bluuebunny/crossref_metadata_2025 huggingface dataset:
The Neo-Assyrian Empire through a Postcolonial Lens
Authors: Marzouk Safwat
Published: January 2020

This essay provides an overview of the Neo-Assyrian imperial ideology (ca. 934–609 bce) including how religion and politics intertwine, and how the images of self and other are constructed in this imperial ideology. This overview is followed by a discussion of how the biblical traditions of Isaiah and Deuteronomy responded to the Assyrian empire. Isaiah of Jerusalem (1-39) and the book of Deuteronomy subvert the Assyrian empire by way of mimicking its imperial discourse in order to underline the sovereignty of YHWH and in order to call the people of Judah to trust in their God. The essay then moves on to discuss how the books of Nahum and Jonah offer different perspectives on the notions of decolonization by way of bringing the divine judgment as in the case of Nahum or by way of calling the Ninevites to repent as in the case of Jonah.
Humanism and Music
Authors: Driscoll Christopher M.
Published: January 2020

This chapter explores the relationship between humanism and music, giving attention to important theoretical and historical developments, before focusing on four brief case studies rooted in popular culture. The first turns to rock band Modest Mouse as an example of music as a space of humanist expression. Next, the chapter explores Austin-based Rock band Quiet Company and Westcoast rapper Ras Kass and their use of music to critique religion. Last, the chapter discusses contemporary popular music created by artificial intelligence and considers what non-human production of music suggests about the category of the human and, resultantly, humanism. These case studies give attention to the historical and theoretical relationship between humanism and music, and they offer examples of that relationship as it plays out in contemporary music.
The Learning Organization: Critical Analysis and Future Directions
Authors: Jørgensen Kenneth Mølbjerg , Hsu Shih-wei , Hersted Lone
Published: January 2020

This chapter contains a critical analysis of the learning organization (LO). As part of this agenda, the possibilities for a more positive agenda for LO are also explored. The chapter introduces a political perspective in which LO is seen as part of power relations that produce particular types of learning. From this perspective the authors move to Foucault’s later ethical writings to clarify an important distinction between reflective and reflexive practices. Three different narratives of LO are then identified and discussed. 1st generation LO is characterized by learning models that are consistent with the rationalities of the classical bureaucratic model. 2nd generation LO is characterized by learning models that emphasize reflection, self-management, and self-directed learning according to corporate performance goals. 3rd generation LO focuses on reflexivity, creativity, and co-creation in groups and teams and across silos supported by the design of collective spaces where such actions and collaborative learning processes unfold.
Contextualizing the Learning Organization: Towards Differentiated Standards
Authors: Örtenblad Anders Ragnar
Published: January 2020

This chapter suggests there is a need to develop a contingency model containing differentiated standards of the learning organization, fit for organization in different generalized contexts (such as a certain industry, sector, national culture, or religion). It is suggested that such differentiated standards would help those who have a real aim to implement the learning organization in practice. It would also make it more difficult for those who “misuse” the learning organization concept, by simply claiming that their organization is a learning organization without having taken any measures for it to actually become one. The chapter argues why it is important to develop a contingency model of differentiated standards, presents some previous studies that could contribute to such a contingency model, and suggests how further studies that could contribute with knowledge to such a contingency model could be conducted.
Building Learning Organizations With Action Learning
Authors: Marquardt Michael John
Published: January 2020

Very few organizations have ever been able to achieve their goal of becoming a learning organization due to the complexity of organizational learning and the impatience and lack of skills of organizational leaders. Over the past twenty-five years, the author of this chapter has discovered that the introduction of action learning programs into the organization is the most effective way of building a learning organization. This chapter briefly summarizes the five subsystems of a learning organization: (1) learning, (2) organization, (3) people, (4) knowledge, and (5) technology. Action learning is a powerful tool that enables a group to learn while in action. It has the unique ability to solve complex problems while simultaneously creating leaders, building teams, and developing each of the five learning organization subsystems.
Learning Company: The Learning Organization According to Pedler, Burgoyne, and Boydell
Authors: Pedler Mike , Boydell Tom , Burgoyne John
Published: January 2020

This chapter provides an overview of the Learning Company model, describing its evolution, key features, and its potential contribution to developing organizations with ambitions to do things that matter. After describing the ideas and materials created around the time of the fall of the Berlin Wall, this chapter considers the multiple criticisms of these ideas that have arisen since then. Following a brief review of changes in the wider world over that time, it considers evidence on the question of whether the Learning Company is still alive or not. Given the seriousness of the problems now facing humanity, pre-eminently that of planetary climate change, it concludes that new concepts are needed to replace models based on ideologies of competitive advantage. A call is made for new organizational visions that go beyond sustainable development to embrace a regenerative purpose that aims to benefit the widest range of social and ecological stakeholders.
The Future of the Learning Organization
Authors: Pedler Mike , Burgoyne John , Boydell Tom
Published: January 2020

