bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of CNS T2-focal lesions on cervical cord atrophy and disability in multiple sclerosis
Authors: Pravatà Emanuele , Valsasina Paola , Gobbi Claudio , Zecca Chiara , Riccitelli Gianna C , Filippi Massimo , Rocca Maria A
Published: July 2019

Background:

Mechanisms associated with cervical spinal cord (CSC) and upper thoracic spinal cord (TSC) atrophy in multiple sclerosis (MS) are poorly understood.

Objective:

To assess the influence of brain, CSC and TSC T2-hyperintense lesions on cord atrophy and disability in MS.

Methods:

Thirty-four MS patients underwent 3T brain, cervical and thoracic cord magnetic resonance imaging (MRI) and Expanded Disability Status Scale (EDSS) score assessment. CSC/TSC lesion number and volume (LV), whole-brain and cortico-spinal tract (CST) LVs were obtained. Normalized whole CSC and upper TSC cross-sectional areas (CSAn) were also derived. Age- and sex-adjusted regression models assessed associations of brain/cord lesions with CSAn and EDSS and identified variables independently associated with CSAn and EDSS with a stepwise variable selection.

Results:

CSC CSAn (β = −0.36, p = 0.03) and TSC CSAn (β = −0.60, p < 0.001) were associated with CSC T2 LV. EDSS (median = 3.0) was correlated with CSC T2 LV (β = 0.42, p = 0.01), brain (β = 0.34, p = 0.04) and CST LV (β = 0.35, p = 0.03). The multivariate analysis retained CSC LV as significant predictor of CSC CSAn ( R2 = 0.20, p = 0.023) and TSC CSAn ( R2 = 0.51, p < 0.001) and retained CSC and CST LVs as significant predictors of EDSS ( R2 = 0.55, p = 0.001).

Conclusions:

CSC LV is an independent predictor of cord atrophy. When neurological impairment is relatively mild, central nervous system (CNS) lesion burden is a better correlate of disability than atrophy.
What factors predict the engagement of dropouts in alternative secondary schools in Chile?
Authors: Espinoza Oscar , González Luis Eduardo , McGinn Noel , Castillo Dante
Published: July 2019

Improvement in education has been one of the strategies of the government of Chile to reduce economic inequality. To that end, it recently established a system of Second Opportunity Centers that enroll out-of-school youth who have not completed high school. The system is modeled on so-called alternative schools operating in Europe and the United States. This study reports results on the first survey of students. Questionnaires were completed by a representative sample of 1112 students, drawn from 18 of the Ministry of Education’s 134 Centers. Most of the respondents expressed satisfaction with their program, but there were significant differences between boys and girls, and across centers. Differences are explained by program activities in which students are engaged. Male students were more likely to have dropped out of regular high school because of academic difficulties; they are more likely to be engaged in the centers’ sports activities. Girls were more likely to have left their school because of a family situation. They are more engaged in the centers’ academic activities. The findings suggest how the centers’ program could be made more effective in retaining students to graduation.
Mechanical behavior of laminated bamboo lumber dowel-type connection
Authors: Li Jiannan , Zhou Aiping
Published: July 2019

Bamboo is a kind of green material with high specific strength, while the hollow tubular structure makes it rather hard to be utilized in structure. Glue and hot-pressing processes make laminated bamboo lumber rectangular cross section and with high strength properties. The dowel-type connection can be used in I-joist instead of the costly adhesive, while the behaviors of which are extremely complicated. European yield model is confirmed to be an effective method to estimate loading capacity of connection and is adopted by various standard and design codes. This article focused on a kind of connection innovatively with laminated bamboo lumber dowel. The embedment tests were carried out to study the embedment strength of laminated bamboo lumber members. Connection tests under lateral load were conducted to investigate the performance and loading capacity. Finally, theoretical results determined by design rules in current codes were compared with experimental results
Experimental behaviour of concrete-filled steel tubes under cyclic axial compression
Authors: Cao Vui Van , Le Quoc Dinh , Nguyen Phuoc Trong
Published: July 2019

This study experimentally investigated the behaviour of concrete-filled steel tubes under cyclic axial compression. A total of 42 concrete-filled steel tube specimens of two groups were tested to failure. In each group, 18 specimens were subjected to three cyclic axial loading histories while three specimens were subjected to monotonic loading for comparison. The results indicated that concrete-filled steel tube specimens under cyclic axial compression failed in the form of buckling and still kept their form which was similar to the failure of specimens under monotonic loading. Effect of cyclic axial loading slightly reduced (approximately 2%–3%) the maximum stress but it increased 25% of the strain corresponding to the maximum stress. Loading and unloading moduli in post-peak stress phase were, respectively, about 70% and 85% higher than initial moduli because better interaction and confinement were resulted from the initial loading cycle. In addition, the absorbed energy exhibited a heavy dependence on strain and confinement while it was insignificantly affected by cyclic loading histories. Details and application of obtained experimental results are reported in this article.
Dimensions of Informality in Bangladesh Labour Market and the Consequent Wage Penalty
Authors: Rahman Mustafizur , Bhattacharya Debapriya , Al-Hasan Md
Published: July 2019

The article examines the various dimensions and underlying causes of informal employment in the Bangladesh labour market and the associated wage penalty. Based on labour force survey data for successive points, we trace the dynamics of employment in Bangladesh along the informal–formal divide over time. Given that wage differential remains a key feature concerning the two market segments, we have carried out mean and quantile decomposition exercises to estimate the wage penalty originating from informality. We find significant wage gaps between formal- and informal-paid employees, formal paid and informal day labour, and formal paid and informal self-employed. The wage gaps range between 65.0 per cent and 225.0 per cent. The gap arises from a combination of observed differences in human capital and job characteristics, and the wage premium accruing from formal employment.

