bluuebunny/crossref_metadata_2025 huggingface dataset:
PSI-13 Amino acid profile of GuarPro F-81, a potential protein source for swine and other agricultural animals in the United States
Authors: McCafferty Alexandra G , Humphrey Rebecca M , Shamimul Hasan M , Crenshaw Mark A , Brett James , Rude Brian J , Liao Shengfa F
Published: July 2019

Feed is the most expensive component in raising agricultural animals such as pigs in the United States Guar meal is the main by-product from the guar gum production from guar (Cyamopsis tetragonoba) seed. Although said to be unpalatable and possibly toxic, the recently improved products possess promise to be alternative protein-providing feedstuffs for animal industries, primarily because they contain great amounts of protein and are inexpensive. This study was conducted to mainly evaluate the amino acid profile of GuarPro F-81, a newly developed guar meal product in India. Three samples were randomly collected from a production company in India and aliquoted to multiple sub-samples (20 to 200 g/sub-sample), after received, for nutrient evaluation in 2 to 7 laboratories. Results showed that GuarPro F-81 contained (as-fed basis, ±SD) 97.1 ± 1.92% dry matter (n = 7), 57.9 ± 1.29% crude protein (n = 7), 7.17 ± 0.38% crude fat (n = 5), 3.24 ± 1.06% crude fiber (n = 4), 4,440 ± 622 kcal/kg gross energy (n = 2), and 5.40 ± 0.43% ash (n = 5). The amino acid contents (as-fed basis, ±SD, n = 3) were 2.30 ± 0.102% lysine, 0.61 ± 0.032% methionine, 0.68 ± 0.029% cysteine, 1.57 ± 0.009% threonine, 0.80 ± 0.048% tryptophan, 7.43 ± 0.149% arginine, 3.10 ± 0.064% leucine, 1.70 ± 0.095% isoleucine, 1.99 ± 0.073% valine, 1.42 ± 0.075% histidine, 2.14 ± 0.030% phenylalanine, 1.53 ± 0.352% tyrosine, 2.79 ± 0.027% glycine, 2.40 ± 0.190% serine, 1.85 ± 0.108% proline, 2.04 ± 0.015% alanine, 11.14 ± 0.268% glutamic acid, and 5.53 ± 0.096% aspartic acid. While the contents of alanine, cysteine, tyrosine, methionine, valine, phenylalanine, leucine, threonine, isoleucine, lysine, and proline were approximately 0.9 to 27% less than that in soybean meal (a dehulled, solvent extracted product), the contents of serine, aspartic acid, histidine, tryptophan, glutamic acid, glycine, and arginine were approximately 1.8 to 115% higher than those in soybean meal, and so was the crude protein content which was approximately 21.3% higher. While the crude fiber content was approximately 17% less, the crude fat and gross energy contents were approximately 372% and 4% higher than that in soybean meal, respectively.
PSI-14 Relationships of neonatal beef calf vigor with metabolic status
Authors: Wichman Lindsey G , Bronkhorst Claiborn M , Wook Ronna J , Stephenson Emma L , Meyer Allison M , Radunz Amy E
Published: July 2019

The objective of this study was to evaluate the relationships of neonatal beef calf behavior with calf serum metabolites. Angus, Hereford and crossbred beef females (n = 36; age = 4.0 ± 1.74; BCS = 6.5 ± 1.04; primiparous =5, multiparous = 31; calving date = April 4, 2018) and their calves were monitored continuously from 0 to 4 h post-parturition using a digital video recording system from March to May 2018. Jugular blood samples were obtained from calves at 24 (24.4 ± 1.73) and 48 to 72 (54.7 ± 9.08) h postnatal to determine serum blood urea nitrogen (BUN), glucose, non-esterified fatty acids (NEFA), and total protein (TP). Video was analyzed for behavior latencies calculated from time of birth to time when calf shakes head, kneels, attempts to stand, stands, and suckles. Time to stand had a weak positive correlation (P = 0.03) with time to suckle. Time to shake head had a moderate positive correlation (P ≤ 0.04) with both time to attempt to stand and time to stand, but did not correlate (P = 0.99) with time to suckle. Dam parity (multiparous or primiparous) did not affect (P ≥ 0.20) calf vigor measures. Time to suckle had a moderate negative correlation (P ≤ 0.05) with both serum glucose and total protein at 24 and 72 h, however did not correlate (P ≥ 0.31) with BUN or NEFA serum concentrations. In conclusion, the initial calf vigor measures were poor predictors of time to suckle; however, time to stand may be a viable vigor measure used to predict calf suckling. Further analysis of immunoglobulin G concentrations in calf serum will be used to determine if these vigor measures have a relationship with passive immune transfer in beef calves.
PSI-15 Factors affecting circulating metabolites and postnatal growth in spring-born neonatal beef calves
Authors: Bronkhorst Claiborn M , Wichman Lindsey G , Wook Ronna J , Stephenson Emma L , Meyer Allison M , Radunz Amy E
Published: July 2019

