bluuebunny/crossref_metadata_2025 huggingface dataset:
Kickstand Rod Technique for Correcting Coronal Imbalance in Adult Scoliosis: 2-Dimensional Operative Video
Authors: Buell Thomas J , Buchholz Avery L , Mazur Marcus D , Mullin Jeffrey P , Chen Ching-Jen , Sokolowski Jennifer D , Yen Chun-Po , Shaffrey Mark E , Shaffrey Christopher I , Smith Justin S
Published: October 2019

Restoration of spinal alignment and balance is a major goal of adult scoliosis surgery. In the past, sagittal alignment has been emphasized and was shown to have the greatest impact on functional outcomes. However, recent evidence suggests the impact of coronal imbalance on pain and functional outcomes has likely been underestimated.
1,2
In addition, iatrogenic coronal imbalance may be common and frequently results from inadequate correction of the lumbosacral fractional curve.
2,3
The “kickstand rod” is a recently described technique to achieve and maintain significant coronal-plane correction.
4
Also, of secondary benefit, the kickstand rod may function as an accessory supplemental rod to offload stress and bolster primary instrumentation. This may reduce occurrence of rod fracture (RF) or pseudarthrosis (PA).
5

 Briefly, this technique involves positioning the kickstand rod on the side of coronal imbalance (along the major curve concavity or fractional curve convexity in our video demonstration). The kickstand rod spans the thoracolumbar junction proximally to the pelvis distally and is secured with an additional iliac screw placed just superior to the primary iliac screw. By using the iliac wing as a base, powerful distraction forces can reduce the major curve to achieve more normal coronal balance. This operative video illustrates the technical nuances of utilizing the kickstand rod technique for correction of severe lumbar scoliosis and coronal malalignment in a 60-yr-old male patient. Alignment correction was achieved and maintained without evidence of RF/PA after nearly 6 mo postoperatively. The patient gave informed consent for surgery and to use imaging for medical publication.
Queering School Literacy Practices: Interventionist Approaches
Authors: Moita-Lopes Luiz Paulo , Falabella Fabrício Branca
Published: October 2019

This chapter reviews research into school literacy practices that suggest a way of discursively destabilizing frozen notions of sexuality. The review explores questions such as: How can school literacies collaborate with the reconfiguration of crystalized meanings about gender and sexuality performances? What kind of queer experiences can classroom talk promote? What are some of the meaning-effects produced by the circulation of gender and sexuality discourses in the classroom? The answers to these questions are organized in three groups: interventionist projects observed by a researcher; interventionist projects carried out and evaluated by a teacher-researcher; and projects involving teacher-researcher collaboration. The last group is explored by analyzing empirical data generated in a high school in Brazil. The underlying argument is that education may contribute to interrupting an essentialized order that defines and legitimates gender and sexuality. By putting sexuality issues at the front of the educational agenda, the interventionist research in literacy contexts reviewed in this chapter destabilizes both the gender divide and the so-called heteronormative matrix that play crucial roles in the ways we have historically learned to (1) understand ourselves and others; and (2) construct patterns of normalcy and deviance.
LGBTIQ Strategies of Interpretation
Authors: Marchal Joseph A.
Published: October 2019

Broadly speaking, one can initially describe LGBTIQ strategies of interpretation as traveling along three trajectories, taking historical-contextual, affirmative-identifying, or queerly critical routes. This essay explores all three strategies. It then argues that when and where LGBTIQ strategies of interpretation do find institutional homes, whether in the church or the academy, one should also find modes for critical reflexivity, particularly to guard against co-optation, accommodation, or complicity. These dynamics require mixing and messing with simple divisions, including those that this essay relies on: attending to historical contexts differently, reflecting on identifications carefully but creatively, and theorizing more eclectically, persistently, and (ultimately) promiscuously.
Pitch vs. Timbre
Authors: Walden Daniel K. S.
Published: October 2019

Early comparative musicology habitually ignored, even extinguished, timbre in its single-minded focus on pitch. This chapter traces the broader social, cultural, and political consequences of this framework. It surveys how, at the turn of the twentieth century, John Comfort Fillmore and Benjamin Ives Gilman followed the lead of Alice Fletcher and Alexander Ellis in deploying a broad range of technologies—phonograph, Helmholtz resonator, keyboard, and musical notation—to develop frameworks for analyzing essential similarities and differences between Native American and Western musics. It argues that such scholarship, while ostensibly aimed at salvaging Native American music, also served American efforts to reform and silence indigenous voices. The postscript examines the resonances between their theories and modern frameworks of parametric analysis that construe pitch and timbre as autonomous, and proposes that there may be unrecognized perils in overly articulating the boundaries between pitch and timbre to focus analytical attention exclusively on the measurable quantities of musical sound.
Helicopter Parenting, Parental Control, and Moral Development During Emerging Adulthood
Authors: Nelson Larry J. , Padilla-Walker Laura M. , Son Daye
Published: October 2019

This chapter considers different types of parental discipline in relation to different antisocial and prosocial child behaviors. Inductive reasoning, in which parents offer explanations and refer to how wrongdoing affects other people, has been related to a reduction in children’s antisocial behavior and an increase in children’s prosocial behavior. In contrast, power-assertive forms of discipline, most notably corporal punishment, have been related to an increase in children’s antisocial behavior and a decrease in children’s prosocial behavior. The chapter considers how discipline fits into the broader context of the parent-child relationship. Moderators (gender, age, temperament, culture) and mediators (children’s social cognitive biases, perceptions of parental acceptance and rejection, development of empathy and conscience, moral reasoning) of links between parental discipline and child outcomes are described. Interventions that have been used to change parents’ use of discipline, thereby attempting to improve child outcomes, are highlighted
Plato On Love
Authors: Kraut Richard
Published: October 2019

