bluuebunny/crossref_metadata_2025 huggingface dataset:
Preparation and characterization of PGS/PLLA@PNIPAM core-shell nanofiber membrane by electrospinning and surface ATRP grafting
Authors: Niu Qijian , Ma Lili , Guo Junxia , Yang Xiaoping
Published: January 2021

In this study, a temperature responsive PGS/PLLA@PNIPAM core-shell nanofiber membrane was prepared by combining electrospinning with surface ATRP grafting polymer technology, in which the core layer of PGS/PLLA nanofiber was prepared by electrospinning, and then the shell layer of temperature responsive PNIPAM polymer was grafted on the nanofiber surface by ATRP reaction. In the experiment, a macromolecule-initiator PGS-Br was prepared and characterized by FTIR and 1H NMR. The surface morphology, composition, element of the core-shell nanofiber membrane were characterized by SEM, FTIR, and XPS. In addition, it is worth noting that the core-shell nanofiber membrane can respond to temperature in drug release tests.
“What Should I Do Now?”: Navigating Relational Ethics in Practice as an Early Career Researcher as Illustrated by a Qualitative Interview Study About Women’s Drinking Practices
Authors: Jackson Katherine
Published: January 2021

Qualitative interview studies on sensitive topics often draw on principles of feminist methodologies which focus on developing and maintaining non-exploitative, caring relationships with participants. For early career researchers, who may have less research experience, managing relational ethical issues that arise in research relationships can be difficult. Additionally, they could experience further pressures because of their junior roles and precarious employment. In the context of health research, early career researchers working on qualitative studies may experience specific challenges because of the predominance of the biomedical paradigm in this discipline. In this article, I explore some of the relational ethical issues I deliberated as an early career researcher when working in a medical faculty on a semi-structured qualitative interview study about women’s alcohol drinking practices. I focus on two overlapping themes from my experience of ethics in practice “Trying to building and maintain relationships” and “Trying to stabilize inequalities in research relationships.” With a primary focus on how I negotiated differing responsibilities, I draw on examples from the community-based face-to-face and virtual recruitment, the fast-paced face-to-face interviews, and the process of returning interview transcripts to women to review. With this analysis, I contribute to existing literature about ethics in practice for early career researchers by indicating the types of relational ethics that will need to be navigated and the resources needed to support them. These resources include having adequate time, opportunities for reflection, and good supervisory support. I also contribute to scholarship which critiques the wider health research context by considering the challenges it can pose for early career researchers when managing relational ethical spaces in qualitative interview studies. This article will be of relevance to novice researchers and those who supervise and manage them.
Formation control of unmanned underwater vehicles using local sensing means in absence of follower position information
Authors: Yan Zheping , Xu Da , Chen Tao , Zhou Jiajia
Published: January 2021

Formation control is one of the essential problems in multi-unmanned underwater vehicle (UUV) coordination. In this article, a practically oriented UUV formation control structure and method are proposed for the problem of large communication in leader–follower approach. To solve the problem of large communication in multi-UUVs, local sensing means of acoustic positioning is used to provide the real relative distance and angle information for the follower UUV. So, only a small amount of state information of the leader UUV needs to be sent to the follower UUV by acoustic communication. Then, the formation control structure in absence of follower position information is proposed. In this control structure, only the relative distance and angle, as well as velocity and heading of the leader UUV, are used for the formation controller design of the follower UUV. Backstepping and Lyapunov methods are used to design the formation controller without position information of the follower UUV. Two formation configurations of rectangle and triangle with five UUVs are simulated to verify the effectiveness of the method proposed. The simulation results show that the follower UUV can successfully constitute and maintain the desired formation by controlling each real relative distance and angle.
Rural and urban primary school heads’ perspectives on staff appraisal systems in Zimbabwe: A phenomenological approach
Authors: Nkoma Elliott , Shoshore Alphonce
Published: January 2021

The study sought to explore rural and urban primary school heads’ perspectives on staff appraisal systems in Masvingo Province, Zimbabwe and utilised a qualitative approach based on a phenomenological design. Five rural primary school heads and five urban primary school heads with at least 14 years of experience were purposely selected. In-depth, face-to-face phenomenological interviews were conducted to collect the lived experiences of participants in relation to performance appraisal systems for teachers. Data were transcribed verbatim and analysed thematically. Three major themes emerged: (a) implementation of performance appraisals; (b) feedback and professional development; and (c) challenges with regard to the implementation of performance appraisals. The economic crisis in Zimbabwe has had a negative impact on school performance appraisal systems. Both school locations had implemented such systems, but were faced with limited resources, time constraints and teachers’ lack of interest in being promoted. In looking at the differences between rural and urban school head participants, the focus was on observation and feedback processes. This study has important implications for staff appraisal systems in Zimbabwe.
Assessment of dental pain in children with intellectual disability using the dental discomfort questionnaire
Authors: Senirkentli Güler Burcu , Tirali Resmiye Ebru , Bani Mehmet
Published: January 2021

Objective:

This study aimed to compare the Dental Discomfort Questionnaire (DDQ) scores in children with and without intellectual disability (ID) and to measure correlation between the total DDQ and the Decayed, Missing, and Filled Teeth (DMFT/dmft) scores, as well as the condition of the tooth causing pain.

