bluuebunny/crossref_metadata_2025 huggingface dataset:
Neuropathic Arthropathy
Authors: Desai Vishal , Zoga Adam C.
Published: June 2019

Chapter 70 discusses neuropathic arthropathy, also referred to as Charcot joint, which represents a spectrum of destructive, monostotic osseous and joint processes. The underlying disease process is loss of neural stimulus, and diabetes mellitus is the most common cause. On imaging, the affected joint can follow an atrophic, hypertrophic, or mixed pattern, with findings including joint destruction, disorganization, fragmentation with loose bodies, a large joint effusion, and variable sclerosis. The foot and ankle are the most commonly affected joints, particularly the midfoot. In advanced disease, a rocker bottom deformity may develop, which can lead to ulceration and osteomyelitis. In the upper extremity, there are severe atrophic changes often in the shoulder and generally a result of syringomyelia. Spinal neuropathic arthropathy demonstrates multilevel destructive changes that mimic osteomyelitis. Radiography is very useful in diagnosis. CT, MRI, and nuclear imaging are used for problem-solving or imaging complications.
Anemias
Authors: Hoover Kevin B.
Published: June 2019

Chapter 74 discusses anemia conditions including sickle cell disease and thalassemia. Anemia is a condition of decreased oxygen delivery to organs caused by a deficit of functional red blood cells. It is a very common clinical condition and has a wide variety of causes. Of the common causes, the hemoglobinopathies have the most characteristic imaging findings. There are common imaging findings secondary to the compensatory increase in red blood cell and precursor number. Radiographs are a standard initial imaging study. MRI is the most sensitive imaging study for the sequelae of anemia. Iron deficiency anemia is treated with iron supplementation, aplastic anemia is treated by removal of the inciting agent, and painful crises of sickle cell are treated symptomatically.
Thyroid Diseases
Authors: Hoover Kevin B.
Published: June 2019

Chapter 81 discusses thyroid diseases. Thyroid hormone is a regulator of normal physiology, including normal function of the musculoskeletal system. The most important causes of both elevated thyroid hormone levels (hyperthyroidism) and decreased hormone levels (hypothyroidism) are diseases of the thyroid gland. These are primarily diagnosed using serum testing and thyroid imaging. Muscle weakness is a common musculoskeletal complaint in both hyperthyroidism and hypothyroidism. In adults, osteoporosis is often evaluated in hyperthyroid patients using DXA, however, other musculoskeletal manifestations are often incidentally detected. Treatment options include radioactive iodine ablation of the thyroid gland, medical therapy, and surgery.
Septic Arthritis
Authors: Shikhare Sumer N. , Peh Wilfred C. G.
Published: June 2019

Chapter 87 reviews septic arthritis. Septic arthritis, a condition wherein joint infection leads to arthritis, is diagnosed based on a multifactorial combined approach including clinical, imaging, and laboratory assessment. Larger joints are more often involved, with the knee most commonly affected in adults and the hip most at risk in children. Rapid and accurate diagnosis is of extreme importance as any delay in diagnosis may irreversibly damage the affected joint. The presenting symptoms and clinical signs may be misleading. Hence, the radiologist should be aware of the imaging appearances and be able to effectively perform imaging-guided arthrocentesis. Knowledge of medical and surgical management is imperative to clinicians and radiologists alike.
Internal Derangements of the Elbow
Authors: Stevens Kathryn J.
Published: June 2019

Chapter 105 covers elbow pain, which is a common presenting complaint, particularly in professional or recreational athletes, and can result in significant morbidity. Although radiographs, US, and CT may have a role to play in the investigation of elbow pain, MRI with its high spatial resolution, excellent soft tissue contrast, and multiplanar imaging capabilities, has emerged as the imaging modality of choice for diagnosis of soft tissue pathology and osteochondral injury around the elbow. MRI is invaluable in the evaluation of acute traumatic injuries of bone and soft tissues structures, particularly if a joint effusion is detected radiographically. Articular cartilage is well seen on MRI, particularly in the presence of a joint effusion. MRI is also beneficial in the evaluation of chronic elbow pain and overuse injuries and can diagnose osseous stress injury, osteochondral pathology, ligamentous instability, nerve pathology, and denervation changes of muscle.
Head and neck cancer
Authors: Nutting Christopher , Gujral Dorothy
Published: June 2019

Chapter 18 covers head and neck cancer emphasising the importance of a multidisciplinary team, comprising specialist surgeons, oncologists, pathologists, radiologists, and palliative care doctors, together with dieticians, speech and language therapists, and clinical nurse specialists. Radiotherapy for tumours of oral cavity, oropharynx, larynx, hypopharynx and nasal sinuses are discussed. .
Quality assurance in radiotherapy
Authors: Díez Patricia , Aird Edwin GA
Published: June 2019

Chapter 23 discusses quality assurance of the patient pathway, concentrating on quality control of treatment planning and delivery. There is also discussion on relevant legislation associated with the radiotherapy process as well as a section on quality assurance for clinical trials.
The psychogenic city
Authors: Solmi Francesca , Kirkbride James B.
Published: June 2019

