bluuebunny/crossref_metadata_2025 huggingface dataset:
Age‐dependent alterations to paraventricular nucleus insulin‐like growth factor 1 receptor as a possible link between sympathoexcitation and inflammation
Authors: Ogundele Olalekan M. , Lee Charles C. , Francis Joseph
Published: September 2016

Modifications to neural circuits of the paraventricular hypothalamic nucleus (PVN) have been implicated in sympathoexcitation and systemic cardiovascular dysfunction. However, to date, the role of insulin‐like growth factor 1 receptor (IGF‐1R) expression on PVN pathophysiology is unknown. Using confocal immunofluorescence quantification and electrophysiological recordings from acute PVN slices, we investigated the mechanism through which age‐dependent IGF‐1R depletion contributes to the progression of inflammation and sympathoexcitation in the PVN of spontaneously hypertensive rats (SHR). Four and twenty weeks old SHR and Wistar Kyoto (WKY) rats were used for this study. Our data showed that angiotensin I/II and pro‐inflammatory high mobility box group protein 1 (HMGB1) exhibited increased expression in the PVN of SHR versus WKY at 4 weeks (p < 0.01), and were even more highly expressed with age in SHR (p < 0.001). This correlated with a significant decrease in IGF‐1R expression, with age, in the PVN of SHR when compared with WKY (p < 0.001) and were accompanied by related changes in astrocytes and microglia. In subsequent analyses, we found an age‐dependent change in the expression of proteins associated with IGF‐1R signaling pathways involved in inflammatory responses and synaptic function in the PVN. MAPK/ErK was more highly expressed in the PVN of SHR by the fourth week (p < 0.001; vs. WKY), while expression of neuronal nitric oxide synthase (p < 0.001) and calcium‐calmodulin‐dependent kinase II alpha (CamKIIα; p < 0.001) were significantly decreased by the 4th and 20th week, respectively. Age‐dependent changes in MAPK/ErK expression in the PVN correlated with an increase in the expression of vesicular glutamate transporter (p < 0.001 vs. WKY), while decreased levels of CamKIIα was associated with a decreased expression of tyrosine hydroxylase (p < 0.001) by the 20th week. In addition, reduced labeling for ϒ‐aminobutyric acid in the PVN of SHR (p < 0.001) correlated with a decrease in neuronal nitric oxide synthase labeling (p < 0.001) when compared with the WKY by the 20th week. Electrophysiological recordings from neurons in acute slice preparations of the PVN of 4 weeks old SHR revealed spontaneous post‐synaptic currents of higher frequency when compared with neurons from WKY PNV slices of the same age (p < 0.001; n = 14 cells). This also correlated with an increase in PSD‐95 in the PVN of SHR when compared with the WKY (p < 0.001). Overall, we found an age‐dependent reduction of IGF‐1R, and related altered expression of associated downstream signaling molecules that may represent a link between the concurrent progression of synaptic dysfunction and inflammation in the PVN of SHR.

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A combined intervention of art therapy and clown visits to reduce preoperative anxiety in children
Authors: Dionigi Alberto , Gremigni Paola
Published: September 2016

Aims and objectives

To test whether a combined intervention of art therapy and clown visits could enhance the efficacy of oral medication in reducing children's anxiety at parental separation prior to induction of anaesthesia.

Background

Approximately 50% of children undergoing surgery report high anxiety at anaesthesia induction. Complementary therapies have been used to decrease children's anxiety, but no study has evaluated the efficacy of a combination of such therapies.

Design

This is an observational study, which involved allocating different interventions to two groups and measuring their anxiety at two time points.

Methods

This study assigned 78 children (aged 3–11 years) undergoing general anaesthesia for surgery to two conditions. The control group underwent general anaesthesia following standard practice, and the intervention group received an intervention of integrated art therapy and clown visits upon their arrival at the hospital and throughout their time in the preoperating room. Each child in both groups received 0·5 mg/kg oral midazolam 30 minutes before surgery and had a parent present throughout their time in the preoperating room. Each child's anxiety was evaluated twice using the Modified Yale Preoperative Anxiety Scale: at baseline and at separation from parents. Repeated measures anova was used to test for differences between the time points and the two groups.

Results

Children in the intervention group showed a significant (p < 0·001) reduction in Modified Yale Preoperative Anxiety Scale scores at parental separation compared to those in the control group. Additionally, the majority of parents and nurses evaluated the intervention to be effective for reducing children's anxiety.

Conclusions

This study found that an intervention based on art therapy and clown visits enhanced the effect of midazolam in reducing children's anxiety at preoperative separation from parents.

Relevance to clinical practice

Paediatric staffs may consider using such a combination of strategies in preparing children for anaesthesia induction.
The effect of clamping the indwelling urinary catheter before removal in cervical cancer patients after radical hysterectomy
Authors: Gong Yao , Zhao Ling , Wang Lin , Wang Fulan
Published: September 2016

Aims and objectives

To determine the effect of clamping the indwelling urinary catheter before its removal on bladder reconditioning in patients with cervical cancer after radical hysterectomy.