Method:

This cross-sectional study included 81 children with normal intellectual development who attended the Departments of Pediatric Dentistry at two Turkish Universities and 80 children with different levels of intellectual disability who reported dental pain in special education centers. The 12-question DDQ (Turkish version) was applied to the parents of the patients with their consent. The relationship of the DDQ scores with tha of the DMFT/dmft, dental status, and demographic data was evaluated.

Results:

When the DDQ scores of children with intellectual disabilities were evaluated, it was found that the majority of the answers given to the questions were statistically similar (p < 0.05) to those of children with normal cognitive level. In the questions in which “pain when eating and brushing teeth” was evaluated, a higher score was obtained, which led to an increase in the total DDQ score (p < 0.001). There was a statistically significant difference between the groups in terms of the distribution of dental conditions (p < 0.001). When compared to the normal cognitive group, patients with mild and severe intellectual disabilities had more deep dentin caries, thoughy, frequent periapical abscess was less common in those groups (p < 0.001 and p = 0.022). There was no statistically significant relationship between DMFTscores.

Conclusion:

The DDQ was found to be a descriptive, functional, and easy-to-use questionnaire for children with intellectual disabilitiesin terms of detecting the presence of dental pain. No correlation was found between DMFT/dmft, dental status and DDQ scores.
Defining quality of life for individuals with neurodevelopmental disorders: Challenges within an inpatient population
Authors: Harriman Emma , Oyefeso Adenekan
Published: January 2021

Purpose:

The concept of Quality of Life (QoL) for people with neurodevelopmental disorders primarily focuses on deinstitutionalisation and community inclusion. This population, however, often presents with comorbid diagnoses and is sectioned to treatment facilities under the Mental Health Act. The aim of this paper is to review the existing literature on QoL and discuss the consideration of this specialised population and the environment when measuring QoL.

Methods:

Databases were searched using specific inclusion and exclusion criteria to ensure literature reviewed was relevant to the defined population. The challenges identified from the literature were categorised into interpersonal and intrapersonal factors.

Results:

A total of 30 articles were retrieved and considered in this review.

Conclusions:

This paper discusses how these individuals present with different behaviours and opportunities, which subsequently make it difficult to apply existing knowledge of QoL. The need to further examine the QoL in this specific population is discussed.
Optimal sensor positioning on pressurized equipment based on Value of Information
Authors: Hoseyni Seyed Mojtaba , Maio Francesco Di , Zio Enrico
Published: January 2021

In this work, we apply a simulation-based framework that makes use of the Value of Information (VoI) for identifying the optimal spatial positioning of sensors on pressurized equipment. VoI is a utility-based Figure of Merit (FoM) which quantifies the beneﬁts/losses of acquiring information. Sensors are typically positioned on pressurized equipment in line with specific recommendations based on operational experience, like UNI 11096 in Italy. We show that the recommendations in UNI 11096 are, indeed, justified and that, incidentally, relying on VoI for the optimization of the sensor positioning, one can achieve the same monitoring performance, as measured by VoI, where following UNI 11096, but with a reduced number of sensors. The proposed VoI-based approach can, thus, be used to confirm or revise recommendations coming from operational experience.
Therapeutic plasma exchange in steroid-refractory multiple sclerosis relapses. A retrospective two-center study
Authors: Blechinger Stephan , Ehler Johannes , Bsteh Gabriel , Winkelmann Alexander , Leutmezer Fritz , Meister Stefanie , Santer Agnes , Hecker Michael , Berger Thomas , Rommer Paulus , Zettl Uwe Klaus
Published: January 2021

Background:

Therapeutic plasma exchange (TPE) is frequently used in glucocorticosteroid (GCS)-refractory multiple sclerosis (MS) relapses. Data regarding predictors of treatment response are scarce. The objective of this study was to analyze predictive factors for response to TPE in GCS-refractory MS patients.

Methods:

A total of 118 MS patients in two tertiary MS centers were analyzed. Primary outcome was TPE response defined as marked, mild, or no improvement. Secondary outcome was change in expanded disability status scale (ΔEDSS). ΔEDSS and relapse activity within 6 months after TPE were studied.

Results:

Marked or mild improvement was observed in 78.8% of patients. ΔEDSS correlated significantly inversely with time from relapse to start of TPE (τ = –0.239, p = 0.001), age (τ = 0.182, p = 0.009) and disease duration (τ = –0.167, p = 0.017). In multivariate analysis, TPE response was predicted by diagnosis of relapsing MS [odds ratio (OR): 3.1], gadolinum-enhancement on magnetic resonance imaging (OR 3.2), age (OR 0.5 per 5 years older) and time from relapse onset to TPE (OR 0.7 per 7 days longer).

