bluuebunny/crossref_metadata_2025 huggingface dataset:
Endoscopic submucosal dissection of early colorectal neoplasms with a monopolar scissor-type knife: short- to long-term outcomes
Authors: Kuwai Toshio , Yamaguchi Toshiki , Imagawa Hiroki , Sumida Yuki , Takasago Takeshi , Miyasako Yuki , Nishimura Tomoyuki , Iio Sumio , Yamaguchi Atsushi , Kouno Hirotaka , Kohno Hiroshi , Ishaq Sauid
Published: July 2017

Background and study aims Endoscopic submucosal dissection (ESD) for colorectal neoplasms remains challenging because of technical issues imposed by the complex anatomical features of the large intestine. We evaluated the feasibility, and the short- and long-term clinical outcomes of ESD for early colorectal neoplasms performed using the Stag-beetle Knife Jr. (SB Knife Jr.)

Patients and methods We retrospectively assessed 228 patients who underwent ESD for 247 colorectal lesions with the SB Knife Jr. Clinicopathological characteristics of the neoplasms, complications, and various short- and long-term outcomes were evaluated.

Results Mean tumor size was 34.3 mm and median procedure time was 76 minutes. The SB Knife Jr. achieved 98.4 % en bloc resection, 93.9 % complete resection, and 85.4 % curative resection. No perforations occurred during the procedure, and a delayed bleeding rate of 2.4 % was observed. Long-term outcomes were favorable with no distant recurrence, 1.1 % local recurrence, a 5-year overall survival rate of 94.1 % and 5-year tumor-specific survival rate of 98.6 % in patients with cancer.

Conclusions ESD using the SB Knife Jr. is technically efficient and safe in treating early colorectal neoplasms and is associated with favorable short- and long-term outcomes.
Chirurgische Methoden in der Behandlung des Aderhautmelanoms
Authors: Blatsios Georgios , Haas Gertrud , Zehetner Claus , Bechrakis Nikolaos
Published: July 2017

In der Behandlung von Aderhautmelanomen wurden in den letzten Jahrzehnten signifikante Fortschritte erzielt. Die lokale Tumorkontrolle kann mit Strahlentherapie je nach Methodik in bis zu 98% der Fälle erreicht werden. Chirurgische Techniken werden zur Behandlung von Strahlenkomplikationen, wie dem sogenannten toxischen Tumorsyndrom, oder zur primären Therapie des Tumors in Kombination mit oder ohne Strahlentherapie angewendet. Hierzu werden endo- und transsklerale Resektionstechniken für Melanome der Aderhaut und des Ziliarkörpers oder Iridotrabekulozyklektomie für Melanome der Iris und des Ziliarkörpers verwendet. Darüber hinaus spielt die Tumorbiopsie eine zunehmend wichtigere Rolle bei der Diagnose, Behandlung und Nachbehandlung von choroidalen Melanomen. Diese Übersichtsarbeit erläutert die therapeutischen Indikationen und chirurgischen Techniken sowie die Ergebnisse und Komplikationen im Rahmen der Exzision und Biopsie von Aderhautmelanomen.
Interiority in Sloterdijk and Deleuze
Authors: Wambacq Judith , van Tuinen Sjoerd
Published: July 2017

This article constitutes one of the first comparisons between the philosophies of Peter Sloterdijk and the philosophical tandem Gilles Deleuze-Félix Guattari. The subject of the discussion between both philosophical positions is on communication with the exterior, and thus also how an interiority is to be conceived. Both philosophers raise these questions in reference to the work of the Estonian biologist Jacob von Uexküll. At first sight, Sloterdijk’s focus on immunity mechanisms seems to suggest a preference for restricting this communication, whereas Deleuze and Guattari’s interest in becomings seems to direct us in the opposite direction. However, a closer examination of both positions reveals that the difference lies in the nature of their approaches: whereas Deleuze and Guattari’s interest in opening up interiorities is ontologically motivated, Sloterdijk’s focus on shielding them off is existential. These findings might help us in demining the opposition between progressive socialism and conservatism.
A localized cathode glow in the presence of a bar magnet and its associated nonlinear dynamics
Authors: Shaw Pankaj Kumar , Samanta Subha , Saha Debajyoti , Ghosh Sabuj , Janaki M. S. , Iyengar A. N. Sekar
Published: July 2017

A localized glowing, fireball like structure, appears near the cathode surface of a glow discharge plasma device when it is subjected to a magnetic dipole field produced by a bar magnet placed outside the plasma chamber. It is seen that the plasma density in the localized glow region and the luminous intensity of this structure increases with the increase in the magnetic field strength. The effect of such localized glow region on the plasma floating potential fluctuation dynamics is investigated. Floating potential fluctuations show that the emergence of such localized structure leads the system towards nonlinear dynamical regimes. Increasing the magnetic field strength reveals a transition from order to chaos via period doubling bifurcation. This transition is analyzed by using bifurcation diagram, phase space plots, power spectrum plots, Hilbert Huang transform, and by estimating the largest Lyapunov exponent. The interaction of plasma with a dipole magnetic field produces a non-monotonic potential structure in the vicinity of the cathode surface. Thus, to understand the dynamical origin of such complex oscillations, we have carried out a numerical modelling for ion dynamics by considering trapping of ions inside the potential structure. Numerical results show the existence of period doubling route to chaos.
Critical slowing down of polar nano regions ensemble in Gd3+-substituted PbMg1/3Nb2/3O3 ceramics
Authors: Pandey Adityanarayan H. , Gupta S. M. , Lalla N. P. , Nigam A. K.
Published: July 2017

