bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of surface wettability of TiO2 particles on evaporation enhancement of silicone oil in the bulk of electrorheological suspensions
Authors: Huang Jing , Wu Xiaoyi , Qiu Zhaohui , Xiong Xiaomin
Published: October 2018

Hydrophilic, oleophilic and raw TiO2 particles are dispered respectively in silicone oil to form electrorheological suspensions and the effect of surface wettability of TiO2 particles on evaporation enhancement of silicone oil is studied. The results show that the evaporation rate of silicone oil increases with the decrease of surface wettability of the particle and the increase of the depth of suspension which indicates that the evaporation mainly occurs in the bulk. The observed phenomena have been explained mainly on the basis of heterogeneous nucleation theory of bubbles. In the bulk of suspensions, the less wettable surface of nanoparticles, the less critical activation energy needed for bubble nucleation, the easier it is to form bubbles which is the origin of the evaporation.
Research on the fluid film lubrication between the piston-cylinder interface
Authors: Wang Dongyun , Song Yang , Tian Jinghong , E Shiju , Haidak Gaston
Published: October 2018

The fluid film between piston and cylinder works simultaneously as bearing and lubricating functions, its thickness determines the lubrication efficiency and performance of an axial piston pump. Because of the thickness is usually micron level, and its change in the whole cycle is difficult to observe directly. In order to reveal it particularly, this paper present a mathematical model which considering structure, piston kinematics and a dynamic piston load to predict the film thickness in a cycle. The minimum thickness is used as an index to evaluate lubrication performance and its variation are studied under different load pressure, rotating speed and length ratio between cylinder and piston. A special test rig with four displacement sensors placed through the cylinder surface allows measuring the film thickness at these points. The model was verified by comparing the numerical results with measurements taken on the test rig. Results indicate that: (1) The mathematical model could effectively predict the film thickness trend and the position of the minimum thickness; (2) The minimum thickness in pressure phase is greater than in suction phase, and increases with the increase of load pressure and decreases with the increase of rotation speed, the influence of load pressure on film thickness is much greater than that of rotational speed. (3) Increasing the length ratio reduces the piston eccentric and raises the minimum film thickness, and in order to obtain the better lubrication, the length ratio should be greater than 0.5.
Analysis of nonequilibrium effects characterizes shock wave-boundary layer interactions in hypersonic flow
Authors: Kim Meeri
Published: October 2018

The study combines direct simulation Monte Carlo calculations, linear global instability analysis and momentum potential theory to characterize nonequilibrium effects.
Physicochemical properties of horse meat as affected by breed, sex, age, muscle type and aging period
Authors: Kaić Ana , Žgur Silvester , Luštrek Barbara , Potočnik Klemen
Published: October 2018

The effects of breed, sex, age, muscle type (longissimus thoracis; LT vs semitendinosus; ST) and post mortem aging period (14 vs 28 days) on the physicochemical properties of horse meat were investigated. A total of 53 horses (21 females and 32 males) categorised into three groups (cold-blooded, CB; Posavje, P; crossbred, CS) were involved in this study. ST muscles showed a higher pH value, a greater intensity of lightness (L*) and yellowness, higher cooking losses and shear force values, and lower thawing losses than LT muscles. The breed affected only muscle redness, whereas sex had a minor effect on drip loss. An extended aging period was associated with higher thawing and cooking losses. An increase of age was followed by a decrease in pH value and L* value, and an increase in cooking loss and Warner–Bratzler shear force. An investigation of the interaction between muscle and aging showed that ST muscle with an aging period of 14 days had the lowest thawing losses. Among the numerous factors that can influence horse meat quality, the most important ones are age at slaughter and muscle type; these factors must be considered in the routine slaughtering practice and in further research.
Social return on investment: application for an Indigenous rangelands context
Authors: Feuerherdt Leah , Peevor Stuart , Clinch Michael , Moore Tim
Published: October 2018

Social Return on Investment (SROI) is an internationally recognised methodology used to measure and value the economic impact of program outcomes. Like a traditional cost-benefit analysis, SROI examines economic outcomes, but also includes the social, environmental and cultural outcomes created by the investment. These outcomes are evaluated against their cost, using financial proxies to estimate their relative economic worth. SROI is particularly valuable in the indigenous natural resource management context, because of the strong ‘value’ or importance of non-economic (particularly cultural) costs and benefits.
The Alinytjara Wilurara Natural Resources Management Board undertook a study of the economic, social, environmental and cultural impacts and benefits of the presence of large feral herbivores in the Anangu Pitjantjatjara Yankunytjatjara (APY) Lands, in the far north-west of South Australia. Camels, donkeys and horses present significant impacts for the community in terms of vehicle collisions, community health, damage to infrastructure and water pollution, as well as impacts on sites of cultural and spiritual significance to the local communities. With the annual cost impacts incurred by society caused by large feral herbivores in the APY lands valued at $4.2million and possible dollar value of those animals valued at $140000, the study found that there was a net cost impact of ~$4million from not managing the impact of these animals. The study also found significant cultural impacts of large feral herbivores, such as the fouling of natural springs and other culturally sensitive sites, and further analysis would be required to determine the economic cost of these impacts. Investment models that consider a broad range of costs and benefits are considered necessary for Australian rangelands, particularly Indigenous-owned land.
This paper presents a case study of the development of a ranger program that employs local community members to manage the impacts of large feral herbivores that will provide a net benefit to society of ~$3million every year, aside from the additional benefits of employment and economic participation. The $3-million net benefit accrues from saving human lives and costs associated with vehicle accidents, and reduced management costs and increased income for pastoral areas of the APY Lands. APY community members, and the APY Pastoral business are core beneficiaries; however, there are several external beneficiaries that this SROI approach recognises including the Motor Accident Commission, Health Departments and South Australian Police. The strongly positive SROI in this case presents an excellent co-investment opportunity for agencies whose core focus is on road safety and health. Importantly, the SROI approach to creation of social value can be implemented in a way that is consistent with stated community aspirations for development.
Naïve rainforest frogs on Cape York, Australia, are at risk of the introduction of amphibian chytridiomycosis disease
Authors: Hoskin Conrad J. , Hines Harry B. , Webb Rebecca J. , Skerratt Lee F. , Berger Lee
Published: October 2018

