bluuebunny/crossref_metadata_2025 huggingface dataset:
Note on ‘Tracking the flight of a spinning football in three dimensions’
Authors: Chu Kwang-Hua R
Published: June 2019

We make some crucial remarks about the recent presentation by Griffiths et al. considering their anomalous experimental results: The ball spin was observed to occasionally increase with time during its flight through the air. Possible reasoning due to experimental set-up and autorotation were given. Our results will be useful to sport education and relevant researchers.
How Clinical Practice Research Datalink data are used to support pharmacovigilance
Authors: Ghosh Rebecca E. , Crellin Elizabeth , Beatty Sue , Donegan Katherine , Myles Puja , Williams Rachael
Published: June 2019

Pharmacovigilance can be defined as the science of monitoring medicines and vaccines after license for use, the purpose of which is to quantify and characterise the safety profile of a medicine, identify previously unknown adverse reactions, inform risk-benefit assessment, and support the development of actions that can be taken to reduce risks, optimise benefits and monitor their effectiveness. This review discusses the Clinical Practice Research Datalink (CPRD), which is the source of the largest research database in the UK with longitudinal, representative primary care data linked to data from other healthcare settings. CPRD supports international pharmacovigilance by providing a large, anonymised representative general population database with comprehensive capture of patient risk factors and outcomes to researchers within academic, regulatory and pharmaceutical organisations. The specific advantages of CPRD data are discussed in the context of the ‘six Vs of big data’ including volume, velocity, variety, veracity, validity and value. Examples of where CPRD data have been used for pharmacovigilance research and how these have fed into guidelines and policy are discussed.
Occult obstructive coronary artery disease is associated with prolonged cardiac troponin elevation following strenuous exercise
Authors: Kleiven Øyunn , Omland Torbjørn , Skadberg Øyvind , Melberg Tor H , Bjørkavoll-Bergseth Magnus F , Auestad Bjørn , Bergseth Rolf , Greve Ole J , Aakre Kristin M , Ørn Stein
Published: June 2019

Background

Sudden cardiac death among middle-aged recreational athletes is predominantly due to myocardial ischaemia. This study examined whether measuring cardiac troponin I and T (cTnI and cTnT) after strenuous exercise could identify occult obstructive coronary artery disease.

Design

Prospective observational study.

Methods

Subjects were recruited from 1002 asymptomatic recreational cyclists completing a 91-km mountain bike race (North Sea Race Endurance Exercise Study). No subject had known cardiovascular disease or took cardiovascular medication. Blood samples were collected within 24 h before and 3 h and 24 h after the race. Coronary computed tomography angiography was performed in 80 participants with the highest post-exercise cTnI and in 40 reference subjects with moderately elevated cTnI values.

Results

Study subjects ( N = 120) were 45 (36–52) years old and 74% were male. There were similar demographics in the High-cTnI group and the Reference group. The cTn concentrations were highest at 3 h post-race: cTnI, 224 (125–304) ng/L; cTnT, 89 (55–124) ng/L. Nine subjects had obstructive coronary artery disease on coronary computed tomography angiography, eight of whom were High-cTnI responders. Two subjects had myocardial bridging, both High-cTnI responders. Troponin concentrations at 24 h post-race were higher in subjects with obstructive coronary artery disease than in the rest of the cohort ( n = 109): cTnI, 151 (72–233) ng/L vs. 24 (19–82) ng/L, p = 0.005; cTnT, 39 (25–55) ng/L vs. 20 (14–31) ng/L, p = 0.002. The areas under the receiver operating characteristic curves for predicting obstructive coronary artery disease were 0.79, p = 0.005 (cTnI) and 0.82, p = 0.002 (cTnT).

Conclusion

In subjects with occult obstructive coronary artery disease there was a prolonged elevation of cTn following strenuous exercise.
Revisiting the obesity paradox in heart failure: Per cent body fat as predictor of biomarkers and outcome
Authors: Aimo Alberto , Januzzi James L , Vergaro Giuseppe , Clerico Aldo , Latini Roberto , Meessen Jennifer , Anand Inder S , Cohn Jay N , Gravning Jørgen , Ueland Thor , Nymo Ståle H , Brunner-La Rocca Hans-Peter , Bayes-Genis Antoni , Lupón Josep , de Boer Rudolf A , Yoshihisa Akiomi , Takeishi Yasuchika , Egstrup Michael , Gustafsson Ida , Gaggin Hanna K , Eggers Kai M , Huber Kurt , Tentzeris Ioannis , Ripoli Andrea , Passino Claudio , Emdin Michele
Published: June 2019

Aims

Obesity defined by body mass index (BMI) is characterized by better prognosis and lower plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) in heart failure. We assessed whether another anthropometric measure, per cent body fat (PBF), reveals different associations with outcome and heart failure biomarkers (NT-proBNP, high-sensitivity troponin T (hs-TnT), soluble suppression of tumorigenesis-2 (sST2)).

Methods

In an individual patient dataset, BMI was calculated as weight (kg)/height (m) 2 , and PBF through the Jackson–Pollock and Gallagher equations.

