bluuebunny/crossref_metadata_2025 huggingface dataset:
Gyrodactylus magadiensisn. sp. (Monogenea, Gyrodactylidae) parasitising the gills ofAlcolapia grahami(Perciformes, Cichlidae), a fish inhabiting the extreme environment of Lake Magadi, Kenya
Authors: Dos Santos Quinton Marco , Maina John Ndegwa , Avenant-Oldewage Annemariè
Published: December 2019

A new species ofGyrodactylusvon Nordmann, 1832 is described from the gills ofAlcolapia grahami, a tilapian fish endemic to Lake Magadi. This alkaline soda lake in the Rift Valley in Kenya is an extreme environment with pH as high as 11, temperatures up to 42 °C, and diurnal fluctuation between hyperoxia and virtual anoxia. Nevertheless, gyrodactylid monogeneans able to survive these hostile conditions were detected from the gills the Magadi tilapia. The worms were studied using light microscopy, isolated sclerites observed using scanning electron microscopy, and molecular techniques used to genetically characterize the specimens. The gyrodactylid was described asGyrodactylus magadiensisn. sp. and could be distinguished from otherGyrodactylusspecies infecting African cichlid fish based on the comparatively long and narrow hamuli, a ventral bar with small rounded anterolateral processes and a tongue-shaped posterior membrane, and marginal hooks with slender sickles which are angled forward, a trapezoid to square toe, rounded heel, a long bridge prior to reaching marginal sickle shaft, and a long lateral edge of the toe. The species is also distinct from all otherGyrodactylustaxa based on the ITS region of rDNA (ITS1–5.8s–ITS2), strongly supporting the designation of a new species. These findings represent the second record ofGyrodactylusfrom Kenya, with the description ofG. magadiensisbringing the total number ofGyrodactylusspecies described from African cichlids to 18.
Fibres optiques topographiques
Authors: Kudlinski Alexandre , Mussot Arnaud , Bouwmans Géraud
Published: December 2019

L’avènement des fibres à cristal photonique dans les années 90 a été une révolution sur les plans tant scientifique qu’applicatif. Leur structuration transverse complexe leur confère en effet des propriétés de guidage inédites. Les fibres optiques topographiques introduites dans les années 2010 offrent, quant à elles, un degré de liberté supplémentaire grâce à leur structuration longitudinale contrôlée. Bien que leur potentiel applicatif soit loin d’être totalement exploré, elles ont déjà été largement exploitées en optique guidée.
Les fibres microstructurées : 20 ans d’existence et un vaste éventail d’applications
Authors: Provino Laurent , Monteville Achille , Landais David , Le Goffic Olivier , Haboucha Adil , Taunay Thiery , Mechin David
Published: December 2019

Les fibres optiques microstructurées, également appelées fibres à trous ou fibres optiques à cristal photonique sont un type récent de guides de lumières originaux et performants apparues dans le milieu des années 1990. Elles se sont depuis imposées comme une technologie incontournable de la photonique moderne. L’originalité première de ce genre de fibre a été de permettre le guidage de la lumière dans un matériau unique grâce à leur structuration périodique. Après une vingtaine d’années de recherche, la gamme possible de structures de ces fibres optiques s’est grandement étoffée, donnant lieu à plusieurs catégories de fibres microstructurées classifiées par type de mécanisme de guidage (par réflexion totale interne, par bande interdite photonique, et par couplage inhibé). Arrivées à maturité aujourd’hui, ces fibres optiques ont démontré au fil des années un potentiel d’applications extrêmement vaste et ce, dans des domaines très variés allant de la défense aux applications biophotoniques, sous la forme de capteurs optiques ou de lasers fibrés de forte puissance.
L’alexithymie : historique, recherches et perspectives psychopathologiques
Authors: Maillard Benoît , Frick Eckhard
Published: December 2019

La notion clinique d’alexithymie désigne littéralement l’absence de mot pour l’expression de l’humeur (a-lexis-thymie). Elle est composée de quatre traits : 1. l’incapacité à exprimer verbalement les émotions ou les sentiments, 2. la limitation de la vie imaginaire, 3. la tendance à recourir à l’action pour éviter ou résoudre les conflits, 4. la description détaillée des faits, des événements, des symptômes physiques. Il est évident que cette notion recoupe certains processus de la pensée opératoire développée par l’École de Paris dans ces travaux sur les phénomènes psycho-somatiques. Si certaines recherches proposent une étiologie neuropsychologique de l’alexithymie, cet article montre les limites d’une telle approche et propose de confronter les hypothèses psychanalytiques sur le fonctionnement alexithymique comme le résultat d’une carence ou la mise en œuvre d’un type défensif. L’idiosyncrasie affective en jeu dans ces processus ouvre la question de savoir si l’absence d’affects peut être impliquée dans des modalités défensives. Un repérage théorique sur l’inscription du corps dans les lignes du langage et les fondements de la subjectivité sera nécessaire pour éclairer la complexité des potentialités psycho-somatiques. Enfin, nous développerons certaines implications contemporaines de ces travaux, notamment dans la clinique de l’obésité.
L’addiction comme rempart à la dépression
Authors: Acier Didier
Published: December 2019

