bluuebunny/crossref_metadata_2025 huggingface dataset:
Design of a Novel Three-Dimensional-Printed Two Degrees-of-Freedom Steerable Electrosurgical Grasper for Minimally Invasive Surgery
Authors: Sakes Aimée , Hovland Kevin , Smit Gerwin , Geraedts Jo , Breedveld Paul
Published: November 2017

In current bipolar electrosurgical instruments, a high frequency electrical sinusoidal wave is passed through the patient's body from an active electrode to the return electrode to cut, coagulate, or desiccate tissues. Even though current bipolar electrosurgical instruments have proven effective in minimizing blood loss, advancement is needed to allow for improved dexterity and adaptability. With current advances in three-dimensional (3D)-print processes and its integration in the medical field, it has become possible to manufacture patient-and operation-specific instruments. In this study, we introduce the first 3D-printed steerable bipolar grasper (◻ 5 mm) for use in minimal invasive surgery. The grasper significantly improves dexterity by the addition of two planar joints allowing for ±65 deg for sideways and ±85 deg for up- and downward movement. The joints enable a significantly higher bending stiffness, 4.0 N/mm for joint 1 and 4.4 N/mm for joint 2, than that of currently available steerable instruments. The tip consists of two metallic movable jaws that can be opened and closed with angles up to 170 deg and allows for grasping and coagulating of tissues; reaching tissue temperatures of over 75 °C for an activation time of ∼5 s, respectively. In order to actuate the joint, tip, and electrosurgical system, as well as to tension the steering cables, a ring handle was designed. In summary, the 3D-printed steerable bipolar grasper provides the surgeon with electrosurgical capabilities, improved dexterity, improved stiffness, and the versatility that is needed to provide patient- and operation-specific care.
Integrating Cadaver Needle Forces Into a Haptic Robotic Simulator
Authors: Pepley David F. , Yovanoff Mary A. , Mirkin Katelin A. , Miller Scarlett R. , Han David C. , Moore Jason Z.
Published: November 2017

Accurate force simulation is essential to haptic simulators for surgical training. Factors such as tissue inhomogeneity pose unique challenges for simulating needle forces. To aid in the development of haptic needle insertion simulators, a handheld force sensing syringe was created to measure the motion and forces of needle insertions. Five needle insertions were performed into the neck of a cadaver using the force sensing syringe. Based on these measurements a piecewise exponential needle force characterization, was implemented into a haptic central venous catheterization (CVC) simulator. The haptic simulator was evaluated through a survey of expert surgeons, fellows, and residents. The maximum needle insertion forces measured ranged from 2.02 N to 1.20 N. With this information, four characterizations were created representing average, muscular, obese, and thin patients. The median survey results showed that users statistically agreed that “the robotic system made me sensitive to how patient anatomy impacts the force required to advance needles in the human body.” The force sensing syringe captured force and position information. The information gained from this syringe was able to be implemented into a haptic simulator for CVC insertions, showing its utility. Survey results showed that experts, fellows, and residents had an overall positive outlook on the haptic simulator's ability to teach haptic skills.
Controlled Phase Interactions Between Pulsed Electric Fields, Ultrasonic Motion, and Magnetic Fields in an Anodic Dissolution Cell
Authors: Bradley Curtis , Samuel Johnson
Published: November 2017

This paper presents the design of a novel testbed that effectively combines pulsed electric field waveforms, ultrasonic velocity, and magnetic field waveforms in an anodic dissolution electrochemical machining (ECM) cell. The testbed consists of a custom three-dimensional (3D)-printed flow cell that is integrated with (i) a bipolar-pulsed ECM circuit, (ii) an ultrasonic transducer, and (iii) a custom-built high-frequency electromagnet. The driving voltages of the ultrasonic transducer and electromagnet are calibrated to achieve a timed workpiece velocity and magnetic field, respectively, in the machining area. The ECM studies conducted using this testbed reveal that phase-controlled waveform interactions between the three assistances affect both the material removal rate (MRR) and surface roughness (Ra) performance metrics. The triad-assisted ECM case involving phase-specific combinations of all three high-frequency (15.625 kHz) assistance waveforms is found to be capable of achieving a 52% increase in MRR while also simultaneously yielding a 78% improvement in the Ra value over the baseline pulsed-ECM case. This result is encouraging because assisted ECM processes reported in the literature typically improve only one of these performance metrics at the expense of the other. In general, the findings reported in this paper are expected to enable the realization of multifield assisted ECM testbeds using phase-specific input waveforms that change on-the-fly to yield preferential combinations of MRR and surface finish.
Analysis of the Relative Velocity and Its Influence on the Process Results in Unguided Vibratory Finishing
Authors: Lachenmaier Maximilian , Brocker Richard , Trauth Daniel , Klocke Fritz
Published: November 2017

The relative velocity between workpiece and media has a strong effect on the material removal rate in vibratory finishing. Due to this fact, a measurement system in the form of a camera-integrated workpiece is presented in this paper, which is capable of measuring the relative velocity between the workpiece and the media in an unguided vibratory finishing process. The unique feature of this measurement system is the completely wireless construction, so that the results are not influenced by wires for the data transfers and the electrical power supply of the light-emitting diodes of the camera system. Furthermore, the influence of the media size and adjustments of the imbalance engine like rotational speed, mass distribution between the upper and the lower imbalance weights, and offset angle between the imbalance weights were investigated. The evaluation of the results has shown that the media size and the rotational speed of the imbalance engine are the major influence factors on the relative velocity between workpiece and media.
Correlation Between Microscale Magnetic Particle Distribution and Magnetic-Field-Responsive Performance of Three-Dimensional Printed Composites
Authors: Lu Lu , Baynojir Joyee Erina , Pan Yayue
Published: November 2017