Investigations on Gd-substituted lead magnesium niobate (Pb1-xGdxMg(1+x)/3Nb(2-x)/3O3; varying x = 0.01–0.1) ceramics have revealed critical slowing down of the polar nano regions (PNRs) ensemble into a “super-dipolar glass state” for higher Gd-substitution x ≥ 0.05. Low temperature electric field induced polarization switching study (P-E) has revealed a sharp decrease in the remanent polarization up to x = 0.03, which strengthen the critical slowing down of polar nano-domains dynamics, suggesting a reduction in the correlation between or within polar nano regions (PNRs) leading to a reduction in its size. Bright field imaging by using transmission electron microscope has also confirmed the reduction of the size of polar nano regions with increasing “x.” Selected area electron diffraction pattern along ⟨110⟩ unit axis has revealed enhancement in intensity of the superlattice reflections spot at ½ ½ ½ along ⟨111⟩ unit axis with increasing “x,” which is associated with the enhancement of chemical ordered regions and correlate well to enhancement in the degree of diffuseness parameters “δA” determined from fitting of the temperature dependent dielectric constant ε(T) plot above the dielectric maximum peak (εmax). The enhanced “δA” for x ≥ 0.05 is due to additional disorder created by the Gd-ions substitution at the Mg-site, which is consistent with the phase and microstructural analysis. Fitting of frequency dependent Tm (temperature of εmax) to the power law of critical dynamic has revealed realistic pre-factor fitting parameters for x ≥ 0.05 suggesting critical slowing down of the polar nano-domains dynamics ensemble resulting in super-dipolar glass state.
Effects of surface dielectric barrier discharge on aerodynamic characteristic of train
Authors: Dong Lei , Gao Guoqiang , Peng Kaisheng , Wei Wenfu , Li Chunmao , Wu Guangning
Published: July 2017

High-speed railway today has become an indispensable means of transportation due to its remarkable advantages, including comfortability, convenience and less pollution. The increase in velocity makes the air drag become the main source of energy consumption, leading to receiving more and more concerns. The surface dielectric barrier discharge has shown some unique characteristics in terms of active airflow control. In this paper, the influences of surface dielectric barrier discharge on the aerodynamic characteristics of a scaled train model have been studied. Aspects of the discharge power consumption, the temperature distribution, the velocity of induced flow and the airflow field around the train model were considered. The applied AC voltage was set in the range of 20 kV to 28 kV, with a fixed frequency of 9 kHz. Results indicated that the discharge power consumption, the maximum temperature and the induced flow velocity increased with increasing applied voltage. Mechanisms of applied voltage influencing these key parameters were discussed from the point of the equivalent circuit. The airflow field around the train model with different applied voltages was observed by the smoke visualization experiment. Finally, the effects of surface dielectric barrier discharge on the train drag reduction with different applied voltages were analyzed.
Experimental characterization of droplet dispensing in electrowetting-based microfluidics
Authors: Ahmadi Mohammad Khorsand , Shokoohi Mehrdad , Passandideh-Fard Mohammad
Published: July 2017

In this study, the effect of various parameters on the dispensed droplet size in microchannels based on the electrowetting on dielectric technique is experimentally investigated. A printed circuit board (PCB)-based microfluidic chip is used as a platform for the experiments. A crescent configuration for the channel electrodes is fabricated, which leads to a higher electrowetting force which improves the motion of the droplet. In addition, two electrode designs are proposed, which provide a nearly constant overlapping length on the reservoir electrode. The focus of this paper is on the geometry of the reservoir and the channel electrode; therefore, the channel dimensions, surface conditions, and applied voltage are kept constant. The experiments are performed for various reservoir liquid volumes and different electrode shapes of the reservoir and the microchannel. The results show that decreasing the length of the small reservoir electrode reduces the size of the dispensed droplet. It is also observed that using a channel electrode curved in the opposite direction of the droplet motion leads to a smaller dispensed droplet.
Phase-transformation in iron oxide and formation of Cu/γ-Fe2O3 nanocomposite using radio-frequency sputtering with metal chips on an α-Fe2O3 target
Authors: Abe Seishi , Watanabe Masato
Published: July 2017

A simple technique that uses radio-frequency sputtering with a functional element on a hematite (α-Fe2O3) target is presented for the production of maghemite (γ-Fe2O3) thin films. These films are prepared on water-cooled glass substrates in an Ar atmosphere. Investigations are done with Ti, Si, Al, Cu, Mo, and Zn, with γ-Fe2O3 being obtained only in the presence of Cu, indicating that phase transition occurs only for this metal. Mössbauer spectra and magnetization analysis reveal that the quality of the obtained γ-Fe2O3 films is higher than that of the film produced using Mg, which was reported in our previous work. High-angle annular dark-field scanning tunneling electron microscopy and electron energy-loss spectroscopy reveal that the added Cu remains in a metallic state (without oxidization), forming a Cu/γ-Fe2O3 phase-mixture in the as-deposited film. The Cu/γ-Fe2O3 composite film exhibits negative magnetoresistance (MR), with a MR ratio of approximately 0.6% at room temperature in an applied field of 10 kOe, and a negative Faraday rotation of −5708 deg cm−1 at 830 nm.
Alkali Metal Ion-Exchanged Zeolite X from Bamboo Leaf Biomass as Base Catalysts in Cyanoethylation of Methanol Enhanced by Non-Microwave Instant Heating
Authors: Ng Eng-Poh , Chow Jack-Hao , Wong Siew-Fang , Mukti Rino R. , Muraza Oki , Ling Tau Chuan , Wong Ka-Lun
Published: July 2017

