bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Vertebral Artery and Middle Cerebral Artery Monitoring for Right-to-left Shunt Detection by Contrast-enhanced Transcranial Doppler
Authors: Guo Yu-Zhu , Gao Yong-Sheng , Guo Zhen-Ni , Niu Peng-Peng , Yang Yi , Xing Ying-qi
Published: April 2016

Contrast-enhanced transcranial Doppler (c-TCD) is a reliable and reproducible method for right-to-left shunt (RLS) detection, with high sensitivity. Monitoring the middle cerebral artery (MCA) is an optimal choice, yet for patients with insufficient temporal bone windows or severe stenosis of carotid arteries, an alternative should be established. The aim of the present study was to further establish whether c-TCD with vertebral artery (VA) monitoring is as effective as MCA monitoring for RLS detection. We evaluated 194 subjects for RLS detection with VA and MCA monitoring simultaneously. There was no significant difference between the positive rates of VA and MCA monitoring for RLS detection. c-TCD with VA monitoring could be an alternative for RLS detection, with high sensitivity and specificity both at rest and during the Valsalva manoeuvre.
Integratable quarter-wave plates enable one-way angular momentum conversion
Authors: Liang Yao , Zhang Fengchun , Gu Jiahua , Huang Xu Guang , Liu Songhao
Published: April 2016

Nanophotonic waveguides are the building blocks of integrated photonics. To date, while quarter-wave plates (QWPs) are widely used as common components for a wide range of applications in free space, there are almost no reports of Integratable QWPs being able to manipulate the angular momentum (AM) of photons inside nanophotonic waveguides. Here, we demonstrate two kinds of Integratable QWPs respectively based on the concept of abrupt phase change and birefringence effect. The orientation of the equivalent optical axis of an Integratable QWP is designable. Remarkably, a combination of two integratable QWPs with different equivalent optical axes leads to an integrated system that performances one-way AM conversion. Moreover, this system can be used as a point source that can excite different patterns on a metal surface via directional excitation of surface plasmon polaritons (SPP). These results allow for the control of AM of light in nanophotonic waveguides, which are crucial for various applications with limited physical space, such as on-chip bio-sensing and integrated quantum information processing.
Diffusing colloidal probes of cell surfaces
Authors: Duncan Gregg A. , Fairbrother D. Howard , Bevan Michael A.
Published: April 2016

A direct non-intrusive measurement technique is reported to characterize the biophysical properties of live cell surfaces using diffusing colloidal probes.
Functionalization of metal nanoclusters for biomedical applications
Authors: Song Xiao-Rong , Goswami Nirmal , Yang Huang-Hao , Xie Jianping
Published: April 2016

Metal nanoclusters (NCs) are emerging as a new class of functional nanomaterials in the area of biological sensing, labelling, imaging and therapy due to their unique physical and chemical properties, such as ultrasmall size, HOMO–LUMO transition, strong luminescence together with good photostability and biocompatibility.
A D–π–A1–π–A2 push–pull small molecule donor for solution processed bulk heterojunction organic solar cells
Authors: Gautam Prabhat , Misra Rajneesh , Biswas Subhayan , Sharma Ganesh D.
Published: April 2016

Herein, benzothiadiazole (BTD), as an acceptor A1, has been used as a backbone to link triphenylamine (TPA) as donor and naphthalimide (NPI) as acceptor (A2) moieties through ethylene linkers to design a small molecule.
Microscopic significance of hydrophobic residues in the protein-stabilizing effect of trimethylamine N-oxide (TMAO)
Authors: Yang Yanmei , Mu Yuguang , Li Weifeng
Published: April 2016

Proteins with a higher hydrophobic content are better protected by TMAO against the deleterious effect of urea.
Correction: Light and oxygen induced degradation limits the operational stability of methylammonium lead triiodide perovskite solar cells
Authors: Bryant Daniel , Aristidou Nicholas , Pont Sebastian , Sanchez-Molina Irene , Chotchuangchutchaval Thana , Wheeler Scot , Durrant James R. , Haque Saif A.
Published: April 2016

Correction for ‘Light and oxygen induced degradation limits the operational stability of methylammonium lead triiodide perovskite solar cells’ by Daniel Bryant et al., Energy Environ. Sci., 2016, DOI: 10.1039/c6ee00409a.
Encapsulation of piceatannol, a naturally occurring hydroxylated analogue of resveratrol, by natural and modified cyclodextrins
Authors: Matencio Adrián , García-Carmona Francisco , López-Nicolás José Manuel
Published: April 2016

In this work, an in-depth study of the interaction between piceatannol (a type of stilbene with high biological activity) and different natural and modified cyclodextrins (CDs) is made, using steady state fluorescence.
Supercritical water hydrolysis of cellulosic biomass as effective pretreatment to catalytic production of hexitols and ethylene glycol over Ru/MCM-48
Authors: Romero Alberto , Cantero Danilo A. , Nieto-Márquez Antonio , Martínez Celia , Alonso Esther , Cocero María J.
Published: April 2016

Supercritical water hydrolysis is an effective pretreatment for hexitol synthesis over Ru/MCM-48.
Selective catalytic Hofmann N-alkylation of poor nucleophilic amines and amides with catalytic amounts of alkyl halides
Authors: Xu Qing , Xie Huamei , Zhang Er-Lei , Ma Xiantao , Chen Jianhui , Yu Xiao-Chun , Li Huan
Published: April 2016