Background

It is suggested that indwelling urinary catheters should be clamped intermittently to fill the bladder and restore bladder function before removal. However, indwelling urinary catheter clamping showed no effect on bladder reconditioning according to some clinical studies.

Design

Randomised controlled study.

Methods

A total of 210 patients with cervical cancer after type C radical hysterectomy were randomised on 1:2 into two groups. In the clamping group, indwelling urinary catheters were clamped intermittently for 48 hours before removal based on a bladder‐training sheet, while in the control group, the indwelling urinary catheters were removed without clamping. The primary outcome of the study was the rate of recatheterisation. The secondary outcomes included residual urine volume 24 hours after removal, incidence of urinary tract infection and duration of recatheterisation.

Results

Seventy patients were assigned to the clamping group and 128 to the control group with paralleled baseline characteristics. The days of the primary catheterisation (13·20 ± 0·79 vs. 13·38 ± 1·04) and the incidence of urinary tract infection (22·9% vs. 20·3%) had no significant differences between the two groups. Ten patients in the clamping group and 19 in the control group underwent recatheterisation, the incidence of which showed no significant difference (14·3% vs. 14·8%). The days of recatheterisation were not statistically different between the two groups (11·40 ± 6·75 vs. 9·42 ± 5·23). However, the residual urine volume 24 hours after removal was higher in the clamping group than that in the control group.

Conclusions

Bladder recondition through indwelling urinary catheter clamping may not restore bladder function in patients after radical hysterectomy.

Relevance to clinical practice

As indwelling urinary catheter clamping may increase the residual urine volume after indwelling urinary catheter removal and lead to an increased nursing workload, it should not be recommended in patients with cervical cancer postoperatively.
Registered nurses’ work with sick leave questions by telephone in primary health care
Authors: Lännerström Linda , von Celsing Anna‐Sophia , Holmström Inger K , Wallman Thorne
Published: September 2016

Aims and objectives

To describe registered nurses’ work with sick leave questions by telephone.

Background

In Sweden, when a sick person needs to request a sickness certification, it is common to contact the primary healthcare centre. The main access to primary health care is by telephone, with a registered nurse answering the care seeker's questions, triaging and helping care seekers to the right level of care. Registered nurses’ work with sick leave questions has not been studied, except for two qualitative interview studies.

Design

A descriptive cross‐sectional study.

Methods

A questionnaire with 120 questions was distributed to 185 registered nurses in one county in central Sweden. Descriptive statistics were used for analysis.

Results

Response rate was 62% (n = 114). Registered nurses (n = 105) in this study talked weekly to persons on, or at risk, for sick leave. A large part (n = 78) felt they had a role in the care of persons on sick leave, consisting of booking appointments as well as acting as a pilot, advisor, caretaker and coordinator. For 74 of 114 registered nurses, it was problematic to handle the phone calls weekly. Measures were ‘often’ booking appointments with physicians (n = 67) and ‘seldom’ providing information on social insurance rules (‘never’ n = 51). The registered nurses expressed a great need for more education.

Conclusion

Registered nurses in this study reported having a role in the care of persons on sick leave when handling sick leave questions by telephone. The telephone calls were problematic to handle, and the registered nurses expressed a great need for education and training in social insurance medicine.

Relevance to clinical practice

There is a need to educate and train registered nurses in social insurance medicine to provide high‐quality nursing for patients on or at risk for sick leave.
Stress, coping and support needs of patients with ulcerative colitis or Crohn's disease: a qualitative descriptive study
Authors: Larsson Kjerstin , Lööf Lars , Nordin Karin
Published: September 2016

Aims and objectives

To examine disease‐related stress, coping strategies and the need for information and support in patients with inflammatory bowel disease (ulcerative colitis or Crohn's disease).

Background

Psychological stress is an important factor in ulcerative colitis and Crohn's disease, and therefore, coping strategies and support needs should be considered in routine clinical practice.

Design

This is a qualitative study using a descriptive interview‐based approach.

Method

Fifteen patients with ulcerative colitis (n = 7) or Crohn's disease (n = 8) were interviewed. The interviews were analysed with content analysis.

Results

The informants largely focused on disease‐related stress (e.g. access to a toilet, symptoms and worries) and relations to other people (various reactions from others and social situations). Behavioural strategies (i.e. taking actions and the need for making plans, prepare and adapt), social strategies (seeking help and information and sharing feelings about the disease with others) and emotional strategies (distraction, positive attitude and acceptance) were adopted to cope with the stress associated with the disease. The need for information and support concerned instrumental support (disease‐related information) and emotional support (to talk about disease management).

Conclusion

Faecal urgency and the fear of losing bowel control are important stressors for patients with inflammatory bowel disease. The patients handle this problem using various coping strategies depending on the type of stressful events. Both instrumental and emotional support were requested which primarily occurred at the time of diagnosis and disease flare‐ups.

Relevance to clinical practice

Patients with ulcerative colitis or Crohn's disease ask for information and psychosocial support that are tailored to their individual needs and at different stages in the disease trajectory to improve everyday life and strengthen self‐management strategies.
Challenges following discharge from acute psychiatric inpatient care in Japan: patients’ perspectives
Authors: Niimura J. , Tanoue M. , Nakanishi M.
Published: September 2016

Accessible summary

What is known on the subject?

