bluuebunny/crossref_metadata_2025 huggingface dataset:
A Newly Integrated Model for Intestinal Cholesterol Absorption and Efflux Infers How Plant Sterol Intake Reduces Circulating Cholesterol Levels
Authors: Nakano Takanari , Inoue Ikuo , Murakoshi Takayuki
Published: September 2018

Hypercholesterolemia accelerates atherosclerosis, and extensive research has been undertaken to ameliorate this abnormality. Plant sterols have been shown to inhibit cholesterol absorption and lower plasma cholesterol level since the 1950s. This ingredient has recently been reappraised as a food additive that can be taken daily in a preclinical period to prevent hypercholesterolemia, considering that cardiovascular-related diseases are the top cause of death globally even with clinical interventions. Intestinal cholesterol handling is still elusive, making it difficult to clarify the mechanism for plant sterol-mediated inhibition. Notably, although the small intestine absorbs cholesterol, it is also the organ that excretes it abundantly, via trans-intestinal cholesterol efflux (TICE). In this review, we show a model where the brush border membrane (BBM) of intestinal epithelial cells stands as the dividing ridge for cholesterol fluxes, making cholesterol absorption and TICE inversely correlated. With this model, we tried to explain the plant sterol-mediated inhibitory mechanism. As well as cholesterol, plant sterols diffuse into the BBM but are effluxed back to the lumen rapidly. We propose that repeated plant sterol shuttling between the BBM and lumen promotes cholesterol efflux, and plant sterol in the BBM may disturb the trafficking machineries that transport cholesterol to the cell interior.
Automatic Fault Detection for Selective Laser Melting Using Semi-Supervised Machine Learning
Authors: Okaro Ikenna A. , Jayasinghe Sarini , Sutcliffe Chris , Black Kate , Paoletti Paolo , Green Peter L.
Published: September 2018

Risk-averse areas such as the medical, aerospace and energy sectors have been somewhat slow towards accepting and applying Additive Manufacturing (AM) in many of their value chains. This is partly because there are still signicant uncertainties concerning the quality of AM builds. This paper introduces a machine learning algorithm for the automatic detection of faults in AM products. The approach is semi-supervised in that, during training, it is able to use data from both builds where the resulting components were certied and builds where the quality of the resulting components is unknown. This makes the approach cost ecient, particularly in scenarios where part certication is costly and time consuming. The study specically analyses Selective Laser Melting (SLM) builds. Key features are extracted from large sets of photodiode data, obtained during the building of 49 tensile test bars. Ultimate tensile strength (UTS) tests were then used to categorise each bar as `faulty' or `acceptable'. A fully supervised approach identied faulty specimens with a 77% success rate while the semi-supervised approach was able to consistently achieve similar results, despite being trained on a fraction of the available certication data. The results show that semi-supervised learning is a promising approach for the automatic certication of AM builds that can be implemented at a fraction of the cost currently required.
Deep Convolutional Neural Networks Capabilities for Binary Classification of Polar Mesocyclones in Satellite Mosaics
Authors: Krinitskiy Mikhail , Verezemskaya Polina , Grashchenkov Kirill , Tilinina Natalia , Gulev Sergey , Lazzara Matthew
Published: September 2018

Polar mesocyclones (MCs) are small marine atmospheric vortices. The class of intense MCs, called polar lows, are accompanied by extremely strong surface winds and heat fluxes and thus largely influencing deep ocean water formation in the polar regions. Accurate detection of polar mesocyclones in high-resolution satellite data, while challenging, is a time-consuming task, when performed manually. Existing algorithms for the automatic detection of polar mesocyclones are based on the conventional analysis of patterns of cloudiness and involve different empirically defined thresholds of geophysical variables. As a result, various detection methods typically reveal very different results when applied to a single dataset. We present a conceptually novel approach for the detection of MCs based on the use of deep convolutional neural networks (DCNNs). We demonstrate that DCNN model is capable of performing binary classification of 500x500km patches of satellite images regarding MC patterns presence in it. The training dataset is based on the reference database of MCs manually tracked in the Southern Hemisphere from satellite mosaics. This dataset is further used for testing several different DCNN setups, specifically, DCNN built “from scratch”, DCNN based on VGG16 pre-trained weights also engaging the Transfer Learning technique, and DCNN based on VGG16 with Fine Tuning technique. Each of these networks is further applied to both infrared (IR) and a combination of infrared and water vapor (IR+WV) satellite imagery. The best skills (97% in terms of the binary classification accuracy score) is achieved with the model that averages the estimates of the ensemble of different DCNNs. The algorithm can be further extended to the automatic identification and tracking numerical scheme and applied to other atmospheric phenomena characterized by a distinct signature in satellite imagery.
Cut-and-Project Schemes for Pisot Family Substitution Tilings
Authors: Lee Jeong-Yup , Akiyama Shigeki , Nagai Yasushi
Published: September 2018

We consider Pisot family substitution tilings in $\R^d$ whose dynamical spectrum is pure point. There are two cut-and-project schemes(CPS) which arise naturally: one from the Pisot family property and the other from the pure point spectrum respectively. The first CPS has an internal space $\R^m$ for some integer $m \in \N$ defined from the Pisot family property, and the second CPS has an internal space $H$ which is an abstract space defined from the property of the pure point spectrum. However it is not known how these two CPS's are related. Here we provide a sufficient condition to make a connection between the two CPS's. In the case of Pisot unimodular substitution tiling in $\R$, the two CPS's turn out to be same due to [5, Remark 18.5].
Field Equations in C4 Space-Time
Authors: Mastoridis Dimitris , Kalogirou K.
Published: September 2018

