bluuebunny/crossref_metadata_2025 huggingface dataset:
Gear grinding system adapting to higher CNC grinder throughput
Authors: Larshin Vasily , Lishchenko Natalya
Published: November 2018

The paper is devoted to a solving an important scientific and technical problem of increasing the productivity of defect-free profile gear grinding on CNC machines on the basis of development of on-machine intelligent subsystems for the grinding operation designing, monitoring, and diagnosing which allow grinding system elements adapting to a higher productivity of the CNC grinder. The characteristic of the adaptation principle in manufacturing systems on CNC machines is given in accordance with both the systems and control theories. The productivity resources based on the use of the adaptation principle are studied and identified as well as a methodology is developed for researching the grinding system using scientific methods of modeling, optimization and control. Besides, corresponding technological preconditions are given in the form of a set of purposeful methods and means of innovative profile grinding technology, including grinding stock on-machine measurement and transformation the stock uncertainty into the grinding wheel displacement from the gear to be grinded.
Analysis of heterogeneous information and diagnostics of complex technical systems based on methods of diakoptics and correlation analysis
Authors: Narakidze Nuri D. , Oganyan Roman G. , Mokhov Vasily A.
Published: November 2018

The article is devoted to the investigation of the applicability of the correlation analysis for the processing of heterogeneous data obtained from complex technical systems. In this article, heterogeneous data is understood to mean heterogeneous data obtained from means of monitoring the state of individual objects. The proposed approach is proposed to be used to diagnose complex technical systems using the example of digital substations. For this purpose, an imitation model for power substation based on the method of diakoptics was developed. And all components of the system, regardless of their physical functioning principles, are represented in the form of electrical sub-models. The substitution schemes based on operational amplifiers are used. The model simulates the operation of measuring current and voltage transformers, power transformer, circuit breaker and relay protection. To test the proposed approach, we also considered an amplifier circuit based on three operational amplifiers. The calculation of the circuit is described, as well as the simulation of the circuit in the MicroCap environment. The simulation was carried out with the aim of realizing parametric and structural diagnostics on the basis of correlation analysis. The results of modeling the applicability of the proposed approach for both parametric and structural diagnostics is proved operability.
Mathematical modelling and analysis of thermometric diagnostics of electrical products
Authors: Shaykhutdinov Danil V. , Shirokov Konstantin M.
Published: November 2018

The actual problem is the diagnosis and monitoring of the technical condition of the machines in operation, as well as the forecasting of their technical condition. The complexity of the problem of condition controlling is that the most informative characteristics of the electrical products can not be accurately determined without the use of special measuring transducers, which considerably increases the test time and makes it difficult to carry out continuous monitoring. A promising direction in solving this problem is the use of sensorless methods. Implementing these methods is based on using as a source of information the working winding of the electrical product, the active component of the resistance of which is determined just before the measurement of the magnetic characteristic and then used as a constant value. In the process of testing, there is heating and, as a consequence, a change in the active component of the winding resistance, which causes an unacceptable errors in determining the electrical products state. In this article the mathematical model of thermal processes are developed and analysis of thermometric diagnostics of electrical products is carried out.
The theory of nonlinear systems as an instrument for solving engineering problems
Authors: Ohrimenko Olga I. , Maltsev Igor M. , Rokotyanskaya Violetta V. , Vilisova Maria L.
Published: November 2018

The article outlines theoretical, methodological and practical issues of modern control and optimization theory, as well as the problems of nonlinear systems theory. Theoretical conclusions and results allowed to build mathematical models applicable to the management of objects of different nature with different principles of action, in particular, to the management of complex technical and technological objects that can be considered as nonlinear dynamic systems. The authors find it appropriate to consider nonlinear dynamic integral models as Volterra integro-power series from many functional arguments with multidimensional weight functions and a certain finite set of inputs to the system. The set of multidimensional kernels of integral Volterra operators completely characterizes the nonlinear and dynamic properties, and, consequently, the technical state of the initial system. The application of Volterra series based models allows to take into account the nonlinear and inertial properties of the initial nonlinear dynamic system more fully and accurately, it also makes the model diagnostic of a technical system more universal, raises the reliability of the forecast. The diagnostic procedure in this case is aimed at defining Volterra kernels based on the data of “input-output” experiment and building the diagnostic system of attribute in the space of which the decisive rule of optimal classification is created.
Exposure of pumping intense external electromagnetic fields on radioelectronic engineering substances with domain structure
Authors: Cherckesova Larissa , Bezuglov Dmitriy
Published: November 2018

Recently, the research of interaction processes of materials with domain structure, applied in radioelectronic techniques, with strong electromagnetic fields of external influence – pumping represents the special interest. Similar processes underlies on the ground of many electronic devices functioning – of quantum, optical, etc. It leads to change of properties and constructions of radioelectronic techniques with domain structure materials, to define of their elementary power processes, phase transitions. Investigations were carried out by means of general interaction processes mathematical model of the strong (intense) field of pumping external influence with radioelectronic techniques materials elements, in which the magnetic, polar, dielectric, optical, elastic and other properties are developing.
A technique for obtaining 3D coordinates of human body parts from RGB-D stream
Authors: Fisunov Alexander V. , Gnezdilova Victoria B. , Marchuk Vladimir I.
Published: November 2018

