bluuebunny/crossref_metadata_2025 huggingface dataset:
A comparison of outcomes between a lumen-apposing metal stent with electrocautery-enhanced delivery system and a bi-flanged metal stent for drainage of walled-off pancreatic necrosis
Authors: Bekkali Noor , Nayar Manu , Leeds John , Charnley Richard , Huggett Matthew , Oppong Kofi
Published: November 2017

Background and study aims Bi-flanged metal stents (BFMS) have shown promise in the drainage of walled-off pancreatic necrosis (WON), but their placement requires multiple steps and the use of other devices. More recently, a novel device consisting of a combined lumen-apposing metal stent (LAMS) and electrocautery-enhanced delivery system has been introduced. The aim of this study was to compare the placement and outcomes of the two devices.

Patients and methods This was a retrospective review of consecutive patients undergoing endoscopic ultrasound-guided placement of BFMS or LAMS for drainage of symptomatic WON. Data from procedures between October 2012 and December 2016 were taken from a prospectively maintained database. We compared technical and clinical success, procedure time, costs, and composite end point of significant events (adverse events, stent migration, additional percutaneous drainage) between BFMS and LAMS.

Results 72 consecutive patients underwent placement of BFMS (40 patients, 44 stents) or LAMS (32 patients, 33 stents). Technical success was 91 % for BFMS and 97 % for LAMS. Clinical success was 65 % vs. 78 %, respectively. Median in-room procedure time was significantly shorter in the LAMS group (45 minutes [range 30 – 80]) than in the BFMS group (62.5 minutes [range 35 – 135]; P < 0.001) and fewer direct endoscopic necrosectomies (DEN) were performed (median 1 [0 – 2.0] vs. 2 [0 – 3.7], respectively; P = 0.005). If only inpatients were considered (35 BFMS and 19 LAMS), there was no significant difference in DEN 2 (range 0 – 11) and 2 (range 0 – 8), respectively. The composite end point of 32 % vs. 24 % was not significantly different. Median procedural costs for all patients with successful stent placement for WON treatment was €4427 (range 1630 – 12 926) for BFMS vs. €3500 (range 2509 – 13 393) for LAMS (P = 0.10).

Conclusion LAMS was superior to BFMS in terms of procedure time, with comparable adverse events, success, and costs.
Exercise Performed Concomitantly with Particulate Matter Exposure Inhibits Lung Injury
Authors: Silva-Renno Adriano , Baldivia Guilherme , Oliveira-Junior Manoel , Brandao-Rangel Maysa , El-Mafarjeh Elias , Dolhnikoff Marisa , Mauad Thaís , Britto Jôse , Saldiva Paulo , Oliveira Luis , Ligeiro-Oliveira Ana , Graudenz Gustavo , Vieira Rodolfo
Published: November 2017

Air pollution is a growing problem worldwide, inducing and exacerbating several diseases. Among the several components of air pollutants, particulate matter (PM), especially thick (10–2.5 µm; PM 10) and thin (≤2.5 µm; PM 2.5), are breathable particles that easily can be deposited within the lungs, resulting in pulmonary and systemic inflammation. Although physical activity is strongly recommended, its effects when practiced in polluted environments are questionable. Therefore, the present study evaluated the pulmonary and systemic response of concomitant treadmill training with PM 2.5 and PM 10 exposure. Treadmill training inhibited PM 2.5- and PM 10-induced accumulation of total leukocytes (p<0.001), neutrophils (p<0.001), macrophages (p<0.001) and lymphocytes (p<0.001) in bronchoalveolar lavage (BAL), as well as the BAL levels of IL-1beta (p<0.001), CXCL1/KC (p<0.001) and TNF-alpha (p<0.001), whereas it increased IL-10 levels (p<0.05). Similar effects were observed on accumulation of polymorphonuclear (p<0.01) and mononuclear (p<0.01) cells in the lung parenchyma and in the peribronchial space. Treadmill training also inhibited PM 2.5- and PM 10-induced systemic inflammation, as observed in the number of total leukocytes (p<0.001) and in the plasma levels of IL-1beta (p<0.001), CXCL1/KC (p<0.001) and TNF-alpha (p<0.001), whereas it increased IL-10 levels (p<0.001). Treadmill training inhibits lung and systemic inflammation induced by particulate matter.
Pharmacological Foundations of Cannabis Chemovars
Authors: Lewis Mark , Russo Ethan , Smith Kevin
Published: November 2017

An advanced Mendelian Cannabis breeding program has been developed utilizing chemical markers to maximize the yield of phytocannabinoids and terpenoids with the aim to improve therapeutic efficacy and safety. Cannabis is often divided into several categories based on cannabinoid content. Type I, Δ
9-tetrahydrocannabinol-predominant, is the prevalent offering in both medical and recreational marketplaces. In recent years, the therapeutic benefits of cannabidiol have been better recognized, leading to the promotion of additional chemovars: Type II, Cannabis that contains both Δ
9-tetrahydrocannabinol and cannabidiol, and cannabidiol-predominant Type III Cannabis. While high-Δ
9-tetrahydrocannabinol and high-myrcene chemovars dominate markets, these may not be optimal for patients who require distinct chemical profiles to achieve symptomatic relief. Type II Cannabis chemovars that display cannabidiol- and terpenoid-rich profiles have the potential to improve both efficacy and minimize adverse events associated with Δ
9-tetrahydrocannabinol exposure. Cannabis samples were analyzed for cannabinoid and terpenoid content, and analytical results are presented via PhytoFacts, a patent-pending method of graphically displaying phytocannabinoid and terpenoid content, as well as scent, taste, and subjective therapeutic effect data. Examples from the breeding program are highlighted and include Type I, II, and III Cannabis chemovars, those highly potent in terpenoids in general, or single components, for example, limonene, pinene, terpinolene, and linalool. Additionally, it is demonstrated how Type I – III chemovars have been developed with conserved terpenoid proportions. Specific chemovars may produce enhanced analgesia, anti-inflammatory, anticonvulsant, antidepressant, and anti-anxiety effects, while simultaneously reducing sequelae of Δ
9-tetrahydrocannabinol such as panic, toxic psychosis, and short-term memory impairment.
Othering in Chinese official media narratives during diplomatic standoffs with the US and Japan
Authors: Lams Lutgard
Published: November 2017