The objective of this experiment was to evaluate relationships of dam parity and calf suckling within 4 h postnatal with neonatal circulating metabolite concentrations, neonatal environment, and postnatal growth. For the experiment, 36 Angus, Hereford, and crossbred dams (age = 4.0 ± 1.74; multiparous (n = 5) and primiparous (n = 31); BCS = 6.5 ± 1.04; average calving date = April 4, 2018) were used. Calves were observed using a digital video recording system for 4 h after birth to determine suckling success [S = suckled (n = 27) or NS = did not suckle (n = 5) ≤ 4 h]. Jugular blood samples were obtained from calves at 24 (24.4 ± 1.73) and 48 to 72 (54.7 ± 9.08) h of age to determine serum blood urea nitrogen (BUN), glucose, non-esterified fatty acids (NEFA), and total protein (TP). Postnatal growth measures were collected at 50.4 ± 13.6 d and 162 ± 19.7 d of age. Calf BW was greater (P ≤ 0.02) at 50 and 162 d of age and ADG (0 to 162 d) was greater (P = 0.04) for S than NS calves, however birth BW was not different (P = 0.69). Ambient temperature at parturition was colder (P = 0.03) for NS calves than S calves. Serum glucose at 24 and 72 h was greater (P ≤ 0.03) in S calves than NS calves, however NEFA, BUN, and TP were not affected (P ≥ 0.09) by suckling success at either sampling time. Dam parity had no effect (P ≥ 0.12) on calf circulating metabolites at 24 and 72 h postnatal. In conclusion, the success of beef calves to suckle within 4 h of birth is associated with greater circulating glucose, warmer ambient temperature at birth, and greater postnatal BW and ADG.
PSI-17 A 16S rDNA reference database of the deep-nasopharynx in steers for bacterial community analysis of cattle with bovine respiratory disease complex
Authors: Henniger Madison T , Myer Phillip R , Smith Timothy P L , McDaneld Tara G , Kuehn Larry A , Keele John W
Published: July 2019

Bovine respiratory disease complex (BRDC) is caused by a variety of complex factors that involves host elements, environmental elements, inadequate management and housing, as well as viral and bacterial pathogens, such as Mannheimia haemolytica and Mycoplasma bovis. The objective of the study was to develop and evaluate a deep-nasopharyngeal bacterial community database to provide greater assignment of taxa within the bovine nasopharynx and as a site-specific tool for examining microbiome dysbioses involved in BRDC. A total of 180 cattle with an overall BW ranging from 164-269 kg were obtained from Athens, Tennessee (n = 60), Maryville, Missouri (n = 60), and Richmond, Kentucky (n = 60). Cattle were transported to a feeding facility in Kansas and housed in open air, dirt floor, group housing pens. At the first diagnosis of BRD, deep nasopharyngeal samples were collected. DNA library preparation of the bacterial 16S rRNA V1–V8 hypervariable regions was performed and sequenced on the Pacific Biosciences RSII instrument. Database construction and all sequencing data were curated using mothur (v1.39.5). For validation analyses using, a subset of cattle was sampled as described above, and three samples sequenced using the V1–V3 hypervariable 16SrRNA regions and the Illumina MiSeq. In the database, Mycoplasma accounted for over 57% of the reads and Mannheimia was present at 0.7%. When validating the database using short-reads, unassigned taxa in the Greengenes analysis was 4.22% contrasted to the 0.91% of the closed reference database analysis. The two taxonomic compositions were not correlated and the correlation was statistically significant (r = -0127; P = 0.001). All alpha diversity indices between the two analysis methods differed (P < 0.05). Development of this reference database provides researchers a tool with considerable improvements in performance for the analysis of bacterial communities in the nasopharynx relating to cattle diagnosed with BRDC.
Effects of endophyte-infected tall fescue seed and protein supplementation on stocker steers: I. Growth performance and hemodynamic responses
Authors: Poole Rebecca K , Womble Carrisa M , Poore Matthew H , Poole Daniel H , Pickworth Carrie L
Published: July 2019

Fescue toxicosis is a multifaceted syndrome common in cattle grazing endophyte-infected tall fescue and is detrimental to growth and performance. Recent research has shown that supplementing protein has the potential to enhance growth performance in weaned steers. Therefore, the objective of this study was to evaluate the effect of supplemental CP on physiological parameters in stocker steers experiencing fescue toxicosis. Thirty-six weaned Angus steers (6 mo of age) stratified by weight (196.1 ± 3.6 kg) were assigned to a 2 × 2 factorial arrangement for 56 d: endophyte-free (EF) seed and 14% CP (EF-14; n = 9), EF seed and 18% CP (EF-18; n = 9), endophyte-infected (EI) seed and 14% CP (EI-14; n = 9), and EI seed and 18% CP (EI-18; n = 9). Steer growth and hemodynamic responses were collected weekly during ergot alkaloid exposure. On day 14 of the trial, iButton temperature data loggers were subcutaneously inserted in the lateral neck region to record hourly body temperature for 42 d. Data were analyzed using PROC MIXED of SAS with repeated measures. No differences were observed in DMI, BW, ADG, F:G, or BCS during the treatment period (P > 0.05). Hair shedding scores, rectal temperatures, surface temperatures, and respiration rates were greater in EI steers compared to EF steers regardless of supplemental CP (P < 0.05). However, subcutaneous body temperature was greater in EI-14 steers (37.94 °C) compared to other steer groups (37.60, 37.68, 37.72 ± 0.04 °C for EF-14, EF-18, and EI-18, respectively; P < 0.05). Prolactin concentrations tended to be greater in EF steers when compared to EI steers (P = 0.07). Heart rate and hematocrit were reduced for EI-18 steers compared to other steer groups (P < 0.05). Caudal artery diameter was reduced in EI-18 steers compared to EI-14 steers (2.60 vs. 2.75 ± 0.05 mm, respectively; P < 0.05) and caudal vein diameter was reduced in EI-18 steers (3.20 mm) compared to all other steer groups (3.36, 3.39, 3.50 mm for EF-14, EF-18, and EI-14, respectively; P < 0.05). However, there was no difference observed in systolic or diastolic blood pressure during the treatment period (P > 0.05). Based on the data, exposure to low to moderate levels of ergot alkaloids during the stocker phase had a negative impact on hemodynamic responses and supplemental CP had minimal impact to alleviate symptoms. Therefore, feeding additional protein above established requirements is not expected to help alleviate fescue toxicosis.
A New System for Detecting Initial Colonization by Invasive Pests and Their Locations
Authors: Ikegawa Yusuke , Honma Atsushi , Himuro Chihiro , Matsuyama Takashi
Published: July 2019