Cet article tente de lier deux temporalités psychiques quant à la construction d’une solution addictive pour un sujet en lutte contre des mouvements dépressifs. Il pose l’hypothèse d’un premier temps de construction psychique aux premiers âges de la vie (Winnicott), amenant la possibilité d’avoir recours de manière durable à un objet addictif, dans un deuxième temps (McDougall), sans oublier l’inscription dans une neurobiologie et un moment socio-culturel (Olivenstein). Ce dernier point est particulièrement mis en avant, avec une société contemporaine qui soutient la chasse à l’ennui et aux temps morts, au profit d’une quête perpétuelle de satisfaction. Les substances ou les comportements addictifs demeurent des Pharmakon, c’est-à-dire qu’elles procurent un plaisir et sont un remède, avant de devenir un terrible poison. Mais l’addiction peut ainsi s’entendre comme une lutte anti-dépressive, l’absorption répétée de la substance visant à se superposer à un sentiment de vide insupportable et à une angoisse de séparation. Cette clinique du vide implique peut-être un mouvement plus étayant de la part du clinicien, un mouvement pour s’engager dans le gué et ne pas être trop frustrant.
Schlüssel zum Erfolg in der Rheumatologie
Authors: Klug Elke
Published: December 2019

Nur einen Steinwurf vom berühmten Panorama „Canaletto-Blick“ Dresdens entfernt, fand vom 4. bis 7. September 2019 im Internationalen Congress Center der 47. Kongress der Deutschen Gesellschaft für Rheumatologie (DGRh) statt. Unter den Themenschwerpunkten Autoimmunsystemerkrankungen und Osteoarthrose diskutieren orthopädische und internistische Rheumatologen sowie Kinderheumatologen die aktuellen Herausforderungen der Rheumatologie und neueste wissenschaftliche Ergebnisse. Gastland war in diesem Jahr Tschechien.
Status epilepticus im Kindes- und Jugendalter – ein oft unterschätztes Notfallereignis
Authors: Bernhard Matthias K. , Kiep Henriette , Merkenschlager Andreas
Published: December 2019

Ein Status epilepticus stellt einen Notfall dar, der mit einer erheblichen Morbidität und Mortalität einhergeht. Aus operationaler Sicht wird daher mittlerweile ein Status epilepticus in der Erwachsenenneurologie ab einer Anfallsdauer von 5 Minuten definiert. Der Notfalltherapie sowohl im Laien- als auch im Klinikbereich kommt eine sehr wichtige Rolle zu. Therapie der ersten Wahl sind weiterhin Benzodiazepine. Zunehmend positive Erfahrungen und Studienergebnisse liegen für Valproat, Levetiracetam und Lacosamid auch für pädiatrische Patienten vor.
Infantile Spasmen
Authors: Hornemann Frauke , Weber Franziska , Beblo Skadi , Merkenschlager Andreas
Published: December 2019

Vorgestellt werden die aktuellen Behandlungsoptionen bei infantilen Spasmen (früher BNS-Epilepsie) in Form eines Stufenschemas. Berücksichtigung finden die deutsche AWMF-Leitlinie 14 sowie die Behandlungsdaten und aktuellen 18-Monats-Nachbeobachtungsergebnisse der internationalen Behandlungsstudie „ICISS“ mit Vergleich einer primären Kombinationstherapie aus Vigabatrin und Prednisolon versus Vigabatrin und ACTH 10, 11.

Dargestellt werden typische und weniger bekannte Symptome bei infantilen Spasmen zur Früherkennung, die Nomenklatur im Bereich West-Syndrom/BNS-Epilepsie, außerdem die Möglichkeiten der akuten Diagnostik und Hinweise auf das Nebenwirkungsspektrum der Therapien.
Fall für Vier – Kloß im Hals
Authors: Christoph Külkens , Hoffmann Marisa , Vollert Marc P. , Roddewig Silke
Published: December 2019

Frau Meyer leidet seit Wochen an starken Schluckbeschwerden, hinzu kommen Ohrgeräusche bei weiter Mundöffnung und ein Fremdkörpergefühl. Ein Team aus vier Professionen will herausfinden, was hinter den Symptomen steckt.
Willkommen, Digitalisierung! – Chancen für die Physiotherapie
Authors: Langemak Shari
Published: December 2019

„Digital versorgt – gesünder vernetzt“ lautet der Slogan des Digitale-Versorgung-Gesetzes, das Gesundheitsminister Jens Spahn 2019 auf den Weg gebracht hat. Aber stimmt das? Führt Digitalisierung zu einer besseren Versorgung? Dr. Shari Langemak gibt Einblicke in die Veränderungen, die Apps und Telerehabilitation mit sich bringen. Ihr Appell an alle Physiotherapeuten: Nutzt die Digitalisierung!
Shortened Fingers and Toes: GNAS Abnormalities are Not the Only Cause
Authors: Reyes Monica , Silve Caroline , Jüppner Harald
Published: December 2019

The PTH/PTHrP receptor (PTHR1) mediates the actions of parathyroid hormone (PTH) and PTH-related peptide (PTHrP) by coupling this G protein-coupled receptor (GPCR) to the alpha-subunit of the heterotrimeric stimulatory G protein (Gsα) and thereby to the formation of cAMP. In growth plates, PTHrP-dependent activation of the cAMP/PKA second messenger pathway prevents the premature differentiation of chondrocytes into hypertrophic cells resulting in delayed growth plate closure. Heterozygous mutations in GNAS, the gene encoding Gsα, lead to a reduction in cAMP levels in growth plate chondrocytes that is sufficient to cause shortening of metacarpals and/or -tarsals, i. e. typical skeletal aspects of Albright’s Hereditary Osteodystrophy (AHO). However, heterozygous mutations in other genes, including those encoding PTHrP, PRKAR1A, PDE4D, and PDE3A, can lead to similar or even more pronounced acceleration of skeletal maturation that is particularly obvious in hands and feet, and reduces final adult height. Genetic mutations other than those resulting in Gsα haploinsufficiency thus reduce intracellular cAMP levels in growth plate chondrocytes to a similar extent and thereby accelerate skeletal maturation.
Divergent Pathways for Reactions of 3-Formylchromone with Cyclic Secondary Amines in Alcoholic Media
Authors: Korzhenko Kirill S. , Osipov Dmitry V. , Osyanin Vitaly A. , Klimochkin Yuri N.
Published: December 2019

