bluuebunny/crossref_metadata_2025 huggingface dataset:
Patellofemoral arthroplasty versus total knee arthroplasty for isolated patellofemoral osteoarthritis: a systematic review and meta-analysis
Authors: Peng Guanrong , Liu Min , Guan Zhenhua , Hou Yunfei , Liu Qiang , Sun Xiaobo , Zhu Xingyang , Feng Wenjun , Zeng Jianchun , Zhong Zhangrong , Zeng Yirong
Published: April 2021

Background

Isolated patellofemoral osteoarthritis (PF-OA) is a common subtype of knee osteoarthritis, leading to a huge economic burden on health care systems. Although previous studies have shown that patellofemoral arthroplasty (PFA) and total knee arthroplasty (TKA) have good clinical effects, it remains largely unclear which treatment is more effective for patients with isolated PF-OA. We aimed to compare postoperative function, complications, revision rates, level of physical activity, and satisfaction rate between the two surgical techniques.

Methods

Our study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Search of literature was conducted in MEDLINE, EMBASE, Cochrane Library, and Web of Science until November 2020. The included studies were those that provided direct comparison of postoperative outcomes between PFA and TKA. Data were extracted from eligible studies and combined to calculate the pooled odds ratio (OR) and 95% confidence interval (CI). Sensitivity analysis and subgroup analysis were conducted to evaluate heterogeneity between the two groups.

Results

A total of 7 eligible studies (3 recent randomized controlled trials and 4 nonrandomized controlled trials) were included in this meta-analysis. The pooled results showed that both the PFA group and the TKA group had improved postoperative indicators, suggesting that the two operation modes could improve the knee function and quality of life of patients. Throughout the first 2 years postoperatively, higher activity level, and better functional recovery were observed for PFA compared with TKA in this study; moreover, the differences between the two operation modes were statistically significant (p < 0.05). We found no significant difference in complications, revision rates, and satisfaction rate between the two procedures.

Conclusion

Although there was no observed difference in the complications, revision rates, and satisfaction rate between PFA and TKA, PFA was superior to TKA in terms of knee function and physical activity in the first 2 years postoperatively. Therefore, PFA is a safe, effective, and less invasive treatment for patients with isolated PF-OA. Our findings are consistent with the systematic review of current evidence that PFA may be more suitable for younger patients with high activity needs. Patient selection is, therefore, thought to be of paramount importance. Individualized surgical plan should be designed according to the patient’s age, BMI, KOA site, and activity level and combined with the doctor’s personal experience.
Repair technique for a rare partial anomalous pulmonary venous return associated with retroaortic innominate vein
Authors: Jung Hanna , Cho Joon Yong , Lee Youngok
Published: April 2021

Background

Retroaortic innominate vein (RIV) is a rare vascular abnormality. Although RIV itself is asymptomatic, its presence in patients with partial anomalous pulmonary venous return (PAPVR) to the superior vena cava (SVC) is surgically challenging because a simple Warden procedure is impossible.

Case presentation

A 16-year-old girl was diagnosed with tetralogy of Fallot, secundum, and sinus venosus atrial septal defect (ASD) at birth. She underwent total correction of tetralogy of Fallot and ASD closure at the age of 14-months. However, the diagnosis of PAPVR was missed. At the age of 16, she developed dyspnea on exercise. Echocardiography demonstrated severe pulmonary regurgitation, mild tricuspid regurgitation, and D-shaped left ventricle with paradoxical septal motion along with RIV and sinus venous ASD. Computed tomography confirmed RIV and PAPVR. Systemic and pulmonary venous blood pathways were separated by bovine pericardial patch, and pulmonary valve replacement was performed. Postoperative echocardiography demonstrated improvement of D-shaped left ventricle and laminar flow through the SVC and pulmonary veins. Postoperative computed tomography showed a well-reconstructed SVC and pulmonary venous pathway without stenosis. After an uneventful postoperative course, patient was discharged.

Conclusions

PAPVR in patients with RIV may be surgically challenging to repair. We report the first case of successfully repaired PAPVR associated with RIV.
Debulking surgery for functional pleural dissemination of parathyroid carcinoma-case report
Authors: Kawagishi Sachi , Funaki Soichiro , Ose Naoko , Kimura Kenji , Mukai Kosuke , Otsuki Michio , Shintani Yasushi
Published: April 2021

Background

A rare cause of primary hyperparathyroidism (PHPT) is a parathyroid carcinoma. Hypercalcemia with an elevated parathyroid hormone (PTH) level seen in recurrent and metastasis disease cases is often refractory to medical therapy, thus surgical resection is recommended when possible. We performed debulking surgery for pleural dissemination of parathyroid cancer for improvement of symptoms in a patient with hypercalcemia.

Case presentation

A 30-year-old male with hypercalcemia was diagnosed with parathyroid cancer. Following surgery, intact PTH level elevation and hypercalcemia progression due to recurrent disease were noted. An active status of functional left pleural dissemination was revealed in 99mTc-methoxyisobutylisonitrile and somatostatin receptor scintigraphy results, but not in the area of pulmonary metastasis, and debulking surgery was performed. Thereafter, the PTH level was decreased temporarily and activities of daily living improved.

Conclusion

Aggressive resection of metastatic disease in patients with a parathyroid carcinoma is taken into consideration to control hypercalcemia.
Using the autologous innominate vein as a substitute for pulmonary arteries in a patient with pulmonary atresia and absent pulmonary arteries
Authors: Amirghofran Ahmad Ali , Jamshidi Kamran , Edraki Mohammadreza , Amoozgar Hamid , Peiravian Farah , Nirooei Elahe
Published: April 2021

Background

Repair of the absence of the whole or major parts of pulmonary arteries is a challenge, and the choice of conduit material to reconstruct the pulmonary arteries is under dispute. We used the autologous innominate vein to construct pulmonary arteries.

