bluuebunny/crossref_metadata_2025 huggingface dataset:
Managing the difficult past: Ukrainian collective memory and public debates on history
Authors: Wylegała Anna
Published: August 2017

This article analyzes the status of difficult historic events in Ukrainian collective memory. Difficult elements of collective memory are defined as those which divide society on basic matters, such as identity and national cohesion, and events which are being actively forgotten because of the role of Ukrainians as perpetrators. Three such issues were analyzed: World War II and the role of the Ukrainian Insurgent Army (UPA), the Holocaust, and the ethnic purge of Poles in Volhynia and Eastern Galicia in 1943–1945. Utilizing data from quantitative and qualitative studies, the author showcases the significance of these issues for contemporary Ukrainian identity and Ukraine's relations with its neighbors. In particular, the evaluation of World War II and the role of the UPA in Ukrainian history polarizes Ukrainian society to a great degree. At the same time, this element of national history is used to construct a common, anti-Russian identity. The difficulty of relating to the memory of the Holocaust and the ethnic purge in Volhynia is of a different character. These events are problematic for Ukrainian collective memory because they demand a painful settling of accounts with the past. At present, only Ukrainian elites are willing to work on these subjects, and only to a limited degree, while the common consciousness either denies or ignores them altogether.
Tribological behaviour of a self-lubricated GO/WC–12Co thermal spray coating
Authors: Tian H.L. , Guo M.Q. , Wang C.L. , Tang Z.H. , Cui Y.J.
Published: August 2017

In this work, we report on the first thermal spray coatings to consist of graphene oxide (GO) embedded in a WC–12Co matrix. The purpose of these coatings is to release lubricant into the system when needed. These coatings were prepared using detonation gun spraying, and tribological tests of the coatings were performed. The results indicated that a coating containing embedded GO exhibited approximately half the wear rate and a 28% lower friction coefficient than a comparable coating without GO. These results were attributed to the presence of GO platelets adhering to the friction surface that formed a self-lubricating layer.
L. V. Shcherba: a ‘new slant’ on modern foreign languages in the school curriculum?
Authors: Campbell-Thomson Olga
Published: August 2017

In this paper, I offer a critical reflection on the thesis of the general educational value of foreign languages developed by Russian linguist Lev Vladimirovich Shcherba. I do so against the background of current debates on the positioning of foreign languages in the school curriculum in the United Kingdom (UK). I argue that Shcherba's thesis, which was developed almost a century ago, retains its currency and can make an important contribution to the on‐going discussion on the value of foreign languages in UK schools. The paper outlines Shcherba's scholarly explorations in general linguistics which underpin his arguments in favour of the inclusion of foreign languages in the basic school curriculum. The conception of language as a system immanently positioned in social experience assigns the foundational role to language in the literacy project. The conscious analytic processing of language phenomena is viewed as an essential pre‐condition of literacy, and foreign languages are shown to be instrumental in developing such an analytic capacity of mind. Shcherba's argumentation reflects a comprehensive and interdisciplinary approach, both to foreign language education and to curriculum matters, and merits the attention of language practitioners, educationalists and policy‐makers alike.
A molecular signature for anastasis, recovery from the brink of apoptotic cell death
Authors: Sun Gongping , Guzman Elmer , Balasanyan Varuzhan , Conner Christopher M. , Wong Kirsten , Zhou Hongjun Robin , Kosik Kenneth S. , Montell Denise J.
Published: August 2017

During apoptosis, executioner caspase activity has been considered a point of no return. However, recent studies show that cells can survive caspase activation following transient apoptotic stimuli, a process called anastasis. To identify a molecular signature, we performed whole-transcriptome RNA sequencing of untreated, apoptotic, and recovering HeLa cells. We found that anastasis is an active, two-stage program. During the early stage, cells transition from growth-arrested to growing. In the late stage, HeLa cells change from proliferating to migratory. Recovering cells also exhibited prolonged elevation of proangiogenic factors. Strikingly, some early-recovery mRNAs, including Snail, were elevated first during apoptosis, implying that dying cells poise to recover, even while under apoptotic stress. Snail was also required for recovery. This study reveals similarities in the anastasis genes, pathways, and cell behaviors to those activated in wound healing and identifies a repertoire of potential targets for therapeutic manipulation.
Co-stimulatory function in primary germinal center responses: CD40 and B7 are required on distinct antigen-presenting cells
Authors: Watanabe Masashi , Fujihara Chiharu , Radtke Andrea J. , Chiang Y. Jeffrey , Bhatia Sumeena , Germain Ronald N. , Hodes Richard J.
Published: August 2017

T cell–dependent germinal center (GC) responses require coordinated interactions of T cells with two antigen-presenting cell (APC) populations, B cells and dendritic cells (DCs), in the presence of B7- and CD40-dependent co-stimulatory pathways. Contrary to the prevailing paradigm, we found unique cellular requirements for B7 and CD40 expression in primary GC responses to vaccine immunization with protein antigen and adjuvant: B7 was required on DCs but was not required on B cells, whereas CD40 was required on B cells but not on DCs in the generation of antigen-specific follicular helper T cells, antigen-specific GC B cells, and high-affinity class-switched antibody production. There was, in fact, no requirement for coexpression of B7 and CD40 on the same cell in these responses. Our findings support a substantially revised model for co-stimulatory function in the primary GC response, with crucial and distinct contributions of B7- and CD40-dependent pathways expressed by different APC populations and with important implications for understanding how to optimize vaccine responses or limit autoimmunity.
Bilateral comparison on electric field measurements between TÜBİTAK UME and SASO NMCC
Authors: Aslan Çağlar , Alrobaish Abdullah M , Şen Osman
Published: August 2017