Reaction of 3-formylchromone with cyclic secondary amines in methanol results in (E)-2-methoxy-3-(R2N-methylene)chroman-4-ones, while use of ethanol leads to (E)-2-morpholino-3-(morpholino­methylene)chroman-4-one or enaminoketones as dihydropyran ring-opening products. The solubility of the formed products in alcoholic media is postulated to be a key factor that determines the reaction pathway.
Bristow artroscópico: Avaliação da segurança e da eficácia, 12 anos de experiência
Authors: Garcia Jose Carlos
Published: December 2019

Objetivo O procedimento de Bristow aberto é um método há muito estabelecido e eficaz no tratamento da instabilidade anterior do ombro. Seguindo as tendências das cirurgias minimamente invasivas, essa cirurgia foi realizada por artroscopia, e seus resultados foram avaliados.

Métodos Foram avaliados 43 ombros de pacientes submetidos ao procedimento de Bristow por artroscopia, com o enxerto em posição horizontal e uso de um parafuso, com pelo menos dois anos de seguimento pós-cirúrgico, por meio de escores qualidade de vida, índice de reluxação e perda de rotação lateral.

Resultados A média de seguimento foi de 76 meses (variando de 129 a 24 meses), e o escore da University of California at Los Angeles (UCLA) variou de 25,56 ± 0,50 (desvio padrão [DP] = 3,25) para 33,23 ± 0,44 (DP = 2,91) (p < 0,0001). A média para o escore de Rowe com 2 anos ou mais de cirurgia foi de 94,25 ± 1,52(DP = 1,34), sendo que o padrão de bons resultados é de 75 pontos (p < 0,0001). A média do teste simples de ombro foi de 11,35 ± 0,21 (DP = 1,34), e, para perda de rotação lateral, foi de 10,37° ± 1,36° (DP = 8,58°). Não houve reluxações.

Entre os 43 pacientes operados, ocorreram um total de 12 complicações, das quais 8 não apresentaram qualquer repercussão clínica. As complicações com repercussão clínica foram uma infecção de possível origem hematogênica seis meses após a cirurgia, uma fratura do coracoide que fez com que o paciente precisasse mudar o procedimento no intraoperatório, e dois pacientes com impacto anterior, que necessitaram de retirada de material de síntese mais de seis meses após a cirurgia.

Conclusão O procedimento de Bristow artroscópico mostrou eficácia no tratamento da instabilidade anterior do ombro, embora não seja livre de complicações.
Recurrence of Cholesteatoma - A Retrospective Study Including 1,006 Patients for More than 33 Years
Authors: Møller Patrick Rønde , Pedersen Christina Nygaard , Grosfjeld Line R. , Faber Christian E. , Djurhuus Bjarki D.
Published: December 2019

Introduction Cholesteatomas are benign tumors consisting of skin, and growing inside a retraction pocket in the tympanic membrane. Cholesteatomas can occupy the entirety of the middle ear, and are known for their osteolytic capabilities. Surgery is the only curative treatment for cholesteatomas.

Objective To describe the risk of recurrence after first-time surgically-treated middle-ear cholesteatoma (STMEC1) on the island of Funen from 1983 to 2015.

Methods Cases of STMEC1 were identified in the Danish National Hospital Register. The medical records were reviewed. Time-to-event analyses were applied. The ears were followed from STMEC1 to a secondary cholesteatoma, emigration, death, or end of follow-up.

Results Records from 1,006 patients with STMEC1 were reviewed. A total of 54 patients were submitted to surgery on both ears. The total sample consisted of 1,060 ears with STMEC1; 300 were children's (< 16 years) ears, and 760 were adult's ears. The total observation time was of 12,049 years.

The overall estimated proportion with recurrence 5 years after surgery was of 37% in children and of 15% in adults. The older the child was at the first surgery, the risk decreased by 7% per year. In children, canal wall up (CWU) mastoidectomy without obliteration was associated with a hazard ratio for recurrence of 1.9 (95% confidence interval [95%CI]: 1.2–3.0) compared with CWU with obliteration.

Conclusion Compared with adults, children were had 2.6 times more risk of recurrence. Procedures performed without mastoidectomy had the lowest risk of recurrence. In children, obliteration was associated with a significantly lower risk of recurrence. However, patients were not randomized regarding the surgical approach; thus, the association between approach and risk of recurrence was likely influenced by confounding factors.
The Watershed Line of the Distal Radius: Cadaveric and Imaging Study of Anatomical Landmarks
Authors: Bergsma Minke , Doornberg Job N. , Borghorst Annelise , Kernkamp W.A. , Jaarsma R. L. , Bain Gregory I.
Published: December 2019

Background Placement of volar plates remains a challenge as the watershed line may not be an easy-identifiable distinct line intraoperatively.

Objectives The main objective of this article is to define how anatomical landmarks identifiable upon the volar surgical approach to the distal radius relate to the watershed line.

Methods We identified anatomical landmarks macroscopically upon standard volar approach to the distal radius in 10 cadaveric forearms and marked these with radiostereometric analysis (RSA) beads in cadaveric wrists. The RSA beads were then referenced against the volar osseous structures using quantification of three-dimensional computed tomography and advanced imaging software.