Quarantine pests in plants can be a serious agricultural problem; many eradication programs using area-wide control measures have been implemented worldwide to combat this threat. Surveillance measures using sex pheromone (in general, male-attractant) traps are also widely implemented for rapid control and eradication of invasive pests. If initial pest colonization can be determined based on temporal count data of trapped insects (i.e., males), and countermeasures are applied only during colonization, costs incurred by these countermeasures would be dramatically reduced, especially in areas with frequent invasions. In this study, we developed a system to detect initial pest colonization, and to narrow down colonized regions using estimated temporal count data of the sweet potato weevil, Cylas formicarius Fabricius (Coleoptera: Curculionidae), in Tsuken Island, Okinawa, Japan. We verified the system by comparing our estimates to actual colonization data obtained via regular host plant surveys. Results indicated that our system was able to successfully detect pest colonization and estimate colonized regions. In this study, we discuss the conditions (i.e., pest biology, environment, etc.) that are optimal for application of our system.
The Law of State Immunity
Authors: Hazel Fox , Philippa Webb
Published: July 2019

Revised and updated to include recent developments since 2013, this new edition provides a detailed guide to the operation of the international rule of State immunity which bars one State's national courts from exercising criminal or civil jurisdiction over claims made against another State. Building on the analysis of its two previous editions, it reviews relevant material at both international and national levels with particular attention to US and UK law; the 2004 UN Convention on Jurisdictional Immunities of the State and its Property (not yet in force), and also seeks to assess the significance of recent changes in the evolution of the law. Although the restrictive doctrine of immunity is now widely observed by which foreign States may be sued in national courts for their commercial transactions, the immunity rule remains controversial, not only by reason of the recognition of a single State's right to deny a remedy for a wrong — China, a major trading State, continues to adhere to the absolute bar — but also by the exclusion of any reparation or relief for the commission on the orders of a State of grave human rights violations. The complexity and moral challenge of the issues is illustrated by high profile cases. The expanding extraterritorial jurisdiction of national courts with regard to torture in disregard of pleas of act of State and nonjusticiability offers a further challenge to the exclusionary nature and continued observance of State immunity. Recent developments in key areas are examined, including: impleading; public policy and non-justiciability; universal civil jurisdiction for reparation for international crimes; the application of the employment exception to embassies and diplomats; immunity from enforcement and procedural measures; immunity of State officials, and tensions between national constitutional requirements and superior international norms.
Part I General Concepts, 3 The Plea of State Immunity Distinguished from Act of State and Non-Justiciability
Authors: Hazel Fox , Philippa Webb
Published: July 2019

This chapter distinguishes the plea of State immunity from the related but different concepts of act of State and non-justiciability, focusing on the approaches taken in the UK and the US. While the doctrines of act of State and non-justiciability will normally work in the same direction as the plea of State immunity to prevent examination of the validity of a foreign State's acts, practice shows that in proceedings between private parties the court may set aside its usual respect for other States' jurisdiction where the acts of the foreign State constitute a fundamental breach of international human rights or other clearly established international law, whereas it will show hesitation in a direct suit to rule against the foreign State defendant.
Part III The Current International Law of State Immunity, 12 The Concept of Commerciality
Authors: Hazel Fox , Philippa Webb
Published: July 2019

This chapter provides a brief overview of the categories of acts in the exercise of sovereign authority, a discussion of the basis of this distinction and the criteria to support it, and a general evaluation of the restrictive doctrine. A core issue for the modern justification of the restriction of absolute State immunity is the private law or commercial nature of the activity which forms the subject of a claim before a national court and supplies the distinction between sovereign governmental acts and private acts on which the rules are based. The commercial or private law exception is driven by an increasing concern for private rights and public morality, coupled with the increasing entry of governments into what had previously been regarded as private pursuits. That concern is widespread, but establishing a legal formulation for the exception has proved difficult.
Part III The Current International Law of State Immunity, 14 Immunity from Adjudication: The Employment Exception in respect of (1) A Foreign State and (2) An International Organization
Authors: Hazel Fox , Philippa Webb
Published: July 2019

This chapter examines the exception for employment as it pertains to States and international organizations. Whilst the employment — its terms for performance, remuneration, including sick pay, overtime, and other benefits, notice and procedures for dismissal or termination — may be provided in an individual contract or imported from standard terms of employment or collective bargaining agreements, there may also be a considerable overlay of statutory or mandatory provisions that the national labour law imposes or in respect of which increasingly the forum State has assumed regional or international law obligations. There are also certain generally accepted practices relating to employment to be taken into account in considering the scope of the immunity of a foreign State and international organization as regards employment claims brought before the national courts of another State.
Think of the Children: Liability for Non-Disclosure of Information Post-Montgomery
Authors: Cave Emma , Purshouse Craig
Published: July 2019