Case presentation l

We present a novel technique using the autologous innominate vein as a free graft in a 6-month-old infant with pulmonary atresia and absence of central pulmonary arteries. Double ductus arteriosus were the only source of perfusion of the lungs. The innominate vein was substituted for the central pulmonary artery between the two lung hila. Total repair by using Contegra graft was performed 9 months later. The patient has been followed for 5 years.

Conclusions

The autologous innominate vein could be used as inter-hilar pulmonary arteries with no calcification and fibrosis in 5-year follow-up.
Correction to: Antibiotics-induced intestinal dysbacteriosis caused behavioral alternations and neuronal activation in different brain regions in mice
Authors: Wang Pan , Tu Ke , Cao Peng , Yang Yuefan , Zhang Hao , Qiu Xin-Tong , Zhang Ming-Ming , Wu Xiao-Jun , Yang Hui , Chen Tao
Published: April 2021

An amendment to this paper has been published and can be accessed via the original article.
Effect of prior treatments on selinexor, bortezomib, and dexamethasone in previously treated multiple myeloma
Authors: Mateos Maria V. , Gavriatopoulou Maria , Facon Thierry , Auner Holger W. , Leleu Xavier , Hájek Roman , Dimopoulos Meletios A. , Delimpasi Sosana , Simonova Maryana , Špička Ivan , Pour Ludĕk , Kriachok Iryna , Pylypenko Halyna , Doronin Vadim , Usenko Ganna , Benjamin Reuben , Dolai Tuphan K. , Sinha Dinesh K. , Venner Christopher P. , Garg Mamta , Stevens Don A. , Quach Hang , Jagannath Sundar , Moreau Philippe , Levy Moshe , Badros Ashraf Z. , Anderson Larry D. , Bahlis Nizar J. , Cavo Michele , Chai Yi , Jeha Jacqueline , Arazy Melina , Shah Jatin , Shacham Sharon , Kauffman Michael G. , Richardson Paul G. , Grosicki Sebastian
Published: April 2021

Therapeutic regimens for previously treated multiple myeloma (MM) may not provide prolonged disease control and are often complicated by significant adverse events, including peripheral neuropathy. In patients with previously treated MM in the Phase 3 BOSTON study, once weekly selinexor, once weekly bortezomib, and 40 mg dexamethasone (XVd) demonstrated a significantly longer median progression-free survival (PFS), higher response rates, deeper responses, a trend to improved survival, and reduced incidence and severity of bortezomib-induced peripheral neuropathy when compared with standard twice weekly bortezomib and 80 mg dexamethasone (Vd). The pre-specified analyses described here evaluated the influence of the number of prior lines of therapy, prior treatment with lenalidomide, prior proteasome inhibitor (PI) therapy, prior immunomodulatory drug therapy, and prior autologous stem cell transplant (ASCT) on the efficacy and safety of XVd compared with Vd. In this 1:1 randomized study, enrolled patients were assigned to receive once weekly oral selinexor (100 mg) with once weekly subcutaneous bortezomib (1.3 mg/m2) and 40 mg per week dexamethasone (XVd) versus standard twice weekly bortezomib and 80 mg per week dexamethasone (Vd). XVd significantly improved PFS, overall response rate, time-to-next-treatment, and showed reduced all grade and grade ≥ 2 peripheral neuropathy compared with Vd regardless of prior treatments, but the benefits of XVd over Vd were more pronounced in patients treated earlier in their disease course who had either received only one prior therapy, had never been treated with a PI, or had prior ASCT. Treatment with XVd improved outcomes as compared to Vd regardless of prior therapies as well as manageable and generally reversible adverse events. XVd was associated with clinical benefit and reduced peripheral neuropathy compared to standard Vd in previously treated MM. These results suggest that the once weekly XVd regimen may be optimally administered to patients earlier in their course of disease, as their first bortezomib-containing regimen, and in those relapsing after ASCT.

Trial registration: ClinicalTrials.gov (NCT03110562). Registered 12 April 2017. https://clinicaltrials.gov/ct2/show/NCT03110562.
Effectiveness of saline water and lidocaine injection treatment of intractable plantar keratoma: a randomised feasibility study
Authors: Mercier Marie‐Philippe , Blanchette Virginie , Cantin Vincent , Brousseau‐Foley Magali
Published: April 2021

Background

An intractable plantar keratoma (IPK) is a conical thickening of the epidermis' stratum corneum and a common cause of foot pain which can have a significant, detrimental impact on the mobility, quality of life and independence of individuals. Conservative treatments are currently offered to patients with IPK, but they are unsatisfactory since they do not offer a sufficient or permanent reduction of symptoms. The purpose of this study was the evaluation of the feasibility, safety and effectiveness of innovative treatments for intractable plantar keratoma (IPK).

Methods

A randomized single blind trial with 40 patients divided with block randomization in four parallel groups was conducted to compare treatment combinations: conservative sharp debridement only or sharp debridement with needle insertion, physiological water injection or lidocaine injection. All patients obtained the same treatment four times at a four‐week interval. At each visit, visual analog scale (VAS), Foot Function Index (FFI) and IPK size were evaluated. VAS and FFI were also completed at a six and twelve‐month follow‐up.