Results

Out of 6468 patients (median 68 years, 78% men, 76% ischaemic heart failure, 90% reduced ejection fraction), 24% died over 2.2 years (1.5–2.9), 17% from cardiovascular death. Median PBF was 26.9% (22.4–33.0%) with the Jackson–Pollock equation, and 28.0% (23.8–33.5%) with the Gallagher equation, with an extremely strong correlation ( r = 0.996, p < 0.001). Patients in the first PBF tertile had the worst prognosis, while patients in the second and third tertile had similar survival. The risks of all-cause and cardiovascular death decreased by up to 36% and 27%, respectively, per each doubling of PBF. Furthermore, prognosis was better in the second or third PBF tertiles than in the first tertile regardless of model variables. Both BMI and PBF were inverse predictors of NT-proBNP, but not hs-TnT. In obese patients (BMI ≥ 30 kg/m2, third PBF tertile), hs-TnT and sST2, but not NT-proBNP, independently predicted outcome.

Conclusion

In parallel with increasing BMI or PBF there is an improvement in patient prognosis and a decrease in NT-proBNP, but not hs-TnT or sST2. hs-TnT or sST2 are stronger predictors of outcome than NT-proBNP among obese patients.
Prognostic value of total testosterone levels in patients with acute coronary syndromes
Authors: Gencer Baris , Vuilleumier Nicolas , Nanchen David , Collet Tinh-Hai , Klingenberg Roland , Räber Lorenz , Auer Reto , Carballo David , Carballo Sebastian , Aghlmandi Soheila , Heg Dik , Windecker Stephan , Lüscher Thomas F , Matter Christian M , Rodondi Nicolas , Mach François
Published: June 2019

Background

Endogenous testosterone levels decrease in men with aging. Controversies persist regarding the screening and treatment of low testosterone levels in patients with acute coronary syndromes (ACS).

Methods and results

Total serum testosterone levels were measured in 1054 men hospitalized for ACS that were part of a Swiss prospective cohort. Total testosterone levels were classified first in tertiles and using the cut-off of 300 ng/dL. Primary endpoint was all-cause mortality at one year. Cox regression models adjusting for the GRACE score (composite of age, heart rate systolic blood pressure, creatinine, cardiac arrest at admission, ST segment deviation, abnormal troponin enzyme and Killip classification), preexisting diabetes and inflammation (high-sensitivity C-reactive protein). A total of 430 men (40.8%) had total testosterone levels ≤300 ng/dL. Low total testosterone levels were correlated with lower high-density lipoprotein cholesterol and higher triglycerides, high-sensitivity C-reactive protein, high-sensitivity troponin T, N-terminal-pro B-type natriuretic peptide and glucose levels (all p < 0.01). Patients in the lowest testosterone tertile had a mortality rate at one-year of 5.4% compared with 2.9% in the highest tertile with an unadjusted hazard ratio of 1.92 (95% confidence interval 0.96–1.90, p = 0.095) and adjusted hazard ratio of 1.26 (95% confidence interval 0.57–2.78, p = 0.565). In an exploratory analysis, the highest mortality rate (10.3%) was observed in men aged >65 years old belonging to the lowest testosterone tertile.

Conclusion

In this large population of men with ACS, we found a prevalence of low total endogenous testosterone levels of almost 40%. However, low testosterone levels were not significantly associated with mortality after adjustment for high-risk confounders.
Estimation of cardiovascular risk based on total cholesterol versus total cholesterol/high-density lipoprotein within different ethnic groups: The HELIUS study
Authors: Perini Wilco , Snijder Marieke B , Peters Ron J , Kunst Anton E , van Valkengoed Irene G
Published: June 2019

Aims

European guidelines recommend estimating cardiovascular disease risk using the Systematic COronary Risk Evaluation (SCORE) algorithm. Two versions of SCORE are available: one based on the total cholesterol/high-density lipoprotein cholesterol ratio, and one based on total cholesterol alone. Cardiovascular risk classification between the two algorithms may differ, particularly among ethnic minority groups with a lipid profile different from the ethnic majority groups among whom the SCORE algorithms were validated. Thus in this study we determined whether discrepancies in cardiovascular risk classification between the two SCORE algorithms are more common in ethnic minority groups relative to the Dutch.

Methods

Using HELIUS study data (Amsterdam, The Netherlands), we obtained data from 7572 participants without self-reported prior cardiovascular disease of Dutch, South-Asian Surinamese, African Surinamese, Ghanaian, Turkish and Moroccan ethnic origin. For both SCORE algorithms, cardiovascular risk was estimated and used to categorise participants as low (<1%), medium (1–5%), high (5–10%) or very high (≥10%) risk. Odds of differential cardiovascular risk classification were determined by logistic regression analyses.

Results

The percentage of participants classified differently between the algorithms ranged from 8.7% to 12.4% among ethnic minority men versus 11.4% among Dutch men, and from 1.9% to 5.5% among ethnic minority women versus 6.2% among Dutch women. Relative to the Dutch, only Turkish and Moroccan women showed significantly different (lower) odds of differential cardiovascular risk classification.

Conclusion

We found no indication that discrepancies in cardiovascular risk classification between the two SCORE algorithms are consistently more common in ethnic minority groups than among ethnic majority groups.
The development of ‘Make One Small Change’: an e-health intervention for the workplace developed using the Person-Based Approach
Authors: Howarth Ana , Quesada Jose , Donnelly Todd , Mills Peter R
Published: June 2019

Background

The application of digital health interventions is widespread and many employers are implementing employee e-health programs. Intended to enhance productivity by increasing wellbeing, workplace interventions often lack evidence of effectiveness and have low rates of retention. Use of the person-based approach (PBA) is one solution, which offers a systematic framework for developing effective digital health interventions. This paper describes the application of the PBA to the development of ‘Make one small change’ (Cigna MSC™), an online behaviour change system for lifestyle habits focused on resilience, movement, eating and sleep.