Do cities cause psychosis? Over 50% of the world’s population now live in cities, a figure set to rise to two-thirds by 2050. This unprecedented change in the organization of human populations will have both positive and negative consequences on a wide variety of social, political, economic, and health-related domains for individuals and society. In this chapter, we focus on one potentially negative consequence of city living; namely, raised risks of non-affective psychotic disorders in urban populations. We review the possible drivers of this phenomenon, which range from a causal role for exposure to deleterious factors in our urban environments through to non-causal factors, such as reverse causation—or social drift—potentially spanning several generations. We conclude by linking current epidemiological evidence with the latest findings from genetics and social neuroscience on this important public mental health issue.
Research challenges
Authors: Litman Todd
Published: June 2019

This chapter examines how urban living affects residents’ mental health and happiness, and ways to use this information to create saner and happier cities. Some often-cited studies suggest that urban living increases mental illness and unhappiness, but a critical review indicates that much of this research is incomplete and biased, and the issues are complex, often involving trade-offs between risk factors. City living may increase some forms of psychosis and mood disorders, drug addiction, and some people’s unhappiness, but tends to reduce dementia, alcohol abuse, and suicide rates, and many people are happier in cities than they would be in smaller communities. This chapter examines specific mechanisms by which urban living can affect mental health and happiness, and identities practical strategies that communities and individuals can use to increase urban mental health and happiness. This analysis suggests that it is possible to create sane and happy cities.
What has changed in children’s behavioural problems reported in Mexico City over a 13-year period?
Authors: Caraveo-Anduaga Jorge Javier , Vélez Nora Angélica Martínez , Pérez José Erazo
Published: June 2019

There is an urgent need to understand the needs of young people in rapidly developing urban spaces. Long-term studies that enable researchers and clinicians to look at aetiological factors that may affect development are required. The chapter investigates what has changed in the reporting of behavioural symptoms and syndromes in children living in Mexico City. Across all age groups, nervousness, restlessness, inattentiveness, irritability, and explosiveness have significantly increased. The relationship between the environment and psychological symptoms is of interest, especially in preschool children who are likely to be irritable. Depressive syndrome with both irritable and depressed mood as core symptoms show an increasing prevalence from preschool age to late childhood; depressive syndrome with only one core symptom, predominantly irritable mood, shows a consistent increase across all age groups. Explosiveness, possibly associated with brain damage, has significantly increased, most notably in older school-age children. This raises significant questions about the environment.
Suicide in cities
Authors: Kõlves Kairi , Ross Victoria , de Leo Diego
Published: June 2019

Urban life has been linked to stress and illness, higher levels of mental health disorders, and altered human brain responses. This chapter investigates the complex relationship between city life and suicide. Suicide rates have been historically higher in urban areas, but a trend of decline in urban suicide rates and an increase in rural trends has been observed. According to Durkheim’s theory, suicide rates are dependent on levels of social integration at a societal level rather than on human’s mental states. This has led some researchers to argue that rural areas have become more socially isolated and have lower levels of social integration. Research on urban areas suggests that suicides are associated with social fragmentation, social deprivation and poverty. Prevention of access to means has been shown to be effective in preventing urban suicides. A combination of the most appropriate strategies should be tailored to the city or suburb context.
On the Gaia DR2 distances for Galactic luminous blue variables
Authors: Smith Nathan , Aghakhanloo Mojgan , Murphy Jeremiah W , Drout Maria R , Stassun Keivan G , Groh Jose H
Published: June 2019

We examine parallaxes and distances for Galactic luminous blue variables (LBVs) in the Gaia second data release (DR2). The sample includes 11 LBVs and 14 LBV candidates. For about half of the sample, DR2 distances are either similar to commonly adopted literature values, or the DR2 values have large uncertainties. For the rest, reliable DR2 distances differ significantly from values in the literature, and in most cases the Gaia DR2 distance is smaller. Two key results are that the S Doradus instability strip may not be as clearly defined as previously thought, and that there exists a population of LBVs at relatively low luminosities. LBVs seem to occupy a wide swath from the end of the main sequence at the blue edge to ∼8000 K at the red side, with a spread in luminosity reaching as low as log(L/L⊙) ≈ 4.5. The lower-luminosity group corresponds to effective single-star initial masses of 10–25 M⊙, and includes objects that have been considered as confirmed LBVs. We discuss implications for LBVs including (1) their instability and origin in binary evolution, (2) connections to some supernova (SN) impostors such as the class of SN 2008S-like objects, and (3) LBVs that may be progenitors of SNe with dense circumstellar material across a wide initial mass range. Although some of the Gaia DR2 distances for LBVs have large uncertainty, this represents the most direct and consistent set of Galactic LBV distance estimates available in the literature.
Convective overshoot and macroscopic diffusion in pure-hydrogen-atmosphere white dwarfs
Authors: Cunningham Tim , Tremblay Pier-Emmanuel , Freytag Bernd , Ludwig Hans-Günter , Koester Detlev
Published: June 2019

We present a theoretical description of macroscopic diffusion caused by convective overshoot in pure-hydrogen DA white dwarfs using 3D, closed-bottom, radiation hydrodynamics co5bold simulations. We rely on a new grid of deep 3D white dwarf models in the temperature range $11\, 400 \le T_{\mathrm{eff}} \le 18\, 000$ K where tracer particles and a tracer density are used to derive macroscopic diffusion coefficients driven by convective overshoot. These diffusion coefficients are compared to microscopic diffusion coefficients from 1D structures. We find that the mass of the fully mixed region is likely to increase by up to 2.5 orders of magnitude while inferred accretion rates increase by a more moderate order of magnitude. We present evidence that an increase in settling time of up to 2 orders of magnitude is to be expected, which is of significance for time-variability studies of polluted white dwarfs. Our grid also provides the most robust constraint on the onset of convective instabilities in DA white dwarfs to be in the effective temperature range from 18 000 to 18 250 K.
On the photometric signature of fast rotators
Authors: Girardi Léo , Costa Guglielmo , Chen Yang , Goudfrooij Paul , Bressan Alessandro , Marigo Paola , Bellini Andrea
Published: June 2019