This chapter examines Plato’s views on love. It argues that Plato was fascinated by eros. He considers it a subject from which philosophers have a great deal to learn and upon which philosophy can cast much light. His greatest contributions to the study of intimate human relationships, which are contained in Symposium and Phaedrus, have to do with eros and with philia only insofar as erotic relationships should involve philia as well. However, he does not have a robust and systematic theory about philia in its own right. Instead, he offers, in his Lysis, a series of puzzles about philia; and then, in Symposium and Phaedrus, a series of contrasting speeches about eros. The heart of his theory of intimacy, affection, and sexuality lies in those speeches.
Global Sexual Diversity Politics and the Trouble with LGBT Rights
Authors: Bosia Michael J.
Published: October 2019

This chapter responds to the challenge state homophobia poses to LGBT rights in its invocation of a “gay menace.” It engages the limits of a rights-based discourse in achieving security for sexual and gender minorities under threat: first, as homophobia is marshalled as a tool of statecraft and then as LGBT rights and identities are bound geotemporally by the historically specific context to which they responded. These two efforts demonstrate the need for an approach sensitive to the practical conditions faced within specific political contexts. The chapter’s argument addresses the political incommensurability of LGBT rights in the context of authoritarian and illiberal states and the danger of associating sexual and gender liberation with autocracy. It considers the consequences of a “gay menace” and of “rights”-claiming in response as both are bounded in geotemporal terms, then dislocated from history, culture, and politics as they become modular. Finally, the chapter asks what a global sexual and gender minority politics might look like through claims around capabilities tied to global civil society that foster collective self-actualization instead of “human rights” or “security” tied to authoritarian or fickle states.
The Energy Politics of the Asia-Pacific Region
Authors: Huda Mirza Sadaqat , Ali Saleem H.
Published: October 2019

This chapter provides a critical overview of extant literature on energy politics in the Asia-Pacific region and proposes a future research agenda for the field. It argues that traditional, security-centric analyses of energy issues in Asia have been complemented in recent years by a small but growing body of literature that addresses environmental and social aspects of energy. While these nascent fields require further development, scholars have yet to comprehensively address crucial contemporary developments in international energy relations, among them the peace-building potential of transnational energy projects, the cybersecurity of energy infrastructure, and competition around deep-sea resources. Addressing these and other research gaps, the chapter formulates eleven broad focuses of the proposed future research agenda, including, among other topics, non-Western IR theories, Arctic resources, energy subsidies, and transnational infrastructure. These research areas will be placed in a rapidly evolving international system underpinned by a simultaneous increase in the securitization of energy and progress in regional cooperation, integration and trade.
The Politics of Energy and Climate Change
Authors: Hughes Llewelyn
Published: October 2019

Social science has a crucial role to play in informing policy makers about political and institutional strategies conducive to implementing more ambitious energy-related climate change policies. This chapter reviews major avenues of research in political science and related disciplines that examine energy policy and climate change. It focuses on how individuals, civil society, business, and governments affect climate-related energy policies. The second section suggests three issues with the potential to promote more rapid decarbonization of energy systems, but which have not been a sustained focus of research to date: (1) the politics of low-carbon economic development, (2) innovation and the deployment of new technologies, and (3) the politics of negative emissions and geoengineering technologies.
Time in International Organizations and International Organizations in Time
Authors: Heldt Eugénia C.
Published: October 2019

Time plays a central role in international organizations (IOs). Interactions among actors are embedded in a temporal dimension, and actors use formal and informal time rules, time discourses, and time pressure to obtain concessions from their counterparts. By the same token, legacies and innovations within and outside IOs can be examined as a dynamic process evolving over time. Against this background, this chapter has a twofold aim. First, it examines how actors use time in IOs with a particular focus on multilateral negotiations to justify their actions. Drawing on international relations studies and negotiation analysis, this piece explores six different dimensions of time in the multilateral system: time pressure, time discourse, time rules, time costs, time horizons, and time as a resource. Second, this chapter delineates the evolution of IOs over time with the focus on innovations that emerge to adapt their institutional system to new political and economic circumstances. This piece looks particularly at endogenous and exogenous changes in IOs, recurring to central concepts used by historical institutionalism, including path dependence, critical junctures, and sequencing. This allows us to map patterns of incremental change, such as displacement, conversion, drift, and layering.
Trait Accuracy in the Workplace
Authors: Blackman Melinda
Published: October 2019

The importance of accurate trait judgments about employees within organizational contexts is highlighted. More specifically, how the employees’ traits affect both positive and negative work outcomes is illustrated. Next, a description of how personality judgments are used to predict these outcomes both during the hiring process and throughout an employee’s tenure (e.g., performance evaluation, decisions about advancement, and formation of workgroups) is given. The remainder of the chapter focuses on the accurate assessment of the job candidate’s personality during the employment interview, with several points of discussion revolving around methods to improve trait judgments about prospective hires.
Suprasegmental Speech Prosody and the Human Brain
Authors: Meyer Martin , Keller Matthias , Giroud Nathalie
Published: October 2019

