bluuebunny/crossref_metadata_2025 huggingface dataset:
Can a robot help a surgeon to predict a good total knee arthroplasty?
Authors: Lee Gwo-Chin , Wakelin Edgar , Randall Amber , Plaskos Christopher
Published: May 2021

Aims

Neither a surgeon’s intraoperative impression nor the parameters of computer navigation have been shown to be predictive of the outcomes following total knee arthroplasty (TKA). The aim of this study was to determine whether a surgeon, with robotic assistance, can predict the outcome as assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) for pain (KPS), one year postoperatively, and establish what factors correlate with poor KOOS scores in a well-aligned and balanced TKA.

Methods

A total of 134 consecutive patients who underwent TKA using a dynamic ligament tensioning robotic system with a tibia first resection technique and a cruciate sacrificing ultracongruent TKA system were enrolled into a prospective study. Each TKA was graded based on the final mediolateral ligament balance at 10° and 90° of flexion: 1) < 1 mm difference in the thickness of the tibial insert and that which was planned (n = 75); 2) < 1 mm difference (n = 26); 3) between 1 mm to 2 mm difference (n = 26); and 4) > 2 mm difference (n = 7). The mean one-year KPS score for each grade of TKA was compared and the likelihood of achieving an KPS score of > 90 was calculated. Finally, the factors associated with lower KPS despite achieving a high-grade TKA (grade A and B) were analyzed.

Results

Patients with a grade of A or B TKA had significantly higher mean one-year KPS scores compared with those with C or D grades (p = 0.031). There was no difference in KPS scores in grade A or B TKAs, but 33% of these patients did not have a KPS score of > 90. While there was no correlation with age, sex, preoperative deformity, and preoperative KOOS and Patient-Reported Outcomes Measurement Information System (PROMIS) physical scores, patients with a KPS score of < 90, despite a grade A or B TKA, had lower PROMIS mental health scores compared with those with KPS scores of > 90 (54.1 vs 50.8; p = 0.043). Patients with grade A and B TKAs with KPS > 90 were significantly more likely to respond with “my expectations were too low”, and with “the knee is performing better than expected” compared with patients with these grades of TKA who had a KPS score of < 90 (40% vs 22%; p = 0.004).

Conclusion

A TKA balanced with robotic assistance to within 1 mm of difference between the medial and lateral sides in both flexion and extension had a higher KPS score one year postoperatively. Despite accurate ligament balance information, a robotic system could not guarantee excellent pain relief. Patient expectations and mental status also significantly affected the perceived success of TKA. Cite this article: Bone Joint J 2021;103-B(6 Supple A):67–73.
When infection mimics cauda equina syndrome: a cautionary tale
Authors: Shah R , Jayakumar N , Athar S , Ashwood N
Published: May 2021

A 63-year-old man presented to the emergency department with low back pain, perineal and genital numbness, together with bilateral lower limb paraesthesia and urinary retention. He was admitted under the orthopaedic service for investigation of suspected cauda equina syndrome. Magnetic resonance imaging of his spine did not reveal any evidence of cauda equina compression. Magnetic resonance imaging of his brain demonstrated nonspecific multiple hyperintensities in the right frontotemporal and left temporo-occipital regions. Computed tomography of his chest, abdomen, and pelvis did not identify any evidence of malignancy. Cerebrospinal fluid from a lumbar puncture showed a high leucocyte count (predominantly lymphocytes). Viral cerebrospinal fluid polymerase chain reaction was positive for varicella zoster virus. A diagnosis of varicella zoster virus myeloradiculitis (Elsberg syndrome) was established and the patient was treated with intravenous aciclovir. Unfortunately, the patient succumbed to a devastating intracerebral haemorrhage during his inpatient stay, probably due to vasculopathy from the underlying varicella zoster virus infection. This case describes a rare infectious mimic of cauda equina syndrome. Elsberg syndrome is an infectious syndrome characterised by bilateral lumbosacral myeloradiculitis, with varicella zoster virus being a well-recognised aetiological agent. We discuss the relevant literature in detail and identify the key, cautionary lessons learned from this case.
Severe dissecting scalp cellulitis successfully treated with serial excisions in combination with anti-TNF therapy
Authors: Spiers J , Vinnicombe Z , Singh G , Pouncey A , McEvoy H
Published: May 2021

