bluuebunny/crossref_metadata_2025 huggingface dataset:
Identification of brain metastasis genes and therapeutic evaluation of histone deacetylase inhibitors in a clinically relevant model of breast cancer brain metastasis
Authors: Kim Soo-Hyun , Redvers Richard P. , Chi Lap Hing , Ling Xiawei , Lucke Andrew J. , Reid Robert C. , Fairlie David P. , Martin Ana Carolina Baptista Moreno , Anderson Robin L. , Denoyer Delphine , Pouliot Normand
Published: May 2018

Breast cancer brain metastases remain largely incurable. Although several mouse models have been developed to investigate the genes and mechanisms regulating breast cancer brain metastasis, these models often lack clinical relevance since they require the use of immunocompromised mice and/or are poorly metastatic to brain from the mammary gland. We describe the development and characterisation of an aggressive brain metastatic variant of the 4T1 syngeneic model (4T1Br4) that spontaneously metastasises to multiple organs, but is selectively more metastatic to the brain from the mammary gland than parental 4T1 tumours. As seen by immunohistochemistry, 4T1Br4 tumours and brain metastases display a triple-negative phenotype, consistent with the high propensity of this breast cancer subtype to spread to brain. In vitro assays indicate that 4T1Br4 cells have an enhanced ability to adhere to or migrate across a brain-derived endothelial monolayer and greater invasive response to brain-derived soluble factors compared to 4T1 cells. These properties are likely to contribute to the brain selectivity of 4T1Br4 tumours. Expression profiling and gene set enrichment analyses demonstrate the clinical relevance of the 4T1Br4 model at the transcriptomic level. Pathway analyses implicate tumour-intrinsic immune regulation and vascular interactions in successful brain colonisation, revealing potential therapeutic targets. Evaluation of two histone deacetylase inhibitors, SB939 and 1179.4b, shows partial efficacy against 4T1Br4 metastasis to brain and other sites in vivo, and potent radio-sensitising properties in vitro. The 4T1Br4 model provides a clinically relevant tool for mechanistic studies and to evaluate novel therapies against brain metastasis.

This article has an associated First Person interview with Soo-Hyun Kim, joint first author of the paper.
Of what use is connectomics? A personal perspective on theDrosophilaconnectome
Authors: Meinertzhagen Ian A.
Published: May 2018

The brain is a network of neurons and its biological output is behaviour. This is an exciting age, with a growing acknowledgement that the comprehensive compilation of synaptic circuits densely reconstructed in the brains of model species is now both technologically feasible and a scientifically enabling possibility in neurobiology, much as 30 years ago genomics was in molecular biology and genetics. Implemented by huge advances in electron microscope technology, especially focused ion beam-scanning electron microscope (FIB-SEM) milling (see Glossary), image capture and alignment, and computer-aided reconstruction of neuron morphologies, enormous progress has been made in the last decade in the detailed knowledge of the actual synaptic circuits formed by real neurons, in various brain regions of the fly Drosophila. It is useful to distinguish synaptic pathways that are major, with 100 or more presynaptic contacts, from those that are minor, with fewer than about 10; most neurites are both presynaptic and postsynaptic, and all synaptic sites have multiple postsynaptic dendrites. Work on Drosophila has spearheaded these advances because cell numbers are manageable, and neuron classes are morphologically discrete and genetically identifiable, many confirmed by reporters. Recent advances are destined within the next few years to reveal the complete connectome in an adult fly, paralleling advances in the larval brain that offer the same prospect possibly within an even shorter time frame. The final amendment and validation of segmented bodies by human proof-readers remains the most time-consuming step, however. The value of a complete connectome in Drosophila is that, by targeting to specific neurons transgenes that either silence or activate morphologically identified circuits, and then identifying the resulting behavioural outcome, we can determine the causal mechanism for behaviour from its loss or gain. More importantly, the connectome reveals hitherto unsuspected pathways, leading us to seek novel behaviours for these. Circuit information will eventually be required to understand how differences between brains underlie differences in behaviour, and especially to herald yet more advanced connectomic strategies for the vertebrate brain, with an eventual prospect of understanding cognitive disorders having a connectomic basis. Connectomes also help us to identify common synaptic circuits in different species and thus to reveal an evolutionary progression in candidate pathways.
Third-Party Ownership Business Models and the Operational Performance of Solar Energy Systems
Authors: Guajardo Jose A.
Published: May 2018

The nonresidential solar energy market has grown rapidly in the United States. Companies considering the adoption of solar energy have an important choice: whether to purchase the system (direct ownership, or DO) or opt for an agreement with a service provider that offers third-party ownership (TPO). Although this decision is financially very important, empirical research comparing the two models from an operational perspective has been scarce. These issues are particularly relevant considering that federal and state incentives are commonly used to stimulate adoption. This paper presents an empirical analysis of the role of TPO in the operational performance of nonresidential solar energy installations in California. Using a panel data estimation framework, and accounting for factors that influence TPO adoption, the analysis shows that TPO systems performed, on average, approximately 4% better than DO systems) in terms of their production yield. This performance improvement is consistent with better system design under TPO, but not with better solar panel technology selection by TPO providers.
Controvérsias atuais no tratamento do autismo na França: o que está em jogo para a psicanálise
Authors: Sauret Marie-Jean , Askofaré Sidi , Macary-Garipuy Pascale , Avila Daniel Camparo
Published: May 2018