A series of alkali form (Na, K, Cs, and Ca) faujisite X-type zeolites were prepared from bamboo leaf ash, which was derived from bamboo agricultural waste. The XRD and SEM results revealed that the zeolite structure remained intact after ion exchange treatment. A very high degree of ion exchange (≥ 85 %) was achieved in all of the prepared zeolite samples. The zeolite samples were tested in a solvent-free cyanoethylation reaction of methanol under an instant heating environment that mimicked microwave fast heating, which was explored for the first time. The catalytic performances of the zeolite samples were well correlated with their surface basicity, which was characterised by pyrrole adsorption followed by in situ infrared spectroscopy. The CsX zeolite showed excellent catalytic performance (~97 % reactant conversion and 100 % product selectivity within 15 min), which was comparable to the microwave-assisted system and superior to the normal reflux system. The catalytic activity of the CsX zeolite was retained even after 10 cycles of reaction.
Corrigendum to: Phosphate minerals in granitic pegmatites from the Mount Wills District, north-eastern Victoria
Authors: Eagle Ryan M. , Birch William D. , McKnight Stafford
Published: July 2017

Tin- and tantalum-bearing LCT-type granitic pegmatites occur in a 45 km long belt between Eskdale and Mount Wills in north-eastern Victoria. Near Mount Wills, several compositionally zoned rare-element pegmatites contain complex assemblages of primary and secondary phosphate minerals, many of which are rare and previously unrecorded in Victoria. The phosphate assemblages can be divided into Al-rich and Fe–Mn-rich suites, in addition to ubiquitous fluorapatite. The Al-rich phosphate suite includes montebrasite, scorzalite, bertossaite and brazilianite. The Fe‒Mn phosphate suite includes heterosite, phosphoferrite, wolfeite, alluaudite (sp.), arrojadite (sp.) and jahnsite (sp.), derived from the metasomatic alteration of primary triplite. Further hydrothermal alteration of this assemblage has resulted in a secondary suite of strengite, rockbridgeite, phosphosiderite, whiteite, jahnsite and whitmoreite forming in etch cavities and fractures. A Late Silurian age of 420±4 Ma was obtained from one of the dykes via CHIME radiometric dating of monazite, suggesting a similar age for the adjacent Mount Wills Granite, which has not been reliably dated. This highly fractionated, peraluminous granite is presumed to be the source of the rare-element pegmatites based on their close spatial relationship.
A study of the gnammas (rock pools) in some granitic outcrops in central Victoria, with a comparison of their invertebrate communities across southern Australia
Authors: Timms Brian V.
Published: July 2017

Gnammas in central Victoria occur at Kooyoora, Terrick Terrick, Mt Pilot near Chiltern and Bald Rock near Euroa. Though similar structurally and with similar hydroperiods to those in the Western Australian Wheatbelt and on Eyre Peninsula (EP), South Australia, many are smaller and all have fresher waters. Momentary species richness in pan gnammas range from 2.7 at Bald Rock to 9.3 at Terrick Terrick and in pit gnammas from 7.6 at Kooyoora to 15.3 at Terrick Terrick. These figures are significantly lower than figures of ca 30 for WA pans and ca 10 for EP pans, but ambivalent for pits, cf 12 in WA, and 9 on EP. Central Victorian gnammas have only one endemic species compared with many in WA and a few on EP. Species seem to have few special adaptations for life in Victorian gnammas, compared to many in WA. Factors thought to be influencing these differences include habitat size (a function of site age), number of gnammas per rock exposure (habitat variability and availability), and past climatic fluctuations (promotion of speciation). All these factors enhance diversity in WA, but mostly inhibit it in central Victoria, with Eyre Peninsula being intermediate.
MEIS homeodomain proteins facilitate PARP1/ARTD1-mediated eviction of histone H1
Authors: Hau Ann-Christin , Grebbin Britta Moyo , Agoston Zsuzsa , Anders-Maurer Marie , Müller Tamara , Groß Anja , Kolb Jasmine , Langer Julian D. , Döring Claudia , Schulte Dorothea
Published: July 2017

Pre–B-cell leukemia homeobox (PBX) and myeloid ecotropic viral integration site (MEIS) proteins control cell fate decisions in many physiological and pathophysiological contexts, but how these proteins function mechanistically remains poorly defined. Focusing on the first hours of neuronal differentiation of adult subventricular zone–derived stem/progenitor cells, we describe a sequence of events by which PBX-MEIS facilitates chromatin accessibility of transcriptionally inactive genes: In undifferentiated cells, PBX1 is bound to the H1-compacted promoter/proximal enhancer of the neuron-specific gene doublecortin (Dcx). Once differentiation is induced, MEIS associates with chromatin-bound PBX1, recruits PARP1/ARTD1, and initiates PARP1-mediated eviction of H1 from the chromatin fiber. These results for the first time link MEIS proteins to PARP-regulated chromatin dynamics and provide a mechanistic basis to explain the profound cellular changes elicited by these proteins.
Spatiotemporal dynamics of climate and agricultural landscape patterns in Xinjiang, China (2000-2015)
Authors: Huang T , Du Q Y , Zou J Q
Published: July 2017