JEL: C21, J31
Optimizing Indocyanine Green Fluorescence Angiography in Reconstructive Flap Surgery: A Systematic Review and Ex Vivo Experiments
Authors: Pruimboom Tim , van Kuijk Sander M. J. , Qiu Shan S. , van den Bos Jacqueline , Wieringa Fokko P. , van der Hulst René R. W. J. , Schols Rutger M.
Published: July 2019

Background. Indocyanine green angiography (ICGA) offers the potential to provide objective data for evaluating tissue perfusion of flaps and reduce the incidence of postoperative necrosis. Consensus on ICGA protocols and information on factors that have an influence on fluorescence intensity is lacking. The aim of this article is to provide a comprehensive insight of in vivo and ex vivo evaluation of factors influencing the fluorescence intensity when using ICGA during reconstructive flap surgery. Methods. A systematic literature search was conducted to provide a comprehensive overview of currently used ICGA protocols in reconstructive flap surgery. Additionally, ex vivo experiments were performed to further investigate the practical influence of potentially relevant factors. Results. Factors that are considered important in ICGA protocols, as well as factors that might influence fluorescence intensity are scarcely reported. The ex vivo experiments demonstrated that fluorescence intensity was significantly related to dose, working distance, angle, penetration depth, and ambient light. Conclusions. This study identified factors that significantly influence the fluorescence intensity of ICGA. Applying a weight-adjusted ICG dose seems preferable over a fixed dose, recommended working distances are advocated, and the imaging head during ICGA should be positioned in an angle of 60° to 90° without significantly influencing the fluorescence intensity. All of these factors should be considered and reported when using ICGA for tissue perfusion assessment during reconstructive flap surgery.
The Development of Trigger Thumb in the Contralateral Thumb in Pediatric Patients Presenting Initially With Unilateral Involvement
Authors: Lin James S. , Pettit Robert , Rosenbaum Joseph A. , Popp James E. , Samora Julie Balch
Published: July 2019

Background: Pediatric trigger thumb is a common condition that can occur bilaterally. There have been reports of a metachronous relationship between trigger thumbs developing in both extremities. Surgeons might consider delaying operative treatment of unilateral trigger thumb due to the concern that contralateral symptoms may develop later in childhood, requiring a second procedure and anesthetic event. Methods: We retrospectively reviewed patients diagnosed with pediatric trigger thumb from 2008 to 2016 at a large pediatric hospital. Data collected included age at presentation and onset, laterality, age and timing of onset of contralateral symptoms, time of index procedure and subsequent procedure (if any), severity of symptoms, previous treatments, range of motion, and birth history. Results: There were 198 patients with pediatric trigger thumb, with 55 patients (28%) presenting with or developing bilateral involvement. Fifty patients (25%) had bilateral involvement upon initial presentation. Five patients (3%) were subsequently diagnosed with contralateral trigger thumb after initial presentation of unilateral trigger thumb. Average time to contralateral trigger thumb development was 12 months after presentation in unilateral patients. Most patients presented with locked flexion contracture with palpable Notta’s nodule. Of the 5 patients who developed contralateral trigger thumbs, three required a second surgery after the index procedure. Conclusions: The vast majority of patients with bilateral trigger thumbs had bilateral involvement upon initial presentation to the pediatric hand clinic. Given the rarity of bilateral symptoms after initial unilateral presentation, we do not recommend delayed surgical intervention for patients with unilateral disease in children over 3 years of age.
Analysis of lncRNA and mRNA Transcriptomes Expression in Thyroid Cancer Tissues Among Patients With Exposure of Medical Occupational Radiation
Authors: Shi Feng , Liu Ying , Li Min , Wen Peng , Qian Qiu Qin , Fan Yibin , Huang Ruixue
Published: July 2019

Background:

Occupational exposure of radiation among medical radiation workers contributes to the subsequent increased risk of thyroid cancer. Long noncoding RNAs (lncRNAs) are emerging as important regulators of cancer biology. However, little is known about lncRNA expression in thyroid cancer tissues from patients who are exposed to medical occupational radiation. The purpose of this study is to reveal the transcriptomes difference between thyroid cancer tissues and adjacent nonneoplastic thyroid tissues.

Methods:

Microarray technology was used in this study. Quantitative reverse transcription polymerase chain reaction was adopted to verify 6 differentially expressed lncRNAs. Gene ontology and pathway analyses were performed using standard enrichment computational methods. Potential target genes of the differentially expressed lncRNAs were predicted with 2 independent algorithms.