Results

Our findings in regards to feasibility demonstrated recruitment challenges because of the anticipated pain that would be provoked by needle insertion may not be worth the potential pain relief compared to debridement alone from the patient's perspective. This was also the principal cause of drop out. Our preliminary results show no main effect of group for any of the clinical outcomes: pain felt on VAS, FFI score, IPK's size (p > 0.05). However, the analysis revealed a statistically significant effect of time on VAS (p < 0.001), FFI score (p < 0.001) and IPK's size (width and depth (p < 0.001); length (p = 0.001)), but no group x time interaction was found (p > 0.05).

Conclusions

This study demonstrates that IPK treatment consisting of sharp debridement with needle insertion, physiological saline water injection or lidocaine injection is feasible and safe. There was a non‐statistically significant trend toward diminishing pain intensity compared to scalpel debridement alone. The pain provoked by needle insertion and injection treatments must be addressed with a scientifically proven protocol to make it more comfortable for patients before these treatments could be considered in further studies.

Trial registration

ClinicalTrials.gov, NCT04777227. 2 March, 2021 ‐ Retrospectively registered (All participants were recruited prior to registration).
A prospective multicenter assessor-blinded randomized controlled study to compare the efficacy of short versus long protocols of electroconvulsive therapy as an augmentation strategy to clozapine in patients with ultra-resistant schizophrenia (SURECT study)
Authors:   SURECT Group, Moulier Virginie , Krir Mohamed Wassim , Dalmont Marine , Guillin Olivier , Rothärmel Maud
Published: April 2021

Background

Although clozapine is the most effective antipsychotic drug for treatment-resistant schizophrenia, it leads to a poor or partial response in 40 to 70% of patients. Augmentation of clozapine with electroconvulsive therapy (ECT) is a highly effective and relatively safe treatment for these clozapine-resistant patients. However, parameters are not yet well specified, such as the optimal number of sessions, their frequency, and the relevance of maintenance ECT. Our objective is to compare the efficacy and tolerance between two protocols of combined ECT and clozapine treatment in patients with ultra-resistant schizophrenia (URS): a 6-month protocol (short protocol with 20 ECT sessions) and a 12-month protocol (long protocol with 40 ECT sessions).

Methods

Sixty-four patients with schizophrenia with persistent psychotic symptoms despite clozapine treatment will be enrolled in a prospective multicentric assessor-blinded randomized controlled trial. Patients will be randomly assigned to the short or the long protocol. The main outcome is the response rate assessed by the Positive and Negative Symptoms Scale (PANSS) 3 months after the end of the treatment in patients following the long protocol compared to those following the short protocol. The response was defined as a 30% reduction on the PANSS baseline. Clinical assessments (PANSS, BPRS, HAMD-21, YMRS, CGI, GAF, Modified Overt Aggression Scale (MOAS), and Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS)) and plasma clozapine concentration will be performed at baseline and at 2, 4, 6, 9, 12, and 15 months. Neuropsychological measures (MMSE, RL/RI-16, Doors test, D2 Test of Attention, Copy of the Rey-Osterrieth complex figure) will be performed at baseline and at 6 and 15 months.

Discussion

The aims of this research are to optimize protocols of combined ECT with clozapine in patients with URS and to offer specific recommendations for these patients’ care.

Trial registration

ClinicalTrials.gov NCT03542903. Registered on May 31, 2018. Id RCB: 2017-A02657-46
Vaspin in atherosclerotic disease and cardiovascular risk in axial spondyloarthritis: a genetic and serological study
Authors: Rueda-Gotor Javier , López-Mejías Raquel , Remuzgo-Martínez Sara , Pulito-Cueto Verónica , Corrales Alfonso , Lera-Gómez Leticia , Portilla Virginia , González-Mazón Íñigo , Blanco Ricardo , Expósito Rosa , Mata Cristina , Llorca Javier , Hernández-Hernández Vanesa , Rodríguez-Lozano Carlos , Barbarroja Nuria , Castro Rafaela Ortega , Vicente Esther , Fernández-Carballido Cristina , Martínez-Vidal María Paz , Castro-Corredor David , Anino-Fernández Joaquín , Peiteado Diana , Plasencia-Rodríguez Chamaida , Galíndez-Agirregoikoa Eva , García-Vivar María Luz , Gualillo Oreste , Quevedo-Abeledo Juan Carlos , Castañeda Santos , Ferraz-Amaro Iván , González-Gay Miguel Á. , Genre Fernanda
Published: April 2021

Background

Vaspin is a novel anti-inflammatory adipokine associated with cardiovascular (CV) disease and inflammation in chronic inflammatory conditions different from axial spondyloarthritis (axSpA). Given the high incidence of CV disease (mainly due to accelerated atherosclerosis) exhibited by axSpA patients, we wondered if vaspin could also be a key molecule in this process. However, data on the role of vaspin regarding atherosclerotic disease in the context of axSpA is scarce. For this reason, we aimed to evaluate the implication of vaspin, at the genetic and serological level, in subclinical atherosclerosis and CV risk in axSpA.

Methods

This study included 510 patients diagnosed with axSpA. Carotid ultrasound (US) was performed to evaluate the presence of subclinical atherosclerosis. Three vaspin gene variants (rs2236242, rs7159023, and rs35262691) were genotyped by TaqMan probes. Serum vaspin levels were assessed by enzyme-linked immunosorbent assay. Statistical analysis was performed using STATA® v.11.1.

Results

Serum vaspin levels were significantly higher in female patients than in males and also in obese patients when compared to those with normal weight (p < 0.05). At the genetic level, we disclosed that the minor allele of rs2236242 (A) was associated with lower serum vaspin levels in axSpA, while the rs7159023 minor allele (A) was linked to higher serum levels (p < 0.05). When the three polymorphisms assessed were combined conforming haplotypes, we disclosed that the TGC haplotype related to high serum levels of vaspin (p = 0.01). However, no statistically significant association was observed between vaspin and markers of subclinical atherosclerosis, both at the genetic and serological level.

