bluuebunny/crossref_metadata_2025 huggingface dataset:
Intercostal Nerve Transfers to the Musculocutaneous–A Reliable Nerve Transfer for Restoration of Elbow Flexion in Birth-Related Brachial Plexus Injuries
Authors: Lara Alex Muset , Bhatia Anil , Correa Jorge Clifton , Gammal Tarek Abdalla El
Published: August 2020

Introduction There is consensus on the need for early microsurgical reconstruction in birth palsies involving three or more roots, that is, extensive partial palsies and total palsies. The fundamental principles of these operations are complete exploration and judicious use of the ruptured stumps by nerve grafting to suitable distal targets. The frequent observation of root avulsions in such cases makes it imperative to look for extraplexual nerve donors for some functions. Intercostal nerves are readily available in such patients.

Materials and Methods This is a study of 50 patients of extensive partial and total birth palsies operated upon by the senior author between 1995 and 2010. These included 33 patients with total palsies, 16 patients with near total palsies, and one patient with C56 deficit (operated upon more than 20 years ago). These children were all operated upon between 3 and 6 months of age, except for two patients in whom surgery was delayed till a year due to the phrenic nerve deficit noted at birth. Four intercostal nerves were transferred to the musculocutaneous nerve (MCN) by direct approximation with fibrin glue.

Results No respiratory complication was noted from the intercostal harvest. The follow-up ranged from 8 to 20 years (mean 10 years). As many as 48 of the 50 patients regained fully independent elbow flexion. In two cases, the procedure failed completely and had to be salvaged with a free functioning muscle transfer and reuse of the intercostal nerves.

Conclusion Intercostal nerve transfers can be relied upon for restoration of elbow flexion in birth palsies. The ruptured roots can then be utilized for augmenting shoulder function in partial palsies or for hand function in total palsies.
To Evaluate the Effect of Water Temperature and Duration of Immersion on the Marginal Accuracy and Microhardness of Provisional Restoration: An In Vitro Study
Authors: Verma Sanjan , Kalra Tarun , Kumar Manjit , Bansal Ajay , Batra Ritu , Avasthi Abhishek
Published: August 2020

Introduction Provisional restoration is a critical component of fixed prosthodontics treatment, which must satisfy many inter-relative factors such as biological, mechanical, and esthetic. These restorations should have accurate marginal adaptation and optimum strength to maintain functional demands. The present “in vitro” study was conducted to evaluate the effect of water temperature and duration of immersion, on the marginal adaptation and microhardness of four different commercially available provisional restorative materials.

Materials and Methods The 240 specimens were then seated on the stainless-steel die which simulated the prepared tooth, and evaluated for the marginal gap for four different provisional restorative materials and divided into four different groups A, B, C, and D. Each group was further divided into six subgroups according to temperature of water and time of immersion. In each group the samples were immersed in water at 20, 30, and 40 degrees, respectively for 5 and 10-minutes duration. Four different temporary restorative materials for crown fabrication were loaded each time to make temporary crowns.

Results Each sample was placed under travelling stereoscopic microscope (20× magnification) and photographed. Results for each surface were obtained, and the average of three surfaces was calculated. Knoop hardness was measured using a microhardness tester. The study was subjected to statistical analysis, to know the statistical significance, of the effect of difference in time and temperature changes at the time of final polymerization on surface microhardness and marginal integrity of four different provisional restorative materials.

Discussion The mean marginal discrepancies of bis-GMA (group B) at 20, 30, and 40°C for 5 and 10 minutes in water were smaller than the results of other groups. Microhardness evaluation showed that the poly ethyl methacrylate (PEMA) type resin exhibited significantly lower microhardness than the bis-acryl resin composites (Protemp 4 and Systemp.c&b) at both time and temperature intervals.

Conclusion The bis-acryl composites material has the least marginal discrepancy in comparison with PEMA and polymethyl methacrylate (PMMA). The bis-acryl composites materials exhibit superior surface microhardness followed by PEMA and PMMA.
Internal Fixation of a Complicated Mandibular Fracture in a Filly Using a String-of-Pearls Locking Plate Assisted by a 3D Printed Model
Authors: Boorman Sophie , Lascola Kara , Mora-Pereira Mariano , Ceriotti Serena , Boone Lindsey
Published: August 2020

Objective The aim of this study was to describe the successful surgical treatment of a complicated mandibular fracture with a 3.5 mm string-of-pearls (SOP) locking plate in a 5-month-old Appaloosa filly presenting with neurological signs.

Study Design This is a case report.

Results The neurological signs were due to severe head trauma and stabilized with medical treatment. Financial concerns initially prevented advanced imaging; radiographs identified a mandibular symphysis fracture, a fracture of the left vertical ramus that originated at the junction between the horizontal and vertical ramus and extended toward the coronoid process and rostral maxillary fractures. Following intra-dental wiring of the symphysis fracture, a lateral malocclusion developed. Computed tomography additionally identified fractures of the right wing of the basisphenoid bone, right zygomatic arch, left paracondylar process and the lateral body of the mandible. The vertical ramus fracture was repaired utilizing a 20-hole 3.5 mm SOP plate contoured to the ventral aspect of the angle of the mandible. A scaled (1:4) three-dimensional printed model aided pre- and intra-operative surgical planning. The filly was comfortable and eating well at the 4-week recheck. Radiographs showed good callus formation at the maxilla, healing of the mandibular symphysis and ramus. Just prior to the 10-week recheck, the filly suffered severe enterocolitis and was euthanatized.