Electromagnetic (EM) probes are widely utilized in the measurement of EM fields for non-ionizing radiation, electromagnetic compatibility (EMC) testing and other applications in the frequency range 5 Hz–60 GHz. They must be calibrated by National Metrology Institutes (NMIs) or accredited calibration laboratories in accordance with international standards such as IEEE 1309. The existing NMIs or emerging NMIs should refer to the international comparison measurements in order to assure the quality of their measurement results. Therefore, the electric field comparison measurements organized by TUBITAK UME were performed between TUBITAK UME and SASO NMCC at the 100 Hz, 1 kHz, 10 MHz, 100 MHz, 1 GHz, 10 GHz and 18 GHz frequencies in order to obtain the correction factors of the electric field probes. The comparison measurements were carried out in accordance with the Technical Protocol prepared by TUBITAK UME. The measurements started in October 2017 and were completed in January 2017. There was good agreement found for the correction factors.

Main text

To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/.

The final report has been peer-reviewed and approved for publication by the CCEM, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).
Potentially inappropriate medication among people with dementia in eight European countries
Authors: Renom-Guiteras Anna , Thürmann Petra A , Miralles Ramón , Klaaßen-Mielke Renate , Thiem Ulrich , Stephan Astrid , Bleijlevens Michel H C , Jolley David , Leino-Kilpi Helena , Rahm Hallberg Ingalill , Saks Kai , Soto-Martin Maria , Zabalegui Adelaida , Meyer Gabriele ,   on behalf of the RightTimePlaceCare Consortium
Published: August 2017

Objectives

to evaluate the frequency of potentially inappropriate medication (PIM) prescription among older people with dementia (PwD) from eight countries participating in the European study ‘RightTimePlaceCare’, and to evaluate factors and adverse outcomes associated with PIM prescription.

Methods

survey of 2,004 PwD including a baseline assessment and follow-up after 3 months. Interviewers gathered data on age, sex, prescription of medication, cognitive status, functional status, comorbidity, setting and admission to hospital, fall-related injuries and mortality in the time between baseline and follow-up. The European Union(7)-PIM list was used to evaluate PIM prescription. Multivariate regression analysis was used to investigate factors and adverse outcomes associated with PIM prescription.

Results

overall, 60% of the participants had at least one PIM prescription and 26.4% at least two. The PIM therapeutic subgroups most frequently prescribed were psycholeptics (26% of all PIM prescriptions) and ‘drugs for acid-related disorders’ (21%). PwD who were 80 years and older, lived in institutional long-term care settings, had higher comorbidity and were more functionally impaired were at higher risk of being prescribed two PIM or more. The prescription of two or more PIM was associated with higher chance of suffering from at least one fall-related injury and at least one episode of hospitalisation in the time between baseline and follow-up.

Conclusions

PIM use among PwD is frequent and is associated with institutional long-term care, age, advanced morbidity and functional impairment. It also appears to be associated with adverse outcomes. Special attention should be paid to psycholeptics and drugs for acid-related disorders.
Ecology and behaviour of holoplanktonic scyphomedusae and their interactions with larval and juvenile fishes in the northern Gulf of Mexico
Authors: Greer Adam T , Chiaverano Luciano M , Luo Jessica Y , Cowen Robert K , Graham William M
Published: August 2017

Pelagia noctiluca is a venomous, globally distributed holoplanktonic scyphomedusa that periodically forms aggregations in coastal environments, yet little is known about its ecology and behaviour in the northern Gulf of Mexico (nGOM). Using a high resolution plankton imaging system, we describe the patch characteristics of Pelagia medusae in relation to fine-scale biological and physical variables during two summers at shallow (∼25 m, 2016) and deeper (∼45 m, 2011) sampling areas on the nGOM shelf. At the deeper site during the day, average Pelagia medusae concentrations just underneath a surface plume of fresher water (10–25 m) ranged from 0.18 to 0.91 ind. m−3, with a Lloyd’s patchiness index of 13.87, indicating strong aggregation tendencies (peak fine-scale concentration reached 27 ind. m−3). These patches were often associated with horizontal gradients in salinity, and concentrations of several zooplankton taxa (e.g. chaetognaths, hydromedusae, siphonophores, and ctenophores) were significantly negatively correlated with Pelagia medusae abundance (p < 0.0001, Spearman correlations). Although larval fish abundance was not correlated with Pelagia medusae on the 1 m3 scale (19.25 m horizontal distance), larval and juvenile fishes between 0.6 and 2.0 cm aggregated underneath the bell of some Pelagia medusae during the daytime only, even within hypoxic waters. Vertical distributions collected on a diel cycle demonstrated that Pelagia medusae perform a reverse diel vertical migration constrained by low salinity near the surface. These data suggest that salinity changes drive the distribution of Pelagia medusae vertically and horizontally, and when sufficient concentrations are present, medusae are capable of exerting a top-down effect on the abundances of their zooplankton prey. For zooplankton with high visual acuity, such as larval and juvenile fishes, the relationship with Pelagia medusae may change on a diel cycle and depend on the sensory ability of potential prey.
Almost Primes in Thin Orbits of Pythagorean Triangles
Authors: Ehrman Max
Published: August 2017