Conclusions

Our results revealed that vaspin is linked to CV risk factors that may influence on the atherosclerotic process in axSpA. Additionally, we disclosed that serum vaspin concentration is genetically modulated in a large cohort of patients with axSpA.
A survey demonstrating that the procedural experience of residents in internal medicine, critical care and emergency medicine is poor: training in ultrasound is required to rectify this
Authors: Souleymane Mamdouh , Rajendram Rajkumar , Mahmood Naveed , Ghazi Amro M. T. , Kharal Yousuf M. S. , Hussain Arif
Published: April 2021

Background

Training in procedural skills is often suboptimal. The aim of this study was to quantify the needs of residents in internal medicine (IM), critical care (CC), and emergency medicine (EM) for instruction in ultrasound-guided procedures.

Methods

All IM, EM and CC residents (n = 200) at King Abdulaziz Medical City, Riyadh, Saudi Arabia, were invited to participate in a questionnaire-based survey to identify skill and experience gaps. The contribution of procedural skills to patient care (i.e. applicability) and proficiency in the sterile technique required to perform ultrasound-guided procedures were rated on Likert scales. Data on training, accreditation, and experience with and without ultrasound were collected.

Results

The overall response rate was 72% (IM 91%, CC 100%, EM 40%). Although the sample reported that procedural skills were very applicable, 19% (IM n = 25, EM n = 2) had not performed any procedures. However, five residents were accredited in point-of-care ultrasound, 61% of the sample had performed ultrasound-guided procedures and 65% had used landmark techniques. Whilst more internists had performed procedures using landmark techniques, CC and EM residents had performed more ultrasound-guided procedures. Whilst CC residents had not missed any opportunities to perform procedures because supervisors were less available, EM (6) and IM (89) residents had. Whilst skill gaps were only identified in the IM residency programme, experience gaps were present in all three residency programmes. The IM residency programme had larger experience gaps than the CC and EM programmes for all procedural skills.

Discussion

Residents in IM, CC and EM perceive that ultrasound-guided procedures are relevant to their practice. However, the IM residents performed fewer procedures than CC residents and EM residents at least partly because internists also lack skills in ultrasound. Training in ultrasound-guided procedures may reduce the use of landmark techniques and improve patient safety. Residents in IM, CC and EM therefore require training in ultrasound-guided procedures.
Prediction of Johne’s disease state based on quantification of T cell markers and their interaction with macrophages in the bovine intestine
Authors: Jenvey Caitlin J. , Shircliff Adrienne L. , Obando Marrero Elsa , Stabel Judith R.
Published: April 2021

Cell-mediated immune responses to Mycobacterium avium subsp. paratuberculosis (MAP) are regulated by various types of T lymphocytes. The aim of this study was to quantitate T cell subsets in the mid-ileum of cows naturally infected with MAP to identify differences during different stages of infection, and to determine whether these subsets could be used as predictors of disease state. Immunofluorescent labeling of T cell subsets and macrophages was performed on frozen mid-ileal tissue sections archived from naturally infected dairy cows in either subclinical or clinical disease status, and noninfected control cows. Comprehensive IF staining for CD4, CD8α, TcR1-N24 (gamma delta), FoxP3, CXCR3 and CCR9 served to define T cell subsets and was correlated with macrophages present. Clinically affected cows demonstrated significantly higher numbers of CXCR3+ (Th1-type) and CCR9+ (total small intestinal lymphocytes) cells at the site of infection compared to the subclinical cows and noninfected controls. Further, predictive modeling indicated a significant interaction between CXCR3+ and AM3K+ (macrophages) cells, suggesting that progression to clinical disease state aligns with increased numbers of these cell types at the site of infection. The ability to predict disease state with this model was improved from previous modeling using immunofluorescent macrophage data. Predictive modelling indicated an interaction between CXCR3+ and AM3K+ cells, which could more sensitively detect subclinical cows compared to clinical cows. It may be possible to use this knowledge to improve and develop an assay to detect subclinically infected animals with more confidence during the early stages of the disease.
A cooperative DDoS attack detection scheme based on entropy and ensemble learning in SDN
Authors: Yu Shanshan , Zhang Jicheng , Liu Ju , Zhang Xiaoqing , Li Yafeng , Xu Tianfeng
Published: April 2021

In order to solve the problem of distributed denial of service (DDoS) attack detection in software-defined network, we proposed a cooperative DDoS attack detection scheme based on entropy and ensemble learning. This method sets up a coarse-grained preliminary detection module based on entropy in the edge switch to monitor the network status in real time and report to the controller if any abnormality is found. Simultaneously, a fine-grained precise attack detection module is designed in the controller, and a ensemble learning-based algorithm is utilized to further identify abnormal traffic accurately. In this framework, the idle computing capability of edge switches is fully utilized with the design idea of edge computing to offload part of the detection task from the control plane to the data plane innovatively. Simulation results of two common DDoS attack methods, ICMP and SYN, show that the system can effectively detect DDoS attacks and greatly reduce the southbound communication overhead and the burden of the controller as well as the detection delay of the attacks.
On a class of solvable difference equations generalizing an iteration process for calculating reciprocals
Authors: Stević Stevo
Published: April 2021

The well-known first-order nonlinear difference equation$$ y_{n+1}=2y_{n}-xy_{n}^{2}, \quad n\in {\mathbb {N}}_{0}, $$yn+1=2yn−xyn2,n∈N0,naturally appeared in the problem of computing the reciprocal value of a given nonzero real numberx. One of the interesting features of the difference equation is that it is solvable in closed form. We show that there is a class of theoretically solvable higher-order nonlinear difference equations that include the equation. We also show that some of these equations are also practically solvable.
Multidimensional sampling theorems for multivariate discrete transforms
Authors: Hassan H. A.
Published: April 2021