A selective Hofmann N-alkylation reaction of amines/amides catalytic in alkyl halides is achieved by using alcohols as the alkylating reagents, affording mono- or di-alkylated amines/amides in high selectivities.
Chemotaxis-driven assembly of endothelial barrier in a tumor-on-a-chip platform
Authors: Aung Aereas , Theprungsirikul Jomkuan , Lim Han Liang , Varghese Shyni
Published: April 2016

Chemotaxis-driven assembly of an endothelial barrier around tumor cells within a microfluidics device.
A study on acute toxicity and solvent capacity of solvate ionic liquids in vivo using a zebrafish model (Danio rerio)
Authors: Yoganantharajah Prusothman , Eyckens Daniel J. , Pedrina Jessie L. , Henderson Luke C. , Gibert Yann
Published: April 2016

The in vivo toxicity of several solvate ionic liquids have been assessed using a zebrafish model.
Chemical proteomics approaches for identifying the cellular targets of natural products
Authors: Wright M. H. , Sieber S. A.
Published: April 2016

This review focuses on chemical probes to identify the protein binding partners of natural products in living systems.
Engineered non-toxic cationic nanocarriers with photo-triggered slow-release properties
Authors: Dinu Ionel A. , Duskey Jason T. , Car Anja , Palivan Cornelia G. , Meier Wolfgang
Published: April 2016

A simple and versatile strategy using cationic amphiphilic diblock copolymers synthesized by a combination of ATRP and post-polymerization quaternization to prepare photo-responsive nanocarriers showing slow-release properties and low cytotoxicity was reported.
50–100 μm-thick pseudocapacitive electrodes of MnO2 nanoparticles uniformly electrodeposited in carbon nanotube papers
Authors: Narubayashi Misato , Chen Zhongming , Hasegawa Kei , Noda Suguru
Published: April 2016

The 62 μm-thick, 1.09 g cm−3-dense hybrid electrode of 82 wt% MnO2 and 18 wt% CNTs realized high total capacitances of 120 F g−1, 131 F cm−3, and 0.81 F cm−2 at 2 mV s−1 scan rate.
Synthesis and biological activity evaluation of 20-epi-salinomycin and its 20-O-acyl derivatives
Authors: Zhang Wenxuan , Wu Jun , Li Bo , Xia Jie , Wu Hongna , Wang Liu , Hao Jie , Zhou Qi , Wu Song
Published: April 2016

20-epi-Salinomycin and six 20-O-acylated analogs were synthesized and tested for their biological activity.
Infiltrated porous oxide monoliths as high lithium transference number electrolytes
Authors: Popovic Jelena , Hasegawa George , Moudrakovski Igor , Maier Joachim
Published: April 2016

We show for the first time that liquid–solid lithium electrolytes can exhibit both a very high lithium transference number (up to 0.89) and high overall ionic conductivity (up to 0.48 mS cm−1) when the solid contains a large number of mesopores covered by a high density of –OH groups enabling anionic adsorption.
Multi‐physic analytical model for a saturated permanent magnet assisted synchronous reluctance motor
Authors: Prieto Dany , Dessante Philippe , Vannier Jean‐Claude , Dagusé Benjamin , Jannot Xavier , Saint‐Michel Jacques
Published: April 2016

This paper presents a multi‐physic analytical model for a permanent magnet assisted synchronous reluctance motor. The proposed model consists of: an electromagnetic model, an electrical model, a loss model, and a thermal model. The electromagnetic model is based on Maxwell's equations. Stator and rotor magnetic saturation is considered, as well as the effect of the magnetic bridges of the flux‐barriers. The electrical model computes the terminal voltage and power factor. Copper loss and iron losses are also considered. The thermal model makes an estimation of the winding and magnet temperature. The goal is to compute the motor performances (average torque, voltage, power factor, efficiency etc.) for several current values and current angles. The analytical model results are compared with those from a finite element model and are subsequently validated by an experimental prototype.
Design of five‐phase permanent magnet assisted synchronous reluctance motor for low output torque ripple applications
Authors: Baek Jeihoon , Bonthu Sai Sudheer Reddy , Choi Seungdeog
Published: April 2016

This paper presents the design of five‐phase permanent magnet assisted synchronous reluctance motor (PMa‐SynRM) for integrated starter and generator (ISG) of hybrid electric vehicle with low torque ripple. When ISG works as starter in order to operate engine, PMa‐SynRM produces 3 kW power at the rated speed of 1800 rpm with reduced vibration by multi‐phase structure. PMa‐SynRMs are similar to interior permanent magnet motors in structure but are more economical due to reduced permanent magnets. In this study, lumped parameter model (LPM) using magnetic circuit design is used in the approach to initially design the five‐phase PMa‐SynRM. Numerical equations are integrated with the LPM to design the machine with its given range of design parameter values. Thousands of designs are generated by LPM, which are then converged to optimised model using differential evolution strategy. In this study, optimisation is done with maximum efficiency and minimum torque ripple as objective. The optimised 3 kW five‐phase PMa‐SynRM is then analysed by finite element method for fine tuning. Simulation results for back electromotive force, flux linkage, developed torque, torque ripple, cogging torque, torque speed characteristics and d and q‐axis inductances variation over respective axis currents are verified by fabricated prototype.
Control algorithms based on the active and non‐active currents for a UPQC without series transformers
Authors: Correa Monteiro Luis Fernando , Aredes Mauricio , Pinto Jose Gabriel , Exposto Bruno Fernandes , Afonso Joao Luiz
Published: April 2016