A lack of transitional care covering the period from psychiatric hospital discharge to community mental health care can increase the likelihood of illness recurrence or readmission of discharged patients.

What this paper adds to existing knowledge?

The participants expressed the view that discontinuity between inpatient and community life was a post‐discharge challenge after being involuntarily admitted to a psychiatric emergency ward.

These challenges arose from the dissatisfaction with inpatient treatment, inability to coordinate post‐discharge life

What are the implications for practice?

Patients should be able to disclose their feelings about their own experiences in inpatient care settings and the current challenges in community care settings in an open manner.

An advocate should be appointed in acute psychiatric inpatient care settings to reflect patients’ own feelings and individual needs to transitional care without bias to inpatient and community care providers.

Introduction

Psychiatric care in Japan usually comprises inpatient care provided during lengthy hospital stays. Recently, policies for shortening psychiatric hospital stays have been aggressively pursued. However, appropriate transitional care is not always provided for acute psychiatric inpatient care.

Aim

We elucidated patients’ challenges immediately after hospital discharge following acute psychiatric inpatient care to clarify how to improve inpatient care and post‐discharge follow‐ups.

Method

This study utilized a qualitative descriptive study design and incorporated patient interviews. Participants comprised 18 patients who experienced involuntary admission following a diagnosis of schizophrenia spectrum disorder. Inductive qualitative content analysis was used to create codes and categories from interview transcripts.

Findings

The core category of post‐discharge challenges that emerged was ‘separating life as an inpatient from community life’. This comprised two subcategories: ‘dissatisfaction with the inpatient care received’ and ‘lack of abilities to coordinate lifestyle following discharge’.

Discussion

Patients should be able to disclose their feelings about their experiences in inpatient care settings and the current challenges in community care settings openly.

Implications for practice

Advocate (e.g. peer staff) should be appointed in acute psychiatric inpatient care settings to reflect patients’ feelings and individual needs to transitional care without bias to inpatient and community care providers.
The relative availability of inorganic carbon and inorganic nitrogen influences the response of the dinoflagellate Protoceratium reticulatum to elevated CO2
Authors: Pierangelini Mattia , Raven John A. , Giordano Mario
Published: September 2016

This work originates from three facts: (i) changes in CO2 availability influence metabolic processes in algal cells; (ii) Spatial and temporal variations of nitrogen availability cause repercussions on phytoplankton physiology; (iii) Growth and cell composition are dependent on the stoichiometry of nutritional resources. In this study, we assess whether the impact of rising pCO2 is influenced by N availability, through the impact that it would have on the C/N stoichiometry, in conditions of N sufficiency. Our experiments used the dinoflagellate Protoceratium reticulatum, which we cultured under three CO2 regimes (400, 1,000, and 5,000 ppmv, pH of 8.1) and either variable (the NO3− concentration was always 2.5 mmol · L−1) or constant (NO3− concentration varied to maintain the same Ci/NO3− ratio at all pCO2) Ci/NO3− ratio. Regardless of N availability, cells had higher specific growth rates, but lower cell dry weight and C and N quotas, at elevated CO2. The carbohydrate pool size and the C/N was unaltered in all treatments. The lipid content only decreased at high pCO2 at constant Ci/NO3− ratio. In the variable Ci/NO3− conditions, the relative abundance of Rubisco (and other proteins) also changed; this did not occur at constant Ci/NO3−. Thus, the biomass quality of P. reticulatum for grazers was affected by the Ci/NO3− ratio in the environment and not only by the pCO2, both with respect to the size of the main organic pools and the composition of the expressed proteome.
Implant osseointegration in irradiated bone: an experimental study
Authors: Ocaña R. P. , Rabelo G. D. , Sassi L. M. , Rodrigues V. P. , Alves F. A.
Published: September 2016

Background and Objectives

The aim of this study was to evaluate the effect of radiotherapy on the osseointegration of dental implants in the tibia and the action of platelet‐rich plasma (PRP) as an adjuvant therapy.

Material and Methods

A total of 18 rabbits received two implants in each tibial epiphysis, totalizing 72 implants. The control group (group I) was composed by six rabbits and did not receive radiotherapy. The test groups (II and III) received a single dose of 1727 cGy. Group II was composed by six irradiated animals and group III by six animals that received irradiation and PRP during implant placement. The implant success rate, the bone–implant contact (BIC), and the bone volume were analyzed.

Results

There was no osseointegration in four of the implants, three in group II and one in group III. Total BIC was significantly higher in group I, when compared to the other groups. There was a significant difference of osteoid BIC only between irradiated animals (group II, 8.5%; group III, 4.7%; p = 0.001). On the other hand, the mineralized BIC was significantly higher in group I. Furthermore, group II had a lower mineralized BIC than group III (p = 0.002). Bone volume was higher in the control group (41.3%), followed by group III (33.4%) and II (25.1%), with differences between groups I and II (p = 0.001) and groups II and III (p = 0.022).