Conclusion The locking function of the SOP plate provided adequate stability for the fracture to heal without the expense of locking screws. The three-dimensional printed model aided in navigation of the complex fracture without the availability of fluoroscopy.
Tracheal Allotransplantation–Lessons Learned
Authors: Iyer Subramania , Subramaniam Narayana , Vidhyadharan Sivakumar , Thankappan Krishnakumar , Balasubramanian Deepak , R. Balasubramanian K. , Nair Arun , Purushottaman Kishore , Ramu Janarthanan , Paul Zachariah
Published: August 2020

Reconstruction of long tracheal defects still proves to be a challenge. Free fasciocutaneous flaps with cartilaginous struts or an allotransplant trachea have been reported but not been widely performed. This article reports with the experience of using a tracheal allotransplant in such a defect.

A 43-year-old lady presented with adenoid cystic carcinoma involving the entire trachea from subglottic area up to the carina, leading to a life-threatening airway occlusion. After preliminary stenting, allotransplant trachea obtained from a brain-dead individual was revascularized in the forearm of the patient after mechanical decellularization to reduce the immune load and fulfil the need for immunosuppression in the background of active cancer. Subsequently, the trachea and larynx were resected. The vascularized neotrachea was transferred successfully into the neck. The patient did well initially but succumbed to a fatal hemorrhage due to innominate vein aneurysmal rupture on the 22nd day after the transplant.

The technical details of resection, fabrication of the neotrachea, its transfer, and the lessons learnt in this tracheal allotransplant are described.
Ecology and conservation of the critically endangered northern hairy-nosed wombat (Lasiorhinus krefftii): past, present and future
Authors: Martin Alynn M. , Carver Scott
Published: August 2020

The northern hairy-nosed wombat (Lasiorhinus krefftii) is an iconic marsupial endemic to Australia, recognised globally for its status as the largest, herbivorous burrowing mammal. Owing to historical challenges, including anthropogenic conflict and environmental threats, the species was pushed to near extinction and was officially classified as Critically Endangered in 1996. Establishing an effective conservation plan is complicated by ongoing and novel threats as well as by aspects of the species’ ecology that remain unstudied due to its neophobic and nocturnal behaviour. To identify areas where additional research is needed, we conducted a comprehensive search of the literature published on the northern hairy-nosed wombat from 1980 to 2019 to identify where knowledge gaps exist and to suggest where future efforts may be focussed. We found that the breeding ecology, in particular, of the northern hairy-nosed wombat is largely unstudied but could be vital in conservation efforts. Further, there is a need to establish additional populations, and several threats – including disease, invasive species, and climate change – may require ongoing management action to ensure the species’ longevity.
Effect of weather forecast errors on fire growth model projections
Authors: Penman Trent D. , Ababei Dan A. , Cawson Jane G. , Cirulis Brett A. , Duff Thomas J. , Swedosh William , Hilton James E.
Published: August 2020

Fire management agencies use fire behaviour simulation tools to predict the potential spread of a fire in both risk planning and operationally during wildfires. These models are generally based on underlying empirical or quasi-empirical relations and rarely are uncertainties considered. Little attention has been given to the quality of the input data used during operational fire predictions. We examined the extent to which error in weather forecasts can affect fire simulation results. The study was conducted using data representing the State of Victoria in south-eastern Australia, including grassland and forest conditions. Two fire simulator software packages were used to compare fire growth under observed and forecast weather. We found that error in the weather forecast data significantly altered the predicted size and location of fires. Large errors in wind speed and temperature resulted in an overprediction of fire size, whereas large errors in wind direction resulted in an increased spatial error in the fire’s location. As the fire weather intensified, fire predictions using forecast weather under predicted fire size, potentially resulting in greater risks to the community. These results highlight the importance of on-ground intelligence during wildfires and the use of ensembles to improve operational fire predictions.
Music attenuates a widened central pulse pressure caused by resistance exercise: A randomized, single‐blinded, sham‐controlled, crossover study
Authors: Tagawa Kaname , Nakata Yoshio , Yokota Atsumu , Sato Tomohito , Maeda Seiji
Published: August 2020

Increasing central blood pressure is an independent predictor of cardiovascular disease and is an acute effect of high‐intensity resistance exercise. It has been shown that classical music suppresses increased peripheral pressure during exercise. We hypothesized that classical music would suppress increased central pressure induced by high‐intensity resistance exercise. To confirm this hypothesis, we examined the effect of classical music on central pressure following high‐intensity resistance exercise in 18 young men. A randomized, single‐blinded, sham‐controlled, crossover trial was conducted under parallel experimental conditions on four separate days. The order of experiments was randomized between sham control (seated rest), music (20‐min classical music track compilation), resistance exercise (5 sets of 10 repetitions at 75% of 1 repetition maximum), and resistance exercise with music conditions. Aortic pressure was measured in all subjects. No significant interaction between time, music, and resistance exercise was observed for aortic systolic pressure and diastolic pressure. In contrast, aortic pulse pressure showed a significant interaction; that is, aortic pulse pressure significantly widened after resistance exercise, whereas music significantly attenuated this widening. No significant change was observed in aortic pulse pressure in sham control and music conditions. The present findings suggest that music attenuates resistance exercise‐induced increase in central pressure.
p‐Synephrine, the main protoalkaloid of Citrus aurantium, raises fat oxidation during exercise in elite cyclists
Authors: Gutiérrez‐Hellín Jorge , Baltazar‐Martins Gabriel , Rodríguez Iván , Lara Beatriz , Ruiz‐Moreno Carlos , Aguilar‐Navarro Millán , Del Coso Juan
Published: August 2020