This study presents control algorithms for a new unified power quality conditioner (UPQC) without the series transformers that are frequently used to make the insertion of the series converter of the UPQC between the power supply and the load. The behaviour of the proposed UPQC is evaluated in presence of voltage imbalances, as well as under non‐sinusoidal voltage‐and current conditions. The presented algorithms derive from the concepts involving the active and non‐active currents, together with a phase‐locked‐loop circuit. Based on these real‐time algorithms, and considering the proposed hardware topology, the UPQC is able to compensate the harmonic components of the voltages and currents, correct the power factor, and keep the load voltages regulated, all of this in a dynamic way, responding instantaneously to changes in the loads or in the electrical power system. The control algorithms were distributed in a two‐DSP digital control architecture, without any communication between them. Consequently, can be increased the sampling frequency of the acquired voltages and currents and improve the UPQC performance. Furthermore, some constraints of the proposed UPQC are evidenced, particularly when the main voltages are imbalanced. Simulation and experimental results are presented to verify the UPQC performance under transient and steady state conditions.
Robust non‐homogeneity detector based on reweighted adaptive power residue
Authors: Jiang Lei , Wang Tong
Published: April 2016

Space time adaptive processing (STAP) is an excellent technique for improving ground moving target detection performance of airborne radar. However, covariance matrix estimation required by STAP is commonly corrupted by the presence of target‐like signals (i.e. outliers), and thus resulting severe performance degradation. To overcome this problem, a robust non‐homogeneity detector based on reweighted adaptive power residue is developed, where an adaptively reweighted scheme is employed to training data set. Therefore, the deleterious effect of outliers on the covariance estimation is eliminated and the robustness of the non‐homogeneity detector is guaranteed. Performance analysis using the simulated and measured data validates that the proposed method can effectively remove outliers from the training data and improves the radar detection performance in a dense target environment.
Automatic dependent surveillance‐broadcast time delay estimation based on extended recursive maximum correntropy algorithm
Authors: Luan Shengyang , Qiu Tianshuang , Song Aimin , Wang Peng , Li Jingchun , Tan Haifeng
Published: April 2016

In this study, a novel adaptive algorithm, termed extended recursive maximum correntropy (EX‐RMC), is proposed to estimate the time delay of automatic dependent surveillance‐broadcast (ADS‐B), an up‐to‐date surveillance technology in civil aviation. The proposed algorithm is designed to deal with both the random time‐varying delay and the impulsive noise. The superiority of EX‐RMC in tracking time‐varying state of an unknown plant has been verified by simulation experiments. On‐site experiments are also carried out to demonstrate the practical value of the ADS‐B time delay estimation method based on EX‐RMC.
Application of micro–meso hierarchical porous carbon for toluene adsorption treatment
Authors: Liu Fang , Yan Xi , Fan Fengtao , Zhao Chaocheng , Liu Rentao , Gao Ya , Wang Yongqiang
Published: April 2016

Organic waste gases from petrochemical industry cause air pollution. Due to the environmental effects of refractory organic gas, the development of effective adsorbent is imperative. The micro–meso hierarchical porous carbon with high surface area was synthesised by the hard‐template method. With MCM‐41 as template, this material was prepared using phenolic resin as carbon source. Dynamic adsorption performance of toluene on micro–meso hierarchical porous carbon was studied by gas chromatographic techniques. Effects of toluene initial concentration, temperature and bed height on adsorption capacity were also researched. The results showed that when toluene concentration was 1750 mg/m3, equilibrium amount of toluene adsorbed was 358.8 mg/g by micro–meso hierarchical porous carbon, 79.41 mg/g by MCM‐41. The adsorption capacity increased with the increase of initial concentration and bed height, while the adsorption capacity decreased along with the increase of temperature. Due to strong toluene adsorption capacity, this micro–meso hierarchical porous carbon manifests profound theoretical and practical significance in petrochemical organic waste gas treatment.
Prädiktoren gesundheitsbezogener Lebensqualität bei bayerischen Einschulungskindern
Authors: Weigl Korbinian , Herr Caroline , Meyer Nicole , Otto Christiane , Stilianakis Nikolaos , Bolte Gabriele , Nennstiel-Ratzel Uta , Kolb Stefanie
Published: April 2016

Hintergrund: In Deutschland gibt es bisher wenige Daten zur gesundheitsbezogenen Lebensqualität von Einschulungskindern.

Ziel: Ziel dieser Studie war es daher, die gesundheitsbezogene Lebensqualität von Einschulungskindern in Bayern zu untersuchen und, unter Berücksichtigung von Umweltfaktoren, Prädiktoren dafür zu finden.

Methoden: Die analysierten Daten stammen aus dem fünften Survey (2010/2011) der in Bayern durchgeführten Gesundheits-Monitoring-Einheiten. Mittels eines Elternfragebogens wurden Informationen zur gesundheitsbezogenen Lebensqualität der Einschulungskinder (KINDL-R(evised)), zu Verhaltensauffälligkeiten und -stärken ( Strength and Difficulties Questionnaire (SDQ)), zu soziodemografischen Merkmalen sowie zu Umweltfaktoren erfasst.

Ergebnisse: Es konnten 3 744 Kinder (45,9% Mädchen; Altersdurchschnitt 6,0 Jahre; SD=0,4) in die Analyse eingeschlossen werden. Mädchen hatten signifikant höherer Werte als Jungen sowohl im Gesamt KINDL-R (83,7 vs. 82,4; p≤0,0001) als auch in allen KINDL-R Subskalen mit Ausnahme der Bereiche „psychisches Wohlbefinden“ und „körperliches Wohlbefinden“. Für letzteres fanden sich bei Jungen signifikant höhere Werte als bei Mädchen (84,1 vs. 82,9; p=0,0103). Multiple lineare Regressionsanalysen zeigten, dass von Eltern berichtete Luftverschmutzung oder Lärmbelästigung, die Möglichkeit der Kinder sicher draußen zu spielen und die Zeit, die ein Kind im Sommer unter der Woche draußen verbringt, signifikante Prädiktoren der mit dem KINDL-R gemessenen gesundheitsbezogenen Lebensqualität sind. Adipositas stand nicht im Zusammenhang mit der gesundheitsbezogenen Lebensqualität. Kinder mit Migrationshintergrund hatten signifikant höhere Werte in den Subskalen „Familie“ und „Freunde“.