Results:

A total of 23 lncRNA and messenger RNA transcripts were found differentially expressed in the thyroid cancer tissues (fold change ≥2.0, P < .05). This differential lncRNA expression may affect many pathways, including those involved in cysteine and methionine metabolism, Huntington disease, propanoate metabolism, and carcinogenesis.

Conclusions:

Our study provides a transcriptome-wide screening and analysis of the lncRNA expression profile in thyroid cancer tissues from patients with medical occupational radiation exposure and lays the foundation for further investigation of lncRNAs related to thyroid cancer development and carcinogenic risk of medical occupational radiation exposure.
The Nominal Group Technique (NGT) as a Tool for Facilitating Pan-Disability Focus Groups and as a New Method for Quantifying Changes in Qualitative Data
Authors: Olsen Jason
Published: July 2019

This article reaffirms the value and flexibility of the nominal group technique (NGT) when conducting qualitative focus groups (QFGs). In the project that will be discussed, the methods used expanded the application of the NGT into the realm of pan-disability (i.e., individuals with differing impairments) research. It provides requirements and recommendations for the full inclusion and participation of disabled people into projects where the pertinent source of qualitative data is obtained from QFGs. Furthermore, this article describes innovative additional steps to the NGT that are beneficial to researchers. This includes a method of evaluating the data that is often lost between the NGTs’ stages of initial and final rankings. These new methods ensure pertinent data are not overlooked.
Effects of non-Newtonian lubricants and elastic coating on transient elastohydrodynamic lubrication at impact squeeze loading
Authors: Chu Li-Ming , Chang Yuh-Ping , Hsu Hsiang-Chen
Published: July 2019

This study explores the effects of non-Newtonian lubricants on elastohydrodynamic lubrication with coating at impact and rebound loading using power law lubricants. The coupled transient modified Reynolds, rheology, elasticity deformation, and ball motion equations are solved simultaneously, thus obtaining the transient pressure profiles, film shapes, normal squeeze velocities and accelerations. The effect of the flow index ( n) is equivalent to enhancing the lubricant viscosity, also enlarging the damper effect. The simulation results reveal that the film thickness, the primary peak, and the secondary peak increase with increasing the flow index. The greater the flow index is, the earlier the dimple form, and the smaller the maximum value of the impact force is. The rebounding velocity and the peak value of acceleration increase with decreasing the flow index. Moreover, this research possesses academic innovation and industrial application.
Transparency and objectivity in governance of clinical trials data sharing: Current practices and approaches
Authors: Shabani Mahsa , Obasa Mojisola
Published: July 2019

Sharing metadata, individual participant data and summary data, as a complement to results dissemination and trial registration requirements, is perceived to be advantageous by enabling faster and more accurate meta-analyses and reducing the need for additional trials. To date, various models of data access have been utilized in order to manage clinical trials data sharing and access in line with the rights and interests of sponsors, researchers and patients involved in clinical trials. In order to ensure responsible data sharing, the data access review process should be developed in a way that ensures fairness, transparency and objectivity. In this article, we critically review some examples of current governance models in clinical trials data sharing and suggest approaches to ensure the objectivity of the data access review process.
Utilizing an HIV community advisory board as an agent of community action and health promotion in a low-resource setting: a case-study from Nova Iguaçu, Rio de Janeiro, Brazil
Authors: Milnor Jacob R. , Santana Clarice Silva , Martos Alexander J. , Pilotto Jose Henrique , Souza Claudia Teresa Viera de
Published: July 2019

Introduction:

Brazil’s HIV burden has greatly increased over the past decade, especially for socially marginalized and vulnerable groups such as adolescents, women, and men who have sex with men. The reasoning for worsening HIV outcomes is complex, but ongoing economic and political crises have placed extreme operational and financial burdens on both the public health system and HIV-related civil society, affecting both treatment and prevention efforts and delivery.

Context:

Community-based HIV-related health-promotion activities have continued in Nova Iguaçu, Rio de Janeiro, despite these setbacks. These efforts have been led by a semi-independent community advisory board and engagement group based at the Hospital Geral de Nova Iguaçu with support from researchers based at the Oswaldo Cruz Foundation.

Methods:

The research team supported, documented, and participated in various activities led by the community advisory board and engagement group from 2017–2018 including meetings, community workshops/lectures, production of health promotion materials, and the dissemination of research findings.

Results:

The research team utilized the concepts of vernacular knowledge and critical pedagogy to describe and document the ongoing, bottom-up approach, community-led efforts of the community advisory board and engagement group. In particular, we describe the process of stakeholder engagement, popularization of research results, and resource sharing spearheaded by the community advisory board in Nova Iguaçu.