The aim of this study was to investigate the acute effects of p‐synephrine ingestion on substrate oxidation during exercise in elite cyclists. Fifteen elite cyclists volunteered to participate in a double blind, crossover, randomized and placebo‐controlled experimental trial. During two different trials, participants either ingested a placebo (cellulose) or 3 mg/kg of p‐synephrine. After 60 min for substances absorption, participants performed an incremental maximal cycle ergometer test until volitional fatigue (25 W/min). Breath‐by‐breath gas exchange data was continuously recorded during the entire test to estimate energy expenditure, carbohydrate oxidation, and fat oxidation rates by stoichiometric equations. Heart rate was continuously measured by using a heart rate monitor. The ingestion of p‐synephrine had no significant effects on energy expenditure (F = 0.71, P = 0.40) or heart rate (F = 0.66, P = 0.43) during exercise. However, there was a main effect of p‐synephrine to increase the rate of fat oxidation over the placebo (F = 5.1, P = 0.04) and the rate of fat oxidation was higher with p‐synephrine in the following loads: 45 ± 2%, 51 ± 3%, 62 ± 3%, 67 ± 4%, 79 ± 5% and 85 ± 5% of the maximum wattage obtained in the test (all P < 0.05). The ingestion of p‐synephrine did not modify the maximal rate of fat oxidation during the ramp test (mean value; 95%CI = 0.91; 0.79–1.03 vs 1.01; 0.91–1.11 g/min, respectively, P = 0.06) nor the exercise intensity at which maximal fat oxidation was achieved (i.e. Fatmax = 49; 48–53 vs 50; 47–51% Wmax, P = 0.52). Acute p‐synephrine ingestion moved the fat oxidation‐exercise intensity curve upwards during an incremental cycling test without affecting Fatmax.
Acute effects of caffeine supplementation on resistance exercise, jumping, and Wingate performance: no influence of habitual caffeine intake
Authors: Grgic Jozo , Mikulic Pavle
Published: August 2020

This study explored the influence of habitual caffeine intake on the acute effects of caffeine ingestion on resistance exercise, jumping, and Wingate performance. Resistance‐trained males were tested following the ingestion of caffeine (3 mg/kg) and placebo (3 mg/kg of dextrose). Participants were classified as low caffeine users (n = 13; habitual caffeine intake: 65 ± 46 mg/day) and as moderate‐to‐high caffeine users (n = 11; habitual caffeine intake: 235 ± 82 mg/day). Exercise performance was evaluated by measuring: (a) movement velocity, power, and muscular endurance in the bench press; (b) countermovement jump; and, (c) a Wingate test, performed in that order. Two‐way repeated‐measures ANOVA revealed a significant main effect (p < 0.05) for condition in the majority of analyzed exercise outcomes. In all cases, effect sizes for condition favoured caffeine and ranged from 0.14 to 0.97. Mean increases in velocity and power in resistance exercise ranged from 0.02 to 0.08 m/s and 42 to 156 W, respectively. The number of performed repetitions increased by 1.2 and jump height by 0.9 cm. Increases in power in the Wingate test ranged from 31 to 75 W. We did not find significant group × condition interaction effect (p > 0.05) in any of the analyzed exercise outcomes. Additionally, there were no significant correlations (p > 0.05; r ranged from −0.29 to 0.32) between habitual caffeine intake and the absolute change in exercise performance. These results suggest that habitual caffeine intake might not moderate the ergogenic effects of acute caffeine supplementation on resistance exercise, jumping, and Wingate performance.
Human Dignity, the Right to be Heard, and Algorithmic Judges
Authors: Dao André
Published: August 2020

This article examines the requirements of the right to a fair trial in the context of the use of machine-learning algorithms (MLAs) in judicial proceedings, with a focus on a core component of this right, the right to be heard. Though NGOs and scholars have begun to note that the right to a fair trial may be the best framework to address the challenges raised by MLAs, the actual requirements of the right in this novel context are underdeveloped. This article evaluates two normative approaches to filling this gap. The first approach, the argument from fairness, produces three broad categories of measures for ensuring fairness: measures for increasing the transparency and accountability of MLAs, measures for ensuring the participation of litigants, and measures for securing the impartiality of the human judge. However, this article argues that the argument from fairness cannot provide the necessary normative grounding for the right to a fair trial in the context of MLAs, as it collapses into the concept of ‘algorithmic fairness’. The second approach is based on the concept of human dignity as a status. The primary argument of this article is that the concept of human dignity as a status can provide better normative grounding for the right to a fair trial because it offers an account of human personhood that resists the de-humanization of data subjectification. That richer account of human personhood allows us to think of the trial not only as a vehicle for accurate outcomes, but also as a forum for the expression of human dignity.
Bidirectional Interaction of Hippocampal Ripples and Cortical Slow Waves Leads to Coordinated Spiking Activity During NREM Sleep
Authors: Sanda Pavel , Malerba Paola , Jiang Xi , Krishnan Giri P , Gonzalez-Martinez Jorge , Halgren Eric , Bazhenov Maxim
Published: August 2020

