bluuebunny/crossref_metadata_2025 huggingface dataset:
Computed Tomographic Validation of the Center-Center Radiographic Technique for Syndesmosis Fixation Axis Alignment in Normal Ankles
Authors: Haupt Edward Thomas , Monir Joseph George , Mansfield Mollie , Pollizzi Anthony , Nichols Jennifer A. , Reb Christopher William
Published: July 2020

Background:

Ankle syndesmotic ligament injury is an important factor affecting clinical outcome after lower extremity injury with as little as 2 mm of syndesmotic displacement leading to worse clinical outcome. One important factor is the appropriate placement of clamps and fixation across the syndesmosis. When not ideally aligned, these can result in malalignment of the fibula in the incisura. This study sought to provide computer validation of using the center-center technique to identify an ideal centroid axis for placement of syndesmotic implants.

Methods:

Thirty computed tomography (CT) scans of patients from July 1, 2016, to June 30, 2018, with normal syndesmoses were evaluated. Center-center and centroid measurements were drawn and compared on the axial CT images at 10, 20, and 30 mm superior to the tibial plafond. Three observers recorded measurements for the same 50 patients in order to compare interobserver reliability.

Results:

The difference between the centroid and center-center axis at each height level was a mean 0.4 degrees (range, 0.3-0.5 degrees). The center-center and centroid axis change by externally rotating as the height increases away from the tibial plafond with mean, 3 degrees (range, 0-6.1 degrees). Intraclass correlation coefficients (ICCs) were measured at 0.98, thus demonstrating excellent intraobserver and interobserver reliability on these measurements.

Conclusion:

The center-center technique can be used to identify the centroid axis within an acceptable degree of rotation at heights above the tibial plafond that are relevant to an operating surgeon placing syndesmotic fixation.

Clinical Relevance:

Theoretically, this aligns the centroids of the fibula and tibia, which achieves the same ideal patient-specific alignment and raises the question as to the extent to which the centroid and center-center axes correlate in the general population. If present, a strong correlation has potentially high clinical importance when planning syndesmotic fixation.
Comparison of Patients’ and Surgeons’ Expectations in Foot and Ankle Surgery
Authors: MacMahon Aoife , Cody Elizabeth A. , Caolo Kristin , Henry Jensen K. , Drakos Mark C. , Demetracopoulos Constantine A. , Savenkov Aleksander , Ellis Scott J.
Published: July 2020

Background:

Aligning patient and surgeon expectations may improve patient satisfaction and outcomes. This study aimed to assess differences in expectations of foot and ankle surgery between patients and their surgeons.

Methods:

Two hundred two patients scheduled to undergo foot or ankle surgery by one of 7 fellowship-trained foot and ankle surgeons were enrolled. Preoperatively, patients and surgeons completed the Hospital for Special Surgery Foot & Ankle Surgery Expectations Survey independently. Differences between patient and surgeon overall expectations scores, number of expectations, and number of expectations with complete improvement expected were assessed. A difference of ≥10 points was considered a clinically important difference in expectations score. Associations between patient demographic and clinical characteristics, major/minor surgery, and individual surgeon with differences in expectations were also assessed.

Results:

Overall, 66.3% of patients had higher expectations, 21.3% had concordant expectations, and 12.4% had lower expectations compared with their surgeons. On average, patients had higher expectations scores than their surgeons (70 ± 20 vs 52 ± 20 points, P < .001). Patients expected complete improvement in a greater number of expectations than surgeons (mean 11 ± 7 vs 1 ± 3, P < .001). Patients had higher expectations than surgeons for 18 of 23 items (78%). Items that had the greatest number of patients with higher expectations than surgeons were “improve confidence in foot/ankle,” “prevent foot/ankle from getting worse,” and “improve pain at rest.” Higher body mass index (BMI) ( P = .027) and individual surgeon ( P < .001) were associated with greater differences between patient-surgeon expectations. Major/minor surgery was not associated with differences in expectations ( P ≥ .142).

Conclusion:

More than two-thirds of patients had significantly higher expectations than their surgeons. Higher BMI was associated with higher patient than surgeon expectations. These results emphasize the importance for foot and ankle surgeons to adequately educate patients preoperatively.

Level of Evidence:

Level II, prospective comparative study.
Effect of Muscle Activation on the Gravity Stress View in Unstable Weber B Ankle Fractures
Authors: Broughton Kimberly K. , Williams Caroline , Miller Christopher P. , Stupay Kristen , Kwon John Y.
Published: July 2020

Background:

In the setting of apparently isolated distal fibula fractures, the gravity stress view (GSV) is a validated method to determine mortise stability. There is currently no published data evaluating whether dynamic muscle activation can reduce an unstable mortise. If patients with instability can overcome gravity, resultant images could yield false-negative results. The goal of this investigation was to determine if patient effort can influence medial clear space (MCS) measurements in proven unstable bimalleolar-equivalent ankle fractures.

Methods:

Patients presenting with Weber B fibula fractures were assessed for mortise stability using the GSV. If the GSV demonstrated instability based on MCS widening >4 mm, 3 additional views were performed: GSV with an assistant maintaining the ankle in a neutral position; GSV with the patient actively dorsiflexing to neutral; and GSV with the patient actively dorsiflexing and supinating the foot. Twenty-four consecutive patients met inclusion criteria, with a mean age of 48.7 (range, 22-85) years. Fifteen patients (62.5%) were female and 9 (37.5%) were male. The laterality was evenly divided.