This paper is devoted to the establishment of two-dimensional sampling theorems for discrete transforms, whose kernels arise from second order partial difference equations. We define a discrete type partial difference operator and investigate its spectral properties. Green’s function is constructed and kernels that generate orthonormal basis of eigenvectors are defined. A discrete Kramer-type lemma is introduced and two sampling theorems of Lagrange interpolation type are proved. Several illustrative examples are depicted. The theory is extendible to higher order settings.
Calcium bilirubinate sludge causes early onset of congenital biliary dilatation: a report of two cases
Authors: Kato Shoko , Kaneko Kenitiro , Matsushita Nozomi , Kurahashi Shintaro , Osawa Takaaki , Matsumura Tatsuki , Saito Takuya , Fukami Yasuyuki , Komatsu Shunichiro , Sano Tsuyoshi
Published: April 2021

Background

Symptomatic congenital biliary dilatation (CBD) during early infancy is always characterized by cystic dilation of the common bile duct with a narrow segment connecting the pancreatic duct.

Case presentation

In two consecutive infants with a prenatal diagnosis of CBD, we found that biliary sludge had formed in the cyst upon the appearance of symptoms including acholic stool and hypertransaminasemia. Infrared absorption spectrometry revealed that the sludge consisted of calcium bilirubinate.

Conclusion

We suggest that overproduction of bilirubin by neonatal hemolysis causes sedimentation of bilirubin calcium, resulting in obstruction of the narrow segment and development of symptoms.
Preoperative imaging optimized for epiretinal membrane surgery
Authors: Philippakis Elise , Thouvenin Raphaël , Gattoussi Sarra , Couturier Aude , Tadayoni Ramin
Published: April 2021

Background

To compare imaging modalities for visualizing primary epiretinal membrane (ERM) with each other and with intraoperative digital images (IDI) after blue staining.

Methods

The records of consecutive patients operated for primary ERM over a 12-month period were retrospectively reviewed. Preoperative imaging included color fundus photography (CFP), En Face spectral-domain optical coherence tomography (OCT), 45° infrared- (IR) and blue-reflectance (BR) scanning laser ophthalmoscopy. All images were qualitatively analyzed and scored from 0–4 according to the ability to visualize ERM details (0 = no visible ERM or vessel contraction, 1 = vessel contraction, 2 = retinal folds, 3 = ERM limits, 4 = elevated ERM edge). The preoperative ERM morphology was then compared to that seen on the IDI acquired after 1-min blue dye staining when available.

Results

Seventy eyes were included. The highest score for ERM visualization was obtained on BR and En Face OCT. A score of 3 or 4 was obtained in 68.5%, 62.1%, 17.9% and 13.6% of cases on En Face OCT, BR, CFP and IR images, respectively. IDI were available for 20 eyes, and showed a similar ERM morphology compared to preoperative images in most cases: a negative staining pattern corresponded to a plaque on En face OCT in 91% of eyes. However, IDI failed to show the ERM edges in 37.5% of cases.

Conclusion

ERM morphology was better visualized preoperatively by BR and En Face OCT, in a similar way to the IDI after staining. Future intraoperative visualization systems could integrate both imaging modalities overlaid with the IDI for guiding ERM removal instead of staining.
Hyperbranched polymer surfactant: synthesis, characterization and surface tension activity
Authors: Ren Longfang , Tang Zheng , Qiang Taotao , Zhang Guoguo
Published: April 2021

A series of hyperbranched polymer surfactants (HBP-C8, HBP-C12 and HBP-C16) were synthesized by the reaction between hydroxyl-terminated hyperbranched polymers (HBP) and fatty acyl chloride. The structure of obtained hyperbranched polymer surfactant was characterized by FTIR, NMR and GPC. The results showed that the products have amphiphilic structure. The thermal property of the hyperbranched polymer surfactant investigated by DSC and TGA was strongly influenced by the length of end alkyl chain. Surface activity of hyperbranched polymer surfactant was analyzed by surface tension method and UV spectrophotometry, respectively. The results showed that hyperbranched polymer surfactant took on better surface activity, which can effectively reduce the surface tension of the water. The hyperbranched polymer surfactant has a lower critical micelle concentration (CMC) and displays single molecular micellar properties, which can package small hydrophilic molecules in relatively low concentration.

Graphical abstract
Permafrost thaw and ground settlement considering long-term climate impact in northern Alaska
Authors: Yang Zhaohui Joey , Lee Kannon C. , Liu Haibo
Published: April 2021

Alaska’s North Slope is predicted to experience twice the warming expected globally. When summers are longer and winters are shortened, ground surface conditions in the Arctic are expected to change considerably. This is significant for Arctic Alaska, a region that supports surface infrastructure such as energy extraction and transport assets (pipelines), buildings, roadways, and bridges. Climatic change at the ground surface has been shown to impact soil layers beneath through the harmonic fluctuation of the active layer, and warmer air temperature can result in progressive permafrost thaw, leading to a deeper active layer. This study attempts to assess climate change based on the climate model data from the fifth phase of the Coupled Model Intercomparison Project and its impact on a permafrost environment in Northern Alaska. The predicted air temperature data are analyzed to evaluate how the freezing and thawing indices will change due to climate warming. A thermal model was developed that incorporated a ground surface condition defined by either undisturbed intact tundra or a gravel fill surface and applied climate model predicted air temperatures. Results indicate similar fluctuation in active layer thickness and values that fall within the range of minimum and maximum readings for the last quarter-century. It is found that the active layer thickness increases, with the amount depending on climate model predictions and ground surface conditions. These variations in active layer thickness are then analyzed by considering the near-surface frozen soil ice content. Analysis of results indicates that thaw strain is most significant in the near-surface layers, indicating that settlement would be concurrent with annual thaw penetration. Moreover, ice content is a major factor in the settlement prediction. This assessment methodology, after improvement, and the results can help enhance the resilience of the existing and future new infrastructure in a changing Arctic environment.
Development and validation of stability-indicating RP-HPLC method for estimation of dalfampridine in bulk drug and tablet dosage form
Authors: Bagal Dipali , Nagar Akhil , Joshi Aditya , Chachare Aishwarya , Shirkhedkar Atul , Khadse Saurabh
Published: April 2021