The management of dissecting scalp cellulitis involves medical treatment with oral antibiotics and isotretinoin, as well as surgical input in more severe cases. In extensive disease, a full scalpectomy with reconstruction can be required. We report a case of severe dissecting scalp cellulitis in a 34-year-old man who underwent serial scalp excisions over three years, with wounds being left to heal by secondary intention. Initially, the excisions helped to control symptoms but, once the patient was on concurrent anti-TNF therapy, further excisions were successful in reducing disease load and inducing remission. He remained disease free at the 20 months follow-up. This case is the first of its kind to be described in the literature and it highlights how a conservative, staged surgical approach, in combination with anti-TNF therapy, can be effective in the management of severe dissecting scalp cellulitis. In doing so, it offers an alternative to full scalpectomy with reconstruction.
Splenocystojejunostomy for the treatment of a symptomatic splenic pseudocyst
Authors: Yatham SS , Perikleous Y , Ezzat A , Chander N , Alsafi A , Abdalla S , Sodergren MH
Published: May 2021

Pancreatic pseudocyst is a widely recognised local complication following acute pancreatitis. Typically occurring more than four weeks after acute pancreatitis, a pseudocyst is a mature, encapsulated collection found within the peripancreatic tissues manifesting as abdominal pain, structural compression, gastroparesis, sepsis and organ dysfunction. Therapeutic interventions include endoscopic transpapillary or transmural drainage, percutaneous catheter drainage and open surgery. We present our management of idiopathic chronic pancreatitis complicated by a pancreatic pseudocyst extending to the splenic capsule in a 38-year-old man. A trial of conservative management was sought, but later escalated to percutaneous fluoroscopic drainage. Despite a period of volume reduction of the pseudocyst, reaccumulation occurred. We describe successful surgical treatment via means of a splenocystojejunostomy and subsequent pain reduction.
Hazards of fatigue: learning from aviation
Authors: Irfan A , Ahmed I , Malik M
Published: May 2021

Fatigue can lead to a degradation in mental and physical performance. This increases the risk for error, which can be disastrous in healthcare or aviation. Professionals in these fields are at a greater risk for fatigue as they often work long hours at unnatural times. While the aviation industry has taken active measures to investigate and reduce fatigue through regulations imposed by its governing bodies, recognition of these effects has been slower in the medical field.

Doctors are frequently reporting burnout and feel as though they are unable to perform effectively at work. As a consequence, physician retention is at an all-time low. The aviation industry provides a model for changes that need to be made to the healthcare schedules. If these are not implemented, the situation may continue to deteriorate and it is the patients who will ultimately suffer.
Teams, performance and trust: a perspective from the vanguard
Authors: James OP , Bowman CR , Parker J , Luton O , Robinson DBT , Hopkins L , Powell AGMT , Egan RJ , Lewis WG ,   * On behalf of the Welsh Surgical Research Initiative T Abdelrahman, E Barlow, C Brown, T Combellack, C Eley, J Hilton, H John, HG Jones, T Key, M Larsen, D Magowan, K Mellor, R Slade, J Wheat, L Wilks
Published: May 2021

Introduction

The aim of this study was to determine surgical trainees’ perspectives on team environment, function, performance and trust.

Methods

A 44-point anonymous survey was distributed to all doctors working in surgery in a single UK statutory education body. Responses were received from 116 doctors (17 foundation year 1 [F1] doctors, 50 senior house officers [SHOs], 49 specialist registrars [SpRs]).

Results

Psychological safety was associated with trainee grade, with SHOs showing the lowest results relating to perception of support (F1 88%, SHO 60%, SpR 82%, p=0.016) and ability to ask for help (F1 100%, SHO 71%, SpR 92%, p=0.043). Dependability among colleagues was perceived to be poorer by women than by men (70% vs 88%, p=0.009). Clarity of team structure was associated with grade and perceived to be poor by SHOs (F1 94%, SHO 60%, SpR 78%, p=0.014). Meaningfulness and impact of team achievement was also associated with grade (F1 77%, SHO 69%, SpR 94%, p=0.005). Inverse correlations were observed between the prevalence of harassment/bullying and markers of psychological safety (rs=-0.382, p<0.001), dependability (rs=-0.270, p=0.003) and clarity of team structure (rs=0.355, p<0.001).