Conclusions

The present study showed that both the bone volume and BIC were higher in the control group. However, the failure rates of the implants were low in both irradiated groups. The PRP was a positive adjuvant in the osseointegration process.
Magnetic resonance imaging, treatment and outcome of canine vertebral chondrosarcomas. Six cases
Authors: Roynard P. F. P. , Bilderback A. , Falzone C. , Stefanacci J. D. , Cherubini G. B.
Published: September 2016

Objectives

To report the clinical presentation, magnetic resonance imaging features, treatments and outcomes of canine vertebral chondrosarcoma.

Materials and Methods

Retrospective review of medical records of dogs with confirmed vertebral chondrosarcoma and magnetic resonance imaging of the lesions, from four different veterinary referral institutions.

Results

A total of six dogs were included in this report. In all cases, magnetic resonance imaging revealed a lobulated mass involving the dorsal vertebral compartment, markedly hyperintense with few foci of hypointensity on T2‐weighted images, iso to hypointense on T1‐weighted images with contrast enhancement after gadolinium administration. Intralesional surgical resection was performed in three dogs and medical management in one, two dogs were euthanased and all lesions were submitted for histopathology. Magnetic resonance imaging findings correlated with histological findings of a low tumour grade. Rapid clinical improvement was noted after surgery but two of three dogs had local regrowth.

Clinical Significance

Chondrosarcomas show local aggressiveness and resistance to conventional radiotherapy and chemotherapy, and so prognosis depends on feasibility of en bloc resection. Magnetic resonance imaging may be helpful in establishing a presumptive diagnosis and prognosis based on the feasibility of surgical resection.
Understanding Supplier Switching Behavior: The Role of Psychological Contracts in a Competitive Setting
Authors: Mir Saif , Aloysius John A. , Eckerd Stephanie
Published: September 2016

Today's globally competitive environment presents ample opportunity for buyers to dissolve relationships by switching suppliers. While previous studies have described supplier switching behavior based on supplier attributes and switching costs, our study leverages attribution theory to evaluate the impact of psychological contracts on supplier switching behavior. We report the results of a controlled experiment involving 265 subjects in which we manipulate three characteristics of a psychological contract breach: attribution (whether the breach was due to reneging by the supplier or a disruption), severity (whether the breach was major or minor), and timing (whether the breach was early or late in the life cycle of the exchange history). Our analysis indicates that in the context of supplier switching, buyers are affected by the attribution and severity of a breach but not by the timing. In contrast to previous experimental research in noncompetitive settings, we find that psychological contract violation mediates the relationship between breach and behavior. We further complement our primary findings with a vignette‐based experiment and interview data collected from experienced managers. Our research makes an important contribution to the relationship dissolution and industrial buyer behavior literatures by providing a behavioral explanation for supplier switching and reveals the complex role of psychological contracts in supply chain exchanges.
Survey of Two New (Kai 1 and Kai 2) and Other Blood Groups in Dogs of North America
Authors: Euler C.C. , Lee J.H. , Kim H.Y. , Raj K. , Mizukami K. , Giger U.
Published: September 2016

Background

Based upon serology, >10 canine blood group systems have been reported.

Objective

We surveyed dogs for dog erythrocyte antigen (DEA) 1 and 2 new blood types (Kai 1 and Kai 2), and some samples also were screened for Dal and DEA 3, 4, and 7.

Methods

Blood samples provided by owners, breeders, animal blood banks, and clinical laboratories were typed for DEA 1 by an immunochromatographic strip technique with a monoclonal antibody and analysis of band intensity. Both new antigens, the Dal and other DEAs (except DEA 7 by tube method), were assessed by a gel column method with either monoclonal or polyclonal antibodies. The same gel column method was applied for alloantibody detection.

Results

Of 503 dogs typed, 59.6% were DEA 1+ with 4% weakly, 10% moderately, and 45.6% strongly DEA 1+. Regarding Kai 1 and Kai 2, 94% were Kai 1+/Kai 2‐, 5% were Kai 1‐/Kai 2‐ and 1% were Kai 1‐/Kai 2+, but none were Kai 1+/Kai 2+. There was no relationship between Kai 1/Kai 2 and other blood types tested. Plasma from DEA 1‐, Kai 1‐, Kai 2‐ dogs, or some combination of these contained no detectable alloantibodies against DEA 1 and Kai 1 or Kai, respectively.

Conclusions and Clinical Importance

The new blood types, called Kai 1 and Kai 2, are unrelated to DEA 1, 3, 4, and 7 and Dal. Kai 1+/Kai 2‐ dogs were most commonly found in North America. The clinical relevance of Kai 1 and Kai 2 in canine transfusion medicine still needs to be elucidated.
Bioseguridad in Mexico: Pursuing Security between Local and Global Biologies
Authors: Wanderer Emily Mannix
Published: September 2016

