mean, 15; median, 12). Donors were matched siblings or family (n = 4), matched unrelated (n = 2), or HLA haploidentical family donors (n = 1). Conditioning was fludarabine and treosulfan based. All 6 patients transplanted from matched donors are currently alive with a follow-up period between 1 and 8 years at time of publication (median, 4 years) and have demonstrated a significant improvement in symptoms and quality of life. Patients with intermediate OP should be considered for HSCT.
CRP-guided antibiotic treatment in acute exacerbations of COPD in hospital admissions
Authors: Prins H.J. , Duijkers Ruud , van der Valk Paul , Schoorl Marianne , Daniels Johannes M.A. , van der Werf Tjip S. , Boersma Wim G.
Published: March 2019

The role of antibiotics in acute exacerbations of chronic obstructive pulmonary disease (COPD) is controversial and a biomarker identifying patients who benefit from antibiotics is mandatory. We performed a randomised, controlled trial in patients with acute exacerbations of COPD, comparing C-reactive protein (CRP)-guided antibiotic treatment to patient reported symptoms in accordance with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy, in order to show a reduction in antibiotic prescription.

Patients hospitalised with acute exacerbations of COPD were randomised to receive antibiotics based either on the GOLD strategy or according to the CRP strategy (CRP ≥50 mg·L−1).

In total, 101 patients were randomised to the CRP group and 119 to the GOLD group. Fewer patients in the CRP group were treated with antibiotics compared to the GOLD group (31.7%versus46.2%, p=0.028; adjusted odds ratio (OR) 0.178, 95% CI 0.077–0.411, p=0.029). The 30-day treatment failure rate was nearly equal (44.5% in the CRP groupversus45.5% in the GOLD-group, p=0.881; adjusted OR 1.146, 95% CI 0.649–1.187, p=0.630), as was the time to next exacerbation (32 days in the CRP groupversus28 days in the GOLD group, p=0.713; adjusted hazard ratio 0.878, 95% CI 0.649–1.187, p=0.398). Length of stay was similar in both groups (7 days in the CRP groupversus6 days in the GOLD group, p=0.206). On day-30, no difference in symptom score, quality of life or serious adverse events was detected.

Use of CRP as a biomarker to guide antibiotic treatment in severe acute exacerbations of COPD leads to a significant reduction in antibiotic treatment. In the present study, no differences in adverse events between both groups were found. Further research is needed for the generalisability of these findings.
Randomised controlled trial of polysomnographic titration of noninvasive ventilation
Authors: Hannan Liam M. , Rautela Linda , Berlowitz David J. , McDonald Christine F. , Cori Jennifer M. , Sheers Nicole , Chao Caroline , O'Donoghue Fergal J. , Howard Mark E.
Published: March 2019

Noninvasive ventilation (NIV) settings determined during wakefulness may produce patient–ventilator asynchrony (PVA) during sleep, causing sleep disruption and limiting tolerance. This study investigated whether NIV titrated with polysomnography (PSG) is associated with less PVA and sleep disruption than therapy titrated during daytime alone.

Treatment-naive individuals referred for NIV were randomised to control (daytime titration followed by sham polysomnographic titration) or PSG (daytime titration followed by polysomnographic titration) groups. Primary outcomes were PVA and arousal indices on PSG at 10 weeks. Secondary outcomes included adherence, gas exchange, symptoms and health-related quality of life (HRQoL).

In total, 60 participants were randomised. Most (88.3%) had a neuromuscular disorder and respiratory muscle weakness but minor derangements in daytime arterial blood gases. PVA events were less frequent in those undergoing polysomnographic titration (median (interquartile range (IQR)): PSG 25.7 (12–68) events·h−1versuscontrol 41.0 (28–182) events·h−1; p=0.046), but arousals were not significantly different (median (IQR): PSG 11.4 (9–19) arousals·h−1versuscontrol 14.6 (11–19) arousals·h−1; p=0.258). Overall adherence was not different except in those with poor early adherence (<4 h·day−1) who increased their use after polysomnographic titration (mean difference: PSG 95 (95% CI 29–161) min·day−1versuscontrol −23 (95% CI −86–39) min·day−1; p=0.01). Arterial carbon dioxide tension, somnolence and sleep quality improved in both groups. There were no differences in nocturnal gas exchange or overall measures of HRQoL.