This paper proposes the method for real time determining three-dimensional coordinates of human body parts from RGB-D stream. Proposed method represent a combined solution in which deep learning and depth map analysis are used.
Obtaining physiological parameters of biological objects from video stream methods analysis
Authors: Beloyvanov Maxim S. , Samara Issam
Published: November 2018

The paper presents the analysis of existing methods for the noncontact measurement of the pulse of the person from the video stream received from the RGB camera. The proposed methods improve the accuracy of their work and decrease the negative impact of human movement on measurement results.
Mathematical model of a communication channel in urban environment
Authors: Chernyshov Dmitry , Fedosov Valentin
Published: November 2018

This article discusses the mechanism of signal propagation in urban environment and for the development of a three-dimensional communication channel model.
JTC-801 Suppresses Melanoma Cells Growth through the PI3K‑Akt‑mTOR Signaling Pathways
Authors: Li Jing , Huang Fei
Published: November 2018

Melanoma is considered as one of the most potentially fatal and aggressive malignancies. Due to the limited efficacy or drug resistance of the current targeted therapies of melanoma, developing new therapeutic drugs against new targets to effectively control tumor growth is greatly needed. In this study, the effect of JTC-801, a selective small-molecule antagonist of nociceptin receptor and analgesic agent, on a melanoma cell line, M14, has been studied. We demonstrate herein that JTC-801 could efficiently suppress the proliferation, migration and invasion capacity of the M14 melanoma cells, and induced a strong apoptosis. Importantly, our results provide the underlying molecular mechanism of these effects. JTC-801 cells regulate M14 cells by inhibiting the PI3K-Akt‑mTOR pathway. These results suggest that JTC-801 should be further studied in preclinical modes to establish whether it represents a potential small anticancer candidate drug against melanoma.
Lycorine inhibits melanoma A375 cell growth and metastasis through the inactivation of the PI3K/AKT signaling pathway
Authors: Jiang Qun-Qun , Liu Wei-Bing
Published: November 2018

Malignant melanoma, one of the most aggressive skin cancers, has a very high mortality rate. Currently, the number of drugs to treat melanoma is low. Although new immunotherapeutic approaches based on the use of antibodies against immune checkpoints have shown long term responses, it is urgent to develop novel anti-melanoma drugs with a high efficiency and a low toxicity in a large number of patients. Lycorine, a natural product, has been reported to exert antitumor effects on some cancers. However, the impact of lycorine on melanoma cells is still unknown. Using the CCK8 assay, we found that lycorine can suppress the proliferation of melanoma A375 cells in a dose-time-dependent manner. Moreover, a transwell assay showed that lycorine inhibited the migration and invasion of A375 cells significantly. Further, lycorine treatment could induce the apoptosis of the A375 cells. Biochemical analyses showed that the expression level of the anti-apoptosis Bcl-2 protein decreased, while the expression of the pro-apoptosis protein Bax and active caspase-3 increased after lycorine treatment. Finally, using western blot assay, we found that the antitumor effects of lycorine on A375 cells might be through the inactivation of the PI3K/Akt signaling pathway. Based on these observations, we suggest that lycorine may be an interesting candidate for further studies on its ability to represent a novel antitumor drug for human melanoma treatment in the future.
Analysis of the long-term efficacy of core decompression with synthetic calcium-sulfate bone grafting on non-traumatic osteonecrosis of the femoral head
Authors: Zhao Pengfei , Hao Jing
Published: November 2018

Objective: to investigate the safety and long-term efficacy of core decompression with synthetic calcium-sulfate bone grafting on non-traumatic osteonecrosis of the femoral head.

Method: a total of 76 patients with non-traumatic osteonecrosis of the femoral head were admitted to our hospital from February 2012 to November 2014 and included in the study. All the patients were treated by core decompression with synthetic calcium-sulfate bone grafting. After treatment, the patients were followed-up for 12 months. The operation time, intraoperative blood loss, and perioperative complications were also recorded intraoperatively to evaluate the clinical efficacy and safety. The preoperative and postoperative pain scores measured by visual analogy score (VAS) were also recorded and compared.

Results: all of the 76 patients were successfully operated and included in the study. The mean operation time was 34.6±14.2 min, and the intraoperative blood loss was 23.6±8.9 mL. The patients hip functions were assessed on the basis of the Harris hip score, 3 and 12 months after operation. The excellent rates 3 and 12 months after operation were significantly higher than those before operation (P<0.05). The imaging stabilities of the hip joints 3 and 12 months after operation were significantly higher than those before operation (P<0.05). The patient postoperative pain scores (VAS score) gradually decreased. The VAS scores 12 months after operation were significantly lower than those before operation (P<0.05).

Conclusion: the long-term efficacy of core decompression with synthetic calcium-sulfate bone grafting on non-traumatic osteonecrosis of the femoral head is good and accompanied with significantly improved postoperative joint functions.
Laparoscopic combined with hysteroscopic repair or operative hysteroscopy in the treatment of symptomatic cesarean-induced diverticulum
Authors: Lv Bingqing , Xie Xi , Liu Chaobin , Lin Yuan
Published: November 2018

Objective: The postmenstrual bleeding with cesarean-induced diverticulum is a bothersome symptom and can be confused with other abnormal-uterine bleeding disease. The aim of the present study was to evaluate the efficacy and safety of laparoscopic combined with hysteroscopic repair vs operative hysteroscopy in treatment of symptomatic cesarean-induced diverticulum.