Based on two critical discourse analyses of Chinese media narratives on international incidents between China and the foreign ‘Other’ with an interval of nine years, this paper demonstrates continuity and consistency in Chinese official media discourse over the last decade when it concerns sensitive matters, such as sovereignty. The two case studies offered are: the 2001 diplomatic standoff with the US following the spy plane collision; and the 2010 conflict with Japan over the Chinese fishing boat collision with the Japanese coastal guard in the disputed waters of the Diaoyutai/Senkaku Islets. Using theoretical insights and methodological tools from Language Pragmatics, Critical Discourse Theory and Analysis, and Positioning Theory, these studies find identical official Chinese media practices of Othering and self-glorification. The article presents concrete examples of categorizing processes that position the actors as antagonists within a victim/aggressor framework, discursive ideological mechanisms of reification, legitimation, dramatization and generalization, and linguistic power games through the employment of assertive speech acts.
Residual stress determination in oxide layers at different length scales combining Raman spectroscopy and X-ray diffraction: Application to chromia-forming metallic alloys
Authors: Guerain Mathieu , Grosseau-Poussard Jean-Luc , Geandier Guillaume , Panicaud Benoit , Tamura Nobumichi , Kunz Martin , Dejoie Catherine , Micha Jean-Sebastien , Thiaudière Dominique , Goudeau Philippe
Published: November 2017

In oxidizing environments, the protection of metals and alloys against further oxidation at high temperature is provided by the oxide film itself. This protection is efficient only if the formed film adheres well to the metal (substrate), i.e., without microcracks and spalls induced by thermomechanical stresses. In this study, the residual stresses at both macroscopic and microscopic scales in the oxide film adhering to the substrate and over the damaged areas have been rigorously determined on the same samples for both techniques. Ni-30Cr and Fe-47Cr alloys have been oxidized together at 900 and 1000 °C, respectively, to create films with a thickness of a few microns. A multi-scale approach was adopted: macroscopic stress was determined by conventional X-ray diffraction and Raman spectroscopy, while microscopic residual stress mappings were performed over different types of bucklings using Raman micro-spectroscopy and synchrotron micro-diffraction. A very good agreement is found at macro- and microscales between the residual stress values obtained with both techniques, giving confidence on the reliability of the measurements. In addition, relevant structural information at the interface between the metallic substrate and the oxide layer was collected by micro-diffraction, a non-destructive technique that allows mapping through the oxide layer, and both the grain size and the crystallographic orientation of the supporting polycrystalline metal located either under a buckling or not were measured.
Numerical simulation of counter-current spontaneous imbibition in water-wet fractured porous media: Influences of water injection velocity, fracture aperture, and grains geometry
Authors: Jafari Iman , Masihi Mohsen , Nasiri Zarandi Masoud
Published: November 2017

Counter-current spontaneous imbibition (SI), in which water and oil flow through the same face in opposite directions, is known as one of the most significant oil recovery mechanisms in naturally fractured reservoirs; however, this mechanism has not received much attention. Understanding the dynamic of water-oil displacement during counter-current SI is very challenging because of simultaneous impacts of multiple factors including geometry complexity and heterogeneity of naturally fractured reservoir materials, e.g., high permeability contrast between the rock matrix and fracture, wettability, and porosity. This study investigates the effects of water injection velocity, fracture aperture, and grain shape during counter-current SI at pore-scale. A robust finite element solver is used to solve the governing equations of multiphase flow, which are the coupled Navier–Stokes and Cahn–Hilliard phase-field equations. The results showed that the case with the highest injection velocity (uinj = 5 mm/s) recovered more than 15% of the matrix oil at the early times and then reached its ultimate recovery factor. However, in the case of the lowest injection velocity, i.e., uinj = 0.05 mm/s, the lowest imbibition rate was observed at the early times, but ultimately 23% of the matrix oil was recovered. The model with uinj = 5 mm/s was able to capture some pore-level mechanisms such as snap-off, oil film thinning, interface coalescence, and water film bridging. The obtained results revealed that changing the fracture aperture has a slight effect on the imbibition rate at the earlier times and ultimate recoveries would be almost equal. To assess the influences of grain shape on the imbibition process, the simulated domain was reconstructed with cubic grains. It was noticed that because of higher permeability and porosity, relatively larger oil drops were formed and resulted in higher oil recovery compared with the model with spherical grains. The developed model can be used as a basis for phase-field counter-current simulations and would be useful to study the qualitative and quantitative nature of this phenomenon.
A modified barbell-shaped PNN-PZT-PIN piezoelectric ceramic energy harvester
Authors: Gao Xiangyu , Wu Jingen , Yu Yang , Dong Shuxiang
Published: November 2017