Conclusions

Important deficiencies in psychological safety had an adverse effect on two in five SHOs. Countermeasures (enhanced stress resilience training) are needed to protect morale, patient safety and clinical out
Multisource feedback for the physician associate role
Authors: Theodoraki M , Hany TS , Singh H , Khatri M
Published: May 2021

Introduction

Physician associates (PAs) are dependent medical practitioners who work alongside doctors and other healthcare professionals. There are approximately 350 PAs working throughout the UK, with another 550 in training.

Methods

An online questionnaire was sent to healthcare professionals throughout the North West region with a total of 119 responding. Participants were asked nine questions on clinical skills and three on communication skills. These were to be rated as ‘excellent’, ‘good’, ‘satisfactory’, ‘needs to improve’ or ‘unacceptable’. In addition, respondents were asked to indicate their agreement with 14 statements about the role of PAs. There was also a field for free text comments.

Results

Of the 1,071 individual responses to the survey questions on clinical skills, 859 (80%) were ‘excellent’ or ‘good’. Similarly, among the 357 answers to the questions on communication skills, 317 (89%) were ‘excellent’ or ‘good’. Comments in the free text field included both positive and negative observations, with all negative comments coming from junior doctors.

Conclusions

Overall feedback for the PA role was overwhelmingly positive. However, the most commonly mentioned problem was that they are not being utilised effectively and in turn, that they are taking learning opportunities from junior doctors. This is an important concern to note and warrants further investigation. PAs are clearly useful assets and are set to increase in number in the NHS over the coming years. It is therefore imperative that this new role works well with the existing roles and training structure of junior doctors.
Prospective Evaluation of Role of Limb Reconstruction System (Rail External Fixator) in Open Fractures and Infected Non-union of Femur
Authors: Chahar Hemant Singh , Gupta Mayur , Kumar Vinod , Yadav Rohit , Patel Jaydeep , Pal Chandra Prakash
Published: May 2021

Introduction: Severe open fractures continue to be a nightmare for orthopedicians even with use of more accepted line of treatment. Open fractures and infected non-union of femur bone are not infrequently seen in orthopedic wards as femur is the most common long bone injured. We present a case series of 14 such patients treated successfully with limb reconstruction system enabling recovery to pre-injury status and activities.
Case Series: The present study was done to access the role of limb reconstruction system in the management of open femur fractures and in infected non-union with modifications to meet the requirements of each case. We viewed the results of treatment of 14 cases of late presentation with complicated open femur fractures and infected non-unions. Average time of fixator removal was 4 months–24 months. Average follow-up duration was 18 months (range 6?36 months). Evaluation of results was based on ASAMI criteria. The excellent bone results were obtained in 85.72% of cases while 7.14% showed good and 7.14% were poor results. Excellent functional results were observed in 71.43% of cases and 28.57% of cases shows good and fair results.
Conclusion: The use of limb reconstruction system is based on compression and distraction technique. It was found to be a simple and effective modality for open injuries in terms of enhanced union rate, rapid rehabilitation, and easy care of soft-tissue injury along with bone loss, thus avoiding multiple surgeries.
Keywords: Open fracture, non-union, femur, limb reconstruction system, ASAMI criteria.
Late Presenting Pediatric Radial Neck Fracture: A Case Report and Review of the Literature
Authors: Turan Kaya , Köroglu Cenk , Çabuk Haluk
Published: May 2021

Introduction: A pediatric radial neck fracture, when the diagnosis is delayed, is still a challenging problem for the treating orthopedic surgeon. We report a pediatric patient with late presenting radial neck fracture and results of open reduction and fixation with Kirschner wires.
Case Report: A 13-year-old right-handed girl fell on an out-stretched right arm after being tackled during playing basketball and had a radial neck fracture. However, the diagnosis of her fracture was delayed for 3 weeks. At the first radiologic examination, the anteroposterior and lateral radiographs were showing over 80 degrees of angulation at the radial neck and subluxation of the radiocapitellar joint. We tried to obtain a closed reduction, but we could not succeed. Then, we performed open reduction while preserving medial periosteal continuity and vascular supply of the radial head by meticulous surgical dissection. Sixth-month radiography control and clinical examination confirmed the complete healing of the fracture without any epiphyseal injury. Painless full range of motion without any restriction of pronation and supination was achieved. The patient and her parents were satisfied with the outcome.
Conclusions: Even if the diagnosis of pediatric radial fractures is delayed if we can preserve medial periosteal continuity and vascularity of the radial head with open reduction, satisfactory results are obtainable.
Keywords: Pediatric, radial neck fracture, open reduction, late diagnosis.
Rare Presentation of Caries Exudata with Dumbbell-Shaped Abscess in an Adult – A Case Report
Authors: Kumar M Kishore , Panchal Sameer , Sabarinathan N , Prabhakar Akil
Published: May 2021