Conclusion:

The community advisory board demonstrates how community-led efforts are essential to HIV and AIDS response efforts in light of worsening HIV burdens and global shifts towards biomedicalization. Their HIV-related activities rely on existing community networks and resources with secondary support from a research team. This illustrates a key intervention point between traditional research and an empowering community mobilization that can inform similar efforts in other low-resource settings.
Examination of explicit definitions of enterprise architecture
Authors: Saint-Louis Patrick , Morency Marcklyvens C , Lapalme James
Published: July 2019

Various understandings of enterprise architecture (EA) exist and there is no agreement on them. The various definitions of EA are not always complementary but sometimes in opposition. Within this study, we conduct a systematic literature review to analyze explicit definitions of EA. Based on concepts from the academic field of terminology, we have broken down these definitions into many parts in order to examine each part individually before making generalizations. The findings show how some of the EA definitions are implicit, incomplete, complex, and incoherent.
Midterm Results of Radiographic and Functional Outcomes After Tibiotalocalcaneal Arthrodesis With Bulk Femoral Head Allograft
Authors: Rogero Ryan , Tsai Justin , Fuchs Daniel , Shakked Rachel , Raikin Steven M.
Published: July 2019

Background: Tibiotalocalcaneal (TTC) arthrodesis implementing adjunctive allografts is a method of limb salvage for patients with complex hindfoot osseous deficits, though outcome results are limited. The purposes of this study were to assess functional and radiographic outcomes after TTC arthrodesis with femoral head allograft and retrospectively identify prognostic factors. Methods: The authors reviewed 24 TTC arthrodesis procedures with bulk femoral head allografts performed by a single surgeon from 2004 to 2016. Radiographic union at the ankle and subtalar joints along with stability of the allograft were assessed. Patients who had clinically successful arthrodeses were contacted to score the Foot and Ankle Ability Measure—Activities of Daily Living (FAAM-ADL) questionnaire, Visual Analog Scale (VAS) for pain, and Short Form-12 (SF-12) at a mean of 58.0 months (range, 28-102) postoperatively. Results: Complete radiographic union of involved joints was achieved in 15 patients (63%) and in 75% (36/48) of all joints; 21 ankles (88%) were assessed to be radiographically stable at final follow-up. Three patients (13%) underwent revision arthrodesis at a mean of 18.9 months postoperatively, and 21 patients (88%) did not require additional surgery as of final follow-up. Patients significantly improved to a mean FAAM-ADL score of 71.5 from 36.3 (P < .001). The mean VAS for pain significantly improved from 77.2 to 32.9 (P < .001). Male sex (P = .08) and a lateral operative approach (P = .03) both resulted in worse outcomes. Conclusion: Use of a femoral head allograft with TTC arthrodesis can offer improved functional scores and sustained radiographic outcomes.

Level of Evidence: Level IV: Case series
Patient Knowledge Regarding Radiation Exposure From Foot and Ankle Imaging
Authors: Manning Blaine T. , Bohl Daniel D. , Idarraga Alexander J. P. , Holmes George B. , Lee Simon , Lin Johnny L. , Hamid Kamran S.
Published: July 2019

Foot and ankle surgeons routinely prescribe diagnostic imaging that exposes patients to potentially harmful ionizing radiation. It is unclear how well patients understand the radiation to which they are exposed. In this study, 946 consecutive new patients were surveyed regarding medical imaging and radiation exposure prior to their first appointment. Respondents compared the amount of radiation associated with chest X-rays (CXRs) with various types of foot and ankle imaging. Results were compared with actual values of radiation exposure from the published literature. Of 946 patients surveyed, 841 (88.9%) participated. Most had private insurance (82.8%) and a bachelor’s degree or higher (60.6%). Most believed that foot X-ray, ankle X-ray, “low dose” foot and ankle computed tomography (CT) scan (alluding to cone-beam CT), and traditional foot and ankle CT scan contain similar amounts of ionizing radiation to CXR. This contradicts the published literature that suggests that the actual exposure to patients is 0.006, 0.006, 0.127, and 0.833 CXR equivalents of radiation, respectively. Of patients who had undergone an X-ray, 55.9% thought about the issue of radiation prior to the study, whereas 46.1% of those undergoing a CT scan considered radiation prior to the exam. Similarly, 35.2% and 27.6% reported their doctor having discussed radiation with them prior to obtaining an X-ray and CT scan, respectively. Patients greatly overestimate the radiation exposure associated with plain film X-rays and cone-beam CT scans of the foot and ankle, and may benefit from increased counseling regarding the relatively low radiation exposure associated with these imaging modalities.

Level of Evidence: Level III: Prospective questionnaire
Digital Technologies and Selective Exposure: How Choice and Filter Bubbles Shape News Media Exposure
Authors: Cardenal Ana S. , Aguilar-Paredes Carlos , Galais Carol , Pérez-Montoro Mario
Published: July 2019

This paper analyzes the role of different origins to news media in selective exposure. We rely on a unique web-tracking online dataset from Spain to identify points of access to news outlets and study the influence of direct navigation and news-referred platforms (i.e., from Facebook and Google) on selective exposure. We also explore cross-level interactions between origins to news and political interest and ideology. We find that direct navigation increases selective exposure while Google reduces it. We also find that the relationship between origins to news and selective exposure is strongly moderated by ideology, suggesting that search engines and social media are not content neutral. Our findings suggest a rather complex picture regarding selective exposure online.
An Experimental Model of Eosinophilic Chronic Rhinosinusitis Induced by Bacterial Toxins in Rabbits
Authors: Braga Andréa A. , Valera Fabiana C. P. , Faria Francesca M. , Rossato Maria , Murashima Adriana A. B. , Fantucci Marina Z. , Aragon Davi C. , Queiroz Danielle L. C. , Anselmo-Lima Wilma T. , Tamashiro Edwin
Published: July 2019

Background

The pathophysiology of chronic rhinosinusitis (CRS) is still not well known due to the multifactorial etiologies involved. Bacteria play a role in the pathogenesis of CRS by various means, including biofilm adhesion, intracellular persistence, or inducing inflammation secondary to toxins. Endotoxins and exotoxins, especially Staphylococcus aureus superantigens, can produce significant immune responses in the host and are implicated in patients with CRS. The majority of animal models described for CRS revalidates the pathophysiology of acute sinusitis, ostium occlusion, or foreign body associated infection.