The quaternary system of relaxor-ferroelectric based Pb(Ni1/3Nb2/3)O3-Pb(ZrxTi1−x)O3-Pb(In0.5Nb0.5)O3 (PNN-PZT-PIN) piezoelectric ceramic at the morphotropic phase boundary was investigated via the solid reaction method. The optimized ceramic with excellent electric properties of εr = 8084, d33 = 977 pC/N, kp = 0.61, and Ec = 3.0 kV/cm was fabricated into d33-mode discs with separated surface electrodes, which were arranged in a series connection and, then as a piezo-stack, assembled into a barbell-shaped energy harvester that could bear a strong mechanical vibration. It is found that under a vibration mass-induced bending moment, the energy harvester produces an open circuit voltage of 26.4 Vp-p at the acceleration of 2.5 g at a load of 1.56 MΩ, which is two times higher in comparison to one without surface electrode separation. Its power output is 30 μW at the acceleration of 1 g and 104 μW at 2.5 g, which are even six times higher than that of a previously reported barbell-shaped energy harvester at room-temperature with the same acceleration. The enhanced power output can be attributed to (i) the excellent piezoelectric response of PNN-PZT-PIN ceramic and (ii) harvesting positive and negative charges from the separated surface electrodes other than a full surface electrode on piezoelectric discs under bending moment. Furthermore, the practical test was performed within a car engine, which shows that the PNN-PZT-PIN piezoelectric ceramic is a promising candidate for vibration energy harvesting.
Mechanical response of spiral interconnect arrays for highly stretchable electronics
Authors: Qaiser N. , Khan S. M. , Nour M. , Rehman M. U. , Rojas J. P. , Hussain M. M.
Published: November 2017

A spiral interconnect array is a commonly used architecture for stretchable electronics, which accommodates large deformations during stretching. Here, we show the effect of different geometrical morphologies on the deformation behavior of the spiral island network. We use numerical modeling to calculate the stresses and strains in the spiral interconnects under the prescribed displacement of 1000 μm. Our result shows that spiral arm elongation depends on the angular position of that particular spiral in the array. We also introduce the concept of a unit-cell, which fairly replicates the deformation mechanism for full complex hexagon, diamond, and square shaped arrays. The spiral interconnects which are axially connected between displaced and fixed islands attain higher stretchability and thus experience the maximum deformations. We perform tensile testing of 3D printed replica and find that experimental observations corroborate with theoretical study.
Strong two-photon absorption of Mn-doped CsPbCl3 perovskite nanocrystals
Authors: He Tingchao , Li Junzi , Ren Can , Xiao Shuyu , Li Yiwen , Chen Rui , Lin Xiaodong
Published: November 2017

Emerging CsPbX3 (X = Cl, Br, and I) perovskite nanocrystals (NCs) have been demonstrated to be efficient emitters with a high fluorescence quantum yield, making these materials interesting for optical applications as well as for fundamental physics. Interestingly, doping with transition metal ions has been extensively explored as a way of introducing new optical, electronic, and magnetic properties, making perovskite NCs much more functional than their undoped counterparts. However, there have been no reports regarding the nonlinear optical properties of transition metal ion doped perovskite NCs. Herein, by using femtosecond-transient absorption spectroscopy, we have determined the one-photon linear absorption cross-section (∼1.42 × 10−14 cm2) of Mn-doped CsPbCl3 NCs (∼11.7 ± 1.8 nm size, ∼0.2% doping concentration, and ∼600 nm emission wavelength). More importantly, their nonlinear optical properties—in particular, the two-photon absorption (TPA) and resultant emission—were investigated. Notably, the NCs exhibit wavelength-dependent TPA with a maximum value up to ∼3.18 × 105 GM at a wavelength of 720 nm. Our results indicate that Mn-doped CsPbCl3 NCs show promise in nonlinear optical devices and multiphoton fluorescence lifetime imaging.
Taxonomic reassessment of species within the chrysaoros group of Calisto (Lepidoptera : Nymphalidae : Satyrinae)
Authors: Aguila Rayner Núñez , Pérez-Asso Antonio R. , Genaro Julio A.
Published: November 2017

The taxonomic status of the Hispaniolan species of Calisto Hübner, 1823 included in the chrysaoros group is reassessed. Morphological data and COI barcode sequences were analysed through different methods: Neighbour-Joining clustering, ABGD, Median-Joining Haplotype Network, Maximum Likelihood, and Bayesian Inference. Analyses yielded two deeply separated groups or putative species: C. clydoniata and C. chrysaoros. A shallower split was found, except in the Bayesian Inference approach, among populations of southern and northern Hispaniola palaeo-islands. In light of these findings we propose the recognition of two species: C. clydoniata and C. chrysaoros. Within the latter, the populations of the southern and northern Hispaniola palaeo-islands should be recognised as different subspecies: C. chrysaoros chrysaoros Bates and C. chrysaoros galii Schwartz, respectively. Calisto clenchi, syn. nov. is a synonym of C. chrysaoros chrysaoros whereas C. galii galli, syn. nov. and C. galii choneupsilon, syn. nov. are synonyms of C. chrysaoros galii.
EB1-binding–myomegalin protein complex promotes centrosomal microtubules functions
Authors: Bouguenina Habib , Salaun Danièle , Mangon Aurélie , Muller Leslie , Baudelet Emilie , Camoin Luc , Tachibana Taro , Cianférani Sarah , Audebert Stéphane , Verdier-Pinard Pascal , Badache Ali
Published: November 2017