Conclusion:

Patients with longer disease duration and higher EDSS pre and post-TPE were more likely to show further disability progression or relapses within 6 months after TPE. No sustained effects were observed during the follow-up period.
Respectful maternity care and breastfeeding
Authors: Ansari Humaira , Yeravdekar Rajiv
Published: January 2021

Respectful maternity care and its effect on breastfeeding is not widely explored. Disrespect and abuse affect the health of the mother and the newborn, affect lactogenesis and negatively influence breastfeeding. This has serious short-term and long-term ill effects. Separation of the mother and the newborn result in failure to establish early breastfeeding. Interventions, policies and programs should be developed to address the issues pertaining to respectful maternity care. This will not only help in breastfeeding but will also safeguard the fundamental rights of the mother and the child.
Modified Temporal Incision for the Management of Zygomatic Arch fractures—A Retrospective Study for 7 Years
Authors: Devakumari S. , Dominic Neil , Vijhayapriya T. , Dinesh D. S. , Devameena S.
Published: January 2021

Study Design:

Retrospective cross-sectional study.

Objective:

The objective of this retrospective study was to evaluate the clinical outcomes of Modified temporal incision in the management of zygomatic arch fractures (ZAF).

Patients and Methods:

Records of 34 patients who underwent open reduction for zygomatic arch fractures were retrieved and included in the study between 2011 and 2018. These patients were followed up at 4 weeks, 8 weeks and 12 weeks respectively. Clinical parameters such as post-operative infection, hematoma, scarring, degree of mouth opening, palpability of plates, alopecia and weakness of temporal branch of Facial nerve recorded were analyzed for complications of modified temporal incision in the management of ZAF.

Results:

A thorough analysis of the clinical parameters revealed that at the end of 4 weeks scarring was present in 4 patients and temporal branch of Facial nerve weakness was present in 21 patients. None of the patients had hematoma, infection or palpability of miniplates. At the end of 8 weeks the only complication recorded was weakness of temporal branch of Facial nerve in 21 patients. By 12 weeks, all patients had complete recovery and none of the patient had weakness of temporal branch of Facial nerve.

Conclusion:

The results obtained proved that the Modified temporal incision can be considered as a reliable method in the management of zygomatic arch fractures. The incision can be adopted with confidence in suitable cases of zygomatic arch fractures without any permanent morbidity.
Patterns of Implicit and Explicit Stereotypes III: Long-Term Change in Gender Stereotypes
Authors: Charlesworth Tessa E. S. , Banaji Mahzarin R.
Published: January 2021

Gender stereotypes are widely shared “collective representations” that link gender groups (e.g., male/female) with roles or attributes (e.g., career/family, science/arts). Such collective stereotypes, especially implicit stereotypes, are assumed to be so deeply embedded in society that they are resistant to change. Yet over the past several decades, shifts in real-world gender roles suggest the possibility that gender stereotypes may also have changed alongside such shifts. The current project tests the patterns of recent gender stereotype change using a decade (2007–2018) of continuously collected data from 1.4 million implicit and explicit tests of gender stereotypes (male-science/female-arts, male-career/female-family). Time series analyses revealed that, over just 10 years, both implicit and explicit male-science/female-arts and male-career/female-family stereotypes have shifted toward neutrality, weakening by 13%–19%. Furthermore, these trends were observed across nearly all demographic groups and in all geographic regions of the United States and several other countries, indicating worldwide shifts in collective implicit and explicit gender stereotypes.
The potential role of incretin-based therapies for polycystic ovary syndrome: a narrative review of the current evidence
Authors: Abdalla Mohammed Altigani , Deshmukh Harshal , Atkin Stephen , Sathyapalan Thozhukat
Published: January 2021

Introduction:

Polycystic ovary syndrome (PCOS) is a common endocrine disorder that affects women of reproductive age. Metabolic consequences associated with PCOS include, but are not limited to, insulin resistance (IR), type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). This narrative review aims to provide a comprehensive overview of the potential therapeutic roles of the incretin-based therapies in the management of PCOS.

Methods:

We performed a systematic search of databases including PubMed, MEDLINE and EMBASE up to 1 October 2020. We developed a search string of medical subject headings (MeSH) including the terms PCOS, incretin mimetics, glucagon-like peptide-1 (GLP-1), glucagon-like peptide-1 receptor antagonists (GLP-1 RAs), liraglutide, exenatide, semaglutide, dipeptidyl peptidase-4 (DPP-4) inhibitors, combined with IR, testosterone and sex hormone-binding globulin (SHBG).

Results:

We identified 854 relevant articles and, after the initial screening, eight interventional animal studies, one observational animal study, 14 interventional human studies, two case–control studies and one systematic review were included. These studies showed the potential significant roles of GLP-1 RAs and DPP-4 inhibitors in the management of PCOS, with significant improvements in the metabolic parameters, including substantial weight reduction and improved insulin sensitivity. These agents also improved the hormonal parameters through decreased free androgen and increased SHBG. Moreover, they improved menstrual regularity, increased fertility with enhanced ovulation and pregnancy in obese women with PCOS.