The dialogue between cortex and hippocampus is known to be crucial for sleep-dependent memory consolidation. During slow wave sleep, memory replay depends on slow oscillation (SO) and spindles in the (neo)cortex and sharp wave-ripples (SWRs) in the hippocampus. The mechanisms underlying interaction of these rhythms are poorly understood. We examined the interaction between cortical SO and hippocampal SWRs in a model of the hippocampo–cortico–thalamic network and compared the results with human intracranial recordings during sleep. We observed that ripple occurrence peaked following the onset of an Up-state of SO and that cortical input to hippocampus was crucial to maintain this relationship. A small fraction of ripples occurred during the Down-state and controlled initiation of the next Up-state. We observed that the effect of ripple depends on its precise timing, which supports the idea that ripples occurring at different phases of SO might serve different functions, particularly in the context of encoding the new and reactivation of the old memories during memory consolidation. The study revealed complex bidirectional interaction of SWRs and SO in which early hippocampal ripples influence transitions to Up-state, while cortical Up-states control occurrence of the later ripples, which in turn influence transition to Down-state.
Forest Matrix Fosters High Similarity in Bee Composition Occurring on Isolated Outcrops Within Amazon Biome
Authors: Maia Ulysses M , Pinto Carlos E , Miranda Leonardo S , Coelho Beatriz W T , Santos Junior José E , Raiol Rafael L , Imperatriz-Fonseca Vera L , Giannini Tereza C
Published: August 2020

Most studies analyze fragmentation due to habitat loss caused by anthropogenic activities and few of them analyzed fragmentation on naturally fragmented areas. In the Eastern Amazon, it is possible to find areas naturally open and surrounded by pristine forest. Understanding how species respond to isolation in these areas is an important challenge for decision-making processes aiming conservation and restoration. Using standardized methods of bee collection (entomological nets, bait trap, pan trap, and nest trap), the objective of this study was to analyze the composition and diversity of bees occurring on six isolated outcrops located in two protected areas within Amazon biome. More specifically, we tested 1) if the dissimilarity in bee species composition is explained by the isolation of outcrops and 2) if bee richness, abundance, and Shannon diversity can be explained by the outcrop size. We found 118 species, with the Meliponini and Euglossini (Hymenoptera: Apidae) tribes representing the highest number of species. The similarity in species composition across all outcrops is high and is not explained by the isolation. In addition, the richness, abundance, and Shannon diversity are not explained by outcrop size. Forest does not seem to be a barrier to bee movement, and although most species probably nest in the forests, they use the highly diverse plants of the outcrops as a complementary food source.
Clinical significance of visceral pleural and lymphovascular invasion in surgically resected adenosquamous lung cancer
Authors: Wang Yanan , Qian Fangfei , Hu Minjuan , Chen Ya , Yang Zhengyu , Han Baohui
Published: August 2020

OBJECTIVES

The aim of this study was to assess the relationship between visceral pleural invasion (VPI), lymphovascular invasion (LVI) and other clinicopathological characteristics and their prognostic impact on surgically resected adenosquamous carcinoma (ASC).

METHODS

We retrospectively reviewed 256 patients with radically resected ASC between January 2010 and December 2015. Patients were divided into 2 groups: those with VPI and those with LVI. The effects of VPI and LVI on disease-free survival and overall survival were evaluated, further stratified by tumour size and lymph node status.

RESULTS

Finally, 213 patients with ASC were enrolled in our study. VPI was correlated with tumour location (P < 0.001), pT stage (P < 0.001) and pN stage (P = 0.012). LVI was related to age (P = 0.005) and pN stage (P = 0.003). Both VPI and LVI were adverse prognostic factors for disease-free survival (P = 0.008, P = 0.028) and overall survival (P = 0.005, P = 0.009) using the Kaplan–Meier method. In multivariable analysis only, VPI was an independent risk factor for disease-free survival [hazard ratio (HR) 0.61, 95% confidence interval (CI) 0.42–0.87; false discovery rate, adjusted P = 0.020] and overall survival (HR 0.60, 95% CI 0.42–0.86; false discovery rate, adjusted P = 0.017). When the prognostic value of VPI was stratified by tumour size and lymph node status, we observed that only patients with VPI in tumours ≤4 cm and patients with N0 status had a worse prognosis than those without visceral invasion (P < 0.05).

CONCLUSIONS

VPI and LVI were poor prognostic factors in patients with ASC, but only VPI was an independent factor for survival, especially in patients with tumours ≤4 cm and pN0 status.
Loneliness in Later Life and Reaching Longevity: Findings From the Longitudinal Aging Study Amsterdam
Authors: Brandts Lloyd , van Tilburg Theo G , Bosma Hans , Huisman Martijn , van den Brandt Piet A
Published: August 2020

Objectives

There is an increasing research interest in factors that characterize those who reach exceptionally old ages. Although loneliness is often associated with an increased risk for premature mortality, its relationship with reaching longevity is still unclear. We aimed to quantify the association between (social/emotional) loneliness and the likelihood of reaching the age of 90 years in men and women separately.

Methods

For these analyses, data from the Longitudinal Aging Study Amsterdam (LASA) were used. Loneliness, social loneliness, and emotional loneliness were assessed at baseline using the 11-item De Jong-Gierveld scale in 1992–1993 (at age 64–85 years). Follow-up for vital status information until the age of 90 years was 99.5% completed. Multivariable-adjusted Cox regression analyses with a fixed follow-up time were based on 1,032 men and 1,078 women to calculate risk ratios (RR) of reaching 90 years.