Schlussfolgerung: Umweltfaktoren stehen im Zusammenhang mit der gesundheitsbezogenen Lebensqualität von Einschulungskindern in Bayern, sind jedoch nur teilweise von relevanter Bedeutung. Obwohl sich signifikante Assoziationen zeigen, ist ihre Aussagekraft aufgrund der geringen erklärten Varianz eher limitiert.
Short wavelength trapped electron modes in tokamak plasmas
Authors: Zhang N. , Gong X. Y. , Dong J. Q. , Huang Q. H. , Gong L. , Li J. C.
Published: April 2016

The collisionless trapped electron modes in the short wavelength region k⊥ρs>1 (SWTEMs) are studied with the gyrokinetic integral eigenmode equation in tokamak plasmas. Here, we present a systematic study of the correlation between the SWTEMs and short wavelength ion temperature gradient (SWITG) modes. The kθρs spectra of TEM have double humps in the short wavelength and long wavelength regions, respectively. The SWITG modes with trapped electron effects taking into account have broader kθρs spectra. Dependences of growth rate and real frequency of SWTEMs on the various parameters, such as ion temperature gradient (ηi), the temperature gradient of trapped electrons (ηe), toroidicity (εn), magnetic shear (ŝ), safety factor (q), and the ratio of temperature (Te/Ti), are investigated in detail. It is found that the SWTEMs propagate in the electron diamagnetic drift direction and require temperature gradient of trapped electrons ηe exceeding thresholds. Moreover, the ion temperature gradient has a strong stabilizing effect on the SWTEMs. The SWTEMs become stable in both regimes of toroidicity εn > 0.1 and magnetic shear ŝ>0.5 regardless of the fraction of trapped electrons. In addition, the properties of short wavelength ITG (SWITG) modes are discussed with different ratio of trapped electrons. It is found that trapped electrons of greater fraction have a stronger destabilizing effect on the SWTEM and SWITG modes. These results are significant for the electrons anomalous transport experiments in the future.
A dual-mode operation overmoded coaxial millimeter-wave generator with high power capacity and pure transverse electric and magnetic mode output
Authors: Bai Zhen , Zhang Jun , Zhong Huihuang
Published: April 2016

An overmoded coaxial millimeter-wave generator with high power capacity and pure transverse electric and magnetic (TEM) mode output is designed and presented, by using a kind of coaxial slow wave structure (SWS) with large transversal dimension and small distance between inner and outer conductors. The generator works in dual-mode operation mechanism. The electron beam synchronously interacts with 7π/8 mode of quasi-TEM, at the meanwhile exchanges energy with 3π/8 mode of TM01. The existence of TM01 mode, which is traveling wave, not only increases the beam-wave interaction efficiency but also improves the extraction efficiency. The large transversal dimension of coaxial SWS makes its power capacity higher than that of other reported millimeter-wave devices and the small distance between inner and outer conductors allows only two azimuthally symmetric modes to coexist. The converter after the SWS guarantees the mode purity of output power. Particle-in-cell simulation shows that when the diode voltage is 400 kV and beam current is 3.8 kA, the generation of microwave at 32.26 GHz with an output power of 611 MW and a conversion efficiency of 40% is obtained. The power percentage carried by TEM mode reaches 99.7% in the output power.
Centimeter-order view for magnetic domain imaging with local magnetization direction by longitudinal Kerr effect
Authors: Meguro Sakae , Akahane Koichi , Saito Shin
Published: April 2016

An observation system of centimeter-order of view of magnetic domain with local magnetization direction was developed by designing a telecentric optical system of finite design through the extension of microscope technology. The field of view realized in the developed system was 1.40 × 1.05 cm as suppressing defocus and distortion. Detection of the local magnetization direction has become possible by longitudinal Kerr observation from the orthogonal two directions. This system can be applied to the domain observation of rough surface samples and time resolved analysis for soft magnetic materials such as amorphous foil strips and soft magnetic thin films.
Continuing innovation in Australian canola breeding
Authors: Salisbury Phillip A. , Cowling Wallace A. , Potter Trent D.
Published: April 2016

Innovation has been integral in the development of the current Australian canola (Brassica napus L.) industry. From the initial introduction of poorly adapted Canadian germplasm, Australian breeders have developed high yielding, high quality, disease-resistant canola cultivars. The Australian canola industry has transitioned from being reliant on imports to becoming one of the world’s major exporters of canola. This review details the progressive innovations in the Australian canola breeding programs from the initial introduction of rapeseed to more recent developments including herbicide resistance, hybrid cultivars, speciality oil types and genetically modified canola.
Boundaries of sexual communication: a mixed-method study exploring Chinese young adults’ engagement with online sexual health information
Authors: Zhang Jingwen , Nurik Chloe , Jemmott John B.
Published: April 2016