We explore the field equations in a 4-d complex space-time, in the same way, that general relativity does for our usual 4-d real space-time, forming this way, a new "general  relativity" in C4 space-time, free of sources. Afterwards, by embedding our usual 4-d real space-time in C4 space-time, we describe  geometrically the energy-momentum tensor Tμν as the lost geometric information of this embedding. We further give possible explanation of dark eld and dark energy.
Photoluminescence Property of Eu3+ Doped CaSiO3 Nano-Phosphor with Controlled Grain Size
Authors: Niraula Boris B. , Rizal Conrad
Published: September 2018

A series of Eu3+ doped CaSiO3/SiO2 nano-phosphor powder of controlled grain size, crystalline structure, and chemical composition were synthesized using the microemulsion technique. XRD profiles of samples sintered over 600 of suggested phase shift from amorphous powder grain to more ordered polycrystalline powder of triclinic type wollastonite, CaSiO3, with preferred crystal phase orientation of (112) and tetragonal type cristobalites of SiO2. The grain size, crystallinity, and chemical composition of the host matrix, activator and sensitizer strongly affected both the absorption and emission bands of these samples. The amplitude of both the orange and red emission bands significantly increased with sintering temperature. The emission band is red-shifted with decreasing grain sizes. These bands displayed good sensitivity to ionic concentration of the Si4+, Ca2+, and Eu3+. With increasing Ca2+ ion concentration both the intensity of the red photoluminescence (PL) band increased and a concentration quenching observed. Increase in Si4+ ion concentration led to quenching in PL intensity of both the orange and red bands whereas the amplitude of the blue-band slightly increased. With increasing Eu3+ ion concentration the red-band initially increased whereas it started decreasing at higher sample concentration. In the presence of Ca2+ ion as a sensitizer, the sample showed a remarkable PL property—including—about 100% photon conversion efficiency and a two-fold increase in excitation and emission photons.
Towards the Validation of Dynamical Models in Regions where there is no Data
Authors: Green Peter , Chodora E. , Zhu Z. , Atamturktur S.
Published: September 2018

The creation of computer models is often driven by the need to make predictions in regions where there is no data (i.e. extrapolations). This makes validation challenging as it is difficult to ensure that a model will be suitable when it is applied in a region where there are no observations of the system of interest. The current paper proposes a method that can reveal flaws in a model which may be difficult to identify using traditional approaches for model calibration and validation. The method specifically targets the situation where one is attempting to model a dynamical system that is believed to possess time-invariant calibration parameters. The proposed approach allows these parameters to vary with time, even though it is believed that they are time-invariant. The of such an analysis is to identify key discrepancies - indications that a model has inherent flaws and, as a result, should not be used to influence decisions in regions where there is no data. The proposed method isn't necessarily a predictor of extrapolation performance, rather, it is a stringent test that, the authors believe, should be applied before extrapolation is attempted. The approach could therefore form a useful part of wider validation frameworks in the future.
Finding the Planck Length Independent of Newton's Gravitational Constant and the Planck Constant: The Compton Clock Model of Matter
Authors: Haug Espen
Published: September 2018

In modern physics, it is assumed that the Planck length is a derived constant from Newton's gravitational constant, the Planck constant and the speed of light, $l_p=\sqrt{\frac{G\hbar}{c^3}}$. This was first discovered by Max Planck in 1899. We suggest a way to find the Planck length independent of any knowledge of Newton's gravitational constant or the Planck constant, but still dependent on the speed of light (directly or indirectly).
Extension of eigenvalue problems on Gauss map of ruled surfaces
Authors: Choi Miekyung , Kim Young Ho
Published: September 2018

A finite-type immersion or smooth map is a nice tool to classify submanifolds of Euclidean space, which comes from eigenvalue problem of immersion. The notion of generalized 1-type is a natural generalization of those of 1-type in the usual sense and pointwise 1-type. We classify ruled surfaces with generalized 1-type Gauss map as part of a plane, a circular cylinder, a cylinder over a base curve of an infinite type, a helicoid, a right cone and a conical surface of $G$-type.
Health Care Professionals’ Views Associated with the Barriers and Facilitators of Advance Care Planning (ACP) for Community Dwelling Older Adults with Palliative and End-of-Life Care Needs Towards Achieving a ‘Good’ Death: Findings from a Qualitative, Exploratory Pilot Study
Authors: Bellamy Gary , Stock Jennifer , Schofield Patricia
Published: September 2018

This paper reports the findings from a pilot study designed to explore the barriers, facilitators and similarities with the delivery and implementation of two distinct models of Advance Care Planning (ACP) documentation for older adults in their last year of life used by health care professionals in their clinical practice. PACe (Proactive Anticipatory Care Plan): a GP led model and PEACE (Proactive Elderly Persons’ Advisory CarE): a nurse led model with community geriatrician oversight were used by participants in their clinical practice. Telephone interviews were conducted with general practitioners (GPs) to explore their views of using the PACe tool. Hospital admission avoidance matrons took part in face to face interviews and care staff employed in private residential care homes took part in individual telephone interviews to explore their views of using the PEACE tool. GPs and admission avoidance matrons were employed by Clinical Commissioning Groups (CCGs) and all study participants were recruited from the South East of England where data collection took place in 2015. Nine telephone interviews and two face-to-face interviews (one joint and one individual) were conducted with twelve participants. The data was analysed thematically. Participants highlighted the similarity of both tools in providing focus to ACP discussions to inform individual end-of-life care preferences. The importance of relationships was a pivotal theme-established, trusting inter-professional relationships to enable multidisciplinary teamwork and a prior relationship with the older person (or their proxy in the case of cognitive impairment) to enable conversations of this nature. Using both tools enabled participants to think critically and reflect on their own practice was another theme identified. Notwithstanding participants’ views to improve the layout of both tools, using a paper-based approach to deliver streamlined ACP and end-of-life care was a theme to emerge as a barrier which focused on the problems with access to paper-based documentation, accuracy and care co-ordination in the context of multidisciplinary team working. The value of technology in overcoming this barrier and underpin ACP as a means to help simplify service provision, promote integrated professional practice and provide seamless care was put forward as the solution.
Inter- and Intra-Host Nucleotide Variations in Hepatitis A Virus in Culture and Clinical Samples Detected by Next-Generation Sequencing
Authors: Yang Zhihui , Mammel Mark , Whitehouse Chris A. , Ngo Diana , Kulka Michael
Published: September 2018