Results The mean measurements were the radial and ulnar prominences 11.1 mm and 2.1 mm proximal to the joint line of the distal radius, respectively. The interfossa sulcus was 0.3 mm proximal and 3 mm dorsal to the ulnar prominence. The watershed line was between 3.5 (minimal) and 7.6 (maximal) mm distal to the distal line of insertion of the pronator quadratus.

Conclusion The watershed line is situated distal to the pronator quadratus, but with a wide variability making it an impractical landmark for plate position. The osseous ulnar prominence is a good anatomical reference for safe plate positioning, as it is located on the watershed line and easily palpated at surgery. One should keep in mind the sulcus—the point on the watershed line where the flexor pollicis longus runs—can be situated just proximal to the ulnar prominence.

Clinical Relevance To provide anatomical landmarks that are easy to identify upon surgical approach without the direct need for intraoperative imaging.
Shortening Postoperative Stay after Parathyroidectomy - A District General Hospital Experience
Authors: Sinha Sidhartha , Fok Matthew , Ahmad Ijaz , Al-Sheikh Mustafa , Backhouse Christopher
Published: December 2019

Introduction Historically, concerns about complications following parathyroid surgery, such as airway compromise, bleeding and hypocalcemia, have precluded its consideration as a short-stay surgical procedure. Recent advancements in perioperative care have resulted in several publications demonstrating that parathyroidectomy can be safely performed as a short-stay procedure.

Objectives The aim of the present study was to describe the process of implementing a short-stay protocol focusing on preoperative patient education and postoperative calcium management for those undergoing surgery for primary hyperparathyroidism (PHP).

Method A retrospective audit of consecutive parathyroidectomies performed for PHP over the period between 2010 and 2013 was performed. A short-stay protocol (SSP) was introduced focusing on postoperative calcium management. Results were reaudited over the period between 2013 and 2015.

Results Consecutive parathyroidectomies in 76 patients were included in the study. A total of 42 patients underwent parathyroidectomy prior to the introduction of the protocol. A total of 26.2% of these patients were symptomatic from hypercalcemia. A total of 40 out of 42 (95.2%) patients had a biochemical cure. A total of 36 out of 42 (85.7%) cases were due to parathyroid adenomas. A total of 34 patients underwent surgery following the introduction of the protocol. A total of 13 out of 34 (38.2%) of the patients had symptomatic hypercalcemia. A total of 33 out of 34 (97.1%) had a biochemical cure. A total of 32 out of 34 (94.1%) cases were due to parathyroid adenomas.

The length of stay decreased from a median of 3 days (range 2–9 days; mean 3.32) preprotocol to a median of 2 days (range 2–3 days; mean 2.16) postprotocol (p < 0.0001) with no difference in the 30-day unplanned readmission rate (4.8 versus 2.9%; p = 0.999).

Conclusions The postoperative length of stay after parathyroidectomy for PHP can be safely reduced through patient education and by rationalizing postoperative calcium management without adversely affecting outcomes.
Protocolo de prevenção do tromboembolismo venoso: Experiência de 2.000 casos em artroplastia total de joelho*
Authors: Carvalho Júnior Lúcio Honório de , Correa Matheus de Almeida , Lima Matheus Rezende , Silvestre Camila Barreto , Almeida Victor Ferreira , Temponi Eduardo Frois
Published: December 2019

Objetivo O objetivo do presente estudo é avaliar o impacto de um protocolo institucional em um hospital terciário na prevenção do tromboembolismo venoso em 2.005 pacientes submetidos a artroplastia total primária de joelho.

Métodos Os dados dos prontuários de pacientes submetidos a artroplastia total do joelho antes (n = 1.115) e após (n = 890) a implantação do protocolo institucional, totalizando 2.005 pacientes, foram relatados retrospectivamente. Dados demográficos, comorbidades e desfechos foram analisados.

Resultados Não houve alteração significativa nos casos de trombose venosa profunda (TVP) (1,6% versus 2,4%; p = 0,211). Houve um aumento nos casos de embolia pulmonar (EP) (0,2% versus 0,8%; p = 0,049).

Conclusão Apesar da implementação do protocolo de prevenção, não houve redução nos eventos estudados. A pequena incidência global faz com que novos estudos, com séries maiores, sejam necessários para confirmar ou descartar esses achados.
A síndrome da dor patelofemoral altera o movimento do retropé, mas não modifica a distribuição da pressão plantar
Authors: Luza Lisiane Piazza , Luza Marcelo , Santos Gilmar Moraes
Published: December 2019

Objetivo Comparar a distribuição da pressão plantar e a cinemática do retropé durante a fase de apoio da marcha de sujeitos com e sem síndrome da dor patelofemoral (SDPF).

Métodos Participaram 26 sujeitos com SDPF e 31 clinicamente saudáveis, pareados em idade, estatura e massa corporal. Foi avaliada a distribuição da pressão plantar (pico de pressão) em seis regiões plantares, e a cinemática do retropé (ângulo máximo de eversão do retropé, porcentagem da fase de apoio da marcha em que o ângulo é atingido, e porcentagem da fase de apoio em que o retropé permaneceu em eversão). Os dados foram analisados por meio da estatística descritiva e inferencial, com nível de significância de p ≤ 0,05.

Resultados A pressão nas seis regiões plantares analisadas e a magnitude do ângulo máximo de eversão do retropé durante a marcha em superfície plana não se mostrou diferente nos sujeitos com SDPF. No entanto, sujeitos com SDPF apresentaram, dentro do ciclo da marcha, ângulo máximo de eversão do retropé mais cedo do que sujeitos do grupo controle, e permaneceram menos tempo com o retropé em eversão.