To date, several additive manufacturing (AM) technologies have been developed for fabricating smart particle–polymer composites. Those techniques can control particle distributions to achieve gradient or heterogeneous properties and functions. Such manufacturing capability opened up new applications in many fields. However, it is still widely unknown how to design the localized material distribution to achieve desired product properties and functionalities. The correlation between microscale material distribution and macroscopic composite performance needs to be established. In our previous work, a novel magnetic field-assisted stereolithography (M-PSL) process was developed, for fabricating magnetic particle–polymer composites. In this work, we focused on the study of magnetic-field-responsive particle–polymer composite design with the aim of developing guidelines for predicting the magnetic-field-responsive properties of the composite. Microscale particle distribution parameters, including particle loading fraction, magnetic particle chain structure, microstructure orientation, and particle distribution patterns, were investigated. Their influences on the properties of particle–polymer liquid suspensions and properties of the three-dimensional (3D) printed composites were characterized. By utilizing the magnetic anisotropy properties of the printed composites, motions of the printed parts could be actuated at different positions in the applied magnetic field. Physical models were established to predict magnetic properties of the composite and trigger distance of fabricated parts. The predicted results agreed well with the experimental measurements, indicating the effectiveness of predicting macroscopic composite performance using microscale distribution data, and the feasibility of using the developed physical models to guide multimaterial and multifunctional composite design.
Performance of statistical process control methods for regional surgical site infection surveillance: a 10-year multicentre pilot study
Authors: Baker Arthur W , Haridy Salah , Salem Joseph , Ilieş Iulian , Ergai Awatef O , Samareh Aven , Andrianas Nicholas , Benneyan James C , Sexton Daniel J , Anderson Deverick J
Published: November 2017

Background

Traditional strategies for surveillance of surgical site infections (SSI) have multiple limitations, including delayed and incomplete outbreak detection. Statistical process control (SPC) methods address these deficiencies by combining longitudinal analysis with graphical presentation of data.

Methods

We performed a pilot study within a large network of community hospitals to evaluate performance of SPC methods for detecting SSI outbreaks. We applied conventional Shewhart and exponentially weighted moving average (EWMA) SPC charts to 10 previously investigated SSI outbreaks that occurred from 2003 to 2013. We compared the results of SPC surveillance to the results of traditional SSI surveillance methods. Then, we analysed the performance of modified SPC charts constructed with different outbreak detection rules, EWMA smoothing factors and baseline SSI rate calculations.

Results

Conventional Shewhart and EWMA SPC charts both detected 8 of the 10 SSI outbreaks analysed, in each case prior to the date of traditional detection. Among detected outbreaks, conventional Shewhart chart detection occurred a median of 12 months prior to outbreak onset and 22 months prior to traditional detection. Conventional EWMA chart detection occurred a median of 7months prior to outbreak onset and 14 months prior to traditional detection. Modified Shewhart and EWMA charts additionally detected several outbreaks earlier than conventional SPC charts. Shewhart and SPC charts had low false-positive rates when used to analyse separate control hospital SSI data.

Conclusions

Our findings illustrate the potential usefulness and feasibility of real-time SPC surveillance of SSI to rapidly identify outbreaks and improve patient safety. Further study is needed to optimise SPC chart selection and calculation, statistical outbreak detection rules and the process for reacting to signals of potential outbreaks.
Ionised calcium levels in major trauma patients who received blood en route to a military medical treatment facility
Authors: Kyle Tony , Greaves Ian , Beynon Anthony , Whittaker Vicky , Brewer Mike , Smith Jason
Published: November 2017

Background

Hypocalcaemia is a common metabolic derangement in critically ill patients. Blood transfusion can also contribute to depleted calcium levels. The aims of this study were to identify the incidence of hypocalcaemia in military trauma patients receiving blood products en route to a deployed hospital facility and to determine if intravenous calcium, given during the prehospital phase, has an effect on admission calcium levels.

Methods

This was a retrospective review of patients transported by the UK Medical Emergency Response Team in Afghanistan between January 2010 and December 2014 who were treated with blood products in the prehospital setting. Total units of blood products administered, basic demographics, Injury Severity Score and trauma type were collected. Ionised serum calcium levels on admission to hospital were compared between those who received blood products without prehospital intravenous calcium supplemental therapy (non-treatment) and patients who were treated with 10 mL of intravenous calcium chloride (10%) concurrently with blood products (treatment).

Results

The study included 297 patients; 237 did not receive calcium and 60 did. The incidence of hypocalcaemia in the non-treatment group was 70.0% (n=166) compared with 28.3% (n=17) in the treatment group. Serum calcium levels were significantly different between the groups (1.03 mmol/L vs 1.25 mmol/L, difference 0.22 mmol/L, 95% CI 0.15 to 0.27). In the non-treatment group, 26.6% (n=63) had calcium levels within the normal range compared with 41.7% (n=25) in those who received calcium. There was a dose response of calcium level to blood products with a significant decrease in calcium levels as the volume of blood products increased.