Background: Although previous research suggests that a majority of Chinese young adults get sexual health information through the Internet, the details of this process and how it translates into subsequent actions are unknown. This study aims to understand the dynamic nature of Chinese young adults’ engagement with online sexual health information (OSHI) through various communication channels to inform the development of effective sexual health intervention strategies. Methods: A mixed-method approach was used, involving individual semi-structured interviews (n = 30) and cross-sectional online surveys (n = 561) with Chinese young adults aged 18 to 25 years. Qualitative themes and prevalence and predictors of engagement with OSHI were analysed. Results: Three themes emerged from the interviews: (1) problem-based searching; (2) multi-criteria evaluation; and (3) stigma of online sharing and discussion. After engaging with OSHI, 87.3% of the survey participants followed online advice on at least one occasion, and 54.9% discussed this information with others (mostly with partners and friends) offline. Having sexual intercourse in the past 3 months was a consistent predictor of engagement with OSHI (P < 0.05). Contrary to previous findings, participants with higher family income were more likely to engage with OSHI (P < 0.05). Conclusions: Chinese young adults obtain sexual health information from online sources when personal problems arise and then circulate this information offline within their peer networks. Although social media interventions have shown some promise, researchers should first increase risk awareness and be cautious about designing programs that promote online sharing or discussion. Finally, researchers need to make extra effort to target young adults with limited resources.
Language documentation and historical linguistics
Authors: Campbell Lyle
Published: April 2016

This paper examines the relationship between language documentation, especially documentation of endangered languages, and historical linguistics. It address the questions, why is language documentation important to historical linguistics? and what can historical linguistics contribute to language documentation? Several ways in which the two are interconnected, mutually supportive, and together contribute to linguistics generally are discussed, illustrated by examples from a number of indigenous languages of the Americas.
Evaluation of Resistance to Leaf Scald by Quantitative PCR ofXanthomonas albilineansin Sugarcane
Authors: Gutierrez A. , Garces F. F. , Hoy J. W.
Published: April 2016

Leaf scald, caused by Xanthomonas albilineans, is a major sugarcane disease controlled primarily with host resistance. Because visual evaluation can be uncertain due to erratic symptom expression, a reliable resistance screening method is needed. A quantitative polymerase chain reaction (qPCR) with potential for resistance screening was used to compare bacterial populations in 31 clones at different times after inoculation, and the correlation with the visual symptom rating method was determined. Comparisons of bacterial populations quantified by qPCR and visual symptom severity ratings in systemically infected leaves showed variable results, with the highest correlation at 8 weeks after inoculation. To measure consistency, the correlation was determined among three different field experiments for data obtained with the same method at different times after inoculation. The qPCR assay was more consistent among experiments compared with visual symptom rating at 8 weeks after inoculation. Susceptible check cultivars always had high bacterial populations but the severe inoculation resulted in moderate to high bacterial populations in two of three resistant checks in some experiments. The results suggest that qPCR can provide an improved method to evaluate resistance to leaf scald in sugarcane; however, multiple experiments will be needed to accurately determine clone resistance levels.
Intraoperative and Postoperative Administration of Dexmedetomidine Reduces Anesthetic and Postoperative Analgesic Requirements in Patients Undergoing Cervical Spine Surgeries
Authors: Gandhi Komal A. , Panda Nidhi B. , Vellaichamy Amutha , Mathew Preethy J. , Sahni Neeru , Batra Yatindra K.
Published: April 2016

Background:

Early recovery from anesthesia and avoidance of analgesics with respiratory depressant properties are vital for maintenance of extubated airway in cervical spine surgeries. The current study investigated the role of dexmedetomidine as an anesthetic sparing agent and as a sole postoperative analgesic in these cases.

Materials and Methods:

Sixty adult patients undergoing cervical spine surgeries were randomized into 2 groups. Group D received intravenous dexmedetomidine infusion 0.5 μg/kg/h throughout the surgery after a loading dose of 1 μg/kg over 10 minutes. Postoperatively, dexmedetomidine infusion was continued at 0.2 μg/kg/h for 24 hours. Group C received a volume-matched bolus and infusion of 0.9% saline. Intraoperative anesthetic requirement, time to recovery, and discharge were recorded. Patients were observed for rescue analgesic requirements for 24 hours after surgery. Hemodynamic stability, sedation scores, and pain scores were assessed for 48 hours after surgery.

Results:

There was significant reduction in intraoperative anesthetic requirement in group D (P<0.001). Although sedation scores and recovery criteria were comparable, pain scores were significantly lower in group D compared with group C for first 24 hours postoperatively at all corresponding times. The mean pain-free period after surgery was significantly longer in group D (1460.67±517.16 min) with significantly less rescue analgesic requirement during 24-hour postoperative period (P=0.018) compared with group C (98.17±81.20 min). Hemodynamic parameters were maintained within clinically normal range during study period.

Conclusions:

Dexmedetomidine lowered the anesthetic requirement with clinically permissible hemodynamic variations without undue prolongation of recovery time. Postoperative dexmedetomidine infusion provided effective analgesia without excessive sedation in patients undergoing cervical spine surgeries.
Successful Strategies for Managing Monteggia Injuries
Authors: Bae Donald S.
Published: April 2016

Monteggia fracture-dislocations refer to traumatic ulnar fractures associated with proximal radioulnar and radiocapitellar joint instability. Careful clinical and radiographic evaluation of the entire limb in the acutely injured child is critical for timely diagnosis and appropriate treatment. Treatment principles include restoring and maintaining both ulnar length and alignment as well as radiocapitellar joint reduction. Recent information suggests that surgical treatment of acute injuries associated with complete ulnar fractures is safe and effective in maintaining bone and joint alignment. In cases of late presentation or missed diagnoses, chronic reconstruction may be considered in symptomatic patients with preserved radiocapitellar morphology. Although challenging, ulnar osteotomy and open joint reduction with or without ligament reconstruction may restore joint congruity in the majority of patients.
Type I Open Fractures Benefit From Immediate Antibiotic Administration But Not Necessarily Immediate Surgery
Authors: Godfrey Jenna , Pace J. Lee
Published: April 2016