Conclusion:

GLP-1 RAs and DPP-4 inhibitors have a promising therapeutic role in PCOS; however, larger clinical trials are needed to establish the role of incretin-based therapies in the management of PCOS.
The effect of specific binding proteins on immunoassay measurements of total and free thyroid hormones and cortisol
Authors: Gant Kanegusuku Anastasia , Araque Katherine A. , Nguyen Hung , Wei Bin , Hosseini Saman , Soldin Steven J.
Published: January 2021

Background:

Immunoassay (IA) measurements of thyroid hormones have previously given inaccurate results of triiodothyronine (T3), free triiodothyronine (FT3), and free thyroxine (FT4) when concentrations of TBG are low. We evaluate the hypothesis that abnormal concentrations of specific binding proteins (BPs) affect IA measurements and provide results which might misguide the diagnosis and treatment of patients. This study assesses IAs for the measurement of T3, FT3, and cortisol when levels of TBG and CBG are high or low. Comparisons are made between IA and LC-MS/MS.

Methods:

Serum or plasma samples with high (>95th percentile, n = 25) or low (<5th percentile, n = 27) concentrations of BP were collected. The concentrations of T3, FT3, and cortisol were measured by validated IA and liquid chromatography tandem mass spectrometry (LC-MS/MS) methods. Spearman correlation and Wilcoxon matched-pairs signed rank analyses were used to compare the two methods.

Results:

When TBG levels are <5th percentile, the differences between the IA and LC-MS/MS results for T3 and FT3 are statistically significant (T3, p = 0.0011; FT3, p = 0.0003). When CBG levels are >95th percentile, the difference between the IA and LC-MS/MS measurements of cortisol is statistically significant ( p = <0.0001).

Conclusion:

Abnormal BP concentrations appear to affect the accuracy of IA measurements of T3, FT3, and cortisol. The population of patients with either high or low levels of BPs is significant. Our samples reflect that 65% of women aged between 15 and 49 years are taking oral contraceptives in the US, and thus have elevated levels of BPs. In this group, IA results for cortisol are falsely low. Our samples reflect that patients with protein losing diseases have low BP concentrations. Among a group with renal complications, IA measurements of T3 are overestimated, while those of FT3 are underestimated. Are the Food and Drug Administration and diagnostic companies adequately assessing the accuracy of IA tests?
Reviewing immunopathology characteristics of SARS-CoV-2 for cancer entwisted with SARS-CoV-2
Authors: Li Hongyan , Lu Wanting , Li Yinyin , Lu Yinying , Li Fei
Published: January 2021

In December 2019, the outbreak of a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), infection that started in Wuhan, Hubei Province, China, has spread to all world. Based on the accumulated data and knowledge on the coronavirus infection and immunology characteristics, this review would hope to give some hints on human immune response to SARS-CoV-2 infection in cancer patients. This insight may help in designing the appropriate immune intervention for treatment and the prophylactic/therapeutic methods against cancer under current coronavirus from immunopathology characteristics of SARS-CoV-2 and cancer entwisted with it. We should achieve accurate diagnosis and treatment for cancer patients through advantages of multidisciplinary diagnosis and treatment team. It is believed that we will eventually overcome the epidemic and win in the future.
Researching the sociocultural: Modelling a responsive focused ethnography
Authors: Kapofu Lifeas Kudakwashe
Published: January 2021

Assuming a methodological posture, this work extends the increasing legitimacy of the sociocultural in qualitative studies. Confronted by sociological questions with potential anthropological answers, this study straddled ethnographies and invoked attributes from both conventional and focused ethnography in a responsive focused ethnography. Responsive-focused ethnography transcends the strictures of traditional sociocultural dichotomies in understanding contemporary institutional arrangements. Experience during its deployment hints a responsive explorative frame for cultural excavation devoid of any illusions of the hidden nature of sociocultural reality. Deployment of this model also demonstrated the possibility of more holistic focused ethnographies with utility in addressing sociological questions with anthropological understandings across diverse contexts.
Shadow Education in Denmark: In the Light of the Danish History of Pedagogy and the Skepticism Toward Competition
Authors: Mikkelsen Sidse Hølvig , Gravesen David Thore
Published: January 2021

Purpose:

This article investigates the role of private supplementary tutoring in Denmark in light of the country’s pedagogical traditions in schools and leisure spheres.

Design/Approach/Methods:

Although tutoring activities are increasing, the phenomenon is not as prevalent in Denmark as in many other countries. In this article, we look into the history of Danish pedagogy for answers as to why this is the case. In the analytical sections of the article, we include research on parental values of child-rearing, as well as findings from a pilot study on Danish families purchasing private supplementary tutoring, the public debate about private tutoring, and contemporary youth research.

Findings:

With a solid emphasis on democracy and equality in Danish pedagogy, the conditions for increasing private supplementary tutoring in Denmark have been challenged. However, a current focus on global competition, formal competencies, and higher academic performance among children and young people suggests that providers of private tutoring perhaps face a brighter future—also in Denmark.

Originality/Value:

This article addresses a new field of qualitative research on private supplementary tutoring in Denmark and may be a platform for further reflection and empirical research.
ASA Physical Status Classification Improves Predictive Ability of a Validated Trauma Risk Score
Authors: Konda Sanjit R. , Parola Rown , Perskin Cody , Egol Kenneth A.
Published: January 2021

Introduction:

The Score for Trauma Triage in the Geriatric and Middle-Aged (STTGMA) is a validated mortality risk score that evaluates 4 major physiologic criteria: age, comorbidities, vital signs, and anatomic injuries. The aim of this study was to investigate whether the addition of ASA physical status classification system to the STTGMA tool would improve risk stratification of a middle-aged and elderly trauma population.

