bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Low-Molecular-Weight Heparins Prepared From Ovine Heparins With Enoxaparin
Authors: Chen Jianle , Yu Yanlei , Fareed Jawed , Hoppensteadt Debra , Jeske Walter , Kouta Ahmed , Jin Caijuan , Jin Yongsheng , Yao Yiming , Xia Ke , Zhang Fuming , Chen Shiguo , Ye Xingqian , Linhardt Robert J.
Published: April 2019

Heparin and its low-molecular-weight heparin derivatives are widely used clinical anticoagulants. These drugs are critical for the practice of medicine in applications, including kidney dialysis, cardiopulmonary bypass, and in the management of venous thromboembolism. Currently, these drugs are derived from livestock, primarily porcine intestine and less frequently bovine intestine and bovine lung. The worldwide dependence on the pig as a single dominant animal species has made the supply chain for this critical drug quite fragile, leading to the search for other sources of these drugs, including the expanded use of bovine tissues. A number of laboratories are now also examining the similarities between heparin and low-molecular-weight heparins prepared from porcine and ovine tissues. This study was designed to compare low-molecular-weight heparin prepared from ovine heparin through chemical β-elimination, a process currently used to prepare the low-molecular-weight heparin, enoxaparin. Using top-down, bottom-up, and compositional analyses as well as bioassays, low-molecular-weight heparin derived from ovine intestine was shown to closely resemble enoxaparin. Moreover, the compositions of daughter low-molecular-weight heparins prepared from three unfractionated ovine parent heparins were compared. Ovine enoxaparins had similar molecular weight and in vitro anticoagulant activities as Lovenox. Some disaccharide compositional, oligosaccharide composition at the reducing and nonreducing ends and intact chain compositional differences could be observed between porcine enoxaparin and ovine low-molecular-weight heparin. The similarity of these ovine and porcine heparin products suggests that their preclinical evaluation and ultimately clinical assessment is warranted.
The rationale for developing a programme of services by and for Indigenous men in a First Nations community
Authors: George Julie , Morton Ninomiya Melody , Graham Kathryn , Bernards Sharon , Wells Samantha
Published: April 2019

While mental well-being is recognized as a significant public health priority in numerous Indigenous communities, little work has focused on the mental health needs of Indigenous men. In this article, we describe results from the mixed-methods research used to inform the development of mental wellness programming for boys and men. Quantitative and qualitative data from two studies conducted in Kettle & Stony Point First Nation, an Indigenous community in southern Ontario, Canada, were used to (a) understand factors that contributed to issues of mental health, substance use and violence for men, (b) understand men’s experiences accessing and seeking supports and services, and (c) identify ways to address mental health, substance use and violence among boys and men in the community. We show how results from two studies ignited a group of men to develop a culturally strong and strengths-based programme of services as well as a wellness strategy for boys and men in the community.
Weather-dependent modelling of the indoor radon concentration in two dwellings using CONTAM
Authors: García-Tobar Javier
Published: April 2019

This study presents a methodology for including weather factors when simulating radon levels inside a dwelling using the CONTAM modelling software. The main purpose is the development of a reliable tool for assessing the various factors that affect radon concentrations, which would increase the possibility of improving indoor air quality. Indoor radon concentrations and weather data collected over six months are presented together with simulation results and compared both qualitatively and quantitatively. The methodology described should assist in simulating more realistic indoor radon concentration variations over a period of several months that can afterwards be used when designing homes with radon mitigation features.
Development of a rubber sole with an integral cushioning system for casual sport shoes
Authors: Cardoso Hugo , Guimarães Marco , Lopes Lígia , Lino Alves Jorge
Published: April 2019

The footwear industry has been experiencing a rapid growth with a constant demand for new and comfortable models of footwear by its consumers. In response to this challenge, a sole with innovative cushioning system, dedicated to a casual segment of sports shoes and aimed at the female audience, was designed. This work reports the shoe sole design process and the study of its behavior under the action of loads equivalent to the human walk. The initial study of the foot and its role in the biomechanics of gait allowed identifying the regions that suffer the most pressure and need more cushioning. Based on that, the selected concept uses a system whose cushioning would be provided by the compression of the sole structure on the most affected areas of the foot during gait. The work focused on the bi- and three-dimensional design of the sole and cushioning system, using 3D scanners, 3D modeling and rendering software, and finite element analysis. In terms of material selection, through the application of loads to the heel and toe sole parts, simulating the human walk, and the use of different types of natural rubber and styrene-butadiene rubber materials, the von Mises stresses and the sample surfaces displacement were analyzed so that it was possible to suggest the most adequate materials and possible design changes. Samples with three rubber mixtures were produced and evaluated through impact tests. It was possible to verify that the most suitable rubber for the shoe sole would be the one that presented low rigidity and high yield strength. Ethylene vinyl acetate was also proposed as a shoe material, taking into account its low density. From the impact tests, it was concluded that the material with a better commitment between the damping and resilience properties is a natural rubber polymer-based mixture that was selected for the industrial production.
The marketing research curriculum: Closing the practitioner–academic gaps
Authors: Vriens Marco , Brokaw Stephen , Rademaker Douwe , Verhulst Rogier
Published: April 2019