Pediatric open fractures are rare, occurring in approximately 2% to 9% of all pediatric fractures. Type I open fractures represent the most common type of open fractures seen in pediatrics and are commonly caused by low-energy mechanisms. The management of these injuries has been primarily dictated by the adult literature. Immediate antibiotic administration, specifically a first generation cephalosporin, has been shown to reduce infection rates. The duration of antibiotic treatment is less clear, but longer courses of antibiotics have not been significantly better than a shorter course. Retrospective case series have shown no difference in infection rates with nonoperative management of type I open fractures. However, concern regarding serious and even life-threatening infection continues to limit the universal adoption of nonoperative treatment protocols. A prospective randomized control trial is underway and will hopefully elucidate which open fractures can be safely managed with prompt antibiotic administration and nonoperative care.
Can Patients With Low Back Pain Be Satisfied With Less Than Expected?
Authors: Silvis Wouter L. , Lakke Sandra E. , Stegeman Patrick , Speijer Bert L.G.N. , Vroomen Patrick C.A.J. , Coppes Maarten H. , Reneman Michiel F. , Soer Remko
Published: April 2016

Study Design.

A prospective cohort study within care as usual.

Objective.

(1) To explore the psychometric properties of a baseline disability questionnaire designed to collect patients’ expectation. (2) To analyze relations between satisfaction with care and treatment success in patients with chronic low back pain (CLBP). (3) To determine the chances of being satisfied with the received care in absence of treatment success.

Summary of Background Data.

There is a lack of evidence on determinants of treatment satisfaction in patients with CLBP, specifically the role of patient's expectation of disability reduction after treatment.

Methods.

Treatment expectation was measured with questions inspired by the Pain Disability Index (PDI) at baseline. Treatment success was considered if disability at the end of therapy was lower than, or equal to pretreatment expectation. An exploratory factor analysis was performed on the new questionnaire. Binary logistic regression models were used to analyze how much variance of satisfaction with care was explained by treatment success, pain disability at baseline, sex, age, duration of complaints, and pain intensity. The odds ratio of being satisfied when treatment was successful was calculated.

Results.

Six hundred nine patients were included. The factor structure of the PDI-expectancy had optimal fit with a one factor structure. There were low correlations between the expected and baseline disability, pain intensity, and duration of pain. Correlation between treatment success and satisfaction with care was low (χ
2 = 0.13; P < 0.01). Treatment success had a low contribution to satisfaction with care. Of all participating patients, 51.4% were satisfied with care even when treatment was not successful. The odds ratio for being satisfied was 2.42 when treatment was successful compared to when treatment was not successful.

Conclusion.

The PDI-expectancy is internally consistent. Pretreatment expectation contributes uniquely but slightly to satisfaction with care; patients whose treatment was considered successful have 1.38 to 4.24 times higher chance of being satisfied at the end of treatment. Even when treatment was not successful, 51.4% of the patients with CLBP are satisfied with care.

Level of Evidence: 2
Does Tobacco Use Attenuate Benefits of Early Decompression in Patients With Cervical Myelopathy?
Authors: Kusin David J. , Li Samuel Q. , Ahn Uri M. , Ahn Nicholas U.
Published: April 2016

Study Design.

A retrospective cohort.

Objective.

This study investigates the interplay between duration of preoperative symptoms and smoking status with respect to postoperative outcomes in patients with cervical spondylotic myelopathy (CSM).

Summary of Background Data.

Many studies have established the harms of smoking and several have identified the benefits of early decompression in patients with cervical myelopathy, but to our knowledge, none have assessed the relationship between these two variables.

Methods.

The medical records of all 212 patients operated on by the senior author between March 2005 and July 2012 were reviewed. Inclusion criteria were the diagnosis of CSM with a Nurick score, surgical intervention, and at least 2 years of follow-up. Patients were categorized according to smoking status and quantification of tobacco use by packs per day and pack-years, and duration of symptoms according to thresholds of 6, 12, or 24 months. Age, sex, preoperative Nurick score, duration of preoperative symptoms, duration of follow-up, procedure performed, prior surgery, number of levels operated on, diabetes status, ethanol use, and signal change on preoperative magnetic resonance imaging were also recorded for ordered logistical regression analysis.

Results.

One hundred twenty-five patients met all criteria. Eighty patients were smokers and 45 were nonsmokers. The median change in Nurick score for nonsmokers was 2 compared with 1 in smokers. Nonsmokers had a statistically significant likelihood of decreased change in Nurick score for symptom duration of greater than 24 months (odds ratio = 0.06, P = 0.0025). Smokers did not show a significant difference in the change in Nurick score for any threshold of symptom duration.

Conclusion.

Increased duration of symptoms significantly affects outcomes in surgical decompression of CSM. A history of cigarette use may attenuate the benefit of early decompression and results in lower improvement in Nurick score regardless of symptom duration.

Level of Evidence: 3
How to Calculate the Exact Angle for Two-level Osteotomy in Ankylosing Spondylitis?
Authors: Zheng Guoquan , Song Kai , Yao Ziming , Zhang Yonggang , Tang Xiangyu , Wang Zheng , Zhang Xuesong , Mao Keya , Cui Geng , Wang Yan
Published: April 2016

Study Design.

A prospective case series study.

Objective.