The essence of a learning organization involves not only the development of new capacities, but also fundamental shifts of mind. This chapter presents seven individual developmental Modes of Being and Learning, which are associated with four organizational Stances—ways of standing in the world. Stance 1, Doing Things Well, calls for Modes 1, 2, and 3, Adhering, Adapting, Accepting. Stance 2, Doing Things Better, requires Modes 4 and 5, Experiencing and Experimenting. Stance 3, Doing Better Things—Together, also involves Mode 6, Connecting; Mode 7, Dedicating, is further needed to move into Stance 4, Doing Things that Matter to the World. The Stances are Weberian “ideal types”, described by referring to a number of characteristics typically experienced in each Stance, but which may not actually be found in every case. A learning organization is in a process of transformation from one Stance to another; a temporary state.
The Learning Organization as a Practice of Becoming Human
Authors: Armstrong Helen D.
Published: January 2020

This chapter reviews the author’s ideas from her earlier 2000 paper on the learning organization, and examines what it might mean to adopt guiding policies and practices of becoming human within a learning organization. In particular, the author revisits Mary Parker Follett’s (1868–1933) guiding principles. Thus, while the author continues a critique of the evolution, aberrations, and abominations of the learning organization, she also suggests how we might work toward a more validating approach and thus redefine the learning organization as a practice of becoming human. Work toward that approach is worthwhile even while we may still always fall short.
Conceptualizing an Organization That Learns
Authors: Watkins Karen E. , Marsick Victoria J.
Published: January 2020

This chapter explores Watkins and Marsick’s (1993, 1996) model of a learning organization, tracing its evolution and situating it among other conceptions of a learning organization. Watkins and Marsick initially defined a learning organization as continuous learning at four levels—individual, team, organization, and global. Organizations they studied over time intentionally sought capability, embedding learning in the culture and structure of the organization as well as in certain capacities. Learning climate and culture stand out in this framework as both conditions for system-level learning and indicators of change toward becoming more effective as a learning system. Their model is integrated in that it blends learning theory and organizational development. This chapter explores applications of the model in research and practice, focusing on its use to measure a learning culture. Finally, it offers critiques of the learning organization model.
Ambidextrous Learning Organizations
Authors: Lam Alice
Published: January 2020

This chapter examines the structures and processes of learning organizations that are capable of engaging in both exploitative and explorative learning. Drawing on structuration theory and paradox thinking, it argues that a focus on the dynamic interplay between structure and agency, and the interdependence between opposite forces in organizations are crucial for understanding ambidextrous learning organizations. The analysis distinguishes three types of ambidextrous learning organizations, labeled as “partitional,” “contextual,” and “alliance,” each with its distinct structural configurations, learning spaces, and agents. While the existing literature emphasizes “balancing” exploitative and explorative learning, this chapter argues that “counter-balancing” the drift towards exploitative learning poses a major challenge. The three types share the common characteristic of allowing “free” spaces within the constraints of structures that enable the key learning agents to counter-balance this drift and sustain ambidextrous learning.
Stakeholders and the Learning Organization
Authors: Schneper William D. , Wernick David A. , Von Glinow Mary Ann
Published: January 2020

This chapter examines the relationship between stakeholder theory and research on the learning organization. It begins by describing the history of the stakeholder concept and some of the most important ideas and trends relating to stakeholder theory. Next, the authors discuss some apparent similarities in the principles underlying stakeholder theory and Senge’s (1990) articulation of the learning organization. They also examine the types of stakeholders that received the greatest attention by Senge (1990). The chapter continues with a review of the various ways that subsequent learning organization scholarship has approached stakeholders and stakeholder theory. The authors find that Senge’s The Fifth Discipline had a strong “anchoring” effect on subsequent learning organization research that has tended to direct attention to just a few major stakeholder theory topics and types of stakeholders. The concluding section offers recommendations on how principles relating to stakeholder theory and the learning organization can be further combined in the future.
Interventions to Create a Learning Organization
Authors: Marsick Victoria J. , Watkins Karen E. , King Smith Angela
Published: January 2020

This chapter examines ways that Watkins and Marsick (1993, 1997), together or with other collaborators (including students), have engaged in, or supported, interventions to create a learning organization. The chapter starts by framing the intervention approach associated with their model. The authors then examine examples of research that illustrate how action science and action learning develop learning capacity toward a learning organization in ways consistent with the model. They turn to a comprehensive framework that Gephart and Marsick (2016) developed focused on system dynamics, and illustrate the way this framework has been used to foster organizational learning. The authors’ final examples come from DLOQ-inspired research carried out by students. They conclude with reflections that suggest a way of creating a learning organization that is less an idealized outcome and more a learning process for iterative—and adjustable—growth toward desired goals.
On Definitions of the Learning Organization: Toward a New Definition of Learning Organization
Authors: Bui Hong T. M.
Published: January 2020

Despite a large body of literature on learning organization, a clear definition of learning organization has proved to be elusive over the years. This chapter critically reviews several “mainstream” as well as less frequent definitions to develop a broader understanding of the conceptualization of learning organization. As a result of the analysis, a comprehensive definition of learning organization is developed for future use. A learning organization is an organization in which a supportive learning culture and structure are strong enough to enable learning mindsets and systems learning across the organization to constantly transform and innovate itself for sustainable development in a complex and uncertain environment. At the same time, this chapter indicates possible venues for future research in the learning organization field.
Learning in the Learning Organization: COncepts and Antecedents
Authors: Visser Max , Tosey Paul
Published: January 2020