Conclusão A SDPF parece estar relacionada à alteração no padrão temporal na cinemática do retropé.
Hypovitaminosis D, Low Bone Mineral Density, and Diabetes Mellitus as Probable Risk Factors for Benign Paroxysmal Positional Vertigo in the Elderly
Authors: Bazoni Jessica Aparecida , Ciquinato Daiane Soares Almeida , Marquez Audrey de Souza , Costa Viviane de Souza Pinho , Marchiori Glória de Moraes , Marchiori Luciana Lozza de Moraes
Published: December 2019

Introduction Studies have found that elderly patients with benign paroxysmal positional vertigo (BPPV) may present low levels of vitamin D (25 (OH) D), changes in bone mineral density, and diabetes mellitus (DM).

Objective: To investigate the possible association between BPPV, bone mineral density, hypovitaminosis D, 25 (OH) D and DM.

Methods The sample consisted of 109 elderly subjects. The BPPV was verified by a standardized questionnaire and the Dix-Hallpike maneuver. Blood samples were collected for the investigation of 25 (OH) D serum levels. The bone mineral density was evaluated by means of a densitometer. Diabetes mellitus verification was performed using a self-reported questionnaire.

Results Of the 109 participants, 17 had BPPV. There was a statistically significant difference between BPPV and gender (p = 0.027, phi = 0.222), with female representing 88.2% of those with BPPV. In the group with BPPV, there was a statistically significant difference for the amount of vitamin D found (p = 0.001) and for age (p = 0.001). In the elderly group with DM and BPPV, a difference was found for the standard deviation of the femur (p = 0.022) with posthoc Dunn, identifying the difference between diabetics with and without BPPV (p = 0.047).

Conclusion Although no association was found (25 (OH) D levels) with BPPV in the general population of this study, it was observed that there was an association with bone mineral density in the elderly group with DM and BPPV, and, in the group with BPPV, there was an association between the amount of vitamin D and age.
Vocal Tract Discomfort Scale (VTDS) and Voice Symptom Scale (VoiSS) in the Early Identification of Italian Teachers with Voice Disorders
Authors: Galletti Bruno , Sireci Federico , Mollica Roberta , Iacona Elisabetta , Freni Francesco , Martines Francesco , Scherdel Enrique Perellò , Bruno Rocco , Longo Patrizia , Galletti Francesco
Published: December 2019

Introduction The current Italian law does not include any guidance regarding voice education, prevention of voice disorders and screening in subjects with high vocal loading such as teachers.

Objectives We aimed to check the correlation between the Vocal Tract Discomfort Scale (VTDS) with the Voice Symptom Scale (VoiSS) for the evaluation of Italian teachers. In addition, we aimed to investigate whether there are differences in the frequency and intensity of discomfort symptoms in teachers with disabilities comparing vocal tract discomfort symptoms in teachers with high risk (HRVD) and low risk (LRVD) of vocal disorders according to the VoiSS cutoff (> 15.5).

Methods We analyzed 160 Italian teachers (111 women and 49 men) that completed the VTDS and VoiSS at vocal evaluation. The Spearman correlation test was applied to all variables. The Mann-Whitney U test was used to compare the average number of discomfort symptoms among HRVD and LRVD teachers.

Results A moderate positive correlation was observed between the average number, frequency, and intensity of discomfort symptom and the total score, physical domain score, and limitation domain score of the VoiSS. Only the emotional domain score of the VoiSS showed a weak positive correlation (p < 0.001). Teachers considered in the HRVD group according to the VoiSS score had a higher number, frequency, and intensity of vocal tract discomfort symptoms.

Conclusion There is correlation between the VTDS and VoiSS scales. Like the VoiSS, the VTDS is a questionnaire that detects HRVD teachers. Therefore, the results suggest that both questionnaires could be useful for a preventive voice program for Italian teachers
25-Hydroxyl Vitamin D Deficiency in Nasal Polyposis
Authors: Chandrakar Ankur Kumar , Alexander Arun , R. Medha , Rajendiran Kalaiselvi , Ramasamy Karthikeyan
Published: December 2019

Introduction Vitamin D is known to have immunomodulatory functions and has action on chronic inflammatory processes, such as nasal polyposis.

Objective The present study assessed the levels of 25-hydroxy vitamin D and high-sensitivity C-reactive protein (hs-CRP) in patients with nasal polyposis, as compared with healthy control subjects, and identified their association with disease severity in nasal polyposis. It further assessed the levels of 25-hydroxyl vitamin D and hs-CRP in patients with nasal polyposis and atopy and compared it with patients with nasal polyposis without atopy.

Methods This was a cross-sectional study involving 2 groups: 80 patients with nasal polyposis and 80 healthy subjects. In patients with nasal polyposis, the disease severity is assessed by the sino-nasal outcome test (SNOT20) and by the Lund & Mackay staging system. Levels of 25-hydroxy vitamin D and hs-CRP were measured by enzyme-linked immunosorbent assay (ELISA).

Result The mean 25-hydroxyl vitamin D levels (ng/ml) was 12.01 ± 7.29 for cases and 22.87 ± 14.95 for controls, with p < 0.0001. The mean hs-CRP levels (mg/L) was 5.99 ± 2.74 in cases and 2.41 ± 1.95 in controls, with p < 0.0001. The severity of polyposis correlated negatively with serum levels of 25-hydroxy vitamin D and positively with hs-CRP.