Results:

The mean MCS was 5.8 ± 2.0 6.0 ± 2.6, and 6.2 ± 2.7 mm for the manual assist, active dorsiflexion, and active supination radiograph measurement groups, respectively ( P = .434). Only 5 of 24 subjects had any measurable decrease in their MCS with active supination, with a maximum change of 1.2 mm. The remainder of the patients had an increase in MCS ranging from 0.1 to 4.0 mm.

Conclusion:

There was no significant difference between measurement states indicating that muscle activation is unlikely to yield a false-negative result on GSV. Mortise instability, secondary to deep deltoid injury in the presence of gravity stress, is unlikely to be actively overcome by dynamic stabilizers, supporting the validity and specificity of the GSV.

Level of Evidence:

Level III, prospective study.
Landing in the Post Qualitative
Authors: Wells Timothy C.
Published: July 2020

This essay considers the field of postqualitative inquiry alongside Bruno Latour’s arguments for a new political landscape in his book Down to Earth. The postqualitative movement and Latour provide insight into what inquiry might look like in a postanthropocentric world, yet leave much unaddressed in terms of social justice and Western colonialism. These are challenges that this essay works through in an attempt to “land” social inquiry in a more sustainable and equitable fashion.
Physicochemical stability study of MYL-1401O, a biosimilar of trastuzumab, following a transient temperature excursion
Authors: Guyader Guillaume Le , Vieillard Victoire , Paul Muriel
Published: July 2020

Introduction

The extended stability of the trastuzumab biosimilar Ogivri™ (MYL-1401O; trastuzumab-dkst) was studied under different storage conditions, including following reconstitution of the lyophilized powder (21 mg/mL) but undiluted and stored in vials at 4°C; after dilution at two concentrations (0.8 and 2.4 mg/mL) in polyolefin bags and stored at 4°C; and following a three-day thermal excursion to 25°C.

Methods

Several methods were utilized to assess the physical and chemical stability of the drug under different storage conditions.

Results

At all storage conditions tested, there was no change in the tertiary structure of MYL-1401O as assessed by second-derivative ultraviolet and fluorescence-derived spectral analysis, and no evidence of oligomer formation or fragmentation was observed as assessed by gel exclusion chromatography and dynamic light scattering, confirmed by assessment of quinary structures using size-exclusion chromatography. Ion-exchange chromatography showed no significant changes in the distribution of ionic variants, particularly deamidations. Thermal denaturation curves indicated no destabilization of the three-dimensional structure after 90 days at 4°C or after thermal excursion for 72 h at 25°C.

Conclusion

The trastuzumab biosimilar MYL-1401O maintained its physical and chemical stability for at least 90 days at 4°C or after thermal excursion to 25°C, supporting the safe use of MYL-1401O in several real-world settings, including advanced preparation for administration or when a break in the cold cycle occurs.
Symptomatic hypocalcemia following a single dose of zoledronic acid in a patient with bone metastases secondary to breast cancer
Authors: Sözel Hasan , Yilmaz Fatih
Published: July 2020

Introduction

The use of bisphosphonates is increasing, for treatment of hypercalcemia and pain in cancer, and post-menopausal osteoporosis and also to decrease the risk of skeletal morbidity in multiple myeloma and metastatic breast cancer.

Case report

A single dose of zoledronic acid was administered for hypercalcemia in a 54-year-old woman breast cancer patient with extensive bone metastasis. After the first dose, the patient developed symptomatic hypocalcemia. Management and outcome: Simultaneous hypocalcemia, hypophosphatemia, and vitamin D deficiency were detected in the patient. In the symptomatic process, intravenous, then oral replacement was performed.

Discussion

There is a need for taking precautionary measures such as vitamin D, serum phosphorus and, calcium monitoring and supplementation to prevent life-threatening complications, such as symptomatic hypocalcemia, especially in populations with vitamin D deficiency like ours.
Risk reduction in a cancer chemotherapy production unit: Contribution of an automated drug dispensing system
Authors: Ouedraogo Jean-Marie , Baraka Soumaya El , Adade Casimir Adade , Sitsopeh Joseph , Sessouma Abou , Belahcen Mohammed Jaouad , Rahali Younes
Published: July 2020

Objective

The purpose of our study was to evaluate the contribution of an automated drug dispensing system in securing cancer chemotherapy production process at the pharmacy of the National Institute of Oncology in Rabat.

Methods

The failure modes and effects analysis method was applied to the chemotherapy production process in two phases: Phase 1, using an open shelf for storage then phase 2, using an automated drug dispensing system. The failure modes were defined and their criticality indexes was calculated on the basis of the likelihood of occurrence, the potential severity for the patients and/or the impact on the process and the detection probability. The criticality indexes of the two phases were prioritized and compared.

Results

We identified 35 failure modes for phase 1 and 37 for phase 2. The sum of criticality indexes was 5957 and 4586, respectively, for phase 1 and phase 2, corresponding to a criticality reduction of −23%. The greatest improvements concerned that the needed drug is missing during the picking, storage of potential expired drugs, and double compounding.