As an industry, marketing research has enjoyed decades of systemic growth. Unfortunately, dissatisfaction with the return on marketing research investments has also been consistently voiced. Part of this complaint may be due to the inadequate way marketing research is being taught. In this article, we review what practitioner–academic gaps have been found in the literature and also present the results of a survey among alumni of a US university. We identify several key gaps including (1) understanding of business issues, (2) ability to define a marketing research problem, (3) ability to design marketing research, (4) ability to analyze data, (5) ability to interpret the results, (6) ability to translate results into actions, (7) ability to effectively interact with clients, and (8) expertise on specific research studies such as customer satisfaction research, branding, and new product development research.
A Comparison of Different Prophylactic Intravesical Chemotherapy Regimens for Bladder Cancer Recurrence After Nephroureterectomy for Primary Upper Tract Urothelial Carcinomas: A Retrospective 2-center Study
Authors: Huang Yong , Cen Junjie , Liu Zhuowei , Wei Jinhuan , Chen Zhenhua , Feng Zihao , Lu Jun , Fang Yong , Zhou Fangjian , Luo Junhang , Mo Chengqiang , Chen Wei
Published: April 2019

Prophylactic intravesical chemotherapy can decrease bladder cancer recurrence rate after nephroureterectomy for upper tract urothelial carcinoma. We aimed to compare the effect of different prophylactic intravesical chemotherapy regimens in bladder recurrence-free survival. From 2000 to 2016, a total of 270 patients treated with radical nephroureterectomy at both institutions were enrolled. Patients were divided into 3 groups: multiple-instillation group, single-instillation group, and no-instillation group. Univariable and multivariable analyses with Cox regression methods were performed to calculate hazard ratios for bladder recurrence using clinicopathologic data, including our different instillation strategies. Sixty-three (23.3%) of 270 patients had subsequent intravesical recurrence. Significantly fewer patients in both the instillation groups had a recurrence compared to in the no-instillation group (13.1% vs 25.4% vs 41.5%, P = .001). Furthermore, there was a significant difference between both the instillation groups ( P = .016). In different subsets of patients with upper tract urothelial carcinoma, intravesical chemotherapy, either multiple or single instillation, was a protective factor of bladder recurrence in pT2-4 ( P = .002) and high grade ( P < .0001). Importantly, Kaplan-Meier curves of bladder recurrence-free survival rate were increased observably in multiple-instillation group compared to that in single-instillation group ( P = .053 in pT2-4 subgroup; P = .048 in high-grade subgroup, respectively). On multivariable analysis, intravesical chemotherapy ( P < .001), especially multiple instillations (hazard ratio 0.230; 95% confidence interval 0.110-0.479), was identified an independent predictor of bladder recurrence-free survival. In conclusion, prophylactic intravesical chemotherapy effectively prevents bladder recurrence after nephroureterectomy, especially with multiple instillations, in patients with invasive upper tract urothelial carcinoma or at high-grade status.
High performance of three-level T-type grid-connected photovoltaic inverter system with three-level boost maximum power point tracking converter
Authors: Zhang Zhi , Zhou Hao
Published: April 2019

A three-phase three-level transformerless T-type grid-connected inverter system with three-level boost maximum power point tracking converter is introduced in this article for high-voltage high-power applications. First, the mathematical model of grid-connected photovoltaic inverter system is built. Second, a multiloop interleaved control scheme is proposed for three-level boost maximum power point tracking converter to reduce the ripple of the inductor current and balance the capacitor voltage of DC bus. A predictive current control method and a power feedforward strategy are also proposed for the T-type three-level inverter part to reduce the harmonic content of grid-connected current and to improve the dynamic response of the system, respectively. In order to solve complex algebraic computation of traditional space vector pulse width modulation or multi-carrier pulse width modulation method, a single-carrier pulse width modulation method is presented for T-type three-level inverter. Finally, all control strategies and modulation method are implemented on a single-chip digital signal processor. A high conversion efficiency, low cost, and low harmonic current could be obtained on a 23-kW experimental prototype.
The Trans-Pacific Partnership’s patent linkage: Unfriending or befriending the right to biologics?
Authors: Boru Zeleke Temesgen
Published: April 2019

The World Trade Organization brought Intellectual Property Rights into the multilateral trading system. The adoption of the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), which formed part of the Agreement Establishing the World Trade Organization, established a minimum level of protection with respect to various forms of Intellectual Property Rights. However, in the aftermath of its adoption, several Free Trade Agreements, which include Intellectual Property Rights provisions of different potency, have come into existence. These Free Trade Agreements have given rise to what is commonly known as TRIPS-plus IP provisions. The provisions may renege on States’ obligation to promote access to biologics, medicines which are derived from proteins through biotechnological process. In this light, one recent Free Trade Agreement is the Trans-Pacific Partnership Agreement, which requires its Parties to implement a number of TRIPS-plus obligations, including data exclusivity and patent linkage. Against the aforementioned backdrop, this article focuses on patent linkage and explores whether the provision allows the Trans-Pacific Partnership Parties to utilize TRIPS flexibilities to promote the right to biologics. In doing so, the article provides potential responses to the question, does patent linkage deter the realization of the right to biologic? With the purpose to do so, while the first section provides a concise introduction into the agreement, the second section discusses the TRIPS standard on patent. While the third part demonstrates the nature of obligations enshrined in the Trans-Pacific Partnership’s rule on patent linkage, the fourth section investigates the obligations’ implication on the right to biologics. The last section provides the conclusion.
Validation of PROMIS Global-10 compared with legacy instruments in patients with shoulder instability
Authors: Suriani Robert J , Kassam Hafiz F , Passarelli Natalie R , Esparza Rachel , Kovacevic David
Published: April 2019