In the aftermath of the 2009 outbreak of H1N1 influenza, scientists in Mexico sought to develop bioseguridad, that is, to protect biological life in Mexico by safely conducting research on infectious disease. Drawing on ethnographic research in laboratories and with scientists in Mexico, I look at how scientists make claims about local differences in regulations, infrastructure, bodies, and culture. The scientists working with infectious microbes sought to establish how different microbial ecologies, human immune systems, and political and regulatory systems made the risks of research different in Mexico from other countries. In developing bioseguridad, the idea of globalized biology that animates many public health projects was undermined as scientists attended to the elements of place that affected human health and safety. Scientists argued for the importance of local biologies, generating tension with global public health projects and regulations premised on the universality of biology.
Misconceptions Regarding the Brain: The Neuromyths of Preservice Teachers
Authors: Dündar Sefa , Gündüz Nazan
Published: September 2016

Understanding preservice teachers' misconceptions regarding the brain and neuroscience (neuromyths) can provide information that helps teachers to apply neuroscience knowledge in an educational context. The objective of this study was to investigate these misconceptions. Following preliminary research, a questionnaire comprising 59 challenging assertions in two categories (education and neuromyths) was developed as a data collection tool. The findings identify preservice teachers' neuromyths, which were found to vary by teaching area.
Copper and cobalt accumulation in plants: a critical assessment of the current state of knowledge
Authors: Lange Bastien , van der Ent Antony , Baker Alan John Martin , Echevarria Guillaume , Mahy Grégory , Malaisse François , Meerts Pierre , Pourret Olivier , Verbruggen Nathalie , Faucon Michel‐Pierre
Published: September 2016

This review synthesizes contemporary understanding of copper–cobalt (Cu–Co) tolerance and accumulation in plants. Accumulation of foliar Cu and Co to > 300 μg g−1 is exceptionally rare globally, and known principally from the Copperbelt of Central Africa. Cobalt accumulation is also observed in a limited number of nickel (Ni) hyperaccumulator plants occurring on ultramafic soils around the world. None of the putative Cu or Co hyperaccumulator plants appears to comply with the fundamental principle of hyperaccumulation, as foliar Cu–Co accumulation is strongly dose‐dependent. Abnormally high plant tissue Cu concentrations occur only when plants are exposed to high soil Cu with a low root to shoot translocation factor. Most Cu‐tolerant plants are Excluders sensu Baker and therefore setting nominal threshold values for Cu hyperaccumulation is not informative. Abnormal accumulation of Co occurs under similar circumstances in the Copperbelt of Central Africa as well as sporadically in Ni hyperaccumulator plants on ultramafic soils; however, Co‐tolerant plants behave physiologically as Indicators sensu Baker. Practical application of Cu–Co accumulator plants in phytomining is limited due to their dose‐dependent accumulation characteristics, although for Co field trials may be warranted on highly Co‐contaminated mineral wastes because of its relatively high metal value.
An overview of human genetic privacy
Authors: Shi Xinghua , Wu Xintao
Published: September 2016

The study of human genomics is becoming a Big Data science, owing to recent biotechnological advances leading to availability of millions of personal genome sequences, which can be combined with biometric measurements from mobile apps and fitness trackers, and of human behavior data monitored from mobile devices and social media. With increasing research opportunities for integrative genomic studies through data sharing, genetic privacy emerges as a legitimate yet challenging concern that needs to be carefully addressed, not only for individuals but also for their families. In this paper, we present potential genetic privacy risks and relevant ethics and regulations for sharing and protecting human genomics data. We also describe the techniques for protecting human genetic privacy from three broad perspectives: controlled access, differential privacy, and cryptographic solutions.
Treatment of Distal Femur Nonunion Following Initial Fixation with a Lateral Locking Plate
Authors: Ebraheim Nabil A. , Buchanan Grant S. , Liu Xiaochen , Cooper Maxwell E. , Peters Nicholas , Hessey Jacob A. , Liu Jiayong
Published: September 2016

Objective

To report and evaluate the outcomes of patients undergoing definitive treatment for distal femur nonunion after initial treatment with a locking plate.

Methods

Fourteen patients who had undergone definitive treatment at an academic Level 1 trauma center from May 2007 to December 2013 for distal femur nonunion were identified from a fracture database. Thirteen of them were female; the average age was 65 years (range, 50–84 years). Ten patients had sustained their injuries in falls at ground level, and four in motor vehicle accidents. Twelve patients were obese (body mass index ≥30), 10 had diabetes, none were current smokers, and one had an open fracture classified as type IIIa according to the Gustilo–Anderson classification system for open fractures. The fractures were classified according to the AO classification system for distal femur fractures; there were three type 33‐A1, six 33‐A2, two 33‐A3 and three 33‐C3 fractures. Methods of definitive treatment involved open reduction and internal fixation (ORIF) revision, medial plating, bone grafting and the use of other biologic materials.

Results

Eight of the 14 patients (57%) achieved union during follow‐up. Definitive treatment for nonunion involved ORIF revision in 11 cases. Three patients who did not undergo ORIF revision were treated with iliac crest stem cell autografts, bone graft substitutes or recombinant human‐bone morphogenetic protein‐2 (rh‐BMP‐2). Other treatments included rh‐BMP‐2 (12 cases), iliac crest bone autograft (five), iliac crest stem cell autograft (two), crushed cancellous bone allograft (three), CaSO
4 and tricalcium phosphate bone graft substitute (two) and demineralized bone matrix (one). The average time from definitive treatment to union was 19 weeks (range, 12–51 weeks). Two of the 11 cases who underwent ORIF revision had medial plates added to improve biomechanical stability and prevent varus collapse. This was also performed in one patient with a grade III open type 33‐C3 fracture and one with a closed 33‐A2 fracture. Five study patients had comminuted fractures. Two had type 33‐A3 and three type 33‐C3 fractures. Both patients with 33‐A3 fractures and 2 two with 33‐C3 fractures had persistent nonunion at the end of follow‐up.