The accurate virus detection, strain discrimination, and source attribution of contaminated food items remains a persistent challenge because of the high mutation rates anticipated to occur in foodborne RNA viruses, such as Hepatitis A virus (HAV). This has led to predictions of the existence of more than one sequence variant between the hosts (inter-host) or within an individual host (intra-host). However, there have been no reports of intra-host variants from an infected single individual, and little is known about the accuracy of the single nucleotide variations (SNVs) calling with various methods. In this study, the presence and identity of viral SNVs, either between HAV clinical specimens or among a series of samples derived from HAV clone1-infected FRhK4 cells, were determined following analyses of nucleotide sequences generated using next-generation sequencing (NGS) and pyrosequencing methods. The results demonstrate the co-existence of inter- and intra-host variants both in the clinical specimens and the cultured samples. The discovery and confirmation of multi-viral RNAs in an infected individual is dependent on the strain discrimination at the SNV level, and critical for successful outbreak traceback and source attribution investigations. The detection of SNVs in a time series of HAV infected FRhK4 cells improved our understanding on the mutation dynamics determined probably by different selective pressures. Additionally, it demonstrated that NGS could potentially provide a valuable investigative approach toward SNV detection and identification for other RNA viruses.
Rapid Determination of Nitrite in Drinking Water Using Ion-Exchange-Enhanced Infrared Spectroscopy
Authors: Du Xiuke , Ye Song , Dong Daming
Published: September 2018

Infrared spectroscopy is an effective method for the determination of compositions and concentrations of liquids, with advantages of fast response, no-sampling, flexible in use and is able for on-line monitoring. However, for trace substances in drinking water, such as nitrates and heavy metals, infrared spectroscopy is not sensitive enough for the quantitative and qualitative measurement. In this study, we improved the sensitivity of infrared spectroscopy for nitrite determination by developing an ion-exchange-enhanced diffuse reflectance spectroscopy, which consist of an accessory based on ion-exchange resin for enrichment and a FTIR spectrometer for measurement. Using this method, the limit of detection for nitrate is 1.7 mg/L, which is enough for drinking water sensing. We also verified the quantitative measurement ability of the method. Furthermore, the limit of detection and quantitative measuring range could be adjusted by changing the mass of resin and adsorption time. This study demonstrated the method can be used to detect trace nitrites in drinking water, can be applied in the field, and is sensitive, rapid, and inexpensive with a wide dynamic range.
Three-Dimensional Cloud Volume Reconstruction from the Multi-Angle Imaging SpectroRadiometer
Authors: Lee Byungsuk , Di Girolamo Larry , Zhao Guangyu , Zhan Yizhe
Published: September 2018

Abstract: Characterization the 3-D structure of clouds is needed for a more complete understanding of the Earth's radiative and latent heat fluxes. Here we develop and explore a “ray casting” algorithm applied to the Multi-angle Imaging SpectroRadiometer (MISR) on board the Terra satellite, to reconstruct 3-D cloud volumes for observed clouds. The ray casting algorithm is first applied to geometrically simple synthetic clouds to show that, under the assumption of perfect, clear-conservative cloud masks, the reconstruction method yields overestimation whose magnitude depends on the cloud geometry and the resolution of the reconstruction grid relative to the image pixel resolution. The method is then applied to two select MISR scenes, fully accounting for MISR’s viewing geometry for reconstructions over the Earth’s ellipsoidal surface. The MISR Radiometric Camera-by-camera Cloud Masks at 1.1 km resolution and custom cloud masks at 275 m resolution independently derived from MISR RGB channels are used as input cloud masks. A wind correction method, termed “cloud spreading”, is devised and applied to the cloud masks to offset potential cloud movements over short time intervals (around 7 minutes at maximum) between the cameras. The MISR cloud top height product is used as a constraint to reduce the overestimation at the cloud top. The reconstruction results show that their uncertainty is significant when the wind correction is applied, and that they have more refined structures when the input cloud mask has a higher resolution. Recommendations for improving the presented cloud volume reconstructions as well as for future passive remote sensing satellite missions are discussed.
Spine-Pelvis-Hip Relationship in the Functioning of a Total Hip Replacement
Authors: Ike Hiroyuki , Dorr Lawrence D. , Trasolini Nicholas , Stefl Michael , McKnight Braden , Heckmann Nathanael
Published: September 2018

* Spine-pelvis-hip motion is normally coordinated to allow balance of the mass of the trunk and hip motion with standing and sitting.

* Normal motion from standing to sitting involves hip flexion of 55° to 70° and pelvic posterior tilt of 20°. Because the acetabulum is part of the pelvis, as the pelvis tilts posteriorly during sitting, the inclination and anteversion increase (the acetabulum opens) to allow clearance of the femoral head and neck during hip flexion. This can be considered the biological opening of the acetabulum.

* Decreased tilt of the pelvis during movement occurs with stiffness of the spine. Loss of pelvic mobility forces hip motion to increase to accommodate postural change. Increased hip motion combined with change in the opening of the acetabulum increases the risk of impingement.