Conclusion

Our study highlighted the contribution of automated drug dispensing system in risk minimization. The use of automated drug dispensing system is a part of security improvement in chemotherapy production unit.
“I Know How to Read and All, but . . .”: Disciplinary Reading Constructions of Middle School Students of Color
Authors: Neugebauer Sabina R. , Blair Elizabeth E.
Published: July 2020

This study explores the disciplinary literacy perspectives of middle school students of color attending urban parochial schools and the reader subject positions they took up across content-area classrooms. Qualitative analysis of 19 student interviews and accompanying observations of subject-area classes revealed that students’ constructions of reading, circumscribed by classroom literacy activities, inhibited discipline-specific reading subject positions. In particular, this study highlights how teachers’ reading activities promoted reading as being about accomplishing a task rather than being apprenticed in ways of taking discipline-specific knowledge from text. When the boundaries between students’ home literacy experiences and school disciplinary literacy experiences were more contiguous, and when more meaningful, authentic literacy experiences were provided, students evidenced deeper disciplinary literacy engagement. Educational implications, including troubling disciplinary knowledge to open the disciplines to wider ways of knowing and learning for all learners, are discussed.
Diet, Physical Activity, and Screen Time to Sleep Better: Multiple Mediation Analysis of Lifestyle Factors in School-Aged Children with and without Attention Deficit Hyperactivity Disorder
Authors: Hong George C.C. , Conduit Russell , Wong Jason , Di Benedetto Mirella , Lee Eunro
Published: July 2020

Objective:

This study examined the mediation roles of multiple lifestyle factors in school-aged children. Structural equation modeling (SEM) tested how lifestyle factors play mechanism roles one another in the impact of ADHD to seek theoretical and intervention insights.

Method:

An online survey assessed children’s lifestyle factors including diet, physical activity, screen time, sleep difficulties, and having ADHD diagnosis. A multi-country sample from English speaking nations included 309 caregivers. Multiple regression and SEM were planned to identify significant correlates and mediators of ADHD in explaining lifestyle differences.

Results:

Preliminary multiple regression showed only sleep quality was significantly different between children with and without ADHD. Significant triple mediation effects suggested diet, physical activity, and screen time mediated the ADHD impact on sleep quality.

Conclusion:

Researchers and practitioners may incorporate the findings to develop intervention models for children with ADHD attending to the mediational roles of lifestyle factors to improve sleep quality.
Fast, good, and repeatable: Summations, vectorization, and reproducibility
Authors: Neuman Brett , Dubois Andy , Monroe Laura , Robey Robert W
Published: July 2020

Enhanced-precision global sums are key to reproducibility in exascale applications. We examine two classic summation algorithms and show that vectorized versions are fast, good and reproducible at exascale. Both 256-bit and 512-bit implementations speed up the operation by almost a factor of four over the serial version. They thus demonstrate improved performance on global summations while retaining the numerical reproducibility of these methods.
Thermal buckling analysis of sandwich plates with soft core and CNT-Reinforced composite face sheets
Authors: Kamarian Saeed , Bodaghi Mahdi , Isfahani Reza Barbaz , Song Jung-il
Published: July 2020

Previous studies on the thermal buckling of sandwich plates with composite face sheets indicate that only thin skins with high stiffness and low coefficients of thermal expansion (CTE) can lead to the desired buckling temperatures. Thus, carbon nanotubes (CNTs) that can significantly enhance thermo-mechanical properties of fibre-reinforced polymer composites are used in the present study to increase the critical buckling temperature of sandwich plates with soft core and laminated composite face sheets. First, a comprehensive series of experimental tests are conducted to evaluate the effects of nanotubes on thermo-mechanical properties of the face sheets. The experimental results indicate that using only 0.3% CNTs considerably increases the longitudinal and transverse Young’s modulus and shear modulus of the carbon fibre/epoxy composite face sheets. The obtained data also show that CNTs significantly decrease the CTE of composite skins. Subsequently, thermal buckling equations of sandwich plates with CNT-reinforced composite face sheets are derived based on piecewise low-order shear deformation theory (PLSDT). Three analytical, semi analytical, and numerical methods are used to investigate thermal buckling behaviour of the sandwich plates with various boundary conditions. To verify the results, several comparisons are performed, which show that the implemented methods can predict the buckling temperatures of sandwich plates with high accuracy. Finally, a parametric study is conducted to examine the effects of CNTs on the thermal buckling of sandwich plates for different length to thickness ratios, thicknesses of face sheets, stacking sequences of layers, and various types of boundary conditions. The results indicate that CNTs can increase the critical buckling temperature of sandwich plates by 22%–36%, based on the layup, geometrical parameters, and boundary conditions.
Results of quadratus femoris muscle pedicle bone grafting (Meyers’ procedure) in the management of ununited femoral neck fractures
Authors: Tüzün Harun Yasin , Türkkan Selim , Erşen Ömer , Arsenishvili Arsen , Kürklü Mustafa
Published: July 2020

Purpose:

Femoral neck fractures in young patients are associated with increase complication risk. The objective of this study was to evaluate the results of quadratus femoris muscle pedicle grafting in the treatment of ununited femoral neck fractures.