Prosody is a unique feature of spoken language and can be conceived as an umbrella term that covers several modulations of acoustic speech signals which mark paralinguistic information—namely stress, sentence accent, sentence mode, and phrasing—which are highly correlated with the semantic, syntactic, phonological organization and emotional tone of spoken and signed languages all over the world. Neuropsychological and neuroimaging research has grossly attributed prosodic functions to the right hemisphere (RH) of the human brain. The RH has been historically considered the site of emotions and this view is still the foundation of the widely held belief that prosody is primarily emotional in origin and nature. This chapter means to replace this ancient view by an innovative, parameter-based approach that considers prosody as an acoustic modulator that primarily serves as a cardinal structuring device to chunk suprasegmental units in spoken language. The chapter offers evidence from recent research that shows how the human brain exploits prosodic cues in spoken language during language acquisition, processing of foreign languages, and language processing under aversive listening conditions (e.g. age-related hearing loss). More importantly, it sketches how the human brain processes suprasegmental information during prelexical stages of language comprehension. In support of this view lies in the stunning fit between functional lateralization of computing prosodic cues and neuroanatomical asymmetry of auditory-related cortex (PARC). Finally, the chapter describes the essential role that prosodic modulations play in spoken language during early infancy and older age.
A Logical Model of Homology for Comparative Biology
Authors: Mabee Paula M , Balhoff James P , Dahdul Wasila M , Lapp Hilmar , Mungall Christopher J , Vision Todd J
Published: October 2019

There is a growing body of research on the evolution of anatomy in a wide variety of organisms. Discoveries in this field could be greatly accelerated by computational methods and resources that enable these findings to be compared across different studies and different organisms and linked with the genes responsible for anatomical modifications. Homology is a key concept in comparative anatomy; two important types are historical homology (the similarity of organisms due to common ancestry) and serial homology (the similarity of repeated structures within an organism). We explored how to most effectively represent historical and serial homology across anatomical structures to facilitate computational reasoning. We assembled a collection of homology assertions from the literature with a set of taxon phenotypes for the skeletal elements of vertebrate fins and limbs from the Phenoscape Knowledgebase. Using seven competency questions, we evaluated the reasoning ramifications of two logical models: the Reciprocal Existential Axioms (REA) homology model and the Ancestral Value Axioms (AVA) homology model. The AVA model returned all user-expected results in addition to the search term and any of its subclasses. The AVA model also returns any superclass of the query term in which a homology relationship has been asserted. The REA model returned the user-expected results for five out of seven queries. We identify some challenges of implementing complete homology queries due to limitations of OWL reasoning. This work lays the foundation for homology reasoning to be incorporated into other ontology-based tools, such as those that enable synthetic supermatrix construction and candidate gene discovery. [Homology; ontology; anatomy; morphology; evolution; knowledgebase; phenoscape.]
Fungal Trunk Pathogens Associated With Juglans regia in the Czech Republic
Authors: Eichmeier A. , Pecenka J. , Spetik M. , Necas T. , Ondrasek I. , Armengol J. , León M. , Berlanas C. , Gramaje D.
Published: October 2019

Juglans regia L. (English walnut) trees with cankers and dieback symptoms were observed in two regions in the Czech Republic. Isolations were made from diseased branches. In total, 138 fungal isolates representing 10 fungal species were obtained from wood samples and identified based on morphological characteristics and molecular methods: Cadophora novi-eboraci, Cadophora spadicis, Cryptovalsa ampelina, Diaporthe eres, Diplodia seriata, Dothiorella omnivora, Eutypa lata, Eutypella sp., Peroneutypa scoparia, and Phaeoacremonium sicilianum. Pathogenicity tests conducted under field conditions with all species using the mycelium-plug method indicated that Eutypa lata and Cadophora spp. were highly virulent to woody stems of walnut. This is the first study to detect and identify fungal trunk pathogens associated with diseased walnut trees in Europe.
Soil Is Not a Reservoir for Phellinus noxius
Authors: Wu Zong-Chi , Chang Ya-Yun , Lai Qiao-Juan , Lin Heng-An , Tzean Shean-Shong , Liou Ruey-Fen , Tsai Isheng J. , Chung Chia-Lin
Published: October 2019

Phellinus noxius causes brown root rot (BRR) of diverse trees. Basidiospores and diseased host tissues have been recognized as important sources of P. noxius inoculum. This study aimed to understand whether P. noxius could occur or survive in soil without host tissues in the natural environment. Soil was sampled before and after the removal of diseased trees at eight BRR infection sites (total of 44 samples). No P. noxius colonies were recovered in soil plating assays, suggesting that no or little viable P. noxius resided in the soil. To know whether P. noxius could disseminate from decayed roots to the surrounding soil, rhizosphere and non-rhizosphere soils were sampled from another two infection sites. Although P. noxius DNA was detectable with specific primers, no P. noxius could be isolated, even from the rhizosphere soils around decayed roots covered with P. noxius mycelial mats. The association between viable P. noxius and the presence of its DNA was also investigated using field soil mixed with P. noxius arthrospores. After P. noxius was exterminated by flooding or fumigation treatment, its DNA remained detectable for a few weeks. The potential of onsite soil as an inoculum was tested using the highly susceptible loquat (Eriobotrya japonica). Loquats replanted in an infection site that had been cleaned up by simply removing the diseased stump and visible residual roots remained healthy for a year. Taken together, P. noxius is not a soilborne pathogen, and diseased host tissues should be the focus of field sanitation and detection for BRR.
Soluble adenylyl cyclase (sAC) regulates calcium signaling in the vascular endothelium
Authors: Mewes Mirja , Lenders Malte , Stappers Franciska , Scharnetzki David , Nedele Johanna , Fels Johannes , Wedlich‐Söldner Roland , Brand Stefan‐Martin , Schmitz Boris , Brand Eva
Published: October 2019