* Hip stiffness can also reduce pelvic mobility because pelvic mobility is affected by both the spine and the hip. Relief of hip stiffness with total hip replacement can improve pelvic mobility postoperatively.

* For hip surgeons, the clinical consequences of changes in the mobility of the spine and pelvis (spinopelvic mobility) can be impingement after total hip replacement, with the most obvious complication being dislocation. The reported increased dislocations in patients with surgical spine fusions is a clinical example of this consequence.
The Impact of Electronic Medical Record Implementation on Labor Cost and Productivity at an Outpatient Orthopaedic Clinic
Authors: Scott Daniel J. , Labro Eva , Penrose Colin T. , Bolognesi Michael P. , Wellman Samuel S. , Mather Richard C.
Published: September 2018

Background:

Widespread adoption of electronic medical record (EMR) systems is increasing. EMR implementation can be costly and typically requires workflow redesign. To our knowledge, no studies to date have examined the impact of EMR implementation using advanced cost accounting methods or the impact of its implementation on orthopaedic surgeons in an outpatient setting.

Methods:

Time-driven activity-based costing (TD-ABC) was used to evaluate the effect of EMR implementation in an outpatient adult reconstruction clinic. One hundred and forty-three patients were prospectively timed throughout their visit to clinics, before implementation of a hospital system-wide EMR system and then again 2 months, 6 months, and 2 years after implementation. Data were analyzed to investigate the effects of EMR implementation on labor cost and provider time.

Results:

Total labor costs per patient visit significantly increased at 2 months after EMR implementation (from $36.88 to $46.04; p = 0.05). Drivers of this change included increases in the amount of time that attending surgeons spent per patient (from 9.38 to 10.97 minutes, with the cost increasing from $21.10 to $27.01), as well as increased time that certified medical assistants spent assessing patients (from 3.4 to 9.1 minutes; p < 0.001). Two months after EMR implementation, providers were spending more than twice as long documenting patient encounters (7.6 compared with 3.3 minutes; p < 0.001). However, by 6 months after implementation, total labor costs were similar to those before implementation ($38.75 compared with $36.88; p = 0.689) and they remained similar at 2 years after implementation ($36.88 compared with $37.73; p = 0.84). After the initial learning period following EMR implementation, providers spent more time documenting encounters (8.43 compared with 3.28 minutes; p < 0.001) but less time interacting with patients (10.03 compared with 14.65 minutes; p = 0.013).

Conclusions:

Using TD-ABC, we observed the EMR implementation learning period, returning to pre-introduction efficiency at 6 months. Cost increases because of increased certified medical assistant time spent with patients and physician time on documentation were offset by less patient-physician interaction. Health-care systems and policymakers should be aware that the length of the implementation period is approximately 6 months and that implementation may alter the time that providers spend with patients.

Clinical Relevance:

This article offers insight into the impact of EMR implementation on the orthopaedic surgeon’s clinic efficiency and workflows.
The Demographic and Geographic Trends of Meniscal Procedures in New York State
Authors: Suchman Kelly I. , Behery Omar A. , Mai David H. , Anil Utkarsh , Bosco Joseph A.
Published: September 2018

Background:

The purpose of this study was to examine the geographic and demographic variations and time trends of different types of meniscal procedures in New York State to determine whether disparities exist in access to treatment.

Methods:

The New York Statewide Planning and Research Cooperative System (SPARCS) outpatient database was reviewed to identify patients who underwent elective, primary knee arthroscopy between January 1, 2003, and December 31, 2015, for 1 of the following diagnosis-related categories: Group 1, meniscectomy; Group 2, meniscal repair; and Group 3, meniscal allograft transplantation, with or without anterior cruciate ligament reconstruction (ACLR). The 3 groups of meniscal procedures were compared on geographic distribution, patient age, insurance, concomitant ACLR, and surgeon and hospital volume over the study period.

Results:

A total of 649,470 patients who underwent knee arthroscopy between 2003 and 2015 were identified for analysis. Both meniscectomies and meniscal repairs had a scattered distribution throughout New York State, with allograft volume concentrated at urban academic hospitals. The majority of patients who underwent any meniscal procedure had private insurance, with Medicaid patients having the lowest rates of meniscal surgery. At high-volume hospitals, meniscal repairs and allografts are being performed with increasing frequency, especially in patients <25 years of age. Meniscal repairs are being performed concomitantly with ACLR with increasing frequency.

Conclusions:

Meniscal repairs and allografts are being performed at high-volume hospitals for privately insured patients with increasing frequency. Geographic access to these treatments, particularly allografts, is limited.

Clinical Relevance:

Disparities in the availability of advanced meniscal treatment require further investigation and understanding to improve access to care.
A Dedicated Pediatric Spine Deformity Team Significantly Reduces Surgical Time and Cost
Authors: Flynn John M. , Striano Brendan M. , Muhly Wallis T. , Kraus Blair , Sankar Wudbhav N. , Mehta Vaidehi , Blum Michael , DeZayas Barbara , Feldman Jeffrey , Keren Ron
Published: September 2018

Background:

As high-quality health care becomes increasingly expensive, improvement projects are focused on reducing cost and increasing value. To increase value by reducing operating room (OR) utilization, we studied the effect of a dedicated team approach for posterior spinal fusion (PSF) for scoliosis.

Methods:

With institutional support, an interdisciplinary, dedicated team was assembled. Members developed standardized protocols for anesthetic management and patient transport, positioning, preparation, draping, imaging, and wake-up. These protocols were initially implemented with a small interdisciplinary team, including 1 surgeon (Phase 1), and then were expanded to include a second surgeon and additional anesthesiology staff (Phase 2). We compared procedures performed with a dedicated team (the Dedicated Team cases) and procedures performed without a such a team (the Casual Team cases). Because of the heterogeneous nature of PSF for scoliosis, we developed a case categorization system: Category 1 was relatively homogeneous and indicated patients with fusion of ≤12 levels, no osteotomies, and a body mass index (BMI) of <25 kg/m2, and Category 2 was more heterogeneous and indicated patients with fusion of >12 levels and/or ≥1 osteotomy and/or a BMI of ≥25 kg/m2.