Introduction: Tuberculosis (TB) of the shoulder joint is a sparse entity. Here, we are presenting a case of glenohumeral joint TB (caries exudata variant) with 1-year follow-up.
Case Presentation: Our patient, a 65-year-old male individual, came to the outpatient department with complaints of swelling and pain in the right shoulder of 6 months duration. Patient's systemic examination and vitals were within normal limits, and local examination of the shoulder joint revealed massive dumbbell-shaped swelling, tenderness along the joint line, and grossly restricted range of movements. Radiograph of the shoulder joint showed osteolytic lesions in the humeral head and glenoid with a reduction in glenohumeral joint space. We treated the case with the aspiration of the abscess followed by three sessions of injection streptomycin into the cavity at monthly intervals. The patient also received anti-tubercular drugs as per the Revised National Tuberculosis Control Program guidelines for 1 year. After 12 months, the patient was disease-free and had a functional range of motion.
Conclusion: In adults, the classical dry type of shoulder TB (caries sicca) has been described, while the fulminating variety rarely has been reported. The latter type of shoulder TB is much more common in children. We report a fulminant variety of shoulder joint TB in an old-aged patient who presented with massive dumbbell-shaped cold abscess and destruction of glenohumeral joint.
Keywords: caries sicca, caries exudate, glenohumeral joint, injection streptomycin.
Tuberculosis of the Left Calcaneum and Collapsed Right Femoral Head: A Case Report
Authors: Bikoroti Joël Bizimanasharale , Buteera Alex Mathias , Manirakiza Felix , Munezero Louise , Nzarora Josué , Nyiraneza Sabine
Published: May 2021

Introduction: Tuberculosis (TB), one of the oldest diseases known to affect humans, is caused by the bacteria Mycobacterium tuberculosis. The disease usually affects the lungs, although, in up to one-third of cases, other organs are involved. TB of the bone mimics other clinical conditions such as chronic osteomyelitis, Madura mycosis and actinomycosis.
Case Report: A fifth child and last-born girl, in a family of living four children, aged 9 years, consulted Kigali University Teaching Hospital (CHUK) on December 7, 2017, from Kibuye Referral Hospital (Western of Rwanda) for ulcerated, infected left heel with swollen foot 4 months before our consultation. Physical examination revealed a patient with swollen and tender foot discharging serous bloody fluids accompanied by inability to stand with a painful right hip. Small left inguinal lymph nodes were present. Blood work-up, computed tomography scan of the left foot, and an incisional biopsy at the level of the left calcaneus were performed and revealed extrapulmonary TB. The histopathological features for TB were scanty, but the high index suspicion of possible extrapulmonary TB led to the confirmation of the diagnosis using auramine-rhodamine special stain. Anti-TB therapy for 12 months course was initiated and the monthly follow-up for 11 months was done.
Conclusion: Although calcaneal TB is very rare, in countries with high incidence of TB, clinicians must have a high suspicion index and skeletal TB must be included in differential diagnosis of bone masses whenever possible bone mass biopsy and special staining technique in addition to most common diagnosis means should be done to rule out the possibility of bone TB.
Keywords: Calcaneus, tuberculosis, Rwanda.
Diagnosis and Arthroscopic Treatment of Synovial Chondromatosis of Glenohumeral Joint: A Case Report
Authors: Memon Fayaz , Pawar Eknath D , Gupta Devanshu , Yadav Amit Kumar
Published: May 2021

Introduction: Synovial chondromatosis is a rare benign entity with the presence of cartilaginous or osseous loose bodies in the synovium. It commonly involves the larger joints such as the knee, hip, ankle and rarely the shoulder joint manifesting with pain, swelling, and restriction of movements. The treatment of choice is surgical intervention in symptomatic patients using either the open or the arthroscopic approach.
Case Report: Here, we report a rare case of synovial chondromatosis affecting the right shoulder joint in a 23-year-old male with a 5-year disease duration who presented with progressive pain and restriction in movements which were impacting his routine activities. The loose bodies were removed using the arthroscopic approach combined with a partial synovectomy, and intra-articular methylprednisolone post procedure. The patient showed an excellent recovery in joint mobility within 4 weeks post-operatively, and there were no clinical signs of recurrence during a 6-month follow-up period.
Conclusion: We believe that arthroscopic surgery is effective in the treatment of patients with synovial chondromatosis with advantages such as good visualization, lesser morbidity, and early return of functional activities.
Keywords: Synovial chondromatosis, loose bodies, arthroscopy.
Actinomycotic Infection of Spine – A Rare Disease with Diagnostic Challenge, an Update on Spinal Infection
Authors: Hadgaonkar Shailesh , Rathi Pradhyumn , Vincent Vivek , Shyam Ashok , Sancheti Parag
Published: May 2021