The vascular endothelium acts as a selective barrier between the bloodstream and extravascular tissues. Intracellular [Ca2+]i signaling is essential for vasoactive agonist‐induced stimulation of endothelial cells (ECs), typically including Ca2+ release from the endoplasmic reticulum (ER). Although it is known that interactions of Ca2+ and cAMP as ubiquitous messengers are involved in this process, the individual contribution of cAMP‐generating adenylyl cyclases (ACs), including the only soluble AC (sAC; ADCY10), remains less clear. Using life‐cell microscopy and plate reader‐based [Ca2+]i measurements, we found that human immortalized ECs, primary aortic and cardiac microvascular ECs, and primary vascular smooth muscle cells treated with sAC‐specific inhibitor KH7 or anti‐sAC‐small interfering RNA did not show endogenous or exogenous ATP‐induced [Ca2+]i elevation. Of note, a transmembrane AC (tmAC) inhibitor did not prevent ATP‐induced [Ca2+]i elevation in ECs. Moreover, l‐phenylephrine‐dependent constriction of ex vivo mouse aortic ring segments was also reduced by KH7. Analysis of the inositol‐1,4,5‐trisphosphate (IP3) pathway revealed reduced IP3 receptor phosphorylation after KH7 application, which also prevented [Ca2+]i elevation induced by IP3 receptor agonist adenophostin A. Our results suggest that sAC rather than tmAC controls the agonist‐induced ER‐dependent Ca2+ response in ECs and may represent a treatment target in arterial hypertension and heart failure.—Mewes, M., Lenders, M., Stappers, F., Scharnetzki, D., Nedele, J., Fels, J., Wedlich‐Söldner, R., Brand, S.‐M., Schmitz, B., Brand, E. Soluble adenylyl cyclase (sAC) regulates calcium signaling in the vascular endothelium. FASEB J. 33, 13762‐13774 (2019). www.fasebj.org
Maternal diet‐induced obesity alters muscle mitochondrial function in offspring without changing insulin sensitivity
Authors: McMurray Fiona , MacFarlane Megan , Kim Kijoo , Patten David A. , Wei‐LaPierre Lan , Fullerton Morgan D. , Harper Mary‐Ellen
Published: October 2019

In utero overnutrition can predispose offspring to metabolic disease. Although the mechanisms are unclear, increased oxidative stress accelerating cellular aging has been shown to play a role. Mitochondria are the main site of reactive oxygen species (ROS) production in most cell types. Levels of ROS and the risk for oxidative damage are dictated by the balance between ROS production and antioxidant defense mechanisms. Originally considered as toxic species, physiologic levels of ROS are now known to be essential cell signaling molecules. Using a model of maternal overnutrition in C57BL6N mice, we investigate the mechanisms involved in the development of insulin resistance (IR) in muscle. In red and white gastrocnemius muscles of offspring, we are the first to report characteristics of oxidative phosphorylation, H2O2 production, activity of mitoflashes, and electron transport chain supercomplex formation. Results demonstrate altered mitochondrial function with reduced response to glucose in offspring of mice fed a high‐fat and high‐sucrose diet, increases in mitochondrial leak respiration, and a reduction in ROS production in red gastrocnemius in response to palmitoyl carnitine. We also demonstrate differences in supercomplex formation between red and white gastrocnemius, which may be integral to fiber‐type specialization. We conclude that in this model of maternal overnutrition, mitochondrial alterations occur before the development of IR.—McMurray, F., MacFarlane, M., Kim, K., Patten, D. A., Wei‐LaPierre, L., Fullerton, M. D., Harper, M. E. Maternaldiet‐induced obesity alters muscle mitochondrial function in offspring without changing insulin sensitivity. FASEB J. 33, 13515‐13526 (2019). www.fasebj.org
Efficacy of gefitinib at reduced dose in EGFR mutant non-small cell lung carcinoma
Authors: Kwok Wang Chun , Ho James Chung Man , Tam Terence Chi Chun , Lui Macy Mei Sze , Ip Mary Sau Man , Lam David Chi Leung
Published: October 2019