NIV titrated with PSG is associated with less PVA but not less sleep disruption when compared with therapy titrated during daytime alone.
Nationwide cloud-based integrated database of idiopathic interstitial pneumonias for multidisciplinary discussion
Authors: Fujisawa Tomoyuki , Mori Kazutaka , Mikamo Masashi , Ohno Takashi , Kataoka Kensuke , Sugimoto Chikatoshi , Kitamura Hideya , Enomoto Noriyuki , Egashira Ryoko , Sumikawa Hiromitsu , Iwasawa Tae , Matsushita Shoichiro , Sugiura Hiroaki , Hashisako Mikiko , Tanaka Tomonori , Terasaki Yasuhiro , Kunugi Shinobu , Kitani Masashi , Okuda Ryo , Horiike Yasuoki , Enomoto Yasunori , Yasui Hideki , Hozumi Hironao , Suzuki Yuzo , Nakamura Yutaro , Fukuoka Junya , Johkoh Takeshi , Kondoh Yasuhiro , Ogura Takashi , Inoue Yoshikazu , Hasegawa Yoshinori , Inase Naohiko , Homma Sakae , Suda Takafumi
Published: March 2019

Multidisciplinary discussion (MDD) requiring close communication between specialists (clinicians, radiologists and pathologists) is the gold standard for the diagnosis of idiopathic interstitial pneumonias (IIPs). However, MDD by specialists is not always feasible because they are often separated by time and location. An online database would facilitate data sharing and MDD. Our aims were to develop a nationwide cloud-based integrated database containing clinical, radiological and pathological data of patients with IIPs along with a web-based MDD system, and to validate the diagnostic utility of web-based MDD in IIPs.

Clinical data, high-resolution computed tomography images and lung biopsy slides from patients with IIPs were digitised and uploaded to separate servers to develop a cloud-based integrated database. Web-based MDD was performed using the database and video-conferencing to reach a diagnosis.

Clinical, radiological and pathological data of 524 patients in 39 institutions were collected, uploaded and incorporated into the cloud-based integrated database. Subsequently, web-based MDDs with a pulmonologist, radiologist and pathologist using the database and video-conferencing were successfully performed for the 465 cases with adequate data. Overall, the web-based MDD changed the institutional diagnosis in 219 cases (47%). Notably, the MDD diagnosis yielded better prognostic separation among the IIPs than did the institutional diagnosis.

This is the first study of developing a nationwide cloud-based integrated database containing clinical, radiological and pathological data for web-based MDD in patients with IIPs. The database and the web-based MDD system that we built made MDD more feasible in practice, potentially increasing accurate diagnosis of IIPs.
Oxygen compared to air during exercise training in COPD with exercise-induced desaturation
Authors: Alison Jennifer A. , McKeough Zoe J. , Leung Regina W.M. , Holland Anne E. , Hill Kylie , Morris Norman R. , Jenkins Sue , Spencer Lissa M. , Hill Catherine J. , Lee Annemarie L. , Seale Helen , Cecins Nola , McDonald Christine F.
Published: March 2019

Almost half the patients referred to pulmonary rehabilitation with chronic obstructive pulmonary disease (COPD) desaturate during exercise. Although oxygen supplementation may ameliorate oxygen desaturation, the effects on outcomes of exercise training have not been rigorously evaluated. This study aimed to determine whether supplemental oxygen during exercise training was more effective than medical air in improving exercise capacity and health-related quality of life (HRQoL) in people with COPD.

People with COPD who demonstrated oxygen desaturation <90% during the 6-min walk test were recruited to this multicentre trial with randomisation (independent, concealed allocation) to either an Oxygen group or Air group, blinding (participants, exercise trainers andEuropean Respiratory Journalassessors) and intention-to-treat analysis. Both groups received the respective gas from concentratorsvianasal prongs at 5 L·min−1during exercise training consisting of treadmill and cycle exercise, three times per week for 8 weeks. Primary outcomes were the endurance shuttle walk test (ESWT) time and Chronic Respiratory Disease Questionnaire (CRQ)-Total score.

111 participants (60 males), mean±sdage 69±7 years, with moderate to severe COPD were recruited and 97 completed (Oxygen group n=52; Air group n=45). At the end of the 8-week training programme there were no between-group differences in change in ESWT (mean difference 15 s (95% CI −106–136 s) or change in CRQ-Total (0.0 points (95% CI −0.3–0.3 points)). Within-group changes at end-training were significant for ESWT and CRQ-Total (all p<0.01).