Like its twin concept organizational learning, the concept of learning organization is characterized by many different approaches and perspectives. While many of these approaches outline in some detail the organizational conditions considered beneficial for learning, the specific nature of that learning is often less precisely defined. The purpose of this chapter is to review three main approaches to the learning organization and focus on their conceptualizations of learning. By tracing the genealogy of these conceptualizations in the broader learning literature, common antecedents can be found mainly in the work of Argyris and Schön and to some degree in the work of Revans.
The Empire Strikes Back: How Learning Organization Scholars Can Learn From The Critiques
Authors: Hong Jacky F. L. , Mak Carry K. Y.
Published: January 2020

The concept of the learning organization (LO) has been subjected to strong criticisms over the past decade. However, excessive emphasis on the negativities will itself undermine the potential benefits that the LO concept promises to offer. By conducting a systematic review of the extant critiques of LO, this chapter aims to offer some suggestions for moving the idea forward. The authors argue that the community of learning organization scholars can reflect and learn from their past errors, thus returning with a more theoretically robust model in the next millennium. It is suggested to adopt a liminal and multi-stakeholder approach for developing a contextualized model of LO in the future.
The evolution of protein domain repertoires: Shedding light on the origins of the Herpesviridae family
Authors: Brito Anderson F , Pinney John W
Published: January 2020

Herpesviruses (HVs, Family: Herpesviridae) have large genomes that encode hundreds of proteins. Apart from amino acid mutations, protein domain acquisitions, duplications and losses are also common modes of evolution. HV domain repertoires differ across species, and only a core set is shared among all species, aspect that raises a question: How have HV domain repertoires diverged while keeping some similarities? To answer such question, we used profile Hidden Markov Models (HMMs) to search for domains in all possible translated open reading frames (ORFs) of fully sequenced HV genomes. With at least 274 domains being identified, we built a matrix of domain counts per species, and applied a parsimony method to reconstruct the ancestral states of these domains along the HV phylogeny. It revealed events of domain gain, duplication, and loss over more than 400 millions of years, where Alpha-, Beta-, and GammaHVs expanded and condensed their domain repertoires at distinct rates. Most of the acquired domains perform ‘Modulation and Control’, ‘Envelope’, or ‘Auxiliary’ functions, categories that showed high flexibility (number of domains) and redundancy (number of copies). Conversely, few gains and duplications were observed for domains involved in ‘Capsid assembly and structure’, and ‘DNA Replication, recombination and metabolism’. Among the forty-one primordial domains encoded by Herpesviridae ancestors, twenty-eight are still found in all present-day HVs. Because of their distinct evolutionary strategies, HV domain repertoires are very specific at the subfamily, genus and species levels. Differences in domain composition may not only explain HV host range and tissue tropism, but also provide hints to the origins of HVs.
Decision aids in anesthesia: do they help?
Authors: Southerland Warren A. , Beight Leah J. , Shapiro Fred E. , Urman Richard D.
Published: January 2020

Purpose of review

Patient decision aids are educational tools used to assist patients and clinicians in healthcare decisions. As healthcare moves toward patient-centered care, these tools can provide support to anesthesiologists by facilitating shared decision-making.

Recent findings

Recent research has shown that patient decision aids are beneficial in the clinical setting for patients and physicians. Studies have shown that patients feel better informed, have better knowledge, and have less anxiety, depression, and decisional conflict after using patient decision aids. In addition, a structured approach for the development of patient decision aids in the field of anesthesia has been established.

Patient decision aids can support patient-centered care delivery and shared decision-making, especially in the field of anesthesia. Current research involves implementing the use of patient decision aids in the discussion for monitored anesthesia care. Further development of quality metrics is needed to improve the decision aids and maximize decision quality.
Effect of Anesthesia on Microelectrode Recordings During Deep Brain Stimulation Surgery: A Narrative Review
Authors: Bos Michaël J. , Buhre Wolfgang , Temel Yasin , Joosten Elbert A.J. , Absalom Anthony R. , Janssen Marcus L.F.
Published: January 2020

Deep brain stimulation (DBS) is an effective surgical treatment for patients with various neurological and psychiatric disorders. Clinical improvements rely on careful patient selection and accurate electrode placement. A common method for target localization is intraoperative microelectrode recording (MER). To facilitate MER, DBS surgery is traditionally performed under local or regional anesthesia. However, sedation or general anesthesia is sometimes needed for patients who are unable to tolerate the procedure fully awake because of severe motor symptoms, psychological distress, pain, or other forms of discomfort. The effect of anesthetic drugs on MER is controversial but likely depends on the type and dose of a particular anesthetic agent, underlying disease, and surgical target. In this narrative review, we provide an overview of the current literature on the anesthetic drugs most often used for sedation and anesthesia during DBS surgery, with a focus on their effects on MERs.
Predicting postoperative complications and mortality after acetabular surgery in the elderly: A comparison of risk stratification models
Authors: Kim Chang-Yeon , Trivedi Nikunj N. , Sivasundaram Lakshmanan , Ochenjele George , Liu Raymond W. , Vallier Heather
Published: January 2020

Background:

Geriatric acetabular fractures are becoming increasingly common. Surgeons must balance the long-term benefits of surgery with the risk of postoperative complications. Several risk stratification models have been adapted to assist surgeons with this decision-making. We compared the accuracy of the Elixhauser Comorbidity Measure (ECM), the Charlson Comorbidity Index (CCI), and the Combined Comorbidity Score (CCS) for predicting adverse events and postoperative discharge destination after surgical treatment of geriatric patients with acetabular fractures.