To describe and assess a two-level osteotomy method for the management of severe thoracolumbar kyphosis (TLK) in patients with ankylosing spondylitis (AS).

Summary of Background Data.

To achieve better postoperative outcomes in these patients, a sophisticated preoperative surgical plan is required. Most deformities are managed using a one-level osteotomy and a two-level osteotomy is seldomly reported. Till date, no study has described a two-level osteotomy for these cases.

Methods.

From January 2011 to December 2012, 10 consecutive patients with ankylosing spondylitis who underwent two-level spinal osteotomy were studied. Pre- and postoperative full-length free-standing radiographs, including the whole spine and pelvis, were available for all patients. Pre- and postoperative radiological parameters, including T5-S1 Cobb angles, TLK, lumbar lordosis, pelvic incidence, pelvic tilt, sacral slope, and sagittal vertical axis were measured. Health related quality of life , including Oswestry Disability Index and Scoliosis Research Society-22 surveys were administered before surgery and at 1-year follow up.

Results.

The preoperative and postoperative T5-S1 Cobb angles was 51.3° and −7.1°, respectively (P < 0.001). All patients demonstrated changes in postoperative radiographic parameters including decreased pelvic tilt (from 37.1° to 14.3°, P < 0.001), TLK (from 36.9° to 12.6°, P < 0.001), and sagittal vertical axis (from 21.4 cm to 7.1 cm, P < 0.001), increased lumbar lordosis (from -5.1° to −47.1°, P < 0.001), sacral slope (from 13.4° to 37.7°, P < 0.001), but no significant change in pelvic incidence. Health related quality of life scores at 1-year follow up were significantly improved compared to those before surgery.

Conclusion.

This calculation of two-level osteotomy provides an accurate and reproducible method for ankylosing spondylitis correction. By which, we can obtain satisfactory radiological parameters and clinical outcomes.

Level of Evidence: 4
Self-assembling Peptide Reduces Glial Scarring, Attenuates Posttraumatic Inflammation, and Promotes Neurite Outgrowth of Spinal Motor Neurons
Authors: Ando Kei , Imagama Shiro , Ito Zenya , Kobayashi Kazuyoshi , Hida Tetsuro , Nakashima Hiroaki , Ito Kenyu , Tsushima Mikito , Ishikawa Yoshimoto , Matsumoto Akiyuki , Nishida Koji , Nishida Yoshihiro , Ishiguro Naoki
Published: April 2016

Study Design.

Self-assembling peptide gel (SPG-178) provides new evidence for the role of a scaffold for treatment of the spinal cord through induction of neuroprotective factors.

Objective.

To verify the reproducibility of SPG-178 as scaffold after spinal cord injury, we examine the characteristics of SPG-178 and protective effect on neural cells in vitro and in vivo.

Summary of Background Data.

The central nervous system extracellular matrix may play a role in maintenance of the neuronal network by inhibiting axonal growth and suppressing formation of additional inadequate synapses. In this study, we show increased expression of nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), neurotrophin-4 (NT-4), and tropomyosin receptor kinase (TrkA and TrkB) in SPG-178-promoted neurite outgrowth of motor neurons in vitro, and decreased inflammation and glial scar with use of SPG-178 in vivo.

Methods.

We examined the effect of a self-assembling peptide, SPG-178, as a scaffold for neurite outgrowth of spinal motor neurons in vitro. An in vivo analysis was performed to evaluate if the SPG-178 scaffold attenuated or enhanced expression of various genes after spinal cord injury model rats.

Results.

Expression of NGF, BDNF, NT-4, TrkA, and TrkB increased in SPG-178-promoted neurite outgrowth of motor neurons in vitro. In vivo, SPG-178 increased expression of glial cell line-derived neurotrophic factor and NGF, and decreased glial scar.

Conclusion.

This study provides new evidence for the role of SPG-178 as a scaffold in the spinal cord and suggests that this peptide is a neuroprotective factor that may serve as an alternative treatment for neuronal injuries.

Level of Evidence: 5
Interleukin-9 Promotes TNF-α and PGE2 Release in Human Degenerated Intervertebral Disc Tissues
Authors: Zhang Yuanqiang , Zhao Yunpeng , Li Jingkun , Wang Shuaishuai , Liu Yi , Nie Lin , Cheng Lei
Published: April 2016

Study Design.

Based on human disc surgical samples and isolated cells in vitro, we undertook a descriptive and mechanistic investigation of proinflammatory effects of interleukin (IL)-9 in intervertebral disc (IVD) degeneration.

Objective.

To investigate the proinflammatory role of IL-9 in the pathological process of IVD degeneration.

Summary of Background Data.

IL-9 is known as a pleiotropic cytokine that regulates the human pathogenesis of inflammatory and autoimmune diseases. However, whether IL-9 cytokine is involved in the immuno-inflammatory pathogenesis of IVD degeneration is unclear.

Methods.

The IVD samples were obtained from 45 patients. Immunohistochemistry, western blot, and real-time Polymerase Chain Reaction (PCR) were performed to detect the expression of IL-9 and tumor necrosis factor alpha (TNF-α) in the degenerated IVDs. Moreover, nucleus pulposus (NP) cells were treated with 0, 1, 10, and 100 ng/mL IL-9 cytokine and stimulated with IL-9 alone at 100 ng/mL for 0, 12, 24, and 48 hours. TNF-α expression was determined by immunofluorescence staining, western blot, and real-time PCR, respectively. The amounts of TNF-α and prostaglandin E2 (PGE2) in the supernatant were quantified by enzyme-linked immunosorbent assay. Additionally, Spearman correlation analyses were performed to analyze the correlation between Pfirrmann grading score of the involved degenerated IVDs and serum levels of IL-9.