Background

Outcomes instruments are used to measure patients’ subjective assessment of health status. The Patient-Reported Outcomes Measurement Information System (PROMIS) Global-10 was developed to be a concise yet comprehensive instrument that provides physical and mental health scores and an estimated EuroQol-5 Dimension (EQ-5D) score.

Methods

A total of 175 prospectively enrolled patients with shoulder instability completed the PROMIS Global-10, EQ-5D, American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and Western Ontario Shoulder Instability Index. Spearman correlations between PROMIS scores and the legacy instruments were calculated. Bland–Altman analysis assessed agreement between estimated and actual EQ-5D scores. Floor and ceiling effects were recorded.

Results

Correlation between actual and estimated EQ-5D was excellent-good (0.64/ p < 0.0005), but Bland–Altman agreement revealed high variability for estimated EQ-5D scores (95% CI: −0.30 to +0.34). Correlation of PROMIS physical scores was excellent-good with ASES (0.69/ p < 0.0005), good with SANE (0.43/ p<0.0005), and poor with WOSI (0.17/ p = 0.13). Correlation between PROMIS mental scores and all legacy instruments was poor.

Conclusions

PROMIS Global-10 physical function scores show high correlation with ASES but poor correlation with other legacy instruments, suggesting it is an unreliable outcomes instrument in populations with shoulder instability. The PROMIS Global-10 cannot replace actual EQ-5D scores for cost-effectiveness assessment in this population.

Level of evidence

Level II, study of diagnostic test.
Adjuvant chemotherapy improves prognosis of resectable stage IV colorectal cancer: a comparative study using inverse probability of treatment weighting
Authors: Nozawa Hiroaki , Takiyama Hirotoshi , Hasegawa Kiyoshi , Kawai Kazushige , Hata Keisuke , Tanaka Toshiaki , Nishikawa Takeshi , Sasaki Kazuhito , Kaneko Manabu , Murono Koji , Emoto Shigenobu , Sonoda Hirofumi , Nakajima Jun
Published: April 2019

Background:

Adjuvant chemotherapy (AC) is known to be beneficial for stage III colorectal cancer (CRC). In contrast, only a few studies have reported the survival benefits of AC for stage IV CRC after curative surgery.

Methods:

We identified 155 CRC patients with various organ metastases who underwent curative surgery in our hospital between 2003 and 2017. Clinicopathological parameters and postoperative AC were reviewed. Multivariate analyses were performed to identify prognostic factors. Moreover, the effects of AC on recurrence-free survival (RFS) and overall survival (OS) were analyzed using inverse probability of treatment weighting.

Results:

The cohort comprised 94 males and 61 females, with a mean age of 63 years. AC was administered to 57% of patients who underwent surgery between 2003 and 2010 and 76% between 2011 and 2017 ( p = 0.015). AC was more likely administered to patients with a good performance status, high preoperative albumin level, regional node and peritoneal metastases, and no intraoperative blood transfusion. Multivariate analyses identified AC as a significant prognostic factors for RFS and OS [hazard ratio (HR): 1.86, p = 0.003, and 2.66, p = 0.002, respectively]. After adjusting for different backgrounds, 5-year RFS and OS rates were higher in patients receiving AC (27% and 67%) than in those without AC (14% and 46%, p < 0.0001 and p = 0.0005). Subgroup analyses showed that AC significantly improved RFS in node-negative patients (HR: 2.16, p = 0.029), and RFS and OS in node-positive patients (HR: 2.03, p < 0.0001, and 2.02, p = 0.001, respectively).

Conclusion:

AC can be discussed with resectable stage IV CRC patients because of its significant survival-improving effects.
Recent developments in advanced imaging in gout
Authors: Davies Joseph , Riede Philipp , van Langevelde Kirsten , Teh James
Published: April 2019

The plain radiographic features of gout are well known; however, the sensitivity of plain radiographs alone for the detection of signs of gout is poor in acute disease. Radiographic abnormalities do not manifest until late in the disease process, after significant joint and soft tissue damage has already occurred. The advent of dual-energy computed tomography (DECT) has enabled the non-invasive diagnosis and quantification of gout by accurately confirming the presence and extent of urate crystals in joints and soft tissues, without the need for painful and often unreliable soft tissue biopsy or joint aspiration. Specific ultrasound findings have been identified and may also be used to aid diagnosis. Both ultrasound and magnetic resonance imaging (MRI) may be used for the measurement of disease extent, monitoring of disease activity or treatment response, although MRI findings are nonspecific. In this article we summarize the imaging findings and diagnostic utility of plain radiographs, ultrasound, DECT, MRI and nuclear medicine studies in the assessment as well as the implications and utility these tools have for measuring disease burden and therapeutic response.
Comparison of AR and physical experiential learning environment in supporting product innovation
Authors: Liu Ying-Chieh , Lu Su-Ju , Kao Ching-Yu , Chung Leanne , Tan Kim Hua
Published: April 2019