Methods:

A search of the National Inpatient Sample for patients over the age of 65 yr who had fixation of an acetabular fracture between 2002 and 2014 was undertaken. Logistic regression models of basic demographic variables and the ECM, CCI, or the CCS were used to predict inpatient mortality, complications, extended length of stay, and discharge disposition. The predictive discrimination of each model was evaluated using the C-statistic.

Results:

A total of 2,497 patients were identified. The model using demographic variables and the CCS outperformed the corresponding ECM and CCI models, with an area under the curve (AUC) of 0.829 for mortality (compared to 0.791 and 0.689, respectively), 0.791 for cardiac complications (compared to 0.694 and 0.704, respectively), 0.789 for renal complications (compared to 0.787 and 0.683, respectively), and 0.760 for pulmonary complications (compared to 0.750 and 0.662, respectively).

Conclusions:

The CCS was the best predictive model for assessing postoperative complications, followed by the ECM then CCI. Our results may assist in preoperative decision-making for geriatric patients with acetabular fractures.

Level of Evidence:

Level III.
Long-term results of antibiotic spacers for the infected total knee: A retrospective case-control study
Authors: Virk Sohrab S. , Drain Joseph P. , Melaku Mikhail S. , Glassman Andrew H. , Granger Jeffrey F.
Published: January 2020

Background:

Surgery to treat deep space infections in total knee arthroplasty can be associated with significant medical comorbidities. A tibiofemoral intramedullary nail with antibiotic cement (nonarticulating spacers) often is used to eradicate infection while allowing a patient to avoid the potential disadvantages of an above-knee amputation.

Methods:

A retrospective review of clinical data was performed on all patients treated with a nonarticulating antibiotic spacer from 2010 to 2014. Operative notes, progress reports, laboratory, and microbiology results were collected and analyzed for our cohort of patients.

Results:

Thirty patients were included within this report of results. The average age was 62.70 yr old (±12.17, min=39, max=86), and the average body mass index was 35.48 (±9.43). Fifty percent were men (15/30), and 56.67% (17/30) of patients had diabetes mellitus. A large portion of patients (20%; 6/30) originally presented to the intensive care unit with septic arthritis and 33.33% (10/30) were septic on arrival. Prior to static spacer placement, 86.67 (26/30) of patients had a previous surgical procedure to attempt to eradicate infection. The average follow-up was 16.82 mo (±12.80 mo), and the most common organism causing the index infection was methicillin-resistant Staphylococcus aureus (MRSA). At final follow-up, 83.33% (15/18) of patients living with a nonarticulating spacer were able to ambulate with the spacer.

Conclusions:

Nonarticulating antibiotic spacers offer a viable treatment option to stabilize a knee with significant soft-tissue injury and bone loss from explant procedures for infection.

Level of Evidence:

Level IV.
Do current comorbidity indices accurately predict adverse events after operative fixation of hip fractures? A retrospective database review
Authors: Sivasundaram Lakshmanan , Kim Chang-Yeon , Trivedi Nikunj N. , Ahn Nicholas U.
Published: January 2020

Background:

The incidence of hip fractures continues to grow due in part to an aging population and increasing activity levels. With the potential implementation of bundled-care payment models for the operative fixation of hip fractures, a metric that accurately predicts postoperative length of stay and adverse events would allow for adjustments in bundled payments for “high-risk” patients.

Methods:

A retrospective review of the National Inpatient Sample was performed to identify patients with a femoral neck fracture or intertrochanteric femoral fracture between 2002-2014. Multivariable logistic regression models, with either the Elixhauser Comorbidity Measure (ECM) or Charlson Comorbidity Index (CCI) were created to predict inpatient mortality and adverse events. A base model that just contained patient demographic characteristics also was evaluated. Last, a combined model that used each index, along with the base model was created. The predictive discrimination of each model was evaluated using the C-statistic.

Results:

A total of 477,648 hip fractures were identified. The mean age of our cohort was 82.3±7.3 yr, with an inpatient mortality rate of 2.2%. The model incorporating the base demographic variables and ECM provided the best predictive models, with a C-statistics of 0.767 for inpatient mortality, 0.713 for cardiac complications, 0.818 for pulmonary complications, 0.818 for renal complications, and 0.615 for thromboembolic complications.

Conclusions:

A combined model that includes basic demographic variables and the ECM outperforms either the CCI or ECM in isolation for predicting inpatient mortality and adverse events after hip fractures.

Level of Evidence:

Level IV.
Impact of the Inclusion of C2 in Posterior Cervical Fusions for Cervical Myelopathy on Sagittal Cervical Alignment
Authors: Woodroffe Royce W. , Helland Logan , Hollatz Chanse , Piscopo Anthony , Close Liesl N. , Nourski Kirill V. , Viljoen Stephanus V. , Grossbach Andrew J. , Hitchon Patrick W.
Published: January 2020

Study Design:

Retrospective cohort study.

Objective:

To determine the impact of including C2 in posterior fusions on radiographic parameters of cervical alignment in cervical spondylotic myelopathy.