In 2015, the Supreme Court in Montgomery v Lanarkshire Health Board handed down a landmark decision on informed consent to medical treatment, heralding a legal shift to a more patient-centred approach. Montgomery, and the extensive commentary that has followed, focuses on ‘adult persons of sound mind’. Cave and Purshouse consider the potential claims that may flow from a failure to adequately inform children. They argue that the relevance of the best interests test blurs the boundaries between negligence and battery. Limitations on children’s rights to make treatment decisions for themselves impact on their potential to claim in negligence for non-disclosure and, conversely, enhance the potential relevance of the tort of battery. In paediatric cases, Montgomery raises expectations that the law is currently ill-equipped to satisfy. Tort law provides a legal incentive to disclose relevant information to children but limits the availability of a remedy.
Apps for Older People’s Pain Self-Management: Perspectives of Primary Care and Allied Health Clinicians
Authors: Bhattarai Priyanka , Newton-John Toby , Phillips Jane L
Published: July 2019

Background

Chronic arthritic pain is one of the major causes of physical suffering and disability among older people. Primary care and allied health clinicians use various approaches to help their older clients better manage their arthritic pain. The growing uptake of technology among older people offers the potential for clinicians to integrate an arthritic pain app into their patients’ self-management plans. This study explored the perspectives of Australian primary care and allied health clinicians regarding the use of pain self-management apps to help their older patients/clients better manage their arthritic pain.

Methods

Qualitative design using a semistructured interview approach. Interviews were conducted via telephone with primary and allied health clinicians (N = 17) across Australia.

Results

The overarching theme underlying participants’ views on integration of apps into older people’s pain self-management strategy was that this approach is an idealistic but uniquely challenging endeavor. Four subthemes emerged, namely: 1) self-management apps are a potentially useful tool but require careful consideration; 2) clinicians’ involvement is crucial yet potentially onerous; 3) no single app is right for every older person with arthritic pain; and 4) patient data access is beneficial, but caution is needed for real-time data access.

Discussion

The predominant clinician perspective of integrating apps into their older patients/clients’ pain self-management strategies was that this approach is an idealistic but uniquely challenging endeavor. Apps were seen as having potential to support various aspects of patients’ self-management behaviors; however, there were notable concerns with regards to the challenges inherent in this approach for both clinicians and older users (patients/clients).
Creative Yoga Intervention Improves Motor and Imitation Skills of Children With Autism Spectrum Disorder
Authors: Kaur Maninderjit , Bhat Anjana
Published: July 2019

Background

There is growing evidence for motor impairments in children with autism spectrum disorder (ASD), including poor gross and fine motor performance, poor balance, and incoordination. However, there is limited evidence on the effects of motor interventions for this population.

Objective

In the present study, the effects of a physical therapy intervention using creative yoga on the motor and imitation skills of children with ASD were evaluated.

Design

This study had a pretest-posttest control group design.

Methods

Twenty-four children with ASD aged between 5 and 13 years received 8 weeks of a physical therapist-delivered yoga or academic intervention. Children were tested before and after the intervention using a standardized motor measure, the Bruininks-Oseretsky Test of Motor Performance–2nd Edition (BOT-2). The imitation skills of children using familiar training-specific actions (ie, poses for the yoga group and building actions for the academic group) were also assessed.

Results

After the intervention, children in the yoga group improved gross motor performance on the BOT-2 and displayed fewer imitation/praxis errors when copying training-specific yoga poses. In contrast, children in the academic group improved their fine motor performance on the BOT-2 and performed fewer imitation errors while completing the training-specific building actions.

Limitations

The study limitations include small sample size and lack of long-term follow-up.

Conclusions

Overall, creative interventions, such as yoga, are promising tools for enhancing the motor and imitation skills of children with ASD.
Maslinic acid protects against obesity‐induced nonalcoholic fatty liver disease in mice through regulation of the Sirt1/AMPK signaling pathway
Authors: Liou Chian‐Jiun , Dai Yi‐Wen , Wang Chia‐Ling , Fang Li‐Wen , Huang Wen‐Chung
Published: July 2019

Maslinic acid is a pentacyclic triterpenoid that is distributed in the peel of olives. Previous studies found that maslinic acid inhibited inflammatory response and antioxidant effects. We investigated whether maslinic acid ameliorates nonalcoholic fatty liver disease in mice with high‐fat‐diet (HFD)‐induced obesity and evaluated the regulation of lipogenesis in hepatocytes. Male C57BL/6 mice fed a normal diet or HFD (60% fat, w/w) were tested for 16 wk. After the fourth week, mice were injected intraperitoneally with maslinic acid for 12 wk. In another experiment, HepG2 cells were treated with oleic acid to induce lipid accumulation or maslinic acid to evaluate lipogenesis. Maslinic acid significantly reduced body weight compared with HFD‐fed mice. Maslinic acid reduced liver weight and liver lipid accumulation and improved hepatocyte steatosis. Furthermore, serum glucose, leptin, and free fatty acid concentrations significantly reduced, but the serum adiponectin concentration was higher, in the maslinic acid group than in the HFD group. In liver tissue, maslinic acid suppressed transcription factors involved in lipogenesis and increased adipose triglyceride lipase. In vitro, maslinic acid decreased lipogenesis by activating AMPK. These findings suggest that maslinic acid acts against hepatic steatosis by regulating enzyme activity involved in lipogenesis, lipolysis, and fatty acid oxidation in the liver.—Liou, C.‐J., Dai, Y.‐W., Wang, C.‐L., Fang, L.‐W., Huang, W.‐C. Maslinic acid protects against obesity‐induced nonalcoholic fatty liver disease in mice through regulation of the Sirt1/AMPK signaling pathway. FASEB J. 33, 11791‐11803 (2019). www.fasebj.org
Imbalance of autophagy and apoptosis in intestinal epithelium lacking the vitamin D receptor
Authors: Lu Rong , Zhang Yong‐Guo , Xia Yinglin , Sun Jun
Published: July 2019