As a first-generation epidermal growth factor receptor-tyrosine kinase inhibitor, gefitinib was approved by the US Food and Drug Administration for treatment of advanced non-small cell carcinoma with sensitizing EGFR mutations. Gefitinib is known to have adverse effects, which may necessitate dose reduction or even change to alternative preparation of epidermal growth factor receptor-tyrosine kinase inhibitor. There has been concern on dose reduction resulting in reduced dose gefitinib, especially on its efficacy. This was a retrospective single-center cohort study conducted in Queen Mary Hospital in Hong Kong that included 159 Chinese patients with advanced adenocarcinoma of lung that carried sensitizing EGFR mutations and had received gefitinib as first-line treatment. Patients who had reduced dose at 250 mg alternate day were compared with those who were able to maintain on standard dose of gefitinib at 250 mg daily. The primary end-point was progression-free survival. Among the 159 patients, 17 (10.7 %) of them were on reduced dose gefitinib, 14 among the 17 patients (82.4%) because of hepatotoxicity, and 3 (17.6%) because of cutaneous side effects. Patients on reduced dose and standard dose of gefitinib have comparable median progression-free survival. Hazard ratio was 1.121 (95% confidence interval = 0. 655–1.917, P-value = 0.678) for the reduced dose group and 3.385 for the standard dose group (95% confidence interval = 2.181–5.255) respectively (P-value < 0.001). Dose reduction in gefitinib to 250 mg alternate day in response to adverse effects was not associated with inferior outcome for patients on first-line gefitinib for advanced non-small cell carcinoma. Dose reduction is a feasible option for patients who have significant adverse effects with gefitinib.
Early Exploratory Analysis for Patient-reported Quality of Life and Dosimetric Correlates in Hypofractionated Stereotactic Body Radiation Therapy (SBRT) for Low-risk and Intermediate-risk Prostate Cancer
Authors: Iarrobino Nick A. , Gill Beant , Sutera Philip A. , Kalash Ronny , D’ Ambrosio David , Heron Dwight E.
Published: October 2019

Objectives:

Given the relative novelty of stereotactic body radiation therapy as a treatment modality low-risk and intermediate-risk prostate cancer, little data exist evaluating dosimetry and its impact on patient-reported quality of life (PR-QOL) metrics. Herein, we present an interim analysis of a phase II clinical trial of PR-QOL and dosimetric correlates.

Methods:

Patients with biopsy-proven low-risk or intermediate-risk prostate cancer, prostate volume ≤100 cm3, and life expectancy ≥10 years were enrolled. Expanded Prostate Cancer Index Composite (EPIC) scores were tabulated by domain and evaluated in relation to dosimetry. Paired t test was performed to compare differences in scores from baseline. Minimally important differences were established using the anchor-based approach and correlations made using the χ2 test.

Results:

A total of 95 patients were analyzed with a median follow-up of 18.1 months (range, 3.0 to 76.9 mo). There were no cases of acute or late grade 3+ GI or GU toxicities. Expanded Prostate Cancer Index Composite scores in urinary obstructive/irritative domain at 1 month (−4.8, P=0.03) and bowel domain at 1, 6, and 12 months (−10.8, −6.1, and −5.2) were significantly different from pretreatment, with both returning to nonsignificant differences around 24 months. Higher bladder V37Gy (≥3.35%) was associated with both late urinary incontinence and obstructive/irritative declines. Both higher rectal D5% and rectal V36Gy >0.6 cm3 were correlated with an enhanced proportion of patients with late minimally important difference declines.

Conclusions:

Higher dose volumes for the bladder and rectum predicted for poorer PR-QOL. In contrast to prostate brachytherapy data, neither prostate volume nor urethral dosimetry at this dose schedule correlated with urinary symptoms.
Left-versus-right-adrenal-volume ratio as a screening index before adrenal venous sampling to identify unilateral primary aldosteronism patients
Authors: Li Sicheng , Sun Huaiqiang , Ma Lifen , Zhu Yuchun , Xie Wei , Sun Jiayu , Zhao Lianling , Qing Bin , Ren Yan , Tian Haoming , Chen Tao
Published: October 2019

Objectives:

The current study aimed to investigate the value of the computed tomography-based left-versus-right adrenal gland volume ratio (L/Rv) in screening patients with unilateral primary aldosteronism.

Methods:

The current study recruited 114 patients who underwent successful adrenal venous sampling (AVS) and adrenal computed tomography at West China Hospital of Sichuan University. The patients were divided into three groups according to the AVS results: AVS-left, AVS-bilateral, and AVS-right primary aldosteronism. The volumes of the left and right adrenal glands were semiautomatically calculated. The L/Rv of each patient was computed, and its value in identifying unilateral primary aldosteronism was analyzed.

Results:

The mean value of the L/Rv was larger in AVS-left patients and smaller in AVS-right patients than that in AVS-bilateral patients. In AVS-left primary aldosteronism patients, the cutoff value of the L/Rv with the highest Youden index was 1.344 [area under the curve (AUC) 0.851, sensitivity 80.0%, specificity 78.1%]. The optimal cutoff value was 1.908, of which 46.0% (23/50) of AVS-left primary aldosteronism patients could be identified (specificity 100.0%). In AVS-right primary aldosteronism patients, the cutoff value of the L/Rv with the highest Youden index was 1.267 (AUC 0.868, specificity 72.8%, sensitivity 87.9%). The optimal cutoff value was 0.765, of which 27.3% (9/33) of AVS-right primary aldosteronism patients could be identified (specificity 100.0%). Patients with L/Rv more than 1.908 or less than 0.765 had higher complete success rate postsurgery.