Summary of Background Data:

Despite the use of posterior instrumentation and arthrodesis after cervical laminectomy, loss of lordosis and the development of kyphosis are prevalent. Inadequate cervical lordosis and other measures of sagittal cervical alignment have been shown to correlate with disability, general health scores, and severity of myelopathy. The role of C2 in the posterior tension band, which maintains sagittal alignment, differs from the subaxial spine, as it is the insertion point for erector spinae muscles that play a critical role in maintaining posture.

Patients and Methods:

This study compares the radiographic outcomes of sagittal balance between 2 cohorts of patients who underwent posterior cervical decompression and fusion for cervical myelopathy over a 12-year period at a single institution. Demographic and surgical characteristics were collected using the electronic medical record of patients undergoing posterior cervical fusions (PCF) which included the axis [axial fusion (AF)] and those that were subaxial fusions (SAF). Radiographic measurements included preopertaive and postoperative C2–C7 lordosis (CL), C2–C7 sagittal vertical axis (SVA), and T1 slope (T1S).

Results:

After review of the electronic medical records, 229 patients were identified as having PCF and decompression for treatment of myelopathy. One hundred sixty-seven patients had AF, whereas 62 had SAF. PCF resulted in loss of CL in both cohorts. Although there was no statistical difference in postoperative CL, there was a significant increase in SVA (P<0.001) and T1S (P<0.001) with AF.

Conclusions:

PCF often result in loss of lordosis. When compared with SAF, inclusion of C2 into the fusion construct may result in worsened sagittal balance, increasing the SVA and T1S.
Thoracolumbar Spinal Cord Stimulator Trial
Authors: Stolzenberg David , Ahn Junyoung J. , Lendner Mayan , Kurd Mark
Published: January 2020

Spinal cord stimulator trials are indicated for the treatment of postlaminectomy syndrome with persistent severe back and limb pain which has failed conservative treatment options and where no further surgery is indicated. They are also indicated for refractory complex regional pain syndrome. This article details patient positioning and set up, step-by-step instructions for the procedure and postoperative management. Pearls and pitfalls are also discussed. In addition, an instructional procedure video, Supplemental Digital Content 1 (http://links.lww.com/CLINSPINE/A121) accompanies this paper.
Do Surgical Site Infection Rates Differ Among Microscope-assisted Versus Loupe-assisted Lumbar Discectomies?
Authors: Omar Adan , Ecternacht Scott , Kurucan Etka , Jubril Ayodeji , Mesfin Addisu
Published: January 2020

Study Design:

Retrospective study.

Objective:

The objective of this study was to compared surgical site infection (SSI) rates between patients under lumbar discectomy with an operative microscope versus surgical loupes.

Summary of Background Data:

Lumbar decompressions for herniated disks or lumbar stenosis are common spine procedures. Some studies have raised the concern that drape contamination of the operative microscope may be an additional risk for SSIs. We hypothesize that the use of the operative microscope for lumbar decompression procedures does not increase infection rates.

Methods:

A retrospective cohort analysis was performed on patients undergoing lumbar spinal decompressions via microscopic assistance (MA) or loupe assistance (LA) by 2 orthopedic spine surgeons at a tertiary academic medical center. Patients treated from November, 2012 to October, 2016 were enrolled. Variables including age, sex, race, body mass index, smoking status, length of surgery, intraoperative complications, estimated blood loss, and postoperative SSIs within 30 days were collected.

Results:

A total of 225 patients were included in the study. Sixty-three patients underwent LA lumbar decompression, and 162 underwent MA lumbar decompression. There were 72 female individuals/90 male individuals in the MA group and 31 female individuals/33 male individuals in the LA group. The MA was significantly older 45.2 versus 40.4 in LA, P-value of 0.02 and had a significantly higher body mass index (30.64 vs. 27.79, P<0.002). SSI rates were not significantly different, MA 3.7% (6/162) and LA 7.9% (5/63), P-value of 0.14. The MA group had a significantly longer operative time (92 vs. 50 min, P<0.001). Dural tears rates were 3.1% in MA and 1.6% in LA, P-value of 0.3 and were associated with longer operative time in the MA group, 162.2 versus 90.2 minutes, P-value of <0.0001. Multivariate regression analysis did not identify any significant differences between the 2 groups.

Conclusions:

The use of the operative microscope had similar infection rates as LA microdiscectomies. In academic institutions, the operative microscope may allow more opportunities for residents or fellows to partake/assist in the procedure as compared with LA procedures.
The Effect of Footprint Mismatch on Heterotopic Ossification After Cervical Disk Replacement
Authors: Guo Qian , Fang Zhong , Guan Hanfeng , Xiong Wei , Li Feng
Published: January 2020

Study Design:

This was a retrospective study.

Objective:

The objective of this study was to analyze risk factors of heterotopic ossification (HO) after cervical disk replacement (CDR) and evaluate the effect of footprint mismatch on HO.

Summary of Background Data:

Incidence of HO after CDR is high, but the exact related factors have not been fully elucidated.