Results

No significant associations were observed between loneliness and reaching 90 years in both men (RR, 0.90; 95% confidence interval [CI], 0.70–1.14) and women (RR, 0.98; 95% CI, 0.83–1.14). Social loneliness was significantly associated with a reduced chance of reaching 90 years in women (RR, 0.82; 95% CI, 0.67–0.99).

Discussion

The current analyses did not show support for the existence of a meaningful effect of loneliness on reaching longevity in both sexes. When investigating specific dimensions of loneliness, we observed that reporting social loneliness was associated with reaching 90 years in women. This indicates that, for women, a large and diverse personal network at an older age could increase the probability of reaching longevity. However, replication of our findings in other cohorts is needed.
Timescales of successful and failed subduction: insights from numerical modelling
Authors: Knight Ben S , Davies J Huw , Capitanio Fabio A
Published: August 2020

The relatively short duration of the early stages of subduction results in a poor geological record, limiting our understanding of this critical stage. Here, we utilize a 2-D numerical model of incipient subduction, that is the stage after a plate margin has formed with a slab tip that extends to a shallow depth and address the conditions under which subduction continues or fails. We assess energy budgets during the evolution from incipient subduction to either a failed or successful state, showing how the growth of potential energy and slab pull, is resisted by the viscous dissipation within the lithosphere and the mantle. The role of rheology is also investigated, as deformation mechanisms operating in the crust and mantle facilitate subduction. In all models, the onset of subduction is characterized by high lithospheric viscous dissipation and low convergence velocities, whilst successful subduction sees the mantle become the main area of viscous dissipation. In contrast, failed subduction is defined by the lithospheric viscous dissipation exceeding the lithospheric potential energy release rate and velocities tend towards zero. We show that development of a subduction zone depends on the convergence rate, required to overcome thermal diffusion and to localize deformation along the margin. The results propose a minimum convergence rate of ∼0.5 cm yr−1 is required to reach a successful state, with 100 km of convergence over 20 Myr, emphasizing the critical role of the incipient stage.
Aberrant Expression of Nodal and Paranodal Molecules in Neuropathy Associated With IgM Monoclonal Gammopathy With Anti-Myelin-Associated Glycoprotein Antibodies
Authors: Kawagashira Yuichi , Koike Haruki , Takahashi Mie , Ohyama Ken , Iijima Masahiro , Katsuno Masahisa , Niwa Jun-ichi , Doyu Manabu , Sobue Gen
Published: August 2020

To clarify the pathogenesis of anti-myelin-associated glycoprotein (MAG) antibody neuropathy associated with IgM monoclonal gammopathy (anti-MAG neuropathy), sural nerve biopsy specimens from 15 patients were investigated. Sodium channels, potassium channels, contactin-associated protein 1 (Caspr1), contactin 1, and neurofascin were evaluated by immunofluorescence in teased-fiber preparations. Immunoreactivity to the pan-sodium channel in both anti-MAG neuropathy patients and in normal controls was concentrated at the node of Ranvier unless there was demyelination, which was defined as the widening of the node of Ranvier. However, this immunoreactivity became weak or disappeared as demyelination progressed. In contrast, KCNQ2 immunostaining was nearly absent even in the absence of demyelination. The lengths of Caspr1, contactin 1, and pan-neurofascin immunostaining sites at the paranode were significantly increased compared with those of normal controls despite the absence of demyelination. The length of paranodal neurofascin staining correlated with the anti-MAG antibody titer, nerve conduction indices, the frequency of de/remyelination in teased-fiber preparations, and the frequency of widely spaced myelin (p < 0.05, p < 0.05, p < 0.01, and <0.05, respectively). These findings suggest that nodal and paranodal molecular alterations occur in early stages preceding the morphological changes associated with demyelination in anti-MAG neuropathy.
The Effect of Perioperative Adverse Events on Long-Term Patient-Reported Outcomes After Lumbar Spine Surgery
Authors: Ayling Oliver G S , Ailon Tamir , Street John T , Dea Nicolas , McIntosh Greg , Abraham Edward , Jacobs W Bradly , Soroceanu Alex , Johnson Michael G , Paquet Jerome , Rasoulinejad Parham , Phan Phillipe , Yee Albert , Christie Sean , Nataraj Andrew , Glennie R Andrew , Hall Hamilton , Manson Neil , Rampersaud Y Raja , Thomas Kenneth , Fisher Charles G
Published: August 2020

BACKGROUND

Perioperative adverse events (AEs) lead to patient disappointment and greater costs. There is a paucity of data on how AEs affect long-term outcomes.

OBJECTIVE

To examine perioperative AEs and their impact on outcome after lumbar spine surgery.

METHODS

A total of 3556 consecutive patients undergoing surgery for lumbar degenerative disorders enrolled in the Canadian Spine Outcomes and Research Network were analyzed. AEs were defined using the validated Spine AdVerse Events Severity system. Outcomes at 3, 12, and 24 mo postoperatively included the Owestry Disability Index (ODI), 12-Item Short-Form Health Survey (SF-12) Physical (PCS) and Mental (MCS) Component Summary scales, visual analog scale (VAS) leg and back, EuroQol-5D (EQ5D), and satisfaction.