Significance

Microtubule dynamics is tightly regulated during fundamental biological processes such as mitosis, thereby representing a major target for anticancer therapies. To better understand the molecular mechanisms underlying the organization of the microtubule network, we systematically investigated proteins interacting with EB1, a major regulator of microtubules dynamics. We identified a specific isoform of myomegalin, which we termed “SMYLE,” that assembles a macromolecular complex associated with the centrosome, the major microtubule-organizing center in cells, and also connected to the microtubule nucleating complex. SMYLE promoted microtubule assembly from the centrosome and subsequent stabilization of microtubules at the cell periphery. This had consequences on cell motility, mitosis, and cell-cycle progression, suggesting that SMYLE might be an important player in tumor progression.
Pilgrimage and reconciliation: crossing boundaries to transcend them.
Authors: Simons D. J.
Published: November 2017

This chapter discusses the concept of 'accidental pilgrimage' and how it may become more intentional. To do this, it explores the correspondence between the outer and inner journey through the lens of three pairs of related concepts often used in discussions of pilgrimage, namely tourist/pilgrim, secular/religious and sacred/holy. Several pilgrimage contexts, including the Camino de Santiago de Compostela, the pilgrimage to Palestine/Israel, the new pilgrimage shrine of St. Paul's Chapel in New York City and the Burning Man festival in Gerlach, Nevada, are in focus. These settings provide an opportunity to examine the function of pilgrimage as an organizing principle for greater psychological and spiritual integration within the individual, between individuals and among estranged groups.
Beyond farmers-first-and-last: the developmental farm model for accelerating agricultural growth in developing countries.
Authors: Behera U. K. , France J.
Published: November 2017

This paper examines the different approaches traditionally used in agriculture for technology transfer in South Asia and other developing regions, and advocates an alternative approach namely that of the developmental farm model. It has been found to be successful in an Indian context, where small-holder farmers are dominant. Such an approach takes the overall situation of the farmers into full consideration and addresses their multiple problems. A developmental farm model can help generate additional income and employment, maintain or enhance biodiversity and produce renewable energy at the farm level. Overall, its implementation can help improve the livelihood of farmers and address issues of climate change, thus it has the potential to accelerate agricultural growth in developing countries such as India.
Microstructure and fatigue properties of friction stir welded high-strength steel plates
Authors: Sorger Gonçalo , Lehtimäki Eero , Hurme Susanna , Remes Heikki , Vilaça Pedro , Molter Lars
Published: November 2017

The weldability of high-strength steels (HSSs) is limited by their loss of strength, toughness and fatigue properties. In demanding applications, the fatigue properties of welds are among the strictest requirements. This paper presents a weldability analysis focusing on the microstructure and fatigue properties of 6 mm thick S690 and S355 HSS plates joined by friction stir welding. Their fatigue properties are compared to design recommendations and to fatigue properties obtained with other welding techniques. Results show that the high-quality friction stir welded steel joints outperform high-quality arc welds and FAT80 design recommendations. The fatigue strength of the friction stir welded joints is increased with material yield strength. The mechanisms governing crack initiation at different maximum stress levels are discussed.
Does institutional entrenchment shape instrument adjustment?: Assessing instrument constituency influences on American and Australian motor fuel taxation
Authors: Perl Anthony , Burke Matthew I
Published: November 2017

This article compares the long-run adjustment of transport finance instruments in the US and Australia. Change and continuity in these policy instruments highlights how the institutional context can influence an instrument constituency’s influence within a policy subsystem. In the US, a mature instrument constituency created and entrenched motor fuel taxes as an exclusive resource for implementing transport policy. In Australia, fuel taxes remained exposed to the politics of inter-governmental competition and fiscal rivalry across subsystems, leaving less opportunity for instrument constituency leverage. We explore the circumstances under which instrument constituencies can either constrain or facilitate adjusting transportation policy through fiscal mechanisms, especially when the efficacy of established instruments appears to decline. The policy paradigm of American transportation rests upon the entrenched segregation of fuel tax revenues for infrastructure spending. When fuel tax revenues grew from the 1980s until 2008, transportation policy yielded an expanding stream of programme outputs – building the interstate highway network and upgrading part of the nation’s urban transit infrastructure. The instrument constituency that shaped the Highway Trust Fund found a privileged position within the transportation subsystem. In Australia, similar instruments have not been entrenched and have thus been open to political influences beyond the subsystem. The effects of institutional configuration on instrument constituency participation in policy change become most apparent during times of austerity, or when fiscal instruments fail to deliver expected revenues. Electrification of vehicle fleets is now creating such disruption in the transportation subsystem.
Sarcopenia Is Negatively Related to High Gravitational Impacts Achieved From Day-to-day Physical Activity
Authors: Hartley April , Gregson Celia L , Hannam Kimberly , Deere Kevin C , Clark Emma M , Tobias Jon H
Published: November 2017

Background

Sarcopenia has been associated with reduced physical activity (PA). We aimed to determine if sarcopenia, and specific components of muscle size, function, and physical performance, are associated with high impacts achieved during habitual PA, as these are related to bone strength in community-dwelling older women.

Methods

Participants were older women from the Cohort of Skeletal Health in Bristol and Avon. We defined sarcopenia using the EWGSOP criteria. Lower limb peak muscle power and force were assessed using Jumping Mechanography (JM). High vertical impacts were assessed by tri-axial accelerometry (at least 1.5g above gravity). Cross-sectional associations were analyzed by linear regression, adjusting for age, height and weight (or fat mass for models including appendicular lean mass index), comorbidities, smoking, alcohol, and Index of Multiple Deprivation.