Apoptosis and autophagy are dynamic processes that determine the fate of cells. Vitamin D receptor (VDR) deficiency in the intestine leads to abnormal Paneth cells and impaired autophagy function. Here, we will elucidate the mechanisms of the intestinal epithelial VDR regulation of autophagy and apoptosis. We used in vivo VDRlox and VDRΔIEC mice and ex vivo organoids generated from small intestine and colon tissues. We found that VDR deficiency induced more apoptotic cells and significantly increased cell death in the small intestine and colon of VDRΔIEC mice. The proapoptotic protein B‐cell lymphoma 2 (BCL‐2) associated X protein (Bax) was enhanced, whereas autophagy related 16 like 1 (ATG16L1) and Beclin‐1 were decreased in the intestines of VDRΔIEC mice. Apoptosis induced by Bax reduced autophagy by decreasing Beclin‐1. Physical interactions between Beclin‐1 and Bcl‐2 were increased in the VDR‐deficient epithelia from mice. The growth of VDRΔIEC organoids was significantly slower with fewer Paneth cells than that of VDR+/+ organoids. The expression levels of Beclin‐1 and lysozyme were decreased in VDRΔIEC organoids. Bacterial endotoxin levels were high in the serum from VDRΔIEC mice and made mice susceptible to colitis. In the organoids and colitis IL‐10‐/‐ mice, vitamin D3 treatment increased VDR and ATG16L1 protein expression levels, which activated autophagic responses. In summary, intestinal epithelial VDR regulates autophagy and apoptosis through ATG16L1 and Beclin‐1. Our studies provide fundamental insights into the tissue‐specific function of VDR in modulating the balance between autophagy and apoptosis.—Lu, R., Zhang, Y.‐G., Xia, Y., Sun, J. Imbalance of autophagy and apoptosis in intestinal epithelium lacking the vitamin D receptor. FASEB J. 33, 11845‐11856 (2019). www.fasebj.org
The Utility of the Early Postoperative Follow-up and Radiographs After Operative Treatment of Supracondylar Humerus Fractures in Children
Authors: Acosta Anna M. , Li Yi-Ju , Bompadre Viviana , Mortimer Alex , Trask Michael , Steinman Suzanne E.
Published: July 2019

Background:

Supracondylar humerus (SCH) fractures are common elbow injuries in pediatric patients. The American Academy of Orthopedic Surgeons published guidelines for the standard of care in the treatment of displaced SCH fractures, however, no recommendations for follow-up care were made. With the recent push to eliminate unnecessary radiographs and decrease health care costs, many are questioning postoperative protocols. The purpose of our study was to evaluate the utility of the 1-week follow-up appointment after closed reduction and percutaneous pinning (CRPP) of displaced SCH fractures.

Methods:

A retrospective review performed at a single institution from 2014 to 2016 included patients under 14 years of age with a closed, displaced SCH fracture treated with CRPP. Exclusion criteria included patients without complete clinical or radiographic follow-up. Variables examined included time to initial follow-up, change in treatment plan after 1-week x-rays, complications, demographics, fracture type, pin number and configuration, reduction parameters, immobilization, time to pin removal, duration of casting, and clinical outcome.

Results:

A total of 412 patients were divided into 2 groups based on time to initial follow-up. Overall, 368 had an initial follow-up at 7 to 10 days (group 1) and 44 at 21 to 28 days (group 2). There was no difference in age, sex, fracture type, pin configuration, or a number of pins between groups. Statistically significant findings included time to initial follow-up and days to pin removal (group 1 at 26.2 d vs. group 2 at 23.8 d), type of immobilization (group 1 with 5% circumferential casts and group 2 with 70%), and time to surgery (26.2 vs. 62.9 h, respectively). There was no significant difference in complication rates and only a 0.5% rate of change in management in group 1.

Conclusions:

Early postoperative follow-up and radiographs did not change the patient outcome and might be eliminated in children with displaced SCH fractures treated with CRPP. Given the current focus of on efficiency and cost-effective care, eliminating the 1-week postoperative appointment would improve appointment availability and decrease medical cost.

Level of Evidence:

Level III—Therapeutic.
Long-term Outcome of Anterior Cervical Decompression With Fusion for Cervical Ossification of Posterior Longitudinal Ligament Including Postsurgical Remnant Ossified Spinal Lesion
Authors: Nakajima Hideaki , Watanabe Shuji , Honjoh Kazuya , Kitade Ippei , Sugita Daisuke , Matsumine Akihiko
Published: July 2019

Study Design.

A retrospective study.

Objective.

The aim of this study was to assess the outcome, perioperative complications, and prognostic factors of anterior cervical decompression and fusion (ACDF) in patients with cervical ossification of posterior longitudinal ligament (OPLL).