Exercise capacity and HRQoL improved in both groups, with no greater benefit from training with supplemental oxygen than medical air.
A value-based evaluation of minimally invasive hysterectomy approaches
Authors: Danilyants Natalya , MacKoul Paul , van der Does Louise , Haworth Leah , Baxi Rupen
Published: March 2019

Background

With surgical care contributing to the rising healthcare costs around the globe, quantifying the value of surgical modalities is critical to pushing healthcare systems in the direction of greater sustainability. The purpose of this study was to assess and compare the value of minimally invasive hysterectomy approaches, as defined by operative outcomes and patient satisfaction relative to direct hospital costs.

Methods

Sequential mixed methods; retrospective chart review of all women (N = 2689) ≥ 18 years old who underwent hysterectomy for benign conditions from 2011 through 2013 at a suburban hospital in Maryland, USA; a mail survey of the same population was administered in June to October 2015. Procedures included laparoscopic supracervical hysterectomy (LSH), robotically assisted laparoscopic hysterectomy (RALH), total laparoscopic hysterectomy (TLH), laparoscopically assisted vaginal hysterectomy (LAVH), total vaginal hysterectomy (TVH), and laparoscopic retroperitoneal hysterectomy (LRH), a procedure that incorporates retroperitoneal dissection and ligation of the uterine arteries at their vascular origin. We estimated the value of each procedure by dividing quality over direct hospital costs, where quality was quantified by creating a summary composite score of the average operating time, estimated blood loss, complication and conversion rates, and patient satisfaction.

Results

The majority of LRH and RALH procedures were performed by high-volume surgeons, while the majority of LSH and TVH procedures were performed by low-volume surgeons. RALH had the highest postoperative complication rate (11.4%;p < .0001). TVH had the highest intraoperative complication rate (9.6%;p < .0001) but lowest postoperative complication rate (1.8%;p < .0001). LRH had the shortest operating time (71.2 min;p < .0001) and lowest intraoperative complication rates (2.1%;p < .0001). LRH and TVH were the least costly ($4061 and $6416, respectively), while RALH was the most costly ($9354). LRH had the highest combined patient satisfaction score, followed by RALH, while TLH, LAVH, TVH, and LSH averaged similar scores.

Conclusion

LRH, TVH, and LAVH yielded the highest value scores; LSH, TLH, and RALH yielded the lowest. Healthcare costs continue to escalate, in large part due to innovations in medical technology. For healthcare stakeholders seeking to control costs without sacrificing quality, it is critical to operationalize the value of varying surgical techniques, including measures of surgeon experience, operative outcomes, costs, and patient satisfaction.
Function of ankle ligaments for subtalar and talocrural joint stability during an inversion movement – an in vitro study
Authors: Li Lu , Gollhofer Albert , Lohrer Heinz , Dorn‐Lange Nadja , Bonsignore Guiseppe , Gehring Dominic
Published: March 2019

Background

The lateral ankle ligament complex consisting of the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL) and the posterior talofibular ligament (PTFL) is known to provide stability against ankle joint inversion. As injuries of the ankle joint have been reported at a wide range of plantarflexion/dorsiflexion angles, the aim of the present study was to evaluate the stabilizing function of these ligaments depending on the sagittal plane positioning of the ankle joint.

Methods

Eight fresh‐frozen specimens were tested on a custom‐built ankle deflection tester allowing the application of inversion torques in various plantarflexion/dorsiflexion positions. A motion capture system recorded kinematic data from the talus, calcaneus and fibula with bone‐pin markers during inversion movements at 10° of dorsiflexion, at neutral position and at plantarflexion 10°. ATFL, CFL and PTFL were separately but sequentially sectioned in order to assess the contribution of the individual ligament with regard to ankle joint stability.

Results

Joint‐ and position‐specific modulations could be observed when the ligaments were cut. Cutting the ATFL did not lead to any observable alterations in ankle inversion angle at a given torque. But subsequently cutting the CFL increased the inversion angle of the talocrural joint in the 10° plantarflexed position, and significantly increased the inversion angle of the subtalar joint in the 10° dorsiflexed position. Sectioning of the PTFL led to minor increases of inversion angles in both joints.

