bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnosis, Differential Diagnosis, and Misdiagnosis of Multiple Sclerosis
Authors: Solomon Andrew J.
Published: June 2019

PURPOSE OF REVIEW

The diagnosis of multiple sclerosis (MS) is often challenging. This article discusses approaches to the clinical assessment for MS that may improve diagnostic accuracy.

RECENT FINDINGS

Contemporary diagnostic criteria for MS continue to evolve, while knowledge about diseases that form the differential diagnosis of MS continues to expand. Recent data concerning causes of MS misdiagnosis (the incorrect assignment of a diagnosis of MS) have further informed approaches to syndromes that may mimic MS and the accurate diagnosis of MS.

This article provides a practical update on MS diagnosis through a discussion of recently revised MS diagnostic criteria, a renewed consideration of MS differential diagnosis, and contemporary data concerning MS misdiagnosis.
Clinically Isolated Syndrome and Early Relapsing Multiple Sclerosis
Authors: Metz Luanne M.
Published: June 2019

PURPOSE OF REVIEW

This article reviews management of clinically isolated syndrome and early relapsing-remitting multiple sclerosis (MS). It provides a general approach to patient management and determination of prognosis, reviews first-line disease-modifying therapies, and provides an approach to treatment selection.

RECENT FINDINGS

Revision of the MS diagnostic criteria allows an earlier MS diagnosis, which reduces diagnostic uncertainty and often allows additional treatment options. Identification of factors that influence disease activity and progression highlights the importance of counseling patients about behavior modifications that, along with disease-modifying therapy, may improve long-term outcomes. Recommended lifestyle modifications include smoking cessation, vitamin D supplementation, a healthy diet, maintaining a healthy weight, remaining active, and management of cardiovascular risk factors. Identifying individuals at high risk for future disability allows them to make informed decisions about the use of highly effective, higher-risk disease-modifying therapies.

Patients with clinically isolated syndrome, even those with only dissemination in space but not dissemination in time, and patients with relapsing-remitting MS and disease activity within the prior 2 years, are at high risk of disease activity within the next 2 years. Lifestyle modification suggestions and disease-modifying therapy should be considered. Treatment decisions should be made in collaboration with patients using the shared decision-making approach.
Pregnancy and Family Planning in Multiple Sclerosis
Authors: Langer-Gould Annette M.
Published: June 2019

PURPOSE OF REVIEW

This article provides practical guidance on successful management of women with multiple sclerosis (MS) through pregnancy and the postpartum period.

RECENT FINDINGS

Recent studies indicate that most women diagnosed with MS today can have children, breast-feed, and resume beta interferons or glatiramer acetate per their preferences without incurring an increased risk of relapses during the postpartum period. More than 40% of women with mild MS do not require any treatment before conception or in the postpartum period. Women with highly active MS can now become well-controlled before, throughout, and after pregnancy via highly effective treatments. Unfortunately, pregnancy does not protect against relapses following the cessation of fingolimod or natalizumab, and some women experience severe rebound relapses during pregnancy. Accidental first-trimester exposure to teriflunomide or fingolimod increases the risk of fetal harm.

Most women with MS can have normal pregnancies and breast-feed without incurring harm. Clinicians should avoid prescribing medications with known teratogenic potential (teriflunomide, fingolimod), known risk of severe rebound relapses (fingolimod, natalizumab), or unclear but plausible risks (dimethyl fumarate, alemtuzumab) to women of childbearing age who desire pregnancy or are not on reliable birth control. If a treatment needs to be resumed during breast-feeding, clinicians should opt for glatiramer acetate, interferon beta, natalizumab, or rituximab/ocrelizumab, as biologically plausible risks to the infant are exceedingly low.
Differential Lung Ventilation Using a Bronchial Blocker in a Pediatric Patient on Extracorporeal Membrane Oxygenation: A Case Report
Authors: Bhargava Vidit , Arastu Ali , Darling Curtis , Wang Ellen , Kache Saraswati
Published: June 2019

We describe a patient with acute on chronic respiratory failure after a cardiac arrest who was cannulated to venoarterial extracorporeal membrane oxygenation. The patient developed right-sided interstitial emphysema with air leak and left-sided hemothorax with secondary atelectasis. A differential lung ventilation strategy was used in which an endotracheal tube was placed in the left main stem bronchus and a bronchial blocker was placed in the right mainstem bronchus. The patient’s overall pulmonary function improved, and he was successfully decannulated from extracorporeal membrane oxygenation. In conclusion, differential lung ventilation may be performed in patients on extracorporeal membrane oxygenation with disparate lung disease as an alternative ventilation strategy.
Pulmonary Artery Catheter Knotted in the Tricuspid Valve Apparatus Requiring Surgery With Cardiopulmonary Bypass: A Case Report
Authors: Perez d’Empaire Pablo , Derzi Simone , Latter David , Tousignant Claude
Published: June 2019