Background

In the current study, a simple, improved, precise, rapid, and accurate reverse phase liquid chromatographic method was produced for the estimation of dalfampridine in bulk and tablet dosage form which is a potassium channel blocker used for the treatment of multiple sclerosis (MS). The separation of dalfampridine was achieved isocratically on a C18 column (250 × 4.6 mm, 5 μm) using (0.1% v/v) buffer pH 3.0 ± 0.05 adjusted with diluted orthophosphoric acid (OPA) and acetonitrile (ACN) in the ratio of 60:40% (v/v) as a mobile phase, at a flow rate of 0.5 mL/min, and column temperature of 40 °C. HPLC grade methanol as diluents was used. Five microliters of the standard solution of the drug was injected, and the eluted analytes were detected at 262 nm.

Results

Dalfampridine was eluted at 4.5 min with a run time of 10 min. Linearity in the method was measured in the concentration range of 25–75 ppm with a correlation coefficient of 0.999. Limit of detection and limit of quantitation were found to be 0.711 μg/mL and 2.154 μg/mL, respectively. Dalfampridine was subjected for forced degradation stability study in conditions of thermal, acid, alkali, and oxidation and photo-degradation condition. The degradants were well resolved from the dalfampridine main peak. Validation of the developed method is carried as per USFDA and ICH guidelines.

Conclusion

The results of the analysis prove that the method is simple, improved, precise, accurate, and rapid for estimating the content of dalfampridine in bulk drug and tablet dosage form and can be applied for routine analysis.
Effectiveness and Safety of Thermal Ablation in the Treatment of Primary Hyperparathyroidism: A Multicenter Study
Authors: Wei Ying , Peng Cheng-Zhong , Wang Shu-Rong , He Jun-Feng , Peng Li-Li , Zhao Zhen-Long , Cao Xiao-Jing , Li Yan , Yu Ming-An
Published: April 2021

Context

Ultrasound (US)-guided thermal ablation has generated recent interest as minimally invasive treatments of primary hyperparathyroidism (pHPT). But definitive evidence for the efficacy of thermal ablation in treating pHPT is not well characterized.

Objective

This work aims to evaluate the effectiveness and safety of thermal ablation for pHPT.

Methods

From January 2015 to March 2020, data pertaining to patients who received thermal ablation for pHPT at 4 centers were retrospectively analyzed. The median follow-up duration was 18.1 months (interquartile range, 6.5-42.2 months). A cure referred to the reestablishment of normal values of serum calcium and intact parathyroid hormone throughout the entire follow-up period, at least more than 6 months. The technical success, effectiveness, and safety of treatment were analyzed.

Results

A total of 119 patients (mean age, 57.2 ± 16.3 years; 81 female) with 134 parathyroid nodules were enrolled. The mean maximum diameter of the parathyroid glands was 1.6 ± 0.9 cm. Ninety-six patients underwent microwave ablation (MWA), and 23 patients underwent radiofrequency ablation (RFA). The technical success rate was 98.3% and the cure rate was 89.9%. Significant differences were found in the maximum diameter between the cured patients and the patients who did not undergo ablation of the target lesions. Except for cases with pHPT nodules less than 0.6 cm in diameter, the cure rate was 95%. There were no difference in cure rates at 6 months between the MWA and RFA groups (MWA vs RFA, 90.6% vs 87.0%; χ 2 = 0.275, P = .699). The volume reduction rate of the ablation zone was 94.6% at 12 months. The complication rate was 6.7% (8/119). With the exception of one patient with persistent voice impairment, other symptoms spontaneously resolved within 6 months.

Conclusion

Thermal ablation is effective and safe for pHPT.
Properly Collected Plasma Metanephrines Excludes PPGL After False-Positive Screening Tests
Authors: Kline Gregory A , Boyd Jessica , Polzin Brenda , Harvey Adrian , Pasieka Janice L , Sadrzadeh Hossein S M , Leung Alexander A
Published: April 2021

Context

False-positive results are common for pheochromocytoma/paraganglioma (PPGL) real-world screening.

Objective

Determine the correlation between screening urine and seated plasma metanephrines in outpatients where PPGL was absent, compared to meticulously prepared and supine-collected plasma metanephrines with age-adjusted references.

Design

Retrospective cohort study.

Setting

Databases from a single-provider provincial laboratory (2012-2018), a validated PPGL registry, and a manual chart review from a specialized endocrine testing unit.

Patients

PPGL registry data excluded known PPGL cases from the laboratory database. Outpatients having both urine and plasma metanephrines <90 days apart.

Methods

The correlation between urine and seated plasma measures along with the total positivity rate. All cases of plasma metanephrines drawn in the endocrine unit were reviewed for test indication and test positivity rate.