Methods:

This study includes 16 patients with ununited femoral neck fractures treated with quadratus femoris muscle pedicle graft. 7 patients had neglected femoral neck fractures while 9 had ununited femoral neck fractures after fixation. Quadratus femoris muscle with 2 × 1 × 1 cm (length-width-height) bone in its insertion was elevated and placed in the posterior cortex of the femoral neck with additional cancellous graft from the posterior iliac bone. The graft was fixed with 3.5-mm cortical screws.

Results:

The average follow-up period was 96 weeks and the radiological union occurred at an average of 7 months. The femoral inclination of all patients was 128.5° ± 3.9° with an average 7 (range 0–35) mm thigh atrophy in the last follow-up visit. Only 1 patient (6%) had avascular necrosis of the femoral head and was treated with hip arthroplasty.

Conclusions:

Quadratus femoris muscle pedicle grafting provides better stability and blood supply in ununited femoral neck fractures. Achieving fracture union provides better clinical and functional results in the treatment of femoral neck fractures.
Development and Construct Validity of the Work Instability Scale for People With Common Mental Disorders in a Sample of Depressed and Anxious Workers: A Rasch Analysis
Authors: Danielsson Louise , Fornazar Robin , Holmgren Kristina , Lundgren Nilsson Åsa , Hensing Gunnel
Published: July 2020

Background:

Sick leave due to common mental disorders, encompassing depression and anxiety disorders, is high. Capturing early signs of reduced function could aid adjustments of work tasks and environment and, thus, endorse a pro-active approach to occupational and health care interventions to prevent long-term sick-leave spells. However, few measurements exist to identify early signs of imbalance, and none that is illness-specific. The aim of this study was to develop a work instability scale for people with common mental disorders and to test the fundamental psychometric properties of the scale.

Methods:

Participants were working adults 18-65 years old with depression or anxiety. The scale development started with qualitative interviews (n = 27) which informed the drafting of a dichotomous, self-report questionnaire. Cognitive debriefing (n = 12) was used to check face validity and modify the draft. Internal construct validity of the draft was tested using Rasch analysis (n = 128). The work ability index was used as a comparator measure.

Results:

The initial 63-item draft showed poor fit to Rasch model expectations. Items displaying poor fit or local response dependency were stepwise removed, resulting in a unidimensional 34-item scale fitting the model expectations, and with no differential item functioning. Person-item threshold distribution showed that the scale is better suited to measure low to moderate work instability, than to measure high instability. Correlations between the newly developed scale and the work ability index showed a significant, moderately strong correlation.

Conclusions:

In the initial target sample, the 34-item scale showed acceptable fundamental properties and internal construct validity. Further validation of the scale in a larger sample, including tests for external validity, is warranted.
Longitudinal cortical thinning progression differs across multiple sclerosis phenotypes and is clinically relevant: A multicentre study
Authors: Hidalgo de la Cruz Milagros , Valsasina Paola , Gobbi Claudio , Gallo Antonio , Zecca Chiara , Bisecco Alvino , Tedeschi Gioacchino , Filippi Massimo , Rocca Maria A
Published: July 2020

Background:

Longitudinal evolution of cortical thickness (CTh) in different MS phenotypes has been rarely studied.

Aim:

To investigate the regional pattern and 1-year progression of cortical thinning in relapsing-remitting (RR) and progressive (P) MS.

Methods:

3T high-resolution T1-weighted magnetic resonance imaging (MRI) was obtained from 86 patients (75 RRMS, 11 PMS) and 34 healthy controls (HC) at three European sites at baseline and 1-year follow-up. Using FreeSurfer, baseline CTh between-group differences, longitudinal CTh changes and their correlations with clinical and MRI variables were assessed.

Results:

Baseline frontal, parietal and sensorimotor atrophy was found in MS versus HC. Such pattern was driven by RRMS, while PMS showed additional parietal, insular and sensorimotor cortical atrophy versus RRMS. At 1-year versus baseline, additional frontal and temporal cortical thinning was detected in RRMS patients, while a widespread CTh reduction was found in PMS patients (significant at time-by-group interaction vs RRMS). In MS, baseline fronto-parietal atrophy correlated with more severe disability and higher lesion volume. Baseline inferior parietal CTh decrease and 1-year temporal cortical thinning correlated with more severe disability.

Conclusion:

Parieto-temporal baseline CTh abnormalities and thinning pattern over time characterized the main MS clinical phenotypes and were associated with 1-year disability worsening.
The experience economy of TV promotion at San Diego Comic-Con
Authors: Kohnen Melanie E.S.
Published: July 2020

This article analyzes the promotional function of pop-up branded entertainment experiences during San Diego Comic-Con (SDCC). I argue that these activations are part of the experience economy, in which affect-driven branded experiences in physical spaces and their mediation on social media become central elements of consumption. Through an analysis of several case studies, I reveal how three trends – the media industry’s recognition of fans’ importance, the development of experiential marketing, and the rise of immersive theater – crystalize in the form of the SDCC activation, making it a premier site for understanding interactions between Hollywood and fandom in the context of life in brand cultures. Overall, I consider the micro- and macro-levels of activations – moving from parsing entertainment companies’ drive to create immersive, interactive experiences and fans’ engagement with them to the larger context of industry–fan relationships – as significant strands in cultural debates around brands and media consumption.
The merits of context: Unfolding mental vulnerability as category and experience
Authors: Ettrup Christiansen Charlotte
Published: July 2020