Amphibian chytridiomycosis disease has caused widespread declines and extinctions of frogs in cool, wet habitats in eastern Australia. Screening suggests that the disease does not yet occupy all areas modelled to be environmentally suitable, including rainforests on Cape York Peninsula. Cape Melville is an area of rainforest with several endemic frogs, including the stream-associated Melville Range treefrog (Litoria andiirrmalin), which is deemed at particular risk of disease impacts. We tested 40 L. andiirrmalin for chytrid infection by PCR and found them all to be negative. In conjunction with previous testing at another high-risk location, McIlwraith Range, this suggests that endemic rainforest frogs on Cape York have been spared the introduction of chytridiomycosis. We discuss how the disease could get to these areas, what can be done to reduce the risk, and suggest an emergency procedure should it be introduced.
In vivo 3′-to-5′ exoribonuclease targetomes of
Streptococcus pyogenes
Authors: Lécrivain Anne-Laure , Le Rhun Anaïs , Renault Thibaud T. , Ahmed-Begrich Rina , Hahnke Karin , Charpentier Emmanuelle
Published: October 2018

Significance

To cope with harsh environments and cause infection, bacteria need to constantly adjust gene expression. Ribonucleases (RNases) control the abundance of regulatory and protein-coding RNA through degradation and maturation. The current characterization of 3′-to-5′ exoribonucleases (exoRNases), processing RNAs from their 3′ end, is solely based on the description of a limited number of targets processed by these RNases. Here, we characterized bacterial 3′-to-5′ exoRNase targetomes. We show that YhaM, polynucleotide phosphorylase (PNPase), and RNase R have exoribonucleolytic activities in the human pathogen
Streptococcus pyogenes
. We demonstrate that PNPase is the main 3′-to-5′ exoRNase participating in RNA decay, we show that RNase R has a limited processing activity, and we describe an intriguing RNA processing behavior for YhaM.
Effects of different dosages of caffeine administration on wrestling performance during a simulated tournament
Authors: Negaresh Raoof , Del Coso Juan , Mokhtarzade Motahare , Lima‐Silva Adriano Eduardo , Baker Julien S. , Willems Mark E. T. , Talebvand Sina , Khodadoost Mostafa , Farhani Farid
Published: October 2018

The aim of the present study was to investigate the effects of different forms of caffeine administration on physical performance during a simulated wrestling tournament. In a double‐blind and randomized experiment, twelve male freestyle wrestlers competed in a simulated wrestling tournament (5 wrestling matches consisting of 2 × 3‐min wrestling rounds) following the ingestion of: a placebo, a high‐dose of caffeine (10 mg/kg), a moderate‐dose caffeine (4 mg/kg), a repeated‐dose caffeine (2 mg/kg before each match to a total of 10 mg/kg) or a selective caffeine administration based on performance decrement previously measured (6.16 ± 1.58 mg/kg). The Pittsburgh Wrestling Performance Test (PWPT) was measured before each match to assess physical performance. In comparison to the placebo, the high dose of caffeine only reduced PWPT time before the first match (56.8 ± 2.0 vs. 52.9 ± 1.8 s; p < .05). The moderate dose of caffeine did not affect PWPT performance during the tournament. Both, the repeated dose and the selective administration of caffeine reduced PWPT time with respect to the placebo in the third (66.7 ± 1.8 vs. 63.1 ± 1.4 s; p < .05) and fourth matches (72.3 ± 2.4 vs. 65.9 ± 1.3 s; p < .05). However, only the selective dose of caffeine reduced PWPT time before the fifth match (62.7 ± 3.0 vs. 56.3 ± 2.0; p < .05). The dosage and administration of caffeine affect the ergogenic effects obtained following the ingestion of this substance. An individualized protocol to provide caffeine when physical performance is expected to be reduced might improve wrestling performance during the latter stages of a tournament.
Iatrogenic Symmastia: Causes and Suggested Repair Technique
Authors: Kalaria Shana S , Henderson Joshua , Moliver Clayton L
Published: October 2018

Background

Various theories exist to explain the etiology of iatrogenic symmastia. Subglandular over-dissection of the medial breast pocket over the sternum, disruption of midline sternal fascia, oversized implant base diameter, and over-dissection of the medial pectoralis muscle attachments to the sternum are popular explanations.