This article compares how virtual and physical learning aids enhance learners’ product innovation capability, that is, design experiences and domain knowledge. The virtual aid utilises augmented reality (AR) allowing learners to experience a range of animated mechanisms using smart devices. The legacy physical aid mechanisms were made using three-dimensional printers. We studied the effects of both manipulatives on learners’ understanding of mechanical movements, for example, rack and pinion, and Geneva mechanism. To investigate learning impact of each aid, we compared the experimental results derived from two learners groups (13 participants each). This study provides a case to support product innovation education under an experiential learning environment. The outcomes showed that both aids were useful in enhancing design experiences and domain knowledge. Pre-and-post attention, relevance, confidence and satisfaction motivation of both aids was found to be similar. However, distinctive differences were observed in terms of divergent search for ideation, suggesting for further research in combining both aids. We also found that learners’ learning motivation is lower in AR-based aid.
Efficacy of Dexamethasone Versus Fluticasone Nasal Sprays in Postoperative Patients With Chronic Rhinosinusitis With Nasal Polyps
Authors: Seiberling Kristin A. , Kidd Stephanie C. , Kim Grace H. , Church Christopher A.
Published: April 2019

Background

Topical nasal steroids are commonly prescribed to patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) following endoscopic sinus surgery (ESS). They are found to be effective in improving symptoms and quality of life as well as reducing the incidence of nasal polyps recurrence.

Objective

We sought to determine whether a higher concentration of topical nasal steroid spray is more effective than the standard nasal steroid spray in controlling symptoms and preventing recurrence of polyps in patients with CRSwNP who underwent ESS.

Method

A double-blind randomized controlled trial was performed on patients with CRSwNP after ESS. Patients were randomized into 2 treatment groups: one received topical nasal dexamethasone 0.032% and the other, fluticasone proprionate. The 22-item Sino-Nasal Outcome Test (SNOT-22) and Lund-Kennedy nasal endoscopy scores were measured at the initiation of topical nasal steroid treatment and then at approximately 4-, 8-, and 12-week intervals.

Results

Thirty-nine patients were enrolled in the study. Eighteen patients continued using the medications prescribed to them for the duration of the study. There were 8 patients in the dexamethasone group and 10 patients in the fluticasone group. Both groups saw significant improvements in postoperative SNOT-22 and Lund-Kenney scores over time. There was no significant difference in improvement between the groups.

Conclusion

There is no significant increased benefit in using a higher dose nasal steroid spray compared to the standard dose nasal steroid spray after ESS.
Influence of pharmacist intervention on drug safety of geriatric inpatients: a prospective, controlled trial
Authors: Nachtigall Angela , Heppner Hans J. , Thürmann Petra A.
Published: April 2019

Background:

Demographic shift leads to an increasing number of geriatric patients suffering from multimorbidity and resulting polypharmacy. Polypharmacy is shown to be associated with drug-related problems (DRPs) and increased morbidity. For Germany, a hospital-based intervention may be successful optimizing of polypharmacy. The aim of this study was to reduce DRPs in geriatric inpatients by a structured pharmacist’s intervention and to measure the acceptance rate of pharmaceutical recommendations.

Methods:

This study followed an open, prospective, quasi-randomized, controlled design and was conducted in a geriatric department in a teaching hospital in Germany. Patients of all sexes were included, with a minimum age of 70 years, a written informed consent and a regular intake of at least five drugs daily. Primary outcome was the percentage of patients having a DRP at admission and discharge. A DRP was defined as a prescription without indication or a relevant drug–drug interaction or prescription of a potentially inappropriate medication or presence of an adverse drug reaction. Recommendations were classified and discussed face to face. Statistical analyses were performed using a full-set analysis and a matched-pairs design.

Results:

Within 12 months, 411 patients were recruited with median age of 82 years (intervention: n = 209; control: n = 202). Median number of drugs at admission was 10 (range 5–24), at discharge 9 (range 3–21). In the intervention group, the percentage of patients with a DRP was reduced from 86.6% to 56.0%; in the control group, from 76.7% to 76.2% ( p value < 0.001). Medication appropriateness index score was reduced by 56% in the intervention group and by 0.2% in the control group ( p value < 0.001). Implementation rate of the pharmaceutical recommendation was 80%.

Conclusion:

This prospective controlled trial showed that a pharmacist’s intervention was successful in optimizing polypharmacy in geriatric inpatients.
Socio-demographic and economic factors are associated with nutritional status of adolescent school girls in Lay Guyint Woreda, Northwest Ethiopia
Authors: Arage Getachew , Assefa Mekonnen , Worku Teshager
Published: April 2019

Objective:

This study was aimed at assessing socio-demographic and economic factors associated with nutritional status of adolescent school girls in Lay Guyint Woreda, Northwest Ethiopia.