Conclusions

Definitive treatment of distal femur nonunion after initial treatment with a locking plate had a low rate of success in this study, suggesting that this procedure is ineffective as a definitive treatment for distal femur nonunion.
Evolution of Design of Interbody Cages for Anterior Lumbar Interbody Fusion
Authors: Phan Kevin , Mobbs Ralph J
Published: September 2016

Anterior lumbar interbody fusion (ALIF) is one of the surgical procedures for the relief of chronic back pain, radiculopathy and neurogenic claudication in patients with degenerative lumbar spine disease that is refractory to conservative therapy, low‐grade spondylolisthesis and pseudo arthrosis. Over the past half century, both the surgical techniques and instrumentation required for ALIF have changed significantly. In particular, the designs of ALIF cage and the materials used have evolved dramatically, the common goal being to improve fusion rates and optimize clinical outcomes. The increasing popularity of ALIF is reflected by the increasing abundance of published studies reporting clinical outcomes, surgical techniques and grafting options for ALIF. Developments in cage designs include cylindrical Bagby and Kuslich, cylindrical ray, cylindrical mesh, lumbar‐tapered, polyethyl‐etherketone cage and integral fixation cages. Biologic implants include bone dowels and femoral ring allografts. Methods for optimization of cage design have included cage dimensions, use of novel composite cage materials and integral fixation technologies. However, the historical development and evolution of cages used for ALIF has not been extensively documented. This article therefore aims to provide an overview of the historical basis for the anterior approach, evolution in design of ALIF cage implants and potential future research directions.
Intermittent Cyclic Mechanical Tension Promotes Degeneration of Endplate Cartilage via the Nuclear Factor‐κB Signaling Pathway: an in Vivo Study
Authors: Xiao Liang , Xu Hong‐guang , Wang Hong , Liu Ping , Liu Chen , Shen Xiang , Zhang Tao , Xu Yong‐ming
Published: September 2016

Objective

To establish a rabbit model for investigating the effects of intermittent cyclic mechanical tension (ICMT) on promoting degeneration of endplate cartilage.

Methods

Forty New Zealand white rabbits were subjected to surgery and randomly divided into three equal groups as follows: control group (no treatment, n = 10), sham group (animals underwent a sham operation but were not subjected to mechanical tensile strain, n = 15) and loaded group (discs were subjected to 1.5 MPa external tensile loading by using an external loading device during the animals' daily activity, n = 15). Mechanical tensile strain was applied for 8 h/d. The animals were examined radiologically after 8 weeks treatment and then killed for removal of endplate cartilage tissue samples from their spines. Histological staining was performed to examine the morphology of endplate cartilage tissue. Multiple strategies were employed to examine degeneration of endplate cartilage and nuclear factor (NF)‐κB signaling pathway activation.

Results

After ICMT loading for 56 days, radiology revealed ossification, hyperosteogeny and stenosis in the intervertebral spaces. Examination of hematoxylin and eosin staining of sections of endplate cartilage showed significant damage as the load duration increased in the ICMT loading group. Expression of aggrecan (ACAN), type II collagen (COL‐2A), SRY‐related high mobility group‐box gene 9 (SOX9) was down‐regulated (FACAN = 21.515, P < 0.01; FCOL‐2A = 6.670, P = 0.05; FSOX9 = 7.888, P < 0.05), whereas that of matrix metallopeptidase 13 (MMP13) was up‐regulated (FMMP13 = 14.120, P < 0.01) after ICMT. Western blot and immunofluorescence revealed that expression of protein was consistent with gene expression results. Additionally, ICMT loading can lead to NF‐κB signaling pathway activation as well as degeneration of endplate cartilage.

Conclusion

These experiments indicate that ICMT contributes to the activation of NF‐κB signaling pathway in vivo and that the NF‐κB signaling pathway further up‐regulates MMP13, leading to degeneration of endplate cartilage.
Direct Tubular Lumbar Microdiscectomy for Far Lateral Disc Herniation: A Modified Approach
Authors: Siu Timothy L T , Lin Kainu
Published: September 2016

Objective

The concept of minimally invasive tubular discectomy is based on precise placement of the retractor over the surgical target to minimize collateral tissue trauma. For far lateral disc herniation, the junction between the pars and the transverse process has generally been adopted as the target for facilitating early nerve root exposure; however, this may limit access to the disc space and increase the risks of iatrogenic neuralgia. An alternative approach to help address these issues involving docking the retractor caudally directly over the disc space with the aid of a microscope is here proposed. The purpose of this study was to evaluate the safety and efficacy of such an approach.