Conclusion The study has thus shown significant correlation between vitamin D deficiency and inflammation in patients with nasal polyps.
Juvenile Granulosa Cell Tumor of the Testis: Prenatal Diagnosis and Management
Authors: Vatta Fabrizio , Raffaele Alessandro , Pasqua Noemi , Cesari Stefania , Romano Piero , Parigi Gian Battista , Avolio Luigi
Published: December 2019

Prepubertal primary testicular tumors account for ∼1% of all pediatric solid tumors. We report a new case of prenatal diagnosis of juvenile-type granulosa cell tumor (JGCT). A fetal ultrasound performed at the 38th week of gestation for suspected nonvertex presentation identified a left multilocular septated cystic testicular mass, suggestive for JGCT. At birth, a painless left scrotal mass was detected. Ultrasound re-evaluation excluded torsion of the testis. Tumor markers and abdominal ultrasound were normal for age. Inguinal exploration revealed a cystic mass beneath the tunica albuginea that had replaced all the normal parenchyma. Since organ-sparing surgery was thus not feasible, an orchiectomy was performed and diagnosis of JGCT was confirmed. At 7-year follow-up, the child presented an uneventful outcome. Our case shows that neonatal JGCT, which has an intrauterine genesis, can be diagnosed prenatally by ultrasound in the last weeks of pregnancy.
Intramural Injection of Botulinum Toxin A in Surgical Treatment of a Long Gap Esophageal Atresia—Rat Model
Authors: Pike Ashton Hideki , Zvara Peter , Antulov Marijana Rincic , Schrøder Henrik Daa , Hejboel Eva Kildall , Rasmussen Lars , Qvist Niels , Ellebæk Mark Bremholm
Published: December 2019

Introduction Anastomosis with minimal tension is desirable in long-gap esophageal atresia. Prior studies in piglets showed that intraesophageal injection of botulinum toxin type A (BTX-A) results in significant esophageal elongation. Our aim was to determine the BTX-A dose, number of injections, and time necessary to elicit maximal response.

Materials and Methods Adult male Wistar rats (n = 48) were randomly assorted into five groups. Four treatment groups received 2 or 4 U/kg of BTX-A, delivered using two or four injections, and a control group received 0.9% NaCl. Esophagus was removed 6 or 24-hours postinjection and tested ex vivo using a stretch tension device. Subsequently, an optimal dose and time following injection was used to study the effects of BTX-A on anastomotic healing in vivo. Rats (n = 12) received an intraesophageal injection of BTX-A or 0.9% NaCl, followed by resection of 0.5 cm of esophagus and end-to-end anastomosis. Rats were observed for 9 days, and esophagus was removed for gross and histological evaluation.

Results The largest effect on elongation was recorded in the BTX-A (2 U/kg) 24 hour, four injection group. In the anastomosis study, stricture formation was observed in all animals in the control group. Absence of esophageal stricture was found in three out of four animals in the treatment group macroscopically and histologically.

Conclusion We found that BTX-A exerts a positive effect on stretch characteristics of esophageal tissue in rats at 2 U/kg via four-injection delivery and 24-hour waiting period. This study suggests that BTX-A might improve anastomotic healing.
Broadening the Categories of Patients Eligible for Extended Venous Thromboembolism Treatment
Authors: Schindewolf Marc , Weitz Jeffrey Ian
Published: December 2019

Traditionally, venous thromboembolism (VTE) resulting from major transient risk factors (e.g., surgery or trauma) or a major persistent risk factor such as cancer, has been defined as being provoked, whereas unprovoked VTE encompasses events without an identifiable cause. These categorizations influence anticoagulant treatment duration; unlike VTE provoked by major transient risk factors, extended anticoagulation beyond 3 months is advised for patients with cancer or unprovoked VTE due to risk persistence after treatment cessation. However, some patients with VTE provoked by minor transient or minor persistent risk factors may also be candidates for extended anticoagulation therapy due to the continuing risk of recurrence. In patients who require extended therapy, vitamin K antagonists (VKAs) are effective but are associated with an increased risk of bleeding and various treatment burdens (e.g., anticoagulation monitoring and dose adjustment). Evaluations of extended VTE treatment with the less-burdensome direct oral anticoagulants such as apixaban, dabigatran, edoxaban, and rivaroxaban show that they are at least as safe and effective as VKAs in a broad range of patients. In addition, apixaban and rivaroxaban offer more than one dosing option, allowing tailoring of treatment to the patient's specific risk factor profile. Analysis of more granular definitions for risk factor groupings has also yielded vital information on the most appropriate strategies for the treatment of patients with specific risk factors, highlighting that extended anticoagulation treatment may benefit those with minor transient and persistent environmental and nonenvironmental risk factors who commonly receive shorter-duration therapy.
Longitudinal Evaluation of Clinical Decision Support to Improve Influenza Vaccine Uptake in an Integrated Pediatric Health Care Delivery System, Houston, Texas
Authors: Bratic Julia S. , Cunningham Rachel M. , Belleza-Bascon Bella , Watson Scott K. , Guffey Danielle , Boom Julie A.
Published: December 2019

Objective Our study retrospectively evaluated the implementation of an influenza vaccine best practice alert (BPA) in an electronic medical record within an integrated pediatric health care delivery system.

Methods An influenza BPA was implemented throughout a large pediatric health care delivery system in Houston, TX, to improve vaccine uptake. Outcomes were measured retrospectively over 3 years of BPA implementation and compared with a control year prior to BPA implementation. Primary outcomes were influenza vaccine uptake, distribution of influenza vaccines ordered by week, proportion of BPA displays ignored, and missed vaccination opportunities.

Results Influenza vaccine uptake declined from the pre-BPA year (47.2%; 95% confidence interval [CI]: 47.0, 47.4) to the last study year (45.1%; 95% CI: 44.9, 45.2). BPA displays were increasingly ignored by clinical staff throughout the study years from 59.6% in 2014–2015 to 72.5% in 2016–2017. For providers, BPA displays were ignored less frequently each year from 53.4% in 2014–2015 to 51.4% in 2017–2017. Within the primary care outpatient group, the proportion of missed vaccination opportunities in sick visits decreased from 86.8% during the pre-BPA year to 81.0, 79.8, and 82.7% during the subsequent study years 2014–2015, 2015–2016, and 2016–2017, respectively.