Conclusion

Trauma patients who received blood products were at high risk of hypocalcaemia. Aggressive management of these patients with intravenous calcium during transfusion may be required.
Paediatric ovarian tumours and their associated cancer susceptibility syndromes
Authors: Goudie Catherine , Witkowski Leora , Vairy Stephanie , McCluggage W Glenn , Foulkes William D
Published: November 2017

Non-epithelial ovarian tumours are rare neoplasms that occasionally arise in childhood and adolescence. They can be associated with various cancer susceptibility syndromes. The morphological overlap seen across these tumours and their rarity can make the diagnosis challenging. In the case of an incorrect diagnosis, the underlying genetic susceptibility may be missed. In this review, we outline the genetic background of ovarian non-epithelial tumours arising in children, emphasizing the genes harbouring pathogenic germline variants associated with each tumour type. Specifically, juvenile granulosa cell tumours, Sertoli-Leydig cell tumours, sex cord tumours with annular tubules, Sertoli cell tumours, germ cell tumours and small cell carcinoma of the ovary of hypercalcaemic type are discussed in this review. For each tumour type, we detail the personal and family history features and the presenting characteristics of the ovarian tumour as well as the pathological features and molecular markers that point towards a cancer predisposition syndrome. Throughout, we stress the need for specialised pathological review in difficult cases.
Limb girdle muscular dystrophy due to mutations in POMT2
Authors: Østergaard Sofie Thurø , Johnson Katherine , Stojkovic Tanya , Krag Thomas , De Ridder Willem , De Jonghe Peter , Baets Jonathan , Claeys Kristl G , Fernández-Torrón Roberto , Phillips Lauren , Topf Ana , Colomer Jaume , Nafissi Shahriar , Jamal-Omidi Shirin , Bouchet-Seraphin Celine , Leturcq France , MacArthur Daniel G , Lek Monkol , Xu Liwen , Nelson Isabelle , Straub Volker , Vissing John
Published: November 2017

Background

Mutations in the gene coding for protein O-mannosyl-transferase 2 (POMT2) are known to cause severe congenital muscular dystrophy, and recently, mutations in POMT2 have also been linked to a milder limb-girdle muscular dystrophy (LGMD) phenotype, named LGMD type 2N (LGMD2N). Only four cases have been reported so far.

ClinicalTrials.gov ID: NCT02759302

Methods

We report 12 new cases of LGMD2N, aged 18–63 years. Muscle involvement was assessed by MRI, muscle strength testing and muscle biopsy analysis. Other clinical features were also recorded.

Results

Presenting symptoms were difficulties in walking, pain during exercise, delayed motor milestones and learning disabilities at school. All had some degree of cognitive impairment. Brain MRIs were abnormal in 3 of 10 patients, showing ventricular enlargement in one, periventricular hyperintensities in another and frontal atrophy of the left hemisphere in a third patient. Most affected muscle groups were hip and knee flexors and extensors on strength testing. On MRI, most affected muscles were hamstrings followed by paraspinal and gluteal muscles. The 12 patients in our cohort carried 11 alleles with known mutations, whereas 11 novel mutations accounted for the remaining 13 alleles.

Conclusion

We describe the first cohort of patients with LGMD2N and show that unlike other LGMD types, all patients had cognitive impairment. Primary muscle involvement was found in hamstring, paraspinal and gluteal muscles on MRI, which correlated well with reduced muscle strength in hip and knee flexors and extensors. The study expands the mutational spectrum for LGMD2N, with the description of 11 novel POMT2 mutations in the association with LGMD2N.

Clinical trial registration

NCT02759302.
Carotid artery longitudinal wall motion: regulatory factors and implications for arterial health
Authors: Au Jason S.
Published: November 2017

The carotid artery wall moves longitudinally along the length of the vessel, although little is known about what causes this motion, or what health information it represents. The overarching purpose of this dissertation was to investigate the regulation of carotid artery longitudinal wall motion (CALM) in humans, as well as how CALM can be used to infer information about arterial health. Through observational and experimental designs, we tested evidence for a structural ventricular–vascular coupling effect, which postulates that systolic anterograde CALM is influenced by the forward blood shear rate while systolic retrograde CALM is influenced by left ventricular rotation, although the data suggest a moderate influence of left ventricular rotation, and minimal influence of shear rate. In cross-sectional analyses, we demonstrated that diastolic CALM variables are better related to age and health status compared with systolic CALM displacement and that this relationship was independent of traditional measures of arterial stiffness. These experimental and observational results directed the use of diastolic CALM as a potential indicator of arterial health in subsequent studies, owing to the relative independence from systolic events. While there was no effect of 12 weeks of exercise training in healthy men on diastolic CALM variables, we observed increased systolic retrograde CALM and diastolic CALM acceleration in men with a history of resistance exercise training compared with sedentary men, suggesting an effect of habitual exercise training. Our novel findings suggest that CALM is regulated by a complex system, in part related to both arterial wall structure and ventricular–vascular coupling, and may have clinical value in complimenting measures of traditional arterial stiffness in humans. Future studies should examine whether local changes to arterial wall structure or indirect changes in regulatory control dictate differences in CALM with aging and with chronic exercise training, before integrating CALM into routine measurement of arterial health.
Asymbiotic nitrogen fixation on woody roots of Norway spruce and silver birch
Authors: Mäkipää Raisa , Huhtiniemi Susanna , Kaseva Janne , Smolander Aino
Published: November 2017