Existe um problema concreto: o sofrimento, a angústia e a violência das quais uma pessoa com autismo infelizmente é testemunha, e o tormento que certas famílias experimentam na medida em que tentam lidar com os problemas emocionais e educacionais desse membro da família, assim como os desassossegos econômicos que os acompanham.
A atualidade dos conceitos freudianos de eu ideal, Ideal do eu e supereu
Authors: Lewkovitch Andréa Di Pietro , Grimbe Angélica Bastos de Freitas Rachid
Published: May 2018

O presente artigo aborda as identificações constitutivas do sujeito e o imperativo superegoico a partir do referencial psicanalítico, com o objetivo de examinar a pertinência e atualidade deste aparato conceitual. A pesquisa deteve-se na questão do narcisismo parental para tratar o papel da fantasia dos pais na formação dos ideais, chegando à concepção do supereu enquanto imperativo de gozo, dimensão que ultrapassa as identificações parentais. Recorremos à autobiografia do tenista Andre Agassi, apresentada no livro escrito após o término de sua carreira profissional. Ele relata ter sido, desde a infância, obrigado por seu pai a praticar tênis, ainda que declarasse incessantemente seu ódio por tal esporte. Não conseguia parar de jogar tênis, e, assim, tornou-se um dos maiores tenistas da história. Considerando as limitações impostas por um relato que não constitui um caso clínico, o conflito trazido por Agassi presta-se a traçar um percurso a respeito da formação dos ideais e da função do supereu na economia psíquica de acordo com a teoria psicanalítica.
EXPEDIENTE - v16n4
Authors: Soares Adriana Benevides , Tsallis Alexandra Cleopatre , Mendes Deise Maria Fernandes , Valentim Renata Patrícia Forain de , Barros Rita Maria Manso de
Published: May 2018

EXPEDIENTE - v16n4
Self-harm in young people: Developing a new pathway
Authors: Botfield Gemma Louise
Published: May 2018

Research has shown that school nurses lack confidence to support children and young people who self-harm. To remedy this, Gemma Louise Botfield developed and introduced a self-harm pathway.
The knowledge and confidence of school nurses following training to promote nutritional health
Authors: Greenshields Sarah
Published: May 2018

This study is part of a larger project that aims to develop evidence-based training and resources for school nurses to support young people with their nutritional health ( Burdett, 2015 ). The purpose of this action research study was to explore the impact upon the knowledge and confidence of school nurses following the completion of the nutritional health training.

A pre-training questionnaire was provided to all school nurses prior to attending the ‘champion training’ in order to gather baseline information on the knowledge and confidence of the school nurse. A further questionnaire was provided to the school nurses one month following the training, along with the provision of resources. One focus group of five school nurses who attended the training was then completed, to explore the themes from the questionnaires.

When analysing the post-course questionnaires, there was a significant impact upon the school nurses self-assessed confidence levels as well as the ability to articulate the health impact of obesity on young people. The questionnaires suggest that the training had a positive impact on school nurses' confidence in particular. The themes highlighted from the focus group were ‘increased knowledge but particularly confidence’, ‘barriers going forward’ and ‘areas for improvement’. Both the returned questionnaires and the focus group were able to highlight barriers going forward, which may inhibit the sustained impact on the knowledge and confidence discussed above. The area for improvement that the focus group appeared to be most vocal and passionate about was how to disseminate the training as ‘champion’.

It is unknown as to whether the training has had an impact on practice in the long term and how it translates when the ‘champions’ disseminate the training within their own teams. It would be beneficial to complete further longitudinal qualitative research to explore these themes.
Gingival retraction techniques: a review
Authors: Adnan Samira , Agwan Muhammad Atif S
Published: May 2018

Abstract: The factors responsible for the longevity and aesthetics of a restoration are intimately linked to the gingival and periodontal tissues. The placement of any restoration placed in close proximity to the gingival tissues requires adequate access and isolation, for which various gingival retraction methods and materials are available. These are classified broadly as mechanical, chemo-mechanical, cordless and surgical techniques. This review focuses on the rationale behind gingival retraction and a discussion of the newer modalities developed in this regard.