Results

There were 810 non-PPGL pairs of urine and plasma metanephrines in the laboratory database; 46.1% of urine metanephrines were reported high. Of seated outpatient plasma metanephrines drawn a median of 5.9 days later, 19.2% were also high (r = 0.33 and 0.50 for normetanephrine and metanephrine, respectively). In contrast, the meticulously prepared and supine collected patients (n = 139, 51% prior high urine metanephrines) had <3% rate of abnormal high results in patients without known PPGL/adrenal mass.

Conclusions

There was a poor-to-moderate correlation between urine and seated plasma metanephrines. Up to 20% of those with high urine measures also had high seated plasma metanephrines in the absence of PPGL. Properly prepared and collected supine plasma metanephrines had a false-positive rate of <3% in the absence of known PPGL/adrenal mass.
An Assessment of Anesthesia Capacity in Liberia: Opportunities for Rebuilding Post-Ebola
Authors: Odinkemelu Didi S. , Sonah Aaron K. , Nsereko Etienne T. , Dahn Bernice T. , Martin Marie H. , Moon Troy D. , Niconchuk Jonathan A. , Walters Camila B. , Kynes J. Matthew
Published: April 2021

BACKGROUND:

The health system of Liberia, a low-income country in West Africa, was devastated by a civil war lasting from 1989 to 2003. Gains made in the post-war period were compromised by the 2014–2016 Ebola epidemic. The already fragile health system experienced worsening of health indicators, including an estimated 111% increase in the country’s maternal mortality rate post-Ebola. Access to safe surgery is necessary for improvement of these metrics, yet data on surgical and anesthesia capacity in Liberia post-Ebola are sparse. The aim of this study was to describe anesthesia capacity in Liberia post-Ebola as part of the development of a National Surgical, Obstetric, and Anesthesia Plan (NSOAP).

METHODS:

Using the World Federation of Societies of Anaesthesiologists (WFSA) Anaesthesia Facility Assessment Tool (AFAT), we conducted a cross-sectional survey of 26 of 32 Ministry of Health recognized hospitals that provide surgical care in Liberia. The surveyed hospitals served approximately 90% of the Liberian population. This assessment surveyed infrastructure, workforce, service delivery, information management, medications, and equipment and was performed between July and September 2019. Researchers obtained data from interviews with anesthesia department heads, medical directors and through direct site visits where possible.

RESULTS:

Anesthesiologist and nurse anesthetist workforce densities were 0.02 and 1.56 per 100,000 population, respectively, compared to 0.63 surgeons per 100,000 population and 0.52 obstetricians/gynecologists per 100,000 population. On average, there were 2 functioning operating rooms (ORs; OR in working condition that can be used for patient care) per hospital (standard deviation [SD] = 0.79; range, 1–3). Half of the hospitals surveyed had a postanesthesia care unit (PACU) and intensive care unit (ICU); however, only 1 hospital had mechanical ventilation capacity in the ICU. Ketamine and lidocaine were widely available. Intravenous (IV) morphine was always available in only 6 hospitals. None of the hospitals surveyed completely met the minimum World Health Organization (WHO)-WFSA standards for health care facilities where surgery and anesthesia are provided.

CONCLUSIONS:

Overall, we noted several critical gaps in anesthesia and surgical capacity in Liberia, in spite of the massive global response post-Ebola directed toward health system development. Further investment across all domains is necessary to attain minimum international standards and to facilitate the provision of safe surgery and anesthesia in Liberia. The study results will be considered in development of an NSOAP for Liberia.
Preclinical Proficiency-Based Model of Ultrasound Training
Authors: Fatima Huma , Mahmood Feroze , Mufarrih Syed Hamza , Mitchell John D. , Wong Vanessa , Amir Rabia , Hai Ting , Montealegre Mario , Jones Stephanie B. , Knio Ziyad O. , Matyal Robina
Published: April 2021

BACKGROUND:

Graduate medical education is being transformed from a time-based training model to a competency-based training model. While the application of ultrasound in the perioperative arena has become an expected skill set for anesthesiologists, clinical exposure during training is intermittent and nongraduated without a structured program. We developed a formal structured perioperative ultrasound program to efficiently train first-year clinical anesthesia (CA-1) residents and evaluated its effectiveness quantitatively in the form of a proficiency index.

METHODS:

In this prospective study, a multimodal perioperative ultrasound training program spread over 3 months was designed by experts at an accredited anesthesiology residency program to train the CA-1 residents. The training model was based on self-learning through web-based modules and instructor-based learning by performing perioperative ultrasound techniques on simulators and live models. The effectiveness of the program was evaluated by comparing the CA-1 residents who completed the training to graduating third-year clinical anesthesia (CA-3) residents who underwent the traditional ultrasound training in the residency program using a designed index called a “proficiency index.” The proficiency index was composed of scores on a cognitive knowledge test (20%) and scores on an objective structured clinical examination (OSCE) to evaluate the workflow understanding (40%) and psychomotor skills (40%).

RESULTS:

Sixteen CA-1 residents successfully completed the perioperative ultrasound training program and the subsequent evaluation with the proficiency index. The total duration of training was 60 hours of self-based learning and instructor-based learning. There was a significant improvement observed in the cognitive knowledge test scores for the CA-1 residents after the training program (pretest: 71% [0.141 ± 0.019]; posttest: 83% [0.165 ± 0.041]; P < .001). At the end of the program, the CA-1 residents achieved an average proficiency index that was not significantly different from the average proficiency index of graduating CA-3 residents who underwent traditional ultrasound training (CA-1: 0.803 ± 0.049; CA-3: 0.823 ± 0.063, P = .307).