‘Mentally vulnerable’ young people are a strong focal point in public debate and policy in Denmark at present, and a variety of cultural activities are now being offered to them. Building on ethnographic fieldwork (April 2018-August 2019) with so-called mentally vulnerable young women (aged 18-36) who meet in literature reading groups, this article seeks to connect the reading group with the phenomenon of ‘mental vulnerability’, first through a review of the historical emergence and contemporary use of the term, and second by considering what (painful) experiences the term signifies for individuals belonging to this category. This contextualization involves a discussion of literature on the role of context in anthropological analyses. The article concludes with an empirical contradiction: the reading group provides a sanctuary from everyday demands for purposefulness and productivity, but it can also be used as a strategy for navigating such demands.
‘The people in the purple shirts’: Froebelian insights to a Singing Medicine project in a children’s hospital
Authors: Blackburn Carolyn
Published: July 2020

Friedrich Wilhelm August Froebel (1782–1852) yearned to promote and foster the harmonious and holistic development of young children through a combination of outdoor activities, songs and games. His Mother Songs, with games and exercises for mothers and their infants, aimed to encourage the use of senses, limbs and body to increase body awareness and promote mental activity. This article reports on a qualitative interpretive study into the role of a Singing Medicine project in a children’s hospital where children on all wards are invited to participate in singing games and activities. An aim was to understand how the application of Froebelian principles can help us to understand and conceptualise children’s rights and well-being in restricted environments such as a Children’s Hospital. Methods included semi-structured interviews with a range of health and education professionals who support children in a children’s hospital in England. In contrast to previous largely quantitative studies relating to the transferable benefits of arts in health projects, the findings from this study suggest that participants value the human connectedness imbued by a Singing Medicine project to children, families and health professionals. Wider benefits for children’s holistic development and empowerment to make choices through participation in singing games were also raised.
More than a footwedge: Golf-specific footwear alters muscle activation patterns during standing balance
Authors: Wilson Samuel J , Gdovin Jacob R , Williams Charles C , Donahue Paul T , Mouser James G , Mutchler Jessica A , Simpson Jeffrey D , Chander Harish , Garner John C
Published: July 2020

Within a golf swing, one aspect that stands out in each phase is the ability to maintain balance. Previous reports suggest that extrinsic factors, such as footwear, and intrinsic factors, such as muscular exertion level, have detrimental effects on human postural control. However, no studies have examined the effects of modern golf footwear on muscle activity of the lower extremity. Thus, the purpose of this study was to examine differences in muscle activity when walking for extended durations in golf footwear. Participants were tested for balance prior to walking sessions and then every 60 min until the 240th minute in three types of golf footwear; dress shoes, tennis shoes, and casual shoes, and barefoot. Mean muscle activity during balance testing of the vastus medialis, semitendinosus, tibialis anterior, and medial gastrocnemius was examined using a 4 × 5 repeated measures analysis of variance to identify differences within time and footwear types. Increases in muscle activity were observed after the second hour. Footwear differences were observed in the dress shoe and tennis shoe style relative to the casual style, and primarily attributed to the increased sole/midsole thickness, and increased mass of the dress shoe. These results suggest that golf footwear characteristics may alter muscle activity patterns during standing balance.
Apparent Motion Is Computed in Perceptual Coordinates
Authors: Hui Jiahan , Wang Yue , Zhang Peng , Tse Peter U. , Cavanagh Patrick
Published: July 2020

When a Gabor moves in one direction in the visual periphery while its internal texture moves in the orthogonal direction, its perceived direction can deviate from its physical direction by as much as 45° or more. Lisi et al. showed that immediate saccades go to the physical location of double-drift targets, whereas delayed saccades primarily go to their perceived locations. Here, we investigated whether the apparent motion seen from the offset of a double-drift stimulus to the onset of a later target probe originates from the perceived or physical location of the double-drift stimulus. We find that apparent motion proceeds away from the perceived position of the double-drift stimulus at all temporal delays. This suggests that apparent motion is computed in perceptual rather than retinotopic coordinates.
Defining chronic rejection in vascularized composite allotransplantation—The American Society of Reconstructive Transplantation and International Society of Vascularized Composite Allotransplantation chronic rejection working group: 2018 American Society of Reconstructive Transplantation meeting report and white paper Research goals in defining chronic rejection in vascularized composite allotransplantation
Authors: Kaufman Christina L , Kanitakis Jean , Weissenbacher Annemarie , Brandacher Gerald , Mehra Mandeep R , Amer Hatem , Zelger Bettina G , Zelger Bernhard , Pomahac Bohdan , McDiarmid Sue , Cendales Linda , Morelon Emmanuel
Published: July 2020

Objectives:

This report summarizes a collaborative effort between the American Society of Reconstructive Transplantation and the International Society of Vascularized Composite Allotransplantation to establish what is known about chronic rejection in recipients of vascularized composite allografts, with an emphasis on upper extremity and face transplants. As a picture of chronic rejection in hand and face vascularized composite allografts emerges, the results will be applied to other types of vascularized composite allografts, such as uterine transplantation.