High rates of asymbiotic nitrogen (N) fixation have been measured in woody roots in temperate forests, but this rate has not been quantified in boreal forests. We studied the asymbiotic N2fixation associated with living and decomposing woody roots of Norway spruce (Picea abies (L.) H. Karst.) in three sites in Finland. In addition, tree species effect was studied in one site that included Norway spruce and silver birch (Betula pendula Roth.) monocultures and mixed stands. The rate of N2fixation measured as nitrogenase activity was affected by host tree species; spruce roots were the most active (0.67 C2H4·day–1·(g dry mass)–1in spruce monocultures). The activity was not statistically different in decayed and living root samples, and moisture content did not explain the observed high variability in nitrogenase activity. In a birch–spruce mixed stand, the average N2fixation in woody roots was 0.17 kg N·ha−1·year−1, whereas in Norway spruce dominated sites, the activity ranged from 0.06 to 0.15 kg N·ha−1·year−1. The N2fixation in decaying and living woody roots is an important contributor to the long-term total N balance of the forest. However, the estimated rate of N2fixation is low compared with atmospheric N deposition.
Pattern formation of a nonlocal, anisotropic interaction model
Authors: Burger Martin , Düring Bertram , Kreusser Lisa Maria , Markowich Peter A. , Schönlieb Carola-Bibiane
Published: November 2017

We consider a class of interacting particle models with anisotropic, repulsive–attractive interaction forces whose orientations depend on an underlying tensor field. An example of this class of models is the so-called Kücken–Champod model describing the formation of fingerprint patterns. This class of models can be regarded as a generalization of a gradient flow of a nonlocal interaction potential which has a local repulsion and a long-range attraction structure. In contrast to isotropic interaction models the anisotropic forces in our class of models cannot be derived from a potential. The underlying tensor field introduces an anisotropy leading to complex patterns which do not occur in isotropic models. This anisotropy is characterized by one parameter in the model. We study the variation of this parameter, describing the transition between the isotropic and the anisotropic model, analytically and numerically. We analyze the equilibria of the corresponding mean-field partial differential equation and investigate pattern formation numerically in two dimensions by studying the dependence of the parameters in the model on the resulting patterns.
A multiphase Cahn–Hilliard–Darcy model for tumour growth with necrosis
Authors: Garcke Harald , Lam Kei Fong , Nürnberg Robert , Sitka Emanuel
Published: November 2017

We derive a Cahn–Hilliard–Darcy model to describe multiphase tumour growth taking interactions with multiple chemical species into account as well as the simultaneous occurrence of proliferating, quiescent and necrotic regions. A multitude of phenomena such as nutrient diffusion and consumption, angiogenesis, hypoxia, blood vessel growth, and inhibition by toxic agents, which are released for example by the necrotic cells, are included. A new feature of the modelling approach is that a volume-averaged velocity is used, which dramatically simplifies the resulting equations. With the help of formally matched asymptotic analysis we develop new sharp interface models. Finite element numerical computations are performed and in particular the effects of necrosis on tumour growth are investigated numerically. In particular, for certain modelling choices, we obtain some form of focal and patchy necrotic growth that have been observed in experiments.
Torsion-free abelian groups with optimal Scott families
Authors: Melnikov Alexander G.
Published: November 2017

We prove that for any computable successor ordinal of the form [Formula: see text] [Formula: see text] limit and [Formula: see text] there exists computable torsion-free abelian group [Formula: see text]TFAG[Formula: see text] that is relatively [Formula: see text] -categorical and not [Formula: see text] -categorical. Equivalently, for any such [Formula: see text] there exists a computable TFAG whose initial segments are uniformly described by [Formula: see text] infinitary computable formulae up to automorphism (i.e. it has a c.e. uniformly [Formula: see text]-Scott family), and there is no syntactically simpler (c.e.) family of formulae that would capture these orbits. As far as we know, the problem of finding such optimal examples of (relatively) [Formula: see text]-categorical TFAGs for arbitrarily large [Formula: see text] was first raised by Goncharov at least 10 years ago, but it has resisted solution (see e.g. Problem 7.1 in survey [Computable abelian groups, Bull. Symbolic Logic 20(3) (2014) 315–356]). As a byproduct of the proof, we introduce an effective functor that transforms a [Formula: see text]-computable worthy labeled tree (to be defined) into a computable TFAG. We expect that this technical result will find further applications not necessarily related to categoricity questions.
The Permian timescale: an introduction
Authors: Lucas Spencer G. , Shen Shu-Zhong
Published: November 2017