Methods:

The school-based cross-sectional study comprising 362 adolescent girls aged 10–19 years was included in the study. Simple random sampling technique with proportional allocation to size was used to select the participants. An interviewer-administered questionnaire and anthropometric measurement were used to collect the data. An anthropometric measurement was converted to the indices of nutritional status using World Health Organization Anthro Plus software.

Result:

The overall prevalence of stunting and thinness among adolescent girls were 16.3% and 29%, respectively. Adolescents aged 14–15 years (AOR = 3.65; 95% confidence interval: 1.87, 7.11), adolescents living in rural areas (AOR = 1.34; 95% confidence interval: 1.24, 2.33), and adolescents who did not have snack (AOR = 11.39; 95% confidence interval: 1.47, 17.8) were positively associated with stunting. Whereas mother’s occupation was negatively associated with stunting (AOR = 0.12; 95% confidence interval: 0.17, 0.87). Similarly, being a rural resident (AOR = 2.40; 95% confidence interval: 1.13, 5.08) and adolescents aged 14–15 years (AOR = 6.05; 95% confidence interval: 2.15, 17.04) were positively associated with thinness. Educational status of adolescent girls was negatively associated with thinness (AOR = 0.13; 95% confidence interval: 0.05, 0.35).

Conclusion:

Stunting and thinness are prevalent among adolescent girls. The age of adolescents, place of residence, having a snack, and mother’s occupation was significantly associated with stunting and thinness. Having at least a one-time snack in addition to the usual diet is strongly recommended.
Narrated oppressive mechanisms: Chinese audiences’ receptions of effeminate masculinity
Authors: Zhang Xiaoxiao
Published: April 2019

Masculinities are widely believed to be oppressive mechanisms for men, but a detailed, systematic picture of these concrete mechanisms is largely lacking. The present analysis of audience reception illustrates four oppressive mechanisms of effeminate-masculinity acting on straight men: normative conceptualization, emotional distancing, discursive stigmatization, and behavioral punishment. The sub-dimensions of these four oppressive mechanisms are also discussed, particularly emotional aversion, patriarchal contempt, stigmatic labeling, essentialist classification, and isolation. Moreover, the symbolic codes of hegemonic masculinity and effeminate masculinity in the Chinese context are explicated. Based on the analysis, flight from the feminine is the core characteristic of Chinese hegemonic masculinity and the source of discrimination against effeminate masculinity. These oppressive mechanisms found in the Chinese context can enrich understanding of the broad literature on masculinities. It is highly possible that the narrated mechanisms also exist in the reception of masculinities in other cases. The clear pattern found in the present case, therefore, is meaningful and relevant for future studies.
What Impacts Feelings of Adulthood Among College-Attending and Non-College-Attending Emerging Adults Who Use Alcohol and Cannabis?
Authors: Blevins Claire E. , Caviness Celeste M. , Anderson Bradley J. , Herman Debra S. , Stein Michael D.
Published: April 2019

Emerging adulthood is a time of transition between adolescence and adulthood, and it also represents a risky time frame for substance use. Perceptions of adulthood, or an individual’s belief about how “adult” they are, is associated with a reduction in risky behavior. The current study evaluated factors that may be related to perceptions of adulthood—living situation, age, gender, financial independence, educational status, domains of adulthood—and the relationship between perceptions of adulthood and cannabis use and binge drinking. Among 558 emerging adults who used substances, higher perceptions of adulthood were associated with less binge drinking, older age, male gender, employment and financial independence, and living away from parents. Additionally, adulthood was associated with higher feelings of stability and a focus on both the self and others. Results emphasize the importance of beliefs about adulthood in the transition into more stable life patterns, including engagement in less risky behavior.
An Analysis of Foreign Exchange Risk Management: Techniques Employed in Indian Pharma Industry
Authors: Basanna Prakash , Vittala K. R. Pundareeka
Published: April 2019

Foreign exchange risk management (FERM) involves using both internal and external techniques such as forwards, futures, options, and swaps that are called as currency derivatives. The firms with greater growth opportunities and tighter financial constraints are more inclined to use currency derivatives. The Forex market provides various derivative instruments to hedge against currency exposures such as currency forwards, options, futures, and swaps. The current article aims at studying various FERM techniques used in the Indian pharmaceutical industry and its impact on exchange gain/losses. For this purpose, foreign exchange cash flows arising out of imports and exports and exchange gain/losses of the companies during 2010–2017 of 10 sample companies chosen from the pharma industry are used. It is observed from the study that only two currencies—USD and EUR—hold command in the forex market and other currencies are being used minimally. It is also noted that there are several currency derivatives available to the business firms such as forwards, futures, options, and swaps for hedging currency exposure. However, among all these techniques, forward contract is considered to be an effective hedging tool and easier to understand.
Polyetheretherketone (PEEK) cages for anterior column reconstruction in pyogenic vertebral osteomyelitis
Authors: Novak Igor , Košak Robert , Travnik Ludvik , Gorenšek Matevž , Bošnjak Klemen , Vengust Rok , Zupanc Oskar
Published: April 2019