Methods: Eighty-two women with cesarean-induced diverticulum who underwent either laparoscopic combined with hysteroscopic repair or operative hysteroscopy between January 2012 and September 2015 were retrospectively included in the study. We evaluated the menstrual duration before and after the surgery, the width, length and depth of the niche, operating time, blood loss, complications, and postoperative pregnancy status.

Results: 62.2% (51/82) patients started to have postmenstrual bleeding immediately when they gained regular menstruation after their cesarean section. The laparoscopic group has longer operative time and greater blood loss (p<0.001). Both groups have a significant improvement in their menstruation duration ( p< 0.001). The patients in the laparoscopic repair group had a greater improvement in bringing the uterine bleeding into normal menstruation duration (P=0.046) and the same in pregnancy rate (P=0.505). The interval between operation and pregnancy in laparoscopic combined with hysteroscopic group was much longer than the hysteroscopic group (27 vs 10 months, p<0.001).

Conclusion: the laparoscopic repair exhibited a better efficiency in bringing the uterine bleeding into normal menstruation duration and in improving the pregnancy rate However, there was not a clear absolute advantage for one of the two type of surgeries. Thus, patients with post-cesarean section diverticulum (PCSD) should choose with caution the type of surgery, considering the residual myometrial thickness (RMT), the age, the desire for further fertility and ovarian reserve capacity.
Computational QSAR model combined molecular descriptors and fingerprints to predict HDAC1 inhibitors
Authors: Shi Jingsheng , Zhao Guanglei , Wei Yibing
Published: November 2018

The dynamic balance between acetylation and deacetylation of histones plays a crucial role in the epigenetic regulation of gene expression. It is equilibrated by two families of enzymes: histone acetyltransferases and histone deacetylases (HDACs). HDACs repress transcription by regulating the conformation of the higher-order chromatin structure. HDAC inhibitors have recently become a class of chemical agents for potential treatment of the abnormal chromatin remodeling process involved in certain cancers. In this study, we constructed a large dataset to predict the activity value of HDAC1 inhibitors. Each compound was represented with seven fingerprints, and computational models were subsequently developed to predict HDAC1 inhibitors via five machine learning methods. These methods include naïve Bayes, κ-nearest neighbor, C4.5 decision tree, random forest, and support vector machine (SVM) algorithms. The best predicting model was CDK fingerprint with SVM, which exhibited an accuracy of 0.89. This model also performed best in five-fold cross-validation. Some representative substructure alerts responsible for HDAC1 inhibitors were identified by using MoSS in KNIME, which could facilitate the identification of HDAC1 inhibitors.
Effects of continuous positive airway pressure on elderly patients with obstructive sleep apnea: a meta-analysis
Authors: Yan Binhong , Jin Yongmei , Hu Yi , Li Shu
Published: November 2018

Objective: the aim of the study was to evaluate the efficacy of continuous positive airway pressure (CPAP) for the treatment of obstructive sleep apnea in the elderly.

Method: a comprehensive search for qualified clinical trials was performed on April, 2016. Basic demographic information of enrolled subjects, study design, survival rate, cardiovascular events, quality of life scores, and neurocognitive data were extracted for analysis.

Results: A total of seven clinical trials were included in this meta-analysis, in which untreated elderly patients exhibited worse survival rate than those with CPAP (OR=2.22, 95% CI=1.64 to 3.01, P< 0.00001). Treated elderly patients exhibited less cardiovascular risk than those without CPAP (RR=0.49, 95% CI=0.36 to 0.66, P<0.00001) and a statistically significant improvement on all the domains of Quebec Sleepiness Questionnaire, supported by pooled weighted mean difference. Furthermore, CPAP treatment partially improved the cognitive functions.

Conclusion: CPAP treatment achieves improvements in decreasing mortality and controlling cardiovascular events and exhibits few effects on neurocognitive function. Further large-scale, well-designed interventional investigation is needed.
The dynamics of value system in 1998 and 2015: Longitudinal research in Latvia
Authors: Sokola-Nazarenko Marina , Martinsone Kristine , Mihailova Sandra , Levina Jelena , Elina Karsa
Published: November 2018

Values may change during life because a person obtains new life experience and competencies. In the past decade, many Latvian psychologists studied people's values and their connections with different factors like cultural, political, social, economic changes and other factors [1, 2, 3 and other]. Since 1994 Latvia has gone through different social-economic changes like crisis, economic growth, assumption to NATO and EU, and acceptation of euro currency. These changes can influence participants’ values. The aim was to conduct a comparative longitudinal research in individuals’ values in 1998 and 2015, at the beginning of their youth and then in adulthood, in order to answer the following questions: what values were in 1998 and 2015; what differences in values had appeared comparing 1998 and 2015 in same persons. Results showed that the most important values in 1998 and 2015 were “Family”, “Love”, “Responsibility”, “Honesty” and “Cheerfulness”. Significant changes appeared in “Health” that became significantly important in 2015 and replaced the importance of “Love”. Most achievable values in 1998 and 2015 were “The beauty of nature and art” and “Cognition” but in 2015 also “Active life” which replaced “Self-confidence” that was important in 1998. Significant changes appeared in “Self-confidence”, “Wisdom”, “Active life”, “Freedom”, “Interesting job”, “Learning” and “Friends” as well, where importance of some values increased and some decreased in 2015.
Preventing and combating hate crimes: Modern approach
Authors: Groma Jelena
Published: November 2018