The Permian timescale has developed over about two centuries of research to the current chronostratigraphic scale advocated by the Subcommission on Permian Stratigraphy of three series and nine stages: Cisuralian (lower Permian) – Asselian, Sakmarian, Artinskian, Kungurian; Guadalupian (middle Permian) – Roadian, Wordian, Capitanian; and Lopingian (upper Permian) – Wuchiapingian and Changhsingian. The boundaries of the Permian System are defined by global stratotype sections and points (GSSPs) and the numerical ages of those boundaries appear to be determined with a precision better than 1‰. Nevertheless, much work remains to be done to refine the Permian timescale. Precise numerical age control within the Permian is very uneven and a global polarity timescale for the Permian is far from established. Chronostratigraphic definitions of three of the nine Permian stages remain unfinished and various issues of marine biostratigraphy are still unresolved. In the non-marine Permian realm, much progress has been made in correlation, especially using palynomorphs, megafossil plants, conchostracans and both the footprints and bones of tetrapods (amphibians and reptiles), but many problems of correlation remain, especially the cross-correlation of non-marine and marine chronologies. The further development of a Permian chronostratigraphic scale faces various problems, including those of stability and priority of nomenclature and concepts, disagreements over changing taxonomy, ammonoid v. fusulinid v. conodont biostratigraphy, differences in the perceived significance of biotic events for chronostratigraphic classification and correlation problems between provinces. Future research on the Permian timescale should focus on GSSP selection for the remaining undefined stage bases, the definition and characterization of substages, and further development and integration of the Permian chronostratigraphic scale with radioisotopic, magnetostratigraphic and chemostratigraphic tools for calibration and correlation.
Acute Kidney Injury Following Acute Ischemic Stroke and Intracerebral Hemorrhage: A Meta-Analysis of Prevalence Rate and Mortality Risk
Authors: Zorrilla-Vaca Andrés , Ziai Wendy , Connolly Jr. E. Sander , Geocadin Romer , Thompson Richard , Rivera-Lara Lucia
Published: November 2017

Background: The epidemiology of acute renal dysfunction after stroke is routinely overlooked following stroke events. Our aim in this meta-analysis is to report the prevalence of acute kidney injury (AKI) following acute stroke and its impact on mortality. Methods: A systematic literature search was performed on PubMed, EMBASE and Google Scholar for observational studies examining the prevalence and mortality risk of stroke patients with AKI as a complication. The pooled prevalence rates and odds ratios for mortality risk were calculated using subgroup analyses between the stroke subtypes: acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH). Results: A total of 12 studies (4,532,181 AIS and 615,636 ICH) were included. The pooled prevalence rate of AKI after all stroke types was 11.6% (95% CI 10.6–12.7). Subgroup analyses revealed that the pooled prevalence rate of AKI after AIS was greater but not statistically significantly different than ICH (19.0%; 95% CI 8.2–29.7 vs. 12.9%; 95% CI 10.3–15.5, p = 0.5). AKI was found to be a significant risk factor of mortality in AIS (adjusted OR [aOR] 2.23; 95% CI 1.28–3.89; I2 = 98.8%), whereas this relationship did not reach statistical significance in ICH (aOR 1.20; 95% CI 0.68–2.12; I2 = 74.2%). Conclusions: This meta-analysis provides evidence that AKI is a common complication following both AIS and ICH and it is associated with increased mortality following AIS but not ICH. This highlights the need for early assessment of renal function in the acute phase of AIS, in particular, and avoidance of factors than may induce AKI in vulnerable patients.
Toward Using a Smartwatch to Monitor Frailty in a Hospital Setting: Using a Single Wrist-Wearable Sensor to Assess Frailty in Bedbound Inpatients
Authors: Lee Hyoki , Joseph Bellal , Enriquez Ana , Najafi Bijan
Published: November 2017

Background: While various objective tools have been validated for assessing physical frailty in the geriatric population, these are often unsuitable for busy clinics and mobility-impaired patients. Recently, we have developed a frailty meter (FM) using two wearable sensors, which allows capturing key frailty phenotypes (weakness, slowness, and exhaustion), by testing 20-s rapid elbow flexion-extension test. Objective: In this study, we proposed an enhanced automated algorithm to identify frailty using a single wrist-worn sensor. Methods: The data collected from 100 geriatric inpatients (age: 78.9 ± 9.1 years, 49% frail) were reanalyzed to validate the new algorithm. The frailty status of the participants was determined using a validated modified frailty index. Different FM phenotypes (31 features) including velocity of elbow rotation, decline in velocity of elbow rotation over 20 s, range of motion, etc. were extracted. A regression model, bootstrap with 2,000 iterations, and recursive feature elimination technique were used for optimizing the FM parameters and identifying frailty using a single wrist-worn sensor. Results: A strong agreement was observed between two-sensor and wrist-worn sensor configuration (r = 0.87, p < 0.001). Results suggest that the wrist-worn FM with no demographic information still yields a high accuracy of 80.0% (95% CI: 79.7-80.3%) and an area under the curve of 87.7% (95% CI: 87.4-87.9%) to identify frailty status. Results are comparable with two-sensor configuration, where the observed accuracy and area under the curve were 80.6% (95% CI: 80.4-80.9%) and 87.4% (95% CI: 87.1-87.6%), respectively. Conclusion: The simplicity of FM may open new avenues to integrate wearable technology and mobile health to capture frailty status in a busy hospital setting. Furthermore, the reduction of needed sensors to a single wrist-worn sensor allows deployment of the proposed algorithm in the form of a smartwatch application. From the application standpoint, the proposed FM is superior to traditional physical frailty-screening tools in which the walking test is a key frailty phenotype, and thus they cannot be used for bedbound patients or in busy clinics where administration of gait test as a part of routine assessment is impractical.
Effect of Etanercept on the Success of Assisted Reproductive Technology in Patients with Endometrioma
Authors: Önalan Göğşen , Tohma Yusuf Aytaç , Zeyneloğlu Hulusi Bülent
Published: November 2017