Method and results

The development of Cigna MSC™ took place over four stages with colleagues ( n = 79) across Cigna globally. Application of the PBA entailed using high amounts of qualitative data to inform development and a cyclical process of ‘listening, applying and delivering’ was adhered to throughout. Early stages involved review of current literature and the collection of feedback in relation to existing interventions. Combined, results revealed key intervention development issues that were then used to form guiding principles. Guiding principles ensured intervention objectives translated into relevant design features. The final stages of evaluation included testing images, text and content approaches. Feedback dictated that the intervention should be fun, easy to use and include milestones for self-monitoring. The resulting version was finalised and made ready to pilot so future analysis can be made in relation to real-world engagement and the embedded evaluative content can be used to provide evidence of intervention effectiveness.

Conclusions

Using the PBA, which was evolved specifically to improve development of digital interventions, resulted in a workplace intervention embedded with in-depth user input combined with evidenced-based theory. This paper illustrates how using a rigorous methodology can drive the creation of an effective digital health intervention that uniquely allows for refinement at each stage.
Using Social Network Analysis and Social Capital to Identify User Roles on Polarized Political Conversations on Twitter
Authors: Recuero Raquel , Zago Gabriela , Soares Felipe
Published: June 2019

In this article, we discuss the roles users play in political conversations on Twitter. Our case study is based on data collected in three dates during the former Brazilian president Lula’s corruption trial. We used a combination of social network analysis metrics and social capital to identify the users’ roles during polarized discussions that took place in each of the dates analyzed. Our research identified four roles, each associated with different aspects of social capital and social network metrics: activists, news clippers, opinion leaders, and information influencers. These roles are particularly useful to understand how users’ actions on political conversations may influence the structure of information flows.
Frequency and prognostic impact of KIT and other genetic variants in indolent systemic mastocytosis
Authors: Muñoz-González Javier I. , Álvarez-Twose Iván , Jara-Acevedo María , Henriques Ana , Viñas Esther , Prieto Carlos , Sánchez-Muñoz Laura , Caldas Carolina , Mayado Andrea , Matito Almudena , Dasilva-Freire Noelia , Orfao Alberto , García-Montero Andrés C.
Published: June 2019

Indolent systemic mastocytosis (ISM) patients have a normal life expectancy, except in the 5% to 10% of cases that progress to more advanced SM (advSM), which has a significantly poorer outcome. Mutations in genes other than KIT frequently found in myeloid neoplasms have been associated with a poorer outcome among advSM, whereas limited information exists about their frequency and prognostic impact in ISM. We investigated the frequency and prognostic impact of variants in 18 genes, found to be altered in advSM, in 322 ISM patients (median follow-up, 5.7 years) divided into discovery (n = 200) and validation (n = 122) cohorts. Overall, 71 genetic variants were detected in 55 of 322 (17%) patients. Mutated ISM cases, particularly those carrying ASXL1, RUNX1, and/or DNMT3A (A/R/D) pathogenic variant allele frequencies (VAFs) ≥ 30%, exhibited significantly shortened (P < .001) progression-free survival (PFS) and overall survival (OS). Multivariate analysis showed that serum β2-microglobulin (sβ2M) levels > 2.5 µg/mL (hazard ratio [HR], 9.8; P = .001), together with a KIT D816V VAF ≥ 1% in bone marrow (BM) (HR, 10.1; P = .02) and pathogenic variants of A/R/D VAFs ≥ 30% (HR, 4.2; P = .02), were the best combination of independent predictors for PFS. In turn, A/R/D gene pathogenic VAF ≥ 30% was the only independent predictor for OS (HR, 51.8; P < .001). Based on these variables, 2 scoring systems were constructed for risk stratification of ISM at diagnosis with significantly different 10-year PFS (100%, 91%, 0% for scores of 0, 1, ≥2, respectively) and OS (100% and 50% for scores of 0 and 1) rates.
Haploidentical hematopoietic cell and kidney transplantation for hematological malignancies and end-stage renal failure
Authors: Chen Yi-Bin , Elias Nahel , Heher Eliot , McCune Jeannine S. , Collier Kerry , Li Shuli , Del Rio Candice , El-Jawahri Areej , Williams Winfred , Tolkoff-Rubin Nina , Fishman Jay A. , McAfee Steven , Dey Bimalangshu R. , DeFilipp Zachariah , O’Donnell Paul V. , Cosimi A. Benedict , Sachs David , Kawai Tatsuo , Spitzer Thomas R.
Published: June 2019