Objectives

The authors hypothesized that the most common risk factor for iatrogenic symmastia is subpectoral breast augmentation.

Methods

A retrospective chart review was conducted including all symmastia patients who underwent surgery from January 2008 to April 2018 by a single surgeon (C.L.M.). ASAPS members were also surveyed regarding the etiology and incidence of symmastia in their practice.

Results

Twenty-three patients with symmastia were included in the retrospective chart review. All had previous subpectoral breast augmentation. In the ASAPS survey, 91 plastic surgeons reported seeing an average of 2.2 consults for acquired symmastia over the preceding year; 1.9 of the 2.2 (84.9%) acquired symmastia consults previously underwent subpectoral breast augmentation. Most surgeons attributed these patients’ symmastia to over-dissection of the medial pectoralis muscle attachments to the sternum.

Conclusions

Symmastia is most often caused by pectoralis major sternal dehiscence during subpectoral breast augmentation. In the senior author’s experience, all patients with iatrogenic symmastia previously had a submuscular breast augmentation. The ASAPS survey supports multiple causes for symmastia with retromuscular breast augmentation occurring in the majority of patients. Repair of symmastia should include securing Scarpa’s fascia to the sternum, reattaching the pectoralis major to the sternum, avoiding another subpectoral implant, and using postoperative modalities to protect the repair.

Level of Evidence: 4
Different Decision-Making Responses Occupy Different Brain Networks for Information Processing: A Study Based on EEG and TMS
Authors: Si Yajing , Wu Xi , Li Fali , Zhang Luyan , Duan Keyi , Li Peiyang , Song Limeng , Jiang Yuanling , Zhang Tao , Zhang Yangsong , Chen Jing , Gao Shan , Biswal Bharat , Yao Dezhong , Xu Peng
Published: November 2018

This study used large-scale time-varying network analysis to reveal the diverse network patterns during the different decision stages and found that the responses of rejection and acceptance involved different network structures. When participants accept unfair offers, the brain recruits a more bottom-up mechanism with a much stronger information flow from the visual cortex (O2) to the frontal area, but when they reject unfair offers, it displayed a more top-down flow derived from the frontal cortex (Fz) to the parietal and occipital cortices. Furthermore, we performed 2 additional studies to validate the above network models: one was to identify the 2 responses based on the out-degree information of network hub nodes, which results in 70% accuracy, and the other utilized theta burst stimulation (TBS) of transcranial magnetic stimulation (TMS) to modulate the frontal area before the decision-making tasks. We found that the intermittent TBS group demonstrated lower acceptance rates and that the continuous TBS group showed higher acceptance rates compared with the sham group. Similar effects were not observed after TBS of a control site. These results suggest that the revealed decision-making network model can serve as a potential intervention model to alter decision responses.
Sex, size, and prey caloric value affect diet specialization and consumption of an invasive prey by a native predator
Authors: Hostert Lauren E , Pintor Lauren M , Byers James E
Published: October 2018

Escaping the control of natural enemies is thought to heavily influence the establishment success and impact of non-native species. Here, we examined how the profitability of alternative prey in combination with the presence of a competitor and predator aggressive behavior explain individual differences in diet specialization and the consumption of the invasive green porcelain crab Petrolisthes armatus by the native mud crab predator Panopeus herbstii. Results from bomb calorimetry estimates show that invasive P. armatus has high caloric value relative to alternative native prey. Laboratory assays indicated that specialization and consumption of invasive P. armatus was mostly exhibited by large, female P. herbstii, but the presence of a competitor and predator aggressiveness did not influence diet and the consumption of P. armatus. Thus, intrinsic factors (e.g., sex and body size) seem to explain consumption of P. armatus and dietary specialization in P. herbstii, more generally. Although there are still many predator individuals that do not consume P. armatus, the proportion of individuals that have begun to specialize on P. armatus suggests that for some, it has become more profitable relative to alternative native prey. Given the high caloric value of P. armatus, we suggest that it is likely that differences in the cost of its consumption, including attack, capture, and handling times relative to alternative prey, determine its net profitability to individual predators.
The unique mechanism of functional mitral regurgitation in acute myocardial infarction: a prospective dynamic 4D quantitative echocardiographic study
Authors: Kimura Toshiyuki , Roger Véronique L , Watanabe Nozomi , Barros-Gomes Sergio , Topilsky Yan , Nishino Shun , Shibata Yoshisato , Enriquez-Sarano Maurice
Published: October 2018

Aims

Mechanisms of chronic ischaemic mitral regurgitation (IMR) are well-characterized by apically tethered leaflet caused by papillary muscles (PMs) displacement and adynamic mitral apparatus. We investigated the unique geometry and dynamics of the mitral apparatus in first acute myocardial infarction (MI) by using quantified 3D echocardiography.