Rapidly rotating stars have been recently recognized as having a major role in the interpretation of colour–magnitude diagrams of young and intermediate-age star clusters in the Magellanic Clouds and in the Milky Way. In this work, we evaluate the distinctive spectra and distributions in colour–colour space that follow from the presence of a substantial range in effective temperatures across the surface of fast rotators. The calculations are inserted in a formalism similar to the one usually adopted for non-rotating stars, which allows us to derive tables of bolometric corrections as a function not only of a reference effective temperature, surface gravity and metallicity, but also of the rotational speed with respect to the break-up value, ω, and the inclination angle, i. We find that only very fast rotators (ω > 0.95) observed nearly equator-on (i > 45°) present sizable deviations from the colour–colour relations of non-rotating stars. In light of these results, we discuss the photometry of the ∼200-Myr-old cluster NGC 1866 and its split main sequence, which has been attributed to the simultaneous presence of slow and fast rotators. The small dispersion of its stars in colour–colour diagrams allows us to conclude that fast rotators in this cluster either have rotational velocities ω < 0.95, or are all observed nearly pole-on. Such geometric colour–colour effects, although small, might be potentially detectable in the huge, high-quality photometric samples in the post-Gaia era, in addition to the evolutionary effects caused by rotation-induced mixing.
Constraining Lyman-alpha spatial offsets at 3 < z < 5.5 from VANDELS slit spectroscopy
Authors: Hoag A , Treu T , Pentericci L , Amorin R , Bolzonella M , Bradač M , Castellano M , Cullen F , Fynbo J P U , Garilli B , Guaita L , Hathi N , Henry A , Jones T , Mason C , McLeod D , McLure R , Morishita T , Pozzetti L , Schaerer D , Schmidt K B , Talia M , Thomas R
Published: June 2019

We constrain the distribution of spatially offset Lyman-alpha emission (Ly α) relative to rest-frame ultraviolet emission in ∼300 high redshift (3 < z < 5.5) Lyman-break galaxies (LBGs) exhibiting Ly α emission from VANDELS, a VLT/VIMOS slit-spectroscopic survey of the CANDELS Ultra Deep Survey and Chandra Deep Field South fields (≃0.2 deg2 total). Because slit spectroscopy only provides one spatial dimension, we use Bayesian inference to recover the underlying two-dimensional Ly α spatial offset distribution. We model the distribution using a two-dimensional circular Gaussian, defined by a single parameter σr,Ly α, the standard deviation expressed in polar coordinates. Over the entire redshift range of our sample (3 < z < 5.5), we find $\sigma _{r,\mathrm{Ly}\,\alpha }=1.70^{+0.09}_{-0.08}$ kpc ($68\hbox{ per cent}$ conf.), corresponding to ∼0${^{\prime\prime}_{.}}$25 at 〈z〉 = 4.5. We also find that σr,Ly α decreases significantly with redshift. Because Ly α spatial offsets can cause slit losses, the decrease in σr,Ly α with redshift can partially explain the increase in the fraction of Ly α emitters observed in the literature over this same interval, although uncertainties are still too large to reach a strong conclusion. If σr,Ly α continues to decrease into the reionization epoch, then the decrease in Ly α transmission from galaxies observed during this epoch might require an even higher neutral hydrogen fraction than what is currently inferred. Conversely, if spatial offsets increase with the increasing opacity of the intergalactic medium, slit losses may explain some of the drop in Ly α transmission observed at z > 6. Spatially resolved observations of Ly α and UV continuum at 6 < z < 8 are needed to settle the issue.
Black hole and neutron star mergers in galactic nuclei: the role of triples
Authors: Fragione Giacomo , Leigh Nathan W C , Perna Rosalba
Published: June 2019

Nuclear star clusters that surround supermassive black holes (SMBHs) in galactic nuclei are thought to contain large numbers of black holes (BHs) and neutron stars (NSs), a fraction of which form binaries and could merge by Kozai–Lidov oscillations (KL). Triple compact objects are likely to be present, given what is known about the multiplicity of massive stars, whose life ends either as an NS or a BH. In this paper, we present a new possible scenario for merging BHs and NSs in galactic nuclei. We study the evolution of a triple black hole (BH) or neutron star (NS) system orbiting an SMBH in a galactic nucleus by means of direct high-precision N-body simulations, including post-Newtonian terms. We find that the four-body dynamical interactions can increase the KL angle window for mergers compared to the binary case and make BH and NS binaries merge on shorter time-scales. We show that the merger fraction can be up to ∼5–8 times higher for triples than for binaries. Therefore, even if the triple fraction is only ∼10–$20\rm{\,per\,cent}$ of the binary fraction, they could contribute to the merger events observed by LIGO/VIRGO in comparable numbers.
High Satellite Repeat Turnover in Great Apes Studied with Short- and Long-Read Technologies
Authors: Cechova Monika , Harris Robert S , Tomaszkiewicz Marta , Arbeithuber Barbara , Chiaromonte Francesca , Makova Kateryna D
Published: June 2019