RESULTS

AEs occurred in 767 (21.6%) patients, and 85 (2.4%) patients suffered major AEs. Patients with major AEs had worse ODI scores and did not reach minimum clinically important differences at 2 yr (no AE: 25.7 ± 19.2, major: 36.4 ± 19.1, P < .001). Major AEs were associated with worse ODI scores on multivariable linear regression (P = .011). PCS scores were lower after major AEs (43.8 ± 9.5, vs 37.7 ± 20.3, P = .002). On VAS leg and back and EQ5D, the 2-yr outcomes were significantly different between the major and no AE groups (<0.01), but these differences were small (VAS leg: 3.4 ± 3.0 vs 4.0 ± 3.3; VAS back: 3.5 ± 2.7 vs 4.5 ± 2.6; EQ5D: 0.75 ± 0.2 vs 0.64 ± 0.2). SF12 MCS scores were not different. Rates of satisfaction were lower after major AEs (no AE: 84.6%, major: 72.3%, P < .05).

CONCLUSION

Major AEs after lumbar spine surgery lead to worse functional outcomes and lower satisfaction. This highlights the need to implement strategies aimed at reducing AEs.
Brain and Heart Crosstalk During Neurointerventional Procedures: The Role of the Trigeminocardiac Reflex: An Updated Systematic Review
Authors: Chowdhury Tumul , Rizk Abanoub A. , Azazi Emad Al , Venkatraghavan Lashmi , Shankar Jai S. , Schaller Bernhard
Published: August 2020

The trigeminocardiac reflex is a well-described brainstem reflex that clinically manifests as bradycardia, hypotension, or apnea. This physiological phenomenon is extensively reported during open neurosurgical procedures, but very few data exist for trigeminocardiac reflex occurrence during neurointerventional procedures. This systematic review aims to provide aggregated information related to the trigeminocardiac reflex during neurointerventional procedures and to improve understanding of the various mechanisms that can incite this unique brain-heart crosstalk.
Lateral Pinning of the Pediatric Phalangeal Neck Fracture
Authors: Wong Kenneth Pak Leung , Reddy Varun , Mishra Neeraj , Mahadev Arjandas , Chew Ee Ming
Published: August 2020

Closed reduction and percutaneous pinning is the treatment of choice for displaced pediatric phalangeal neck fractures. Multiple techniques have been described to address challenges in managing these unstable fractures. We describe our technique of closed reduction and percutaneous pinning, which avoids the physis and increases the wire insertion accuracy, minimizing the number of attempts and wire passes made at percutaneous pinning.
Comparative analysis of three data mining techniques in diagnosis of lung cancer
Authors: Li Di , Li Zunshui , Ding Mingcui , Ni Ran , Wang Jing , Qu Lingbo , Wang Wei , Wu Yongjun
Published: August 2020

There is a lot of abnormal information in the development of lung cancer, and how to extract useful knowledge is urgent from massive information. Data mining technology has become a popular tool for medical classification and prediction. However, each technology has its advantage and disadvantage, and several data mining methods will be applied to conduct the in-depth analysis step by step. And the prediction results of different models are compared. A total of 180 lung cancer patients and 243 lung benign individuals were collected from the First Affiliated Hospital of Zhengzhou University from October 2014 to March 2016, and the prediction models based on epidemiological data, clinical features and tumor markers were developed by artificial neural network (ANN), decision tree C5.0 and support vector machine (SVM). The results showed that there were significant differences between the lung cancer group and the lung benign group in terms of seven tumor markers and 10 epidemiological and clinical indicators. The accuracy rates of ANN, C5.0 and SVM were 76.47, 89.92 and 85.71%, respectively. The results of receiver operating characteristic curve (ROC) curve revealed the area under the ROC curve (AUC) of ANN was 0.811 (0.770–0.847), the AUC of C5.0 was 0.897 (0.864–0.924) and the AUC of SVM was 0.878 (0.843–0.908). It was shown that the decision tree C5.0 model has the least error rate and highest accuracy, and it could be used to diagnose lung cancer.
Expression and clinical significance of paired- related homeobox 1 and Smad2 in gastric cancer
Authors: Yang Zhong , Huang Wan-Xia , Wang Shang , Yao Ji-Bin , Da Mingxu
Published: August 2020

Background

China has a high incidence rate and low survival rate of gastric cancer. Therefore, there is a great need to further identify novel oncogenes and clinically applicable molecular targets for the diagnosis and treatment of this disease.

Methods

Expressions of PRRX1, Smad2, epithelial phenotype marker E-cadherin, and interstitial phenotype vimentin protein in a sample of 64 gastric carcinoma and adjacent nontumorous tissues were detected by immunohistochemistry. Their relationship and correlations with clinicopathological features were analyzed.

Results

The positive rates of PRRX1, Smad2, E-cadherin, and vimentin protein in primary tumors were 60.94% (39/64), 59.38% (38/64), 34.38%(22/64), and 64.06% (41/64), respectively. A significant correlation was found among the expression of PRRX1, Smad2, E-cadherin, and vimentin (P < 0.05). Expression of the PRRX1, Smad2, and vimentin protein in gastric cancer tissue was correlated with Borrmann classification, lymph node-positive number, the degree of differentiation, depth of tumor invasion, and serum pepsinogen I (PGI) level (P < 0.05), but not with age, sex, serum carcinoembryonic antigen, serum CA199, or PGI/PGII (P > 0.05).