Let $F=x^2+y^2-z^2$, and let $x_0 \in \mathbb{Z}^3$ be a $primitive$ solution to $F(x_0)=0$, e.g., so that its coordinates share no nontrivial divisor. Let $\Gamma \leq \mathrm{SO_F(\mathbb{Z})}$ be a thin subgroup. We consider the resulting thin orbits of Pythagorean triples $x_0 \cdot \Gamma$—specifically which hypotenuses, areas, and products of all three coordinates arise. We produce infinitely many $R$-almost primes in these three cases whenever $\Gamma$ has exponent $\delta_\Gamma>\delta_0(R)$ for explicit $R$, $\delta_0$.
An environmental scan of shared access to patient portals
Authors: Wolff Jennifer L , Kim Victoria S , Mintz Suzanne , Stametz Rebecca , Griffin Joan M
Published: August 2017

We sought to understand the comprehensiveness of consumer-oriented information describing the availability of shared access to adult patient portals from publicly reported information on institutional websites of 20 large and geographically diverse health systems. All 20 health systems reported that they offer patients the ability to share access to their patient portal account with a family member or friend; however, the comprehensiveness of information regarding registration procedures, features, and terminology varied widely. Half of the systems (n = 10) reported having shared access available on their patient portal registration webpage. Few systems (n = 2) reported affording patients the ability to differentiate specific role-based privileges. No systems reported uptake of shared access among adult patients, which was variably described as “proxy,” “caregiver,” “parental,” or “delegate” access. Findings suggest that engaging families through health information technology will require greater efforts to promote awareness and differentiate privileges that respect patients’ choice and control in information-sharing preferences.
Brain Shift and Pneumocephalus Assessment During Frame-Based Deep Brain Stimulation Implantation With Intraoperative Magnetic Resonance Imaging
Authors: Matias Caio M , Frizon Leonardo A , Asfahan Fadi , Uribe Juan D , Machado Andre G
Published: August 2017

BACKGROUND

Brain shift and pneumocephalus are major concerns regarding deep brain stimulation (DBS).

OBJECTIVE

To report the extent of brain shift in deep structures and pneumocephalus in intraoperative magnetic resonance imaging (MRI).

METHODS

Twenty patients underwent bilateral DBS implantation in an MRI suite. Volume of pneumocephalus, duration of procedure, and 6 anatomic landmarks (anterior commissure, posterior commissure, right fornix [RF], left fornix [LF], right putaminal point, and left putaminal point) were measured.

RESULTS

Pneumocephalus varied from 0 to 32 mL (median = 0.6 mL). Duration of the procedure was on average 195.5 min (118-268 min) and was not correlated with the amount of pneumocephalus. There was a significant posterior displacement of the anterior commissure (mean = −1.1 mm, P < .001), RF (mean = −0.6 mm, P < .001), LF (mean = −0.7 mm, P < .001), right putaminal point (mean = −0.9 mm, P = .001), and left putaminal point (mean = −1.0 mm, P = .001), but not of the posterior commissure (mean = 0.0 mm, P = .85). Both RF (mean = −.7 mm, P < .001) and LF (mean = −0.5 mm, P < .001) were posteriorly displaced after a right-sided burr hole. There was a correlation between anatomic landmarks displacement and pneumocephalus after 2 burr holes (rho = 0.61, P = .007), but not after 1 burr hole (rho = 0.16, P = .60).

CONCLUSION

Better understanding of how pneumocephalus displaces subcortical structures can significantly enhance our intraoperative decision making and overall targeting strategy.
Varieties of risk regulation in Europe: coordination, complementarity and occupational safety in capitalist welfare states
Authors: Rothstein Henry , Demeritt David , Paul Regine , Beaussier Anne-Laure , Wesseling Mara , Howard Michael , de Haan Maarten , Borraz Olivier , Huber Michael , Bouder Frederic
Published: August 2017

This article tests the extent to which the organization and stringency of occupational health and safety regulation complements the dominant mode of coordination in the political economy. While the UK explicitly sanctions risk-cost-benefit trade-offs, other European countries mandate ambitious safety goals. That contrast appears to reflect cleavages identified in the Varieties of Capitalism literature, which suggests worker protection regimes are stronger in coordinated market economies than in liberal market economies. Our analysis of Germany, France, UK and the Netherlands, shows that the varied organization of their regulatory regimes is explained through a three-way complementarity with their welfare systems and modes of coordination. However, despite varied headline goals, we find no systematic differences in the stringency of those countries’ regulatory protections insofar as they all make trade-offs on safety. Instead, the explicitness, rationalizations and logics of trade-offs vary according to each country’s legal system, state tradition and coupling between regulation and welfare system.
Population Structure and Biodiversity of Pectobacterium parmentieri Isolated from Potato Fields in Temperate Climate
Authors: Zoledowska Sabina , Motyka Agata , Zukowska Dominika , Sledz Wojciech , Lojkowska Ewa
Published: August 2017