Conclusion Implementation of a widespread influenza BPA in an integrated pediatric health care delivery system did not produce meaningful increases in influenza vaccine uptake. Differences between clinical staff and providers on BPA use warrant further investigation.
Pediatric Scaphoid Nonunions: A Case Series, Review of the Literature, and Evidence-Based Guidelines
Authors: Oestreich Kerstin , Jacomel Tatiana Umata Yoko , Hassan Sami , Horwitz Maxim David , Lindau Tommy Roger
Published: December 2019

Background Scaphoid fractures represent less than 3% of hand and wrist fractures in the pediatric population. Nonunions are very rare. We present a case series (n = 18) of nonunions in skeletally immature children and adolescents. We further present a review of the literature on pediatric scaphoid nonunions.

Materials and Methods We reviewed the literature by searching the main databases on pediatric scaphoid nonunions, but to identify factors that lead to nonunion, we also searched for databases on scaphoid fractures. Seventy articles were found for the period between 1961 and 2019, all with level 4/5 evidence.

Results The nonunion rate of pediatric scaphoid fractures in the literature is on average 1.5%, occurring mostly as a result of missed or underdiagnosed injuries, similar to our presented case series. Half (n = 9) of the injuries in our case series were missed initial injuries, leading to scaphoid nonunions and half developed nonunions after initial treatment. We found excellent outcomes and with surgical and nonoperative management, with few complications. Not surprisingly, the duration of immobilization is longer with nonoperative management.

Conclusions Based on the literature, we recommend a period of nonoperative management before surgery in undisplaced nonunions. In displaced nonunions, open reduction and internal fixation ± bone grafting is necessary. In pediatric scaphoid fractures, similar to adult cases, we identified that suspicious scaphoid fractures should be considered for initial immobilization, and repeat X-rays and early magnetic resonance imaging (MRI) or computed tomography (CT) scans should be considered at follow-up. Immobilization time and type of plaster should be appropriate in relation to the fracture site, similar to the adult scaphoid fracture.

Level of Evidence This is a Level IV study.
Assessment of needle penetration depth and relationship with its analgesic effect
Authors: M. Bosque , M. Siquella , P. Monclús , MM Santafe
Published: December 2019

Background and Aims The field of invasive physical therapy offers a wide spectrum of effective methods for the treatment of myofascial pain. All these methods share the fact that they begin with the insertion of a solid needle. Thereafter, they diverge either because of the variable use of repeated insertions or because of the application of an electric current with different intensity and duration parameters. The so-called “needle effect” is described as an anesthetic effect which is achieved by probing with the needle the point where pain pressure sensitivity is found, using an appropriate orientation and depth in order to elicit this effect. At present, there continues to be controversy regarding whether the needle effect is a true clinical effect or placebo.

Material and Methods This study is a controlled clinical trial with double blinding formed by three randomized groups: sham needling, needling at the level of the subcutaneous tissue (superficial) and needling at the level of the muscle tissue (deep). The intervention consisted in the insertion of the needle at the specified depth according to each group and maintained during 60 seconds. Each group comprised of 17 volunteer inline hockey players of both sexes from the Club Reus Deportiu sports club in the junior and senior categories (between 18 and 36 years of age). Algometry and joint range of motion were determined for the dominant lower limb before and after the intervention. A Student's t-test was performed for paired comparisons and an ANOVA for multiple comparisons.

Results The same degree of algometry and joint range variation was obtained before and after the intervention in the three groups under study. No significant differences regarding algometry or joint range were obtained between the group of superficial needle insertion compared to the deep dry needling group, nor for any of these groups compared to the sham group.

Conclusion No improvement was found in the pain pressure sensitivity in a latent Myofascial Trigger Point (MTrP) of the gastrocnemius muscle nor were there improvements in dorsal and plantar ankle flexion immediately after treatment for any of the needle depths studied. The mere insertion of an acupuncture needle in a MTrP in young athletes does not provide any therapeutic benefit within the study parameters. Therefore, it seems reasonable that repeated insertions or specific techniques should be used to achieve a beneficial effect.
Effectiveness of acupuncture and moxibustion compared with electroacupuncture and moxibustion in older people with gonarthrosis
Authors: MF Enachescu
Published: December 2019

Background Gonarthrosis is a subtype of arthrosis which produces greater functional disability in our context. Women are more affected, with a prevalence in the general population of 16% and a clear increase as age advances, reaching up to 43%.

Aims To evaluate whether the combined treatment of electroacupuncture and moxibustion is more effective than the treatment of acupuncture and moxibustion in patients of advanced age with gonarthrosis.

Material and Methods An experimental, prospective and randomized study. Patients were divided into two groups: group A, who received acupuncture (n = 6) and group EA who received electroacupuncture (n = 7): modulated TENS (F = 5 Hz, P = 50 µS, I = 90%, 10 min). Both group A and EA combined treatments with moxibustion. Three interventions were performed, over three consecutive weeks, and the results obtained in each group were compared using several validated scales.

Results 84.6% of patients were women, with a mean age of 83.3 years, and 53.8% of these with obesity. The right leg was the more affected (76.9%) and 46.2% had a severe disability. Pain reduction (Visual Analog Scale) was statistically significant in each session in both groups however, to a greater extent in group EA (reduction of pain EA 3.4 versus 1.3 in A). The improvements of stiffness with both treatments was evident (mean 69.2%), however without statistically significant between-group differences. A clear difference was not found in the functionality according to the different scales applied (WOMAC, Barthel, Katz, Up&Go) nor in the reduction in the use of medication.