Methods:

A total of 1332 patients aged 55 years and older who sustained a hip fracture through a low-energy mechanism between October 2014 and February 2020 were included. The STTGMA and STTGMAASA mortality risk scores were calculated. The ability of the models to predict inpatient mortality was compared using area under the receiver operating characteristic curves (AUROCs) by DeLong’s test. Patients were stratified into minimal, low, moderate, and high risk cohorts based on their risk scores. Comparative analyses between risk score stratification distribution of mortality, complications, length of stay, ICU admission, and readmission were performed using Fisher’s exact test. Total cost of admission was fitted by univariate linear regression with STTGMA and STTGMAASA.

Results:

There were 27 inpatient mortalities (2.0%). When STTGMA was used, the AUROC was 0.742. When STTGMAASA was used, the AUROC was 0.823. DeLong’s test resulted in significant difference in predictive capacity for inpatient mortality between STTGMA and STTGMAASA (p = 0.04). Risk score stratification yielded significantly different distribution of all outcomes between risk cohorts (p < 0.01). STTGMAASA stratification produced a larger percentage of all negative outcomes with increasing risk cohort. Total hospital cost was statistically correlated with both STTGMAASA (p < 0.01) and STTGMA (p = 0.02).

Conclusion:

Including ASA physical status as a variable in STTGMA improves the model’s ability to predict inpatient mortality and risk stratify middle-aged and geriatric hip fracture patients.
An Organizational Change With Quarantined Members
Authors: Mattar Dorine Maurice
Published: January 2021

This study tackles the extent to which employees’ attributions and acknowledgments of the innovation implementation’s urgency play a role in their acceptance and readiness behavior during a crisis. Moreover, it highlights the importance of support and knowledge sharing among organization members on social media, given that an organizational change is taking place during a crisis while everyone is being quarantined. Qualitative data are collected from semi-structured interviews as well as from the chats on the WhatsApp group created for this quick innovation implementation decision. Findings reveal that during a crisis, employees’ sensemaking of the organization’s innovation adoption is triggered by attribution to constructive intentionality. The urgency imposed boosts the contextual dimension of the readiness for change, which enhances organization members’ commitment to implement the change. Moreover, when everyone is quarantined, social media is found to be the only means for maintaining social relations, ensuring colleagues’ support and sharing knowledge; and consequently boosting members’ readiness. The value of this research lies in the topic addressed, and in the unusual context in which the innovation implementation took place.
Imaging Features of Aggressive Giant Cell Tumors of the Mobile Spine: Retrospective Analysis of 101 Patients From Single Center
Authors: Yuan Bei , Zhang Lihua , Yang Shaomin , Ouyang Hanqiang , Han Songbo , Jiang Liang , Wei Feng , Yuan Huishu , Liu Xiaoguang , Liu Zhongjun
Published: January 2021

Study Design:

Retrospective study.

Objectives:

Giant cell tumors (GCTs) of the mobile spine can be locally aggressive. This study described and classified the typical and atypical appearance of aggressive spinal GCTs according to imaging findings to help the imaging diagnosis, especially for patients with rapid neurological deficit that may require emergent surgery without biopsy.

Methods:

Computed tomography (CT) and magnetic resonance imaging (MRI) scans of patients diagnosed with aggressive spinal GCTs at single center were reviewed.

Results:

Overall, 101 patients with 100 CT images and 94 MR images were examined. All lesions were osteolytic with cortical destruction; 95 lesions showed epidural extension; 90 were centered in the vertebral body; 82 showed pathological fracture and/or collapse of the vertebral body; 78 had pseudotrabeculation on CT; 80 showed low-to-iso signal intensity or heterogeneous high-signal intensity with cystic areas on the T2-weighted images; 9 showed fluid–fluid level on T2-weighted images; and 61 patients showed marked enhancement on contrast-enhanced CT and/or MRI. Forty-one lesions (40.6%) had at least 1 atypical radiographic feature: 19 involved ≥2 segments; 11 were centered in the posterior neural arch; 10 had a paravertebral mass over 2 segments; 16 showed partial margin sclerosis with partial cortical destruction on CT scans; and 3 showed mineralization within the tumor on CT. Eighty-eight patients underwent CT-guided biopsy with a diagnostic accuracy rate of 94.3%.

Conclusions:

Spinal GCTs might appear more radiologically atypical, and about 40% of the lesions may have at least 1 atypical feature. CT-guided biopsies are recommended for definitive diagnosis.
Return to Activity After Gluteus Medius Repair in Active Patients Older Than 50 Years
Authors: Meghpara Mitchell B. , Yelton Mitchell J. , Annin Shawn , Rosinsky Philip J. , Shapira Jacob , Maldonado David R. , Lall Ajay C. , Domb Benjamin G.
Published: January 2021

Background:

Gluteus medius (GM) tears are a known cause of dysfunction and disability predominantly in older women.

Purpose

To report on return to activity, patient-reported outcomes (PROs), and a uniquely calculated minimal clinically important difference (MCID) at a minimum 2-year follow-up for active patients who had undergone either an endoscopic or an open GM repair.