Results

Our analyses included 380 participants, with mean age 76.7 (SD 3.0) years; 242 (64%) also completed JM. In age-adjusted analysis, a negative relationship was observed between severity of sarcopenia and high, but not medium or low, impacts (p = .03 for trend). Regarding components of sarcopenia underlying this relationship, multivariable analyses revealed that gait speed (β 1.47 [95% CI 1.14, 1.89], [β-1] reflects the proportionate increase in high impacts per SD increase in exposure) and peak force (1.40 [1.07, 1.84]) were independently associated with high impacts.

Conclusions

Older women with sarcopenia experienced fewer bone-strengthening high impacts than those with presarcopenia or without sarcopenia. To increase bone strengthening activity in older women, interventions need to improve both lower limb muscle force and walking speed.
Learning and Retention Using Virtual Reality in a Decontamination Simulation
Authors: Smith Sherrill J. , Farra Sharon , Ulrich Deborah L. , Hodgson Eric , Nicely Stephanie , Matcham William
Published: November 2017

AIM

The purpose of this study was to examine the longitudinal effects of virtual reality simulation (VRS) on learning outcomes and retention.

BACKGROUND

Disaster preparation for health care professionals is seriously inadequate. VRS offers an opportunity to practice within a realistic and safe environment, but little is known about learning and retention using this pedagogy.

METHOD

A quasiexperimental design was used to examine the use of VRS with baccalaureate nursing students in two different nursing programs in terms of the skill of decontamination.

RESULTS

Results indicate that VRS is at least as good as traditional methods and is superior in some cases for retention of knowledge and performance of skills.

CONCLUSION

VRS may provide a valuable option for promoting skill development and retention. More research is needed to determine how to prepare nurses for skills that may not be required until months or even years after initial introduction.
Treatment of Hypovitaminosis D in an Orthopaedic Trauma Population
Authors: Andres Brendan A. , Childs Benjamin R. , Vallier Heather A.
Published: November 2017

Objectives:

To determine the incidence of hypovitaminosis D and to evaluate a supplementation intervention. We hypothesized that patients would exhibit high adherence with a free sample, and levels would become sufficient.

Design:

Prospective observational study.

Setting:

Level 1 trauma center.

Patients:

One hundred forty-four consecutive, skeletally mature patients treated for acute fractures.

Intervention:

All were provided 600 mg calcium and 800 IU vitamin D3 capsules twice daily.

Main Outcome Measurements:

Serum 25(OH) D levels were obtained on presentation and after supplementation. Patient surveys determined adherence, vitamin D intake, and sun exposure.

Results:

Ninety-one men and 53 women, mean age 45 years, mean body mass index 28.1, were studied. Mean baseline 25(OH) D level was 20.2 ng/mL, including 9 patients taking vitamin D supplements before injury. All others (mean baseline 16.9 ng/mL) were prescribed calcium and vitamin D and were offered free supplements when discharged. Seventy-seven patients completed surveys, and mean 25(OH) D level was 36.7 ng/mL after a mean of 7.0 weeks of supplementation (P < 0.0001). Seventy-nine percent reported adherence to supplement recommendations. All adherent patients achieved normal levels. Sixteen patients were nonadherent, with 10 who forgot to take the supplement, 4 choosing not to use it, 1 choosing to sell the sample, and 1 losing the sample.

Conclusion:

Hypovitaminosis D was present in 97% of orthopaedic trauma patients who were not already taking supplements. The intervention was effective in reducing hypovitaminosis D within several weeks, with all supplemented patients achieving normal levels. Seventy-nine percent of patients adhered to recommendations. Further study to determine the long-term cost-effectiveness of this strategy seems warranted.

Level of Evidence:

Therapeutic, Level II. See Instructions for Authors for a complete description of levels of evidence.
Functional and Radiographic Outcomes After Allograft Anatomic Coracoclavicular Ligament Reconstruction
Authors: Baran Sean , Belisle Jeffrey G. , Granger Erin K. , Tashjian Robert Z.
Published: November 2017

Objectives:

To analyze the functional and radiographic outcomes of anatomic coracoclavicular ligament reconstruction (ACCR) using allograft tendon without interference screw fixation.

Design:

Retrospective nonrandomized study.

Setting:

Level I trauma center (University Hospital).

Patients:

Seventeen patients (mean age of 44 years) with Rockwood III through V acromioclavicular joint disruptions. Twelve of 17 patients had a primary reconstruction, including 4 patients sustaining their injuries as part of a polytrauma incident. Five of 17 patients were revisions of a previously failed acromioclavicular reconstruction procedure.

Intervention:

Open ACCR using hamstring allograft with high-strength suture augmentation and knotted graft fixation without interference screws.

Main outcome measures:

Clinical and patient reported outcome measures including Simple Shoulder Test, American Shoulder and Elbow Surgeons scores, and visual analog scale scores for pain and radiographic outcomes.

Results:

The average final postoperative Simple Shoulder Test and American Shoulder and Elbow Surgeons scores were 10.8 and 80.5, respectively. The average final postoperative visual analog scale pain was 1.8. All patients demonstrated clavicle tunnel widening on final postoperative radiographs compared with immediate postoperative radiographs. The overall complication rate was 36%, with no clavicle or coracoid fractures.