Materials and Methods:

Radiographic data of patients who had undergone CDR with Prestige LP or Discover prosthesis in Tongji Hospital from July 2012 to December 2015 were reviewed. HO was graded according to McAfee classification and classified according to Jin morphologic classification. Footprint matching degree was evaluated using 3-dimensional computed tomographic images. Cervical sagittal alignment, functional spinal unit height, and range of motion were measured on radiographs. Preexisting degeneration was scored using Walraevens scoring system. Postulated risk factors including general factors, cervical sagittal alignment, functional spinal unit height, range of motion, postoperative biomechanical changes, preexisting degeneration, number of surgical levels, prosthesis type, use of nonsteroid anti-inflammatory drugs, and footprint matching degree were analyzed by first univariate tests, and then multivariate logistic regression was done to examine the relation with HO occurrence. Effect of footprint mismatch on type 1 HO of morphologic classification was evaluated.

Results:

Data of 46 patients were collected; 43 were finally evaluated with a total 57 prostheses implanted, with a mean follow-up duration of 41.16±12.49 months. No significant differences in basic characteristics existed between 2 prosthesis groups, except follow-up time. Incidence of HO was 66.7%. Mean footprint matching degree in sagittal plane was 0.877±0.068 and in coronal plane was 0.852±0.092. Mean overall footprint matching degree was 0.699±0.102 (range: 0.388–0.993). Prosthesis type and footprint matching degree were significantly related with HO among all postulated risk factors in both univariate and multivariate analyses (P<0.05); the latter had larger Exp(B). Type 1 HO occurrence significantly related with footprint mismatch.

Conclusions:

Incidence of HO after CDR was high, and serious footprint mismatch existed. HO occurrence was significantly related with prosthesis type and footprint matching degree; the latter played a more important role.
Preoperative Anemia Management: Value-based Care for Orthopedic Surgery
Authors: Heller Lori B. , Shander Aryeh
Published: January 2020

Preoperative anemia is common in elective orthopedic surgical patients and is an independent risk factor for perioperative morbidity and mortality. The detrimental effects of anemia on surgical outcomes impact the costs associated with perioperative care as well. In addition to the direct expenditures related to the complications of anemia, perioperative anemia is the leading predictor of perioperative transfusion and it is estimated that up to 6 million dollars are spent on transfusion-related costs per hospital per year. Anemia is a preventable and manageable condition that can often be treated effectively without relying on blood transfusion. In addition to providing optimal outcomes for orthopedic patients, preoperative anemia management is an effective strategy to lower the overall cost of care of surgical patients.
A novel bis-aryl urea compound inhibits tumor proliferation via cathepsin D-associated apoptosis
Authors: Wu Jianping , Huang Yao , Xie Qian , Zhang Junfeng , Zhan Zhen
Published: January 2020

Derivatives of bis-aryl urea have been widely investigated for their various biological activities, such as antiviral, anti-inflammatory and antiproliferative. We evaluated a new chemical entity consisting of bis-aryl urea moiety, N69B, for its anticancer activities and explored their underlying molecular mechanism. The compound inhibited proliferation of multiple types of murine and human cancer cells in vitro, and reduced tumor growth in mouse 4T1 breast tumor model in vivo. Protein microarray analysis revealed and western blot confirmed that the compound significantly increased protein levels of cathepsins, especially cathepsin D, a lysosomal aspartyl protease known to have various pathophysiological functions. Further studies showed that the compound induced tumor cell apoptosis through the Bid/Bax/Cytochrome C/caspase 9/caspase 3 pathway, in which cathepsin D appeared to be a main mediator. Unlike kinase inhibition commonly seen with many other anticancer bis-aryl urea derivatives, this unique mechanism of N69B may suggest potential of the compound as a novel anticancer drug.
Dissecting visceral fibromuscular dysplasia reveals a new vascular phenotype of the disease: a report from the ARCADIA-POL study
Authors: Warchoł-Celińska Ewa , Pieluszczak Krzysztof , Pappaccogli Marco , Soplińska Aleksandra , Prejbisz Aleksander , Dobrowolski Piotr , Klisiewicz Anna , Kądziela Jacek , Falkowski Aleksander , Śmigielski Witold , Florczak Elżbieta , Jóźwik-Plebanek Katarzyna , Michałowska Ilona , Kabat Marek , Zgorzelski Cezary , Madej Krzysztof , Nazarewski Sławomir , Smólski Mikołaj , Olewnik Łukasz , Litwin Mieczysław , Szczerbo-Trojanowska Małgorzata , Zieniewicz Krzysztof , Drygas Wojciech , Rowiński Olgierd , Witkowski Adam , Adlam David , Van der Niepen Patricia , Persu Alexandre , Januszewicz Andrzej , Januszewicz Magdalena
Published: January 2020

Objective:

Visceral artery fibromuscular dysplasia (VA FMD) manifestations range from asymptomatic to life-threatening. The aim of the study is to evaluate the prevalence and clinical characteristics of VA FMD.

Methods:

A total of 232 FMD patients enrolled into ongoing ARCADIA-POL study were included in this analysis. All patients underwent detailed clinical evaluation including ambulatory blood pressure monitoring, biobanking, duplex Doppler of carotid and abdominal arteries and whole body angio-computed tomography. Three control groups (patients with renal FMD without visceral involvement, healthy normotensive patients and resistant hypertensive patients) matched for age and sex were included.