Satellite repeats are a structural component of centromeres and telomeres, and in some instances, their divergence is known to drive speciation. Due to their highly repetitive nature, satellite sequences have been understudied and underrepresented in genome assemblies. To investigate their turnover in great apes, we studied satellite repeats of unit sizes up to 50 bp in human, chimpanzee, bonobo, gorilla, and Sumatran and Bornean orangutans, using unassembled short and long sequencing reads. The density of satellite repeats, as identified from accurate short reads (Illumina), varied greatly among great ape genomes. These were dominated by a handful of abundant repeated motifs, frequently shared among species, which formed two groups: 1) the (AATGG)n repeat (critical for heat shock response) and its derivatives; and 2) subtelomeric 32-mers involved in telomeric metabolism. Using the densities of abundant repeats, individuals could be classified into species. However, clustering did not reproduce the accepted species phylogeny, suggesting rapid repeat evolution. Several abundant repeats were enriched in males versus females; using Y chromosome assemblies or Fluorescent In Situ Hybridization, we validated their location on the Y. Finally, applying a novel computational tool, we identified many satellite repeats completely embedded within long Oxford Nanopore and Pacific Biosciences reads. Such repeats were up to 59 kb in length and consisted of perfect repeats interspersed with other similar sequences. Our results based on sequencing reads generated with three different technologies provide the first detailed characterization of great ape satellite repeats, and open new avenues for exploring their functions.
Ten-Step Minimally Invasive Cervical Decompression via Unilateral Tubular Laminotomy: Technical Note and Early Clinical Experience
Authors: Hernandez Robert Nick , Wipplinger Christoph , Navarro-Ramirez Rodrigo , Soriano-Solis Sergio , Kirnaz Sertac , Hussain Ibrahim , Schmidt Franziska Anna , Soriano-Sánchez José-Antonio , Härtl Roger
Published: June 2019

BACKGROUND

Minimally invasive techniques utilizing tubular retractors have become an increasingly popular approach to the spinal column. The concept of a unilateral laminotomy for bilateral decompression (ULBD), first applied in the lumbar spine, has recently been applied to the cervical spine for the treatment of cervical spondylotic myelopathy (CSM). A better understanding of the indications and surgical techniques is required to effectively educate surgeons on how to appropriately and safely perform tubular cervical laminotomy via ULBD.

OBJECTIVE

To describe a 10-step technique for minimally invasive cervical laminotomy and report our early clinical experience.

METHODS

A retrospective review identified 15 patients with CSM who were treated with this procedure. Visual analogue scale (VAS), neck disability index (NDI), and modified Japanese Orthopaedic Association (mJOA) scores were obtained pre- and postoperatively.

RESULTS

The mean age of the 15 patients was 73.1 ± 6.8 yr. The median number of levels treated was 1 (range 1-3). Mean operative time was 125.3 ± 30.8 or 81.7 ± 19.2 min per level. Mean estimated blood loss was 57.3 ± 24.6 cc. Median postoperative hospital length of stay was 36 h. No complications were encountered. Median follow-up was 18 mo. Mean pre- and postoperative VAS were 6.4 ± 2.4 and 1.0 ± 0.8, respectively (P < .001). Mean pre- and postoperative NDI were 46.4 ± 19.2 and 7.0 ± 6.9, respectively (P < .001). Mean pre- and postoperative Mjoa were 11.3 ± 2.5 and 14.5 ± 0.5, respectively (P < .001).

CONCLUSION

In our early clinical experience, minimally invasive cervical ULBD is safe and effective. Adherence to the presented 10-step technique will allow surgeons to safely address bilateral cervical pathology while avoiding complications.
Weight Gain Trajectory and Pain Interference in Young Adulthood: Evidence from a Longitudinal Birth Cohort Study
Authors: Tumin Dmitry , Frech Adrianne , Lynch Jamie L , Raman Vidya T , Bhalla Tarun , Tobias Joseph D
Published: June 2019

Objective

Obesity is associated with chronic pain, but the contribution of body mass index (BMI) trajectories over the life course to the onset of pain problems remains unclear. We retrospectively analyzed how BMI trajectories during the transition to adulthood were associated with a measure of pain interference obtained at age 29 in a longitudinal birth cohort study.

Methods

Data from the National Longitudinal Survey of Youth, 1997 Cohort (follow-up from 1997 to 2015), were used to determine BMI trajectories from age 14 to 29 via group trajectory modeling. At age 29, respondents described whether pain interfered with their work inside and outside the home over the past four weeks (not at all, a little, or a lot). Multivariable ordinal logistic regression was used to evaluate pain interference according to BMI trajectory and study covariates.

Results

Among 7,875 respondents, 11% reported “a little” and 4% reported “a lot” of pain interference at age 29. Four BMI trajectory groups were identified, varying in starting BMI and rate of weight gain. The “obese” group (8% of respondents) had a starting BMI of 30 kg/m2 and gained an average of 0.7 kg/m2/y. On multivariable analysis, this group was the most likely to have greater pain interference, compared with “high normal weight” (odds ratio [OR] = 1.47, 95% confidence interval [CI] = 1.14–1.88), “low normal weight” (OR = 1.45, 95% CI = 1.13–1.87), and “overweight” trajectories (OR = 1.33, 95% CI = 1.02–1.73).