A sufficient body of research, originally American and British, as well as practice has been accumulated in the last decades in the field of hate crime. Modern understanding of the issue distinguishes multinational and global character of the harm appearing due to hate crime, thus setting up topicality of this crucial problem. This paper is aimed at description of measures of effective prevention of hate crime and general considerations for an effective strategy of hate crime prevention and combating proposed by well recognized specialists in the field, mentioning prioritizing the response to hate crime within the police department, establishing multi-agency task forces, training police officers, responding to hate-crime victims’ needs, increasing police presence and attention in high-risk neighbourhoods, monitoring hate groups and tracking hate incidents, reaching out to minority communities, engaging educational institutions and the mass media. Reporting on recent development of Latvian Criminal Law regulation related to hate crime author sets up some specific problematic issues and discusses solution options.
Assessment of non-technical skills of operating room nurses
Authors: Ribakova Anna , Deklava Liana
Published: November 2018

Training of non-technical skills helps to achieve reduction of human errors that could contribute to safety of patients. For assessment of non-technical skills of Operating Room (OR) nurses, researchers of the University of Aberdeen developed intra-operative work organization protocol for observation of non-technical behaviour. This system includes taxonomy of non-technical skills, definitions, desirable and adverse behavioural markers, and Likert scale for behavioural assessment. The objective of this research is to assess non-technical skills of OR nurses in work environment and compare the findings with OR nurses self-assessment of non-technical skills. The study involved 15 interviews with OR nurses in sterile position (scrub nurses) and 15 observations of their work in four hospitals. Providing self-assessment, OR nurses note a tendency to minimal communication. In practice, nurses often show good ability to think analytically, to predict events and needs and are able to act decisively during surgery. OR nurses in Latvia partially associate their work with non-technical skills, however in practice these skills are used, and they were relatively highly valued during the study. Insufficient self-assessment of such skills of nurses as cooperation in performance of physical tasks, promotion of personnel safety and decisive action, indicates the need for development of scrub nurse's work standards with clearly defined area of responsibility and duties.
Limbs joint position sense in patients with chronic non-specific back pain
Authors: Pahomova Natalija , Smite Daina
Published: November 2018

Purpose: To analyze limbs joint positions’ sense and its relationship with pain intensity and duration in patients with chronic non-specific back pain. Methods: Study design: cross-sectional study. For assessment of patients, the following elements were used: general data collection protocol; evaluation of pain intensity using the Visual Analogue Scale; assessment of limb kinesthesia: determination of reposition precision of a 90-degree flexion angle in shoulder, elbow, hip and knee joints. Subjects. The study included 100 patients (88 women, 12 men) with chronic non-specific back pain, who met the selection criteria for the study. The average age of patients was 45.9 ± 11.6 years, and it ranged from 19 to 64 years. Results: All participants of the study were found to have diminished upper and lower limbs kinesthesia. The study results showed plausible (p < 0.05) relation between limbs kinesthesia and pain intensity and duration, and these correlations were significantly determined by pain localization. Conclusion: Limb kinesthesia is plausibly related to the manifestation of pain in patients with chronic non-specific back pain.
Topical questions of the substitute family care in the Czech Republic with a special attention to the process of foster families preparation
Authors: Junova Iva , Slaninova Gabriela
Published: November 2018

Authors deal with the substitute family care in the Czech Republic. Attention is concentrated on a conception of the substitute family care as a form of a children care in that children are raised by “substitute” parents in an ambience that is very similar to a natural family life. In the Czech Republic, the substitute family care is always preferred to an institutional upbringing. The aim of the article is to describe the system of the substitute family care in the Czech Republic and to introduce a foster care as one of the institutes of the substitute family care. Authors paid attention to a foster care and to a temporary foster care in the context of a professional preparation of foster families. The professionally led preparation in the Czech Republic is legally regulated by performing some law provisions of the social and legal children protection.
Biographical disruption and factors facilitating overcoming it
Authors: Pranka Maruta
Published: November 2018

In the paper the concept “biographical disruption” is interpreted as a process that includes significant changes in the course of an individual's life and biography as the perception and interpretation of the life course. As the central concept of the paper, biographical disruption is analyzed as having been brought about by an inherited heightened risk of breast cancer or ovarian cancer. The paper has examined the influence of the inherited breast cancer genes BRCA1 and BRCA2 on the development of biographical disruption. The empirical research data used for the study were obtained from the interdisciplinary research project “Creation of a new interdisciplinary research team to investigate breast cancer and to increase the efficacy of therapy and the patient's quality of life” (agreement No. 2009/0230/1DP/1.1.1.2.0/09/APIA/VIAA/070). In studying and analyzing the possibilities of overcoming a biographical disruption, the conclusion is that this depends on the individual's own biographical work, or narrative reconstruction and various types of social support.
Disability management in the workplace: Problems and trends in Latvia
Authors: Oborenko Zaiga , Zivitere Marga , Konstantinova Elina
Published: November 2018