Summary of Background Data.

There is little information on the long-term surgical outcome of ACDF including postsurgical remnant ossified spinal lesion.

Methods.

Between 1993 and 2013, 80 patients with cervical myelopathy towing to OPLL underwent ACDF at our hospital. Among these, 42 patients were followed-up for at least 5 years and their data were analyzed.

Results.

The mean follow-up period was 7.9 ± 2.8 years, and the overall improvement rate was 59.2% ± 15.0%. Although 12 (15.0%) perioperative complications were observed in 6 patients, accompanied by neurological deterioration, none of the patients had chronic complications. Multivariate logistic regression analysis that included the preoperative Japanese Orthopaedic Association (JOA) score, type of OPLL, occupying ratio of OPLL, and number of fused segments and increase in the transverse area of the cord identified the latter parameter as the only independent and significant determinant of radiological and clinical improvement of >50%. Among the patients with remaining ossified spinal lesions out of the decompressed range (16 patients), postoperative progression was observed in 6 cases (14.3%) who were all of the mixed type; floated lesions within the decompressed range did not show progression during the follow-up. Adjacent segment degeneration was seen in nine (21.4%) patients, and neurological signs and symptoms were seen in only three of the nine patients and only one patient required revision surgery.

Conclusion.

The long-term clinical outcome of patients with cervical OPLL after ACDF is considered satisfactory. Surgery-related complications and adjacent segment diseases should not be reasons to avoid ACDF. Care should be taken in selecting ACDF with postsurgical remnant ossified spinal lesion, as it could progress postoperatively especially in the mixed type OPLL.

Level of Evidence: 4
Radial Head Resection and Corium Interposition Arthroplasty in Skeletally Immature Patients With Isolated Posttraumatic Radial Head Arthrosis
Authors: Farr Sebastian , Abualruz Mohammad M. , Girsch Werner
Published: July 2019

Radiocapitellar arthrosis represents a serious sequela of pediatric elbow injuries. Although persistent pain and disability are not uncommon in such cases, treatment remains controversial. The present study aimed to review the clinical outcomes after a new surgical treatment with partial radial head resection and corium interposition arthroplasty. To date, 3 adolescent cases underwent the surgical procedure and postoperative care. Thorough clinical and radiographic follow-up was performed. The mean age at the time of surgery was 14.4 years (range, 13 to 16 y) and mean duration of follow-up was 19 months (range, 12 to 29 mo). The postoperative range of motion was maintained in all cases. The outcome was rated as excellent in all 3 patients for the Disabilities of the Arm, Shoulder and Hand score (mean, 3; range, 0 to 6.7) and Mayo Elbow Performance Score (mean, 92; range, 80 to 100). The mean Timmermann score; however, was still rated as fair despite marked improvements (mean, 153; range, 145 to 165). No complications such as elbow stiffness, osteophytes formation, radial head overgrowth, or proximal radius migration occurred. In pediatric isolated posttraumatic radiocapitellar arthrosis, we believe that radial head resection and corium interposition arthroplasty is an effective salvage procedure to alleviate symptoms and maintain elbow function with good to excellent clinical outcomes and no proximal migration of the radius.
The Impact of Radiotherapy Facility Volume on the Survival and Guideline Concordance of Patients With Muscle-invasive Bladder Cancer Receiving Bladder-preservation Therapy
Authors: D’Rummo Kevin A. , TenNapel Mindi J. , Shen Xinglei
Published: July 2019

Objectives:

Higher facility surgical volume predicts for improved outcomes in patients with muscle-invasive bladder cancer (MIBC) who undergo radical cystectomy. We investigated the association between facility radiotherapy (RT) case volume and overall survival (OS) for patients with MIBC who received bladder-preserving RT, and the relationship with adherence to National Comprehensive Cancer Network (NCCN) guidelines for bladder preservation.

Methods:

The National Cancer Database was used to identify patients diagnosed with nonmetastatic MIBC from 2004 to 2015 and received RT at the reporting center. Facility case volume was defined as the total MIBC patients treated with RT during the period. Facilities were stratified into high-volume facility (HVF) or low-volume facility at the 80th percentile of RT case volume. OS was assessed using Kaplan-Meier analysis. Rates of compliance with NCCN guidelines regarding the use of transurethral resection of the bladder tumor before RT, planned use of concurrent chemotherapy, and total RT dose were compared. Cox proportional hazard model was used to evaluate predictors of OS.

Results:

There were 7562 patients included. No differences in age, Charlson-Deyo score, T stage, or node-positive rates were observed between groups. HVFs exhibited greater compliance with NCCN guidelines for bladder preservation (P<0.0001). Treatment at an HVF was associated with the improved OS for all patients (P=0.001) and for the subset of patients receiving NCCN-recommended RT doses (P=0.0081). Volume was an independent predictor of OS (P=0.002).