At Massachusetts General Hospital, we pioneered simultaneous hematopoietic cell (HCT)/kidney transplantation from HLA-identical related donors for the treatment of hematological malignancies with end-stage renal failure. We have now extended this to HLA-haploidentical donors in a pilot trial. Six recipients, 5 of whom were conditioned with fludarabine, cyclophosphamide, and total-body irradiation, underwent combined HCT/kidney transplantation from haploidentical donors; graft-versus-host disease (GVHD) prophylaxis included post-HCT cyclophosphamide, tacrolimus, and mycophenolate mofetil. One patient died as a result of complications of fludarabine neurological toxicity. No neurological toxicity was observed in subsequent patients who received lower fludarabine doses and more intense postfludarabine dialysis. There were no cases of grade 2 to 4 acute GVHD and 1 case of moderate chronic GVHD by 12 months. One patient experienced relapse of multiple myeloma at 30 months after HCT and died 4 years posttransplantation. Overall, 4 of 6 patients remain alive, without disease relapse and with long-term renal rejection–free survival. This trial was registered at www.clinicaltrials.gov as #NCT01758042.
Lack of Gdf11 does not improve anemia or prevent the activity of RAP-536 in a mouse model of β-thalassemia
Authors: Guerra Amaliris , Oikonomidou Paraskevi Rea , Sinha Sayantani , Zhang Jianbing , Lo Presti Vania , Hamilton Callum R. , Breda Laura , Casu Carla , La Ping , Martins Ana C. , Sendamarai Anoop K. , Fleming Mark , Rivella Stefano
Published: June 2019

There is a Blood Commentary on this article in this issue.
Music and dance in chronic lung disease
Authors: Philip Keir , Lewis Adam , Hopkinson Nicholas S.
Published: June 2019

Arts in Health interventions show potential to improve the quality of life of people with chronic lung disease. Listening to music, making music, and dance have accepted and established roles in the lives of people without chronic disease. However, their potential utility in chronic disease management is infrequently considered by medical professionals. The aim of this review is to examine the use of music and dance in the treatment and self-management of chronic lung disease. Although the evidence base is currently limited, existing research suggests a range of biopsychosocial benefits. As personalised medicine and social prescribing become more prominent, further research is required to establish the role of arts interventions in chronic lung disease.
Communication and trust: rethinking the way construction industry professionals and software vendors utilise computer communication mediums
Authors: Oliver Stephen
Published: June 2019

Contemporary communication mediums in isolation have reached a technological plateau, proximal communication is no longer limited by spatial or technological constraints. However, integration of communication mediums and their application in pedagogy do not appear to receive the attention they deserve outwith marketing and social psychology research. This is to the determinant of AEC industries where the forefront of proximal communication extends to video conferencing and high latency sharing of open standard models. Underutilisation is not just a missed opportunity; it is the source of many cascading conflicts, trust issues and delivery failures in in AEC projects. Although effective communication will not resolve all problems, those associated with its absence are unnecessarily endemic. Through discussion of the antecedents of trust and the social presence principles that underpin effective communication, this paper proposes the next disruptive innovation in industry should be a paradigm shift in its approach to communication.
Iatrogenic wounds: a common but often overlooked problem
Authors: Cheng Biao , Tian Ju , Peng Yan , Fu Xiaobing
Published: June 2019

Iatrogenic wounds are a common but often overlooked concept. They can lead to increases in hospital stays, therapy costs, repeat surgeries, and implant removal. If not handled properly, these wounds have a very poor prognosis and will cause serious physical and psychological harm to patients, which may result in medicolegal disputes. In recent years, the incidence of iatrogenic wounds has increased because of (1) an increase in the population of older people owing to increased life expectancy, (2) the continued expansion of surgical indications, (3) an increase in difficult surgeries, and (4) the constant emergence and application of new implantable biomaterials and other therapies. Thus, there is a pressing clinical need to improve the therapy of iatrogenic wounds. However, the difficulty in treating these wounds is considerable due to the emergence of drug-resistant bacteria, the high number of patients with metabolic diseases, and complex complications in patients. In particular, iatrogenic wounds caused by surgical site infections due to implantable biomaterials could lead to material leakage and conflicts regarding whether to retain or remove the implants. This review provides a definition of iatrogenic wounds, describes their characteristics, classifies them, and provides information about the importance of analyzing iatrogenic wounds. We hope that this review will provide useful information for the diagnosis and treatment of iatrogenic wounds and help to reduce their incidence in the future.
Efficient electroporation of neuronal cells using synthetic oligonucleotides: identifying duplex RNA and antisense oligonucleotide activators of human frataxin expression
Authors: Shen Xiulong , Beasley Sharon , Putman Jennifer N. , Li Yanjie , Prakash Thahza P. , Rigo Frank , Napierala Marek , Corey David R.
Published: June 2019

Oligonucleotide drugs are experiencing greater success in the clinic, encouraging the initiation of new projects. Resources are insufficient to develop every potentially important project, and persuasive experimental data using cell lines close to disease target tissue is needed to prioritize candidates. Friedreich's ataxia (FRDA) is a devastating and currently incurable disease caused by insufficient expression of the enzyme frataxin (FXN). We have previously shown that synthetic nucleic acids can activate FXN expression in human patient-derived fibroblast cells. We chose to further test these compounds in induced pluripotent stem cell-derived neuronal progenitor cells (iPSC-NPCs). Here we describe methods to deliver oligonucleotides and duplex RNAs into iPSC-NPCs using electroporation. Activation of FXN expression is potent, easily reproducible, and potencies parallel those determined using patient-derived fibroblast cells. A duplex RNA and several antisense oligonucleotides (ASOs) with different combinations of 2′-methoxyethyl (2′-MOE), 2′-fluoro (2′-F), and constrained ethyl (cEt) were active, providing multiple starting points for further development and highlighting improved potency as an important goal for preclinical development. Our data support the conclusion that ASO-mediated activation of FXN is a feasible approach for treating FRDA and that electroporation is a robust method for introducing ASOs to modulate gene expressions in neuronal cells.
Radiobiological Proton Effects
Authors: Иванов А. , Ivanov A. , Бычкова Т. , Bichkova T. , Никитенко О. , Nikitenko O. , Ушаков И. , Ushakov I.
Published: June 2019

The article contains an analysis of literature data and the author’s own results on the radiobiological effects of protons at the cellular, systemic (intercellular) and organismic levels, as applied to the practical tasks of radiation therapy of oncological diseases and the protons effects on the astronauts’ organism.