Study Design:

Case series; Level of evidence, 4.

Methods:

Patients were considered eligible if they (1) underwent a GM repair with or without concomitant central and peripheral compartment procedures; (2) had baseline preoperative and minimum 2-year scores for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score–Sports Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain; and (3) participated in a physical activity or sport within 1 year before their surgery. Return to activity was defined as the patient being able to participate in his or her activity at a minimum of 2 years postoperatively.

Results:

Of 87 eligible patients, 84 (96.6%) met all inclusion criteria. The mean follow-up was at 44.5 months. Six patients (7.1%) underwent an open GM repair, while the remaining 78 (92.9%) underwent an endoscopic GM repair. Concomitant central and peripheral compartment arthroscopic procedures were performed in 69 patients (82.1%). All PROs significantly ( P < .001) improved as follows: mHHS, from 59.0 to 85.8; NAHS, from 57.9 to 84.0; HOS-SSS, from 32.6 to 63.7; and VAS pain, from 5.4 to 1.9. A total of 57 patients (67.9%) returned to their preoperative activity at the 2-year follow-up. The MCID was calculated for the mHHS, NAHS, and HOS-SSS to be 7.5, 7.4, and 10.9, respectively, with 79.3%, 86.4%, and 70.2% of patients achieving the MCID for each respective PROs.

Conclusion:

Active patients over the age of 50 years may benefit from endoscopic or open repair of GM tears, as the majority of patients in our cohort were able to return to their activity of choice. All measured PROs had significantly improved at a minimum 2-year follow-up, with high survivorship, satisfaction, and clinical effectiveness. Patients with partial-thickness tears compared with full-thickness tears and those who underwent isolated GM repair compared with GM repair with concomitant procedures had similar return to activity rates and PROs at the latest follow-up.
Comparison of Dynamic In Vivo Shoulder Kinematics Before and After Superior Capsular Reconstruction for Irreparable Rotator Cuff Tears
Authors: Lee Seung-Jun , Min Young-Kyoung , Chung Il-Kwon , Kang Suk-Woong , Banks Scott A.
Published: January 2021

Background:

Superior capsular reconstruction (SCR) is an alternative surgical option for young active patients with irreparable rotator cuff tears without arthritis. Although cadaveric studies have shown superior stability of the humerus, it remains unclear whether the humerus migrates superiorly after SCR in vivo.

Purpose:

To analyze the change in glenohumeral translation in patients before and after SCR.

Study Design:

Case series; Level of evidence, 4.

Methods:

A total of 22 patients who underwent SCR by a single surgeon for irreparable rotator cuff tears were included. Among them, 14 patients had intact grafts, and 8 patients were diagnosed with retears on 1-year postoperative magnetic resonance imaging (MRI) scans. Fluoroscopy was performed in all patients preoperatively and at 3-month, 6-month, and 1-year follow-up. Moreover, 3-dimensional bone models from computed tomography, MRI, and fluoroscopic scans during scapular plane abduction of the shoulder joints were analyzed.

Results:

In the intact graft group, 3-dimensional dynamic shoulder kinematics at 6 months ( P = .026) and 1 year ( P = .032) postoperatively showed statistically significant decreases in humeral head superior translation compared with preoperatively. The ≥6-mm acromiohumeral distance (AHD) subgroup had a larger decrease in humeral head superior translation from preoperatively than did the <6-mm AHD subgroup (6 months: P = .026; 1 year: P = .032). The retear group had significantly greater humeral head superior translation at 1 year postoperatively than did the ≥6-mm and <6-mm AHD subgroups (post hoc test: P < .001; ≥6-mm AHD vs retear group: P = .001; <6-mm AHD vs retear group: P = .012).

Conclusion:

SCR with intact grafts resulted in decreased humeral head superior translation after 6 months. Patients with retears showed no improvement in humeral head superior translation. Patients with a preoperative AHD <6 mm had less improvement in humeral head superior translation than did those with a preoperative AHD ≥6 mm. Early surgical treatment before an excessive decrease in preoperative AHD could be helpful for postoperative humeral head translation recovery.
Comparing the Tibial Tuberosity–Trochlear Groove Distance Between CT and MRI in Skeletally Immature Patients With and Without Patellar Instability
Authors: Dai Zhen-Zhen , Sha Lin , Zhang Zi-Ming , Liang Zhen-Peng , Li Hao , Li Hai
Published: January 2021

Background:

The tibial tubercle–trochlear groove (TT-TG) distance was originally described for computed tomography (CT), but it has been measured on magnetic resonance imaging (MRI) in patients with patellar instability (PI). Whether the TT-TG measured on CT versus MRI can be considered equivalent in skeletally immature children remains unclear.

Purpose:

To investigate in skeletally immature patients (1) the effects of CT versus MRI imaging modality and cartilage versus bony landmarks on consistency of TT-TG measurement, (2) the difference between CT and MRI measurements of the TT-TG, and (3) the difference in TT-TG between patients with and without PI.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

We retrospectively identified 24 skeletally immature patients with PI and 24 patients with other knee disorders or injury but without PI. The bony and cartilaginous TT-TG distances on CT and MRI were measured by 2 researchers, and related clinical data were collected. The interrater, interperiod (bony vs cartilaginous), and intermethod (CT vs MRI) reliabilities of TT-TG measurement were assessed with intraclass correlation coefficients.