Pectobacterium parmentieri (formerly Pectobacterium wasabiae) is a newly established species of pectinolytic plant-pathogenic bacteria responsible for the symptoms of soft rot and blackleg on potato. In this work, we describe biodiversity and the population structure of P. parmentieri strains isolated during two consecutive growing seasons from the seed potato fields in Poland. About 450 samples of diseased potato tubers, potato plants, or accompanying weeds were collected throughout the country and tested for the presence of P. parmentieri by molecular identification methods. We found that P. parmentieri strains commonly occur in almost all regions of Poland. Furthermore, these isolates constituted significant fraction of pectinolytic bacteria from seed potato fields because 16% (2013) and 13% (2014) of the analyzed plant samples were infected with P. parmentieri. Subsequently, a detailed characterization of the obtained strains was conducted basing on repetitive sequences profiling, recA-gene-based phylogeny, and phenotypic features. By applying repetitive extragenic palindromic sequence-based polymerase chain reaction (REP-PCR), we revealed the presence of five distinct genomic profiles among P. parmentieri strains, with profile I being the most abundant (approximately 44%). The performed recA gene-based phylogenetic analysis divided P. parmentieri isolates into two distinct clades, although the strains originating from different years did not group separately. Evaluation of the phenotypic traits playing crucial roles for the virulence of pectinolytic bacteria (namely, pectinase, cellulase and protease activities, and siderophore production, in addition to potato tissue maceration, swimming, and swarming motility) indicated some differences among the characterized strains. To the best of our knowledge, this is the first study that describes biodiversity and the population structure of P. parmentieri isolated in two growing seasons under temperate climate conditions and, hence, illustrates high heterogeneity within this species.
Making the First Cut: An Analysis of Academic Medicine Editors’ Reasons for Not Sending Manuscripts Out for External Peer Review
Authors: Meyer Holly S. , Durning Steven J. , Sklar David P. , Maggio Lauren A.
Published: August 2017

Purpose

Manuscripts submitted to Academic Medicine (AM) undergo an internal editor review to determine whether they will be sent for external peer review. Increasingly, manuscripts are rejected at this early stage. This study seeks to inform scholars about common reasons for internal editor review rejections, increase transparency of the process, and provide suggestions for improving submissions.

Method

A mixed-methods approach was used to retrospectively analyze editors’ free-text comments. Descriptive content analysis was performed of editors’ comments for 369 manuscripts submitted between December 2014 and December 2015, and rejected prior to external peer review from AM. Comments were analyzed, categorized, and counted for explicit reasons for rejection.

Results

Nine categories of rejection reasons were identified: ineffective study question and/or design (338; 92%); suboptimal data collection process (180; 49%); weak discussion and/or conclusions (139; 37%); unimportant or irrelevant topic to the journal’s mission (137; 37%); weak data analysis and/or presentation of results (120; 33%); text difficult to follow, to understand (89; 24%); inadequate or incomplete introduction (67; 18%); other publishing considerations (42; 11%); and issues with scientific conduct (20; 5%). Manuscripts had, on average, three or more reasons for rejection.

Conclusions

Findings suggest that clear identification of a research question that is addressed by a well-designed study methodology on a topic aligned with the mission of the journal would address many of the problems that lead to rejection through the internal review process. The findings also align with research on external peer review.
Addressing Stigma in Medication Treatment of Adolescents With Opioid Use Disorder
Authors: Bagley Sarah M. , Hadland Scott E. , Carney Brittany L. , Saitz Richard
Published: August 2017

In September 2016, the American Academic of Pediatrics released a policy statement that adolescents with opioid use disorder should be offered pharmacotherapy with buprenorphine/naloxone, methadone, or naltrexone. In our clinical practice, however, we have encountered the perception among patients, families, and clinicians alike that medications should be used as a last resort. That we should wait until things get worse is a discarded approach. As addiction specialists, it is imperative that we prevent and identify risky use and use disorders, then intervene early and offer timely, evidence-based treatment. We suggest that adolescents deserve special attention and that specific efforts should be made to reduce the stigma associated with treating adolescents with opioid use disorder with medications to optimize those efforts.
Auditory Acclimatization to Bilateral Hearing Aids: Effects on Sentence-in-Noise Processing Times and Speech-Evoked Potentials
Authors: Habicht Julia , Finke Mareike , Neher Tobias
Published: August 2017

Objectives:

Using a longitudinal design, the present study sought to substantiate indications from two previous cross-sectional studies that hearing aid (HA) experience leads to improved speech processing abilities as quantified using eye-gaze measurements. Another aim was to explore potential concomitant changes in event-related potentials (ERPs) to speech stimuli.

Design:

Groups of elderly novice (novHA) and experienced (expHA) HA users matched in terms of age and working memory capacity participated. The novHA users were acclimatized to bilateral HA fittings for up to 24 weeks. The expHA users continued to use their own HAs during the same period. The participants’ speech processing abilities were assessed after 0 weeks (novHA: N = 16; expHA: N = 14), 12 weeks (novHA: N = 16; expHA: N = 14), and 24 weeks (N = 10 each). To that end, an eye-tracking paradigm was used for estimating how quickly the participants could grasp the meaning of sentences presented against background noise together with two similar pictures that either correctly or incorrectly depicted the meaning conveyed by the sentences (the “processing time”). Additionally, ERPs were measured with an active oddball paradigm requiring the participants to categorize word stimuli as living (targets) or nonliving (nontargets) entities. For all measurements, the stimuli were spectrally shaped according to individual real-ear insertion gains and presented via earphones.

Results:

Concerning the processing times, no changes across time were found for the expHA group. After 0 weeks of HA use, the novHA group had significantly longer (poorer) processing times than the expHA group, consistent with previous findings. After 24 weeks, a significant mean improvement of ~30% was observed for the novHA users, leading to a performance comparable with that of the expHA group. Concerning the ERPs, no changes across time were found.