This study integrated remote sensing, geographic information system, landscape ecology, and spatial analysis, and is based on meteorological data and four remote sensing images (2000-2015). The aim of this study was to analyse climate trends and spatiotemporal changes in agricultural landscape patterns, and calculate agricultural ecosystem service value (AESV) in Xinjiang, China. In addition, correlation analysis further enabled the quantification of agricultural landscape pattern changes in response to climate change. Results showed that temperature and precipitation registered a fluctuating ascending trend in most areas of Xinjiang. Landscape diversity and fragmentation increased during the same period. AESV showed a trend of gradual increase, the waste disposal and the water retention are the most important ecological functions. Besides, agricultural landscape pattern significantly correlated to climate and the effect of precipitation on agricultural landscape patterns has been greater than the effect of temperature during 2000-2015.
Medicine as a Community of Practice: Implications for Medical Education
Authors: Cruess Richard L. , Cruess Sylvia R. , Steinert Yvonne
Published: July 2017

The presence of a variety of independent learning theories makes it difficult for medical educators to construct a comprehensive theoretical framework for medical education, resulting in numerous and often unrelated curricular, instructional, and assessment practices. Linked with an understanding of identity formation, the concept of communities of practice could provide such a framework, emphasizing the social nature of learning. Individuals wish to join the community, moving from legitimate peripheral to full participation, acquiring the identity of community members and accepting the community’s norms.

Having communities of practice as the theoretical basis of medical education does not diminish the value of other learning theories. Communities of practice can serve as the foundational theory, and other theories can provide a theoretical basis for the multiple educational activities that take place within the community, thus helping create an integrated theoretical approach.

Communities of practice can guide the development of interventions to make medical education more effective and can help both learners and educators better cope with medical education’s complexity. An initial step is to acknowledge the potential of communities of practice as the foundational theory. Educational initiatives that could result from this approach include adding communities of practice to the cognitive base; actively engaging students in joining the community; creating a welcoming community; expanding the emphasis on explicitly addressing role modeling, mentoring, experiential learning, and reflection; providing faculty development to support the program; and recognizing the necessity to chart progress toward membership in the community.
Toward a Utopian Model for Teaching and Nonteaching Services: Every Journey Begins With a First Step
Authors: Bellini Lisa M. , Ende Jack
Published: July 2017

Nonteaching services are an imperfect step toward enabling inpatient teaching services to transition from an unregulated, natural state, driven solely by the exigencies of patient volume and throughput, to one that is more controlled and intends to achieve the proper balance between service and education. As career educators the authors prefer to view nonteaching services as critical components of an integrated system that enables the best possible patient care and learning, yet they acknowledge that, to meet the needs of patients and learners, teaching and nonteaching services alike must be truly complementary, collaborative, and integrated components of a single system.

In this Invited Commentary the authors offer a “utopian” view of a teaching service in an institution that explicitly acknowledges its contract with society to transform health care delivery. In this setting, highly engaged teachers and learners are supported by a high-performing cast of an advanced practice provider, primary nurses, a social worker, a case manager, a clinical pharmacist, and an analyst. This group forms a Clinical Learning Unit (CLU) where the curriculum has evolved into an interdependent framework of basic, clinical, and systems science. CLUs train tomorrow’s health care workforce through adaptive service learning made possible because the team has a manageable census, time for daily reflection, and inspiring relationships with trained teachers. CLUs cannot exist without complementary nonteaching services.

Elsewhere in this issue Repp and colleagues outline seven design principles to improve nonteaching services. These are a good first step toward the utopian vision outlined by the authors.
Online Sales of Unscheduled Pharmaceutical Agents: A Case Report of Tianeptine Use in the United States
Authors: Gupta Swapnil , Wallace Ryan , Sloshower Jordan
Published: July 2017

Tianeptine is a tricyclic antidepressant that stimulates mu-opioid receptors at high doses. It is marketed and used across Europe and Latin America as an antidepressant, but is not approved by the Food and Drug Administration for use in the United States. In the United States, tianeptine is sold through online health stores as a cognition enhancer, dietary supplement, or as research chemical. We report the case of a 36-year-old man with a history of major depressive disorder, responsive to sertraline, who turned to the unmonitored use of tianeptine purchased online to treat residual feelings of apathy and boredom. His use of tianeptine was marked by rapidly escalating doses and a significant withdrawal syndrome that made discontinuation of this substance difficult. This case serves as a reminder that unscheduled pharmaceutical agents are available for misuse by the general population and have the potential to cause significant harm. Therefore, medical providers must be aware of and screen for the use of such products amongst their patients.
Quality and readability of online resources regarding shoulder osteoarthritis
Authors: Davis Daniel E. , Stoll Laura , Brolin Tyler , Updegrove Gary , Horneff John G.
Published: July 2017

Background:

Education through internet searches is becoming more commonplace as patients look to become more involved in the medical decision-making process. Studies have shown poor quality and readability of online discussion of several orthopaedic conditions. The goal of this study was to evaluate the quality of online information available for arthritis of the shoulder.