Placement of a pulmonary artery catheter (PAC) is associated with complications such as entrapment or knotting. PAC entrapment in the heart, vena cava, or pulmonary artery is serious, potentially life-threatening, particularly if they are unrecognized. We present a patient with a PAC knot after aortic valve replacement. Interventional radiology (IR) determined that the catheter may have lodged in the tricuspid valve. Surgical exploration requiring cardiopulmonary bypass revealed that the PAC had passed through the tricuspid valve orifice and knotted itself around the anterior leaflet chordal structure. The catheter was unknotted, with the patient subsequently recovering without long-term sequelae.
Stellate Ganglion Catheter Effective for Treatment of Ventricular Tachycardia Storm in a Pediatric Patient on Extracorporeal Membrane Oxygenation: A Case Report
Authors: Franklin Andrew D. , Llobet J. Rodrigo , Sobey Christopher M. , Daniels Jessica M. , Kannankeril Prince J.
Published: June 2019

Ventricular tachycardia (VT) storm, defined as recurrent VT requiring electrical cardioversion ≥3 times within 24 hours, is a rare presentation of long-QT syndrome. Pharmacologic autonomic modulation and/or left cardiac sympathetic denervation are established therapies in long-QT syndrome in adults but may not be effective or practical in the emergent treatment of VT storm. We present a novel case of a child with drug-refractory VT storm and prolonged QT requiring extracorporeal membrane oxygenation (ECMO) support. Continuous stellate ganglion blockade was remarkably effective in stabilizing his rhythm and should be considered in similar pediatric cases.
Evidence of a developmental origin of beta-cell heterogeneity using a dual lineage tracing technology
Authors: Chen Congde , Shiota Chiyo , Agostinelli Guy , Ridley Daniel , Jiang Yinan , Ma Jie , Prasadan Krishna , Xiao Xiangwei , Gittes George K.
Published: June 2019

The Cre/loxP system has been used extensively in mouse models with a limitation of one lineage at a time. Differences in function and other properties among populations of adult beta-cells is termed beta-cell heterogeneity, which was recently associated with diabetic phenotypes. Nevertheless, the presence of a developmentally-derived beta-cell heterogeneity is unclear. Here, we developed a novel dual lineage tracing technology, using a combination of two recombinase systems, Dre/RoxP and Cre/LoxP, to independently trace green fluorescent Pdx1-lineage cells and red fluorescent Ptf1a-lineage cells in the developing and adult mouse pancreas. We detected a few Pdx1+/Ptf1a- lineage cells in addition to the vast majority of Pdx1+/Ptf1a+ lineage cells in the pancreas. Moreover, Pdx1+/Ptf1a+ lineage beta-cells had fewer Ki-67+ proliferating beta-cells, and expressed higher mRNA levels of insulin, Glut2, Pdx1, MafA and Nkx6.1, but lower CCND1 and CDK4, compared to Pdx1+/Ptf1a- lineage beta-cells. Furthermore, more TSQ-high, SSC-high cells were detected in the Pdx1+Ptf1a+ lineage population than in the Pdx1+Ptf1a- lineage population. Together, these data suggest that differential activation of Ptf1a in the developing pancreas may correlate with this beta-cell heterogeneity.
Prior reproduction alters how mitochondria respond to an oxidative event
Authors: Hood Wendy R. , Zhang Yufeng , Taylor Halie A. , Park Noel R. , Beatty Abby E. , Weaver Ryan J. , Yap Kang Nian , Kavazis Andreas N.
Published: June 2019

An animal's pace of life is mediated by the physiological demands and stressors it experiences (e.g., reproduction) and one likely mechanism that underlies these effects is oxidative stress. Reproduction has been shown to increase or reduce oxidative stress under different conditions and modify mitochondrial performance. We hypothesized that the changes associated with reproduction can alter how animals respond to future oxidative stressors. We tested this theory by comparing the organ-specific mitochondrial response in female wild-derived house mice. Specifically, we compared mice that reproduced or were virgins to mice that were exposed to an oxidant (i.e., radiation) or not-exposed to radiation. We measured liver and skeletal muscle mitochondrial density, respiratory performance, enzyme activity, and oxidant production, as well as markers of oxidative damage to tissues. In the liver, prior reproduction prevented a radiation-induced reduction in mitochondrial density and increased mitochondrial respiratory performance. In skeletal muscle, prior reproduction resulted in a radiation-induced decline in mitochondrial density which could reduce the bioenergetic capacity of skeletal muscle mitochondria. Yet, electron transport chain complex I activity in skeletal muscle, which dropped with reproduction, returned to control levels following oxidant exposure. The results of this investigation indicate that prior reproduction alters the response of mitochondria to an oxidative challenge in an organ-specific manner. Such changes could have differential effects on future reproductive performance and risk of death.
Predatory behavior changes with satiety or increased insulin levels in the praying mantis (Tenodera sinensis)
Authors: Bertsch David J. , Martin Joshua P. , Svenson Gavin J. , Ritzmann Roy E.
Published: June 2019

At any given moment behavior is controlled by a combination of external stimuli and an animal's internal state. As physiological conditions change, vastly different behaviors might result from the same stimuli. For example, the motivation to hunt and hunting strategy is influenced by satiety. Here, we describe how sensory responsiveness and motor activity of a praying mantis (Tenodera sinensis) are changed as the insect feeds, leading to an altered hunting strategy. We further show that these changes can be induced by injection of insulin, which likely functions as a metabotropic indicator.