Aims: To determine the effects of a tumor necrosis factor inhibitor (etanercept) on pregnancy outcomes in patients with endometrioma who were treated with assisted reproductive technology. Methods: Sixty-eight infertile patients who had endometrioma were included in our retrospective case-control study. We administered etanercept (Enbrel, 50 mg in 1 mL intramuscularly) to 19 patients on the second day of their previous menstrual cycle. All patients were treated with assisted reproductive technology. Pregnancy and live birth rates (LBR) were documented. Results: When all other parameters (age, body mass index, infertility) are supposed to be constant, the clinical pregnancy rate was significantly higher in patients who used etanercept in an antagonist protocol than in patients who did not use etanercept (χ2 = 5.547; p = 0.019) but LBR did not reach a statistical significance (χ2 = 3.179; p = 0.075). The use of etanercept had an OR of 4.17 (95% CI 1.23–14.14) compared with not using etanercept for clinical pregnancy rate. The use of etanercept increased the rate of pregnancy (χ2 = 6.55; p = 0.01). The pregnancy rate with the use of etanercept had an OR of 4.23 (95% CI 1.35–13.25) compared with patients who did not use etanercept. In the same way, the use of etanercept increased LBR twofold, but it is not significant in the border line (χ2 = 3.771; p = 0.052). Conclusions: Etanercept may be a new non-hormonal therapy that may be an adjunct to treatment of infertile women with endometrioma. However, the safety of etanercept on embryos and fetuses has not been fully clarified.
Elevated Expression of Zinc Finger Protein 703 Promotes Cell Proliferation and Metastasis through PI3K/AKT/GSK-3β Signalling in Oral Squamous Cell Carcinoma
Authors: Wang Hao , Deng Xubin , Zhang Jinshan , Ou Zhilin , Mai Jiajie , Ding Shangwei , Huo Shaofen
Published: November 2017

Background/Aims: Zinc finger protein 703 (ZNF703), initially identified as a novel oncogene in human breast cancer, is a member of the NET/NlZ family of zinc finger transcription factors. It is recognized that the overexpression of ZNF703 is associated with various types of human cancers, but the role and molecular mechanism of ZNF703 in oral squamous cell carcinoma (OSCC) are unknown. Methods: ZNF703 expression levels were examined in OSCC tissues and non-cancerous tissues by qRT-PCR and immunohistochemistry (IHC). The molecular mechanisms of ZNF703 and its effects on cell growth and metastasis were explored in vitro and in vivo using the CCK8 assay, colony formation assay, cell cycle analysis, migration and invasion assays, wound-healing assay, western blotting and xenograft experiments in nude mice. Results: In this study, ZNF703 was found to be upregulated in OSCC tissues compared to that in normal tissues at both mRNA and protein levels, and its expression level was closely correlated with the overall survival of patients with OSCC. Silencing of the ZNF703 gene in OSCC cells significantly inhibited cell growth and metastasis in vitro and in vivo. Conversely, the overexpression of ZNF703 in OSCC cells promoted cancer growth and metastasis in vitro. Mechanistically, ZNF703 activated the PI3K/AKT/GSK-3β signalling pathway and its downstream effectors, thus regulating the cell cycle and epithelial-mesenchymal transition (EMT). Furthermore, the promotive effects of ZNF703 on cellular proliferation and metastasis could be rescued by LY294002 (a PI3K-specific inhibitor) and MK2206 (an Akt-specific inhibitor). Conclusion: The results show that ZNF703 promotes cell growth and metastasis through PI3K/Akt/GSK-3β signalling in OSCC and that it may be a promising target in the treatment of patients with OSCC.
Power Doppler sonography in the assessment of neovascularization following surgical fracture repair in sheep: case report
Authors: Baccarelli Danielle Cristinne , Paretsis Nicole Fidalgo , Lhamas Cínthia Lima , Corrêa Rodrigo Romero , Spagnolo Júlio David , Benesi Fernando José , Manchini Giuliana , Zoppa André Luis Do Valle de
Published: November 2017

A ultrassonografia é técnica de imagem segura e não invasiva que fornece imagens dinâmicas. O Power Doppler é modalidade ultrassonográfica que permite a visualização de vasos sanguíneos sem depender de intensidade e direção de fluxo. Admitiu-se no Hospital Veterinário da FMVZ-USP um ovino fêmea, de raça Ile de France, com um ano de idade e apresentando fratura completa de tíbia em bisel. O animal foi submetido à anestesia inalatória para a realização de osteossíntese com placa bloqueada de 3,5 mm. Durante o período pós-operatório foram realizadas imagens de ultrassonografia Power Doppler para a avaliação da neovascularização ao longo do processo de regeneração óssea. Entre o 14º e o 21º dia do período pós-operatório, identificou-se a presença de vasos sanguíneos neoformados, que apresentaram sinais de regressão nas avaliações subsequentes (realizadas no 28º e no 35º dia pós-operatório). A ultrassonografia Power Doppler mostrou-se eficiente na detecção precoce de vasos sanguíneos neoformados na região da fratura no período pós-operatório, sendo um exame não invasivo, que não gerou estresse para o animal e que pode estar relacionado ao sucesso no reparo ósseo da tíbia do animal submetido à osteossíntese.
Occurrences of antibodies against Toxoplasma gondii, Neospora spp., and Sarcocystis neurona in horses and dogs in the municipality of Pauliceia, São Paulo, Brazil
Authors: Oliveira Solange , Silva Natalia Quadros Bessa , Silveira Iara , Labruna Marcelo Bahoa , Gennari Solange Maria , PENA Hilda Fátima Jesus
Published: November 2017