Conclusions:

Treatment at an HVF is associated with improved OS and greater guideline-concordant management among patients with MIBC.
The Warrior Athlete Part 2—Return to Duty in the US Military: Advancing ACL Rehabilitation in the Tactical Athlete
Authors: Peebles Liam A. , O’Brien Luke T. , Dekker Travis J. , Kennedy Mitchell I. , Akamefula Ramesses , Provencher Matthew T.
Published: July 2019

Rehabilitation following an anterior cruciate ligament reconstruction is a crucial component of the healing and recovery process and full return to duty/play in the tactical modern-day warfighter. The burden of anterior cruciate ligament injuries and subsequent loss of readiness in these military warfighters highlights one of the most significant gaps in musculoskeletal injury care today. Emphasis must be placed on early weight-bearing and range of motion (ROM), namely in this athlete population, to best facilitate a timely care and recovery process. Preoperative rehabilitation should commence immediately following the diagnosis of an anterior cruciate ligament tear, because one of the best predictors of postoperative ROM is preoperative ROM. Recent advances in rehabilitation technology such as Alter-G treadmills, inertial measurement units, and blood flow restriction therapy systems, have demonstrated success in the early rehabilitation of tactical athletes. Alter-G treadmills allow for early weight-bearing with reduced impact and progression in ROM following operative management, while inertial measurement units have been applied to tailoring rehabilitation protocols specifically to an athlete’s unique functional deficits. When used in conjunction with a fined tune rehabilitation protocol, implemented by a well versed clinical team, these treatment techniques can greatly expedite the return to duty process and limit long-term complications.
Perioperative Pain Management and Avoidance of Long-term Opioid Use
Authors: Patzkowski Michael S. , Patzkowski Jeanne C.
Published: July 2019

The opioid epidemic continues to be a problem in the United States and prescription opioid overdose fatalities continue to rise. Chronic opioid use threatens military readiness and puts service members at risk for medical separation from military service. Orthopedic surgeons commonly prescribe opioid medications for postsurgical patients. Long-term opioid use can be the result of acute, postoperative opioid intake. Overprescribing may increase the risk of long-term opioid use, medication diversion and adverse outcomes. Preoperative administration of opioids dramatically increases the risk of continued use up to 1 year after surgery. Strategies to minimize opioid use include opioid-specific preoperative counseling, multimodal analgesia with opioid-sparing oral and intravenous medications, regional anesthesia, minimizing tourniquet use, and preoperative behavioral health evaluation.
Preclinical Validation of a Novel Device Designed to Reduce Biofilms on Percutaneous Osseointegrated Abutments
Authors: Sammons Rachel , East Matthew , Grant Melissa , Proops David
Published: July 2019

Aim:

To assess the efficacy of a prototype cleaning device in removing biofilm from skin-penetrating abutments.

Background:

Adverse skin reactions around percutaneous osseointegrated implants have been linked to poor hygiene and infection. A cleaning device made from open-cell polyfoam has been developed to facilitate manual cleaning of abutments by the patient.

Methods:

Serratia biofilm was grown on clean and sterile conical bone-anchored hearing system abutments including both pre-2007 (straight sided) and post-2007 (conical-sided) designs. Eighteen were photographed and then subjected to cleaning using a toothbrush or the cleaning device soaked in water or a proprietary mouthwash. Biofilm on a further group of 10 conical abutments was recorded using a scanning electron microscope before and after cleaning with the test device soaked in water. Quantitative analysis of the efficiency of the cleaning was made using image analysis.

Results:

Removal of biofilm using a dry or wet toothbrush was not as effective as cleaning with the device. In 10 cases subjected to image analysis, approximately 90% of the biofilm was removed from the top third of the abutments, 85% from the middle third, and 48% from the basal third.

Conclusion:

The cleaning device is effective in removing most biofilm from the test abutments and represents a significant improvement in comparison with traditional methods such as a toothbrush.
Diagnosis and management of spontaneous cerebrospinal fluid fistula and encephaloceles
Authors: Kutz Joe Walter , Tolisano Anthony M.
Published: July 2019

Purpose of review

To describe the current state in the diagnosis and management of spontaneous cerebrospinal fluid (sCSF) fistula and encephaloceles.

Recent findings

The increased incidence of obesity has resulted in more cases of sCSF fistula and encephaloceles. Obesity results in increased intracranial pressure and a greater chance of developing a sCSF fistula or encephalocele. Obstructive sleep apnea can also result in transient increase in intracranial pressure and has been shown to be common in patients with sCSF fistula. Treatment of CSF fistula is usually necessary because of the increased risk of meningitis. The use of hydroxyapatite bone cements to repair the temporal bone defects has been described with a high success rate of closing the fistula and a low complication rate. Concurrent superior semicircular canal dehiscent can be seen in up to 15% of cases and should be suspected during the surgical approach to avoid potential sensorineural hearing loss and chronic imbalance.

sCSF fistula and encephaloceles are an uncommon cause of hearing loss, middle ear effusion, and otorrhea, but should be recognized and repaired because of the risk of meningitis.
What Do We Know About the Do-It-Yourself Diets of Patients in Our Care?
Authors: Veneroni Laura , Rossi Pietro , Della Valle Serena , Gavazzi Cecilia , Meazza Cristina , Clerici Carlo Alfredo , Ferrari Andrea , Massimino Maura
Published: July 2019

This pilot study aimed to investigate dietary changes introduced after being diagnosed with cancer in a sample of 60 consecutive children and adolescents on the basis of a self-report questionnaire. The study showed that 53% of patients changed their diet, usually “to combat the tumor” (in 47% of cases). In 1 in 2 of these cases, the health care staff were not informed about any changes. This study underscores the fact that many patients and families chose to impose dietary changes that are not always discussed with their health care staff and that may risk interfering with the continuity of a patient’s treatment. It is essential to have more opportunities to speak with patients and families about this issue.
Riding the Roller Coaster
Authors: Phillips Carolyn S. , Volker Deborah L.
Published: July 2019

Background

Rates of burnout and compassion fatigue among oncology nurses are rising, and the emotional impact of the work increases the risk. This study examined how oncology nurses describe the evolution of emotions from first significant patient loss through cumulative patient death.