Conclusion:

Although not perfect, the L/Rv is an applicable index to screen unilateral primary aldosteronism patients for surgery. Primary aldosteronism patients, even those aged more than 35 years, with an L/Rv more than 1.908 or less than 0.765 can be spared AVS before surgery.
Preparing students to be ready for practice: An innovative approach to teaching advanced physical assessment skills online
Authors: Higgins Karen , Kirkland Tracie , Le-Jenkins Uyen , Rutledge Carolyn
Published: October 2019

Distance graduate nursing education has been expanding. Although many didactic courses are taught through an online platform, there are often challenges to providing skill-based courses, such as advanced physical assessment, through an online format. To prepare and assess advanced practice nursing students on their clinical knowledge and physical assessment skills, an online course was developed using multisource feedback and videography. Students used videography to record themselves as they conducted physical assessments on a volunteer patient. Students then critiqued their own video, critiqued two of their colleagues' videos, and the final critiques of the videos were conducted by faculty. All students were expected to perform and pass a complete physical examination on a standardize patient as their final examination. The final scores of the students learning through the online course were equivalent to the scores achieved by the students in the traditional face-to-face physical assessment course.
Open Mastoid Cavity Obliteration With a High-Porosity Hydroxyapatite Ceramic Leads to High Rate of Revision Surgery and Insufficient Cavity Obliteration
Authors: Weiss Nora M. , Stecher Sophie , Bächinger David , Schuldt Tobias , Langner Sönke , Zonnur Sarah , Mlynski Robert , Schraven Sebastian P.
Published: October 2019

Objective:

To assess long-term results and present experience with a high-porosity hydroxyapatite ceramic for obliterating large open mastoid cavities.

Study-Design:

Cross-sectional cohort study.

Setting:

Tertiary academic referral center.

Patients:

All patients who underwent tympanomastoid surgery for chronic middle ear disease or revision surgery with reduction of an open mastoid cavity using a highly porous hydroxyapatite matrix material (HMM) between May 2005 and June 2013 were assessed for eligibility. Twenty three patients (56.9 ± 18.3 yr) were included.

Intervention:

Primary middle ear surgery or revision surgery using a HMM.

Main Outcome Measures:

Pure-tone average, computed tomography (CT), and magnetic resonance imaging (MRI) to investigate osseoinduction, osseointegration and presence of cholesteatoma, current quality of life assessed by Zurich Chronic Middle Ear Inventory and change in quality of life post-intervention assessed by the Glasgow Benefit Inventory.

Results:

Patients were reexamined after a mean follow-up period of 88.3 months (SD 21.4 mo) after obliteration of the open mastoid cavity with HMM. Compared with visit 1, patients showed a significantly reduced ABG at visit 2 (29.22 dB ± 2.71 dB versus 12.77 dB ± 3.46 dB).

CT scan was carried out in 21 patients (91%) patients and 17 patients (74%) underwent MRI.

Revision surgery was required in a total of 17 cases (74%). In four patients recurrent cholesteatoma was found at follow up.

Conclusions:

Poor cavity obliteration, a high rate of revision surgery and difficult differentiation between recurrent cholesteatoma and granulation tissue in CT scan was observed.
Comparison of computed tomography hepatic steatosis criteria for identification of abnormal liver function and clinical risk factors, in incidentally noted fatty liver
Authors: Jawahar Anugayathri , Gonzalez Beverly , Balasubramanian Neelam , Adams William , Goldberg Ari
Published: October 2019

Objectives

Hounsfield Units (HU) to compare the various computed tomography (CT) criteria for diagnosing hepatic steatosis with laboratory liver function parameters, and clinical risk factors retrospectively, when hepatic steatosis was incidentally detected.

Methods

Institutional review board-approved, Health Insurance Portability and Accountability Act-compliant, retrospective study in 200 randomly selected patients who had either nonenhanced CT (NECT) or contrast-enhanced CT (CECT) studies with reported hepatic steatosis. The participants were matched to age, gender, and ethnicity with 200 patients without hepatic steatosis. For NECT, four different criteria have been proposed in the literature to diagnose fatty liver: (1) liver HU less than 48 HU; (2) ratio of liver to spleen HU less than 0.8; (3) HU difference between liver and spleen less than −10; and (4) hepatic vessel HU ≥ liver HU. For CECT, difference between liver and spleen HU, in portal venous phase, ≤ −20 to −25 HU. Serum glucose, aspartate aminotransferase (AST), amino alanine transferase (ALT), total bilirubin were documented. Clinical history and clinical risk factors were documented from the electronic health records. Matched analyses and Wilcoxon signed rank sum test analysis were performed for matched variables.

Results

Fatty liver by NECT criteria 1 and 3 has statistically significant correlation with elevated glucose levels (P = 0.02). Similarly, fatty liver by 1, 3, and 4 NECT criteria showed statistically significant associations with higher levels of ALT and AST. There were statistically significant higher prevalence of diabetes mellitus (P = 0.003) and alcohol consumption (P ≤ 0.0001) in cases when compared with the controls. There was marginal significance in CT Dose Index between cases and controls (95% confidence interval: 0.98, 1.00; odds ratio 0.99), reflecting that cases had slightly higher BMI compared to their matched controls, thereby requiring slightly higher mA/mAs for imaging.