Results.

The expressions of IL-9 and TNF-α in degenerated IVD tissues were dramatically elevated in comparison with the control. IL-9 significantly up-regulated the TNF-α and PGE2 secretion of NP cells in dose- and time-dependent manner. Moreover, there is a positive correlation between IL-9 serum level and severity of involved IVD degeneration.

Conclusion.

Our findings suggest that IL-9 may play a potential role in the inflammatory processes of IVD degeneration. IL-9 may be involved in the IVD degeneration, at least in part, though stimulating the release of TNF-α and PGE2 in NP cells.

Level of Evidence: N/A
Patient Priority Weighting of the Roland Morris Disability Questionnaire Does Not Change Results of the Lumbar Epidural Steroid Injections for Spinal Stenosis Trial
Authors: Makris Una E. , Edwards Todd C. , Lavallee Danielle C. , Bauer Zoya , Comstock Bryan A. , Jarvik Jeffrey G. , Patrick Donald L. , Lotfi Mahshid , Friedly Janna L.
Published: April 2016

Study Design.

Secondary analysis of lumbar epidural steroid injections for spinal stenosis randomized controlled trial data.

Objective.

To reevaluate whether outcomes for older adults receiving epidural steroid injections with or without corticosteroid improve after using patient-prioritized Roland-Morris Disability Questionnaire (RDQ) items.

Summary of Background Data.

Epidural corticosteroid injections are commonly used to treat lumbar spinal stenosis symptoms, despite limited evidence for their effectiveness in clinical trials. It is unclear whether evaluating patient-prioritized outcomes would alter results of a large clinical trial.

Methods.

Outcomes from the trial of lumbar epidural corticosteroid injections for spinal stenosis (LESS) trial were reanalyzed using RDQ, Sickness Impact Profile (SIP) weights assigned to the RDQ items, and patient-prioritized RDQ items. Differences between corticosteroid + lidocaine versus lidocaine-alone groups and 95% confidence intervals (CI) were calculated using analysis of covariance with adjustment for baseline values of the RDQ and recruitment site.

Results.

At 6 weeks, both the corticosteroid + lidocaine group and the lidocaine-alone group had improvement in the RDQ scores (RDQ, RDQ using SIP weights, patient-prioritized RDQ) as compared with baseline scores (corticosteroid + lidocaine: −4.2 points, −4.1 points, −4.2; lidocaine-alone: −3.1 points, −2.9 points, and −3.1 points, respectively). However, there was no significant between-group difference in the RDQ or patient-prioritized RDQ (average treatment effect −1.0 points, 95% CI −2.1 to 0.1, P = 0.07; −1.0 points, 95% CI −2.0 to 0.1, P = 0.08, respectively). Although the between-group difference of RDQ using SIP weights was statistically significant (average treatment effect −1.1, 95% CI −2.2 to −0.1, P = 0.04), this was not clinically important.

Conclusion.

Results of the LESS trial did not substantively differ based on reanalysis of data using RDQ with SIP weights or patient-prioritized RDQ outcomes. This provides additional evidence that epidural injection of corticosteroid + lidocaine offered minimal or no short-term benefit as compared with epidural injection of lidocaine alone for older adults with lumbar spinal stenosis.

Level of Evidence: 2
Extracorporeal Free Flap Perfusion in Case of Prolonged Ischemia Time
Authors: Taeger C. D. , Präbst K. , Beier J. P. , Meyer A. , Horch R. E.
Published: April 2016

In free flap surgery, a clinically established concept still has to be found for the reduction of ischemia-related cell damage in the case of prolonged ischemia. Although promising results using extracorporeal free flap perfusion in the laboratory have been published in the past, until now this concept has not yet paved its way into clinical routine. This might be due to the complexity of perfusion systems and a lack of standardized tools. Here, we want to present the results of the first extracorporeal free flap perfusion in a clinical setting using a simple approach without the application of a complex perfusion machinery.
SPECT-CT-Guided Thoracoscopic Biopsy of Sentinel Lymph Nodes in the Internal Mammary Chain in Patients with Breast Cancer: A Pilot Study
Authors: Piato José; Roberto Morales , Filassi José; Roberto , Vega Alberto Jorge Monteiro Dela , Coura-Filho George Barberio , Aguiar Fernando Nalesso , Porciuncula Ligia Maria Teixeira Pereira , Dória Maíra Teixeira , Soares José Maria , Baracat Edmund Chada
Published: April 2016

Objective

The objective of this study was to determine the impact of the use of single-photon emission computed tomography fused with computed tomography (SPECT-CT) on thoracoscopic biopsy of sentinel lymph nodes (SLNs) in the internal mammary chain in patients with breast cancer by evaluating resultant changes in staging and their clinical implications.

Methods

Between September 2010 and January 2014, we performed lymphoscintigraphy-assisted thoracoscopic biopsy of the internal mammary chain SLN in 20 patients with breast cancer. Single-photon emission computed tomography fused with computed tomography was also used in 13 of these patients. The sentinel nodes were surgically identified with the aid of a gamma probe.

Results

Sentinel lymph nodes were identified surgically in 19 of 20 patients. In the 13 patients in whom SPECT-CT was used, it readily identified SLNs, especially when they were located over an intercostal space. Change of staging occurred in three patients (15%), two of whom accordingly received adjuvant radiotherapy to the internal thoracic chain.

Conclusions

Compared with lymphoscintigraphy alone, the use of SPECT-CT improves localization of the SLN in the internal mammary chain, allowing more accurate planning of each individual's treatment.