Methods:

The overall goal is to develop a definition of chronic rejection in vascularized composite allografts so that we can establish longitudinal correlates of factors such as acute rejection, immunosuppressive therapy, de novo donor-specific antibody and trauma/infection and other external factors on the development of chronic rejection. As Dr Kanitakis eloquently stated at the 2017 International Society of Vascularized Composite Allotransplantation meeting in Salzburg, “Before we can correlate causative factors of chronic rejection, we have to define what chronic rejection in VCA is.”

Results:

The first meeting report was presented at the sixth Biennial meeting of the American Society of Reconstructive Transplantation in November 2018. Based on collaborative efforts and descriptions of clinical cases of chronic rejection in vascularized composite allograft recipients, a working definition of chronic rejection in vascularized composite allografts with respect to overt functional decline, subclinical functional decline, histologic evidence without functional decline, and normal allograft function in the absence of histologic evidence of chronic rejection is proposed.

Conclusions:

It is the intent of this collaborative working group that these working definitions will help to focus ongoing research to define the incidence, risk factors and treatment regimens that will identify mechanisms of chronic rejection in vascularized composite allografts. As with all good research, our initial efforts have generated more questions than answers. We hope that this is the first of many updates.
Partial Intraoperative Global Alignment and Proportion Scores Do Not Reliably Predict Postoperative Mechanical Failure in Adult Spinal Deformity Surgery
Authors: Ha Alex S. , Hong Daniel Y. , Coury Josephine R. , Cerpa Meghan , Baum Griffin , Sardar Zeeshan , Lenke Lawrence G.
Published: July 2020

Study Design:

Retrospective radiographic review.

Objectives:

The Global Alignment and Proportion (GAP) score allows sagittal plane analysis for deformity patients and may be predictive of mechanical complications. This study aims to assess the effectiveness of predicting mechanical failure based on partial intraoperative GAP (iGAP) scores.

Methods:

A retrospective radiographic review was performed on 48 deformity patients between July 2015 to January 2017 with a 2-year follow-up. Using the same methodology as the original GAP study, the partial iGAP score was calculated with the sum of the scores for age, relative lumbar lordosis (RLL), and lordosis distribution index (LDI). Therefore, the iGAP score (0-7) was grouped into proportional (0-2), mildly disproportionate (3-5), and severely disproportionate (6-7). Logistic regression was performed to assess the ability of the partial iGAP score to predict postoperative mechanical failure.

Results:

The mean iGAP for patients with a mechanical failure was 3.54, whereas the iGAP for those without a mechanical failure was 3.46 ( P = .90). The overall mechanical failure rate was 27.1%. The mechanical failures included 8 proximal junctional kyphosis, 7 rod fractures, and 1 rod slippage from the distal end of the construct. Logistic regression analysis revealed that the partial iGAP score was not able to predict postoperative mechanical failure (χ2 = 1.4; P = .49).

Conclusion:

The iGAP scores for RLL or LDI did not show any significant correlation to postoperative mechanical failure. Ultimately, the proposed partial iGAP score did not predict postoperative mechanical failure and thus, cannot be used as an intraoperative alignment assessment to avoid postoperative mechanical complications.
High-dose exposure to synthetic chemicals, hormones, or homeostatic substances in experimental animals or humans can induce artefactual pathology
Authors: Smith Carr J , Perfetti Thomas A
Published: July 2020

The maximum tolerated dose (MTD) provides the highest probability of a positive result in a toxicology bioassay. The assumption underlying the MTD in animal bioassays is that adverse effects at very high doses are qualitatively the same as those occurring at low doses. In contrast with the MTD, the optimal top dose in a toxicology animal study is the highest dose that does not produce a pathological end point that presents no risk at lower doses, for example, the dose below which cytotoxicity induces tumors in the absence of genotoxicity or other carcinogenic mechanisms. Normal concentrations or biological activity levels of many substances necessary for normal physiological function induce pathology when found at high levels. For example, the demonstration that ingestion of abnormally high levels of certain dietary fats can cause or exacerbate atherosclerosis in relevant animal models like rhesus macaques does not demonstrate that normal levels of these fats should be considered as toxic. Excessive estrogenic stimulation is associated with breast, ovarian, and endometrial cancers. This does not imply that normal age-appropriate levels of estrogen are toxic. Normal wound healing is associated with transforming growth factors beta 1 and 2. Excessive stimulation of fibroblasts by these growth factors results in hypertrophic scarring and keloid formation. An understanding of the mode of action of a test substance can facilitate the selection of dose levels much higher than those expected to be experienced by humans, but not beyond a dose level at which pathology is an experimental artefact of the high-dose level.
Development of a Surgical Video Atlas for Resident Education: 3‐Year Experience
Authors: Brown C. Scott , Cunningham Calhoun D. , Lee Walter T. , Puscas Liana
Published: July 2020

Objective

To create a high‐quality annotated online surgical video atlas of key indicator otolaryngology cases and assess its use and overall journal trends over time.

Methods

Videos are recorded from multiple viewpoints within the operating room and compiled into a single stream. Postediting includes chaptering videos and overlaying relevant text annotations. Videos are published online and viewership trends analyzed.