Conclusion

Particular NECT criteria for fatty liver are best at identification of abnormal liver function and certain comorbidities, in the setting of incidental fatty liver detection, This creates the potential for benefits of early detection in clinical management.
Pasta’s History and Role in Healthful Diets
Authors: Webb Densie
Published: October 2019

Over the years, pasta has gained an unearned reputation as a contributor to health issues, such as weight gain, diabetes, and cardiovascular disease. The sustained popularity of low-carbohydrate diets has further propagated the belief that eating pasta is bad for health, but the evidence is insufficient to support these perceptions. Pasta has a long culinary history as one of the major components of the Mediterranean diet, which has been proven through years of research to be a healthy dietary pattern. Most dry pasta in the United States is enriched with iron, riboflavin, thiamine, and folic acid. A 2-oz serving of dry pasta (about 1 cup, cooked) supplies the equivalent of roughly 100 μg of folic acid, or 25% of the Daily Value, making it an excellent source of the B vitamin, and it is a good source of iron, providing about 10% of the Daily Value. Pasta’s unique profile as a low-cost, convenient, versatile, and nutritious food with a long shelf-life establishes an important role for pasta in meeting the nutrient needs of not only the United States, but globally as well.
Clinical Tests of the Shoulder
Authors: Chang Ke-Vin , Wu Wei-Ting , Hsu Po-Cheng , Lew Henry L. , Özçakar Levent
Published: October 2019

Shoulder pain is a common musculoskeletal disorder that has a significant impact on the patient’s quality of life and functional health. Because the shoulder joint is a complex structure, the relevant symptoms of shoulder pain may not directly reflect the underlying pathology. Hence, several shoulder tests have been developed to examine shoulder problems, and their diagnostic accuracy varies. Familiarization with the performance of those physical tests and their strength and limitation are of utmost importance for physicians dealing with shoulder disorders. Therefore, the present narrative review focuses on summarizing the most commonly used tests in physical examination and their diagnostic performance on several shoulder pathologies. This article also discusses how ultrasound imaging can serve as an extension of those tests.
Effects of Load Addition During Gait Training on Weight-Bearing and Temporal Asymmetry After Stroke
Authors: Ribeiro Tatiana Souza , Gomes de Souza e Silva Emília Márcia , Regalado Isabelly Cristina Rodrigues , Silva Stephano Tomaz da , Sousa Catarina de Oliveira , Ribeiro Karyna Myrelly Oliveira Bezerra de Figueiredo , Lindquist Ana Raquel Rodrigues
Published: October 2019

Objective

The aim of the study was to evaluate the effects of adding load to restrain the nonparetic lower limb during gait training on weight-bearing and temporal asymmetry after stroke.

Design

Thirty-eight subjects were randomized into treadmill training with load (5% of body weight) on the nonparetic limb (experimental group) and treadmill training without load (control group). Interventions lasted 30 mins/d for 2 wks (9 sessions). Both groups performed home-based exercises and were instructed to increase the use of paretic limb in daily life situations. Ground reaction force was obtained by a force plate during standing position (static) and gait (dynamic). Temporal gait parameters were assessed by a motion system analysis. Outcome measures were evaluated at baseline, posttraining, and after a 40-day follow-up.

Results

The experimental group increased static ground reaction force of the paretic limb at posttraining (P = 0.037) and the control group increased dynamic ground reaction force of the paretic limb at posttraining (P = 0.021), both with maintenance at follow-up. Neither group showed a change in the swing time symmetry ratio after training (P = 0.190).

Conclusions

Treadmill training associated with behavioral strategies/home-based exercises seemed to be useful to minimize weight-bearing asymmetry, but not to improve temporal gait asymmetry. Load addition did not show additional benefits.
Recipient-Site Preconditioning with Deferoxamine Increases Fat Graft Survival by Inducing VEGF and Neovascularization in a Rat Model
Authors: Kim Junhyung , Park Minwoo , Jeong Woonhyeok , Lee Hyoun Wook , Lee Geumhong , Suk Lee Kyung , Park Sang Woo , Choi Jaehoon
Published: October 2019

Background:

The authors hypothesize that ischemic preconditioning of the recipient site with deferoxamine will increase fat graft survival by enhancing angiogenesis in a rat model.

Methods:

Cell viability, tube formation, and mRNA expression were measured in human umbilical vein endothelial cells treated with deferoxamine. A total of 36 rats were then used for an in vivo study. A dose of 100 mg/kg of deferoxamine was injected subcutaneously into the rat scalp every other day for five treatments. On the day after the final injection, the scalp skin was harvested from half the animals to evaluate the effects of deferoxamine on the recipient site. In the remaining animals, inguinal fat tissue was transplanted to the scalp. Eight weeks after transplantation, the grafts were harvested to evaluate the effects of deferoxamine preconditioning on fat graft survival.

Results:

In human umbilical vein endothelial cells, treatment with a deferoxamine concentration higher than 400 μM decreased cell viability compared with the control (p = 0.002). Treatment with 100 and 200 μM deferoxamine increased endothelial tube formation (p = 0.001) and mRNA levels of angiogenesis-related factors (p = 0.02). Rat scalps treated with deferoxamine exhibited increased capillary neoformation (p = 0.001) and vascular endothelial growth factor protein expression (p = 0.024) compared with controls. Fat graft volume retention, capillary density (p < 0.001), and adipocyte viability (p < 0.001) in the grafted fat increased when the recipient site was preconditioned with deferoxamine.