People with disabilities are a largely untapped employment resource in many countries. About 48.5% of people with disabilities are employed in the European Union (EU), compared with only 24.4% in Latvia. Although there has been some progress on employing disabled people in Latvia, as the statistical facts and figures show, the problem still remains. This paper investigates how developing disability management in the workplace could open the possibilities for work for people with disabilities. It can be matched with the opportunities to increase the employment rate according to the European Disability Strategy (2010–2020) objectives, as well as fighting against social exclusion and allowing practical implementation of the United Convention on the rights of this group of people in Latvia. The aim of this research is to analyse the employment problems for people with disabilities and investigate disability management trends in Latvia. The main findings of this research are as follows: 1) people with disabilities are not considered as a prospective labour force by employers, 2) Latvian companies generally play a passive role in recruiting disabled people, especially those who have never had work experience with disabled people, 3) employers think that they do not receive state institutions’ interest and support to encourage them to employ people with disabilities. The disability management is developing, although it shows quite slow movement in understanding people with disabilities as a valuable human resource.
Zertifikate und ärztliche Tätigkeitsschwerpunkte in der Dermatologie: Rechtlicher Hintergrund
Authors: Elsner P.
Published: November 2018

Der Arztberuf ist ein freier Beruf und kein Gewerbe; als Angehörige eines freien Berufs üben Ärzte ihren Beruf eigenverantwortlich und medizinisch unabhängig aus.

Werbung für ihre ärztliche Tätigkeit ist Ärzten daher gemäß ihrer Berufsordnung nur eingeschränkt möglich, um Irrtümern und damit einer Verunsicherung von Patienten vorzubeugen, was das Vertrauen in den Arztberuf untergraben und langfristig negative Rückwirkungen auf die medizinische Versorgung der Bevölkerung haben könnte. Andererseits haben Patienten ein Recht darauf, über besondere Fähigkeiten und Qualifizierungen von Ärzten aufgeklärt zu werden, um den für ihre Behandlung geeigneten Arzt zu finden. Dieser inhärente Konflikt zwischen Werbeverbot und Informationsrecht und -pflicht wurde vom deutschen Bundesverfassungsgericht in mehreren Grundsatzurteilen im Sinne einer Lockerung des früher streng ausgelegten Werbeverbotes entschieden. Nach der Muster-Berufsordnung für Ärzte sind ÄrztInnen nunmehr „sachliche berufsbezogene Informationen gestattet“. „Qualifikationen und Tätigkeitsschwerpunkte“ dürfen angekündigt werden, „wenn diese Angaben nicht mit solchen nach geregeltem Weiterbildungsrecht erworbenen Qualifikationen verwechselt werden können“.

Die von der Deutschen Dermatologischen Akademie ausgestellten Zertifikate als besondere Weiterbildungs- und Kompetenznachweise für FachärztInnen für Haut- und Geschlechtskrankheiten entsprechen diesen Anforderungen.
ADR evaluation of screening colonoscopies during 2016 – 2017 in a private health clinic in Peru
Authors: León Moreno Julio F.
Published: November 2018

Background and study aims High-quality colonoscopy is fundamental for preventing colorectal cancer (CRC). The adenoma detection rate (ADR) is a key colonoscopy quality measure. The aim of this study was to establish the screening colonoscopy ADR of a tertiary referral center in Peru, identify the relationship between the ADR and patient age, sex and the colonoscopist, and determine the endoscopic and histopathological characteristics of the lesions found.

Patients and methods A retrospective observational longitudinal study was undertaken between January 2016 and June 2017.

Results Eight colonoscopists performed screening colonoscopies on 620 patients scoring ≥ 6 points on the Boston Bowel Preparation Scale (BBPS); cecal intubation was complete in 595 patients (cecal intubation rate [CIR] 95.9 %). The overall ADR was 29.7 % (females 25.4 %, males 33.1 %, P = 0.040, 95 %Cl). The ADR colonoscopist range was 25.0 % to 34.4 %. The highest ADR (41.2 %, P = 0.013, 95 %Cl) was for patients aged 65 to 75 years. Adenoma colon locations were: left 49 %, transverse 21.6 % and right 29.4 %. Adenoma dysplasia grades: low 98 %, high 2 %. Sixty-three percent of the lesions were 5 mm to 10 mm. Resections performed: 78.5 % cold biopsy forceps (CBF), 3.4 % cold snare polypectomy (CSP) and 18.1 % endoscopic mucosal resection (EMR).

Conclusions The ADR established was in line with the joint American College of Gastroenterology (ACG)/American Society for Gastrointestinal Endoscopy (ASGE) recommendations and related to patient age and gender but not to the colonoscopist. Colonoscopists should ensure rigorous application of the colonoscopy quality actions. ADR should be evaluated frequently.
Notfälle an Bord von Linienflugzeugen: In-Flight Medical Emergencies (IFME) und In-Flight Cardiac Arrest (IFCA)
Authors: Hinkelbein Jochen , Adler Christoph , Bernhard Michael , Hohn Andreas , Jansen Stefanie , Komorowski Matthieu , Glaser Eckard , Warnecke Tobias , Kalina Steffen , Kerkhoff Steffen , Hinkelbein Franziska , Braunecker Stefan , Neuhaus Christopher
Published: November 2018