Conclusions:

The results from this exploratory study are consistent with the view that auditory acclimatization to HAs positively impacts speech comprehension in noise. Further research is needed to substantiate them.
The Locations of Anterior Cruciate Ligament Tears in Pediatric and Adolescent Patients: A Magnetic Resonance Study
Authors: van der List Jelle P. , Mintz Douglas N. , DiFelice Gregory S.
Published: August 2017

Background:

Recently, a resurgence of interest has been noted in anterior cruciate ligament (ACL) preservation in pediatric and adolescent patients. Different tear types, defined by their tear location, require different preservation techniques: proximal and distal avulsion tears can be treated with arthroscopic primary repair, whereas primary repair with biological scaffold has been proposed for midsubstance tears. The goal of this study was to assess the distribution of different tear types in pediatric and adolescent patients, as these are currently unknown.

Methods:

A retrospective search in an institutional radiographic database was performed for patients under 18.0 years undergoing knee magnetic resonance imaging (MRI) for ACL tears between June 2005 and June 2016. Patients with reports of chronic tears, partial tears, and multiligamentous injuries were excluded.

Tear locations were graded using MRI as: proximal avulsion (distal remnant length >90% of total length; type I), proximal (75% to 90%; type II), midsubstance (25% to 75%; type III), distal (10% to 25%; type IV), and distal avulsion (<10%; type V).

Results:

A total of 274 patients (59% girls; mean±SD age, 15.1±2.1 y; range, 6.9 to 18.0 y) were included. Frequency of type I tears was 15%, type II 23%, type III 52%, type IV 1%, and type V 8% (of which 7% had bony avulsion).

Prevalence of tear types varied with age. At age 6 to 10 years, 93% were type V (bony) avulsion tears. At age 11 to 13 years, 32% were type I, 16% type II, 32% type III, and 16% type V. At age 14 to 17 years, type III tears were more common (57%) than type I (14%), type II (25%) and type V (2%) tears.

Conclusions:

It was noted that the ACL was torn at different locations depending on the patients’ age. These data provide more information on the potential application for ACL preservation in pediatric and adolescent patients. Future studies correlating these findings with arthroscopy are needed before using MRI for preoperative planning of ACL preservation surgery.

Level of Evidence:

Diagnostic level III.
3D Modeling of Lower Extremities With Biplanar Radiographs: Reliability of Measures on Subsequent Examinations
Authors: Westberry David E. , Carpenter Ashley M.
Published: August 2017

Background:

Biplanar radiography with 3-dimensional (3D) modeling (EOS) provides a comprehensive assessment of lower limb alignment in an upright weight-bearing position with less radiation than conventional radiography. A study was performed to assess the consistency and reliability of 2 lower extremity 3D biplanar radiograph models created at least 1 year apart in a pediatric population.

Methods:

All patients who had 2 lower extremity radiographic evaluations with EOS performed at visits a minimum of 1 year apart were reviewed. Digital radiographs, of lower extremities in both frontal and sagittal planes, were acquired simultaneously, using the EOS system. The 3D reconstruction of the images was achieved utilizing the SterEOS software. Pelvic position, femoral and tibial anatomy, and the torsional profile were evaluated and compared using t tests.

Results:

In total, 53 patients with a mean age of 11.7 years (range, 6.1 to 18.9 y) met inclusion criteria. When comparing 3D models between visits, minimal differences were noted in proximal femoral anatomy and pelvic alignment (pelvic incidence, sacral slope, sagittal tilt, neck shaft angle). Expected differences in femoral and tibial length corresponded with normal longitudinal growth between visits. Sagittal plane knee position varied widely between examinations. Femoral and/or tibial rotational osteotomies were performed in 37% of extremities between examinations. After femoral derotational osteotomy, a significant difference in femoral anteversion was appreciated when comparing preoperative and postoperative 3D models. However, this difference was less than the expected difference based on the anatomic correction achieved intraoperatively. No differences were noted in tibial torsion measures after tibial derotational osteotomy.

Conclusions:

The 3D modeling based on biplanar radiographs provides consistent and reliable measures of pelvic and hip joint anatomy of the lower extremity. Patient positioning may influence the reproducibility of knee alignment. The torsional profile assessment did not accurately reflect changes obtained by derotational osteotomy.

Level of Evidence:

Level III.
Outcomes of Primary Posterior Spinal Fusion for Scoliosis in Spinal Muscular Atrophy: Clinical, Radiographic, and Pulmonary Outcomes and Complications
Authors: Holt Joshua B. , Dolan Lori A. , Weinstein Stuart L.
Published: August 2017

Background:

Spinal muscular atrophy (SMA) is a progressive neuromuscular disease commonly including progressive scoliosis resulting in severe deformity and negatively affecting pulmonary function. Surgical correction and stabilization of this progressive deformity is generally recommended; however, the timing and method of surgical fixation remains controversial.

Methods:

Retrospective review of clinical, radiographic, and pulmonary function data from 16 children with SMA and surgically treated scoliosis between 1985 and 2013. Radiographic data included direct measures of major curve, coronal balance, pelvic obliquity, T1-T12 height, T1-S1 height, and T1-rod length. Estimations of rib collapse, thoracic cavity shape, and space-available-for-lung (T6:T12, width ratio; T6:T10, rib-vertebral-angle difference ratios; and lung height) were determined. Eleven patients were able to complete pulmonary function testing. Results were compared with published outcomes for growing rod constructs.