The objective of study was to evaluate a case series of patients in whom polyetheretherketone (PEEK) cages were used for anterior column reconstruction in vertebral osteomyelitis. Fifteen patients underwent clinical and radiological evaluation with average follow-up of 26 months. Parameters assessed were time of surgery, blood loss, segmental kyphosis or lordosis angle, time to solid bony fusion, ambulatory status, and functional outcome. Mean time of surgery was 150 min with mean blood loss of 530 ml. One patient died in early postoperative period. All patients without preoperative neurologic deficit were walking unaided first day postoperatively. Solid bony fusion was demonstrated in 14 patients, on average 7.1 months postoperatively. Functional outcome at the latest follow-up was excellent, good, or fair in 86%. Two failures with recurrent infection were treated with PEEK cage removal and reinstrumentation. High success rate could be expected when PEEK cages are used for anterior column support in pyogenic vertebral osteomyelitis.
Motion of the distal tibiofibular syndesmosis under different loading patterns: A biomechanical study
Authors: Hu Wan-kun , Chen Da-wei , Li Bing , Yang Yun-feng , Yu Guang-rong
Published: April 2019

Purpose:

The distal tibiofibular syndesmosis is an important structure for ankle stability. The objective of this study was to evaluate the motion of the syndesmosis under different loading patterns and determine the characteristics of the syndesmotic motion.

Methods:

Six fresh cadaveric lower extremity specimens with the knee reserved were tested in this study. The skin and muscles were removed with all ligaments around the syndesmosis and knee and ankle joint intact. An axial load of 600 N was applied to the specimens with the ankle joint in 10° dorsiflexion, neutral position, and 15° plantar flexion using a universal material testing machine. Then, with the ankle joint positioned neutrally, a combination of 600-N axial and 5-Nm torsional external rotation loading was applied to the specimens. The medial–lateral and anterior–posterior displacement and rotation of the distal fibula relative to the distal tibia were measured.

Results:

Under the axial loading, the distal fibula tended to move medially and anteriorly and rotate internally with the ankle positioned from the neutral position to 15° plantar flexion. Meanwhile, when the ankle was positioned from the neutral position to 10° dorsiflexion, the distal fibula tended to move laterally and posteriorly and rotate externally. Under the combined loading, with respect to the isolated axial loading, the distal fibula tended to move medially and posteriorly, and rotate externally relative to the distal tibia.

Conclusion:

Micro motion existed in the syndesmosis. The relative motion of the syndesmosis was correlated to the ankle position and loading patterns.
Effects of Perioperative Nonsteroidal Anti-inflammatory Drug Administration on Soft Tissue Healing: A Systematic Review of Clinical Outcomes After Sports Medicine Orthopaedic Surgery Procedures
Authors: Constantinescu David S. , Campbell Michael P. , Moatshe Gilbert , Vap Alexander R.
Published: April 2019

Background:

The effects of perioperative nonsteroidal anti-inflammatory drugs (NSAIDs) on soft tissue healing in humans have yet to be established.

Purpose:

To systematically review the literature addressing the effects of perioperative NSAID administration on soft tissue healing and clinical patient outcomes.

Study Design:

Systematic review; Level of evidence, 3.

Methods:

This review study was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. A review of the literature regarding the existing evidence for clinical effects of NSAID use on soft tissue healing was performed through use of the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed (1980 to present), and MEDLINE. Inclusion criteria for articles were as follows: outcome studies after soft tissue (ligament, meniscus, tendon, muscle) healing after surgical procedure with perioperative NSAID administration, at least 1 year of follow-up, English language, and human participants.

Results:

A total of 466 studies were initially retrieved, with 4 studies satisfying all inclusion criteria. Among the surgical procedures reported, 93% of the patients (4144/4451) underwent anterior cruciate ligament (ACL) reconstruction, 3% (120/4451) underwent rotator cuff repair, 3% (155/4451) underwent Bankart shoulder repair, and 1% (32/4451) underwent meniscal repair. The reported surgical failure rate among patients administered NSAIDs was 3.6% (157/4360). The reported surgical failure rate among control participants not given NSAIDs was 3.7% (147/3996). NSAID use showed no statistically significant effect on need for reoperation in meniscal repair ( P = .99), ACL reconstruction ( P = .8), and Bankart repair ( P = .8) compared with no NSAID administration. Celecoxib administration had a significantly higher rate of retear (37%) after rotator cuff repair compared with ibuprofen (7%) ( P = .009).