Results:

In total, 89 Casual Team and 78 Dedicated Team cases were evaluated: 71 were in Category 1 and 96 were in Category 2. Dedicated Team cases used significantly less OR time for both Categories 1 and 2 (p < 0.001). In Category-1 cases, the average reduction was 111.4 minutes (29.7%); in Category-2 cases, it was 76.9 minutes (18.5%). The effect of the Dedicated Team was scalable: the reduction in OR time was significant in both Phase 1 and Phase 2 (p < 0.001). The Dedicated Team cases had no complications. Cost reduction averaged approximately $8,900 for Category-1 and $6,000 for Category-2 cases.

Conclusions:

By creating a dedicated team and standardizing several aspects of PSFs for scoliosis, we achieved a large reduction in OR time. This increase in team efficiency was significant, consistent, and scalable. As a result, we can routinely complete 2 Category-1 PSFs in the same OR with the same team without exceeding standard block time.
Staggered Rather Than Staged or Simultaneous Surgical Strategy May Reduce the Risk of Acute Kidney Injury in Patients Undergoing Bilateral TKA
Authors: Koh Won Uk , Kim Ha-Jung , Park Hee-Sun , Jang Min-Jeong , Ro Young-Jin , Song Jun-Gol
Published: September 2018

Background:

The strategy for bilateral total knee arthroplasty (TKA) depends on the timing of surgery for each knee. The purpose of this study was to determine whether the type of surgical strategy for bilateral TKA (staggered, staged, or simultaneous) influences the incidence of acute kidney injury (AKI) and related complications.

Methods:

Enrolled patients from a single tertiary teaching hospital were divided into 3 groups according to the surgical strategy for bilateral TKA: staggered (≤7 days between the first and second procedure; n = 368), staged (8 days to 1 year between the first and second procedure; n = 265), or simultaneous (n = 820). The incidence of AKI as defined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria was assessed. The rates of major postoperative complications, major adverse cardiovascular and cerebral events, intensive care unit (ICU) admissions, and mortality were also evaluated. To reduce the influence of possible confounding factors, inverse probability of treatment weighting based on propensity-score analysis was used.

Results:

The primary outcome was the incidence of AKI according to surgical strategy. The staggered group had a lower rate of AKI compared with the other 2 groups (p < 0.001): 2.4% (9 of 368 patients), 6.0% (16 of 265), and 11.2% (92 of 820) in the staggered, staged, and simultaneous groups, respectively.

Conclusions:

The type of bilateral TKA strategy was an independent risk factor for the development of AKI. The assessment of additional risk factors for the development of AKI is essential before deciding on surgical strategy.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Update on Misrepresentation of Research Publications Among Orthopaedic Surgery Residency Applicants
Authors: Meeks Brett D. , Kiskaddon Eric M. , Burton Michael G. , Froehle Andrew W. , Crosby Lynn A. , Laughlin Richard T.
Published: September 2018

Background:

Our 2 previous studies (1999, 2007) examining misrepresentation of research publications among orthopaedic residency applicants revealed rates of misrepresentation of 18.0% and 20.6%, respectively. As the residency selection process has become more competitive, the number of applicants who list publications has increased. The purpose of this study was to determine current rates of research misrepresentation by orthopaedic surgery applicants.

Methods:

We reviewed the publication listings and research section of the Common Application Form from the Electronic Residency Application Service (ERAS) for all applicants applying to 1 orthopaedic residency program. The PubMed-MEDLINE database was principally used to search for citations. The PubMed Identifier (PMID) number was used; if no PMID number was listed, a combination of authors or the title of the work was used. If the citations were not found through PubMed, a previously developed algorithm was followed to determine misrepresentation. Misrepresentation was defined as (1) nonauthorship of a published article in which authorship was claimed, (2) claimed authorship of a nonexistent article, or (3) self-promotion to a higher authorship status within a published article.

Results:

Five hundred and seventy-three applicants applied to our institution for residency in 2016 to 2017: 250 (43.6%) of 573 applicants did not list a publication, whereas 323 (56.4%) of 573 applicants listed ≥1 publication. We found 13 cases of misrepresentation among a total of 1,100 citations (1.18% in 2017 versus 18.0% in 1999 and 20.6% in 2007, p < 0.001). Ten cases of misrepresentation were self-promotion to a higher authorship status. There were 2 cases of claimed authorship of an article that could not be found. Only 1 applicant misrepresented more than once.

Conclusions:

Based on our findings, orthopaedic surgery residency applicants are accurately representing their publication information. The incorporation of the PMID number on the ERAS application has streamlined the process for finding publications, and has possibly encouraged veracity on residency applications. Faculty involved in the resident selection process should be aware of the significant decline in the rate of misrepresentation by medical students applying for orthopaedic surgery residency versus the rate in our prior studies.
Necessidades não atendidas em mieloma múltiplo no Brasil sob a perspectiva de médicos – barreiras na qualidade de vida e manejo da doença
Authors: Maiolino Angelo , Pinto Neto Jorge , Leite Leonardo , Seguro Fernanda , Braga Walter , Zanella Karla , Sobrinho Jairo Jose , Oliveira Renato , Julian Guilherme , Tanaka Paula
Published: September 2018