CPD/Clinical Relevance: In clinical practice, a wide variety of procedures require the retraction of gingival tissues. Therefore, the clinician must be familiar with the various methods that can be employed to achieve gingival retraction in different clinical scenarios.
The iatrogenic anterior open bite; a potential side-effect of thermoplastic orthodontic retainers
Authors: Hemmings Nick , Taylor Nigel G
Published: May 2018

Abstract: Thermoplastic orthodontic retainers are popular with both patients and clinicians. Tooth coverage provides retention of orthodontic alignment, particularly in the lower labial segment, and their aesthetics are improved in comparison with more traditional acrylic and wire varieties. Iatrogenic side-effects are possible if the design is inadequate. Lack of coverage of terminal molars can allow overeruption, causing an anterior open bite. This report describes an anterior open bite caused by an inadequate thermoplastic retainer and management using a Hawley type retainer to improve the open bite which had arisen.

CPD/Clinical Relevance: The provision of orthodontics has grown and with this the potential for detrimental occlusal effects due to inadequate extension of occlusal coverage appliances such as retainers and clear aligners.
Foreign bodies in the nasal cavity: incidental findings during routine orthodontic radiographs
Authors: Lam Yung , Murray Alison , Patel Anjli
Published: May 2018

Abstract: Foreign bodies in the nasal cavity are common amongst young children as they begin to explore their senses. The occurrence in teenagers often goes unreported from a fear of embarrassment therefore resulting in a delay in presentation or until they become symptomatic. The sequelae of foreign bodies in the nasal cavity include prudent discharge, epistaxis, sinusitis and respiratory symptoms. If left untreated this can lead to mucosal necrosis, cutaneous fistula, rhinolith formation and chronic pain. Here, two patients who had foreign bodies in their nasal cavity, which were only discovered as an incidental finding as part of their orthodontic assessment, are reported.

CPD/Clinical Relevance: Clinicians should be mindful of the sequelae of foreign bodies in the nasal cavity and the need for thorough assessment of radiographic investigations, particularly in children.
Dental infection as a cause of bacteraemia in infective endocarditis
Authors: Baldin Marysia , Srinivasan Badri , Sharma Sanjay
Published: May 2018

Abstract: Infective endocarditis is a life-threatening disease that not only involves the heart, but can also affect other organs. Bacteria enter the bloodstream from a source such as a dental infection, and travel through the blood to form vegetations on compromised heart valves. C-reactive Protein (CRP) levels and blood cultures are valuable markers in diagnosing infective endocarditis and the latter can also provide valuable insight into the type of bacteria causing sepsis and which antibiotics are best prescribed. Dental infection has been implicated in over a third of cases of infective endocarditis, and therefore it is important to treat carious, periapically infected or periodontally involved teeth as soon as possible to prevent further deterioration of the patient.

CPD/Clinical Relevance: There is much evidence that suggests that dental extractions are a way of introducing bacteria into the bloodstream. However, it is important also to be aware that carious and infected teeth can be a cause of sepsis in a patient with infective endocarditis and may need to be removed to prevent further deterioration.
A case of extensive oral kaposi's sarcoma in a patient with undiagnosed HIV infection
Authors: Causey Christine , Singh Navroz , Parkin Richard
Published: May 2018

Abstract: Kaposi's sarcoma (KS) is a multifocal soft tissue tumour estimated to affect up to 1 in 20 HIV-infected individuals. Oral involvement is commonly the initial presentation, making it important that oral health providers are able to recognize oral disease in all stages of progression. Its various clinical stages (patch, plaque, nodular) can often mimic other benign lesions, such as pyogenic granuloma, potentially leading to misdiagnosis. This article aims to help improve recognition of KS amongst oral health professionals by raising awareness of its oral features. It is hoped that this will aid in early diagnosis and improved outcomes for patients.

CPD/Clinical Relevance: Kaposi's sarcoma is a common tumour amongst HIV-infected individuals often presenting with oral involvement. Recognition of the tumour, especially at the early stages, allows for early diagnosis and treatment, helping to improve patient prognosis.
Essentials of light curing
Authors: Price Richard B , Shortall Adrian C
Published: May 2018

Abstract: This article provides the key points for ensuring safe, effective and efficient light curing protocols in clinical practice. The article covers light curing unit selection, appropriate irradiance ranges, the effect of operator training and the importance of incorporating material requirements and clinical variables when choosing an appropriate light curing time. Practical advice is given about how to measure the light output and how to minimize the risks of thermal damage to the dental pulp and adjacent soft tissues. The need to protect the eyes of the dental team from the blue light hazard is discussed.

CPD/Clinical Relevance: This article is written because there is a wide range of technical knowledge and safety awareness about light curing procedures among dentists.
Managing the adenomatous odontogenic tumour (AOT): a case series
Authors: Vasudev Joyti , Panesar Jaspal , Linklater Rognvald , Green Jason , Kelly Robert
Published: May 2018

Abstract: This article aims to alert clinicians to the presentation and management of the adenomatous odontogenic tumour (AOT). AOTs are unusual benign lesions, often associated with unerupted teeth. They commonly present in the second decade of life and may be particularly relevant to the orthodontist and general dental practitioner, as they may coincide with the age of referral for impacted teeth. The AOT can encapsulate the crown and root of the tooth, resulting in bucco-lingual expansion and can be relatively painless with few or no subjective symptoms. It is important to be aware of this lesion in the maxillofacial region to ensure correct management of this tumour and involvement of any associated teeth.