Results:

Posterior spinal fusion was performed at an average age of 9.8±3.6 years. The mean age at most recent follow-up was 19.4 years (range, 10 to 37 y), with a mean follow-up of 10.1 years (range, 3.1 to 26 y). Radiographic measurements improved from preoperative to latest follow-up as follows: major curve, 78±20 degrees to 27±24 degrees; coronal balance, 4.1±4.0 cm to 1.9±2.2 cm; pelvic obliquity (median), 23 to 5 degrees; T1-T12 height, 19±3 cm to 22±3 cm; T1-S1 height, 31±7 cm to 36±6 cm; T1-rod length, 0.8±1.1 cm (postop) to 2.8±1.6 cm (final); and space-available-for-lung ratio, 0.88±0.26 to 0.95±0.25. Rib collapse continued throughout the follow-up period in all but 1 patient. Pulmonary function testing demonstrated a decrease in rate of decline in forced vital capacity and forced expiratory volume when comparing preoperative with postoperative rates. Mean length of stay was 7.8±4.4 days. Complications included reintubation for low tidal volumes (n=1), pneumonia (n=1), superficial wound breakdown (n=1), and superficial infection (n=1).

Conclusions:

Definitive posterior spinal fusion for treatment of scoliosis associated with SMA is effective at controlling curve progression and pelvic obliquity without negatively impacting the space-available-for-lung ratio, trunk height, or pulmonary function at 10 years follow-up.

Level of Evidence:

Therapeutic Level IV.
A Comparison of Pavlik Harness Treatment Regimens for Dislocated But Reducible (Ortolani+) Hips in Infantile Developmental Dysplasia of the Hip
Authors: Hines Adam C. , Neal David C. , Beckwith Terri , Jo ChanHee , Kim Harry K.W.
Published: August 2017

Background:

Variation exists in the Pavlik harness (PH) treatment regimen for infantile developmental dysplasia of the hip (DDH). The purpose of this study was to determine if the daily PH wear duration (23 vs. 24 h) and frequency of follow-up visits affect the clinical and radiographic outcomes of infants with dislocated but reducible (Ortolani+) hips.

Methods:

This study reviewed prospectively enrolled patients with DDH in a single center who presented at age <6 months with Ortolani+ hips and were treated with PH. Recommended daily PH wear duration (23 vs. 24 h) and the frequency of clinic visits in first 4 weeks after the initiation of PH treatment were analyzed. The clinical success (stable hip that did not require closed or open reduction or the use of an abduction orthosis) and radiographic success based on the acetabular index at 2-year follow-up were compared between different PH regimen groups.

Results:

Sixty-two patients (74 hips, 53 females) with Ortolani+ hips had a mean age of presentation of 23±28 days (range, 4 to 128 d) and mean follow-up of 33.2±18.4 months (range, 8 to 85 mo). Overall clinical success rate of PH for Ortolani+ hips was 93% (69/74 hips) and radiographic success rate at 2 years was 84% (48/57 hips). There was no difference in clinical or radiographic success rate between the 23- and 24-hour wear groups (P>0.99, 0.73) or between hips assessed almost weekly compared with once or twice during the first 4 weeks of PH treatment (P>0.99 for both).

Conclusions:

The 23- versus 24-hour PH regimen and frequency of clinic visits in the first 4 weeks of PH treatment did not affect the clinical or radiographic success rate of Ortolani+ hips in infantile DDH. A strict weekly clinic visit and 24-hour PH regimen may not be necessary to obtain stable reduced hips in infants presenting <6 months of age with Ortolani+ hips.

Level of Evidence:

Level III—therapeutic.
Gait Deviations in Children With Osteogenesis Imperfecta Type I
Authors: Garman Christina R. , Graf Adam , Krzak Joseph , Caudill Angela , Smith Peter , Harris Gerald
Published: August 2017

Background:

Osteogenesis imperfecta (OI) is a congenital connective tissue disorder often characterized by orthopaedic complications that impact normal gait. As such, mobility is of particular interest in the OI population as it is associated with multiple aspects of participation and quality of life. The purpose of the current study was to identify and describe common gait deviations in a large sample of individuals with type I OI and speculate the etiology with a goal of improving function.

Methods:

Gait analysis was performed on 44 subjects with type I (11.7±3.08 y old) and 30 typically developing controls (9.54±3.1 y old ). Spatial temporal, kinematic, and kinetic gait data were calculated from the Vicon Plug-in-Gait Model. Musculoskeletal modeling of the muscle tendon lengths (MTL) was done in OpenSim 3.3 to evaluate the MTL of the gastrocnemius and gluteus maximus. The gait deviation index, a dimensionless parameter that evaluates the deviation of 9 kinematic gait parameters from a control database, was also calculated.

Results:

Walking speed, single support time, stride, and step length were lower and double support time was higher in the OI group. The gait deviation index score was lower and external hip rotation angle was higher in the OI group. Peak hip flexor, knee extensor and ankle plantarflexor moments, and power generation at the ankle were lower in the OI group. MTL analysis revealed no significant length discrepancies between the OI group and the typically developing group.

Conclusions:

Together, these findings provide a comprehensive description of gait characteristics among a group of individuals with type I OI. Such data inform clinicians about specific gait deviations in this population allowing clinicians to recommend more focused interventions.

Level of Evidence:

Level III—case-control study.
Low Bone-Mineral Density Is a Significant Risk for Proximal Junctional Failure After Surgical Correction of Adult Spinal Deformity
Authors: Yagi Mitsuru , Fujita Nobuyuki , Tsuji Osahiko , Nagoshi Narihito , Asazuma Takashi , Ishii Ken , Nakamura Masaya , Matsumoto Morio , Watanabe Kota
Published: August 2017

Study Design.