Conclusions

Obesity and rapid weight gain during the transition to adulthood were associated with higher risk of pain interference among young adults.
Money, morale, and motivation: a study of the Output-Based Research Support Scheme in University College Dublin
Authors: Ma Lai
Published: June 2019

Adapted from the Norwegian model, University College Dublin has implemented the Output-Based Research Support Scheme (OBRSS) to stimulate research performance. Semi-structured interviews were conducted to understand the perception of the OBRSS after two years of implementation, its implications on research and publication practices, and the responses to monetary reward as an incentive. This study shows that the effects of the OBRSS on publication practices are intertwined with intrinsic and instrumental values. More importantly and unexpectedly, the study reveals the norms and values concerning academic integrity and research culture, the importance of intrinsic motivation in research and scholarship, as well as morale issues in academic work environment. The findings are consistent with studies of self-determination theory that an incentive scheme can be highly effective if it conveys clear goals and values with a vision of enhanced intrinsic motivation; however, a scheme can be demoralizing when it is perceived as a controlling mechanism.
II Old English
Authors: Lacey Eric , Thomson Simon
Published: June 2019

This chapter has eleven sections: 1. Bibliography; 2. Manuscript Studies, Palaeography, and Facsimiles; 3. Cultural and Intellectual Contexts; 4. Literature: General; 5. The Poems of the Exeter Book; 6. The Poems of the Vercelli Book; 7. The Poems of the Junius Manuscript; 8. Beowulf and the Beowulf Manuscript; 9. Other Poems; 10. Prose; 11. Reception.

Sections 1, 5, and 9 are by Simon Thomson and Eric Lacey; sections 2, 6, 7, and 8 are by Simon Thomson; sections 3, 4, 10, and 11 are by Eric Lacey.
A Novel LAMP Assay for the Detection ofPhytophthora cinnamomiUtilizing a New Target Gene Identified From Genome Sequences
Authors: Dai Tingting , Yang Xiao , Hu Tao , Li Zhongyan , Xu Yue , Lu Chenchen
Published: June 2019

Phytophthora cinnamomi is an ecologically and agriculturally significant plant pathogen. Early and accurate detection of P. cinnamomi is paramount to disease prevention and management. In this study, a loop-mediated isothermal amplification (LAMP) assay utilizing a new target gene Pcinn100006 identified from genomic sequence data was developed and evaluated for the detection of P. cinnamomi. This Pcinn100006 LAMP assay was found highly specific to P. cinnamomi. All 10 tested isolates of P. cinnamomi yielded positive results, whereas 50 isolates belonging to 16 other Phytophthora species, Globisporangium ultimum, and 14 fungal species lacked detection. This assay was 10 times more sensitive (100 pg in a 25-µl reaction mixture) than a conventional PCR assay (2 ng in a 50-µl reaction mixture) for detecting the genomic DNA of P. cinnamomi. In addition, it detected P. cinnamomi from artificially inoculated leaves of Cedrus deodara. Moreover, detection rates of P. cinnamomi using environmental DNAs extracted from 13 naturally infested rhizosphere samples were 100% in the Pcinn100006 LAMP assay versus 46% in the conventional PCR assay. Considering its higher accuracy and shorter time span, this Pcinn100006 LAMP assay is a promising diagnostic tool to replace conventional PCR-based and culture-dependent assays for screening of P. cinnamomi in regions at risk of infection or contamination.
Treatment of Distal Femur Fractures With the DePuy-Synthes Variable Angle Locking Compression Plate
Authors: McDonald Tyler C. , Lambert Joella J. , Hulick R. Miles , Graves Matthew L. , Russell George V. , Spitler Clay A. , Bergin Patrick F.
Published: June 2019

Objectives:

To determine the failure rate of the DePuy-Synthes variable angle locking compression curved condylar plate (VA-LCP) and quantify failure modes.

Design:

Retrospective review.

Setting:

Level I Trauma Center.

Patients/Participants:

One hundred thirteen patients with 118 OTA/AO classification 33A and 33C distal femoral fractures were included in the study.

Intervention:

Internal fixation using only the DePuy-Synthes VA-LCP plate.

Main Outcome Measurements:

Primary outcomes included mechanical failure rate of the DePuy-Synthes VA-LCP plate in open and closed fractures. Secondary outcomes included overall failure rate of treatment, risk factors for mechanical failure, and the specific location of failure: loss of fixation in the proximal segment, implant failure over the working length, or failure of locking screw fixation distally.

Results:

There were 11 total failures (9.3%) in 118 fractures. Failure rates for the closed and open fracture groups were 5.4% and 15.9%, respectively. Twenty patients (16.9%) required reoperation to promote union. Open fractures (P = 0.00475), the presence of medial metaphyseal comminution (P = 0.037), the length of the zone of comminution (P = 0.037), and plate length (P = 0.0096) were significantly higher in those with implant failure. Most failures (63.6%) were in the working length of the implant.

Conclusions:

The use of the Synthes VA-LCP is a viable option in distal femoral fractures and has an acceptable failure rate and reoperation to promote union rate.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
The Influence of Body Habitus on Documented Brace Wear and Progression in Adolescents With Idiopathic Scoliosis
Authors: Karol Lori A. , Wingfield Jessica J. , Virostek Donald , Felton Kevin , Jo ChanHee
Published: June 2019

Background:

Although studies have been published stating obese patients are less compliant with brace use, no objective studies measuring hours of daily brace wear have been performed to correlate brace wear and success with body mass index (BMI). The purpose of this study was to establish the relationship between BMI and brace compliance, and between BMI and progression to surgical magnitude of 50 degrees or more.