Methods and results

We prospectively performed 3D echocardiography 2.3 ± 1.8 days after first MI, in 174 matched patients with (n = 87) and without IMR (n = 87). 3D echocardiography of left ventricular (LV) volumes and of mitral apparatus dynamics throughout cardiac cycle was quantified. Similar mitral quantification was obtained at chronic post-MI stage (n = 44). Mechanistically, acute IMR was associated with larger and flatter annulus (area 9.29 ± 1.74 cm2 vs. 8.57 ± 1.94 cm2, P = 0.002, saddle shape 12.7 ± 4.5% vs. 15.0 ± 4.6%, P = 0.001), and larger tenting (length 6.36 ± 1.78 mm vs. 5.60 ± 1.55 mm, P = 0.003) but vs. chronic MI, mitral apparatus displayed smaller alterations (all P < 0.01) and annular size, PM movement remained dynamic (all P < 0.01). Specific to acute IMR, without PM apical displacement (P > 0.70), greater separation (21.7 ± 4.9 mm vs. 20.0 ± 3.4 mm, P = 0.01), and widest angulation of PM (38.4 ± 6.2° for moderate vs. 33.5 ± 7.3° for mild vs. 31.4 ± 6.3° for no-IMR, P = 0.0009) wider vs. chronic MI (P < 0.01).

Conclusions

3D echocardiography of patients with first MI provides insights into unique 4D dynamics of the mitral apparatus in acute IMR. Mitral apparatus remained dynamic in acute MI and distinct IMR mechanism in acute MI is not PM displacement seen in chronic IMR but separation and excess angulation of PM deforming the mitral valve, probably because of sudden-onset regional wall motion abnormality without apparent global LV remodelling. This specific mechanism should be considered in novel therapeutic strategies for IMR complicating acute MI.
Mixed reality holograms for heart surgery planning: first user experience in congenital heart disease
Authors: Brun H , Bugge R A B , Suther L K R , Birkeland S , Kumar R , Pelanis E , Elle O J
Published: November 2018

Aims

Proof of concept and feasibility study for preoperative diagnostic use of mixed reality (MR) holograms of individual 3D heart models from standard cardiac computed tomography angiograms (CTA) images. Optimal repair for complex congenital heart disease poses high demands on 3D anatomical imagination. Three-dimensional printed heart models are increasingly used for improved morphological understanding during surgical and interventional planning. Holograms are a dynamic and interactive alternative, probably with wider applications.

Methods and results

A 3D heart model was segmented from CTA images in a patient with double outlet right ventricle and transposition of the great arteries (DORV-TGA). The hologram was visualized in the wearable MR platform HoloLens® for 36 paediatric heart team members who filled out a diagnostic and quality rating questionnaire. Morphological and diagnostic output from the hologram was assessed and the 3D experience was evaluated. Locally developed app tools such as hologram rotation, scaling, and cutting were rated. Anatomy identification and diagnostic output was high as well as rating of 3D experience. Younger and female users rated the app tools higher.

Conclusion

This preliminary study demonstrates that MR holograms as surgical planning tool for congenital heart disease may have a high diagnostic value and contribute to understanding complex morphology. The first users experience of the hologram presentation was found to be very positive, with a preference among the female and the younger users. There is potential for improvement of the hologram manipulation tools.
Evaluation of the French reactive mortality surveillance system supporting decision making
Authors: Baghdadi Yasmine , Gallay Anne , Caserio-Schönemann Céline , Fouillet Anne
Published: October 2018

Background

In France, a mortality syndromic surveillance system was set up with objectives of early detection and reactive evaluation of the impact of expected and unexpected events to support decision makers. This study aims to describe the characteristics of the system and its usefulness for decision makers.

Methods

Anonymized data from the administrative part of death certificates were daily collected from 3062 computerized city halls and were transmitted to Santé publique France in routine. Coverage of the system was measured as the proportion of deaths registered by the system among the complete number of deaths and analyzed by age, month and region. Deaths were described by gender, age and geographical level using proportion. The excess periods of deaths were described based on the comparison of the weekly observed and expected numbers of deaths between 2012 and 2016.

Results

The system recorded 77.5% of the national mortality covering the whole territory. About 81% of deaths were aged 65 years old and more. The surveillance system identified mortality variations mainly during winter and summer, for some concomitant with influenza epidemic or heatwave period, and thus provided information for decision makers.

Conclusion

The ability of the system to detect and follow mortality outbreaks in routine in the whole territory has been demonstrated. It is a useful tool to provide early evaluation of the impact of threats on mortality and alert decision makers to adapt control measures. However, the absence of information on medical causes of death may limit the ability to target recommendations.
Household Accessibility and Residential Relocation in Older Adults
Authors: Granbom Marianne , Perrin Nancy , Szanton Sarah , K.M. Cudjoe Thomas , Gitlin Laura N
Published: October 2018

Objectives

It is unclear how home environmental factors influence relocation decisions. We examined whether indoor accessibility, entrance accessibility, bathroom safety features, housing type, and housing condition were associated with relocations either within the community or to residential care facilities.

Methods

We used prospective data over 4 years from the nationally representative National Health and Aging Trends Study in the United States of Medicare beneficiaries 65 years and older living in the community (N = 7,197). We used multinomial regression analysis with survey weights.

Results

Over the 4 years, 8.2% of the population moved within the community, and 3.9% moved to residential care facilities. After adjusting for demographics and health factors, poor indoor accessibility was found to be associated with moves within the community but not to residential care facilities. No additional home environmental factors were associated with relocation.