Results:

The 48 study patients (19 boys, 29 girls) had a mean age of 11.3 years (range, 7-14 years). TT-TG measurements had excellent interrater reliability and good or excellent interperiod reliability but fair or poor intermethod reliability. TT-TG distance was greater on CT versus MRI (mean difference, 4.07 mm; 95% CI, 2.6-5.5 mm), and cartilaginous distance was greater than bony distance (mean difference, 2.3 mm; 95% CI, 0.79-3.8 mm). The TT-TG measured on CT was found to increase with the femoral width. Patients in the PI group had increased TT-TG distance compared with those in the control group, regardless of landmarks or modality used ( P > .05 for all).

Conclusion:

For skeletally immature patients, the TT-TG distance could be evaluated on MRI, regardless of whether cartilage or bony landmarks were used. Its value could not be interchanged with CT according to our results; however, further research on this topic is needed.
Morphology of the Undersurface of the Anterolateral Acromion and Its Relationship to Surrounding Structures
Authors: Ueda Yusuke , Nimura Akimoto , Matsuki Keisuke , Yamaguchi Kumiko , Sugaya Hiroyuki , Akita Keiichi
Published: January 2021

Background:

A better understanding of the morphology underneath the acromion is needed to prevent complications after arthroscopic subacromial decompression. The precise correlations between the morphologic features underneath the acromion and the surrounding structures including the attachment of the coracoacromial ligament (CAL) and the origin of the deltoid middle head have not yet been determined in the absence of artifacts on the bony surface caused by dissection techniques. Moreover, anatomic findings in previous studies using only older-aged cadavers or dried bones may not reflect the morphologic features of younger and healthy specimens.

Purpose:

To characterize the anterolateral structures morphologically in the inferior aspect of the acromion, assess the relationships of these structures with surrounding structures without dissection artifacts on the bony surface, and verify the cadaveric data in the asymptomatic shoulders of living middle-aged patients.

Study Design:

Descriptive laboratory study.

Methods:

We initially analyzed the relationship between the morphology of the anterolateral structures and surrounding structures in 18 cadaveric shoulders (mean age, 81.8 years), 15 of which were subjected to macroscopic investigation of the CAL attachment and 3-dimensional micro—computed tomography investigation with radiopaque markers and 3 of which were subjected to histologic examination. We also analyzed the morphology underneath the anterolateral acromion in 24 asymptomatic shoulders of middle-aged patients (mean age, 54.8 years) to verify the cadaveric data. In both the cadaveric shoulders and the asymptomatic shoulders of live patients, the long axis, width, and height of the anterolateral prominence were measured by use of 3-dimensional CT imaging.

Results:

In cadavers, the anterolateral prominence underneath the acromion corresponded to the attachment of the CAL. Histologic evaluation revealed that the CAL was continuous to the deep layer of the deltoid middle head in the lateral acromion. The study in asymptomatic shoulders of middle-aged patients revealed bony prominences similar to those observed in cadavers.

Conclusion:

The anterolateral prominence, which corresponds to the attachment of the CAL below the acromion, may be a native structure below the acromion. Moreover, the CAL is continuous to the deep layer of the deltoid middle head in the lateral acromion.
Cross-border Entrepreneurial Education, Development and Knowledge and Technology Transfer: Experiences with the Cambridge–Riga Venture Camp Programme—A Reflective Report
Authors: Barrell Alan , Paalzow Anders , Baltins Elmars , Storgårds Jan , Purmalis Karlis , Berzina Kristine , Mara Irbe Madara , Ozolins Modris
Published: January 2021

Over a 6-year period, a collaboration has been developed between a group in Cambridge, UK, and two Latvian Universities, Stockholm School of Economics in Riga and other organisations, including Riga City Council, supported by the British Embassy Riga and the Latvian Embassy in London, enabling structured processes to be developed to identify aspiring entrepreneurs based in Latvia and Estonia and provide education, coaching, mentoring and encouragement first in the home territory, leading to an intense whole-week development venture camp in Cambridge for selected candidates. The programme was extended to provide ongoing business development support for a number of entrepreneurial companies with global potential, and the developing venture camp activities attracted, supported and helped accelerate the evolution in Riga of an innovative ecosystem providing leadership in the Baltics. Practical examples of cross-border knowledge and technology transfers have been recorded as part of the Cambridge–Riga Venture Camp process. This report presents the development, content and outcomes of this innovative project aimed at supporting the emergence of entrepreneurial and innovative capabilities of Latvian delegates to the project. Detailed appendices including data and narrative based survey of outcomes and assessments containing structured feedback from delegates participating in the 2020 Cambridge-Riga Venture Camp are available as the Supplementary material online. This is an interim report, since the activity is ongoing and continuously developing.
Acute kidney Injury due to Alectinib, an Anaplastic Lymphoma Kinase inhibitor
Authors: Ng Chin Lin , Abdalla Alaeldin , Galambosi Greta , Cuffe Sinead , Doyle Brendan , Griffin Brenda , Sexton Donal J
Published: January 2021

Introduction:

The array of unintended effects of targeted oncological treatments is still being elucidated. Cognizance of these effects is important since they allow early identification and intervention.