Praying mantises directed their attention toward real and simulated prey less often as they fed and became sated. The ranges of distance and azimuth at which prey was detected decreased as did pursuit of prey, while opportunistic close range attacks persisted. Together, these sensorimotor changes are indicative of a behavioral paradigm shift from “pursuit” to “ambush.” A similar effect was induced in starved praying mantises injected with 0.05 ml of 200 μg/ml bovine insulin. These experiments showed that insulin injection into the circulating hemolymph is sufficient to decrease prey orientation as well as in prey-directed locomotor behaviors (tracking and pursuit). The effects of both prey consumption and insulin injection were similarly dose-dependent. These results suggest that insulin is a signal of internal, physiological conditions that can modify responses to external stimuli. A change in hunting strategy thus results from coordinated effects of a neurohormone on a set of independent sensorimotor processes and the overall activity level of the animal.
Upstroke-based acceleration and head stabilization are the norm for the wing-propelled swimming of alcid seabirds
Authors: Lapsansky Anthony B. , Tobalske Bret W.
Published: June 2019

Alcids, a family of seabirds including murres, guillemots, and puffins, exhibit the greatest mass-specific dive depths and durations of any birds or mammals. These impressive diving capabilities have motivated numerous studies on the biomechanics of alcid swimming and diving, with one objective being to compare stroke-acceleration patterns of swimming alcids to those of penguins, where upstroke and downstroke are used for horizontal acceleration. Studies of free-ranging, descending alcids have found that alcids accelerate in the direction of travel during both their upstroke and downstroke, but only at depths<20m, whereas studies of alcids swimming horizontally report upstroke-based acceleration to be rare (≤ 16% of upstrokes). We hypothesized that swimming trajectory, via its interaction with buoyancy, determines the magnitude of acceleration produced during the upstroke. Thus, we studied the stroke-acceleration relationships of five species of alcids swimming freely at the Alaska SeaLife Center using videography and kinematic analysis. Contrary to our prediction, we found that upstroke-based acceleration is very common (87% of upstrokes) during both descending and horizontal swimming. We reveal that head-damping – wherein an animal extends and retracts its head to offset periodic accelerations – is common in swimming alcids, underscoring the importance of head stabilization during avian locomotion.
Acetoin, a key odor for resource location in the giant robber crab, Birgus latro
Authors: Knaden Markus , Bisch-Knaden Sonja , Linz Jeanine , Reinecke Andreas , Krieger Jakob , Erland Susanne , Harzsch Steffen , Hansson Bill S.
Published: June 2019

The terrestrial and omnivorous robber crab Birgus latro inhabits islands of the Indian Ocean and the Pacific Ocean. The animals live solitarily but occasionally gather at freshly opened coconuts or fructiferous arenga palms. By analyzing volatiles of coconuts and arenga fruit we identified five compounds, including Acetoin, which are present in both food sources. In a behavioral screen performed in the crabs’ habitat, a beach on Christmas Island, we found that of 15 tested fruit compounds Acetoin was the only volatile eliciting significant attraction. Hence, Acetoin might play a key role in governing the crabs’ aggregation behavior at both food sources.
New Chemical Family of [n-CxH(2x+1)NEt3][BEt3Me] Showing Ionic Plastic-Crystal (x = 4, 5), Rotator-Crystal (x = 6, 7) and Liquid-Crystal Phases (x = 8–16)
Authors: Yamada Yudai , Kashimoto Erina , Honda Hisashi
Published: June 2019

New ionic liquid crystals of [n-CxH(2x+1)NEt3][BEt3Me] (abbreviated to [CxNEt3][BEt3Me]) were detected for species with even numbers of 8 ≤ x ≤ 16. In contrast, plastic- and rotator-crystal phases were obtained for [CxNEt3][BEt3Me] species with lower x values of x = 4, 5, and 6, 7, respectively. Because we previously documented plastic phases for the [CxNEt3][BEt3Me] (x = 1–3) species, [CxNEt3][BEt3Me] can be classified as a novel chemical family adopting the entire range of states (mesophases) between solid and isotropic liquid phases (plastic, rotator, and liquid crystals) as a function of the alkyl chain length. Polarized optical microscope (POM) and X-ray diffraction (XRD) measurements revealed that these liquid crystals (x = 8–16 with even numbers of x) form smectic B (x = 8) and A (x = 10), and nematic phases (x ≥ 12) in the liquid-crystal phases. In the case of x = 4, 5, XRD analysis showed that the salts form cubic crystal structures. Furthermore, the NMR line shapes revealed that both the cation and anion underwent isotropic reorientation. In contrast, the NMR spectra showed that the cations rotated about their long axis in the [C6NEt3][BEt3Me] and [C7NEt3][BEt3Me] crystals.
Photoreversible Interference Color Modulation to Multicolor in Photochromic Molecular Crystals
Authors: Morimoto Kohei , Tsujioka Hajime , Kitagawa Daichi , Kobatake Seiya
Published: June 2019

Functional molecular crystals responsive to external stimuli represent a new frontier for material chemistry and crystal engineering. Here, we report on the photoreversible interference color change in single crystals composed of a photochromic diarylethene derivative, 1,2-bis(2-ethyl-5-phenyl-3-thienyl)perfluorocyclopentene (1a). When crystal 1a was observed by rotating the sample stage at 45° from the extinction position under crossed Nicols, it showed an interference color. Upon irradiation with ultraviolet (UV) light, the interference color changed dramatically and instantaneously in response to photoirradiation due to the photocyclization reaction from the open-ring form to the closed-ring form. The change was quite sensitive to the photochromic reaction. It is attributable to the large decrease in retardation induced by the photocyclization reaction in crystals. These results might provide new opportunities for application of photochromic crystals.
Quality Assessment of Professional Tourism Education in International Certification Systems
Authors: Ефремцева Т. , Efremceva T.
Published: June 2019