Discussion

One-floor dwellings, access to a lift, or having a kitchen, bedroom, and bathroom on the same floor may help older adults age in place. Understanding which modifiable home environmental factors trigger late-life relocation, and to where, has practical implications for developing policies and programs to help older adults age in their place of choice.
UV background fluctuations traced by metal ions at z ≈ 3
Authors: Graziani L , Maselli A , Maio U
Published: October 2018

Here we investigate how LyC-opaque systems present in the intergalactic medium at $z$ ≈ 3 can distort the spectral shape of a uniform UV background (UVB) through radiative transfer (RT) effects. With this aim in mind, we perform a multifrequency RT simulation through a cosmic volume of 10 h−1 cMpc scale polluted by metals, and self-consistently derive the ions of all the species. The UVB spatial fluctuations are traced by the ratio of He $\,\small {II}$ and H $\,\small {I}$ column density, η, and the ratio of C $\, \small {IV}$ and Si $\, \small {IV}$ optical depths, ζ. We find that: (i) η spatially fluctuates through overdense systems (Δ) with statistically significant deviations δη > 25 per cent in 18 per cent of the volume; (ii) same fluctuations in ζ are also present in 34 per cent of the enriched domain (only 8 per cent of the total volume) and derive from a combination of RT induced effects and in-homogeneous metal enrichment, both effective in systems with Δ > 1.5.
Time for Precision: A World Without Susceptibility Breakpoints
Authors: Bader Justin C , Lakota Elizabeth A , Andes David R , Rubino Christopher M , Ambrose Paul G , Bhavnani Sujata M
Published: October 2018

Interpretive criteria for in vitro susceptibility testing criteria, “susceptibility breakpoints,” underpin the evaluation and selection of antimicrobial regimens. However, despite their strengths, susceptibility breakpoints are a relatively blunt instrument employed to address an extremely complex question—what is the likelihood of treatment success for individual patients? With regard to evaluating patients on a case-by-case basis, breakpoints merely allow us to account for pathogen susceptibility. This approach precludes consideration of drug exposures achieved in patients, thus overlooking half of the equation for predicting treatment success. Herein, we propose the framework for considering both pathogen- and patient-specific information to provide clinicians a means of evaluating antimicrobial regimens for individual patients through tools automating pharmacokinetic-pharmacodynamic target attainment analyses. Implementing these tools along with their acceptance by professional organizations will allow for a shift in the paradigm for how antimicrobials are selected and dosed—toward patient-centered care through precision medicine.
Growth Through Inter-sectoral Knowledge Linkages
Authors: Cai Jie , Li Nan
Published: October 2018

The majority of innovations are developed by multi-sector firms. The knowledge needed to invent new products is more easily adapted from some sectors than from others. We study this network of knowledge linkages between sectors and its impact on firm innovation and aggregate growth. We first document a set of sectoral-level and firm-level observations on knowledge applicability and firms’ multi-sector patenting behaviour. We then develop a general equilibrium model of firm innovation in which inter-sectoral knowledge linkages determine the set of sectors a firm chooses to innovate in and how much R&D to invest in each sector. It captures how firms evolve in the technology space, accounts for cross-sector differences in R&D intensity, and describes an aggregate model of technological change. The model matches new observations as demonstrated by simulation. It also yields new insights regarding the mechanism through which sectoral fixed costs of R&D affect growth.
Antiphospholipid score is a novel risk factor for idiopathic osteonecrosis of the femoral head in patients with systemic lupus erythematosus
Authors: Hisada Ryo , Kato Masaru , Ohnishi Naoki , Sugawara Eri , Fujieda Yuichiro , Oku Kenji , Bohgaki Toshiyuki , Amengual Olga , Yasuda Shinsuke , Atsumi Tatsuya
Published: October 2018

Objective

Idiopathic osteonecrosis of the femoral head (ION) is a common complication of SLE associated with CS therapy. Although the pathogenesis of ION involves local bone ischaemia favoured by thrombophilia, the involvement of aPL in lupus ION remains to be elucidated. We have previously reported the aPL score (aPL-S) as a quantitative marker of aPL and the development of thrombotic events in autoimmune diseases. The aim of this study was to identify the impact of aPL on the development of ION using aPL-S.

Methods

This was a single-centre retrospective study comprising 88 consecutive SLE patients who underwent MRI of the hip joints from January 2000 to March 2017. Baseline characteristics, pharmacotherapy and total hip arthroplasty performed during follow-up were evaluated.

Results

The presence of ION was confirmed by MRI scan in 38 patients (43.1%). Male gender, positivity of any aPL, aPL-S, high aPL-S (≥30) and high dose of CS were identified as risk factors for ION by univariate analysis. Multivariate analysis revealed high aPL-S (odds ratio 5.12, 95% CI 1.18–29.79) and use of high-dose CS (odds ratio 10.25, 95% CI 3.00–48.38) as independent variables. Kaplan–Meier analysis showed that patients with high aPL-S received total hip arthroplasty more frequently than those without aPL (P = 0.010).