Results

Over 3 years, 29 otolaryngology videos were published out of 161 journal publications (18%). Eight of the 14 key indicator procedures are included (57%). From the beginning of 2017 to the end of 2019, viewership of otolaryngology pages increased from 548 to 11,139 views per month, totaling >150,000 views. These now represent 10% of the total journal monthly views and 10% of the overall views. Users originate from the United States and from >10 other countries.

Discussion

Residents and faculty face challenges of providing the highest standard of clinical care, teaching, and learning in and out of the operating room. Inherent difficulties of surgical training, high‐fidelity surgical simulation, and imposed work hour restrictions necessitate additional, more efficient and effective means of teaching and learning. Surgical videos demonstrating key anatomy, procedural steps, and surgical dexterity with hand positioning are increasing in their popularity among learners.

Implications for Practice

Surgical video atlases provide a unique adjunct for resident education. They are enduring and easily accessible. In a climate of work hour restrictions or elective case reduction, they may supplement how residents learn to operate outside the operating theater.
Molecular evolution of the ATP-binding cassette subfamily G member 2 gene subfamily and its paralogs in birds
Authors: Ma Shengchao , Liu Hehe , Sun Wenqiang , Mustafa Ahsan , Xi Yang , Pu Fajun , Li Yanying , Han Chunchun , Bai Lili , Hua He
Published: July 2020

Background

ATP-binding cassette (ABC) transporters are involved in the active transportation of various endogenous or exogenous substances. Two ABCG2 gene subfamily members have been identified in birds. A detailed comparative study of the ABCG2 and ABCG2-like genes aid our understanding of their evolutionary history at the molecular level and provide a theoretical reference for studying the specific functions of ABCG2 and ABCG2-like genes in birds.

Results

We first identified 77 ABCG2/ABCG2-like gene sequences in the genomes of 41 birds. Further analysis showed that both the nucleic acid and amino acid sequences of ABCG2 and ABCG2-like genes were highly conserved and exhibited high homology in birds. However, significant differences in the N-terminal structure were found between the ABCG2 and ABCG2-like amino acid sequences. A selective pressure analysis showed that the ABCG2 and ABCG2-like genes were affected by purifying selection during the process of bird evolution.

Conclusions

We believe that multiple members of the ABCG2 gene subfamily exist on chromosome 4 in the ancestors of birds. Over the long course of evolution, only the ABCG2 gene was retained on chromosome 4 in birds. The ABCG2-like gene on chromosome 6 might have originated from chromosome replication or fusion. The structural differences between the N terminus of ABCG2 protein and those of ABCG2-like proteins might lead to functional differences between the corresponding genes.
Identification of candidate tolerance genes to low-temperature during maize germination by GWAS and RNA-seq approaches
Authors: Zhang Hong , Zhang Jiayue , Xu Qingyu , Wang Dandan , Di Hong , Huang Jun , Yang Xiuwei , Wang Zhoufei , Zhang Lin , Dong Ling , Wang Zhenhua , Zhou Yu
Published: July 2020

Background

Maize (Zea maysL.) is one of the main agricultural crops with the largest yield and acreage in the world. However, maize germplasm is very sensitive to low temperatures, mainly during germination, and low temperatures significantly affect plant growth and crop yield. Therefore, the identification of genes capable of increasing tolerance to low temperature has become necessary.

Results

In this study, fourteen phenotypic traits related to seed germination were used to assess the genetic diversity of maize through genome-wide association study (GWAS). A total of 30 single-nucleotide polymorphisms (SNPs) linked to low-temperature tolerance were detected (−log10(P) > 4), fourteen candidate genes were found to be directly related to the SNPs, further additional 68 genes were identified when the screen was extended to include a linkage disequilibrium (LD) decay distance ofr2 ≥ 0.2 from the SNPs. RNA-sequencing (RNA-seq) analysis was then used to confirm the linkage between the candidate gene and low-temperature tolerance. A total of ten differentially expressed genes (DEGs) (|log2fold change (FC)| ≥ 0.585,P < 0.05) were found within the set distance of LD decay (r2 ≥ 0.2). Among these genes, the expression of six DEGs was verified using qRT-PCR.Zm00001d039219andZm00001d034319were putatively involved in ‘mitogen activated protein kinase (MAPK) signal transduction’ and ‘fatty acid metabolic process’, respectively, based on Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses. Thus, these genes appeared to be related to low-temperature signal transduction and cell membrane fluidity.

Conclusion

Overall, by integrating the results of our GWAS and DEG analysis of low-temperature tolerance during germination in maize, we were able to identify a total of 30 SNPs and 82 related candidate genes, including 10 DEGs, two of which were involved in the response to tolerance to low temperature. Functional analysis will provide valuable information for understanding the genetic mechanism of low-temperature tolerance during germination in maize.
Relationship between the place of living and mortality in patients with advanced heart failure
Authors: Muñoz Miguel-Angel , Garcia Raquel , Navas Elena , Duran Julio , Del Val-Garcia José-Luis , Verdú-Rotellar José-Maria
Published: July 2020

Background

Social and environmental factors in advanced heart failure (HF) patients may be crucial to cope with the end stages of the disease. This study analyzes health inequalities and mortality according to place of residence (rural vs urban) in HF patients at advanced stages of the disease.

Methods

Population-based cohort study including 1148 adult patients with HF attended in 279 primary care centers. Patients were followed for at least 1 year after reaching New York Heart Association IV functional class, between 2010 and 2014.