Methods:

Three search engines were used to identify three common terms signifying shoulder osteoarthritis: “shoulder arthritis,” “glenohumeral arthritis,” and “shoulder joint disease.” The top resulting websites were collected, repeats were eliminated, and the resulting sites were evaluated. Four shoulder and elbow fellows evaluated each using a quality scoring system. The websites were also graded on readability using the Flesch-Kincaid system.

Results:

Forty-five unique websites were evaluated for quality and readability. The average quality of websites scored was 12.33±4.11 out of 25 with no significant difference due to search term or author. When scored for accuracy, “shoulder arthritis” was significantly lower than “glenohumeral arthritis” or “shoulder joint disease.” Flesh-Kincaid (FK) analysis revealed that zero studies were below an 8th grade reading level and overall mean FK score was 11.32±2.66 (range, 8.2 to 18.2).

Conclusions:

This study found that there is a consistently low quality of web-based information available to patients in regards to glenohumeral arthritis of the shoulder. Additionally, this information is presented in a way that is above the average reading level of the Unites States population. It is important that orthopaedic surgeons help to improve web-based material and provide this information to patients.
Coccygectomy for posttraumatic coccygodynia: a long-term prospective study
Authors: El Mohsen Arafa Abd , El Rady Mahmoud Abd , Zayan Mohammed , Kotb Ahmed
Published: July 2017

Background:

Coccygodynia is pain around the coccyx; its most common etiology is trauma. About 20% of patients do not respond to conservative measures in the form of medical treatment, local injection, or physical therapy. Our prospective clinical study aims at highlighting the results of coccygectomy for coccygodynia caused by trauma that could not be treated conservatively.

Methods:

Thirty eight patients were included in the study with 28 women (73.7%) and 10 men (26.3%). After failure of conservative treatment measures, coccygectomy was done in all patients. The duration of symptoms before the surgical procedure varied between 9 and 48 mo with a mean of 19.6 mo. Clinical presentation of the local pain was quantified according to a visual analog scale (VAS) on deep manual palpation at the tip of coccyx preoperatively and at 4 mo, 12 mo, then at 2-year and 4-year follow-up.

Results:

The mean preoperative VAS was 9.2, at 4 mo it was 2.7, and at 12 mo it was 1.8. At 2 and 4-year postoperative follow-up, VAS was 1.5 and 1.3, respectively (P=0.0001).

Conclusion:

Coccygectomy for coccygodynia caused by a traumatic event affords significant pain relief postoperatively. Coccygectomy is recommended as a last resort treatment for coccygodynia after failed conservative treatment.

Level of Evidence:

Level IV (prospective study).
Isolated medial patellofemoral ligament reconstruction for posttraumatic recurrent lateral patellar instability. How can it be successful?
Authors: Azim Foda Adel Abdel , Aabdel Salam Mohamad A.
Published: July 2017

Background:

Injury to the medial patellofemoral ligament (MPFL) occurs in nearly all cases of traumatic patellar dislocation. Reconstruction of the MFPL is the main treatment of such conditions. Other anatomical abnormalities that predispose to lateral patellar instability should be excluded for successful outcome after isolated MPFL reconstruction.

Methods:

In the period from June 2012 to January 2015, 18 patients with had recurrent posttraumatic unilateral lateral patellar instability caused by an isolated MPFL tear that was reconstructed with a semitendinosus autograft to reconstruct MPFL. The mean follow-up period was 24 mo. Patients with isolated MPFL tears were carefully chosen through a series of clinical and radiographic workups. The technique was done through a less invasive approach, with the graft fixed to the femur by a bioabsorbable interference screw and to the patella; the graft was passed through two transverse tunnels making a laterally based loop.

Results:

No dislocations or apprehension was recorded. Furthermore, there were no major complications, only persistent patellofemoral pain in patients with preoperative osteochondral patellar injuries. Kujala functional score improved from 35.6 preoperatively to 90.4.

Conclusions:

Careful patient selection and proper surgical technique are the two main items for patellar stabilization with isolated MPFL reconstruction.
Gross Motor Function Classification System in patients with cerebral palsy: interobserver reliability between parents and orthopaedic specialists
Authors: Peck Jeffrey B. , McMulkin Mark L. , Baird Glen O. , Caskey Paul M. , Elizondo Tayler , Tompkins Bryan
Published: July 2017

Background:

The widely used Gross Motor Function Classification System (GMFCS) was designed to improve understanding and subsequent treatment of children with cerebral palsy. Previous studies investigating reliability between physician and family report of GMFCS have focused on limited age groups or mobility levels. The current study aims to investigate the GMFCS agreement between pediatric orthopaedic healthcare professionals (HCP) and families across all age groups for children with cerebral palsy.

Methods:

A total of 124 participants completed this prospective study at an orthopaedic children’s hospital. The HCP and family classified the mobility level of each child with cerebral palsy using the GMFCS. Each group was blinded to the other’s assessment of the child. Agreement reliability in GMFCS assessment between parents of children with cerebral palsy and HCP was determined.

Results:

The interclass correlation coefficient between parents and HCP was 0.92. There was agreement between HCP and parents in 69% of the children evaluated. These findings are similar to results of previous studies. Of those in which there was disagreement, 97% differed by one GMFCS level. In those that differed, the parents provided a lower functional level in 54%, in contrast to previous studies that reported much higher percentages.