Hintergrund Im Jahr 2017 wurden weltweit etwa 4 Milliarden Menschen mit einem Flugzeug transportiert. Die International Air Transport Association (IATA) prognostiziert für Europa bis zum Jahr 2034 eine durchschnittliche jährliche Steigerung der Passagierzahlen von 2,7%. In der zivilen Luftfahrt treten Notfälle an Bord (sogenannte In-Flight Medical Emergencies, IFME) mit einer Häufigkeit von 1 pro 14 000 bis 1 pro 50 000 transportierte Passagiere auf. Belastbare Daten über die exakte Häufigkeit und Art von medizinischen Notfällen an Bord von Flugzeugen existieren nicht. Ein Herz-Kreislauf-Stillstand tritt statistisch gesehen nur in 0,3% der Notfälle an Bord auf. Dieses Ereignis ist jedoch mit einer Mortalität von 86% assoziiert und stellt daher Passagiere und Crew zugleich vor eine große Herausforderung. Mit der Leitlinie zum In-Flight Cardiac Arrest (IFCA) wurden 28 spezifische Empfehlungen erarbeitet. Ziel der Leitlinie war es, spezifische Handlungsempfehlungen für mitfliegende Ärzte, Kabinenpersonal (Cabin Crew) und auch Fluglinien zur Behandlung des Herz-Kreislauf-Stillstands an Bord von Luftfahrzeugen zu generieren.
Image-guided versus palpation-guided injections for the
treatment of chronic lateral epicondylopathy: a randomized controlled clinical
trial
Authors: Malahias Michael-Alexander , Kaseta Maria-Kyriaki , Kazas Sotirios-Tsambikos , Megaloikonomos Panayiotis D , Mavrogenis Andreas F , Babis George C
Published: November 2018

Background There have been several studies published comparing the
ultrasound-guided with the “blind” infiltrations in the shoulder’s area. On the
contrary, there is only very limited data regarding the necessity of ultrasound
guidance in lateral epicondylitis.

Materials and Methods A prospective, randomized, blinded at initial and
follow-up evaluation, comparative clinical trial was conducted, involving 44
patients with a history of chronic persistent epicondylopathy. The patients were
randomly divided into 2 groups of 22 people each. Group A patients underwent
three ultrasound-guided betamethazone injections, while group B included those
who underwent three “blind” injections, centered at the palpable point of
maximum pain. The evaluation was done before and after (4 and 12 weeks) the
injections using the Visual Analogue Scale for pain (VAS, 0–10) and the Roles
& Maudsley score.

Results There was not any significant statistical difference between the
two groups as for mean VAS at 4 weeks (p = 0.150, t-test) and mean VAS at 12
weeks (p = 0.286, t-test). Furthermore, the final success rate, as measured by
the Roles & Maudsley score, was slightly superior in group B (67 % of the
patients with excellent or good results) when compared with group A (46 % of the
patients), but without any statistical difference (p = 0.161, chi-square).

Conclusion Our trial proved that an ultrasound-guided injection is not
superior than a palpation-guided injection of corticosteroids in the treatment
of lateral epicondylopathy.
Enteral self-expandable metal stent placement for malignant afferent limb syndrome using single-balloon enteroscope: report of five cases
Authors: Yane Kei , Katanuma Akio , Hayashi Tsuyoshi , Takahashi Kuniyuki , Kin Toshifumi , Nagai Kazumasa , Tanaka Kazunari , Komatsu Naohiro , Endo Masato , Kobayashi Yousuke , Takigawa Yukiko , Utsunomiya Ran
Published: November 2018

Endoscopic enteral self-expandable metal stent (SEMS) placement is a useful alternative treatment option for malignant afferent limb syndrome (ALS). We investigated the safety, efficacy, and follow-up results of enteral SEMS placement using a single-balloon enteroscope for the treatment of malignant ALS.
Single-operator cholangioscopy for diagnosis of cholangioadenoma (bile duct adenoma) and its potential impact on surgical management
Authors: Eccles John , Thiesen Aducio , Sandha Gurpal
Published: November 2018

Background and study aims Cholangioadenoma is not recognized commonly and is often only diagnosed on surgical specimens. Direct per oral single-operator cholangioscopy (SOC) allows characterization of common bile duct (CBD) lesions through direct visualization and directed forceps biopsies with potential for impacting surgical management decisions. This is a retrospective review of all SOC cases diagnosed with cholangioadenoma. Patient demographics and outcomes were recorded. Three patients (all male), average age 68 years (range 62 – 76 years), were identified to have a cholangioadenoma. The clinical indication for SOC was deranged liver enzymes with a dilated CBD and a CBD abnormality identified on biliary imaging. The site of cholangioadenoma was proximal, mid and distal CBD, respectively. All patients had a successful SOC with targeted biopsy-proven diagnosis. One patient had a synchronous cholangiocarcinoma and underwent palliative stenting whereas the other two patients underwent appropriate curative resection based on cholangioadenoma location. We conclude that SOC is safe and effective for diagnosis of cholangioadenoma and has potential impact on decisions for surgical management.
Endoscopic submucosal dissection for rectal neoplasia extending to the dentate line: European experience
Authors: Probst Andreas , Ebigbo Alanna , Märkl Bruno , Ting Saskia , Schaller Tina , Anthuber Matthias , Fleischmann Carola , Messmann Helmut
Published: November 2018

Background and study aims The ideal treatment strategy for rectal neoplasia extending to the dentate line (RNDL) is not well defined. Endoscopic mucosal resection (EMR) and submucosal dissection (ESD) compete with surgical techniques such as transanal endoscopic microsurgery (TEM). Non-Asian data and prospective data on ESD are lacking. The study aim was to evaluate the role of ESD in treatment of RNDL in a Western center.