Data came from primary care electronic medical records. Cox regression models were applied to determine the hazard ratios (HR) of mortality.

Results

Mean age was 81.6 (SD 8.9) years, and 62% were women. Patients in rural areas were older, particularly women aged > 74 years (p = 0.036), and presented lower comorbidity. Mortality percentages were 59 and 51% among rural and urban patients, respectively (p = 0.030). Urban patients living in the most socio-economically deprived neighborhoods presented the highest rate of health service utilization, particularly with primary care nurses (p-trend < 0.001). Multivariate analyses confirmed that men (HR 1.60, 95% confidence interval (CI) 1.34–1.90), older patients (HR 1.05, 95% CI 1.04–1.06), Charlson comorbidity index (HR 1.16, 95% CI 1.11–1.22), and residing in rural areas (HR 1.35, 95% CI 1.09 to 1.67) was associated with higher mortality risk.

Conclusions

Living in rural areas determines an increased risk of mortality in patients at final stages of heart failure.
Mitochondrial pyruvate carrier: a potential target for diabetic nephropathy
Authors: Zhu Huanhuan , Wan Huiting , Wu Lin , Li Qing , Liu Simeng , Duan Suyan , Huang Zhimin , Zhang Chengning , Zhang Bo , Xing Changying , Yuan Yanggang
Published: July 2020

Background

Mitochondrial dysfunction contributes to the pathogenesis of diabetic nephropathy (DN). Mitochondrial pyruvate carrier 1 (MPC1) and mitochondrial pyruvate carrier 2 (MPC2) play a bottleneck role in the transport of pyruvate into mitochondrial across the mitochondrial inner membrane. A previous study showed that increasing mitochondrial pyruvate carrier content might ameliorate diabetic kidney disease in db/db mice. However, the expression status of MPC1 and MPC2 in patients with DN is unclear.

Methods

Patients with primary glomerulonephropathy (PGN, n = 30), PGN with diabetes mellitus (PGN-DM, n = 30) and diabetic nephropathy (DN, n = 30) were included. MPC1 and MPC2 protein levels were examined by immunohistochemistry. The expression of MPC in different groups was evaluated by the Kruskal-Wallis test. Spearman’s rank correlation was performed for correlation analysis between MPC levels and clinical factors.

Results

Both MPC1 and MPC2 were localized in renal tubules. Levels of MPC1 and MPC2 were lower in DN patients than in PGN patients and in PGN patients with DM, whereas there were no differences in MPC1 and MPC2 levels among DN stage II to stage IV. Moreover, both MPC1 and MPC2 levels were significantly correlated with serum creatinine, BUN and eGFR in patients with DN, whereas no analogous trend was observed in nondiabetic kidney disease.

Conclusions

Our study indicated that MPC localized in renal tubules, which were significantly decreased in DN. MPC was associated with clinical features, especially those representing renal functions.
Sudden onset of syncope and disseminated intravascular coagulation at 14 weeks of pregnancy: a case report
Authors: Kamata Mayumi , Maruyama Tetsuo , Nishiguchi Tomizo , Iwasaki Shinya
Published: July 2020

Background

Amniotic fluid embolism (AFE), also known as anaphylactoid syndrome of pregnancy (ASP), typically occurs during labor and may result in cardiorespiratory collapse and disseminated intravascular coagulation (DIC). There are reports describing less typical presentations of AFE/ASP in which patients do not necessarily have the classic triad of hypoxia, hypotension, and coagulopathy. AFE/ASP rarely occurs in the absence of labor, but such cases may involve medical or surgical abortion, spontaneous miscarriage, or obstetrical procedures including amniocentesis and amnioinfusion. There are, however, no previously reported cases of AFE/ASP with sudden loss of consciousness and disseminated intravascular coagulation occurring during early pregnancy, in the absence of any intervention or obstetric event.

Case presentation

A 32-year-old G3P2 Japanese woman had sudden-onset syncope at 14 weeks’ gestation. On arrival at our hospital, her level of consciousness was severely disturbed as determined by the Glasgow Coma Scale. Although her vital signs were initially stable, blood samples collected intravenously and by femoral artery puncture did not coagulate. A subchorionic hematoma with active extravasation of blood was apparent on contrast-enhanced computed tomography. Two hours after her arrival, she developed hypovolemic shock with progression of DIC, presumably due to intrauterine and retroperitoneal bleeding. After transfusion of blood products; treatments for DIC including the use of recombinant human soluble thrombomodulin, ulinastatin, and corticosteroids; and hysterectomy, her level of consciousness and physical condition improved remarkably. Later investigation of preoperative blood samples revealed that serum levels of AFE/ASP-associated markers were elevated. Immunohistochemical studies on the excised, unruptured uterus showed that amniotic fluid components were present inside a uterine blood vessel.

Conclusions

This is the first reported patient with sudden-onset syncope and DIC, but without apparent cardiorespiratory collapse, with the highly likely etiology of AFE/ASP occurring at the beginning of the second trimester of pregnancy and in the absence of intervention or delivery. Maternal collapse with DIC during any stage of pregnancy should be considered an AFE/ASP-associated event, even in the absence of labor or obstetric procedures. This event may occur in the presence of subchorionic hematoma alone.