Amostras de soro de 116 equinos e 47 cães provenientes do município de Paulicéia, São Paulo, foram testadas para detecção de anticorpos anti-Toxoplasma gondii, -Neospora spp. e -Sarcocystis neurona por meio da reação de imunofluorescência indireta (RIFI). Apenas um equino, entre 116 equinos testados, teve diagnóstico soropositivo para T. gondii (0,9%), e três deles (2,6%) apresentaram anticorpos anti-Neospora spp. Entretanto, 27 equinos apresentaram anticorpos anti-S. neurona (23,8%). Nas amostras de cães, dez dos 47 animais apresentaram anticorpos anti-T. gondii (21,3%) e três tiveram diagnóstico soropositivo para Neospora caninum (6,4%). Este estudo relata que no município de Paulicéia os cães das áreas urbana e rural foram expostos a T. gondii e N. caninum, enquanto os equinos da área rural foram expostos aos três protozoários estudados, com alta ocorrência de anticorpos anti- S. neurona.
The generic classification of the Trochilini (Aves: Trochilidae): Reconciling taxonomy with phylogeny
Authors: STILES F. GARY , REMSEN J. V. JR. , MCGUIRE JIMMY A.
Published: November 2017

The generic nomenclature of the hummingbirds is unusually complicated. McGuire et al.’s (2014) recent phylogeny of the Trochilidae based on DNA sequence data has greatly clarified relationships within the family but conflicts strongly with the traditional classification of the family at the genus level, especially that of the largest and most recently derived clade, the Trochilini or “emeralds”. We recently presented a historical review of this classification and the generic modifications required by the Code of the International Commission on Zoological Nomenclature. Herein we present a revised generic classification of the Trochilini based upon McGuire et al.’s genetic data, while producing diagnosable generic groupings and preserving nomenclatural stability insofar as possible. However, this generic rearrangement has necessitated the resurrection of nine generic names currently considered synonyms, the synonymization of seven currently recognized genera and the creation of one new genus. The generic changes we recommend to the classification are drastic, and we summarize these in tabular form in comparison with the three most recent classifications of the Trochilini. Where appropriate, we outline alternatives to our proposed arrangement. The classification treats 110 species in 35 genera, including two species that remain unplaced for lack of genetic samples.
First record of the genus Parasitorhabditis Fuchs, 1937 (Rhabditida, Nematoda) from Iran with notes on morphological and molecular characters of the Iranian population of P. obtusa (Fuchs, 1915) Chitwood & Chitwood, 1950
Authors: VALIZADEH AHMAD , GOLDASTEH SHILA , RAFIEI-KARAHROODI ZAHRA , PEDRAM MAJID
Published: November 2017

Parasitorhabditis obtusa is reported from Iran for the first time. The studied population is characterised with its morphological and molecular data. Morphological characters of the recovered population is in agreement with the currently available data of the species. In molecular phylogenetic studies using partial sequences of 28S rDNA D2/D3 fragment, the species formed a clade with two other isolates of the species with maximal Bayesian posterior probability (1.00) and maximum likelihood bootstrap values (100). The species was in association with bark samples of dead coniferous trees having galleries of bark beetles. It was also recovered from inside of the body of the Mediterranean pine beetle, Orthotomicus erosus, representing a new insect host for this nematode species.
Complete Malleus Removal for Cholesteatoma: A Multivariate Analysis of Ossiculoplasty Success and Residual Disease
Authors: Shapiro Scott , Bennett Donald , Wetmore Stephen , Cassis Adam
Published: November 2017

Objective:

Determine the effect of complete malleus removal during canal wall up tympanomastoidectomy for cholesteatoma on ossiculoplasty success and rate of residual cholesteatoma.

Methods:

We reviewed the operative, audiogram, and clinical reports of patients who underwent canal wall up tympanomastoidectomy for cholesteatoma between 2009 and 2016 at a tertiary academic medical center with at least 8 months of follow-up after surgery. To control for extent of disease, we independently catalogued the subsites of the middle ear and mastoid that cholesteatoma involved from each operation. We performed multivariate logistic regression to determine the independent effect of complete removal of the malleus on the rate of residual disease and success of ossiculoplasty.

Results:

One hundred eighty surgeries were included in the analysis. For ossiculoplasty success, the adjusted odds ratio of complete malleus removal was 1.7 (95% CI, 0.43-7.0, P = .43), which was not statistically significant. For residual disease, the adjusted odds ratio of complete malleus removal versus not was 0.29 (95% CI, 0.074-1.1, P = .076), which approached but did not meet statistical significance.

Conclusion:

Though complete malleus removal does not independently decrease the rate of residual cholesteatoma, it may be a safe technique as it did not compromise ossiculoplasty success.
Tubeless Total Intravenous Anesthesia Spontaneous Ventilation for Adult Suspension Microlaryngoscopy
Authors: Yoo Mi Jin , Joffe Aaron M. , Meyer Tanya K.
Published: November 2017

Introduction:

Maintaining spontaneous ventilation (SV) under total intravenous anesthesia (TIVA) without an endotracheal tube provides uninterrupted and unobstructed surgical access for suspension microlaryngoscopy (SML). This study describes the method and outcome of adults who underwent SML under tubeless TIVA-SV.