Conclusion:

Insufficient data are available to definitively state the effects of perioperative NSAIDs on soft tissue healing. Use of NSAIDs should be considered on a case-by-case basis and may not affect healing rates following either meniscal, ACL, rotator cuff, or Bankart repair. However, celecoxib (a selective COX-2 inhibitor) may inhibit tendon-to-bone healing in rotator cuff repair. Further research through clinical trials is required to fully determine whether NSAIDs have an adverse effect on soft tissue healing.
Gastrointestinal Conditions in Children With Severe Feeding Difficulties
Authors: Rivera-Nieves Desiree , Conley Anita , Nagib Keri , Shannon Kaiya , Horvath Karoly , Mehta Devendra
Published: April 2019

Feeding aversion in children may progress to severe feeding difficulties. While oral-motor and sensory issues are usually the leading causes, organic etiologies should be considered. This study aimed to assess the prevalence of gastrointestinal conditions in children with severe feeding difficulties. We conducted a retrospective study of 93 children requiring an intensive feeding program. The medical records, radiologic and diagnostic tests, use of gastric tube feedings, preexisting medical conditions, and medications were reviewed. Fifty-two percent (52%) had esophagitis, 26.2% gastritis, and 40.7% lactase deficiency in upper endoscopy. In those who underwent an upper endoscopy, 26% of patients that were also tested for small intestinal bacterial overgrowth were found to be positive. Allergy testing was abnormal in 56.6% of those tested, while 27.5% and 75% had abnormal gastric emptying times and pH impedance results, respectively. Constipation was present in 76.3%. Thirteen of 32 were weaned off tube feedings. We conclude that gastrointestinal conditions are common in children with feeding disorders and should be investigated prior to feeding therapy.
Ambedkar’s Journey of Conversion to Buddhism
Authors: Kumar Sanjeev
Published: April 2019

The history of religious conversions has highlighted two aspects. One is the transformation in one’s spiritual and transcendental realm and the other is the social and the political domain that encompasses a sense of rejection of existing religious and philosophical world views as well as assertion of one’s political outlook. In this context, this article explores the contours of one of the most important political thinkers of modern India, that is, B. R. Ambedkar who embraced Buddhism after 40 years of his experiment with the Hindu religion. This article is divided into two parts; the first deals with Ambedkar’s engagement with Hinduism with a hope of reforming the same but having failed in his attempt for 20 years, he declared to leave the religion in 1936. The second part deals with Ambedkar’s both explicit and implicit deliberations for selecting the right noble faith, that is, Buddhism whose foundation was egalitarianism, based on equality and compassion. He used Deweyian experimentalism and Buddhist rationalism, to reject Hinduism and seek refuge in the reformed Buddhism, that is, Navayana Buddhism.
Women and Heritage Preservation in Southeast Nigeria: Exploring New Approaches
Authors: Nwankwo Elochukwu A.
Published: April 2019

The current state of women in heritage studies and the response of culture and tradition to gender issues in the rural areas are the basis for this article. The article examined the role of women in heritage preservation and promotion in Southeast Nigeria and beyond. This study was able to identify that women have great roles to play in the preservation of heritage resources in their various localities through different dimensions, and relevant/critical studies on heritage. Culture demands, treachery, inconsiderate gender struggles and gender limitations have hindered the potentialities of women in heritage issues. At the end, the study suggested new dimensions to the study of heritage that accommodate the relevance of women in heritage preservation and studies. These include feminist heritage, which implies that women and heritage can be studied in two fronts; looking at the activities of women in heritage preservation and the activities of women in heritage studies. Also important is the WECS Heritage Model which tends to address likely issues that may arise. The implication of the study is that it will open a new direction in heritage studies that would not only accommodate the relevance of women in heritage preservation and studies but also ensure smooth women studies on heritage resources in Southeast Nigeria and beyond.
Prospects for Cultural Heritage Promotion Within the Creative Economy Framework
Authors: Vencatachellum Indrasen
Published: April 2019

This article uses the recent concept of ‘creative economy’ to argue in favour of a dynamic and holistic approach to the promotion of the cultural heritage. This implies namely that the heritage is viewed in both its material and intangible forms and as a driver of sustainable development. After an overview of the diverse interpretations, at natioanl, regional and international levels, of the creative economy, the author illustrates how the cultural heritage can benefit from the growing importance given to unlilited, renewable resources for the development of individuals and communities, especially in the developing countries. The article contains, however, words of caution on the negative effects of the creative economy and submits that these can be overcomed by extending the sphere of the cultural heritage to all areas of developement.
The Role of Heritage Impact Assessment in Safeguarding World Heritage Sites: Application Study on Historic Areas of Istanbul and Giza Pyramids
Authors: Yilmaz Yildirim , Gamil Rehab El
Published: April 2019

This article aims to explore the role of heritage impact assessment (HIA) as a tool to safeguard world heritage sites from the adverse impacts of proposed projects as well as to recommend effective mitigation measures to create the balance between preservation and development. These mitigations will help the decision makers to take the right decision concerning the potential development.

The methodology adopts a qualitative approach which is based on semi-structured interviews with site managers of two world heritage sites: historic areas of Istanbul in Turkey and the Giza pyramids in Egypt. Other interviews were conducted with some archaeologists and some governmental bodies in both countries to evaluate the level of awareness of HIA and assess the current and potential threats resulting from development proposals. Consequently, the article applies the HIA methodology to evaluate the potential impacts of proposed projects in both heritage sites.