Methods:

A total of 175 adolescents were prescribed thoracolumbarsacral orthosis for the treatment of an adolescent idiopathic scoliosis and followed to completion of treatment. BMI was measured at brace prescription, and divided into: (1) underweight (< 5th percentile), (2) normal (>5th, <85%), (3) overweight (>85%, <95%), and (4) Obese (>95%). Thermochron sensors were used to measure compliance. Radiographs were measured at brace prescription, and at time of brace discontinuation or surgery. Outcome was classified as successful if curve magnitude was <50 degrees and no surgery was performed.

Results:

The underweight group wore their braces more hours than the other groups (15.7 h low, 12.5 h normal, 11.7 h high, and 9.0 h obese BMI (low vs. normal P=0.031, low vs. high P=0.01, low vs. obese P=0.01). The underweight group had the highest rate of surgical progression (60%), compared with 27.7% of normal BMI teens, 28.6% of overweight patients, and 55.6% of obese patients. The low BMI had a significantly higher rate of surgery than the normal BMI group (P=0.01).

Conclusions:

Although overweight and obese patients wear orthoses the least hours daily, the highest surgical risk is in underweight adolescents despite good compliance.

Level of evidence:

Level 2.
Is There a Temporal Relationship Between Trough Whole Blood Tacrolimus Concentration and Acute Rejection in the First 14 Days After Kidney Transplantation?
Authors: Hu Rong , Barratt Daniel T. , Coller Janet K. , Sallustio Benedetta C. , Somogyi Andrew A.
Published: June 2019

Background:

There are inconsistent findings regarding the relationship between trough whole blood tacrolimus concentration (TAC C0) and acute kidney rejection in recipients undergoing TAC therapeutic drug monitoring (TDM). However, studies have not always assessed TAC C0 at the time of rejection or accounted for variability in hematocrit. Therefore, this study aimed to investigate the temporal relationship between TAC C0 and acute rejection, including when accounting for variation in hematocrit.

Methods:

For 38 recipients who developed biopsy-proven acute rejection (BPAR) in the first 14 days after kidney transplantation, daily TAC C0 from TDM and hematocrit was collected from case notes. Differences in log10-transformed TAC C0 between the day of BPAR (log Cr), 1 day before BPAR (log Cr-1), and 2 days before BPAR (log Cr-2) and the combined median concentrations for the days preceding these (log Cprior) were examined by repeated-measures analysis of variance with Dunnett post hoc testing. Generalized linear mixed-effects regression (glmer) examined the ability of TAC C0 to predict acute rejection episodes with and without controlling for hematocrit.

Results:

Log Cr-1 [mean difference (95% confidence interval) = −0.13 (−0.21 to −0.048), post hoc P = 0.002] and log Cr [−0.13 (−0.24 to −0.025), post hoc P = 0.013] were significantly lower than log Cprior. TAC C0 was a significant (P = 0.0078) predictor of rejection episodes (area under the receiver operating characteristic curve = 0.79) only in glmer models accounting for variability in hematocrit.

Conclusions:

In recipients who developed BPAR, there was a significant temporal relationship between TAC C0 and BPAR incidence under TAC TDM that may not be detected in cross-sectional studies, especially if variability in hematocrit is not addressed. This supports a TAC C0–rejection relationship, which differs between recipients, and may explain why some recipients do or do not experience rejection within or below the TDM range, respectively. However, studies with larger sample sizes are needed to confirm this finding.
Office-based Approach to Evaluation and Management of Abnormal Uterine Bleeding
Authors: GARCIA AMY L.
Published: June 2019

Evaluation and management of abnormal uterine bleeding (AUB) are possible in the office. Approaching AUB evaluation from an etiology-based perspective allows the gynecologist to focus evaluation efforts on the most probable causes of AUB for a particular patient and therefore customize the management accordingly. Developing skills with imaging such as transvaginal ultrasound, saline infusion sonography, and diagnostic hysteroscopy are important for AUB etiology diagnosis. Operative hysteroscopy experience can be developed for AUB management in the office and endometrial ablation provides a minimally invasive solution for some patients.
Automated Ocular Surface Image Analysis and Health-Related Quality of Life Utility Tool to Measure Blepharokeratoconjunctivitis Activity in Children
Authors: Al-Hayouti Huda , Daniel Moritz , Hingorani Melanie , Calder Virginia , Dahlmann-Noor Annegret
Published: June 2019

Purpose:

To explore the tolerability of automated conjunctival hyperemia quantification in children with blepharokeratoconjunctivitis (BKC) and its agreement with clinical activity grading and to explore the Children's Health Utility 9D (CHU9D) as a measure of health-related quality of life in children with BKC.

Methods:

We enrolled 63 children, 31 with BKC and 32 without ocular surface inflammation, with a median [interquartile range (IQR)] age of 10.6 (7.2–13.9) years for BKC and 11.4 (9.5–13.8) years for healthy volunteers. Two masked observers graded the ocular surface images. The children indicated discomfort during imaging on a 5-point Likert scale. Using nonparametric tests, we explored the interobserver agreement and the agreement of automated redness index (RI) measurements of limbal and bulbar conjunctival hyperemia with clinician assessment. The children also completed the 9-item CHU9D.