Objectives

To evaluate an experimental model of eosinophilic CRS using prolonged exposure to bacterial toxins. The histological changes in rabbits exposed to S. aureus enterotoxin B (SEB), lipopolysaccharide (LPS), or lipoteichoic acid (LTA) were compared.

Methods

After induction with ovalbumin (OVA) sensitization with subcutaneous injection for 2 weeks, rabbits underwent surgery to insert an indwelling catheter into the maxillary sinus. The sinus was irrigated with OVA 3 times weekly for 2 weeks, followed by sinus irrigation with bacterial toxin (SEB: 1 µg/mL, LPS: 100 ng/mL, or LTA: 100 ng/mL) 3 times weekly for 4 weeks. The histological changes in the treated sinus were compared with control rabbits.

Results

Sinuses exposed to bacterial toxins (SEB, LPS, and LTA) produced significant mucosal thickening with infiltration of inflammatory cells, notably eosinophils. SEB was the only toxin that promoted a mixed pattern of inflammation, including eosinophilic and neutrophilic infiltration.

Conclusion

Our experimental model of eosinophilic CRS in rabbits produced significant mucosal thickening and inflammation in the sinuses exposed to bacterial toxins, with histological changes analogous to what is observed in patients with CRS with nasal polyps. This model may serve as a basis for future investigation of the pathogenesis of eosinophilic CRS in relation to bacterial toxins or as a model for testing new therapeutic modalities for this disease.
Postmarket surveillance: a review on key aspects and measures on the effective functioning in the context of the United Kingdom and Canada
Authors: Raj Nikhil , Fernandes Swapnil , Charyulu Narayana R. , Dubey Akhilesh , G. S. Ravi , Hebbar Srinivas
Published: July 2019

Regulatory approvals for the marketing of medicinal products authorize medical practitioners to prescribe drugs to a group of patients that are defined within the license of the medicinal product. However, such prescriptions are carried out in a controlled manner. Prior to being approved, the medicinal product will have been evaluated in a population pool containing fewer than 5,000 patients and in a predesigned environment where several factors may be lacking, such as the absence of women of childbearing potential, geriatric patients and paediatric patients. Therefore, it is not surprising that several major adverse drug reactions are detected only when the product has been prescribed to the general population. National and international regulatory bodies have devised systems for monitoring medicinal products after marketing, commonly known as postmarketing surveillance systems. Postmarketing surveillance refers to the process of monitoring the safety of drugs once they reach the market, after the successful completion of clinical trials. The primary purpose for conducting postmarketing surveillance is to identify previously unrecognized adverse effects as well as positive effects. The Yellow Card scheme, practiced in the United Kingdom and the Canada Vigilance Program adopted in the Canadian jurisdiction, are two of the most successful postmarketing surveillance systems implemented across the world. Therefore, this article intends to discuss postmarketing surveillance and its role in the context of the United Kingdom and Canadian jurisdictions with a view on presenting key aspects and measures that are employed for operating an efficient postmarketing surveillance system in regulated markets.
Evolving ethics, policy and reimbursement issues of vascularized composite allotransplantation: Symposium summary
Authors: Rose John , Cooney Carisa M , Kaufman Christina , Talbot Simon G , Caplan Arthur , Kahn Jeffrey , Sugarman Jeremy , Shores Jaimie T , Levin L Scott , Brandacher Gerald , McDiarmid Sue V , Lee WP Andrew , Dean Wendy
Published: July 2019

In this article, we present a report from a national meeting titled, “Evolving Issues of Vascularized Composite Allotransplantation—A Symposium on Ethics, Policy, and Reimbursement Issues,” which convened in September 2017. We discuss the maturation of vascularized composite allotransplantation from an emerging technology to becoming an extension of clinical practice for select patients with complex reconstructive needs. Viewpoints and action items were presented by and discussed among the 70+ clinicians, researchers, policymakers, ethicists, healthcare administrators, and third-party payers who attended the symposium with the goals of implementing a collaborative roadmap for vascularized composite allotransplantation growth, evaluation, and sustainability by establishing a unified plan to help address concerns of the public, policymakers, and healthcare finance. We review the current status of vascularized composite allotransplantation in clinical practice and summarize symposium discussions regarding ethical considerations, reimbursement, payer strategies, and standardization of data collection.
Clinical and Radiological Results After Minimally Invasive Transpsoas Lateral Access Surgery for Degenerative Lumbar Stenosis
Authors: Coutinho Thiago Pereira , Cristante Alexandre Fogaça , Marcon Raphael Martus , da Rocha Ivan Dias , Ono Allan Hiroshi , Meyer Guilherme Pereira Correa , Barros Filho Tarcísio Eloy de Pessoa
Published: July 2019

Study Design:

Prospective cohort study.