Results:

VA FMD was present in 32 patients (13.8%). Among these patients (women: 84.4%), FMD lesions were more frequent in celiac trunk (83.1%), 62.5% of patients showed at least one visceral aneurysm, and five patients presented with severe complications related to VA FMD. No demographic differences were found between patients with VA FMD and individuals from the three control groups, with the exception of lower weight (P < 0.001) and BMI (P < 0.001) in VA FMD patients. Patients with FMD (with or without visceral artery involvement) showed significantly smaller visceral arterial diameters compared with controls without FMD.

Conclusion:

Patients with FMD showed smaller visceral arterial diameters when compared with patients without FMD. This may reflect a new phenotype of FMD, as a generalized arteriopathy, what needs further investigation. Lower BMI in patients with VA FMD might be explained by chronic mesenteric ischemia resulting from FMD lesions. FMD visceral involvement and visceral arterial aneurysms in patients with renal FMD are far to be rare. This strengthens the need for a systematic evaluation of all vascular beds, including visceral arteries, regardless of initial FMD involvement.
Novel Targets to Treat Depression: Opioid-Based Therapeutics
Authors: Browne Caroline A. , Jacobson Moriah L. , Lucki Irwin
Published: January 2020

Learning objectives

After participating in this activity, learners should be better able to:

• Identify the effects of dysregulated opioid signalling in depression

• Evaluate the use of opioid compounds and ketamine in patients with depression

Major depressive disorder (MDD) remains one of the leading causes of disability and functional impairment worldwide. Current antidepressant therapeutics require weeks to months of treatment prior to the onset of clinical efficacy on depressed mood but remain ineffective in treating suicidal ideation and cognitive impairment. Moreover, 30%–40% of individuals fail to respond to currently available antidepressant medications. MDD is a heterogeneous disorder with an unknown etiology; novel strategies must be developed to treat MDD more effectively. Emerging evidence suggests that targeting one or more of the four opioid receptors—mu (MOR), kappa (KOR), delta (DOR), and the nociceptin/orphanin FQ receptor (NOP)—may yield effective therapeutics for stress-related psychiatric disorders. Furthermore, the effects of the rapidly acting antidepressant ketamine may involve opioid receptors. This review highlights dysregulated opioid signaling in depression, evaluates clinical trials with opioid compounds, and considers the role of opioid mechanisms in rapidly acting antidepressants.
ATTENUATION OUTER RETINAL BANDS ON OPTICAL COHERENCE TOMOGRAPHY FOLLOWING MACULAR EDEMA
Authors: Paques Michel , Rossant Florence , Finocchio Lucia , Grieve Kate , Sahel José-Alain , Pedinielli Alexandre , Mrejen Sarah
Published: January 2020

Purpose:

Macular edema is a common retinal disease which may leave important anatomical and functional sequelaes. Directional fundus imaging consists of comparing on- and off-axis images to reveal angle-dependent reflectance properties of fundus structures, which may be related to misaligned photoreceptors. Here, we analyzed directional optical coherence tomography (OCT) and flood-illumination adaptive optics ophthalmoscopy images to detect evidence of misaligned photoreceptors following macular edema.

Methods:

Transversal, observational study. Nine patients having recovered a normal macular profile after macular edema due to retinal vein occlusion were included. For each patient, a reference OCT scan (i.e., with the incident beam normal to the fovea) was acquired, and off-axis scans were then acquired by laterally shifting the entry pupil. In addition, in four of these eyes, directional adaptive optics ophthalmoscopy documented the directional variations of cone metrics.

Results:

Included patients comprised two women and seven men (age range, 19–76 years). Reference OCT scans showed patchy attenuation of the cone outer segment tips and to a lesser extent of the inner segment/outer segment lines in all, but two eyes; these. Increased intensity of the cone outer segment tips and inner segment/outer segment lines could be observed on off-axis scans. Accordingly, fusion images showed 66% average reduction of the length of cone outer segment tips attenuation. In two cases, although reference scans showed continuity of outer bands, focal attenuation was evidenced in off-axis images. Directional adaptive optics ophthalmoscopy imaging showed a strong directional variability of cone counts in these areas, ranging from near absence to roughly two-third of reference values. In each case, directional variations of cone counts paralleled those of the reflectance of outer bands.

Conclusion:

After macular edema, focal attenuations of the inner segment/outer segment and of the cone outer segment tips lines may be present on OCT. These areas may show a strong directional variability by both OCT and adaptive optics ophthalmoscopy, suggesting that misaligned photoreceptor outer segments contribute to such features. The evaluation of outer retinal damage following macular edema should therefore take into account the optical Stiles–Crawford effect to disambiguate missing from misaligned cones.
SURGICAL OUTCOMES OF 25-GAUGE PARS PLANA VITRECTOMY USING AIR AS AN INTERNAL TAMPONADE FOR PRIMARY RHEGMATOGENOUS RETINAL DETACHMENT
Authors: Li Yunyun , Cheung Ning , Jia Liyun , Zhang Hui , Liu Ningpu
Published: January 2020

Purpose:

To report surgical outcomes of 25-gauge pars plana vitrectomy using air as an internal tamponade for patients with primary rhegmatogenous retinal detachment (RRD).

Methods:

A retrospective clinical study of 59 eyes of 59 consecutive patients presented with primary RRD at the Beijing Tongren Eye Center in China. From August 2016 to May 2018, medical records of the patients who underwent 25-gauge pars plana vitrectomy with air tamponade for RRD were reviewed. The main outcome measures were primary and final anatomical success (retinal re-attachment) rates, and postoperative complications.