Results:

The children tolerated imaging well: median (IQR) Likert value of 0 (“comfortable”) (0–0) in healthy volunteers and 1 (“a little bit uncomfortable”) (0–2) in mild/moderate BKC. In children with BKC, the median (IQR) bulbar RI was 1.3 (0.8–1.6) and the median limbal RI was 0.7 (0.3–1.1). In healthy volunteers, the median bulbar RI was 0.8 (0.55–1.1; P = 0.162) and the median limbal RI was 0.3 (0.2–0.4; P = 0.02). The agreement between RI and clinical grading was high. There was no significant difference between the mean CHU9D utility score between the 2 groups [0.89 (SD 0.08) vs. 0.92 (SD 0.07); P = 0.15].

Conclusions:

Automated conjunctival hyperemia quantification is feasible in children with ocular surface inflammation and may prove useful for long-term monitoring and as an objective outcome measure in clinical trials.
Epidemiology of eye injuries in a high-income developing country
Authors: AlMahmoud Tahra , Al Hadhrami Sameeha M. , Elhanan Mohamed , Alshamsi Hanan N. , Abu-Zidan Fikri M.
Published: June 2019

Vision loss following eye trauma is a serious health problem worldwide. The aim of the study was to report the epidemiology of eye injury that requires hospitalization and surgery at a secondary referral center in a high-income developing country so as to give recommendations regarding its prevention.

All patients who had an eye injury that required surgical intervention between 2012 and 2017 at Al-Ain Hospital were retrospectively studied. Demography, cause of injury, and visual acuity before and after treatment were studied.

Results revealed that 141 patients were operated, 96 eyes with open globe and 48 with other injuries. The median (IQR) age was 25 (11.5–37) years, 89% were males. Majority of injuries occurred at work (50.4%) followed by home (31.2%). Sharp objects (24.1%) and blunt trauma (16.3%) were the most common mechanism of injury. Eye injury was less during the weekends (Friday and Saturday) and during the summer vacation. Cornea injuries (48.2%) were the most frequent cause for visual acuity deterioration followed by lens/cataract (23.4%). Among injured eyes, 30 eyes (21.3%) retained intraocular foreign bodies. There was significant improvement of the visual acuity after surgery (P < .0001, Wilcoxon signed rank test).

Our study has shown that eye injury is a major risk for visual loss of young people which is mainly work-related. Use of personal protective equipment for the eyes and adopting legislative eye safety regulations will reduce the impact of eye injuries in our community.
Volume growth trend and correlation of atrial diameter with lateral ventricular volume in normal fetus and fetus with ventriculomegaly
Authors: Ma Hong-Li , Zhao Si-Xiu , Lv Fu-Rong , Zhang Zhi-Wei , Xiao Yun-Hua , Sheng Bo
Published: June 2019

To explore the growth trend of fetal lateral ventricular volume, for understanding the relationship between atrial diameter (AD) and volume in normal fetus and fetus with ventriculomegaly.

Overall, 97 sequential fetal head magnetic resonance imaging scans were performed; these pertained to 50 fetuses with normal lateral ventricles [normal group; gestational age (GA): 24–38 weeks] and 47 fetuses with ventriculomegaly (VM) (VM group; GA: 24–37 weeks). The left, right, and total lateral ventricular volume were measured using 3-dimensional magnetic resonance hydrography (MRH). Correlation coefficient (r) was calculated to assess the relationships of measurements. Lineal regression analysis was used to assess correlation of AD and GA with volume. Between-group differences in terms of AD and volume were assessed using t test.

Significant linear growth was observed in the total lateral ventricular volume compared with GA in the normal group with a relative growth rate of 2.87% per week (P <.001). Significant linear relationship between AD and volume was observed, and a significant equation was acquired in the normal group and VM groups, respectively, using the simple linear regression model: left volume = 0.438 ∗ normal left diameter (NLD) + 1.359; right volume = 0.493 ∗ normal right diameter (NRD) + 1.012; left volume = 0.959 ∗ left diameter in VM (VLD) − 2.074; right volume = 0.799 ∗ right diameter in VM (VRD) − 0.443. A significant equation was obtained in the normal group and the VM group, using the multiple linear regression model: Total volume (mL) = 0.396 ∗ NLD + 0.410 ∗ NRD + 3.101; and total volume = 0.989 ∗ VLD + 0.834 ∗ VRD − 3.141, respectively. In terms of AD and volume, the left lateral ventricle was significantly larger than the right side in both groups. The volume of lateral ventricle in AD ≥10 mm group was larger than that in the AD <10 mm group. The total volume in the VM group was significantly larger than that in the normal group.

The total lateral ventricular volume increased with GA. AD can be used to evaluate the fetal ventricular volume.
Optical skill-assist device for ultrasound-guided vascular access
Authors: Asao Takayuki , Kikuchi Mami , Tokumine Joho , Matsushima Hisao , Andoh Hideaki , Tanaka Kazumi , Kanamoto Masafumi , Ideno Yuki
Published: June 2019

Ultrasound-guided central venous catheterization may cause lethal mechanical complications intraoperatively. We developed a novel device to prevent such complications. It works as a needle guide to supplement the operator's skill. We evaluated the utility of this device in terms of the success rate and visualization of the needle tip while penetrating the target vessel using a simulator.