HIA can be an effective solution in order to eliminate the contradictions between the stakeholders investing in world heritage sites. The findings revealed that both world heritage sites are threatened by infrastructure and development projects. There is a lack of professionals who are able to conduct HIA methodology, thus Turkey and Egypt depend mainly on foreign experts to conduct it.
Treatment-free remission in CML: who, how, and why?
Authors: Mahon Francois-Xavier
Published: April 2019

Chronic myeloid leukemia (CML) is the best example of successful targeted therapy. Today, the overall survival of patients with CML treated by using tyrosine kinase inhibitors (TKIs) is very close to that of the healthy population. The current question is: how can we further ameliorate the clinical outcome of patients with CML? Clinical trials have shown that some patients with CML in the chronic phase who achieve sustained deep molecular responses on TKI therapy can safely suspend therapy with no evidence of relapse. The long follow-up studies and the number of eligible patients have now validated the concept of treatment-free remission (ie, the ability to maintain a molecular response after stopping therapy). It should be considered as the future criterion to evaluate the success of clinical trials, especially if we want to take into account the quality of life of patients in addition to the economic aspect. Because post-TKI discontinuation follow-ups have been increasing over time with no evidence of relapse in some patients, the next step for the coming decade will be to address the topic of CML cure.
Cardiovascular care of patients with chronic myeloid leukemia (CML) on tyrosine kinase inhibitor (TKI) therapy
Authors: Barber Mary C. , Mauro Michael J. , Moslehi Javid
Published: April 2019

Cardiovascular (CV) health has emerged as an important consideration in patients with chronic myeloid leukemia (CML) because of improved prognosis. Indeed, the success of BCR-ABL1 tyrosine kinase inhibitors (TKIs) has increased the focus on survivorship and late toxicity in oncological care. Survivorship issues in this population include CV disease prevention, given its prevalence in the general population. The introduction of BCR-ABL1 TKIs represented a unique concept of indefinite cancer therapy, only recently evolving to include “treatment-free remission.” Importantly, later-generation BCR-ABL1 TKIs have been associated with CV complications. Dasatinib has been associated with pleural/pericardial effusions and pulmonary hypertension, whereas nilotinib and ponatinib have been linked to the development of vascular occlusive events. There is currently a dearth of data with respect to the mechanisms of drug toxicities, the subsets of patients at risk, and prevention and treatment strategies to mitigate CV complications in patients with CML. Nevertheless, optimal patient CV risk assessment needs to become a more central tenet of patient care in CML. We propose several practical considerations for the practicing oncologist relative to the CV health of patients with CML, especially those on chronic TKI therapy.
Iron deficiency in gynecology and obstetrics: clinical implications and management
Authors: Breymann Christian , Auerbach Michael
Published: April 2019

Iron deficiency is the commonest cause of anemia during pregnancy; however, its prevalence is highly determined by nutritional and socioeconomic status. Oral iron is the frontline therapy, but is often poorly tolerated. Awareness of the available intravenous formulations is essential for management. Before delivery, risk factors such as multiparity and heavy uterine bleeding increase the prevalence of iron deficiency and should be motivation for early diagnosis and treatment. Neonates born with iron deficiency have a statistically significant increment in both cognitive and behavioral abnormalities that persist after repletion, highlighting the need for heightened awareness of the diagnosis. A smartphone application providing information on nutrition and treatment is provided. New formulations of intravenous iron with carbohydrate cores, which bind elemental iron more tightly, minimize the release of labile free iron to allow complete replacement doses of intravenous iron in 15 to 60 minutes, facilitating and simplifying care.
Preventing venous thromboembolism during pregnancy and postpartum: crossing the threshold
Authors: Skeith Leslie
Published: April 2019

When should a patient with a known thrombophilia or prior venous thromboembolism (VTE) receive low-molecular-weight heparin (LMWH) prophylaxis during pregnancy and/or the postpartum period? Accurately predicting thrombotic and bleeding risks and knowing what to do with this information is at the heart of decision-making in these challenging scenarios. This article will explore the concept of a risk threshold from clinician and patient perspectives and provide guidance for the use of antepartum and postpartum LMWH prophylaxis in women with a known thrombophilia or prior VTE. Advice for the management of LMWH prophylaxis use around labor and delivery is also reviewed.
Diagnosis and management of postpartum ovarian vein thrombosis
Authors: Bannow Bethany T. Samuelson , Skeith Leslie
Published: April 2019

Case presentation: A 26-year-old woman experienced persistent fever (39.5°C), chills, and right-lower-quadrant tenderness 3 days after caesarean delivery. A computed tomography (CT) scan of the abdomen and pelvis with contrast revealed enlargement of her right ovarian vein with an associated intraluminal filling defect. What is the best treatment of this patient?
Chronic neutropenia in LGL leukemia and rheumatoid arthritis
Authors: Gazitt Tal , Loughran Thomas P.
Published: April 2019

This section reviews the diagnostic criteria and pathogenesis of large granular lymphocyte (LGL) leukemia. There is a particular focus on the overlap of LGL leukemia and rheumatoid arthritis (Felty's syndrome). Current understanding of the mechanisms of neutropenia in these disorders is discussed. Finally, treatment indications and therapeutic recommendations are outlined.