Objective:

The lateral transpsoas access is a retroperitoneal approach for the lumbar spine to perform the lateral lumbar interbody fusion (LLIF), an intersomatic arthrodesis performed with a cage placed on the lateral borders of the epiphyseal ring. The procedure can be used to provide indirect decompression of the nervous structures through the discectomy and restoration of the disc height. The objective of the present study was to evaluate the indirect decompression following LLIF both with radiological and clinical parameters.

Methods:

Prospective clinical and radiological study in a single center with 20 patients diagnosed with 1- or 2-level degenerative lumbar stenosis. Radiological analysis on magnetic resonance imaging included foramen height, canal area, canal diameter, and disc height. Clinical outcomes included visual analogue scale (VAS) and Oswestry Disability Index (ODI) collected up to 12 months. Complications and reoperations were recorded.

Results:

In total, 25 levels were treated. No reoperation was required. Disc height was increased by an average of 25% ( P < .001). The canal area increased from 109 to 149 mm2 ( P < .001) and from 9.3 to 12.2 mm ( P < .001) in anteroposterior diameter. The foramen area demonstrated the effect of indirect decompression on both sides ( P < .001). The height of the foramen showed significant average increase of 2.8 mm ( P < .001). The results from VAS and ODI questionnaires confirmed the clinical effect of indirect decompression.

Conclusion:

We observed that indirect decompression by the LLIF method is feasible both radiologically and clinically with a low rate of complications and reoperations.
Early Sports Specialization Is Associated With Upper Extremity Injuries in Throwers and Fewer Games Played in Major League Baseball
Authors: Confino Jamie , Irvine James N. , O’Connor Michaela , Ahmad Christopher S. , Lynch T. Sean
Published: July 2019

Background:

Single-sport athletes who specialize in baseball at a young age may have a greater predisposition to overuse injury, burnout, and decreased career longevity when compared with multiple-sport athletes. The effect of sport specialization has not been studied in professional baseball players.

Hypothesis:

Major League Baseball (MLB) players who played multiple sports in high school would experience fewer injuries, spend less time on the disabled list, play more games, and have a longer career than athletes who played only baseball in high school.

Study Design:

Descriptive epidemiology study.

Methods:

First- and second-round MLB draft picks from 2008 to 2016 who played in at least 1 professional game were included in this study. Athletes who participated in 1 or more sports in addition to baseball during high school were considered multisport athletes, and athletes who participated in only baseball were considered single-sport athletes. For each athlete, participation in high school sports, injuries sustained in MLB and Minor League Baseball, number of days on the disabled list for each injury, number of games played in both leagues, and whether the athlete was still active were collected from publicly available records.

Results:

A total of 746 athletes were included in this study: 240 (32%) multisport and 506 (68%) single sport. Multisport athletes played in significantly more mean total games (362.8 vs 300.8; P < .01) as well as more mean MLB games (95.9 vs 71.6; P = .04) than single-sport athletes. There was no difference in the mean number of seasons played in the major leagues (1.8 vs 1.6; P = .15) or minor league (5.25 vs 5.20; P = .23) between multisport and single-sport athletes. Single-sport athletes had a significantly higher prevalence of upper extremity injuries compared with multisport athletes (136 [63%] vs 55 [50%]; P = .009). Single-sport pitchers also had a higher prevalence of shoulder and elbow injuries (86 vs 27; P = .008) and were more likely to have recurrent elbow injuries (33% vs 17% recurrence; P = .002) compared with multisport pitchers.

Conclusion:

Professional baseball players who participated in multiple sports in high school played in more major league games and experienced lower rates of upper and lower extremity injuries than players who played only baseball in high school.
A phase 2 study of brentuximab vedotin in patients with CD30-positive advanced systemic mastocytosis
Authors: Gotlib Jason , Baird John H. , George Tracy I. , Langford Cheryl , Reyes Isabel , Abuel Justin , Perkins Cecelia , Schroeder Kurt , Bose Prithviraj , Verstovsek Srdan
Published: July 2019

There is an unmet need for effective therapies for advanced systemic mastocytosis (advSM). CD30 is expressed on the surface of neoplastic mast cells (MC) in more than 50% of patients with advSM. Brentuximab vedotin (BV) is a CD30-directed antibody-drug conjugate with preclinical evidence supporting both an antineoplastic effect and an attenuation of immunoglobulin E-associated mediator release. These observations are the basis for this phase 2 trial of BV monotherapy (1.8 mg/kg IV every 3 weeks up to 8 cycles) in patients with CD30-positive advSM. The primary objective was to determine the efficacy of BV according to International Working Group-Myeloproliferative Neoplasms Research and Treatment-European Competence Network on Mastocytosis (IWG-MRT-ECNM) response criteria. Secondary objectives included evaluation of safety, changes in bone marrow (BM) MC burden, serum tryptase level, flow cytometric quantification of MC surface expression of CD30, and self-reported symptom burden. The trial enrolled 10 patients with a diagnosis of CD30+ advSM (aggressive SM, SM with an associated hematologic neoplasm [SM-AHN], or mast cell leukemia [MCL]) with 1 or more signs of SM-related organ damage. According to IWG-MRT-ECNM criteria, none of the patients demonstrated better than stable disease with BV. In addition, there were no significant reductions in BM MC burden, serum tryptase levels, or MC surface expression of CD30. Self-reported symptom scores showed no durable improvement with BV treatment. We conclude that BV is not active as a single agent in CD30+ advSM. This trial was registered at www.clinicaltrials.gov as #NCT01807598.
Acoustic wave propagation in orthorhombic media: Phase velocity, group velocity, and moveout approximations
Authors: Abedi Mohammad Mahdi , Stovas Alexey , Ivanov Yuriy
Published: July 2019