The article analyzes the international quality systems of vocational tourism education. The main focus is on the dynamics of the development of these systems for the evaluation and accreditation of higher education institutions programs in the field of tourism and hospitality. The competencies necessary for a graduate of a tourism university to undergo international certification are highlighted.
Theoretical Model for Forming Hardiness for Persons with Disabilities
Authors: Михальчи Екатерина , Mihal'chi Ekaterina
Published: June 2019

The article presents the results of the study of the component of hardiness, in the opinion of students of inclusive groups. Based on the data obtained on the components of hardiness, theoretical model of the formation of hardiness for persons with disability was compiled. In the well-known model of the hardiness of the American scientist Maddy S. and his colleagues added the volitional qualities - courage and resilience, as a "national" component of the construct of the viability of the individual, as well as the individual's overall psychological ability - responsibility. The study of hardiness, as the psychological quality of the individual, is currently the current direction in the psychology of disability. The developed theoretical model of the formation of hardiness includes the components of physical, social and personal components and can be used as the basis for the content of the adaptation discipline “Psychology of Hardiness” for people with disabilities.
The Role and the Place of Geometry in the System of Mathematical School Olympiads
Authors: Келдибекова Аида , Keldibekova Aida , Селиванова Н. , Selivanova N.
Published: June 2019

The purpose of this article is to determine the role and place of school geometry in the subject olympiad system. For this, the authors turn to the experience of Russia in organizing and conducting geometric olympiads for schoolchildren, exploring the specifics of the olympiads named after named I.F. Sharygin, named S.A. Anischenko, named A.P. Savina, Moscow and Iran olympiads. The objectives and themes of full-time, extramural, oral geometric olympiads are defined. It is revealed that the topics of topology, projective, affine, combinatorial sections of geometry constitute the content of olympiad geometry. The study showed that the tasks of the olympiad work on geometry checked mathematical skills to perform actions with geometric figures, coordinates and vectors; build and explore simple mathematical models; apply acquired knowledge and skills in practical activities. The conclusions are made about the need to include tasks of geometric content in the block of olympiad tasks for the development of spatial thinking of schoolchildren.
Między biologią a kulturą. Atrakcyjność fizyczna w badaniach międzykulturowych
Authors: Hołda Renata
Published: June 2019

BETWEEN BIOLOGY AND CULTURE. PHYSICAL ATTRACTIVENESS IN INTERCULTURAL STUDIESThe aim of the paper is to review the most important positions on the biological, evolutionary approach to culture, and on this background, to present selected notions for physical attractiveness identified with beauty and prettiness. Proponents of these concepts mostly argue with the researchers of culture, undermining relativism and pointing out that the diversity of human groups and the canons of beauty are only a less important veil under which the universal patterns of aesthetic choices are hidden. These views have not found reflection in the mainstream of humanistic research yet, but the possible implementation of postulates to create non-anthropocentric humanities makes the main findings of evolution supporters relevant for researchers of culture.
Лемківска Республика во Фльоринці 1918‑1921
Authors: Horbal Bogdan
Published: June 2019

Florynka Republic 1918-1921The main part of the article is a synthesis of the issues discussed by the author in his book Działalność polityczna Łemków na Łemkowszczyźnie 1918‑1921 [Political activity of the Lemkos in the Lemko Region in 1918‑1921]. The author presents successive phases of the activity of the Lemko elites who were inspired by the message expressed by Woodrow Wilson in his speech about the nations’ right to self-determination. The article quotes the demands formulated at national councils, reconstructs the structure of administration and government and demonstrates the connections between and the political agenda of the leaders who comprised the Ruthenian National Republic of the Lemkos. Furthermore, the author emphasizes the mutual attitudes between the Poles and the Lemkos in that period, as well as the restrictions imposed on the Lemko population and discusses how the Lemko Republic ended after its leaders were arrested and then acquitted several months later at a court trial. This synthesis is preceded by a contemporary introduction whose primary goal is to present the state of research that has been carried out since 1997.
Innominate Salter osteotomy using resorbable screws: A retrospective case series and presentation of a new concept for fixation
Authors: Hedelin H. , Larnert P. , Hebelka H. , Brisby H. , Lagerstrand K. , Laine T.
Published: June 2019

Purpose

The Salter innominate osteotomy (SIO) in children is traditionally stabilized by Kirschner-wires, which have issues regarding stability, infection and the need to be extracted. To counter these disadvantages, we present a surgical method to stabilize SIO with modern resorbable poly lactic-co-glycolic acid screws. Using a case series of 21 patients treated with SIO for developmental dysplasia of the hip or Legg-Calvé-Perthes disease we evaluate the feasibility of the method.

Methods

The integrity of the osteotomy was interpreted by radiological measurements of acetabular index, centre-edge angle and Reimer's index. Perioperative and postoperative complications were evaluated.

Results

Radiographic evaluation revealed a stable osteotomy and favourable development in all measured parameters with the exception of one patient who fell out of bed the first day postoperatively. No other perioperative surgical complications were observed and there were no local reactions to the resorbable screws.