Conclusion

The positive rate of PRRX1 protein expression was positively correlated with the protein expression of Smad2 and vimentin, but negatively correlated with E-cadherin protein. PRRX1, Smad2, and vimentin proteins are associated with Borrmann type, lymph node positives, histologic grade, depth of tumor invasion, and serum PGI levels, all of which contribute to a poor prognosis for patients with gastric cancer.
A randomized, double-blind, dose-ranging, pilot trial of piperine with resveratrol on the effects on serum levels of resveratrol
Authors: Bailey Howard H. , Johnson Jeremy J. , Lozar Taja , Scarlett Cameron O. , Wollmer Barbara W. , Kim KyungMann , Havinghurst Thomas , Ahmad Nihal
Published: August 2020

Resveratrol (3,4,5-trihydroxystilbene) is a naturally occurring phytoalexin with purported health-promoting effects, but with limited oral bioavailability. Our prior murine modeling research observed enhanced resveratrol bioavailability with piperine co-administration. In this study, single-dose pharmacokinetics of resveratrol with or without piperine and the associated toxicities were studied on a cohort of healthy volunteers. We performed a double-blind, randomized, three-arm pilot study. Participants were randomized to receive a single dose of resveratrol 2.5 g, with piperine in 0 mg, 5 mg, or 25 mg dose. An improved liquid chromatography/mass spectrometry assay was used to determine serum levels of resveratrol and resveratrol-glucuronide. Baseline through 24 h post-study drug serum analyses were performed and adverse events were followed for 30 days. Twenty-four participants were enroled. No significant relationship between dose and pharmacokinetic values were found. In the sex stratified analysis, C
max for resveratrol in women showed a trend (P = 0.057) toward an increase with piperine. Pharmacokinetic values for resveratrol were: C
max – 18.5 ± 16 ng/mL resveratrol alone, 29 ± 29 resveratrol + 5 mg piperine, 16 ± 13 resveratrol + 25 mg piperine; area under the concentration × time curve – 1270 ± 852 ng/h/mL resveratrol alone, 2083 ± 2284 resveratrol + 5 mg piperine, 1132 ± 222 resveratrol + 25 mg piperine. All subjects tolerated their protocol therapy with minimal to no toxicity and no evidence of differences between the three groups. The co-administration of resveratrol with piperine at 5 and 25 mg doses did not sufficiently alter the pharmacokinetics of resveratrol or resveratrol-glucuronide to demonstrate the significant enhancement observed in murine modeling.
Factors Associated With Voriconazole Concentration in Pediatric Patients
Authors: Kang Suyeon , Yee Jeong , Kim Jae Youn , Han Hye Won , Kang Sang Oh , Lee Kyung Eun , Gwak Hye Sun
Published: August 2020

Background:

Serum concentrations of voriconazole are difficult to predict, especially in pediatric patients, because of its complex pharmacokinetic characteristics. This study aimed to identify the factors associated with the concentration of voriconazole in pediatric patients.

Methods:

This cohort study was based on retrospective data collection and involved the administration of voriconazole to pediatric patients younger than 18 years, between January 2010 and August 2017. Electronic medical records of the patients were reviewed to collect demographic characteristics, voriconazole treatment regimen, and factors that could potentially influence voriconazole trough concentrations. A voriconazole trough serum concentration of less than 1.0 mcg/mL or greater than 5.5 mcg/mL was defined as outside the therapeutic range and was set as the outcome of this study.

Results:

Among the 114 patients enrolled, 61 patients were included in the analysis. Oral administration of a maintenance dose of voriconazole and C-reactive protein (CRP) level were significantly and independently associated with a low initial trough concentration of voriconazole (<1.0 mcg/mL). Alanine aminotransferase levels were a significant factor associated with a high initial trough concentration of voriconazole (>5.5 mcg/mL) after adjusting for sex, age, weight, and serum creatinine (odds ratio 5.42; 95% confidence interval 1.34–21.97).

Conclusions:

Considering the variability of voriconazole concentrations in pediatric patients, monitoring certain parameters and considering the route of administration could help determine the therapeutic range of voriconazole and subsequently avoid unwanted effects.
Day-to-Day Change in Pulsatility Index Describes Anterior Cerebral Circulation Disturbance and Functional Outcomes in Pediatric Traumatic Brain Injury
Authors: Jordan Jeremy D. , Reuter-Rice Karin E.
Published: August 2020

BACKGROUND: Traumatic brain injury (TBI) is a significant source of morbidity and mortality in children. Transcranial Doppler (TCD) ultrasound measures the cerebral arterial circulation allowing for the calculation of pulsatility indices (PIs) that provide an assessment of cerebral blood flow alterations. However, the use of PI in children with TBI is poorly understood and may be an important measure for the nursing care of children. OBJECTIVES: The purpose of this article is to define day-to-day PI change and to describe its relationship to injury characteristics and functional outcomes in children with TBI. METHOD: We performed a secondary analysis of a prospective observational parent study of 40 children aged 2 months to 15 years with mild or moderate-severe TBI who had serial TCDs. Sequential TCD PI measurements of day-to-day change revealed several consistencies among the TBI severity groups. RESULTS: Day-to-day PI change was higher in children with a moderate-severe injury (40%) when compared with those with a mild injury (21%). Greater day-to-day PI change was seen in children whose Glasgow Outcome Scale-Extended Pediatrics scores worsened (25%) compared with those who had an improved (19%) or unchanged (23%) scores. DISCUSSION: This study is the first to report day-to-day PI change in children with TBI and provides early insights into anterior cerebral artery circulation alterations of children with TBI. Although further research is needed, this study provides early evidence that TCD may be a valuable noninvasive neuromonitoring option in the management of children with TBI.
Occupational Health and Disease Knowledge and Practices of Family Physicians
Authors: Gök Ahmet Said , Yilmaz Tarik Eren , Kasim İsmail , Şencan İrfan , Özkara Adem
Published: August 2020

Objective:

This study aims to evaluate the awareness and approaches of all family physicians from one province in Turkey regarding occupational diseases.