Conclusions:

Open ACCR using hamstring allograft tendon secured with a square knot and high-strength suture augmentation yields equivalent outcomes to those repairs requiring an additional interference screw. Clavicle tunnel widening predictably occurs, but the clinical significance is undetermined. It appears therefore that an interference screw is not needed. Larger comparison studies are needed.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Inter- and Intra-rater Reliability of the Hart-ISSG Proximal Junctional Failure Severity Scale
Authors: Hart Robert A. , Rastegar Farbod , Contag Alec , Kane Marie , Daniels Alan , Klineberg Eric , Eastlack Robert , Smith Justin S. , Hostin Richard , Hamilton D. Kojo , Gum Jeffrey L. , Burton Douglas C. , Sheer Justin K. , Ames Christopher , Schwab Frank , Lafage Virginie , Bess Shay , Shaffrey Christopher , Kebaish Khaled
Published: November 2017

Study Design.

Reliability/external validation study.

Objective.

Investigate inter- and intrarater reliability of the Hart-International Spine Study Group (ISSG) Proximal Junctional Failure Severity Scale (PJFSS) and its correlation with operative revision in patients with proximal junctional failure (PJF).

Summary of Background Data.

The Hart-ISSG PJFSS is a validated classification system for PJF. Reliability of the PJFSS has not been assessed.

Methods.

Sixteen detailed clinical scenarios were assessed using the ISSG PJFSS classification in six categories: neurologic status, axial pain, instrumentation issue, proximal kyphotic angle, level of upper instrumented vertebrae (UIV), and severity of UIV/UIV+1 fracture. Eleven spine surgeons evaluated each case in all six categories during two different assessments, and provided recommendations regarding operative revision or observation for each case. Inter- and intrarater reliability were calculated based on intraclass correlation coefficients.

Results.

All intraclass correlation coefficients demonstrated “almost perfect”’ (0.817–0.988) inter-rater agreement for both assessments, except UIV/UIV+1 fracture severity during the second assessment, which demonstrated “substantial” agreement’ (0.692). Five of six categories had “almost perfect” mean intrarater reliability (0.805–0.981), while “instrumentation issue” demonstrated “substantial” mean agreement (0.757). Inter-rater reliability for recommendation of surgical intervention was “almost perfect” during both assessments (0.911 and 0.922, respectively). Mean PJFSS scores between the two assessments were significantly higher for cases recommended for operative revision (8.43 ± 0.90) versus cases recommended for observation (P < 0.0001).

Conclusion.

The ISSG PJFSS is a reliable and repeatable classification system for assessing patients with PJF. Higher PJFSS scales correlate with recommendation for operative revision, extending prior external validation of the PJFSS.

Level of Evidence: 3
A Multicenter Radiographic Evaluation of the Rates of Preoperative and Postoperative Malalignment in Degenerative Spinal Fusions
Authors: Leveque Jean-Christophe A. , Segebarth Bradley , Schroerlucke Samuel R. , Khanna Nitin , Pollina John , Youssef Jim A. , Tohmeh Antoine G. , Uribe Juan S.
Published: November 2017

Study Design.

Multicenter, retrospective, institutional-review-board -approved study at 18 institutions in the United States with 24 treating investigators.

Objective.

This study was designed to retrospectively assess the prevalence of spinopelvic malalignment in patients who underwent one- or two-level lumbar fusions for degenerative (nondeformity) indications and to assess the incidence of malalignment after fusion surgery as well as the rate of alignment preservation and/or correction in this population.

Summary of Background Data.

Spinopelvic malalignment after lumbar fusion has been associated with lower postoperative health-related quality of life and elevated risk of adjacent segment failure. The prevalence of spinopelvic malalignment in short-segment degenerative lumbar fusion procedures from a large sample of patients is heretofore unreported and may lead to an under-appreciation of these factors in surgical planning and ultimate preservation or correction of alignment.

Methods.

Lateral preoperative and postoperative lumbar radiographs were retrospectively acquired from 578 one- or two-level lumbar fusion patients and newly measured for lumbar lordosis (LL), pelvic incidence (PI), and pelvic tilt. Patients were categorized at preop and postop time points as aligned if PI-LL < 10° or malaligned if PI-LL≥10°. Patients were grouped into categories based on their alignment progression from pre- to postoperative, with preserved (aligned to aligned), restored (malaligned to aligned), not corrected (malaligned to malaligned), and worsened (aligned to malaligned) designations.

Results.

Preoperatively, 173 (30%) patients exhibited malalignment. Postoperatively, 161 (28%) of patients were malaligned. Alignment was preserved in 63%, restored in 9%, not corrected in 21%, and worsened in 7% of patients.

Conclusion.

This is the first multicenter study to evaluate the preoperative prevalence and postoperative incidence of spinopelvic malalignment in a large series of short-segment degenerative lumbar fusions, finding over 25% of patients out of alignment at both time points, suggesting that alignment preservation/restoration considerations should be incorporated into the decision-making of even degenerative lumbar spinal fusions.

Level of Evidence: 3
Individualized Treatment of Botulinum Toxin Type A for Hypertrophic Muscular Calves With Different Bulging Units in Asian Women
Authors: Xu Fawei , Ma Hongfang , Li Yirun , Cai Jiaqin , Gu Zi-chun
Published: November 2017

BACKGROUND

Dermatologic surgeons have performed botulinum toxin type A injection to treat muscular calves, with different dosages and injection sites suggested.

OBJECTIVE

We investigated the use of individualized botulinum toxin type A injection protocols to treat hypertrophic calves in Asian women.

MATERIALS AND METHODS

A total of 294 calves were examined and their bulging areas divided into 4 units (Units 1, 2, 3, 4). The rare bulging area unit 5 was only seen in 1 case. Thirty-five cases were treated using botulinum toxin type A between September 2011 and May 2016, with the treatment protocol chosen according to the assessed bulging units. Standard photo documentation was performed at each clinical visit.