Conclusion

Modern resorbable screws carry multiple benefits both for the patient and the surgeon. In our case series the implants provided sufficient stability and the implants caused no local reactions. The use of resorbable implants gave the surgeon a wider range of possible screw placements and avoided the need for implant removal.

Level of evidence

Level IV – Case series
Emergency room closed reduction versus in situ splinting in the treatment of paediatric supracondylar humerus fractures
Authors: Sylvia S. M. , Maguire K. J. , Molho D. A. , Levens B. J. , Stone M. E. , Hanstein R. , Schulz J. F. , Fornari E. D.
Published: June 2019

Purpose

Displaced supracondylar humerus fractures are treated with open or closed reduction and percutaneous pinning. In 2012, our management of patients with a displaced fracture changed from closed reduction in the emergency department (ED) to in situ splinting prior to closed reduction and pinning in the operating room (OR). The purpose of this study was to investigate if outcomes or complications differ between these two management methods.

Methods

Patients less than ten years old with a Gartland type II or III supracondylar humerus fracture between 2008 and 2016 were included. Cases of polytrauma were excluded. Radiographic outcomes were assessed at follow-up. The Fisher's exact test was used for categorical variables and the Wilcoxon rank sums tests for continuous variables.

Results

In all, 157 patients were included, 89 with reduction in the ED and 68 without. There was no significant difference between the groups related to demographic factors or fracture characteristics. Patients managed without reduction in the ED had a lower average delay from ED to OR compared with those treated with reduction (16 hours versus 22 hours, p < 0.005) and a shorter hospital length of stay (34 hours versus 40 hours, p < 0.005).

Conclusion

No difference in complications or outcomes was found between patients with Type II or III supracondylar fractures treated initially with or without closed reduction in the ED. Patients treated without ED reduction were taken to the OR sooner and remained in the hospital for a shorter period of time. Splinting in situ reduces anaesthesia exposure without increasing postoperative complications or suboptimal outcomes.

Level of Evidence

Level III, retrospective comparative study
Exposing the glenoid in shoulder arthroplasty
Authors: Nové-Josserand Laurent
Published: June 2019

Glenoid exposure should offer frontal access to the glenoid to allow the ancillary tools to be used freely and thus facilitate the good positioning of the glenoid implant. The two classically recognized approaches for shoulder arthroplasty are the deltopectoral and the transdeltoid approach. The axillary nerve is the most important anatomical structure in the glenoid, passing down the anterior part of the subscapularis, the inferior pole of the joint and the deep face of the deltoid muscle. Inferior glenohumeral release is the key step that allows the humerus to be retracted back or downwards thereby exposing the glenoid face on. In difficult and stiff cases, once pectoralis major release, osteophyte resection and posterior capsulectomy have been performed, a compression fracture, produced by using a retractor to push against the upper extremity of the humerus, can provide the extra few millimetres of space required to use the ancillary tools without hindrance.

Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180057
The benefits of collaboration: the Nordic Arthroplasty Register Association
Authors: Mäkelä Keijo T. , Furnes Ove , Hallan Geir , Fenstad Anne Marie , Rolfson Ola , Kärrholm Johan , Rogmark Cecilia , Pedersen Alma Becic , Robertsson Otto , W-Dahl Annette , Eskelinen Antti , Schrøder Henrik M. , Äärimaa Ville , Rasmussen Jeppe V. , Salomonsson Björn , Hole Randi , Overgaard Søren
Published: June 2019

The Nordic Arthroplasty Register Association (NARA) was established in 2007 by arthroplasty register representatives from Sweden, Norway and Denmark with the overall aim to improve the quality of research and thereby enhance the possibility for quality improvement with arthroplasty surgery. Finland joined the NARA collaboration in 2010. NARA minimal hip, knee and shoulder datasets were created with variables that all countries can deliver. They are dynamic datasets, currently with 25 variables for hip arthroplasty, 20 for knee arthroplasty and 20 for shoulder arthroplasty. NARA has published statistical guidelines for the analysis of arthroplasty register data. The association is continuously working on the improvement of statistical methods and the application of new ones. There are 31 published peer-reviewed papers based on the NARA databases and 20 ongoing projects in different phases. Several NARA publications have significantly affected clinical practice. For example, metal-on-metal total hip arthroplasty and resurfacing arthroplasty have been abandoned due to increased revision risk based on i.a. NARA reports. Further, the use of uncemented total hip arthroplasty in elderly patients has decreased significantly, especially in Finland, based on the NARA data. The NARA collaboration has been successful because the countries were able to agree on a common dataset and variable definitions. The collaboration was also successful because the group was able to initiate a number of research projects and provide answers to clinically relevant questions. A number of specific goals, set up in 2007, have been achieved and new one has emerged in the process.

Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180058
Inadvertent excision of malignant soft tissue tumours
Authors: Grimer Robert , Parry Michael , James Steven
Published: June 2019

Inadvertent excision of lumps which turn out to be sarcomas is not uncommon. Imaging has a limited role in detecting microscopic residual disease but can show the extent of the previous surgical field. Standard treatment is wide re-excision, usually combined with radiotherapy. Residual tumour is found in an average of 50% of reported cases. The presence of residual disease is an adverse prognostic factor. All lumps bigger than a golf ball should have a diagnosis prior to excision.

Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180060
Musculoskeletal treatment in haemophilia
Authors: Atilla Bülent , Güney-Deniz Hande
Published: June 2019

Haemophilia is a group of coagulation disorders inherited in an X-linked recessive pattern. Nearly three-quarters of all haemorrhages in haemophilia occur in the musculoskeletal system, usually in the large muscles and joints of the lower extremity. While prevention of bleeding with active prophylaxis is the recommended optimal therapy for severe haemophilia, there are many patients suffering from musculoskeletal system complications subsequent to uncontrolled bleeding. Recombinant clotting factor concentrates led to home treatment of acute bleeding episodes as well as allowing for minor and major surgical interventions. Avoiding of further complications by radiosynoviorthesis is the first-line recommendation, and arthroplasty is regarded as the effective salvage procedure for patients presenting with severe disability. Physiotherapy and rehabilitation in haemophilia patients are important to return the normal status of joint motion, to regain the muscle strength, to obtain the optimal functional levels and to improve patients’ quality of life.

Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180068
The geriatric patient: special aspects of peri-operative management
Authors: Wirtz Dieter , Kohlhof Hendrik
Published: June 2019

This article offers a German perspective on orthopaedic management of geriatric populations in higher-income countries. Specific orthopaedic procedures necessitate a more intensive level of care in older adult patients, especially with co-morbidities, than in younger patients. During the pre-, peri- and post-operative periods, several aspects such as patient blood management principles improve the outcomes of geriatric patients. New interdisciplinary geriatric models of care including geriatric and orthopaedic specialties have to be established to take care of the special needs of geriatric patients.

Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180087
Does the source of referral affect outcomes for paediatric testicular torsion?
Authors: Peeraully R , Jancauskaite M , Dawes S , Green S , Fraser N
Published: June 2019

Introduction

This single centre study retrospectively analysed the intraoperative findings relative to source of referral for emergency scrotal explorations performed in a tertiary level paediatric surgery department.

Methods

All patients who underwent emergency scrotal exploration under the care of paediatric surgeons in our unit between April 2008 and April 2016 were identified. Clinical data were obtained from contemporaneous records.

Results

Over the 8-year study period, 662 boys underwent emergency scrotal exploration: 6 (1%) were internal referrals, 294 (44%) attended our emergency department (ED) directly, 271 (41%) were referred from primary care and 91 (14%) were transferred from other hospitals. Excluding procedures in neonates, testicular torsion was present in 100 cases (15%). Testicular detorsion with bilateral 3-point testicular fixation was performed in 66 (66%) and orchidectomy with contralateral fixation in 34 (34%) where the torted testis was non-viable intraoperatively. The orchidectomy rate in the presence of torsion was 23% in ED referrals (12/52), 43% in primary care referrals (12/28) and 50% for transfers (10/20). The difference in rates between ED referrals and patients transferred from other hospitals was significant (p=0.026). There was no significant difference in median age between any of the groups (p=0.10).

Conclusions

Boys undergoing emergency scrotal exploration had a higher orchidectomy rate when transferred from other hospitals to our unit. This difference was statistically significant when compared with boys presenting directly to our ED. This supports advice from The Royal College of Surgeons of England for undertaking paediatric scrotal explorations in the presenting hospital when safe to do so rather than delaying the care of these patients by transferring them to a tertiary paediatric surgical unit.
Giant anterior urethra stones combined with a diverticulum: a case report
Authors: Chen S , Su X , Jiang M , Mi H
Published: June 2019

Urethral diverticulum is a condition where the urethra or the periurethral glands push into the connective tissue layers that surround it. Patients of urethral diverticulum present with nonspecific symptoms such as incontinence, urinary frequency and urgency, and pain during sexual intercourse and urination. The incidence of this condition is low. We report a case of giant anterior urethra stones combined with a diverticulum with no lower urinary tract symptoms. We believe that this case is extremely rare, and the process of diagnosis and treatment is of great significance in clinical practice.
A rare case of thoracic spinal intradural extramedullary enterogenous cyst with acute onset: case report and literature review
Authors: Liu CX , Meng B , Li YB , Bai H , Wu ZX
Published: June 2019

The intraspinal enterogenous cyst, also called an neurenteric cyst, is a rare congenital disease. It was reported to be local to the C1 to L2 spinal segments, with the majority located in the cervicothoracic region. Most patients present with symptoms of progressive focal pain, myelopathic signs or radicular symptoms. We report a rare case of thoracic spinal intradural extramedullary enterogenous cyst with rapidly progressive weakness of both lower extremities. Additionally, we analysed the literature concerning the clinical features, diagnosis and prognosis of this disease.
Revascularisation through the obturator foramen of lower limbs with a compromised ipsilateral groin due to infection
Authors: Zenunaj G , Traina L , Acciarri P , Spataro C , Gasbarro V
Published: June 2019

Introduction

Infra-inguinal vascular reconstruction with active groin infection is a concerning issue. Using resistant grafts to infection is the most adopted approach. However, in absence of these materials in acute situations, the trans-obturator approach allows for limb revascularisation avoiding the infected site. We evaluated the effectiveness of this approach in patients who needed lower limb revascularisation with an ipsilateral groin infection.

Materials and methods

A retrospective study was conducted over a four-year period.