Objective

To explore the emotional evolution of being an oncology nurse.

Methods

Semistructured interviews with 7 oncology nurses. Thematic analysis was used to analyze the data.

Results

Participant’s mean age was 41.3 years, with 13.9 years of nursing experience and 10.6 years of oncology experience. One metatheme, “riding the roller coaster,” described the overall emotional experience of the nurses. Three subthemes, “all in and then,” “finding your way,” and “impact on self,” further outlined the process taken to cope with workplace emotions.

Conclusions

Oncology nurses are frequently exposed to loss and suffering. Findings from this study suggest that new nurses are underprepared for the emotional experience of being an oncology nurse. Further, they define their emotional boundaries in isolation and without guidance on how to develop healthy coping skills. Changing the culture of silence around mental health and well-being among healthcare professionals can provide space for important conversations to occur.

Implications for Practice

Oncology nurses have few resources to teach them how to cope with the emotions experienced while caring for oncology patients. These findings suggest that alternative approaches to the traditional bereavement programs and innovative interventions offered to new oncology nurses within their first few years are needed.
TFEB Expression Profiling in Renal Cell Carcinomas
Authors: Gupta Sounak , Argani Pedram , Jungbluth Achim A. , Chen Ying-Bei , Tickoo Satish K. , Fine Samson W. , Gopalan Anuradha , Al-Ahmadie Hikmat A. , Sirintrapun Sahussapont J. , Sanchez Alejandro , Hakimi Abraham Ari , Mcfarlane Tiffany , Salazar Paulo A. , Williamson Sean R. , Skala Stephanie L. , Mehra Rohit , Hes Ondrej , Antonescu Cristina R. , Ladanyi Marc , Arcila Maria E. , Reuter Victor E.
Published: July 2019

TFEB is overexpressed in TFEB-rearranged renal cell carcinomas as well as in renal tumors with amplifications of TFEB at 6p21.1. As recent literature suggests that renal tumors with 6p21.1 amplification behave more aggressively than those with rearrangements of TFEB, we compared relative TFEB gene expression in these tumors. This study included 37 TFEB-altered tumors: 15 6p21.1-amplified and 22 TFEB-rearranged (including 5 cases from The Cancer Genome Atlas data set). TFEB status was verified using a combination of fluorescent in situ hybridization (n=27) or comprehensive molecular profiling (n=13) and digital droplet polymerase chain reaction was used to quantify TFEB mRNA expression in 6p21.1-amplified (n=9) and TFEB-rearranged renal tumors (n=19). These results were correlated with TFEB immunohistochemistry. TFEB-altered tumors had higher TFEB expression when normalized to B2M (mean: 168.9%, n=28), compared with non–TFEB-altered controls (mean: 7%, n=18, P=0.005). Interestingly, TFEB expression in tumors with rearrangements (mean: 224.7%, n=19) was higher compared with 6p21.1-amplified tumors (mean: 51.2%, n=9; P=0.06). Of note, classic biphasic morphology was only seen in TFEB-rearranged tumors and when present correlated with 6.8-fold higher TFEB expression (P=0.00004). Our results suggest that 6p21.1 amplified renal tumors show increased TFEB gene expression but not as much as t(6;11) renal tumors. These findings correlate with the less consistent/diffuse expression of downstream markers of TFEB activation (cathepsin K, melan A, HMB45) seen in the amplified neoplasms. This suggests that the aggressive biological behavior of 6p21.1 amplified renal tumors might be secondary to other genes at the 6p21.1 locus that are co-amplified, such as VEGFA and CCND3, or other genetic alterations.
Quality Control Measures and Validation in Gene Association Studies: Lessons for Acute Illness
Authors: Cohen Maria , Lamparello Ashley J. , Schimunek Lukas , El-Dehaibi Fayten , Namas Rami A. , Xu Yan , Kaynar A Murat , Billiar Timothy R. , Vodovotz Yoram
Published: July 2019

Acute illness is a complex constellation of responses involving dysregulated inflammatory and immune responses, which are ultimately associated with multiple organ dysfunction. Gene association studies have associated single-nucleotide polymorphisms (SNPs) with clinical and pharmacological outcomes in a variety of disease states, including acute illness. With approximately 4 to 5 million SNPs in the human genome and recent studies suggesting that a large portion of SNP studies are not reproducible, we suggest that the ultimate clinical utility of SNPs in acute illness depends on validation and quality control measures. To investigate this issue, in December 2018 and January 2019 we searched the literature for peer-reviewed studies reporting data on associations between SNPs and clinical outcomes and between SNPs and pharmaceuticals (i.e., pharmacogenomics) published between January 2011 to February 2019. We review key methodologies and results from a variety of clinical and pharmacological gene association studies, including trauma and sepsis studies, as illustrative examples on current SNP association studies. In this review article, we have found three key points which strengthen the potential accuracy of SNP association studies in acute illness and other diseases: providing evidence of following a protocol quality control method such as the one in Nature Protocols or the OncoArray QC Guidelines; enrolling enough patients to have large cohort groups; and validating the SNPs using an independent technique such as a second study using the same SNPs with new patient cohorts. Our survey suggests the need to standardize validation methods and SNP quality control measures in medicine in general, and specifically in the context of complex disease states such as acute illness.