It is established that the proton RBE is a variable value, depending on the LET of the particles, the amount and dose rate, the presence or absence of oxygen. Proton RBE varies depending on the object of study, the type of tissue, proton energy and particle penetration depth, as well as the method for evaluating the biological efficiency of protons. which corresponds to general radiobiology.

In particular, it has been shown that the RBE of protons adopted in radiation therapy at the level of 1.1 is conditional. A firmly established and repeatedly confirmed is an increase in RBE with a decrease in proton energy and, accordingly, an increase in LET.

The use of elements of the physical protection of a spacecraft during exposure to protons with an energy of 170 MeV leads to an increase in LET and RBE of protons in terms of the cellularity of the bone marrow.

Pharmacological agents effective in photon irradiation are also effective when exposed to a proton beam. It has been shown that natural melanin pigment and recombinant manganese superoxide dismutase helps to preserve and accelerate the resumption of blood formation in animals irradiated by protons. The Grippol vaccine increases radioresistance during proton irradiation. Neuropeptide Semax has a positive effect on the central nervous system and the strength of the forepaws of animals irradiated with protons at Bragg’s peak.
Spectral Correlation Analysis of EEG of liquidators of the Chernobyl Accident with Neurological Disorders
Authors: Торубаров Ф. , Torubarov F. , Кулешова М. , Kuleshova M. , Лукьянова С. , Luk'yanova S. , Зверева З. , Zvereva Z.
Published: June 2019

Purpose: Comparative analysis of spectral correlation characteristics of EEG from liquidators of the Chernobyl accident and persons group, with neurological disorders.

Material and methods: A study carried out with the participation of 141 of the liquidator of the Chernobyl accident and 84 people group. Ionizing effects could be subject only to the liquidators. The average radiation dose in a group of liquidators was 110 ± 14 mSv. Groups were matched on age and employment. All persons have passed clinical neurological and electrophysiological examination. The focus of the article given that spectral and correlation analysis of EEG.

Results: Clinical examination made it possible to diagnose neurological disorders in both groups as: vegetovascular dystonia, neurocirculatory dystonia, dyscirculatory encephalopathy of different etiology. Their number and extent dominated statistically in a group of liquidators of the Chernobyl accident. It is important to note that increasing the frequency of their manifestations depending on the liquidators received radiation doses have not been identified. However, the disorder is diagnosed more often in the psychoemotional sphere among liquidators, than in the group mapping (61.7 % and 29.7 %, respectively). The analysis reveals statistically significant differences in EEG spectra in the presence of specified diagnoses compared with known characteristic of norms. Spectral and correlation analysis of EEG complements these data, demonstrating the existence of correlative considered diagnoses and significant differences between groups of liquidators and mappings. Liquidators increased delta-range observed in the authentically greater degree (as compared to a matched group) and combined with a significant reduction in the alpha-frequency index. The observed changes among liquidators are functional and non-specific in nature. Picture of the totality of the observed changes is not specific. It is regarded as one of the non-pathogenic mechanisms of development of the asthenic symptoms of different etiology.

Conclusions: In the group of liquidators revealed a significant increase in the quantity and the degree of neurological disorders. In the spectrum of EEG liquidators reliably amplifies the index delta-activity and decreases the severity of alpha range compared to a mappings group. It is important that these changes are accompanied by a weakening of the correlations between brain structures and disruption EEG rest.
Individual Dose Distribution in Cohort of People Exposed as a Result of Radioactive Contamination of the Techa River
Authors: Дёгтева М. , Degteva M. , Напье Б. , Napier B. , Толстых Е. , Tolstykh E. , Шишкина Е. , Shishkina E. , Бугров Н. , Bougrov N. , Крестинина Л. , Krestinina L. , Аклеев А. , Akleev A.
Published: June 2019

Purpose: Descriptive analysis of the distributions of organ/tissue doses for individuals exposed to radiation as a result of liquid waste releases into the Techa River by the Mayak Production Association (PA) in 1949–1956.

Material and methods: The dosimetry system TRDS-2016D has been used to compute individual doses of external and internal exposures. TRDS-2016D databases include information on radionuclide intakes and dose rates in air for settlements located in the contaminated areas of the Techa River and the East Ural Radioactive Trace (EURT). Combining these village-average data with the residence history and age of a particular person, the system produces an individual scenario of external exposure and individual radionuclide intakes and then calculates corresponding external and internal doses from the Techa River and EURT. Available 90Sr-body-burden measurements and available information on individual household locations relative to the contaminated river have been used for refinement of individual dose estimates.