CONCLUSIONS:

Our results suggest that the implementation of a formal, structured curriculum allows CA-1 residents to achieve a level of proficiency in perioperative ultrasound applications before clinical exposure.
Systems Exercise Genetics Research Design Standards
Authors: Lightfoot J. Timothy , Roth Stephen M. , Hubal Monica J.
Published: April 2021

It is clear, based on a deep scientific literature base, that genetic and genomic factors play significant roles in determining a wide range of sport and exercise characteristics including exercise endurance capacity, strength, daily physical activity levels, and trainability of both endurance and strength. Although the research field of exercise systems genetics has rapidly expanded over the past two decades, many researchers publishing in this field are not extensively trained in molecular biology or genomics techniques, sometimes creating gaps in generating high-quality and cutting-edge research for publication. As current or former Associate Editors for Medicine and Science in Sports and Exercise that have handled the majority of exercise genetics articles for Medicine and Science in Sports and Exercise in the past 15 yr, we have observed a large number of scientific manuscripts submitted for publication review that have exhibited significant flaws preventing their publication; flaws that often directly stem from a lack of knowledge regarding the “state-of-the-art” methods and accepted literature base that is rapidly changing as the field evolves. The purpose of this commentary is to provide researchers—especially those coming from a nongenetics background attempting to publish in the exercise system genetics area—with recommendations regarding best-practice research standards and data analysis in the field of exercise systems genetics, to strengthen the overall literature in this important and evolving field of research.
Η οικονομική ισχύς της Ευρωπαϊκής Ένωσης στην παγκόσμια οικονομία
Authors: Παπανικολάου Κωνσταντίνος
Published: April 2021

H μελέτη των διεθνών οικονομικών κρίσεων και των συνεπειών τους στην παγκόσμια οικονομία αποτελεί έναν από τους πλέον δυναμικούς κλάδους του γνωστικού αντικειμένου της Διεθνούς Πολιτικής Οικονομίας. Τα τελευταία χρόνια έχει τεθεί, μεταξύ άλλων, το ερώτημα κατά πόσο οι οικονομικές κρίσεις επηρεάζουν την ισορροπία οικονομικής ισχύος ανάμεσα στις δυνάμεις της παγκόσμιας οικονομίας. Η χρηματοπιστωτική κρίση του 2007–2008 και η ευρωπαϊκή κρίση χρέους του 2010–2015 ενίσχυσαν ακόμη περισσότερο αυτή την τάση στη διεθνή βιβλιογραφία. Στις σύγχρονες διεθνείς σχέσεις, ο οικονομικός παράγοντας έχει αναδειχθεί στο σημαντικότερο χαρακτηριστικό που διαμορφώνει την εξέλιξη τους. Αντιστοίχως, η οικονομική ισχύς αποτελεί πλέον το κρισιμότερο συστατικό στοιχείο του μεγέθους της ισχύος στο διεθνές σύστημα. Η αποτίμηση των συσχετισμών οικονομικής ισχύος ανάμεσα στις χώρες καθορίζει σε μεγάλο βαθμό τη μορφή της διακρατικής ιεραρχίας της παγκόσμιας οικονομίας, αναδεικνύοντας τις ηγεμονικές οικονομικές δυνάμεις που δραστηριοποιούνται σε αυτή. Η συσχέτιση των οικονομικών και χρηματοπιστωτικών κρίσεων με την ισορροπία ισχύος στην παγκόσμια οικονομία αποτέλεσε την αφορμή για την επιλογή του κεντρικού ερευνητικού ερωτήματος της διατριβής. Στόχος της παρούσας διατριβής είναι να εξετάσει την επιρροή και την ισχύ της Ευρωπαϊκής Ένωσης στη σύγχρονη παγκόσμια οικονομία και να εξακριβώσει τις μεταβολές που έχουν προκύψει σε αυτή κατά την τελευταία δεκαετία. Αυτή η αξιολόγηση πραγματοποιείται μέσω της εξέτασης των συνεπειών που έχουν προκύψει από τις μεγαλύτερες προκλήσεις με τις οποίες βρέθηκε αντιμέτωπη η ΕΕ στη σύγχρονη ιστορία της, ήτοι τη διεθνή χρηματοπιστωτική κρίση και την κρίση χρέους της ευρωζώνης. Το ερευνητικό ερώτημα εξετάζεται μέσω της σύγκρισης των συνεπειών που έχει επιφέρει η παγκόσμια οικονομική κρίση στην ισορροπία οικονομικής ισχύος ανάμεσα στις τρεις ισχυρότερες οικονομικές δυνάμεις του διεθνούς συστήματος (ΕΕ, ΗΠΑ, Κίνα). Η μελέτη φιλοδοξεί να αποτελέσει μία συνέχεια της έρευνας του Y. Cassis στο πόνημά του Crises and Opportunities-The Shaping of Modern Finance και να επιβεβαιώσει ή να διαψεύσει το κατά πόσο οι οικονομικές και χρηματοπιστωτικές κρίσεις ή άλλα σημαντικά γεγονότα επηρεάζουν την ισορροπία οικονομικής ισχύος στην υψηλότερη κλίμακα ιεραρχίας της παγκόσμιας οικονομίας. Αυτή η συγκριτική μελέτη αφορά τις βασικότερες θεματικές διαστάσεις της παγκόσμιας οικονομίας όπως αναφέρονται και θα αναλύονται κατά την περιγραφή του μεθοδολογικού πλαισίου της διατριβής. Οι βασικές θεματικές διαστάσεις της παγκόσμιας οικονομίας είναι το διεθνές νομισματικό σύστημα, το διεθνές χρηματοπιστωτικό σύστημα, οι διεθνείς εμπορικές συναλλαγές, οι διεθνείς επενδυτικές ροές και το θεσμικό και κανονιστικό πλαίσιο της διεθνούς οικονομικής διακυβέρνησης.