A propensity-matched comparison of risk factors for proximal junctional failure (PJF), which is a symptomatic proximal junctional kyphosis developing after corrective surgery for adult spinal deformity (ASD).

Objective.

To elucidate the role of bone strength for developing PJF.

Summary of Background Data.

PJF, a devastating complication of corrective surgery for ASD, often recurs even after revision surgery. Most studies of risk factors for PJF are retrospective and have a selection bias in surgical strategy, making it difficult to identify modifiable PJF risk factors.

Methods.

We conducted propensity-matched comparisons of 113 surgically treated ASD patients who were followed for at least 2 years, to elucidate whether low bone-mineral density (BMD) was a true risk factor for PJF in a uniform population from a multicenter database. Patients were grouped as having mildly low to normal BMD (M group; T-score≧ − 1.5) or significantly low BMD (S group; T-score <  −1.5), and were propensity-matched for age, upper and lower instrumented vertebrae, history of spine surgery, and Schwab-Scoliosis Research Society (SRS) ASD classification. PJF was defined as a ≥20° increase from the baseline proximal junction angle with a concomitant deterioration of at least one SRS-Schwab sagittal modifier grade, or any type of proximal junctional kyphosis requiring revision.

Results.

PJF developed in 22 of 113 patients (19%). There were 48 propensity-matched patients in the M and S groups (24 in each) with similar parameters for age, body mass index, number of vertebrae involved, C7SVA, pelvic incidence  − LL, and SRS-Schwab type. In this propensity-matched population, the incidence of PJF was significantly higher in the S group (33% vs. 8%, P < 0.01, odds ratio 6.4, 95% CI: 1.2–32.3).

Conclusion.

Low BMD was a significant risk factor for PJF in this propensity-matched cohort (odds ratio 6.4). Surgeons should consider prophylactic treatments when correcting ASD in patients with low BMD.

Level of Evidence: 3
Patient-Reported Outcomes and Costs Associated With Revision Surgery for Degenerative Cervical Spine Diseases
Authors: Kim Elliott J. , Chotai Silky , Wick Joseph B. , Stonko David P. , Sivaganesan Ahilan , Devin Clinton J.
Published: August 2017

Study Design.

A retrospective review of a prospective database.

Objective.

The aim of this study was to determine cost and outcomes of revision cervical spine surgery.

Summary of Background Data.

Revision rates for cervical spine surgery are steadily increasing. It is important to counsel patients on expected results following a revision procedure. However, outcomes and cost of these procedures are poorly defined in the literature.

Methods.

Patients undergoing revision cervical spine surgery at a single institution were included between October 2010 and January 2016 in a prospective registry database. Patients were divided into three cohorts depending on their etiology for revision, including recurrent disease, pseudoarthrosis, or adjacent segment disease. Patient-reported outcomes (PROs), including Neck Disability Index (NDI), EuroQol-5D (EQ-5D), modified Japanese Orthopaedic Association (mJOA) score, numeric rating scale-neck pain (NRS-NP), and numeric rating scale-arm pain (NRS-AP), were measured at baseline and 12 months following revision surgery. Mean costs at 12 months following revision surgery were also calculated. Satisfaction was determined by the NASS patient satisfaction index. Variables were compared using Student t test.

Results.

A total of 115 patients underwent cervical revision surgery for recurrent disease (n = 21), pseudoarthrosis (n = 45), and adjacent segment disease (n = 49). There was significant improvement in all patient-reported outcomes at 12 months following surgery regardless of etiology (P < 0.0001). Total cost of revision surgery ranged between 21,294 ± 8614 and 23,914 ± 15,396 depending on pathology. No significant differences were seen between costs among different revision groups (P = 0.53). Satisfaction was met in 75.5% to 85.7% (P = 0.21) of patients depending on the etiology of the revision need. Complication rates were between 4% and 9%.

Conclusion.

This is one of the first studies to determine costs and outcome measures in the setting of cervical spine revision surgery. On the basis of our analysis, a majority of patients can expect to receive some benefit by 12 months and are satisfied with their procedure.

Level of Evidence: 4
Effects of Training and Overtraining on Intervertebral Disc Proteoglycans
Authors: Ueta Renato H. S. , Tarini Victor A. F. , Franciozi Carlos E. S. , Tamaoki Marcel J. S. , Medeiros Valquíria P. , Nader Helena B. , Faloppa Flávio
Published: August 2017

Study Design.

Animal experimental study.

Objective.

Evaluate the effect of physical activity and overtraining condition on glycosaminoglycan concentration on the intervertebral disc (IVD) using a rat running model.

Summary of Background Data.

Some guidelines recommend the implementation of a physical exercise program as treatment for low back pain; however, cyclic loading impact on the health of the IVD and whether there is a dose-response relationship is still incompletely understood.

Methods.

Thirty-two rats ages 8 weeks were divided into four groups with eight animals each. The first 8 weeks were the adaptive phase, the overtraining phase was from the ninth to the eleventh week, which consisted of increasing the number of daily training sessions from 1 to 4 and the recovery phase was represented by the 12th and 13th weeks without training. Control group 1 (CG1) did not undergo any kind of training. Control group 2 (CG2) completed just the adaptive phase. Overtraining group 1 (OT1) completed the overtraining phase. Overtraining group 2 (OT2) completed the recovery phase. Running performance tests were used to assess the “overtraining” status of the animals. IVD glycosaminoglycans were extracted and quantified, and identified by electrophoresis.