Conclusion The results obtained show a clear improvement in the control of pain and rigidity with the combination of both therapies, although differences were not found in the functionality and muscle strength scales, which are values that we believe would improve with a greater sample and a greater duration of interventions. In conclusion, in our study, electroacupuncture combined with moxibustion provides slightly better results to acupuncture combined with moxibustion, regarding the improvement of pain and stiffness in older patients with gonarthrosis.
NS5A-P32 Deletion in Hepatitis C Genotype 1b Infection is the Most Refractory Treatment-Mediated Amino Acid Change Exhibiting Resistance to all NS5A Inhibitors
Authors: Hikita Hayato , Takehara Tetsuo
Published: December 2019

NS5A-P32 deletion (P32del) is a resistance-associated amino acid change that has recently gained popularity in direct-acting antiviral treatment for chronic hepatitis C. Although not yet detected in naive patients, it appears in 5 to 10% of hepatitis C genotype 1b patients who fail to respond to daclatasvir/asunaprevir and sofosbuvir/ledipasvir treatments. In contrast to signature resistance-associated substitutions, such as substitutions at the NS5A-L31 and NS5A-Y93 positions, it shows complete resistance to all NS5A inhibitors in replicon and cell culture. Studies of humanized liver mice suggest that P32del retains good replication fitness and requires two classes of antivirals, except NS5A inhibitors, to be suppressed effectively. Patients with the P32del virus do not respond to glecaprevir/pibrentasvir but do respond to sofosbuvir/velpatasvir/voxilaprevir, presumably to sofosbuvir + glecaprevir/pibrentasvir, and at least partially to sofosbuvir/velpatasvir + ribavirin. Attention should be given to P32del in patients who experience failure with any NS5A inhibitor, especially those with genotype 1b infection.
Contact Pressure between Digital Flexors and Plates for Distal Radius Approaches
Authors: Jones Christopher M. , Melvani Roshan , Aziz Keith T. , Abbasi Pooyan , Means Kenneth R.
Published: December 2019

Background Flexor tendon irritation or rupture following open reduction and volar plate fixation of distal radius fractures can cause significant morbidity and necessitate additional surgical intervention.

Objectives To compare the impact of the extended flexor carpi radialis (e-FCR) and standard flexor carpi radialis (FCR) approaches on contact pressures between the flexor tendons and volar distal radius plates.

Methods Eight matched pairs of fresh frozen cadavers had each limb randomized to undergo either the e-FCR or standard FCR approach. After the approach, a locking plate was applied to the volar distal radius more distally than ideally to create a worst-case scenario for the digital flexor tendons. Electronic pressure sensors were secured to the volar aspect of each locking plate. Each wrist was pinned in 20 degrees of extension during testing. Using a computer-controlled stepper motor system attached to the digital flexor and extensor tendons, the digits were taken through 4,000 cycles simulating 12 weeks of active flexion and extension.

Results There were no statistically or clinically significant differences when comparing the contact pressures of the e-FCR approach with the standard FCR approach at any time intervals. The e-FCR had statistically significantly higher radial-sided contact pressures than ulnar-sided contact pressures during early-to-intermediate testing intervals. These differences resolved at late and final testing intervals.

Conclusions When comparing the standard FCR approach with the e-FCR approach, with the wrist in 20 degrees of extension, there is no significant difference in contact pressures that occur between the digital flexor tendons and volar distal radius plates.

Clinical Relevance Further study and technique modifications may eventually lead to better methods of avoiding flexor tendon rupture during the volar plating of distal radius fractures.
Optimising cattle grazing distribution on rangeland: a systematic review and network analysis
Authors: Creamer Maggie L. , Roche Leslie M. , Horback Kristina M. , Saitone Tina L.
Published: December 2019

Optimising beef cattle (Bos taurus and Bos indicus) distribution, both spatially and temporally, is one of the most significant challenges associated with managing extensive grazed rangelands. Landscape variability and behavioural patterns of cattle may lead to non-uniform and inefficient forage utilisation, damage to critical habitats, and water quality impairment. In order to overcome these distribution challenges, a large suite of tools have been developed and researched to optimise grazing patterns. The objectives of this synthesis paper are 2-fold: (i) to survey and categorise distribution tools; and (ii) to analyse the connectivity of existing research across academic disciplines to identify and isolate knowledge gaps. A systematic literature review revealed specific types of tools and strategies to improve cattle distribution, which were categorised as either ‘animal’ or ‘environmental manipulations’. Animal manipulations utilise aspects of individual behaviour and herd dynamics to alter grazing patterns, whereas environmental manipulations involve transforming aspects of the animal’s surroundings to overcome challenges associated with inefficient distribution. This review reveals that strategies are overwhelmingly studied in isolation, and that there is potential to increase efficacy by integrating multiple strategies to achieve a desired outcome. Motivated by these findings, an author collaboration network analysis was conducted to investigate connectivity within and among author fields of expertise to understand why more integrated management strategies are not currently studied. Authors were classified into five fields of research: animal behaviour science, animal production science, biophysical rangeland science, economics, and other. The network analysis revealed that communities of authors contributing to papers on enhancing cattle distribution are disjointed. These results suggest that in order to fulfil knowledge gaps about the efficacy and cost of management strategies, there needs to be interdisciplinary engagement with particular attention to strategies that integrate animal and environmental manipulations to enhance cattle grazing distribution on extensively grazed landscapes.