Results: Individual doses have been calculated for 29,647 persons included in the Techa River Cohort (TRC). According to residence history data, 5,280 members of the TRC were additionally exposed due to residency in the EURT villages. The cohort-average dose for the majority of extra-skeletal tissues does not exceed 100 mGy, while for the red bone marrow (RBM) it is equal to 350 mGy. In addition to the doses from the Techa River and EURT, individual thyroid doses for TRC members exposed to the Mayak PA atmospheric 131I releases have been calculated in a separate computer program. The cohort–average thyroid dose is 210 mGy. Maximum doses (about 1 Gy to the majority of extra-skeletal tissues and over 7 Gy to the thyroid and RBM) are observed for the persons who lived in their childhood and adolescence in the upper Techa region at close distance to the Mayak PA.

Conclusion: The TRC members were exposed to chronic radiation over a wide range of doses, but at low-to-moderate-dose rates. Estimates of absorbed doses can be used to analyze the dose dependences of the incidence of solid cancers and leukemias. This can make it possible to verify risk coefficients of low-dose-rate effects of ionizing radiation which can be used for radiation protection purposes.
Estimation of Radiation Risk of the Initiation of Malignant Novelties in the Liquidators of the Consequences of the Accident at the Chernobyl Nuclear Power Plant, Workers of the Nuclear Industry, with the Account of Doses of Various Types of Irradiation
Authors: Туков А. , Tukov A. , Шафранский И. , Shafransky I. , Цовьянов А. , Tsoviyanov A. , Бирюков А. , Biryukov A. , Сидорин И. , Sidorin I. , Прохорова О. , Prokhorova O. , Журавлева В. , Zhuravleva V.
Published: June 2019

Purpose: Estimate of the excess relative risk of malignant neoplasm disease (MND) in nuclear industry workers, participants in the elimination of the consequences of the Chernobyl accident, taking into account the doses of various types of irradiation.

Material and methods: An epidemiological experiment was conducted in which the personal data of the information base of the Industry Register of persons exposed to radiation as a result of the Chernobyl accident, the doses of occupational exposure, and tabular data on the dose of natural exposure, presented in the reports on the radiation situation in populated areas ESKID, No. 4-DOZ) were used.

Results: It is shown that the risk assessment of the disease in the Chernobyl accident liquidators, obtained with the use of doses of different types of exposure, has different risk indicators (ERR at 1 Sv: the Chernobyl NPP radiation dose is 0.13, the ChNPP + professional dose is 1.13 and the ChNPP dose + professional + natural – 0.56).

Conclusions:

– Using any part of the total radiation dose of a person to calculate the risk of dose-induced diseases, we will get incorrect results is unknown how far from the truth.

– For a reliable assessment of the risk of the disease, an overall dose is required from a person from all types of radiation, which is required by the radiation safety directives.
The preoperative management of Hepatitis C may improve the outcome after total knee arthroplasty
Authors: Schwarzkopf R. , Novikov D. , Anoushiravani A. A. , Feng J. E. , Vigdorchik J. , Schurko B. , Dwyer M. K. , Bedair H. S.
Published: June 2019

Aims

With an ageing population of patients who are infected with hepatitis C virus (HCV), the demand for total knee arthroplasty (TKA) in this high-risk group continues to grow. It has previously been shown that HCV infection predisposes to poor outcomes following TKA. However, there is little information about the outcome of TKA in patients with HCV who have been treated successfully. The purpose of this study was to compare the outcomes of TKA in untreated HCV patients and those with HCV who have been successfully treated and have a serologically confirmed remission.

Patients and Methods

A retrospective review of all patients diagnosed with HCV who underwent primary TKA between November 2011 and April 2018 was conducted. HCV patients were divided into two groups: 1) those whose HCV was cured (HCV-C); and 2) those in whom it was untreated (HCV-UT). All variables including demographics, HCV infection characteristics, surgical details, and postoperative medical and surgical outcomes were evaluated. There were 64 patients (70 TKAs) in the HCV-C group and 63 patients (71 TKAs) in the HCV-UT cohort. The mean age at the time of surgery was 63.0 years (sd 7.5; 44 to 79) in the HCV-C group and 61.7 years (sd 6.9; 47 to 88) in the HCV-UT group.

Results

HCV-UT patients had a significantly longer mean hospital stay (3.4 days vs 2.9 days; p = 0.04), were more likely to be transferred to the intensive care unit (14.1% vs 4.3%; p = 0.04), and were significantly more often discharged to a post-acute care facility (39.4% vs 14.3%; p < 0.01). HCV-UT patients had significantly more postoperative infections (15.5% vs 4.3%; p = 0.03), surgical complications (21.1% vs 7.1%; p = 0.02), and revision TKA (12.7% vs 1.4%; p < 0.01) than HCV-C patients.

Conclusion

The preoperative treatment of HCV can reduce the risk of complications, including prosthetic joint infection and revision TKA. We recommend that HCV treatment regimens should be integrated into the preoperative optimization protocol for this high-risk group of patients. Cite this article: Bone Joint J 2019;101-B:667–674.
Factors associated with the magnitude of limitations during recovery from a fracture of the proximal humerus
Authors: Jayakumar P. , Teunis T. , Williams M. , Lamb S. E. , Ring D. , Gwilym S.
Published: June 2019

Aims

The purpose of this study was to identify factors associated with limitations in function, measured by patient-reported outcome measures (PROMs), six to nine months after a proximal humeral fracture, from a range of demographic, injury, psychological, and social variables measured within a week and two to four weeks after injury.