Objetivo: Existe uma tendência no aumento das taxas de sobrevida global de pacientes de mieloma múltiplo (MM) ao longo dos anos, aumentando a necessidade de melhorar sua qualidade de vida e atenuar as necessidades médicas não atendidas na área. Desta forma, o objetivo deste estudo é explorar e descrever as necessidades médicas não atendidas e as barreiras em pacientes brasileiros de MM, a partir da perspectiva de médicos. Métodos: Um questionário com 41 questões foi desenvolvido para coletar dados sobre as características clínicas, necessidades médicas não atendidas e barreiras no diagnóstico e tratamento de MM no Brasil. Depois de coletar a resposta dos médicos, uma discussão em forma de painel com todos os participantes foi realizada para coletar dados adicionais e validar as respostas do questionário. Resultados: Os participantes tinham, em média, 18 anos de experiência profissional, atendendo-se no total uma média de 30 pacientes de MM por mês. Os pacientes de MM atendidos por esses médicos no sistema público apresentam em média 7,5 meses de doença ao iniciar o tratamento, enquanto no sistema privado apresentavam 2,5 meses. Em ambos os sistemas, a maioria dos pacientes foi referenciada por clínicos gerais. Neuropatia periférica foi o evento adverso mais frequentemente reportado pelos médicos, com maior impacto na adesão ao tratamento e na qualidade de vida. Conclusão: Existem diversos desafios relativos às necessidades médicas não atendidas, especialmente ao comparar os sistemas público e privado no Brasil. De acordo com os participantes, o acesso aos procedimentos diagnósticos básicos e a adoção de medidas de educação médica e de pacientes minimizariam as barreiras importantes no cenário brasileiro atual
Treatment patterns of Hodgkin’s lymphoma in Brazil: experts’ perspective
Authors: Silveira Talita , Buccheri Valeria , Perini Guilherme , Bigni Ricardo , Penna Adriana , Pimenta Flavia Cristina , Cerci Juliano Julio , Bacchi Carlos Eduardo , Oliveira Renato , Barreto Tania
Published: September 2018

Background: Hodgkin’s Lymphoma (HL) is a curable type of cancer, with a wide variety of therapies, especially for refractory/relapsing cases. Therefore, the study aims to explore the treatment patterns used in the management of HL patients in Brazil. Methods: A survey was developed to explore the treatment patterns in Brazil, addressing topics such as clinical characteristics, lines of therapy, transplant information and cure rates. Then, results were presented in a panel discussion to validate participants’ responses and gain additional insights. Main results: The eight experts reported that most patients are women and under 60 years old. In both private and public healthcare systems, ABVD was the most commonly used first-line therapy for patients of all stages. The median cure rates for patients in stages I and II were 80% and 87.5%, and for stages III and IV 60% and 67.5%, respectively, in public and private sectors. For the subsequent lines of therapy, different regimens such as DHAP, GVD, GEV, ICE and allogeneic transplant are used, among others. Brentuximab vedotin was present mainly in the private sector. In the public sector, 70% of the patients are eligible for autologous stem cell transplant; of them, 75% actually receive the transplant. In the private sector, 80% of the patients are eligible, and 100% of them receive the transplant. Conclusion: Similarities were found between the public and private sectors in first-line therapy and cure rates. However, barriers for subsequent lines of therapy are more evident in the public system.
Padrões de tratamento, uso de recursos e custo do câncer de pulmão de não pequenas células avançado em instituições brasileiras privadas
Authors: Baldotto Clarissa , Julian Guilherme , Mascarenhas Eldsamira , Laloni Mariana , Azevedo Carla , Kashiura Diego , Moreira Eloisa , Oliveira Ana Paula
Published: September 2018

Objetivo: No Brasil, dados clínicos e custos econômicos do câncer de pulmão de não pequenas células (CPNPC) são escassos. Portanto, conduzimos este estudo para coletar dados de mundo real sobre padrões de tratamento e uso de recursos para CPNPC avançado (CPNPCa) em pacientes em instituições privadas brasileiras. Métodos: Coletamos dados de prontuários de seis instituições privadas no Brasil. Os pacientes elegíveis tinham diagnóstico de CPNPC avançado ou recorrente (estágios IIIB e IV) entre janeiro de 2011 e julho de 2014, e haviam recebido pelo menos duas linhas de quimioterapia. Dados foram resumidos usando estatísticas descritivas e os custos foram estimados pela abordagem bottom-up. Resultados: Dos 430 pacientes selecionados, 152 foram elegíveis para coleta de dados. A idade mediana dos pacientes foi de 62 anos e 55,9% eram do sexo masculino. Entre os pacientes, 57,2% e 31,6% receberam três e quatro linhas de tratamento, respectivamente. Dezesseis e vinte regimes foram utilizados como tratamentos de primeira e segunda linha. Bevacizumabe + carboplatina + paclitaxel (n = 32; 21,1%) foi o mais frequente na primeira linha, enquanto docetaxel isolado (n = 36; 23,7%) foi o regime mais comum de segunda linha. Hospitalizações e visitas ao pronto-socorro foram registradas em 52% e 25% dos pacientes, respectivamente. O custo total da coorte foi de R$ 47.692.195,1 (US$ 14.803.425,4). Conclusões: Os padrões de tratamento para pacientes com CPNPCa em instituições privadas brasileiras são heterogêneos. O alto uso e custos de recursos observados entre os pacientes da CPNPCa têm um impacto econômico significativo para o sistema de saúde privado brasileiro.
Significant limitations associated with the analysis of human plasma soluble CD36 performed by ELISA
Authors: Dziedziejko Violetta , Pauli Natalia , Kuligowska Agnieszka , Safranow Krzysztof , Goschorska Marta , Chlubek Dariusz , Rać Monika E.
Published: September 2018