An approximation is of practical interest whenever an exact approach is not available or is too complicated to be used. Kinematic properties of wave propagation in orthorhombic media are generally more complicated than in transversely isotropic media — an issue that emphasizes the necessity of proper approximate equations that keep a balance between accuracy and simplicity. Exact phase velocity equation in orthorhombic media is algebraically too complicated for some practical purposes, even after acoustic assumption. Although the exact phase velocity equation is readily calculated, there is not an explicit equation for the exact group velocity as a function of group angle nor for the traveltime as a function of offset. Accordingly, we have developed new approximate phase velocity, group velocity, and moveout equations for acoustic orthorhombic media in a simple and uniform functional form. They fit to their corresponding exact kinematic properties, within and outside the orthorhombic symmetry planes. We find a higher accuracy of our approximations compared with other existing approximations in a variety of orthorhombic models. As an example, we convert our phase velocity approximation to a dispersion relation in the frequency domain and use it for wavefield modeling in a heterogeneous orthorhombic model. Our dispersion relation is simpler and more accurate than the original equation being in use in the wave extrapolation modeling by low-rank approximation.
Tumor Mutational Burden Is Site Specific in Non–Small-Cell Lung Cancer and Is Highest in Lung Adenocarcinoma Brain Metastases
Authors: Stein Matthew K. , Pandey Manjari , Xiu Joanne , Tae Hongseok , Swensen Jeff , Mittal Sandeep , Brenner Andrew J. , Korn W. Michael , Heimberger Amy B. , Martin Mike G.
Published: July 2019

PURPOSE

Tumor mutational burden (TMB) is a developing biomarker in non–small-cell lung cancer (NSCLC). Little is known regarding differences between TMB and sample location, histology, or other biomarkers.

METHODS

A total of 3,424 unmatched NSCLC samples, including 2,351 lung adenocarcinomas (LUADs) and 1,073 lung squamous cell carcinomas (LUSCs), underwent profiling, including next-generation sequencing of 592 cancer-related genes, programmed death ligand 1 immunohistochemistry, and TMB. The rate TMB of 10 mutations per megabase (Mb) or greater was compared between primary and metastatic LUAD and LUSC. Molecular alteration frequency was compared at a cutoff of 10 mutations/Mb.

RESULTS

LUAD metastases were more likely to have a TMB of 10 mutations/Mb or greater compared with primary LUADs (38% v 25%; P < .001), and this difference was most pronounced with brain metastases (61% v 35% for other metastases; P < .001). The median TMB for LUAD brain metastases was 13 mutations/Mb compared with six mutations/Mb for primary LUADs. Variability existed for other LUAD metastasis sites, with adrenal metastases most likely to meet the cutoff of 10 mutations/Mb (51%) and bone metastases least likely to meet the cutoff (19%). TMB was more commonly 10 mutations/Mb or greater for LUSC primary tumors than for LUAD primary tumors (35% v 25%, respectively; P < .001). LUSC metastases were more likely to have a TMB of 10 mutations/Mb or greater than LUSC primary tumors. Poorly differentiated disease was more likely have a TMB of 10 mutations/Mb or greater when stratified by histology and primary tumor or metastasis. Site-specific molecular differences existed at this TMB cutoff including programmed death ligand 1 positivity and STK11 and KRAS mutation rate.

CONCLUSION

TMB is a site-specific biomarker in NSCLC with important spatial and histologic differences. TMB is more frequently 10 mutations/Mb or greater in LUAD and LUSC metastases and highest in LUAD brain metastases. Along this TMB cutoff, clinically informative distinctions exist in other tumor profiling characteristics. Further investigation is needed to expand on these findings.
A Mixed-Method Design Evaluation of the SAFE Obstetric Anaesthesia Course at 4 and 12–18 Months After Training in the Republic of Congo and Madagascar
Authors: White Michelle C. , Rakotoarisoa Tsiferana , Cox Nicola H. , Close Kristin L. , Kotze Joan , Watrous Abigail
Published: July 2019

BACKGROUND:

Maternal mortality in low- and middle-income countries (LMICs) is higher than in high-income countries (HICs), and poor anesthesia care is a contributing factor. Many anesthesia complications are considered preventable with adequate training. The Safer Anaesthesia From Education Obstetric Anaesthesia (SAFE-OB) course was designed as a refresher course to upgrade the skills of anesthesia providers in low-income countries, but little is known about the long-term impact of the course on changes in practice. We report changes in practice at 4 and 12–18 months after SAFE-OB courses in Madagascar and the Republic of Congo.