Conclusions:

These findings add to the reliability of the GMFCS being used as a tool for effective communication between HCP and parents of those children with cerebral palsy across all age groups. This reliability can assist with the development of goals and expectations for that child.
Treatment and Complications of Patients With Ipsilateral Acetabular and Femur Fractures: A Multicenter Retrospective Analysis
Authors: Cannada Lisa K. , Hire Justin M. , Boyer Preston J. , Israel Heidi , Mir Hassan , Halvorson Jason , Della Rocca Gregory J. , Ming Bryan , Mullis Brian , Deshpande Chetan
Published: July 2017

Objectives:

The purpose of this study was to review the treatment of patients with ipsilateral acetabular and femur fractures to provide descriptive demographic data, injury pattern classification, treatment, and evaluate the complication profile reflective of current practices.

Study Design:

Multicenter retrospective cohort.

Setting:

Eight Level 1 Trauma Centers.

Patients/Participants:

One hundred one patients met inclusion criteria.

Intervention:

Surgical treatment of both the acetabular and femur fractures.

Main Outcome Measurements:

The complications evaluated include avascular necrosis, heterotopic ossification, posttraumatic arthritis, deep venous thrombosis, pulmonary embolism and superficial/deep infection, fracture union, and secondary surgeries.

Results:

Forty-three patients had 31 type fractures (29A; 11B, and 3C), 60 had 32 type (37A, 8B; 15C), and 8 had 33 type (1A, 4B, 3C) femur fractures; 10 patients had combinations involving more than 1 femur fracture pattern. There were 35 62A type fractures, 47 62B, and 19 62C acetabular fractures. Age of 45 or older was associated with marginal impaction (P = 0.001). The aggregate infection rate was 17%. More than 30% of patients required secondary surgeries. The rate of avascular necrosis was higher in acetabular fractures combined with proximal femur fractures (P < 0.05). The rate of deep venous thrombosis was associated with increased age and time to surgical fixation (P < 0.05).

Conclusions:

We report the largest review of the surgical treatment and complications of ipsilateral acetabular and femoral fractures. This study provides useful information regarding the complications and provides some treatment recommendations regarding these injuries.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Computer-Assisted Corrective Osteotomy of Malunited Pediatric Radial Neck Fractures—Three-Dimensional Postoperative Accuracy and Clinical Outcome
Authors: Weigelt Lizzy , Fürnstahl Philipp , Schweizer Andreas
Published: July 2017

Neglected or incorrect treatment of pediatric radial neck fractures may lead to symptomatic malunions. Computer-assisted corrective osteotomies with patient-specific guides have been proposed as a promising technique for the reconstruction of malunited long bone deformities. The aim of this study was to evaluate the accuracy and clinical outcome of this technique in children with malunited fractures of the radial neck. Four children [2 boys, 2 girls; mean age 12 (10–16) years] underwent computer-assisted closing wedge osteotomy of the radial neck. The contralateral uninjured side was used as a reconstruction template. Computed tomography were performed 8 weeks postoperatively to confirm bony consolidation and to quantify residual 3D rotational and translational displacement error. Clinical outcome [pain, range of motion (ROM)] and overall satisfaction were documented. Preoperative subluxation of the radial head could be corrected in 2 of 3 patients. One patient had to be revised because of secondary traumatic loss of reduction. At the last follow-up [mean 16 (range, 12–24) months], all patients were pain free for activities of daily living (preoperative pain: visual analog scale 6). Pain during sport activities could be substantially reduced (visual analog scale 8→2). Although the procedure failed to improve ROM, none of the patients had limitations regarding work, daily, or sports activities. Yet, restricted ROM was considered as a cosmetic problem in 1 patient. Full consolidation of the osteotomy site, with no signs of avascular necrosis of the radial head, was achieved in all patients. The deformity could be substantially reduced, from a 3D angle of 13–40 degrees to 3–7 degrees (58%–89% deformity correction). Computer-assisted corrective osteotomy is a novel technique for the treatment of radial neck malunions that led to adequate pain reduction and 3D accuracy of deformity correction in our small case series. Despite the lack of improved ROM, all patients were satisfied and would undergo the same procedure again.
Functional Outcomes of Elderly Patients With Nonoperatively Treated Acetabular Fractures That Meet Operative Criteria
Authors: Ryan Scott P. , Manson Theodore T. , Sciadini Marcus F. , Nascone Jason W. , LeBrun Christopher T. , Castillo Renan C. , Muppavarapu Ragu , Schurko Brian , O'Toole Robert V.
Published: July 2017

Objectives:

To report functional outcomes of displaced acetabular fractures treated nonoperatively in the geriatric patient population.

Design:

Retrospective case series.

Setting:

Two Level I trauma centers.

Patients:

Twenty-seven patients 60 years of age or older who sustained displaced acetabular fractures during an 11-year period.

Intervention:

Nonoperative treatment.

Main Outcome Measurements:

Primary outcome measurements were Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and Short Form 8 (SF-8) scores. Secondary outcome measurements were conversion to open reduction and internal fixation or total hip arthroplasty and 1-year mortality.

Results:

Twenty-six patients completed the WOMAC and SF-8 surveys. The overall WOMAC score was 12.9 ± 15.6 (range, 0–59.4). The average physical SF-8 was 51.1 ± 8.7 (range, 30.4–58.6), and the average mental SF-8 was 55 ± 6.2 (range, 30.4–58.6). The 1-year mortality rate was 24%. Conversion of treatment occurred in 15% of patients.