RESULTS

The average injection dose was 187 ± 10 U per patient. The average maximum calf circumference was significantly reduced 3 months postinjection, with that of the right leg reduced from 36.48 ± 0.57 to 34.87 ± 0.44 cm, and that of the left leg from 36.26 ± 0.61 to 34.71 ± 0.53 cm (both p < .01). The overall patient satisfaction rate was 73.08%.

CONCLUSION

A botulinum toxin type A injection protocol tailored to the shape of the hypertrophic calf muscle can effectively improve the contour of the lower leg.
IncobotulinumtoxinA Is an Effective and Well-Tolerated Treatment for Upper Facial Lines: Results From an Open-Label Extension Period of a Phase III Study
Authors: Trevidic Patrick , Connolly Simon A. , Biwer Bernard , Ellers-Lenz Barbara , Harrington Laura S. , Kestemont Philippe , Noah Ernst M. , Sattler Gerhard , Weissenberger Petra , Kerscher Martina
Published: November 2017

BACKGROUND

In clinical practice, different upper facial areas are commonly treated together.

OBJECTIVE

To evaluate the efficacy and safety of repeated incobotulinumtoxinA injections for the treatment of upper facial lines (UFL) in a 3-month open-label extension (OLEX) period.

MATERIALS AND METHODS

In the main study period (randomized, double blind, placebo controlled; n = 156), subjects with moderate-to-severe UFL (glabellar frown lines [GFL], horizontal forehead lines [HFL], and lateral periorbital lines [LPL]) on the 5-point Merz Aesthetics Scales (MAS) received 54 to 64 U incobotulinumtoxinA or placebo. In the OLEX, all subjects (n = 139) received 1 treatment with 54 to 64 U incobotulinumtoxinA. Investigator- and subject-assessed MAS scores were evaluated at rest and maximum contraction. Response was defined either as a MAS score of “none” or “mild” or a ≥1-point improvement in MAS scores.

RESULTS

A clear, rapid treatment response was seen in each individual treated area and for all areas combined. At Day 30, a response of none or mild at maximum contraction (investigator's rating) was reported for 80.1%, 77.2%, and 66.9% of subjects for GFL, HFL, and LPL, respectively. IncobotulinumtoxinA was well tolerated, with no evidence of an increase in adverse events with repeat injection.

CONCLUSION

IncobotulinumtoxinA is highly effective for the simultaneous treatment of UFL with a good safety profile (EudraCT Number: 2011-005887-20).
Levosimendan enhances memory through antioxidant effect in rat model: behavioral and molecular study
Authors: Rababa’h Abeer M. , Alzoubi Karem H. , Atmeh Ala’a
Published: November 2017

Impairment of learning and memory has been associated with accumulation of reactive oxygen species in the body. It has also been found that antioxidants enhance learning and memory. Levosimendan is a cardiac inotropic and vasodilator agent that has pleotropic effects including antioxidant, anti-inflammatory, and smooth muscle vasodilatory actions. In this study, we investigated the effect of levosimendan on learning and memory in rats. Levosimendan (12 µg/kg, intraperitoneally) or vehicle was administered once a week for 8 weeks. The radial arm water maze was used to assess spatial learning and memory. In addition, hippocampus levels of antioxidant biomarkers/enzyme – reduced glutathione (GSH), oxidized glutathione (GSSG), GSH/GSSG ratio, glutathione peroxidase, superoxide dismutase, catalase, and thiobarbituric acid reactive substance – were assessed. Levosimendan significantly enhanced short-term (30 min) and long-term (5 h) memory. Levosimendan also significantly increased levels of glutathione peroxidase and GSH and decreased thiobarbituric acid reactive substance. There were no significant effects on the level of other oxidative stress biomarkers. In conclusion, levosimendan enhanced short-term and long-term memory by potentiating antioxidant defense mechanism in the hippocampus.
Pharmacoeconomic and associated cost savings among women who were prescribed systemic conjugated estrogens therapy compared with those without menopausal therapy
Authors: Tang Wing Yu , Grothe Dale , Keshishian Allison , Morgenstern Diana , Haider Seema
Published: November 2017

Objective:

To explore changes in healthcare costs among postmenopausal women in a commercial population who were prescribed conjugated estrogens for menopausal symptoms.

Methods:

Using the MarketScan dataset from April 1, 2008 through September 30, 2012, postmenopausal women aged ≥45 years, who were prescribed conjugated estrogen tablets (Premarin), were identified. A comparative cohort of postmenopausal women with vasomotor symptoms without any menopause therapy was also identified. Women included were required to have continuous medical and pharmacy benefits for 6 months before and 12 months after index date, with baseline characteristics compared using chi-square and t tests. The 6 and 12-month change (difference in follow-up and baseline costs) in direct healthcare costs was calculated and a difference-in-differences model was used to compare the incremental change at 6 and 12 months in healthcare costs between the cohorts, adjusting for demographic and clinical characteristics.

Results:

The study included 1,404 women who were prescribed conjugated estrogens, and 3,096 untreated women. Women prescribed conjugated estrogens were significantly younger (52 vs 54 years; P < 0.0001) and had a lower Charlson comorbidity index score (0.29 vs 0.41; P < 0.001) compared with the untreated women. After adjusting for baseline characteristics, women treated with conjugated estrogens showed a greater difference in the change in total healthcare costs (−$1,601 vs −$503; P = 0.044), including inpatient stay costs (−$1,431 vs −$28; P < 0.0001), between the baseline and follow-up periods compared with untreated women.