CPD/Clinical Relevance: It is important for referring practitioners to be aware of the multifactorial aetiology of impacted teeth and the timeliness of referral. These anomalies require a multidisciplinary input from both the orthodontic and oral and maxillofacial team. The tumour can result in a three-dimensional thinning of the alveolar bone, resulting in an overall poor long-term prognosis of any involved teeth, particularly during orthodontic alignment.
Demonstrating the benefit of self-ligating brackets in the management of severe dental crowding on a non–extraction basis
Authors: Basati Manveer , Nightingale Claire
Published: May 2018

Abstract: There is a growing amount of literature describing the benefits of self-ligating brackets; one such benefit is their low friction properties. A clinical case is described in which dental extractions were avoided to alleviate severe crowding and the conclusion is drawn that this may, in part, have been due to the decreased friction in the orthodontic appliance afforded by the use of self-ligating brackets.

CPD/Clinical Relevance: This article discusses the benefits of self-ligating brackets and describes a clinical case in which, potentially, the low friction properties of self-ligating brackets helped avoid dental extractions.
Photonic applications of Silicon nanostructures
Authors: Ghoshal S. K. , Tewari H. S.
Published: May 2018

This presentation highlights of some scientific insights on the possibilities of photonic applications of silicon nanostructures (NSs) one of the most fertile research field in nano-crystallite physics that has innumerable possibilities of device applications. Nanostructured silicon is generic name used for porous Si (p-Si) as well as Si nanocrystals (NC-Si) having length scale of the order of few nanometer. The emission of a very bright photo-luminescence (PL) band and relatively weak electro-luminescence (EL) from low-dimensional silicon has opened up new avenue in recent years. It is important from a fundamental physics viewpoint because of the potential application of Si wires and dots in opto-electronics devices and information technology. Nanostructuring silicon is an effective way to turn silicon into a photonic material. It is observed that low-dimensional (one and two dimensions) silicon shows light amplification, photon confinement, photon trapping as well as non-linear optical effects. There is strong evidence of light localization and gas sensing properties of such NSs. Future nano-technology would replace electrical with optical interconnects that has appealing potentialities for higher-speed performance and immunity to signal cross talk. A varieties of applications includes LD, LED, solar cells, sensors, photonic band gap devices and Fibonacci quasi-crystals, to cite a few.
Solvents effect of quantum sized SnO2 nanoparticles via solvothermal process and optical properties
Authors: Anandan K. , Rajendran V.
Published: May 2018

Well-dispersed quantum sized SnO2 nanoparticles have been successfully synthesized by simple solvothermal process using ethylenediamine as both a coordination and an alkali reagent. The size of the prepared tin oxide nanoparticle has been characterized by X-ray powder diffraction (XRD) and transmission electron microscopy (TEM) analysis. The TEM images show nano-particles as clusters with size in the range of 2.27–3.35 nm. Morphological studies were obtained by scanning electron microscopy (SEM). The optical direct band gap values of SnO2 nanoparticles were calculated to be about 3.75–4.27eV, which were confirmed the quantum size effect. The photoluminescence (PL) properties and the possible mechanisms were also discussed.
Experimental investigation on performance and emission characteristics of diesel - Jatropha methyl ester blends fueled diesel engine at optimum engine operating parameters
Authors: Venkatraman M. , Devaradjane G.
Published: May 2018

In the present investigation, tests were carried out to determine engine performance, combustion and emissions of a naturally aspirated direct injection diesel engine fueled with diesel and Jatropha Methyl ester and their blends (JME10, JME20 and JME30). Comparison of performance and emission was done for different values of compression ratio, injection pressure and injection timing to find best possible combination for operating engine with JME. It is found that the combined compression ratio of 19:1, injection pressure of 240 bar and injection timing of 27?bTDC increases the BTHE and reduces BSFC while having lower emissions.From the investigation, it is concluded that the both performance and emissions can considerably improved for Methyl ester of jatropha oil blended fuel JME20 compared to diesel.
Microbiologically influenced corrosion and its mitigation: (A review)
Authors: Bhola Rahul , Bhola Shaily M. , Mishra Brajendra , Olson David L.
Published: May 2018

The microbiologically influenced corrosion (MIC) is one of the most common forms of corrosion that results from the presence and activity of microorganisms. The presence of microorganism aids in the formation of a bio film and constitutes various bacterial cells, extracellular polymeric substrates (EPS) and corrosion products. In this paper, a review on the importance of MIC and various ways to mitigate has been introduced; a brief description of the physical, chemical, electrochemical and biological mitigation methods for MIC has been included and EPS formation mechanism, chemical composition, properties and its influence on corrosion has been discussed.
Cylindrical grinding of Al/SiC metal matrix composites
Authors: Thiagarajan C. , Sivaramakrishnan R. , Somasundaram3 S.
Published: May 2018