Patients and methods Eighty-six patients with rectal adenomas were included. ESD was performed in 86 rectal adenomas including 24 RNDLs (27.9 %) and 62 lesions distant from the dentate line (72.1 %).

Results En bloc resection rate was comparable (91.7 % vs. 93.5 %, P = 0.670) between ESD for RNDL and non-RNDL. R0 resection rate was significantly lower in ESD for RNDL compared to that for non-RNDL (70.8 % vs 88.7 %; P = 0.039), but most non-R0 resection was unclear margin (Rx) and was not obvious positive margin (R1). Accordingly, the recurrence rate after ESD for RNDL (4.5 %) was not statistically different from that for non-RNDL (0 %, P = 0.275) and was lower than that previously reported for EMR. Median procedure time was 127 vs. 110 minutes (P = 0.182). Risk of delayed bleeding (20.8 % vs. 0 %, P = 0.001) and postinterventional pain (33.3 % vs. 14.5 %, P = 0.07) increased in RNDL cases, but they were managed conservatively. Incidence of stricture (4.2 % vs. 1.6 %, P = 0.483) and perforation (0 % vs. 1.6 %, P = 1.000) were similar.

Conclusions ESD is a feasible and safe resection technique for RNDLs. A randomized controlled trial comparing ESD to other methods (EMR or transanal surgery) is warranted.
Reisebericht CK Spies – ASSH International Traveling
Fellowship 2018
Authors: Spies CK
Published: November 2018

Es ist mir eine außerordentliche Freude und Ehre über mein ASSH (American Society for
Surgery of the Hand) Reisestipendium, das von der Deutschen Gesellschaft für
Handchirurgie gefördert wurde, zu berichten. Im Rahmen des akademischen weltweiten
Austausches erlässt die amerikanische Gesellschaft die Kongressgebühren für den
jährlichen Handchirurgenkongress und organisiert Hospitationen, sog.
„Observerships“, verteilt über die Vereinigten Staaten in renommierten Abteilungen,
die sich auf die Hand spezialisiert haben. Man konnte sich im Vorfeld eine
Reiseroute wünschen. Es gab sieben Gruppen mit i. d. R. drei Stipendiaten. Meine
Wunschkliniken wurden mir zu meiner Freude zugewiesen. Danach erfolgte die
Korrespondenz mit den jeweiligen Institutionen, um die Aufenthalte gründlich zu
planen. Man bekam stapelweise Unterlagen zu Datenschutzerklärungen, Verhaltensregeln
usw. zugeschickt, die unterschrieben werden mussten. Der Impfschutznachweis war
ebenfalls obligatorisch. Dies bedurfte einiger Mühe und Planung, da auch ein
TBC-Status mit dem Quantiferon-Test vorgelegt werden musste. Nachdem alles
organisiert war, startete der Flieger am fünften September vom Frankfurter Flughafen
Richtung Ann Arbor, Michigan. Am folgenden Tag sollten wir uns um 6:30 Uhr am
Haupteingang einfinden, wo wir unseren Ausweis mit Lichtbild bekamen. Zu diesem
Zeitpunkt traf ich meine Mitreisenden, eine Kollegin aus Spanien und einen Kollegen
aus Südkorea, zum ersten Mal. Zusammen ging es dann mit einem Fellow (Arzt in der
Weiterbildung zum Handchirurgen und bereits Facharzt für Orthopädie bzw. plastische
Chirurgie) zur sog. „Grand Round“ von 7:00 Uhr bis 8:00 Uhr. Ein Forum, in dem
Forschergruppen ihre Projekte vor Investoren vorstellen dürfen. Ziel dieses
Symposiums ist die Einwerbung von Drittmittel bzw. Planung eines „Start-ups“. Danach
trafen wir Professor Kevin Chung, Leiter der Abteilung für Handchirurgie, und
verbrachten einen sehr interessanten und lehrreichen Tag im Operationssaal. Wir
hatten die Möglichkeit zu einem ungezwungenen Austausch. Aufgrund der juristischen
Umstände durften wir in allen Abteilungen lediglich beobachten und nicht
assistieren. Wir sahen u. a. einen ECRL-Sehnentransfer auf die FDP 3–5-Sehnen bei
komplexer Nervenschädigung nach Crush-Verletzung, eine Neurolyse des Nervus ulnaris
in Kombination mit einer Tenolyse der Flexoren nach alter Nervus ulnaris Läsion und
auch eine Revision einer sekundär dislozierten distalen Radiusfraktur nach
Plattenosteosynthese. Danach trafen wir uns mit dem Ärzteteam in der
Abteilungsbibliothek. Wir durften Präsentationen über unsere Forschungsprojekte mit
anschließender Diskussion vortragen.
Treatment of Pulmonary Vasculitis
Authors: Guillevin Loïc , Terrier Benjamin
Published: November 2018