Results

Over this period, 13 patients underwent trans-obturator reconstructions (13 external iliac–popliteal above-knee and one aortobipopliteal above-knee bypass). Seven patients had been previously revascularised and were admitted for graft infection (six infra-inguinal bypasses, one axillo-bifemoral bypass). Four presented with acute limb ischaemia, three with groin haematoma and one with a groin abscess. The remaining cases consisted of drug-addicted patients with injury of femoral vessels due to self-injection of drugs. The patients underwent reconstructions with autologous grafts which complicated early with groin haematoma. After transobturator revascularisation, the groin underwent debridement with applying vacuum-assisted wound closure device.

Conclusion

The transobturator approach could be considered as a chance for lower limb revascularisation in case of ipsilateral groin infection. Moreover, avoiding the infected site allowed us to focus separately and safely on the treatment of the inguinal wound.
Perforated diverticulitis in the North of England: trends in patient outcomes, management approach and the influence of subspecialisation
Authors: Baldock TE , Brown LR , McLean RC
Published: June 2019

Introduction

In recent years, several management options have been used in the management of perforated diverticulitis, ranging from conservative treatment to laparotomy. General surgery has also become increasingly specialised over time. This retrospective cohort study investigated changes in patient outcomes following perforated diverticulitis, management approach and the influence of consultant subspecialisation over time.

Materials and methods

Data was collected on patients admitted with perforated diverticulitis in the North of England between 2002 and 2016. Subspecialisation was categorised as colorectal or other general subspecialties. The primary outcome of interest was overall 30-day mortality; secondary outcomes included surgical approach, stoma and anastomosis rate.

Results

A total of 3394 cases of perforated diverticulitis were analysed (colorectal, n = 1290 and other subspecialists, n = 2104) with a 30-day mortality of 11.6%. There was a significant reduction in mortality over time (2002–2006: 18.6% to 2012–2016: 6.8, P < 0.001). There was a significant reduction in open surgery (60% to 25.3%, P < 0.001) with increased conservative management (37.4% to 63.5%, P < 0.001), laparoscopic resection (0.1% to 4.9%, P < 0.001) and laparoscopic washout (0.1% to 5.7%, P < 0.001). Patients admitted under colorectal surgeons had lower mortality than other subspecialists (9.9% vs 12.4%, P = 0.027), which remained significant following multivariate adjustment (hazard ratio 1.44, P = 0.039). These patients had fewer stomas (13.9% vs. 21.0%, P = 0.001) and higher anastomosis rates (22.1% vs 15.8%, P = 0.004).

Conclusion

This study demonstrated considerable improvements in the management of perforated diverticulitis alongside the positive impact of subspecialisation on patient outcomes.
A Preparation Guide for Java Call Graph Comparison
Authors: Pengő Edit , Ságodi Zoltán
Published: June 2019

Call graphs provide basis for numerous interprocedural analysers and tools, therefore it is crucial how precisely they are constructed. Developers need to know the features of a call graph builder before applying it to subsequent algorithms. The characteristics of call graph builders are best understood by comparing the generated call graphs themselves. The comparison can be done by matching the corresponding nodes in each graph and then analysing the found methods and calls. In this paper, we developed a process for pairing the nodes of multiple call graphs produced for the same source code. As the six static analysers that we collected for call graph building handles Java language elements differently, it was necessary to refine the basic name-wise pairing mechanism in several steps.  Two language elements, the anonymous and generic methods, needed extra consideration. We describe the steps of improvement and our final solution to achieve the best possible pairing through the analysis of the Apache Commons-Math project.
Operations on Signed Distance Functions
Authors: Bálint Csaba , Valasek Gábor , Gergó Lajos
Published: June 2019

We present a theoretical overview of signed distance functions and analyze how this representation changes when applying an offset transformation. First, we analyze the properties of signed distance and the sets they describe.

Second, we introduce our main theorem regarding the distance to an offset set in (X,||.||) strictly normed Banach spaces. An offset set of D in X is the set of points equidistant to D. We show when such a set can be represented by f(x)-c=0, where c denotes the radius of the offset. Finally, we explain these results for applications that offset signed distance functions.
Multi Party Computation Motivated by the Birthday Problem
Authors: Hudoba Péter , Burcsi Péter
Published: June 2019

Suppose there are n people in a classroom and we want to decide if there are two of them who were born on the same day of the year. The well-known birthday paradox is concerned with the probability of this event and is discussed in many textbooks on probability. In this paper we focus on cryptographic aspects of the problem: how can we decide if there is a collision of birthdays without the participants disclosing their respective date of birth. We propose several procedures for solving this in a privacy-preserving way and compare them according to their computational and communication complexity.
Multi-Cloud Management Strategies for Simulating IoT Applications
Authors: Márkus András , Dombi József Dániel
Published: June 2019

The Internet of Things (IoT) paradigm is closely coupled with cloud technologies, and the support for managing sensor data is one of the primary concerns of Cloud Computing. IoT-Cloud systems are widely used to manage sensors and different smart devices connected to the cloud, hence a large amount of data is generated by these things that need to be efficiently stored and processed. Simulation platforms have the advantage of enabling the investigation of complex systems without the need of purchasing and installing physical resources. In our previous work, we chose the DISSECT-CF simulator to model IoT-Cloud systems, and we also introduced provider policies to enable cost-aware policies resource management. The aim of this paper is to further extend the simulation capabilities of this tool by enabling multi-cloud management. In this paper we introduce four cloud selection strategies aimed to reduce application execution time and utilization costs. We detail our proposed method towards multi-cloud extension, and evaluate defined strategies through a meteorological application.
Preprints na comunicação científica: uma introdução
Authors: Damasio Edilson
Published: June 2019