Patients and Methods

We enrolled 177 adult patients who sustained an isolated proximal humeral fracture into the study and invited them to complete PROMs at their initial outpatient visit within one week of injury, between two and four weeks, and between six to nine months after injury. There were 128 women and 49 men; the mean age was 66 years (sd 16; 18 to 95). In all, 173 patients completed the final assessment. Bivariate analysis was performed followed by multivariable regression analysis accounting for multicollinearity using partial R2, correlation matrices, and variable inflation factor.

Results

Many variables within a week of injury and between two and four weeks after injury correlated with six- to nine-month PROMs in bivariate analysis. Kinesiophobia measured within a week of injury (Tampa Scale for Kinesiophobia-11: partial R2 = 0.14; p = 0.000) and self-efficacy measured between two and four weeks (Pain Self-efficacy Questionnaire-2: partial R2 = 0.266; p < 0.001) were the strongest predictors of limitations (measured by Patient Reported Outcome Measurement Information System Upper Extremity Physical Function Computer Adaptive Test (PROMIS UE)) at six to nine months in multivariable analysis. Similar findings were observed with other types of PROM. Regression models accounted for a substantial amount of variance in all PROMs at both timepoints (e.g. 66% of the overall variance within one week, and 70% within two to four weeks for PROMIS UE at six to nine months).

Conclusion

Recovery from a proximal humeral fracture appears to be enhanced by overcoming fears of movement or reinjury within a week after injury and greater self-efficacy (developing resilience and more effective coping strategies) within a month. Such factors are modifiable using enhanced communication skills and cognitive behavioural treatments. These findings could be a catalyst for the routine assessment and treatment of psychological and social factors in the management of patients with fractures. Cite this article: Bone Joint J 2019;101-B:715–723.
A flexion osteotomy for correction of a distal tibial recurvatum deformity
Authors: Scheidegger P. , Horn Lang T. , Schweizer C. , Zwicky L. , Hintermann B.
Published: June 2019

Aims

There is little information about how to manage patients with a recurvatum deformity of the distal tibia and osteoarthritis (OA) of the ankle. The aim of this study was to evaluate the functional and radiological outcome of addressing this deformity using a flexion osteotomy and to assess the progression of OA after this procedure.

Patients and Methods

A total of 39 patients (12 women, 27 men; mean age 47 years (28 to 72)) with a distal tibial recurvatum deformity were treated with a flexion osteotomy, between 2010 and 2015. Nine patients (23%) subsequently required conversion to either a total ankle arthroplasty (seven) or an arthrodesis (two) after a mean of 21 months (9 to 36). A total of 30 patients (77%), with a mean follow-up of 30 months (24 to 76), remained for further evaluation. Functional outcome, sagittal ankle joint OA using a modified Kellgren and Lawrence Score, tibial lateral surface (TLS) angle, and talar offset ratio (TOR) were evaluated on pre- and postoperative weight-bearing radiographs.

Results

Postoperatively, the mean score for pain, using a visual analogue scale, decreased significantly from 4.3 to 2.5 points and the mean American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score improved significantly from 59 to 75 points (both p < 0.001). The mean TLS angle increased significantly by 6.6°; the mean TOR decreased significantly by 0.24 (p < 0.001). Radiological evaluation showed an improvement or no progression of sagittal ankle joint OA in 32 ankles (82%), while seven ankles (18%) showed further progression.

Conclusion

A flexion osteotomy effectively improved the congruency of the ankle joint. In 30 patients (77%), the joint could be saved, whereas in nine patients (23%), the treatment delayed a joint-sacrificing procedure. Cite this article: Bone Joint J 2019;101-B:682–690.
Long-term follow-up of custom cross-pin fixation of 56 tumour endoprosthesis stems
Authors: Bernthal N. M. , Upfill-Brown A. , Burke Z. D. C. , Ishmael C. R. , Hsiue P. , Hori K. , Hornicek F. , Eckardt J. J.
Published: June 2019

Aims

Aseptic loosening is a major cause of failure in cemented endoprosthetic reconstructions. This paper presents the long-term outcomes of a custom-designed cross-pin fixation construct designed to minimize rotational stress and subsequent aseptic loosening in selected patients. The paper will also examine the long-term survivorship and modes of failure when using this technique.

Patients and Methods

A review of 658 consecutive, prospectively collected cemented endoprosthetic reconstructions for oncological diagnoses at a single centre between 1980 and 2017 was performed. A total of 51 patients were identified with 56 endoprosthetic implants with cross-pin fixation, 21 of which were implanted following primary resection of tumour. Locations included distal femoral (n = 36), proximal femoral (n = 7), intercalary (n = 6), proximal humeral (n = 3), proximal tibial (n = 3), and distal humeral (n = 1).

Results

The median follow-up was 132 months (interquartile range (IQR) 44 to 189). In all, 20 stems required revision: eight for infection, five for structural failure, five for aseptic loosening, and two for tumour progression. Mechanical survivorship at five, ten, and 15 years was 84%, 78%, and 78%, respectively. Mechanical failure rate varied by location, with no mechanical failures of proximal femoral constructs and distal femoral survivorship of 82%, 77%, and 77% at five, ten, and 15 years. The survivorship of primary constructs at five years was 74%, with no failure after 40 months, while the survivorship for revision constructs was 89%, 80%, and 80% at five, ten, and 15 years.