Conclusions:

Women who were prescribed oral conjugated estrogens had a significantly greater reduction in healthcare costs after treatment initiation compared with untreated postmenopausal women.
Reconstruction of Congenital Sternal Clefts: Surgical Experience and Literature Review
Authors: Alshomer F. , Aldaghri Faris , Alohaideb Nawaf , Aljehani Reem , Murad Mohamed Amir , Hashem Fuad
Published: November 2017

Background:

Sternal cleft is a rare anomaly with a reported incidence of 1:100,000 cases per live births. Surgical intervention represents a crucial factor altering the overall patient prognosis, since they are at high risk of impaired oxygenation, as well as multiple chest infections. Herein, we are reporting our experience of surgical management of such rare cases, alerting plastic surgeons to their possibly crucial role in the reconstructive team.

Methods:

A retrospective chart review of 2 cases presenting with chest wall defects. All perioperative data were collected and presented.

Results:

Two patients with sternal clefts of variable degrees were managed. The first was an 18-month-old boy with partial inferior sternal cleft, who was otherwise asymptomatic. The patient underwent reconstruction at the same age using autologous rib graft and pectoralis major flaps due to ectopia cordis that was putting the patient at higher risk for cardiac trauma. The second patient was a 3-month-old girl having a V-shaped partial superior cleft with lung herniation. Surgical reconstruction was applied due to difficulty in weaning the patient off of ventilator support. Initially, reconstruction was applied with SurgiMend dermal matrix, but this was complicated by chest retraction and high oxygen requirement. Definitive reconstruction was later applied with allogeneic bone graft and pectoralis major flaps.

Conclusions:

Meticulous patient assessment and screening for associated anomalies are crucial. Surgical intervention is warranted at an early age. The use of acellular dermal matrix products in the reconstruction is of interest, but should be approached with caution.
CHOROIDAL THICKNESS CHANGES IN ACUTE ZONAL OCCULT OUTER RETINOPATHY
Authors: Maehara Hiroki , Sekiryu Tetsuju , Sugano Yukinori , Maruko Ichiro
Published: November 2017

Purpose:

To investigate the longitudinal morphologic choroidal changes in eyes with acute zonal occult outer retinopathy.

Methods:

In this retrospective observational case series, we studied 10 patients (11 eyes) with unilateral acute zonal occult outer retinopathy at the first visit who were followed more than 12 months by enhanced depth optical coherence tomography. The retinal and choroidal thicknesses (CTs) were measured at six sites in the macula.

Results:

The integrity of the ellipsoid zone was lost 1,500 μm and 3,000 μm nasally in all 11 eyes at the first visit. Compared with the unaffected fellow eyes, the mean total retinal thickness at the first visit was significantly (P = 0.03) thinner 3,000 μm nasal to the fovea in the affected eyes. The mean CTs in the affected eyes did not differ from that in the unaffected eyes at any evaluation; the mean subfoveal CT in the affected eyes gradually decreased during the follow-up period. Compared with the first visit, the mean subfoveal CT decreased significantly (P = 0.011) at the foveal center and nasal, superior, and temporal to the fovea 12 months after disease onset.

Conclusion:

The subfoveal CT in eyes with acute zonal occult outer retinopathy can decrease during follow-up.
Evaluation of the Influence of Gastrointestinal Coinfections on Rotavirus Vaccine Effectiveness in Botswana
Authors: Mokomane Margaret , Tate Jacqueline E. , Steenhoff Andrew P. , Esona Mathew D. , Bowen Michael D. , Lechiile Kwana , Pernica Jeffrey M. , Kasvosve Ishmael , Parashar Umesh D. , Goldfarb David M.
Published: November 2017

Background:

Studies have demonstrated reduced rotavirus vaccine effectiveness (VE) in resource-limited settings. Enteropathogen coinfections in rotavirus cases have been hypothesized to contribute to the lower VE in such settings. We sought to determine if coinfections affect rotavirus VE in Botswana.

Methods:

Between June 2013 and April 2015, children <60 months old, presenting with severe gastroenteritis at 4 hospitals as part of a national rotavirus surveillance were enrolled. Rotavirus enzyme immunoassay (EIA)–positive samples were tested with an in-house real-time polymerase chain reaction (PCR) panel that detected 9 pathogens and a commercial 15 multiplex PCR gastrointestinal pathogen panel. Coinfection was defined as detection of rotavirus plus 1 of the 5 pathogens with the highest attributable fractions for diarrhea. Vaccine status was compared between rotavirus case patients and non-rotavirus “test-negative” controls. VE was also calculated restricting cases to those with rotavirus as the only pathogen detected.

Results:

Two hundred and forty-two children tested rotavirus EIA positive, and 368 children were negative. Of the 182 rotavirus EIA-positive samples tested with the gastrointestinal pathogen panel assay, coinfections were detected in 60 (33%). The overall adjusted 2-dose VE was 59% (95% confidence interval [CI]: 27–77) in the rotavirus coinfection group and 51% (95% CI: −14 to 79) in the rotavirus monoinfection subgroup. Using in-house multiplex PCR panel, of 213 rotavirus EIA-positive subjects, coinfections were detected in 98 samples (46%). The overall adjusted VEs for 2 doses were 48% (95% CI: −2 to 74) and 62% (95% CI: 25–80) in rotavirus monoinfection subgroup.

Conclusions:

We could not find evidence of an effect of enteric coinfections on the effectiveness of rotavirus vaccine.