This study was approved by the local ethics committee. The new device – an optical skill-assist device – has a slit and a mirror in the center. The operator can see the needle's reflection in the mirror through the slit and can thus ensure that the needle is directed in line with the ultrasound beam. Participants were recruited by placing an advertisement for a hands-on seminar on ultrasound-guided vascular access. They received hands-on training on the in-plane approach for 2 hours. Pre-test and post-test without the device and an additional test using the device were performed to evaluate the proficiency of ultrasound-guided vascular access. An endoscope inserted into the simulated vessel was used to detect the precise location of the needle tip in the vessel.

The primary outcomes were the success rate of the procedure. The secondary outcome was visualization of the needle tip while penetrating the simulated vessel. The chi-squared test was used for comparing the success rate and needle tip visualization between the different tests. P < .05 was considered to indicate significant differences.

Forty-two participants were enrolled in this study. The success rate did not increase after the simulation training (P = .1). Using the optical skill-assist device, the rate improved to 100%. There was a significant difference in success rate between the pre-test and additional test using the optical skill-assist device (P = .003). Needle tip visualization significantly improved with the use of the optical skill-assist device compared to the pre-test (P < .001) and post-test (P = .001).

Simulation training improved participants’ skill for ultrasound-guided vascular access, but the improvement depended on each participant. However, further, improvement was achieved with the use of the optical skill-assist device.

The optical skill-assist device is useful for supplementing the operator's skill for ultrasound-guided central venous catheterization.
Nomograms predicting overall survival and cancer-specific survival in osteosarcoma patients (STROBE)
Authors: Chen Wenhao , Lin Yuxiang
Published: June 2019

The aim of this study was to develop nomograms to predict long-term overall survival and cancer-specific survival of patients with osteosarcoma.

We carried out univariate and multivariate analyses and set up nomograms predicting survival outcome using osteosarcoma patient data collected from the Surveillance, Epidemiology and End Results (SEER) program of the National Cancer Institute (2004–2011, n = 1426). The patients were divided into a training cohort (2004–2008, n = 863) and a validation cohort (2009–2011, n = 563), and the mean follow-up was 55 months.

In the training cohort, 304 patients (35.2%) died from osteosarcoma and 91 (10.5%) died from other causes. In the validation cohort, 155 patients (27.5%) died from osteosarcoma and (12.3%) died from other causes. Nomograms predicting overall survival (OS) and cancer-specific survival (CSS) were developed according to 6 clinicopathologic factors (age, tumor site, historic grade, surgery, AJCC T/N, and M), with concordance indexes (C-index) of 0.725 (OS) and 0.718 (CSS), respectively. The validation C-indexes were 0.775 and 0.742 for OS and CSS, respectively.

Our results suggest that we have successfully developed highly accurate nomograms for predicting 5-year OS and CSS for osteosarcoma patients. These nomograms will help surgeons customize treatment and monitoring strategies for osteosarcoma patients.
The use of APACHE II, SOFA, SAPS 3, C-reactive protein/albumin ratio, and lactate to predict mortality of surgical critically ill patients
Authors: Basile-Filho Anibal , Lago Alessandra Fabiane , Menegueti Mayra Gonçalves , Nicolini Edson Antonio , Rodrigues Lorena Aparecida de Brito , Nunes Roosevelt Santos , Auxiliadora-Martins Maria , Ferez Marcus Antonio
Published: June 2019

Several prognostic indices have been employed to predict the outcome of surgical critically ill patients. Among them, acute physiology and chronic health evaluation (APACHE) II, sequential organ failure assessment (SOFA) and simplified acute physiology score (SAPS 3) are widely used. It seems that biological markers such as C-reactive protein (CRP), albumin, and blood lactate levels correlate with the degree of inflammation during the immediate postoperative phase and could be used as independent predictors. The objective of this study is to compare the different predictive values of prognostic indices and biological markers in the outcome of 847 surgical patients admitted to the intensive care unit (ICU) in the postoperative phase.

The patients were divided into survivors (n = 765, 57.4% males, age 61, interquartile range 51–71) and nonsurvivors (n = 82, 57.3% males, age 70, interquartile range 58–79). APACHE II, APACHE II death probability (DP), SOFA, SAPS 3, SAPS 3 DP, CRP, albumin, and lactate were recorded on ICU admission (first 24 hours). The area under the ROC curve (AUROC) and 95% confidence interval (95% CI) were used to measure the index accuracy to predict mortality.

The AUROC and 95% CI for APACHE II, APACHE II DP, SOFA, SAPS 3, SAPS 3 DP, CRP/albumin ratio, CRP, albumin, and lactate were 0.850 (0.824–0.873), 0.855 (0.829–0.878), 0.791 (0.762–0.818), 0.840 (0.813–0.864), 0.840 (0.813–0.864), 0.731 (0.700–0.761), 0.708 (0.676–0.739), 0.697 (0.665–0.728), and 0.601 (0.567–0.634), respectively. The ICU and overall in-hospital mortality were 6.6 and 9.7%, respectively. The APACHE II, APACHE II DP, SAPS 3, SAPS 3 DP, and SOFA scores showed a better performance than CRP/albumin ratio, CRP, albumin, or lactate to predict in-hospital mortality of surgical critically ill patients.

Even though all indices were able to discriminate septic from nonseptic patients, only APACHE II, APACHE II DP, SOFA and to a lesser extent SAPS 3, SAPS 3 DP, and blood lactate levels could predict in the first 24-hour ICU admission surgical patients who have survived sepsis.