Conclusion:

This study demonstrated that recipient site preconditioning with deferoxamine increases fat graft survival by inducing vascular endothelial growth factor and neovascularization.
Addressing Surgeon Fatigue: Current Understanding and Strategies for Mitigation
Authors: Janhofer David E. , Lakhiani Chrisovalantis , Song David H.
Published: October 2019

Fatigue is inevitable at all stages of a surgical career. The sustained high degree of concentration required for surgery is complicated by long surgeon working hours and sleep deprivation, which force surgeons to learn to manage and mitigate the effects of physical and mental fatigue on their performance. Extensive evidence exists detailing the potentially dangerous effects of surgeon fatigue on patient safety, but few reports exist offering a comprehensive strategy to mitigate the effects of fatigue on clinical performance. To promote improved detection and mitigation of fatigue among surgeons, the authors have highlighted several deliberate fatigue-management techniques that they have found to be particularly effective in their own experiences. These techniques include proper planning to maximize team efficiency, and the use of scheduled and unscheduled intraoperative breaks for mental and physical rest and regeneration. The decision to take a much-needed break is often neglected because of concerns about prolonging the duration of an operation; with proper self-awareness of fatigue and brief mental checks during natural intraoperative slowdowns, however, the surgeon can quickly assess the need for a much-needed moment of recovery. The authors hope surgeons will find the fatigue-mitigation strategies presented here to be helpful in promoting both their own wellness and the safety and wellness of their patients.
A Novel Application of [18F]Fluorothymidine-PET ([18F]FLT-PET) in Clinical Practice to Quantify Regional Bone Marrow Function in a Patient With Treatment-Induced Cytopenias and to Guide “Marrow-Sparing” Radiotherapy
Authors: Campbell Belinda A. , Hofman Michael S. , Prince H. Miles
Published: October 2019

18F-Fluorothymidine-positron emission tomography with CT fusion ([18F]FLT-PET/CT) offers a unique and non-invasive method for three-dimensional localization and quantification of functional bone marrow. [18F]FLT-PET/CT has potential application in radiotherapy planning when risk of marrow toxicity is a significant clinical concern. In this patient with chemo-refractory, transformed lymphoma and treatment-induced cytopenias, [18F]FLT-PET/CT was a novel and useful adjunct to (1) image the distribution of functional bone marrow reserve, (2) guide “marrow-sparing” radiotherapy planning, and (3) quantify the effects of radiotherapy-induced bone marrow suppression both in-field and out-of-field.
Lymphangioma in the Buccal Mucosa
Authors: Yalçin Mustafa , Laçin Nihat
Published: October 2019

Lymphangiomas are benign hamartomatous tumors which are characterized by abnormal proliferation of lymphatic vessels. They are lymphatic malformations which are commonly localized to head and neck region. They are rare located in the oral cavity and tongue, lips, buccal mucosa, soft palate, floor of the mouth are mostly affected.
APACHE IV Score is Useful For Assessment and Stratification of Elderly Patients Over 65 Years With Acute Cholecystitis
Authors: Jiang Hua , Yao Zhimin , Guo Guo , Wang Yuehua , Li Fei
Published: October 2019

Purpose:

One of the main problems concerning the design of clinical trials in critically ill patients with acute cholecystitis (AC) is the lack of validated, well-established scoring systems to stratify the severity of patient disease states. The aim of this study was to evaluate the performance of the Acute Physiology and Chronic Health Evaluation IV (APACHE IV) scoring system in patients over 65 years with AC.

Methods:

All patients over 65 years of age admitted to our hospital for treatment of AC in the intensive care unit between January 2013 and January 2019 were retrospectively analyzed.

Results:

A total of 443 consecutive patients with AC were enrolled in this study. As for the patients over 65 years, the survivors had lower APACHE IV scores and lower risk of death than nonsurvivors (P<0.01). The discrimination of the APACHE IV score prediction was good, with an area under the curve of 0.850 (95% confidence interval, 0.780-0.932). The APACHE IV models were well-calibrated with the Hosmer-Lemeshow goodness-of-fit test (P=0.635). Similar results were obtained for patients over 85 years of age.

Conclusion:

The APACHE IV model was good at predicting hospital mortality in elderly patients with AC, which would be helpful to make clinical and therapeutic decisions in the future.
Control of cytokinesis by β-adrenergic receptors indicates an approach for regulating cardiomyocyte endowment
Authors: Liu Honghai , Zhang Cheng-Hai , Ammanamanchi Niyatie , Suresh Sangita , Lewarchik Christopher , Rao Krithika , Uys Gerrida M. , Han Lu , Abrial Maryline , Yimlamai Dean , Ganapathy Balakrishnan , Guillermier Christelle , Chen Nathalie , Khaladkar Mugdha , Spaethling Jennifer , Eberwine James H. , Kim Junhyong , Walsh Stuart , Choudhury Sangita , Little Kathryn , Francis Kimberly , Sharma Mahesh , Viegas Melita , Bais Abha , Kostka Dennis , Ding Jun , Bar-Joseph Ziv , Wu Yijen , Steinhauser Matthew L. , Kühn Bernhard
Published: October 2019

ABSTRACT/SUMMARY

One million patients with congenital heart disease (CHD) live in the US. They have a lifelong risk of developing heart failure. Current concepts do not sufficiently address mechanisms of heart failure development specifically for these patients. We show that cardiomyocyte cytokinesis failure is increased in tetralogy of Fallot with pulmonary stenosis (ToF/PS), a common form of CHD. Labeling of a ToF/PS baby with isotope-tagged thymidine showed cytokinesis failure after birth. We used single-cell transcriptional profiling to discover that the underlying mechanism is repression of the cytokinesis gene ECT2, and show that this is downstream of β-adrenergic receptors (β-AR). Inactivation of the β-AR genes and administration of the β-blocker propranolol increased cardiomyocyte division in neonatal mice, which increased the endowment and conferred benefit after myocardial infarction in adults. Propranolol enabled the division of ToF/PS cardiomyocytes. These results suggest that β-blockers should be evaluated for increasing cardiomyocyte division in patients with ToF/PS and other types of CHD.