Results:

Of the 59 patients, aged 54.47 ± 11.81 years, 31 (52.5%) were men. Vitrectomy was performed 3 to 40 (averaged 16.98 ± 10.17) days after the onset of symptoms, and the mean follow-up period was 12.90 ± 5.92 months (ranging 6.07–26.10 months). Forty-two eyes (71.2%) had RRD with retinal breaks in the superior half of the retina, and the mean number of retinal breaks was 1.75 ± 0.94. Three eyes (5.1%) had RRD with giant retinal tears. Of the 59 eyes, 35 (59.3%) had RRD with inferior quadrants involved. Proliferative vitreoretinopathy (PVR) gradings were C1 in 2 (3.4%) eyes and B or below in 57 (96.6%) eyes. The primary and final anatomical success rates were 94.9% (56/59) and 98.3% (58/59), respectively. Of the three eyes which developed re-detachment of the retina, one eye had postoperative progression of PVR and two eyes were RRD associated with macular hole in high myopia. Postoperative complications included 5 eyes (8.5%) with serous choroidal detachment within 3 days after surgery and 4 eyes (6.8%) with macular epiretinal membrane formation 1 to 8 months after surgery. Secondary cataract surgery was performed in 13 of the 53 phakic eyes (24.5%) during follow-up.

Conclusion:

Small-gauge pars plana vitrectomy with air tamponade may be effective in treating selected cases of relatively simple primary RRD. Additional studies are needed to verify the efficacy of this surgical approach for more complicated cases such as those with giant retinal tears.
INTRAVITREAL RANIBIZUMAB INJECTION AND RETINAL LASER PHOTOCOAGULATION TREATMENT FOR ADULT-ONSET COATS DISEASE
Authors: Plaza-Laguardia Carlos , Pascual-Camps Isabel , Bayón-Porras María Rosa , Sánchez-Cañizal Jorge , Gallego-Pinazo Roberto
Published: January 2020

Purpose:

To describe the evolution of a case of adult-onset Coats disease and the results of treatment with intravitreal ranibizumab and laser photocoagulation.

Methods:

Observational case report.

Case report:

A 17-year-old girl presented with vision loss in her right eye (20/50) showing aneurysmatic and abnormal telangiectatic vessels associated with profuse lipid exudation and serous retinal detachment within the temporal posterior pole. The diagnosis of Coats disease was established and therapy with intravitreal injections of ranibizumab and photocoagulation was initiated achieving control of the exudative manifestations leading to restoration of visual acuity (20/20).

Conclusion:

Treatment with antiangiogenic agents before laser photocoagulation may be useful for treatment of adult-onset Coats disease.
SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY FINDINGS IN A CASE OF PACHYCHOROID NEOVASCULOPATHY IN RETINITIS PIGMENTOSA
Authors: Attanasio Marcella , Maggio Emilia , Arena Fabrizio , Pertile Grazia
Published: January 2020

Purpose:

To report a rare case of pachychoroid neovasculopathy in retinitis pigmentosa (RP) and to describe its features and changes after treatment with bevacizumab as documented by swept-source optical coherence angiography.

Methods:

A case report of a 69-year-old man with a history of RP who presented at our clinic with an acute decrease in visual acuity (Best corrected visual acuity) in his left eye.

Results:

Upon the first examination, best-corrected visual acuity in the left eye was 20/50. Fundus examination and fundus autofluorescence showed bilaterally typical features of RP, and enhanced depth imaging–optical coherence tomography revealed a pachychoroid pattern. Fluorescein angiography and indocyanine green angiography suggested the presence of a choroidal neovascularization in the left eye, although no clear evidence of any neovascular network could be identified. Swept-source optical coherence angiography was performed, confirming the presence of a choroidal neovascularization network. The patient was treated with 2 monthly intravitreal injections of bevacizumab. After treatment, BVCA improved to 20/25, and no evidence of the vascular network was detectable on swept-source optical coherence angiography.

Conclusion:

Our case reports the uncommon association of RP with pachychoroid neovasculopathy. Swept-source optical coherence angiography proved to be a useful imaging technique for the diagnosis and follow-up of this condition. Intravitreal bevacizumab represents an effective treatment for choroidal neovascularization associated with RP.
Tempestuous Course of Enterococcus Infective Endocarditis — From Daptomycin Lung Toxicity to Successful Treatment With Surgery and Fosfomycin Combination Therapy
Authors: Gupta Neha , Sah Ranjit , Chawla Sony , Kasliwal Ravi R. , Tarique Ahmar , Mehta Yatin , Trehan Naresh
Published: January 2020

Management of enterococcal infective endocarditis (IE) is one of the intriguing challenges in infectious diseases. Ampicillin with gentamicin is the standard therapy for susceptible Enterococcus faecalis. However, in presence of β-lactam-resistant isolates, nephroxicity, or allergy to β-lactams, alternatives like glycopeptides and daptomycin have been used for the treatment of enterococcus IE. We report a patient with E. faecalis IE who had allergy to β-lactam and during treatment had developed daptomycin lung toxicity. He was subsequently treated with intravenous fosfomycin and surgery with aortic valve replacement.