Methods:

We report a case of progressive reduction in kidney function following the introduction of the oral second generation Anaplastic Lymphoma Kinase (ALK) Inhibitor: Alectinib for the treatment of metastatic non-small cell carcinoma of the lung (NSCLC). Kidney biopsy findings suggested that the predominant manifestation was acute tubular injury, which resolved with cessation of Alectinib therapy and did not recur with the introduction of the third generation ALK inhibitor Lorlatinib.

Conclusions:

This case report adds to the Onco-Nephrology literature in relation to the potential nephrotoxic effects of ALK inhibitors.
Tolerogenic anti–IL-2 mAb prevents graft-versus-host disease while preserving strong graft-versus-leukemia activity
Authors: Song Qingxiao , Wang Xiaoning , Wu Xiwei , Qin Hanjun , Li Yingfei , Riggs Arthur D. , Martin Paul J. , Chen Yuan-Zhong , Zeng Defu
Published: January 2021

Donor T cells mediate both graft-versus-leukemia (GVL) activity and graft-versus-host disease (GVHD) after allogeneic hematopoietic cell transplantation (allo-HCT). Development of methods that preserve GVL activity while preventing GVHD remains a long-sought goal. Tolerogenic anti–interleukin-2 (IL-2) monoclonal antibody (JES6-1) forms anti–IL-2/IL-2 complexes that block IL-2 binding to IL-2Rβ and IL-2Rγ on conventional T cells that have low expression of IL-2Rα. Here, we show that administration of JES6 early after allo-HCT in mice markedly attenuates acute GVHD while preserving GVL activity that is dramatically stronger than observed with tacrolimus (TAC) treatment. The anti–IL-2 treatment downregulated activation of the IL-2-Stat5 pathway and reduced production of granulocyte-macrophage colony-stimulating factor (GM-CSF). In GVHD target tissues, enhanced T-cell programmed cell death protein 1 (PD-1) interaction with tissue–programmed cell death-ligand 1 (PD-L1) led to reduced activation of protein kinase–mammalian target of rapamycin pathway and increased expression of eomesodermin and B-lymphocyte-induced maturation protein-1, increased T-cell anergy/exhaustion, expansion of Foxp3–IL-10–producing type 1 regulatory (Tr1) cells, and depletion of GM-CSF–producing T helper type 1 (Th1)/cytotoxic T cell type 1 (Tc1) cells. In recipient lymphoid tissues, lack of donor T-cell PD-1 interaction with tissue PD-L1 preserved donor PD-1+TCF-1+Ly108+CD8+ T memory progenitors and functional effectors that have strong GVL activity. Anti–IL-2 and TAC treatments have qualitatively distinct effects on donor T cells in the lymphoid tissues, and CD8+ T memory progenitor cells are enriched with anti–IL-2 treatment compared with TAC treatment. We conclude that administration of tolerogenic anti–IL-2 monoclonal antibody early after allo-HCT represents a novel approach for preventing acute GVHD while preserving GVL activity.
Structural characterization of a novel GPVI-nanobody complex reveals a biologically active domain-swapped GPVI dimer
Authors: Slater Alexandre , Di Ying , Clark Joanne C. , Jooss Natalie J. , Martin Eleyna M. , Alenazy Fawaz , Thomas Mark R. , Ariëns Robert A. S. , Herr Andrew B. , Poulter Natalie S. , Emsley Jonas , Watson Steve P.
Published: January 2021

Glycoprotein VI (GPVI) is the major signaling receptor for collagen on platelets. We have raised 54 nanobodies (Nb), grouped into 33 structural classes based on their complementary determining region 3 loops, against recombinant GPVI-Fc (dimeric GPVI) and have characterized their ability to bind recombinant GPVI, resting and activated platelets, and to inhibit platelet activation by collagen. Nbs from 6 different binding classes showed the strongest binding to recombinant GPVI-Fc, suggesting that there was not a single dominant class. The most potent 3, Nb2, 21, and 35, inhibited collagen-induced platelet aggregation with nanomolar half maximal inhibitory concentration (IC50) values and inhibited platelet aggregation under flow. The binding KD of the most potent Nb, Nb2, against recombinant monomeric and dimeric GPVI was 0.6 and 0.7 nM, respectively. The crystal structure of monomeric GPVI in complex with Nb2 revealed a binding epitope adjacent to the collagen-related peptide (CRP) binding groove within the D1 domain. In addition, a novel conformation of GPVI involving a domain swap between the D2 domains was observed. The domain swap is facilitated by the outward extension of the C-C′ loop, which forms the domain swap hinge. The functional significance of this conformation was tested by truncating the hinge region so that the domain swap cannot occur. Nb2 was still able to displace collagen and CRP binding to the mutant, but signaling was abolished in a cell-based NFAT reporter assay. This demonstrates that the C-C′ loop region is important for GPVI signaling but not ligand binding and suggests the domain-swapped structure may represent an active GPVI conformation.