Methods

Nineteen patients in whom the modified approach was performed over a 35‐month period were identified. Direct access to the disc space was attained by directing the retractor against the lateral margin of the facet joint and following the inferior transverse process medially towards the foramen with minimal exposure of the nerve root. Clinical outcomes were assessed by the Oswestry Disability Index, visual analogue scale scores for leg and back pain, Short Form 36 physical functioning (SF36‐PF) and bodily pain (SF36‐BP) scores and sciatica bothersomeness and frequency indexes (SBI & SFI) and obtained from a prospective patient database. Follow‐up data in the first 6 months were compared with preoperative baseline data.

Results

All procedures were successfully completed with the modified approach. Contained disc herniation without sequestrated fragments was found in all but four cases. No perioperative complications or reoperation were recorded and no postoperative dysesthesia was noted. Clinically significant reductions in mean Oswestry Disability Index (32; 95% CI, 21–43) and visual analogue scale scores for leg pain (38 mm; 95% CI, 23–54 mm) and back pain (35 mm; 95% CI, 21–48 mm) scores were noted in the first 6 months. Significant improvements in SF36‐PF (40; 95% CI, 30–51) and SF36‐BP (35; 95% CI, 26–43), SBI (9; 95% CI, 6–11) and SFI (11; 95% CI, 8–13) were also recorded.

Conclusions

A modified direct tubular approach is safe and effective for treating far lateral lumbar disc herniation. Our early results suggest that this approach helps safeguard adequate decompression and reduce the risk of postoperative dysesthesia.
Robot‐assisted Anterior Odontoid Screw Fixation: A Case Report
Authors: Tian Wei , Wang Han , Liu Ya‐jun
Published: September 2016

Anterior odontoid screw fixation has been proved to be effective but technically challenging because the difficult approach is associated with high risks of screw malposition and damage to surrounding vital structures. Navigation techniques are therefore increasingly being used to improve safety and accuracy. However, no robot‐assisted odontoid screw fixation has yet been reported. We here report a 61‐year‐old woman with a type II dens fracture on whom anterior odontoid screw fixation was performed under the guidance of a newly developed robotic system (TiRobot, co‐designed by Beijing Jishuitan Hospital and TINAVI Medical Technologies). One odontoid screw was safely and accurately placed, the calculated deviation between the planned and actual positions being 0.9 mm. No intraoperative complications were identified and the patient was discharged on Day 5. Follow‐up studies after 2 weeks showed good clinical and radiological results. We believe this is the first reported case of robot‐assisted anterior odontoid screw fixation. We consider that complicated procedures can become feasible, safe and accurate using TiRobot systems.
Consensus on Surgical Management of Myeloma Bone Disease
Authors:   The Surgeon's Committee of the Chinese Myeloma Working Group of the International Myeloma Foundation
Published: September 2016

Myeloma bone disease (MBD), the skeletal lesions caused by multiple myeloma, is also known as skeletal related events and includes bone pain, osteoporosis, pathological fractures, osteolytic bone lesions, spinal instability, spinal cord and nerve root compression and extramedullary plasmacytoma. It is now generally accepted that patients with these complications usually require surgical management and that such treatment is safe and effective. The aims of surgical interventions are to alleviate pain, improve quality of life, treat potential or existing pathological fractures, decompress the spinal cord and nerve roots, and reestablish bone continuity. Thus far, there have not been uniform standards for surgical treatment of MBD. The Surgeon's Committee of the Chinese Myeloma Working Group has therefore achieved a consensus with the aim of providing guidance for clinicians and benefitting patients with MBD. This consensus focuses on the treatment of MBD, including its clinical definition and characteristics, diagnosis and surgical management. This expert consensus document was compiled after discussion and revision by experts from several relevant institutions in China. However, it is only an interim guide that cannot be enforced legally. It will be updated with development of new techniques of treatment.
Analgesic Efficacy of Adductor Canal Block in Total Knee Arthroplasty: A Meta‐analysis and Systematic Review
Authors: Jiang Xu , Wang Qian‐qian , Wu Cheng‐ai , Tian Wei
Published: September 2016

The aim of this meta‐analysis and systematic review of randomized controlled trials (RCTs) was to evaluate the efficacy and safety of adductor canal block (ACB) for early postoperative pain management in patients undergoing total knee arthroplasty (TKA). Relevant manuscripts comparing ACB with saline or femoral nerve block (FNB) in TKA patients were searched for in the databases of PubMed, EMBASE, and Cochrane library. The outcomes assessed included cumulative analgesic consumption, pain at rest or during movement, ability to ambulate, quadriceps strength, and complications (nausea, vomiting or sedation). For continuous outcomes, pooled effects were measured using weighted mean difference (WMD) or standard mean difference (SMD), together with 95% confidence intervals (CIs). For outcomes without sufficient data for synthesis, qualitative interpretation of individual studies was summarized. Finally, 11 RCTs involving 675 patients met the inclusion criteria. The pooled results showed that ACB resulted in less postoperative analgesic consumption than saline (WMD, −12.84 mg; 95% CI, −19.40 mg to −6.27 mg; P < 0.001) and less pain at rest or during activity. No conclusions could be drawn regarding ability to ambulate and quadriceps strength, because only one study reported these variables. Most studies comparing ACB and FNB reported similar effects on postoperative analgesic consumption (WMD, −0.56 mg; 95% CI, −8.05 mg to 6.93 mg; P = 0.884) and pain; however, ability to ambulate and quadriceps strength were significantly better with ACB (SMD, 0.99; 95% CI, 0.04–1.94; P = 0.041). Additionally, ACB did not increase the rate of complications. Our results suggest that, compared with saline, ACB decreases analgesic consumption and offers short‐term advantages in terms of pain relief. Compared with FNB, ACB was associated with better ability to ambulate and quadriceps strength.
Partial versus Intact Posterior Cruciate Ligament‐retaining Total Knee Arthroplasty: A Comparative Study of Early Clinical Outcomes
Authors: Zhang Bo , Cheng Cheng‐kung , Qu Tie‐Bing , Hai Yong , Lin Yuan , Pan Jiang , Wang Zhi‐wei , Wen Liang
Published: September 2016