O modelo de publicação em preprints está inserido na comunicação científica. Definido como um documento técnico científico disponibilizado de forma preliminar antes de sua publicação. Após os recursos da Internet e com diretrizes indicadas pelos movimentos de Acesso Aberto, surgiram na década de 1990 os primeiros projetos de disponibilização e arquivamento de artigos científicos antes da publicação, denominados preprints. O primeiro servidor, o arXiv é muito utilizado por áreas de exatas e computação há duas décadas. No início de 2010 os preprints começam a ganhar vida em outras áreas, e em 2013 na área biomédica com a criação do bioRXiv, com o objetivo de compartilhar textos, rascunhos, documentos de trabalho e seus resultados antes da revisão por pares e publicação. O modelo de publicação preprints está em constante crescimento junto às publicações em acesso aberto, e mostra-se como um novo paradigma da revisão por pares, e uma das atuais discussões em comunicação científica e editoração, chegando a ser um modelo adotado pelas principais revistas interdisciplinares do mundo as revistas Nature e Science, e com projeto lançado em 2017 para o SciELO. Também são incentivados por agências de financiamento e autores da área biomédica como um modelo muito positivo, prioritário e eficiente. Outra facilidade dos preprints é a sua possibilidade de conexão com outros modelos de disponibilização de conteúdos atuais, como as redes sociais e outras mídias gerando uma visualização e impacto nos meios de divulgação não tradicionais.
Reconstrução da memória social através de práticas culturais na Biblioteca Central da Universidade Federal de Santa Maria/RS
Authors: Arabidian Lizandra Veleda
Published: June 2019

A universidade exerce importante função na sociedade, pois é considerado um espaço fundamental para a construção da identidade sociocultural de um país. E neste contexto se apresenta a biblioteca como lugar fundamental na construção dos sujeitos sociais, em consonância com a função social que a universidade desempenha. Partindo dessa premissa, este trabalho tem o objetivo de apresentar a função social da biblioteca universitária enquanto lugar de memória, como um espaço de práticas culturais, onde através da reconstrução da sua memória social, são elaboradas representações, contribuindo para a preservação e difusão da sua memória, através de exposições que marcaram a sua história no âmbito da Instituição.
Las derrotas de Alberto Méndez: memoria y duelo en Los girasoles ciegos (2004)
Authors: Giménez Facundo
Published: June 2019

El libro de Alberto Méndez, Los girasoles ciegos (2004), se publica en el contexto de un boom memorístico que, en España, tuvo como centro a los sucesos de la guerra civil y la posguerra franquista. El siguiente trabajo se propone analizar, en principio, la polisemia de la palabra «derrota» con que Méndez titula los cuatro relatos del libro, para luego, observar los alcances de este término en la construcción de una memoria colectiva. El volumen en cuestión, en este sentido, será abordado menos como una reconstrucción histórica, que como una intervención en la memoria traumática de la derrota. De este modo, se observará cómo Los girasoles ciegos propone la necesidad de un trabajo de duelo y de una escena de perdón.
Zoopoéticas: tres escrituras animales
Authors: Vergara Pablo
Published: June 2019

El artículo busca pensar algunos aspectos de las obras de los escritores Felisberto Hernández, Mario Levrero y Antonio Di Benedetto a partir de un corpus de textos breves y fragmentos de novela en los que se piensa el elusivo acto de la escritura a partir del uso de figuraciones animales. Se intenta definir a partir de esto lo que podría ser una «escritura animal» y desentrañar su posibilidad o imposibilidad. Este intento trae a un primer plano consideraciones particulares acerca del tiempo, y de la relación entre autor y obra, además de abrevar en ciertas consideraciones acerca de la animalidad y la filosofía vitalista de Derrida y Deleuze−Guattari respectivamente.
Il n'y a pas le sujet: vive le citoyen!
Authors: Antelo Raúl
Published: June 2019

El sujeto, entendido como síntesis moderna de lo transcendental y lo fenoménico, se ha vuelto, en el pensamiento contemporáneo, un límite más que una fundación. La guerra civil o stasis es actualmente la auténtica condición de lo político y por ello la viabilidad del sujeto depende de su participación en la lucha democrática. Cincuenta años después de 1968, una exposición (¡Proteste! Resistencia en cartel) nos brinda no solo un atlas de memoria visual así como un llamado a la necesidad de resistencia sino también nos muestra el lugar del sujeto latinoamericano desde la perspectiva europea.
Sobre: La narración perturbadora: un nuevo concepto narratológico transmedial, de Sabine Schlickers, con la colaboración de Vera Toro. Madrid/Frankfurt: Iberoamericana/Vervuert, 2017.
Authors: Gerbaudo Analía Isabel
Published: June 2019

Sobre: La narración perturbadora: un nuevo concepto narratológico transmedial, de Sabine Schlickers, con la colaboración de Vera Toro. Madrid/Frankfurt: Iberoamericana/Vervuert, 2017.