Conclusions

We newly identified high aPL-S as an important risk factor for ION development in SLE, suggesting the involvement of aPL-induced coagulopathy in the pathophysiology of lupus ION.
SURVEILLANCE OF ENVIRONMENTAL DOSE RATE WITH THE COVARIANCE MATRIX
Authors: Benito G , Sáez J C , Blázquez J B , Quiñones J
Published: October 2018

The objective of this study is the operational verification of an environmental dose rate monitoring network composed by several sensors. The verification of the study has been tested on the CIEMAT’s Radiological Network, establishing a records quality assurance of the detectors using the covariance matrix and the eigenvalues. The technique has revealed an underlying records malfunction, which have not been appreciated by applying conventional surveillance. In this sense, the malfunction has economic and security consequences, which can be minimized with an alternative methodology, which guarantees the radiological protection of a local area according to the Regulatory Agency.
OPTIMISATION OF PATIENT DOSE AND IMAGE QUALITY IN FLUOROSCOPICALLY GUIDED CERVICAL SPINE SURGERY: A PHANTOM-BASED STUDY
Authors: Metaxas Vasileios I , Messaris Gerasimos A , Gatzounis George D , Panayiotakis George S
Published: October 2018

The purpose of the current study was to provide useful data, which may help neurosurgeons to manage the patient dose and image quality in spinal surgery procedures, utilising a phantom and a test object. The kerma area product, cumulative dose (CD) and entrance surface dose (ESD) rate on the phantom and image intensifier were measured, for selectable fields of view (FOVs), fluoroscopy modes, two geometric magnifications and various phantom thicknesses. The images were subjectively evaluated regarding low-contrast detectability and high-contrast resolution. Signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), high-contrast spatial resolution (HCSR) and figure of merit (FOM) values were also estimated. The ESD rates increased with increasing phantom thickness, when using electronic or geometric magnification, continuous or high-definition fluoroscopy (HDF). The observers’ evaluation showed relatively slight changes in image quality when pulsed fluoroscopy was used. SNR, CNR and HCSR values decreased with increasing phantom thicknesses, while remained almost constant when using pulsed fluoroscopy. SNR and HCSR improved in HDF, while the CNR remained almost constant only for the FOVs 23 and 17 cm. By applying electronic magnification, this resulted in improved HCSR. FOM values decreased in HDF, with increasing phantom thickness and using electronic magnification. For the ‘thinnest’ patients, CD may overestimate skin dose by 25% than the actual values. Geometric magnification resulted in improved FOM, especially for low-dose fluoroscopy and FOV 23 cm. The knowledge of the increments in dose values, image quality and FOM indices concerning phantom thickness may help neurosurgeons to optimise spinal surgery procedures by selecting the appropriate operational parameters, which could contribute toward the establishment of a radiation protection culture.
MCNP APPROACHES FOR DOSE RATES MODELING IN LABORATORY FOR NEUTRON ACTIVATION ANALYSIS AND GAMMA SPECTROMETRY AT OSTRAVA
Authors: Uhlář Radim , Alexa Petr
Published: November 2018

The Laboratory for Neutron Activation Analysis and Gamma Spectrometry at the VŠB-Technical University of Ostrava was equipped with the neutron generator MP320 operating on the principle of the deuterium–tritium fusion and producing 108 neutrons/s at maximum. To ensure radiation protection of radiation workers and public outside the laboratory, the concrete shielding was designed and its protection efficiency was validated by MCNP simulations. Three approaches to calculate the dose rates were compared. The dose rates were estimated for the ORNL MIRD phantom located at the relevant positions (Tally F6 and *F8) and using the MCNPX mesh tally feature with the new ICRP Publication 116 flux-to-dose conversion factors. It was proven that the Approach II in which the absorbed dose rates due to neutrons for all organs are computed using the cell tally F6 and the photon dose calculation is performed by the *F8 energy deposition tally is the most valuable one.
Changing practice, saving lives
Authors: John Sherley , Jacob Merin Thomas , Meskill Katie , Moolsankar Kishun , Altman Marian
Published: October 2018

Reduction of CAUTIs in the neurosurgical ICU
A Simple Technical Tip for Removal of Intramedullary Broken Drill Bit
Authors: Balaji Gopisankar , Menon Jagdish , Sharma Deep
Published: October 2018

A 35-year-old man presented to us with nonunion of both bones of the right forearm. He was planned for open reduction and internal fixation. Intraoperatively while trying to open the medullary canal of the ulna with a 2.5-mm noncannulated drill bit, the distal end of the drill bit broke and was stuck within the medullary cavity. Under image intensifier, the broken piece was retrieved with the help of a long depth gauge from the 4.5-mm system. This technique is simple, cost-effective, and less time-consuming.
The Transtrochanteric Approach to the Total Femur Replacement: A Novel Technique
Authors: Pennington Jake , Riggle Patrick K. , Brazier Brett G. , Cochran Jason M.
Published: October 2018

Nononcologic total femur replacement (TFR) secondary to periprosthetic fracture, aseptic loosening or infection has had many surgical approach options provided in the literature. No single approach has been proven to be superior in preventing postoperative complications due to its rare and complex nature, however. Therefore, we believe that a successful outcome following a previously undescribed approach for a TFR is valuable contribution to the current literature. Technique, in the following report, we present is a transtrochanteric approach to a TFR. This approach involved a vertical transtrochanteric osteotomy which allowed the anterior and posterior capsular and muscular attachments to the greater trochanter to be maintained. By doing this, we believe the stability was significantly improved. At 2-year follow-up, the patient has had a good functional outcome without complications. Pearls: (1) The use of a transtrochanteric osteotomy allows for increased stability of the hip. (2) A modular system for revision total knee arthroplasties can be beneficial for conversion to TFR. (3) A total femur hemiarthroplasty prevents the need for a constrained liner that has high long-term failure rates. (4) Vacuum-assisted closure systems can be used to help prevent postoperative edema and seroma formation.
Local Excision Versus Radical Resection for 1- to 2-cm Neuroendocrine Tumors of the Rectum: A National Cancer Database Analysis
Authors: Fields Adam C. , Saadat Lily V. , Scully Rebecca E. , Davids Jennifer S. , Goldberg Joel E. , Bleday Ronald , Melnitchouk Nelya
Published: November 2018

BACKGROUND:

The optimal surgical management for 1- to 2-cm, nonmetastatic rectal neuroendocrine tumors remains unknown.