Conclusions

The CFL is the primary ligamentous stabilizer of the ankle joint against a forced inversion. Its functioning depends greatly on the plantar−/dorsiflexion position of the ankle joint complex, as it provides the stability of the talocrural joint primarily during plantarflexion and the stability of the subtalar joint primarily during dorsiflexion.
Correction to: Visual analytics for collaborative human-machine confidence in human-centric active learning tasks
Authors: Legg Phil , Smith Jim , Downing Alexander
Published: March 2019

In the original publication of this article [1], some labels in the left column are incorrect in Fig. 3. They are revised in the updated figure below:
The gut microbiome and response to immune checkpoint inhibitors: preclinical and clinical strategies
Authors: Gong Jun , Chehrazi‐Raffle Alexander , Placencio‐Hickok Veronica , Guan Michelle , Hendifar Andrew , Salgia Ravi
Published: March 2019

There is growing interest in identifying predictive biomarkers for inhibitors of programmed cell death protein 1 receptor (PD‐1), programmed death ligand 1 (PD‐L1), and cytotoxic T‐lymphocyte associated protein 4 (CTLA‐4). Given the links between the stool microbiota, anticancer immunosurveillance, and general health, the composition of the gut microbiome has recently undergone investigation as a biomarker for immunotherapy. In this review, we highlight published results from preclinical and clinical studies to date supporting a relationship between the gut microbiome and antitumor efficacy of immune checkpoint inhibitors. Despite the promising and hypothesis‐generating findings that have been produced in this arena to date, there remain some inconsistencies amongst present data that may need to be resolved to contribute to further development. Among these, a better understanding of the immunomodulatory function of the microbiome, standardization in sampling, sequencing techniques, and data analysis, and ensuring uniformity across various aspects of study design are warranted in conducting future prospective studies seeking to validate the gut microbiome as a potential biomarker of response to checkpoint blockade.
Contemporary decongestant practices of Canadian otolaryngologists for endoscopic sinus surgery
Authors: Reid Jonathan W. , Rotenberg Brian W. , Sowerby Leigh J
Published: March 2019

Background

Cocaine has traditionally been the topical decongestant most frequently used for visualization of the surgical field in Endoscopic Sinus Surgery (ESS). Alternatives include xylometazoline, oxymetazoline, and epinephrine. The understanding of the safety profile of each agent is changing, as are the practices of Otolaryngologists-Head & Neck Surgeons. The objective of this study is to determine decongestant use practices in ESS across Canada, which has not previously been studied.

Methods

A cross-sectional survey design using a 24-item electronic questionnaire was distributed to actively practicing members of the Canadian Society of Otolaryngology-Head and Neck Surgery via email. A French translated version of the survey was also available. Questions explored the respondents’ demographics and decongestion practices for ESS.

Results

Ninety-six surveys from otolaryngologists practicing in Canada were completed (19% response rate). The average time in practice was 16.5 years (range 1–50 years, SD 12.0 years). Twenty-six (27%) of respondents use some form of cocaine solution for topical decongestion in ESS. Over a total of over 1500 combined practice-years, eight respondents (8%) personally experienced an adverse event that could be attributed to cocaine, including two mortalities. One cardiac even was directly attributable to the patients’ use of recreational cocaine in the immediate pre-operative period.

Conclusion

The popularity of cocaine for topical decongestion in ESS in present-day Canada is less than in surveys from other countries. However, there are few reported adverse events with long-term consequences that are attributable to intraoperative cocaine. Considering the beneficial effects of cocaine for visualization and pain control, this change in practice warrants further investigation.
How to evoke consumer approach intention toward VR stores? Sequential mediation through telepresence and experiential value
Authors: Jang Ju Yeun , Hur Hee Jin , Choo Ho Jung
Published: March 2019

This study explores the roles of vividness and interactivity—two technological dimensions of virtual reality mediums—for consumers’ approach intention toward immersive virtual reality stores. In addition to telepresence, a well-established variable in explaining the effectiveness of virtual mediums, this study proposes experiential value as the second mediator that can lead to successful consumer experiences in commercial virtual environments. We recruited 101 volunteers who were willing to experience a virtual reality store with head-mounted displays. The results show that participants who perceive higher vividness and interactivity of an immersive virtual reality store tend to show stronger approach intentions, and that such positive influences are serially mediated by perceived telepresence and experiential shopping value. In multiple-step mediation analysis, the perceived experiential shopping value is found to be the key determinant in evoking consumers’ approach intention. The study concludes that virtual reality stores should be built in a way that provides experiential value by utilizing strong telepresence to achieve positive consumers’ approach intention. Suggestions for further research and practical applications are also discussed.