METHODS:

We used a concurrent embedded mixed-methods design based on the Kirkpatrick model for evaluating educational training courses. The primary outcome was qualitative determination of personal and organizational change at 4 months and 12–18 months. Secondary outcomes were quantitative evaluations of knowledge and skill retention over time. From 2014 to 2016, 213 participants participated in 5 SAFE-OB courses in 2 countries. Semistructured interviews were conducted at 4 and 12–18 months using purposive sampling and analyzed using thematic content analysis. Participants underwent baseline knowledge and skill assessment, with 1 cohort reevaluated using repeat knowledge and skills tests at 4 months and another at 12–18 months.

RESULTS:

At 4 months, 2 themes of practice change (Kirkpatrick level 3) emerged that were not present at 12–18 months: neonatal resuscitation and airway management. At 12–18 months, 4 themes emerged: management of obstetric hemorrhage, management of eclampsia, using a structured approach to assessing a pregnant woman, and management of spinal anesthesia. With respect to organizational culture change (Kirkpatrick level 4), the same 3 themes emerged at both 4 and 12–18 months: improved teamwork, communication, and preparation. Resistance from peers, lack of senior support, and lack of resources were cited as barriers to change at 4 months, but at 12–18 months, very few interviewees mentioned lack of resources. Identified catalysts for change were self-motivation, credibility, peer support, and senior support. Knowledge and skills tests both showed an immediate improvement after the course that was sustained. This supports the qualitative responses suggesting personal and organizational change.

CONCLUSIONS:

Participation at a SAFE-OB course in the Republic of Congo and in Madagascar was associated with personal and organizational changes in practice and sustained improvements in knowledge and skill at 12–18 months.
Two-Week Multimodal Prehabilitation Program Improves Perioperative Functional Capability in Patients Undergoing Thoracoscopic Lobectomy for Lung Cancer: A Randomized Controlled Trial
Authors: Liu Zijia , Qiu Tian , Pei Lijian , Zhang Yuelun , Xu Li , Cui Yushang , Liang Naixin , Li Shanqing , Chen Wei , Huang Yuguang
Published: July 2019

BACKGROUND:

Patients with lung cancer often experience reduced functional capacity and quality of life after surgery. The current study investigated the impact of a short-term, home-based, multimodal prehabilitation program on perioperative functional capacity in patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy for nonsmall cell lung cancer (NSCLC).

METHODS:

A randomized controlled trial was conducted with 73 patients. Patients in the prehabilitation group (n = 37) received a 2-week multimodal intervention program before surgery, including aerobic and resistance exercises, respiratory training, nutrition counseling with whey protein supplementation, and psychological guidance. Patients in the control group (n = 36) received the usual clinical care. The assessors were blinded to the patient allocation. The primary outcome was perioperative functional capacity measured as the 6-minute walk distance (6MWD), which was assessed at 1 day before and 30 days after surgery. A linear mixed-effects model was built to analyze the perioperative 6MWD. Other outcomes included lung function, disability and psychometric evaluations, length of stay (LOS), short-term recovery quality, postoperative complications, and mortality.

RESULTS:

The median duration of prehabilitation was 15 days. The average 6MWD was 60.9 m higher perioperatively in the prehabilitation group compared to the control group (95% confidence interval [CI], 32.4–89.5; P < .001). There were no differences in lung function, disability and psychological assessment, LOS, short-term recovery quality, postoperative complications, and mortality, except for forced vital capacity (FVC; 0.35 L higher in the prehabilitation group, 95% CI, 0.05–0.66; P = .021).

CONCLUSIONS:

A 2-week, home-based, multimodal prehabilitation program could produce clinically relevant improvements in perioperative functional capacity in patients undergoing VATS lobectomy for lung cancer.
Soft-surface grasping: radular opening in Aplysia californica
Authors: Kehl Catherine E. , Wu Joey , Lu Sisi , Neustadter David M. , Drushel Richard F. , Smoldt Rebekah K. , Chiel Hillel J.
Published: July 2019

Grasping soft, irregular material is challenging both for animals and robots. The feeding systems of many animals have adapted to this challenge. In particular, the feeding system of the marine mollusk, Aplysia californica, a generalist herbivore, allows it to grasp and ingest seaweeds of varying shapes, textures and toughness. On the surface of Aplysia's grasper is a structure known as the radula, a thin flexible cartilaginous sheet with fine teeth. Previous in vitro studies suggested that an intrinsic muscle, I7, is responsible for opening the radula. Lesioning I7 in vivo does not prevent animals from grasping and ingesting food. New in vitro studies demonstrate that a set of fine muscle fibers on the ventral surface of the radula – the sub-radular fibers (SRFs) – mediate opening movements even if the I7 muscles are absent. Both in vitro and in vivo lesions demonstrate that removing the sub-radular fibers leads to profound deficits in radular opening, and significantly reduces feeding efficiency. A theoretical biomechanical analysis of the actions of the sub-radular fibers suggests that they induce the radular surface to open around a central crease in the radular surface and to arch the radular surface, allowing it to softly conform to irregular material. A three-dimensional model of the radular surface, based on in vivo observations and magnetic resonance imaging of intact animals, provides support for the biomechanical analysis. These results suggest how a soft grasper can work during feeding, and suggest novel designs for artificial soft graspers.