Methods:

Retrospective review of adults who underwent SML between June 2014 and September 2016 using TIVA-SV without an endotracheal tube.

Results:

Sixty-six cases in 36 patients were included with mean age of 50.6 years and 52.7% were female. Airway pathology included 41.6% subglottic or tracheal stenosis, 19.4% laryngeal lesion or mass, 16.7% glottic stenosis, 13.9% recurrent respiratory papilloma, and 8.3% supraglottic stenosis. Anesthesia was most commonly provided by continuous infusion of propofol and remifentanil (57.6%). Approximately half (53%) of cases received superior laryngeal nerve block. Average operative time was 72.9 minutes (range, 27-166 minutes). Eight cases required supplemental ventilation: 6 cases required transient endotracheal ventilation or mask ventilation, and 2 cases were converted to alternative ventilation.

Conclusions:

Total intravenous anesthesia is an attractive alternative to traditional endotracheal tube intubation, jet ventilation, or intermittent apneic ventilation for adult SML. During episodes of hypoventilation or desaturation, endotracheal ventilation, mask ventilation, or jet ventilation can effectively recover oxygenation.
Life in Contradiction to Life
Authors: Carroll Jill
Published: November 2017

This article examines the central moral injunction of non-violence toward sentient beings, rooted in both religious and secular worldviews, which exhorts the practice of vegetarianism, condemns the killing of animals, and rejects all forms of predation in general, including hunting. Specifically, this article examines the moral injunction of non-violence through the prism of Nietzsche’s analysis of metaphysical dualism and the decadent, nihilistic, world-denying postures that he claims accompany such dualism. A Nietzschean analysis exposes the condemnations of hunting (and of predation in general) rooted in the moral injunction of non-violence as distinct versions of a nature-denying, world-hating philosophy – despite the fact that those who defend such an approach usually claim it to be a world-affirming (and animal loving) stance. The article concludes with a warning against the particular human arrogance that seeks to re-order natural processes in accordance with human moral conventions and ideals.
Medicine and Religion are Not-Two
Authors: Skrivanic Peter
Published: November 2017

This paper considers the relationship between religion, medicine and the secular by paying attention to the sensory dimensions of knowledge practices in shiatsu, a Japanese manual therapy. Strongly shaped by the secularist ethos of the postwar US occupation, shiatsu in Japan has been rationalized according to biomedical models. Yet a reaction to this development would see the emergence of “Zen Shiatsu”: a shiatsu style emphasizing meditation and compassionate touch as foundational acts of medical assessment, and one that would migrate successfully to American shores. Ethnographic engagements with contemporary North American practitioners of Zen Shiatsu illustrate how their sensory economies of knowledge enable expressions of subjectivity that trouble the visualistic and objectivist dimensions of biomedical knowledge that are crucial to maintaining the boundary between biomedicine and its others.
Nimrod
Authors: Hoerig Karl A.
Published: November 2017

Each fall from 1984 to 2007 a group of Lutheran pastors in Texas gathered at the ranch of another pastor to hunt white-tailed deer during the opening week of the annual hunting season. Called “Nimrod” after the ancient Babylonian king identified in the Bible as “a mighty hunter before the Lord” (Genesis 10:9), also an acronym for “November Invitational Ministerial Recreational Outdoor Diversion,” the event provided opportunities for recreation and fellowship for active and retired clergy, centered around the hunt. To the casual observer hunting is not an immediately obvious pastime to bring Christian ministers together. This ethnographic study examines the place of hunting within Christian theology and explores how the annual deer hunting retreat in fact created an ideal opportunity for clergy to escape from the social constraints of their professional lives while engaging in the deeply meaningful practice of harvesting wild game.
The Impact of Civil Gang Injunctions on Networked Violence Between the Bloods and the Crips
Authors: Bichler Gisela , Norris Alexis , Dmello Jared R. , Randle Jasmin
Published: November 2017

Comparing the centrality of gangs and changing structure in attack behavior, this study examines the effects of civil gang injunctions (CGIs) on violence involving 23 gangs (seven Bloods and 16 Crips) operating in Southern California. We mapped violence networks by linking defendants and victims named in 272 court cases prosecuted in the City of Los Angeles (1997-2015), involving at least one conviction for a violent crime and a defendant tried as an adult. The results show that a small number of gangs are centrally located in a dynamic web of non-reciprocated conflict that exhibited complex hierarchical structures. These results raise four implications for combating gang violence.
A Testing System for a Safety Lock based on LabVIEW
Authors: Yu Jianfeng , Fu Jian
Published: November 2017

This paper proposes an accurate and efficient testing system for the safety lock that is used in the suspended access platforms. The measurement methods conform to the standard EN 1808:2015. First, the whole architecture of the system is designed, including the mechanical structure unit, lower control unit, sensors and data acquisition. Second, the upper control software based on LabVIEW is presented. In addition, manual and automatic testing modes are proposed. The field experimental results demonstrated that the proposed testing system has the advantage of high accuracy, high automation and high efficiency.