Results.

Glycosaminoglycans showed a distribution between chondroitin sulfate and dermatan sulfate. Glycosaminoglycans quantification showed decreasing concentration at the following order: OT1 > CG2 > OT2 > CG1. Increased expression of dermatan sulfate was verified at the groups submitted to any training.

Conclusion.

Overtraining condition, as assessed by muscle and cardiovascular endurance did not lessen glycosaminoglycan concentration in the IVD. In fact, physical exercise increased glycosaminoglycan concentration in the IVD in proportion to the training load, even at overtraining condition, returning to normal levels after the recovery phase and glycosaminoglycan production is a reversible acute positive response for mechanical stimulation of the IVD.

Level of Evidence: N/A
The UTE Disc Sign on MRI
Authors: Pang Henry , Bow Cora , Cheung Jason Pui Yin , Zehra Uruj , Borthakur Arijitt , Karppinen Jaro , Inoue Nozomu , Wang Hai-Qiang , Luk Keith D.K. , Cheung Kenneth M.C. , Samartzis Dino
Published: August 2017

Study Design.

Cross-sectional.

Objective.

To assess the distribution of the ultra-short time-to-echo (UTE) disc sign (UDS) and its association with disc degeneration, other magnetic resonance imaging (MRI) phenotypes, pain, and disability profiles.

Summary of Background Data.

Disc degeneration has been conventionally assessed by T2-weighted (T2W) signal intensity on MRI; however, its clinical utility has been questionable. UTE MRI assesses short T2 components. The authors have identified a new imaging biomarker on UTE—the UDS.

Methods.

One hundred eight subjects were recruited. T2W MRI assessed disc degeneration and other phenotypes, and T1-rho MRI values represented quantitative proteoglycan disc profiles of L1-S1. UDS was detected on UTE (i.e., hyper-/hypointense disc band). A UDS score (cumulative number of UDS levels) and T2W summated lumbar degenerated scores (cumulative disc degeneration score) were assessed. Subject demographics, chronic low back pain (LBP), and disability profiles (Oswestry Disability Index: ODI) were obtained.

Results.

UDS was noted in 39.8% subjects, 61.4% occurred at the lower lumbar spine and 39.5% had multilevel UDS. UDS subjects had significantly greater severity and extent of disc degeneration, and Modic changes (P < 0.05). By disc levels, a higher prevalence of disc degeneration/displacement, Modic changes, and spondylolisthesis were noted in UDS discs than non-UDS discs (P < 0.05). T1-rho values were also lower in UDS discs (P = 0.022). The majority of UDS could not be detected on T2W. The UDS score significantly correlated with worse ODI scores (r = 0.311; P = 0.001), whereas T2W cumulative disc degeneration score did not (r = 0.13; P = 0.19). LBP subjects exhibited more multilevel UDS (P < 0.015) but not on T2W MRI (P = 0.53). The UDS score was significantly related to LBP (P = 0.009), whereas T2W cumulative disc degeneration score was not (P = 0.127).

Conclusion.

This is the first study to report “UDS” in humans. UDS is a novel imaging biomarker that is highly associated with degenerative spine changes, chronic LBP, and disability than conventional T2W MRI.

Level of Evidence: 2
Spinopelvic Changes Based on the Simplified SRS-Schwab Adult Spinal Deformity Classification
Authors: Kyrölä Kati , Repo Jussi , Mecklin Jukka-Pekka , Ylinen Jari , Kautiainen Hannu , Häkkinen Arja
Published: August 2017

Study Design.

Cross-sectional, observational study.

Objective.

To study the occurrence of sagittal malalignment, the adaptability of a simplified sagittal modifiers grading of the Scoliosis Research Society (SRS)-Schwab adult spinal deformity (ASD) classification, and the deformity-specific SRS questionnaire version 30 (SRS-30) in an unselected adult cohort with symptomatic degenerative spinal disorders.

Summary of Background Data.

The sagittal modifiers of the SRS-Schwab ASD classification correlate with health-related quality of life (HRQoL) measures in patients with ASD. The deformities and disabilities caused by sagittal malalignment in patients with common degenerative spinal disorders of multiple etiologies are rarely studied. A simplified and categorizing version of the SRS-Schwab ASD classification in relation to the Oswestry Disability Index (ODI) and the SRS-30 outcomes has not yet been developed.

Methods.

We recruited 874 consecutive patients with degenerative spinal disorders between March 2013 and February 2014. Full spine radiographs were taken and the patients divided into sagittal deformity severity groups: mild or none, moderate, and marked deformity. Participants completed the ODI, SRS-30, and a general health questionnaire.

Results.

We included 637 patients in the analysis. The severity of sagittal deformity was mild or none in 407 (63.9%) patients, moderate in 159 (25.0%), and marked in 71 (11.1%). Linearity across the modifier grades and deformity classes was found for ODI total score (P = 0.033), and the function/activity (P = 0.004) and self-image/appearance (P = 0.030) domains of the SRS-30. Age, body mass index, duration of symptoms, and the use of painkillers increased while physical activity, working, and educational status decreased significantly with deformity severity.

Conclusion.

Sagittal spinopelvic malalignment is significantly related to deterioration of the ODI and the SRS-30 in symptomatic adults with degenerative spinal disorders. The SRS-Schwab classification sagittal modifiers categorized into three groups is a practical tool to detect various clinically significant grades of deformity in a cohort with no recognized ASD.

Level of Evidence: 3