Conclusion

The rate of mechanical survivorship in our series is similar to those reported for other methods of reconstruction for short diaphyseal segments, such as compressive osseointegration. The mechanical failure rate differed by location, while there was no substantial difference in long-term survival between primary and revision reconstructions. Overall, custom cross-pin fixation is a viable option for endoprosthetic reconstruction of short metaphyseal segments with an acceptable rate of mechanical failure. Cite this article: Bone Joint J 2019;101-B:724–731.
How common are acromial and scapular spine fractures after reverse shoulder arthroplasty?
Authors: King J. J. , Dalton S. S. , Gulotta L. V. , Wright T. W. , Schoch B. S.
Published: June 2019

Aims

Acromial fractures following reverse shoulder arthroplasty (RSA) have a wide range of incidences in reported case series. This study evaluates their incidence following RSA by systematically reviewing the current literature.

Materials and Methods

A systematic review using the search terms “reverse shoulder”, “reverse total shoulder”, or “inverted shoulder” was performed using PubMed, Web of Science, and Cochrane databases between 1 January 2010 and 31 March 2018. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. Studies were included if they reported on RSA outcomes and the incidence rate of acromial and/or scapular spine fractures. The rate of these fractures was evaluated for primary RSA, revision RSA, RSA indications, and RSA implant design.

Results

The review included 90 articles out of 686 identified after exclusions. The incidence rate of acromial and/or scapular spine fractures was 2.8% (253/9048 RSAs). The fracture rate was similar for primary and revision RSA (2.8% vs 2.1%; p = 0.4). Acromial fractures were most common after RSA for inflammatory arthritis (10.9%) and massive rotator cuff tears (3.8%). The incidence was lowest in RSA for post-traumatic arthritis (2.1%) and acute proximal humerus fractures (0%). Lateralized glenosphere design had a significantly higher rate of acromial fractures compared with medial glenosphere designs.

Conclusion

Based on current English literature, acromial and/or scapular spine fractures occur at a rate of 2.8% after RSA. The incidence is slightly more common after primary compared with revision arthroplasty. Also, higher rates of acromial fractures are reported in RSA performed for inflammatory arthritis and in the lateralized glenoid design. Cite this article: Bone Joint J 2019;101-B:627–634.
A clinical comparison between dedifferentiated low-grade osteosarcoma and conventional osteosarcoma
Authors: Toki S. , Kobayashi E. , Yoshida A. , Ogura K. , Wakai S. , Yoshimoto S. , Yonemori K. , Kawai A.
Published: June 2019

Aims

The purpose of this study was to clarify the clinical behaviour, prognosis, and optimum treatment of dedifferentiated low-grade osteosarcoma (DLOS) diagnosed based on molecular pathology.

Patients and Methods

We retrospectively reviewed 13 DLOS patients (six men, seven women; median age 32 years (interquartile range (IQR) 27 to 38)) diagnosed using the following criteria: the histological coexistence of low-grade and high-grade osteosarcoma components in the lesion, and positive immunohistochemistry of mouse double minute 2 homolog (MDM2) and cyclin-dependent kinase 4 (CDK4) associated with MDM2 amplification. These patients were then compared with 51 age-matched consecutive conventional osteosarcoma (COS) patients (33 men, 18 women; median age 25 years (IQR 20 to 38)) regarding their clinicopathological features.

Results

The five-year overall survival (OAS) rates in the DLOS and COS patients were 85.7% and 77.1% (p = 0.728), respectively, and the five-year progression-free survival (PFS) rates were 57.7% and 44.9% (p = 0.368), respectively. A total of 12 DLOS patients received chemotherapy largely according to regimens for COS. Among the nine cases with a histological evaluation after chemotherapy, eight showed a poor response, and seven of these had a necrosis rate of < 50%. One DLOS patient developed local recurrence and five developed distant metastases.

Conclusion

Based on our study of 13 DLOS cases that were strictly defined by histological and molecular means, DLOS showed a poorer response to a standard chemotherapy regimen than COS, while the clinical outcomes were not markedly different. Cite this article: Bone Joint J 2019;101-B:745–752.
Reverse shoulder arthroplasty has a higher risk of revision due to infection than anatomical shoulder arthroplasty
Authors: Moeini S. , Rasmussen J. V. , Salomonsson B. , Domeij-Arverud E. , Fenstad A. M. , Hole R. , Jensen S. L. , Brorson S.
Published: June 2019

Aims

The aim of this study was to use national registry database information to estimate cumulative rates and relative risk of revision due to infection after reverse shoulder arthroplasty.

Patients and Methods

We included 17 730 primary shoulder arthroplasties recorded between 2004 and 2013 in The Nordic Arthroplasty Register Association (NARA) data set. With the Kaplan–Meier method, we illustrated the ten-year cumulative rates of revision due to infection and with the Cox regression model, we reported the hazard ratios as a measure of the relative risk of revision due to infection.

Results

In all, 188 revisions were reported due to infection during a mean follow-up of three years and nine months. The ten-year cumulative rate of revision due to infection was 1.4% overall, but 3.1% for reverse shoulder arthroplasties and 8.0% for reverse shoulder arthroplasties in men. Reverse shoulder arthroplasties were associated with an increased risk of revision due to infection also when adjusted for sex, age, primary diagnosis, and year of surgery (relative risk 2.41 (95% conﬁdence interval 1.26 to 5.59); p = 0.001).

Conclusion

The overall incidence of revision due to infection was low. The increased risk in reverse shoulder arthroplasty must be borne in mind, especially when offering it to men. Cite this article: Bone Joint J 2019;101-B:702–707.