Conclusions:

Elderly patients with fracture patterns that would qualify for operative treatment in younger healthy patients had surprisingly good outcome scores when treated nonoperatively.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Percutaneous Instrumentation and Reduction Technique for the Treatment of Thoracolumbar Fractures: A Case Report
Authors: Grazina Rita , Andrade Renato , Marinhas José , Santos Filipe , Lemos Rui , Freitas Rolando , Gonzalez-Diaz Rafael , Espregueira-Mendes João , Rocha Rui
Published: July 2017

Minimally invasive spine surgery suffered a sustained development in the last 15 years. One of its main goals is to achieve the same results as conventional surgery with less blood loss, muscle damage, infection rate, and hospital stay. Surgical management of thoracolumbar fractures aims to correct sagittal deformities and provide a stable and durable fixation. This article describes a new percutaneous method of thoracolumbar fracture reduction based on the 6-screw construct, which promotes an indirect reduction of the fractured vertebrae with lordotic rods connected with 4 long monoaxial percutaneous pedicle screws in the fractured and upper adjacent vertebrae. The vertebra below the fractured one is instrumented with polyaxial screws to facilitate the introduction of the lordotic rods. The postoperative radiography and computed tomography imaging results show that this technique is able to correct posttraumatic kyphosis and provide a solid and durable construct.
Can Concurrent Abnormalities in Free Light Chains and Immunoglobulin Concentrations Identify a Target Population for Immunoglobulin Trials in Sepsis?*
Authors: Shankar-Hari Manu , Singer Mervyn , Spencer Jo
Published: July 2017

Objectives:

Light chains κ and λ are immunoglobulin constituents but also circulate independently in blood as free light chains. We investigated whether a concomitant abnormality in free light chain and immunoglobulin levels could identify a high risk of death sepsis subpopulation to inform future IV immunoglobulin trials. We tested whether light chain allelic inclusion occurs in circulating B cells.

Design:

Prospective cohort study.

Setting:

Adult general ICUs.

Patients:

Adult sepsis patients without any documented immune comorbidity.

Interventions:

None.

Measurements and Main Results:

Serum total free light chain, immunoglobulin G, immunoglobulin A, and immunoglobulin M were measured on ICU days 1, 3, and 7. Population normal ranges defined normal and abnormal categories. Logistic regression models tested any independent relationship between high free light chain, immunoglobulins and hospital mortality. CD19 B-cell subsets expressing cell surface κ and λ were quantified by flow cytometry; their frequencies were compared against healthy subjects and correlation assessed against free light chain concentrations. On ICU day 1, high free light chain λ and high free light chain κ were seen in 46.5% and 75.3% of the study cohort (n = 101). Low immunoglobulin levels were commonplace (45.5%) at ICU admission. ICU admission day free light chain and immunoglobulin concentrations were significantly correlated. Septic patients had significantly more CD19 B cells expressing both κ and λ compared with healthy controls (median [interquartile range] 4.1% [2.4–11.0] vs 1.3% [1.2–2.9], respectively; p = 0.0001); these correlated with free light chain concentrations.

Conclusions:

To our knowledge, abnormalities and associations of free light chain in critically ill adults with sepsis have not been previously reported. The additional prognostic value of free light chain λ and the significance of allelic inclusion in B cells in sepsis require further investigation.
Glomangiosarcoma Arising from a Prior Biopsy Site
Authors: Maselli Amy M. , Jambhekar Amani V. , Hunter John G.
Published: July 2017

Glomangiosarcoma represents a rare malignant variant of the benign glomus tumor that typically presents as a tender, slowly growing nodule with a predilection for the lower extremities. Unlike their benign counterparts, glomangiosarcomas may display aggressive characteristics such as large size, local invasion, and a tendency to recur after excision. Although wide local excision remains the treatment of choice, rare cases of systemic metastasis have been previously reported. We present a case of glomangiosarcoma arising at a prior biopsy site after excision of an unknown soft tissue lesion.
Animation Deformity in Postmastectomy Implant-Based Reconstruction
Authors: Nigro Lauren C. , Blanchet Nadia P.
Published: July 2017

Background:

Despite increasing interest in prepectoral implant-based reconstruction to avoid animation deformity (AD), the prevalence of this deformity and patient attitudes toward it have not been extensively studied. The purpose of this study was to report on AD in the breast reconstruction population and identify those at highest risk.

Methods:

A retrospective chart review was completed for patients at least 6 months postoperative from subpectoral, implant-based breast reconstruction using acellular dermal matrix in the lower pole. Patient age, BMI, and implant size were collected. A questionnaire was distributed to the patients. Returned questionnaires were compiled and data were analyzed.

Results:

Eighty-four of 108 patients (77.8%) returned the questionnaire with 62 (75.6%) reporting AD; 75.6% of patients were aware of AD, 14.6% considered it moderate, and 11% considered it severe. No statistically significant differences in age, body mass index, implant size, or athleticism were found between those who noted AD versus those who did not. Forty-one of 79 patients (51.9%) would have been interested in an initial surgical procedure without AD; interest dropped significantly if the alternative surgery involved increased risk, cost, or additional stages of reconstruction.