This paper deals with an experimental study on the grindability of Al/SiC metal matrix composites in cylindrical grinding. Machining of metal matrix composites (MMCs) is an area to be focused and finishing processes such as grinding to obtain a good surface finish and damage-free surfaces are crucial for the application of these materials. Nevertheless, grinding of MMCs has received little attention so far, thereby a detailed study on that has been carried out. In the present work, experiments are carried out to study the effect of grinding parameters; wheel velocity, work piece velocity, feed and depth of cut and SiC volume fraction percentage on the responses; grinding force, surface roughness and grinding temperature. Surface integrity of the ground surfaces is assessed using a scanning electron microscope (SEM). There are no cracks and defects found on the cylindrical ground surfaces at high wheel and work piece velocities, low feed and depth of cut.
Viscosity studies of polyvinyl alcohol (PVA, Mw = 1,25,000) in solvent distilled water and aqueous solution of urea
Authors: Panda S. , Mohanty G. C. , Samal R.N. , Roy G. S.
Published: May 2018

Reduced viscosity (ηsp/C) and inherent viscosity ln (ηrel/C) of PVA (Mw = 1,25,000) has been calculated by measuring the flow time of polymer solution in solvents like distilled water and 4M Urea at six different tempratures 25° C, 30° C, 35° C, 40° C, 45° C, and 50° C. From exptrapolation of curve (/C) versus C and (ln /C) versus C, thermoviscosity parameters like Huggins’ Constrant (KHl), Kraemer's constant (KHll) and viscosity concentration co-efficient (a2) have been estimated. In aqueous solution (PVA in distilled water), Huggins' relation does not hold good. So a2 = .201[h]2.28 is used; but in aqueous Urea (PVA in 4M Urea), Huggins' relation holds good. Also η =KMα and value of a more for 4M Urea i.e aqueous Urea is better solvent for PVA than distilled water.
Vibrational spectra of aniline in gas phase: An ab-initio study
Authors: Chauhan S. D. S. , Sharma A.K. , Kumar R. , Kulshreshtha D. , Gupta R. , Chauhan P. K. S. , Singh O. P.
Published: May 2018

Vibrational frequencies of aniline in gas phase have been calculated and each of their modes of vibration assigned properly at RHF and DFT with 6-31G(d) basis set. In the present study, it has been observed that the 6-31G(d) basis set at both RHF and DFT levels of calculations provides better agreement to the experimental findings as compared to other basis sets. Simultaneously, Density functional theory is found to be superior to its counterpart Hartree Fock method.
Dielectric characterization of the system Sr1-xGdxTi1-xCoxO3 (x = 0.10) using impedance spectroscopy
Authors: Tewari H. S. , Sakharkar P. K.
Published: May 2018

The structure of ceramic grain boundaries, boundary composition, the boundary charge and associated space charge controls the dielectric and electrical behavior of ceramics. Various methods were researched and applied to increase the dielectric constant by formation of insulating layers between semi-conducting grains. In this communication, we are reporting the effect of cooling rates from sintering temperature to room temperature on dielectric properties of the resulting ceramics in the system, Sr1-xGdxTi1-xCoxO3 with x = 0.10. All the samples in this system were prepared by conventional high temperature solid state reaction method. The samples were cooled at different cooling rates from sintering temperature to room temperature. The capacitance and dielectric loss were measured as a function of frequency and temperature using HP 4192A LF impedance analyzer. The samples cooled from different cooling rates from sintering temperature show interesting dielectric properties due to formation of insulating layers between grains. The impedance spectroscopy is used successfully in explaining the dielectric properties of these materials.
Curie-temperature variation and microwave absorption in perovskites containing substitutional impurities
Authors: Yadav M. S. , Deorani S. C.
Published: May 2018

Using thermal-double time Green?s function method, Fourier transform and Dyson?s equation, theoretical expressions are obtained for Curie-temperature and microwave absorption coefficient for a ferroelectric cubic crystal containing defect (substitutional impurities). Chang in Curie-temperature occures due to impurity content in the crystal. Microwave loss deviates from Curie-Wiess law at high temperature due to ?T2 term being significant.
Current trends in the management of degenerative lumbar spondylolisthesis
Authors: Ferrero Emmanuelle , Guigui Pierre
Published: May 2018

Degenerative spondylolisthesis (DS) is a common disease of the degenerative spine, often associated with lumbar canal stenosis. However, the choice between the different medical or surgical treatments remains under debate. Preference for surgical strategy is based on the functional symptoms, and when surgical treatment is selected, several questions should be posed and the surgical strategy adapted accordingly. One of the main goals of surgery is to improve neurological symptoms. Therefore, radicular decompression may be necessary. Radicular decompression can be performed indirectly through interbody fusion or interspinous spacer. However, indirect decompression has some limits, and the most frequent technique is a posterior decompression with fusion. Indeed, in cases of DS, associated fusion or dynamic stabilization are recommended to improve functional outcomes and prevent future destabilization. Risk factors for destabilization, such as anteroposterior and angular mobility, and significant disc height, have been discussed in the literature. When fusion is performed, osteosynthesis is often associated. It is essential to choose the length and position of the fusion according to the pelvic incidence and global alignment of the patient. It is possible to add interbody fusion to the posterolateral arthrodesis to improve graft area and stability, increase local lordosis and open foramina. The most common surgical treatment for DS is posterior decompression with instrumented fusion. Nevertheless, some cases are more complicated and it is crucial to consider the patient’s general health status, symptoms and alignment when selecting the surgical strategy.

Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170050
Treatment strategies for early-onset scoliosis
Authors: Helenius Ilkka J.
Published: May 2018

Early-onset scoliosis (EOS) is defined as a spinal deformity occurring before the age of ten years. Untreated EOS or early spinal fusion resulting in a short spine is associated with increased mortality and cardiopulmonary compromise. EOS may progress rapidly, and therefore prompt clinical diagnosis and referral to a paediatric orthopaedic or spine unit is necessary. Casting under general anaesthesia can be effective and may prevent or delay the need for surgery in curves of less than 60°. ‘Growing’ rods (traditional or magnetically-controlled) represent the standard surgical treatment in progressive curves of 45° or greater. Children with congenital scoliosis associated with fused ribs benefit from surgery with a vertical titanium prosthetic rib. Surgery with growth-friendly instrumentation is associated with a high risk of complications.

Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170051
Percutaneous fixation of acetabular fractures
Authors: Caviglia Horacio , Mejail Adrian , Landro Maria Eulalia , Vatani Nosratolah
Published: May 2018

The objective of surgery for acetabular fractures is to achieve precise reduction to restore joint congruence, fix internal bone fragments, avoid displacement of the fracture and allow rapid rehabilitation. Open reduction and internal fixation is the benchmark method for displaced acetabular fractures, but open reductions can increase morbidity, causing neurovascular injury, blood loss, heterotopic bone formation, infection and poor wound healing. An anatomical reduction with a gap of 2 mm or less is a predictor of good joint function and reduced risk of post-traumatic osteoarthritis. The percutaneous approach is associated with fewer complications than open techniques, but acetabular geometry makes percutaneous screw insertion a challenging procedure. The percutaneous technique is recommended for non-displaced or slightly displaced fractures, and in obese, osteoporotic and elderly patients who cannot receive total joint arthroplasty. We recommend the use of intramedullary cannulated screws. Fracture reductions are achieved by manual traction of the affected bones. If some fracture displacement remains, accessory windows can be used to introduce a ball spike pusher, a hook or a Steinmann pin which can be used as a joystick to rotate the fracture. In this paper, we describe the accessory windows for the anterior column, the quadrilateral plate and the posterior column. We detail the position, direction and kind of screws used to stabilize the anterior and posterior columns.

Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170054
Bioceramics and bone healing
Authors: Ginebra Maria-Pau , Espanol Montserrat , Maazouz Yassine , Bergez Victor , Pastorino David
Published: May 2018

Calcium phosphates have long been used as synthetic bone grafts. Recent studies have shown that the modulation of composition and textural properties, such as nano-, micro- and macro-porosity, is a powerful strategy to control and synchronize material resorption and bone formation. Biomimetic calcium phosphates, which closely mimic the composition and structure of bone mineral, can be produced using low-temperature processing routes, and offer the possibility to modulate the material properties to a larger extent than conventional high temperature sintering processes. Advanced technologies open up new possibilities in the design of bioceramics for bone regeneration; 3D-printing technologies, in combination with the development of hybrid materials with enhanced mechanical properties, supported by finite element modelling tools, are expected to enable the design and fabrication of mechanically competent patient-specific bone grafts. The association of ions, drugs and cells allows leveraging of the osteogenic potential of bioceramic scaffolds in compromised clinical situations, where the intrinsic bone regeneration potential is impaired.

Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170056
Stability in ankle fractures
Authors: Lampridis Vasileios , Gougoulias Nikolaos , Sakellariou Anthony
Published: May 2018

Medial column (deltoid ligament) integrity is of key importance when considering the stability of isolated lateral malleolus ankle fractures. Weight-bearing radiographs are the best method of evaluating stability of isolated distal fibula fractures. Computed tomography (CT) scanning is mandatory for the assessment of complex ankle fractures, especially those involving the posterior malleolus. Most isolated trans-syndesmotic fibular fractures (Weber-B, SER, AO 44-B) are stable and can safely be treated non-operatively. Posterior malleolus fractures, regardless of size, should be considered for surgical fixation to restore stability, reduce the need for syndesmosis fixation, and improve contact pressure distribution.

Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170057
Trochlear dysplasia: imaging and treatment options
Authors: Batailler Cécile , Neyret Philippe
Published: May 2018

Recurrent patellar dislocation is a disabling condition, which can lead to articular cartilage injuries, osteochondral fractures, recurrent instability, pain, decreased activity and patellofemoral osteoarthritis. Trochlear dysplasia represents an important component of patellar dislocation. Imaging provides an objective basis for the morphological abnormalities and thus allows determination of the surgical strategy according to the concept of ‘à la carte’ surgery. The main surgical techniques of trochleoplasty are the sulcus deepening trochleoplasty, the ‘Bereiter’ trochleoplasty and the recession trochleoplasty. At mid-term, all techniques have shown a postoperative improvement in clinical scores, with a low rate of recurrence of dislocation and a possible return to sport. But these techniques do not halt the progression of patellofemoral arthritis.

Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170058
Post-traumatic stiff elbow
Authors: Adolfsson Lars
Published: May 2018

Post-traumatic and post-operative stiffness of the elbow joint is relatively common and may in pronounced cases markedly interfere with normal upper extremity function. Soft-tissue contractures and heterotopic bone formation are two major causes of limited movement. Extensive recent research has elucidated many of the pathways contributing to these conditions, but the exact mechanisms are still unknown. In the early phase of soft-tissue contractures conservative treatment may be valuable, but in longstanding cases operative treatment is often necessary. Several different options are available depending on the severity of the condition and the underlying offending structures. Surgical treatment may allow significant gains in movement but rarely complete restoration, and complications are not uncommon. The following presentation reviews the recent literature on pathomechanisms and treatment alternatives.

Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170062
Research methodology: how to maximize your research potential
Authors: Alves Cristina
Published: May 2018

Scientific education and a clinical background allow orthopaedic surgeons to perform leading research. Several resources, skills and techniques may be developed to maximize their research potential. Surgeon-researchers should develop Specific, Measurable, Achievable, Realistic, and Time-defined (SMART) goals. It is critical to define a timeline – which can be 1 year, 3 years, 5 years – to re-evaluate goals and to plan and identify potential obstacles. Physician-scientists are a product of training, funding, resources, practice setting, context, environment, and infrastructure. Although orthopaedic surgery has difficulty in recruiting surgeon-scientists, these are essential for the promotion of advances in technologies and treatment, as they have unique abilities to raise questions from the bedside and the operating room. The most critical personal traits necessary to succeed as a surgeon-scientist are persistence, resilience, and passion for research. These traits may be innate or acquired through mentorship and from role models. Mentors can improve mentees’ research efficiency and help them to persevere. Clinical researchers and surgeon-scientists should focus their research interests and efforts in their areas of clinical expertise. For surgeon-researchers to succeed they must have passion for research, persistence in working toward a goal, collaboration/teamwork skills, resilience, research training/experience, a track record of publications, clear goals and expectations, and a defined research plan as well as being clinically excellent. A formal research degree is desirable. Having non-clinician scientists in the team brings added expertise and value. Funding and protected research time are important. To provide outstanding clinical care and improve the quality of the care delivered, surgeons must be leaders in innovation and research.

Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170065
Total hip arthroplasty
Authors: Karachalios Theofilos , Komnos George , Koutalos Antonios
Published: May 2018

Total hip arthroplasty (THA) is a very satisfactory surgical procedure for end-stage hip disorders. Implant modifications, such as large femoral heads to improve stability, porous metals to enhance fixation and alternative bearings to improve wear, have been introduced over the last decade in order to decrease the rate of early and late failures. There is a changing pattern of THA failure modes. The relationship between failure modes and patient-related factors, and the time and type of revision are important for understanding and preventing short and late failure of implants. The early adoption of innovations in either technique or implant design may lead to an increased risk of early failure.

Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170068
Pelvic post-traumatic asymmetry
Authors: Cano-Luís Pedro , Giráldez-Sánchez Miguel Ángel , Andrés-Cano Pablo
Published: May 2018

The most common cause of post-traumatic pelvic asymmetry is, by far, initial nonoperative treatment. Open reduction and internal fixation of unstable pelvic fractures are recommended to avoid pelvic nonunion or subsequent structural deformities. The most common symptom is pelvic pain. Pelvic instability is another symptom, as well as persistent urogenital problems and neurological sequelae. Preoperative evaluation of these patients requires careful clinical and functional assessment, in addition to a complete radiological study. Surgical treatment of pelvic fracture nonunions is technically demanding and has potentially serious complications. We have developed a new classification that modifies and completes Mears and Velyvis’s classification in which we highlight two types of post-traumatic sequelae with different clinical conditions and whose basic differentiating element is whether pelvic deformity is present or not. Based on this classification, we have established our strategy of surgical treatment.

Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170069.
Open fractures of the lower extremity
Authors: Elniel Abdel Rahim , Giannoudis Peter V.
Published: May 2018

Open fractures of the lower extremity are the most common open long bone injuries, yet their management remains a topic of debate. This article discusses the basic tenets of management and the subsequent impact on clinical outcome. These include the rationale for initial debridement, antimicrobial cover, addressing the soft-tissue injury and definitive skeletal management. The classification of injury severity continues to be a useful tool in guiding treatment and predicting outcome and prognosis. The Gustilo-Anderson classification continues to be the mainstay, but the adoption of severity scores such as the Ganga Hospital score may provide additional predictive utility. Recent literature has challenged the perceived need for rapid debridement within 6 hours and the rationale for prolonged antibiotic therapy in the open fracture. The choice of definitive treatment must be decided against known efficacy and injury severity/type. Recent data demonstrate better outcomes with internal fixation methods in most open tibial fractures, but external fixation continues to be an appropriate choice in more severe injuries. The incidence of infection and non-union has decreased with new treatment approaches but continues to be a source of significant morbidity and mortality. Assessment of functional outcome using various measures has been prevalent in the literature, but there is limited consensus regarding the best measures to be used.

Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170072
3D printing and high tibial osteotomy
Authors: Jones Gareth G. , Jaere Martin , Clarke Susannah , Cobb Justin
Published: May 2018

High tibial osteotomy (HTO) is a relatively conservative surgical option in the management of medial knee pain. Thus far, the outcomes have been variable, and apparently worse than the arthroplasty alternatives when judged using conventional metrics, owing in large part to uncertainty around the extent of the correction planned and achieved. This review paper introduces the concept of detailed 3D planning of the procedure, and describes the 3D printing technology that enables the plan to be performed. The different ways that the osteotomy can be undertaken, and the varying guide designs that enable accurate registration are discussed and described. The system accuracy is reported. In keeping with other assistive technologies, 3D printing enables the surgeon to achieve a preoperative plan with a degree of accuracy that is not possible using conventional instruments. With the advent of low dose CT, it has been possible to confirm that the procedure has been undertaken accurately too. HTO is the ‘ultimate’ personal intervention: the amount of correction needed for optimal offloading is not yet completely understood. For the athletic person with early medial joint line overload who still runs and enjoys life, HTO using 3D printing is an attractive option. The clinical effectiveness remains unproven.

Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170075.
Safe management of acute cervical spine injuries
Authors: Schleicher Philipp , Pingel Andreas , Kandziora Frank
Published: May 2018

Cervical spine injuries are frequent and often caused by a blunt trauma mechanism. They can have severe consequences, with a high mortality rate and a high rate of neurological lesions. Diagnosis is a three-step process: 1) risk assessment according to the history and clinical features, guided by a clinical decision rule such as the Canadian C-Spine rule; 2) imaging if needed; 3) classification of the injury according to different classification systems in the different regions of the cervical spine. The urgency of treatment is dependent on the presence of a neurological lesion and/or instability. The treatment strategy depends on the morphological criteria as defined by the classification.

Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170076
3D printing and unicompartmental knee arthroplasty
Authors: Jones Gareth G. , Clarke Susannah , Jaere Martin , Cobb Justin
Published: May 2018

In suitable patients, unicompartmental knee arthroplasty (UKA) offers a number of advantages compared with total knee arthroplasty. However, the procedure is technically demanding, with a small tolerance for error. Assistive technology has the potential to improve the accuracy of implant positioning. This review paper describes the concept of detailed UKA planning in 3D, and the 3D printing technology that enables a plan to be delivered intraoperatively using patient-specific instrumentation (PSI). The varying guide designs that enable accurate registration are discussed and described. The system accuracy is reported. Future studies need to ascertain whether accuracy for low-volume surgeons can be delivered in the operating theatre using PSI, and reflected in improved patient reported outcome measures, and lower revision rates.

Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.180001
Ischaemia, healing and outcomes in proximal humeral fractures
Authors: Lambert Simon M.
Published: May 2018

Interfragmental ischaemia is a prerequisite for the initiation of the inflammatory and immunological response to fracturing of bone. Intrafragmental ischaemia is inevitable: the extent of the initial ischaemic insult does not, however, directly relate to the outcome for healing of the fracture zones and avascular necrosis of the humeral head. The survival of distal regions of fragments with critical perfusion may be the result of a type of inosculation (blood vessel contact), which establishes reperfusion before either revascularization or neo-angiogenesis has occurred. Periosteum has a poorly defined role in fracture healing in the proximal humerus. The metaphyseal periosteal perfusion may have a profound effect, as yet undefined, on the healing of most metaphyseal fractures of the proximal humerus, and may be disturbed further by inadvertent surgical manipulation. The metaphysis can be considered as a ‘torus’ or ring of bone, its surface covered by periosteum antero- and posterolaterally, through which the tuberosity segments gain perfusion and capsular reflections antero- and posteromedially, through which the humeral head (articular) fragment gains perfusion. The torus is broken in relatively simple primary patterns: a fracture line at the upper surface of the torus is an anatomical ‘neck’ fracture; a fracture line at the lower surface of the torus is the surgical ‘neck’ fracture. Secondary fragmentation (through compression and/or distraction) of the torus itself creates complexity for analysis (classification), alters the capacity and outcome for healing (by variable interruption of the fragmental blood supply) and influences interfragmental stability.

Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.180005