Pulmonary vasculitis can be heterogeneous and have some pathophysiological, clinical, and biological specificities that might influence treatment choices. Main vasculitides associated with pulmonary vasculitis include antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis, immune complex small vessel vasculitis, and antiglomerular basement membrane disease. Patient characteristics and association of lung involvement with other manifestations affecting disease severity may also influence treatment strategy. Alveolar hemorrhage frequently requires urgent treatment to control the underlying disease and provide supportive care such as mechanical ventilation. The level of evidence of each treatment strategy varies according to the underlying disease, but treatment is usually based on a combination of glucocorticoids and immunosuppressive agents, especially cyclophosphamide and rituximab. The role of plasma exchanges, widely used in patients with severe vasculitis, is controversial, based on results from recent prospective randomized controlled trials.
Therapeutic Intervention in Musculoskeletal Radiology: Current Practice and Future Directions
Authors: Farrell Terence , Hynes John , Hughes Nicola , O'Byrne Ciara , Eustace Stephen , Walsh John
Published: November 2018

Over the last several decades, the volume and range of therapeutic musculoskeletal (MSK) interventions that radiologists can offer their patients has dramatically increased. With new materials and improving imaging modalities, as well as significant investment in research, the field of MSK interventional radiologic intervention will likely continue to expand. In this article, we summarize the range of interventions currently available to the MSK radiologist. We also seek to explore new and emerging techniques that may become commonplace in the near future while considering the challenges that may lie ahead in the field of MSK radiology.
Pathogenesis of ANCA-Associated Pulmonary Vasculitis
Authors: Alba Marco , Jennette J. , Falk Ronald
Published: November 2018

Antineutrophil cytoplasmic antibodies (ANCAs) are autoantibodies specific for antigens located in the cytoplasmic granules of neutrophils and lysosomes of monocytes. ANCAs are associated with a spectrum of necrotizing vasculitis that includes granulomatosis with polyangiitis, microscopic polyangiitis, and eosinophilic granulomatosis with polyangiitis. Pulmonary vasculitis and related extravascular inflammation and fibrosis are frequent components of ANCA vasculitis. In this review, we detail the factors that have been associated with the origin of the ANCA autoimmune response and summarize the most relevant clinical observations, in vitro evidence, and animal studies strongly indicating the pathogenic potential of ANCA. In addition, we describe the putative sequence of pathogenic mechanisms driven by ANCA-induced activation of neutrophils that result in small vessel necrotizing vasculitis and extravascular granulomatous necrotizing inflammation.
An Electronic Medical Record in Pediatric Medical Education: Survey of Medical Students' Expectations and Experiences
Authors: Cheng Daryl , Scodellaro Thomas , Uahwatanasakul Wonie , South Mike
Published: November 2018

Objective This study sought to quantitatively characterize medical students' expectations and experiences of an electronic health record (EHR) system in a hospital setting, and to examine perceived and actual impacts on learning.

Methods Medical students from July to December 2016 at a tertiary pediatric institution completed pre- and postrotation surveys evaluating their expectations and experience of using an EHR during a pediatric medicine rotation. Survey data included past technology experience, EHR accessibility, use of learning resources, and effect on learning outcomes and patient–clinician communication.

Results Students generally reported high computer self-efficacy (4.16 ± 0.752, mean ± standard deviation), were comfortable with learning new software (4.08 ± 0.771), and expected the EHR to enhance their overall learning (4.074 ± 0.722). Students anticipated the EHR to be easy to learn, use, and operate, which was consistent with their experience (pre 3.86 vs. post 3.90, p = 0.56). Students did not expect nor experience that the EHR reduced their interaction, visual contact, or ability to build rapport with patients. The EHR did not meet expectations to facilitate learning around medication prescribing, placing orders, and utilizing online resources. Students found that the EHR marginally improved feedback surrounding clinical contributions to patient care from clinicians, although not to the expected levels (pre 3.50 vs. post 3.17, p < 0.01).

Conclusion Medical students readily engaged with the EHR, recognized several advantages in clinical practice, and did not consider their ability to interact with patients was impaired. There was widespread consensus that the EHR enhanced their learning and clinician's feedback, but not to the degree they had expected.
The consequences of growth modes on the magnetotransport properties of La0.4Pr0.3Ca0.3MnO3/LAO films
Authors: Zarifi Mehdi , Kameli Parviz , Ahmadvand Hossein , Nikmanesh Hossein
Published: November 2018

The impact of pulse repetition rate and film thickness on the magnetic, magnetoresistance (MR) and anisotropic magnetoresistance (AMR) has been investigated for La0.4Pr0.3Ca0.3MnO3 thin films grown on LaAlO3 (LAO) substrates by pulsed laser deposition technique. Change in repetition rate led to a difference in growth modes and altered the magnetic and electrical properties (MR and AMR) of thin films. The XRD results show that in the films with the thickness of 100 nm, by increasing the pulse repetition rate from 2 to 7 Hz the strain level doesn’t change, while strain significantly increased at the repetition rate of 10Hz. Analysis of transport and magnetization measurements show that at 2 and 5 Hz deposited films, the ferromagnetic metallic behavior is dominant, while in the film deposited at 10 Hz the antiferromagnetic (AFM) insulating phase increased. Moreover, with increasing strain in the thinner films (40 nm), deposited at 2 Hz, AFM phase is strengthened. Exchange bias confirms the existence of a dead layer in 100 nm film deposited at 10 Hz and 40 nm film deposited at 2 Hz. In addition, high strain in thinner films led to an enhanced Jahn-Teller coupling, so the angular momentum and spin-orbital/lattice interactions are significantly increased, which led to a lower magnetoresistance in thinner films. These results suggest that the pulse repetition rate provides an additional degree of freedom to tune magnetic and electrical properties of manganite thin films prepared by pulsed laser deposition technique.