Objective

Whether the entire posterior cruciate ligament (PCL) should be retained during cruciate‐retaining total knee arthroplasty (CR TKA) is controversial. The goal of this study was to compare the early clinical outcomes of partial versus intact PCL‐retaining TKA.

Methods

Ninety‐two patients who had undergone unilateral CR TKA from March 2012 to June 2013 were enrolled in this study. Forty‐six of these patients were randomly selected to undergo intact PCL‐retaining TKA (intact group), whereas the remaining 46 patients underwent tibial osteotomy together with anterolateral bundle and bone island resection (partial group). All operations were performed by a senior orthopedic surgeon and the PCL was released to some extent in both groups. After TKA, active and passive flexion and extension exercises of the knee and lower limb strength exercises were maintained until at least 3 months after surgery. Before surgery and 6, 12, and 24 months after surgery, range of motion, Knee Society Clinical Rating System scores (including clinical and functional scores of the knee) and maximum anteroposterior (AP) displacement of the knee at 30° and 90° of knee flexion were evaluated in both groups.

Results

Fourteen patients were rejected from the final analysis because of loss to follow‐up or development of complications. Thus, 40 patients from the partial group and 38 from the intact group were followed up for 24–41 months (mean 32.8 months). Knee functional scores were significantly higher in the intact than in the partial group (88.1 vs. 84.8 points) 24 months after surgery There were no significant differences in range of motion or knee clinical scores between the two groups at any time point. However, 12 and 24 months after surgery, the mean maximum AP displacement of the knee in 90° knee flexion was significantly greater in the partial than in the intact group (12 months: 6.3 vs. 5.7 mm; 24 months: 7.0 vs. 6.2 mm).

Conclusion

Double‐bundle PCL plays an important role in maintaining knee stability; the entire PCL should therefore be retained during CR TKA.
Comparison of AO Titanium Locking Plate and Screw Fixation versus Anterograde Intramedullary Fixation for Isolated Unstable Metacarpal and Phalangeal Fractures
Authors: Zhang Bing , Hu Pan , Yu Kun‐lun , Bai Jiang‐bo , Tian De‐hu , Zhang Gui‐sheng , Shao Xin‐zhong , Zhang Ying‐ze
Published: September 2016

Objective

This study aimed to compare the clinical and radiologic outcomes of AO titanium locking plate and screw (ATLPS) and anterograde intramedullary (AIM) fixation for treating unstable metacarpal and phalangeal fractures.

Methods

Adult patients with isolated fresh unstable metacarpal and phalangeal fractures who met the inclusion criteria were enrolled into this prospective study from July 2013. Patients were divided into ATLPS or AIM groups when they were admitted to our department after considering their work requirement, fracture complexity, and surgeon's experience and were then treated accordingly. Relevant demographic, clinical and preoperative clinical data were collected and analyzed. Clinical examination and radiograph evaluation were performed 1 week and 1, 3, and 6 months postoperatively. Outcome measures were visual analog scale (VAS) scores for pain, total range of motion (ROM) of the injured digit, Quick Disabilities of the Arm, Shoulder, and Hand scores (Quick‐DASH) and grip strength (percentage of the contralateral corresponding digit).

Results

From July 2013 to September 2014, 76 patients were treated by AIM and 71 by ATLPS. Age, sex, time from injury to operation, dominant hand, injury mechanism, fracture location, fracture type and participant occupation were similar in both groups (P > 0.05). Operations were all performed well and followed by uneventful postoperative functional recoveries. At 3‐month follow‐up, all clinical outcomes were significantly better in the AIM than ATLPS group (
P
< 0.05) except for VAS pain scores. However, at 6‐month follow‐up, the differences were no longer significant, indicating similar results for both types of fixation. Patients in the AIM group developed significantly more complications (
P
= 0.037). Sick leave was significantly longer in the AIM group (
P
= 0.02).

Conclusions

AIM outperforms ATLPS in the treatment of unstable metacarpal and phalangeal fractures in the early, but not the later, postoperative period; the latter is associated with significantly more complications. Patients treated by ATLPS require shorter sick leave, which is of particular benefit to workers with specialized manual skills.