OBJECTIVE:

We sought to determine overall survival and operative outcomes in patients who underwent local excision versus radical resection of rectal neuroendocrine tumors.

DESIGN:

The National Cancer Database (2004–2013) was queried to identify patients with nonmetastatic rectal neuroendocrine tumors who underwent local excision or radical resection.

SETTING:

The study included national data.

PATIENTS:

There were 274 patients in the local excision group and 47 patients in the radical resection group.

MAIN OUTCOME MEASURES:

The primary outcome was overall survival. Secondary outcomes included 30-day mortality, hospital length of stay, and procedural outcomes.

RESULTS:

There were no differences in demographics between the 2 groups. Patients who underwent radical resection had slightly larger tumors with higher stage and grade. Patients undergoing local excision had higher rates of positive margins (8.23% vs 0%; p = 0.04). There were no deaths within 30 days in either group, but patients who had radical resection had longer median hospital length of stay (0 vs 3 d; p < 0.01). After adjusting with a Cox proportional hazards model, no difference was seen in survival between the 2 patient groups (HR = 2.39 (95% CI, 0.85–6.70); p = 0.10).

LIMITATIONS:

There are several limitations, which include that this work is a retrospective review; the data set does not include variables such as depth of tumor invasion, which may influence surgical treatment or local recurrence rates; and patients were not randomly assigned to treatment groups.

CONCLUSIONS:

There is no survival benefit to radical resection of 1- to 2-cm, nonmetastatic rectal neuroendocrine tumors. This suggests that local excision may be a feasible and less morbid option for intermediate-sized rectal neuroendocrine tumors. See Video Abstract at http://links.lww.com/DCR/A744.
Tactile cues change trunk and scapular muscle activity, scapular winging, and thoracic kyphosis during knee push-up plus in subjects with scapular winging
Authors: Shin A-Reum , Lee Ji-Hyun , Kim Da-Eun , Cynn Heon-Seock
Published: October 2018

Serratus anterior muscle weakness causes scapular winging, characterized by scapular downward rotation and scapular anterior tipping in the resting position. Knee push-up plus (KPP), a modified push-up plus that is generally used in early rehabilitation programs, is performed to elicit SA activation. However, excessive thoracic kyphosis can easily occur as a compensatory movement during KPP. Therefore, the aim of this study was to examine the effect of tactile cues during KPP on activities of the thoracic erector spinae, rectus abdominis, lower trapezius, serratus anterior, and upper trapezius; scapular winging; and thoracic kyphosis in subjects with scapular winging.

Thirteen men with scapular winging performed KPP exercises under 3 different tactile cue conditions (no cue, to the thoracic spinous process [TSP], and to the interscapular region [ISR]). Electromyography was used to collect the muscle activity; in addition, a scapulometer and ImageJ software were used to measure the amount of scapular winging and thoracic kyphosis, respectively. One-way repeated-measures analysis of variance and Bonferroni correction were used to assess for statistical significance.

The activity of the thoracic erector spinae, rectus abdominis, serratus anterior, and upper trapezius had significant difference among three conditions (P < .05). Lower trapezius activity was no significantly different among 3 conditions. Degrees of scapular winging and thoracic kyphosis had also significant difference among 3 conditions (P < .05).

These results suggest that the tactile cue to the TSP and ISR in KPP exercise can be an effective method for decreasing scapular winging as well as correcting compensatory thoracic kyphosis during the KPP in subjects with scapular winging.
Clinical research on a flapless surgical technique application of narrow implants
Authors: Xu Li , Liu Yihan , Wang Yuanyuan , Chen Jiangang
Published: October 2018

The aim of the present study was to investigate the role of Axiom (implant diameter) ø2.8 mm narrow body implant in the clinical effect of minimally invasive implants in edentulous space.

This study included 10 patients with 10 edentulous spaces less than 5 mm and received minimally invasive surgery with 10 Axiom ø2.8 mm narrow implants. Re-stabilization of all implants began 6 months after surgery to fix the partial denture. All cases were followed up for clinical and panoramic X-ray examinations.

Imaging examination on these 10 pieces of narrow implants after 6 months showed that implant alveolar bone crest average absorption amount was 0.20 mm and no implant peripheral inflammation mucositis and denture with adjacent teeth gingival papilla between the fillings. All patients felt strong mastication and the reparation effect was more than up to expectation. No implant loosening and shedding were observed.

Hence, <5 mm edentulous space by Axiom ø2.8 mm implant minimally invasive reparation can be used for aesthetic purposes.
Nuanxin capsule for heart failure
Authors: Wen Junmao , Cai Yinhe , Sun Weipeng , Jiang Chenguang , Lin Tong , Jiang Nan , Luo Chuanjin , Zhou Chi , Wu Wei
Published: October 2018

Objective

To assess the efficacy and safety of Nuanxin capsule for patients with heart failure (HF).