ABSTRAKTWstęp: Badania wskazują, że stężenie białka sCD36 w osoczu mogłoby być markerem aktywacji makrofagów i stanu zapalnego oraz przyspieszonej akumulacji lipidów w ścianie naczyniowej, które w rezultacie prowadzą do miażdżycy tętnic.Celem badania było opracowanie wiarygodnej metodyki oznaczania sCD36.Materiały i metody: Jako materiał do opracowania metodyki oznaczania stężenia sCD36 w osoczu testem ELISA posłużyły pobrane na czczo próbki krwi od losowo wybranych zdrowych osób, które zgłosiły się na obowiązkowe badania kontrolne w Przychodni Medycyny Pracy.Wyniki: Wykazano możliwe problemy w pomiarze stężenia sCD36 w osoczu metodą ELISA. Wskazano również, że interakcje sCD36 z innymi czynnikami mogą wpływać w szerokim zakresie na stężenie sCD36 w osoczu.Wnioski: Uwzględniając pewne ograniczenia, test ELISA można wykorzystać do oznaczania stężenia sCD36 w osoczu ludzkim.
Analiza cytogenetyczna zespołów mielodysplastycznych*
Authors: Gibka Magdalena
Published: September 2018

ABSTRAKTWstęp: Zespoły mielodysplastyczne (myelodysplastic syndromes – MDS), wg klasyfikacji Światowej Organizacji Zdrowia nowotwory mielodysplastyczne, to heterogenna grupa klonalnych chorób komórki macierzystej szpiku charakteryzująca się nieefektywną hematopoezą, cytopeniami we krwi obwodowej oraz skłonnością do transformacji w ostrą białaczkę szpikową. Celem pracy była ocena aberracji chromosomowych dorosłych pacjentów z zespołem mielodysplastycznym metodami cytogenetyki klasycznej i molekularnej. Materiały i metody: Materiał badawczy stanowił wynik badania szpiku kostnego. Dla każdego pacjenta została założona 24-godzinna niestymulowana hodowla szpiku kostnego. Na preparatach uzyskanych po hodowli in vitro wykonano analizę technikami cytogenetyki klasycznej GTG oraz fluorescencyjnej hybrydyzacji in situ (FISH). Poszczególne etapy pracy obejmowały analizę wyników badania kariotypu oraz wybranych aberracji chromosomów Y, 3, 5, 7, 8 i 20 pary za pomocą techniki FISH. Porównano skuteczność metod klasycznych i molekularnych w diagnostyce cytogenetycznej zespołów mielodysplastycznych oraz przeprowadzono analizę statystyczną badającą korelację uzyskanych wyników cytogenetycznych z danymi klinicznymi pacjentów. Badanie cytogenetyczne przeprowadzono u wszystkich 38 pacjentów, analizy statystycznej dokonano u 30, u których potwierdzono klinicznie zespół mielodysplastyczny. Wyniki: Aberracje chromosomowe wykryto u 14 (47%) chorych. Do najczęściej występujących zmian cytogenetycznych należały: delecja długiego ramienia chromosomu 5 pary (13,3%), trisomia chromosomu 8 pary (6,6%) oraz delecja długiego ramienia chromosomu 20 pary (6,6%). Wyniki analizy statystycznej wykazały istotny statystycznie związek pomiędzy wiekiem zachorowania na MDS a płcią pacjentów (p = 0,035) oraz zbliżony do progu istotności statystycznej związek pomiędzy wiekiem zachorowania pacjentów z prawidłowym wynikiem badania kariotypu i pacjentów z wynikiem kariotypu obejmującym charakterystyczne aberracje chromosomów (p = 0,07). Wnioski: Powyższe wyniki dowodzą zasadności wykonywania badań kariotypu oraz badań techniką FISH u pacjentów z podejrzeniem MDS. Analiza cytogenetyczna w połączeniu z innymi kryteriami diagnostycznymi zwiększa skuteczność diagnostyczną, a także pozwala na dokładniejsze określenie grup ryzyka oraz wybór odpowiedniej metody leczenia pacjentów z MDS.
Oznaczenie fentanylu i remifentanylu we krwi metodą chromatografii cieczowej sprzężonej z tandemową spektrometrią mas LC-MS/MS
Authors: Janus Tomasz , Potocka-Banaś Barbara , Jasionowicz Ewa , Borowiak Krzysztof , Polewczak Izabela
Published: September 2018