Methods:

This study is a cross-sectional, descriptive study. A questionnaire was applied to family physicians between November 2018 and February 2019. The questionnaire investigates family physicians’ knowledge, attitude, behavior, proficiency, and approaches to occupational diseases.

Results:

Three hundred twenty four family physicians participated in our study. 59.3% had received training on occupational diseases and only 22.9% of these physicians indicated that this training was adequate. Physicians identified “lack of occupational anamnesis” as the most common reason behind the underreporting of occupational diseases, and “difficulties in identifying occupational diseases” as the second.

Conclusions:

Family physicians believe that they inadequately evaluate occupational diseases and find the occupational disease-related training to be insufficient.
Relationship Between Burnout and Professional Behaviors and Beliefs Among US Nurses
Authors: Dyrbye Liselotte N. , West Colin P. , Leep Hunderfund Andrea , Johnson Pamela , Cipriano Pamela , Peterson Cheryl , Beatty Dale , Major-Elechi Brittny , Shanafelt Tait
Published: August 2020

Objective:

To evaluate the relationship between burnout and professional behaviors and beliefs among US nurses.

Methods:

We used data from 2256 nurses who completed a survey that included the Maslach Burnout Inventory and items exploring their professional conduct (documented something they had not done so they could “close out” an encounter in the EHR or part of the assessment not completed, requested continuing education credit for an activity not attended) and beliefs about reporting impaired colleagues.

Results:

On multivariable analysis, burnout was independently associated with higher odds of reporting 1 or more unprofessional behaviors in the last year and not believing nurses have a duty to report impairment among colleagues due to substance use or mental health problems.

Conclusions:

Occupational burnout is associated with self-reported unprofessional behaviors and less favorable beliefs about reporting impaired colleagues among nurses.
Progress in Corrections Worker Health: The National Corrections Collaborative Utilizing a Total Worker Health® Strategy
Authors: El Ghaziri Mazen , Jaegers Lisa A. , Monteiro Carlos E. , Grubb Paula L. , Cherniack Martin G.
Published: August 2020

Objective:

To examine National Corrections Collaborative (NCC) activities, as an outreach initiative, to advance corrections workplace health and safety research, practice, and policy through a series of applied Research to Practice (r2p) meetings informed by the Total Worker Health®(Total Worker Health®is a registered trademark of the U.S. Department of Health and Human Services) (TWH) strategy.

Methods:

We mapped the coalescence of correctional worker health concerns, federal and national professional organization initiatives, and research activities that formed the NCC in 2014.

Results:

During the NCC's 5-years of TWH activities, attendance increased, partner composition expanded, and themes of concern evolved. Partners were motivated to participate and work together towards building evidence for health and safety r2p.

Conclusions:

A unified plea to the academic and federal research communities for assistance with better evaluation instruments, data linkages, and for adopting an integrated TWH approach to workforce health and wellbeing continue to drive NCC r2p activities.
Safety and efficacy of the NovaCross microcatheter in facilitating crossing of chronic total occlusion coronary lesions: a multicenter, single-arm clinical trial
Authors: Walsh Simon J. , Dudek Darius , Bryniarski Leszek , Nicholson William , Karmpaliotis Dimtri , Uretsky Barry , McEntegart Margaret , Assali Abid , Knaapen Paul , Kornowski Ran , Spratt James C. , Goodwin Mark , Hanratty Colm G.
Published: August 2020

Background

The aim of this study was to evaluate the safety and efficacy of the novel NovaCross microcatheter system in patients with ischemic heart disease due to coronary chronic total occlusions (CTO).

Methods

A total of 191 subjects between the ages of 25–80 years were recruited in 10 investigational sites. Each subject underwent a percutaneous coronary intervention (PCI) of a CTO lesion using the NovaCross microcatheter, equipped with expandable nitinol scaffolds to enhance guidewire penetration and crossing of the CTO lesion. The primary safety endpoint was procedural major adverse cardiac events [composite of death, myocardial infarction (MI), or urgent target vessel revascularization]. The primary efficacy endpoint was to assess the ability of the NovaCross microcatheter to successfully facilitate the placement of a guidewire beyond a native coronary CTO in the true vessel lumen. After the PCI, subjects remained in hospital until a 12-lead ECG and blood tests for cardiac biomarkers were taken at 3–6 h and 8–16 h post-procedure.

Results

No deaths, urgent revascularization, or urgent coronary artery bypass surgery were reported. The reported MI rate according to the protocol definition was 12.3%, and technical success was achieved in 75.3% of the subjects regardless of CTO procedure technique. In 89.2% of the subjects, the NovaCross succeeded in penetrating the proximal CTO cap, and in 25.8% of the subjects, the extendable portion of the NovaCross crossed the full length of the CTO lesion.

Conclusions

The NovaCross met both the primary safety endpoint and the primary efficacy endpoint. We, therefore, conclude that the device is well tolerated, effective, and could be easily adopted by interventional cardiologists.