Methods

A systematic literature search was performed in 6 databases: PubMed, EMBASE, Chinese National Knowledge Infrastructure (CNKI), Wan-fang Data Information Site, Chinese BioMedical Database (CBM), VIP Chinese Science and Technique Journals Database from the date of its inception up to November 2016. Review Manager 5.2 software was used for assessment of risk of bias, data synthesis and subgroup analysis. Begg and Egger tests were used for assessing symmetries of funnel plot by software Stata 12.0. We conducted the GRADE system to assess the quality of evidence.

Results

12 trials involving 1418 participants were eligible. Compared with western medicine (WM) alone, Nuanxin capsule plus WM showed statistical significance in total effective rate (RR 1.18, 95% condidence interval [CI] 1.13–1.25). According to subgroup analysis, the 6-months group and the 12-months group have better effect than the 3-month group. As for 6-minute walking distance (6MWT), Nuanxin capsule plus WM compared with WM has significantly increased walking distance (weighted mean difference [WMD] 42.56, 95% CI 34.27–50.85). Nuanxin capsule plus WM has significantly decreased in mortality (RR 0.29, 95% CI 0.18–0.46) and re-admission rate (RR 0.48, 95% CI 0.39–0.60) compared with WM. Nuanxin capsule plus WM was beneficial for B-type natriuretic peptide (−240.47, 95% CI −332.45–148.49). gger's and Begg's test showed that there was no publication bias exist (P = .937). Influence analysis showed that no single study affected the overall result. The GRADE quality of the evidence was very low to Moderate across the different outcomes.

Conclusions

Despite of the apparently positive findings, we cannot draw a sound conclusion that Nuanxin capsule has positive effect in patients with HF, because of the insufficient evidence.
A case report of pregnancy in a patient with common variable immunodeficiency emphasizing the need for personalized immunoglobulin replacement
Authors: Więsik-Szewczyk Ewa , Jahnz-Różyk Karina
Published: October 2018

Rationale:

Subcutaneous immunoglobulin administration facilitated by recombinant human hyaluronidase is a new mode of immunoglobulin replacement. It has been approved for treatment in primary and secondary antibody immunodeficiency. To date, it has not been reported in the literature as therapy of choice during pregnancy.

Patient concerns:

We report a 31-year-old woman with common variable immunodeficiency (CVID) followed during her first pregnancy.

Diagnoses:

The patient had a history of increased susceptibility to infections and autoimmune phenomena. From diagnosis at the age 29, she received IVIg replacement with partial response to treatment. Due to medical indications and lack of venous access, we had to search for another mode of application. The patient refused traditional, weekly conventional subcutaneous immunoglobulin (SCIg) administration.

Interventions:

Immunoglobulin replacement therapy was successfully continued during pregnancy after the IV route was replaced with subcutaneous administration facilitated by recombinant human hyaluronidase. The frequency of infusions was every 3–4 weeks.

Outcomes:

The treatment was effective and well tolerated by the patient who continued it after delivery. Dosage and the schedule of infusions provided sufficient immunoglobulin G (IgG) levels for the newborn baby.

Lessons:

The presented CVID case illustrates that the selection of the mode of immunoglobulin administration has to be a shared decision, which considers both patient preferences and medical needs. This approach is especially important for the pregnancy period. The case shows that the switch from IVIg to fSCIg can be a management option during pregnancy.
Predictive value of microRNA let-7a expression for efficacy and prognosis of radiotherapy in patients with lung cancer brain metastasis
Authors: Liu Ji-Kuan , Liu Hong-Feng , Ding Yong , Gao Guo-Dong
Published: October 2018

Background:

As a well-known cancer with high mortality, lung cancer has been implied to be closely associated with brain metastasis. Despite notable advances, effective treatment methods are still in urgent need. This study aims to investigate the value of serum microRNA-let-7a (miR-let-7a) expression in predicting efficacy and prognosis of radiotherapy in patients with lung cancer brain metastasis.

Methods:

To begin with, reverse transcription quantitative polymerase chain reaction (RT-qPCR) was performed for better understand of the correlation between miR-let-7a and lung cancer. Afterwards, the relationship between serum miR-let-7a expression and radiotherapy efficacy was analyzed by receiver operating characteristic curve analysis. Following successful transfection, RT-qPCR and Western blot assay were utilized for evaluating the involvement of miR-let-7a in regulation of DICER1 expression in lung cancer cell line. Then, whether miR-let-7a was implicated in proliferation and cell cycle distribution of lung cancer cells were confirmed by cell counting kit-8 assay and flow cytometry respectively.

Results:

Initially, it was revealed that serum miR-let-7a expression was decreased in lung cancer. Later, we found that decreased miR-let-7a displayed an unfavorable role in radiotherapy efficacy and overall survival rate of patients with lung cancer brain metastasis. After the successful transfection, the inverse relationship between miR-let-7a and DICER1 expression was uncovered. Meanwhile, biological behaviors of lung cancer cells were presented to be limited after transfection of overexpressed miR-let-7a.

Conclusion:

Our findings demonstrated that the lower expression of miR-let-7a in patients with lung cancer brain metastasis was closely related to unfavorable efficacy and prognosis of radiotherapy, and it may be an important predictive biomarker by regulation of DICER1.