ABSTRAKTWstęp: Fentanyl i remifentanyl to syntetyczne związki należące do grupy opioidów działające agonistycznie na receptory opioidowe. Są powszechnie używane w neuroleptanalgezji w różnych zabiegowych dyscyplinach medycznych, jak: ginekologia, kardiochirurgia, ortopedia oraz onkologia. Ze względu na szerokie zastosowanie i efektywne biologicznie działanie w niskich stężeniach coraz częściej zachodzi potrzeba zarówno jakościowej identyfikacji, jak i jednoczesnego ustalenia stężeń fentanylu i remifentanylu w materiale biologicznym. Dlatego też opracowanie czułych i zarazem precyzyjnych oraz pewnych procedur analityczno-toksykologicznych jest istotnym problemem dla diagnostów pracujących w specjalistycznych laboratoriach toksykologicznych.Celem pracy było opracowanie diagnostycznej procedury jednoczesnego jakościowego i ilościowego oznaczenia fentanylu oraz remifentanylu we krwi pełnej i ustalenie optymalnych parametrów analitycznych. Materiały i metody: Materiałem biologicznym była krew pełna zakupiona w Wojewódzkiej Stacji Krwiodawstwa w Szczecinie. Próby poddawane badaniom uzyskano poprzez obciążenie krwi pełnej wzorcami: fentanylu, remifentanylu i fentanylu-d5 o znanych stężeniach. Izolację analitów z matrycy przeprowadzono techniką ciecz–ciecz, stosując jako czynnik ekstrahujący octan etylu. Uzyskane próbki analizowano z wykorzystaniem wysokosprawnej chromatografii cieczowej sprzężonej z tandemowym spektrometrem mas (LC-MS/MS). Na podstawie uzyskanych wyników wyznaczono średnią, odchylenie standardowe, względne odchylenie standardowe i współczynnik zmienności. W celu zwiększenia czułości metody LC-MS/MS na podstawie analizy napięcia rozkładu cząsteczki w zakresie 0–300 V dokonano wyboru napięcia rozkładu cząsteczki DP = 80. Ustalono odpowiednią energię kolizyjną (35 V). Wysoka rozdzielczość aparatu pozwoliła na wybranie wąskich przedziałów mas dla każdego związku: fentanyl-d5 – 188,143 ±0,0047 Da, fentanyl – 188,1445 ±0,0043 Da i remifentanyl – 317,186 ±0,007 Da. Wyniki: Wyniki analizy fentanylu i remifentanylu pozwoliły na uzyskanie krzywych kalibracyjnych w zakresie 1–200 ng/mL, które wykazały wymaganą liniowość.Wniosek: Otrzymane wyniki umożliwiły identyfikację oraz ocenę ilościową fentanylu i remifentanylu we krwi pełnej. Metoda LC-MS/MS znajduje zastosowanie zarówno w diagnostyce ostrych zatruć, monitorowaniu terapii, jak i praktyce orzeczniczo-sądowej.
Zastosowanie termografii w medycynie – przegląd literatury
Authors: Modrzejewska Anna , Parafiniuk Mirosław
Published: September 2018

ABSTRAKT Wstęp: Celem doniesienia jest przedstawienie zastosowania zjawiska termoemisji w różnych dziedzinach medycyny z uwzględnieniem okulistyki. Zastosowanie tomografii: Dane w piśmiennictwie wskazują, że detekcja promieniowania podczerwonego, która jest emitowana przez różne obiekty, w tym tkanki ludzkie, może być wykorzystywana w medycynie. Termografia w medycynie najczęściej służy do oceny rozległości i nasilenia stanu zapalnego w badanej tkance na postawie zjawiska wysokiej termoemisji, czyli lokalnego wzmożonego ukrwienia i metabolizmu tkankowego. Używana jest w diagnostyce zapalenia stawów, skóry czy gałki ocznej. Wzrost temperatury obserwuje się w guzach nowotworowych takich jak czerniak oraz naczyniak. Obniżenie temperatury jako efekt zaburzeń ukrwienia stwierdza się w termografii dynamicznej w Zespole Raynauda, po zawale serca, po oparzeniach skóry oraz w niedokrwieniu siatkówki. Zaobserwowano, iż w zespole suchego oka oczy chore mają niższą temperaturę niż oczy zdrowe, co może wynikać z niższej emisji promieniowania podczerwonego przez zaburzony film łzowy. Wnioski: Termografia jest metodą nieinwazyjną, szybką oraz obiektywną, która może znaleźć w przyszłości zastosowanie w wielu dziedzinach medycyny, w tym w okulistyce.
Źródła stresu zawodowego a sposoby radzenia sobie w sytuacjach stresogennych pielęgniarek pracujących na wybranych oddziałach szpitalnych – doniesienia wstępne*
Authors: Kwiecień-Jaguś Katarzyna , Mędrzycka-Dąbrowska Wioletta , Małecka-Dubiela Anna
Published: September 2018

ABSTRAKT Wstęp: Stres jest nieodłącznym elementem pracy personelu medycznego. Problem stresu w środowisku pracy personelu pielęgniarskiego nabiera znaczenia w kontekście coraz częstszych braków kadrowych, a także braku wsparcia ze strony pracodawców. Celem pracy była analiza czynników stresogennych związanych z codzienną pracą personelu pielęgniarskiego wybranych oddziałów szpitalnych oraz zbadanie związku pomiędzy stresem a sposobami radzenia sobie z nim. Materiały i metody: W badaniu wykorzystano kwestionariusz wywiadu oraz dwa wystandaryzowane narzędzia badawcze: Nursing Stress Scale i Brief Cope-28 Scale. W badaniu prowadzonym anonimowo dobrowolny udział wzięło 110 pielęgniarek. Obliczenia statystyczne wykonano w oparciu o program komputerowy IBM SPSS 20 oraz arkusz Excel. Wyniki: Analizy statystyczne wykazały, że spośród wielu czynników stresogennych w środowisku pracy personelu pielęgniarskiego największe źródło stresu stanowiły: śmierć i umieranie (M 15,19; SD ±3,10), obciążenie pracą (M 14,73; SD ±3,13) oraz konflikty na linii pielęgniarka–lekarz (M 10,42; SD ±1,85). Wykazano istotną statystycznie zależność pomiędzy miejscem zatrudnienia a poziomem odczuwanego stresu (H = 13,99; p < 0,05). W sytuacjach stresowych personel pielęgniarski najczęściej odnosił się do aktywnych sposobów radzenia sobie ze stresem, w tym rozwiązywania sytuacji stresowych poprzez planowanie (M 6,31; SD ±1,31) oraz pozytywnego przewartościowania (M 5,84; SD ±1,49). Dalsze analizy wykazały związek pomiędzy wiekiem a uciekaniem do spraw duchowych lub poszukiwaniem wsparcia społecznego. Wnioski: Praca personelu pielęgniarskiego nacechowana jest wysokim poziomem stresu, który w dużym stopniu zależy od profilu medycznego danego oddziału. Część czynników stresogennych można zmniejszyć poprzez poprawę organizacji pracy, zwłaszcza w kontekście współpracy pielęgniarki z lekarzem.