Conclusion:

The prevalence of AD in subpectoral implant-based breast reconstruction is significantly higher than in subpectoral augmentation. The majority of patients expressed interest in an alternative procedure to avoid AD unless it involved increased risk, cost, or additional surgeries. We found insignificant differences in age, athleticism, BMI, and implant size between patients who note AD and those who do not. Further study is necessary to better define patients at risk for AD to guide patient-centered breast reconstruction.
Elizabeth Croll: ASPS Patient of Courage 2016
Authors: Gosain Arun K.
Published: July 2017

Mrs. Elizabeth Croll was selected as an American Society of Plastic Surgeons (ASPS) Patient of Courage in 2016. During a boating accident that occurred within 1 month after graduating from Harvard Business School, she was struck by an oncoming boat and suffered severe facial trauma, resulting in an open skull injury with loss of her right eye. She has since undergone multiple reconstructive surgical procedures beginning in 1997 and continuing up to the month before she was awarded the ASPS Patient of Courage. During this time, she got married, started a family, and continued an ambitious business career. Mrs. Croll is the epitome of an individual who has overcome tragedy to further her career, her community, and access to medical care for indigent children.
Vismodegib for Locally Advanced Periocular and Orbital Basal Cell Carcinoma: A Review of 15 Consecutive Cases
Authors: Wong Kai Yuen , Fife Kate , Lear John T. , Price Richard D. , Durrani Amer J.
Published: July 2017

Basal cell carcinoma (BCC) is the most common periocular skin cancer and can lead to significant morbidity. We assess the effectiveness of vismodegib, a first-in-class Hedgehog signaling pathway inhibitor, in the management of periocular and orbital BCCs based on clinical response, tolerability, and orbital content preservation. All patients with periocular or orbital BCCs who met criteria for vismodegib treatment were recruited prospectively between May 2012 and 2014 from 2 hospitals. Patients received oral vismodegib (150 mg daily) until disease progression, unacceptable toxicity, or withdrawal. All patients were followed up monthly. Patient demographics, tumor size, treatment duration including dosing regimen, adverse events, response rate, duration of response, progression-free survival, and disease-free survival were analyzed. All 15 patients had biopsy-proven BCCs with no metastatic disease at presentation. The mean age was 74 years and 10 patients (67%) had orbital involvement. The mean lesion longest dimension was 51 mm and 7 cases (47%) represented recurrence following previous surgery and/or radiotherapy. The mean treatment duration was 13 months and mean follow-up duration 36 months. Ten patients (67%) had a complete response, 3 (20%) had a partial response, and 2 had progressive disease following an initial partial response (13%). The partial response of 55% in 1 patient allowed subsequent surgical resection with clear margins. Vismodegib is effective for treating periocular and orbital BCCs with orbital salvage of patients who otherwise would have required exenteration. There is a neoadjuvant role for vismodegib but further studies are required.
Surgery and Endometriosis
Authors: ZANELOTTI AUSTIN , DECHERNEY ALAN H.
Published: July 2017

Care of the endometriosis patient today can be complex and difficult. Once medical management has been exhausted and symptoms persist patients desire further treatment options. This chapter takes an evidence-based approach at discussion of patient surgcical options for treatment of endometriosis symptoms. Surgical techniques, success rates, patient satisfaction, and risks must be discussed and understood at depth before planning patient surgical intervention. This chapter provides reference to current surgical management options and symptom relief following those interventions.
Sonographic Tips for Evaluation of Adnexal Masses in Pregnancy
Authors: CANAVAN TIMOTHY P.
Published: July 2017

Pregnancy is frequently a women’s first contact with the health care system and often her first pelvic ultrasound examination. This first sonogram can reveal previously unknown adnexal pathology. Approximately 4% of pregnant women will have an adnexal mass detected by sonography and 1% to 2% of these masses will persist. It is estimated that up to 7% of these persistent masses will be malignant. Sonography plays an important role in differentiating benign from malignant adnexal masses and physiological from pathologic masses and should be used judiciously to complement evaluation and help guide treatment.
Pregnancy in an Abnormal Location
Authors: MONTEAGUDO ANA , ROMERO JULIE A. , TIMOR-TRITSCH ILAN E.
Published: July 2017

Cesarean scar pregnancy and cervical pregnancy are 2 relatively rare types of abnormally implanted pregnancies. Both if unrecognized can result in significant morbidity to the patient. The most important issue regarding cesarean scar pregnancy and cervical pregnancy is to establish the diagnosis early in order for the patient to be adequately counseled and appropriate management carried out. For both of these conditions early detection and treatment can result in preservation of fertility.
Contemporary Modalities to Image the Fetal Brain
Authors: DAVILA IVAN , MOSCARDO ISABEL , YEPEZ MAYEL , SANZ CORTES MAGDALENA
Published: July 2017

Fetal brain ultrasound remains as the mainstay for screening fetal intracranial anatomy. One of its main advantages is the availability of 3 dimensional and other ultrasound modalities for a better understanding of fetal neurodevelopment. Neurosonography is performed when findings, suggestive of an abnormality, are present on a screening ultrasound or if a high-risk situation of brain injury is present. This technique offers the use of complementary imaging planes, axial, coronal and sagittal, and the ability to image intracranial anatomy from the transabdominal and transvaginal approaches. Fetal brain magnetic resonance imaging is more sensitive than ultrasound. As an adjunctive imaging modality, magnetic resonance imaging offers additional sequences to complete the information on neurodevelopment from different perspectives, such as brain metabolism, microstructure, and connectivity.