Introduction: We are reporting a rare case of lumbar spinal actinomycosis with superficial discharging sinuses in an elderly female.
Case Report: A 56-year-old female came in outpatient with chief complaints of low back pain radiating to both buttocks, burning sensations to both lower limbs. Magnetic resonance imaging (MRI) re-vealed signal intensity changes suggestive of patchy marrow edema present over the L2 to S1 vertebra. Surgery was performed in the form of laminectomy and decompression by posterior approach and tissue was collected from right sacral ala. Contrast MRI showed patchy areas of marrow signal ab-normality L1, L2, L4, and L5 vertebra and adjoining end plates of L5, S1, and S2 segments. Ring en-hancing lesions at L2 and L3 levels. The patient underwent revision surgery. Histopathology revealed clumps of basophilic filamentous bacteria in a vaguely rosette-like configuration surrounded by acute inflammatory cells, characteristic of actinomycosis.
Conclusion: Actinomycotic infections of spine are a rare cause of spinal infections but should be kept in mind once the tubercular infection is ruled out. The definitive diagnosis of actinomycosis can be made by finding actinomycetes in the pus from affected tissue.
Keywords: Actinomycosis, epidural abscess, laminectomy, magnetic resonance imaging, spinal cord compression.
Adult Primary Tuberculosis of Lateral End of Clavicle – A Case of Missed Diagnosis
Authors: Muthu Sathish , Chellamuthu Girinivasan
Published: May 2021

Introduction: Of the largest series on osteoarticular tuberculosis (TB) by Tuli et al. involving 1074 cases, only seven involved clavicle. It is also noted that the lateral end of the clavicle has been less frequently involved by tubercular disease than the medial end. We present a case of primary tubercular involvement of the lateral end of the clavicle and discuss its management by an innovative modification of the Weaver-Dunn procedure.
Case Report: Twenty-five-year-old working women came with complaints of swelling in her left shoulder for the past 2 months. On examination, swelling with restricted shoulder movements was noted. Radiological evaluation revealed an osteolytic lesion with a pathological fracture in the lateral end of the clavicle. With a provisional diagnosis of giant cell tumor, we proceeded with fine-needle aspiration cytology which was inconclusive. Blood parameters were within normal limits. We proceeded with the excision biopsy of the lateral end of the clavicle and stabilization with a modified Weaver-Dunn procedure involving the reconstruction of the coracoclavicular ligament and augmentation with an Endobutton loop. Biopsy reported the lesion to be of tuberculous etiology. The patient made a good recovery without any complications.
Conclusion: Primary TB of the clavicle is a rarity that mimics other diseases like a tumor; hence, clinicians should be aware of a wide range of presentations to diagnose such an entity. Although antitubercular treatment remains the mainstay of treatment, surgical resection is justified in cases of uncertain diagnosis or disease not responding to conservative lines of management and in cases that need the removal of the sequestrum.
Keywords: Primary tuberculosis, clavicle, modified Weaver-Dunn procedure, osteoarticular tuberculosis, pathological fracture.
Anterior Fusion using a Vascularized Fibular Graft for Cervical Kyphosis Associated with Neurofibromatosis Type 1: A Report of Two Cases with Long-term Follow-up
Authors: Kumagai Gentaro , Echigoya Naoki , Wada Kanichiro , Asari Toru , Toh Satoshi , Ishibashi Yasuyuki
Published: May 2021

Introduction: Vascularized fibular grafts (VFG) in the cervicothoracic spine have been used for patients with progressive neurofibromatosis (NF) type-1-related kyphosis, but the long-term outcomes of VFG with NF-1 are not well described. We describe the long-term follow-up of two cases of cervical kyphosis related to NF-1 treated with VFG in the cervical spine.
Case Report: Case 1 was that of a 33-year-old man with a large neurofibroma at the back of his neck and an arteriovenous malformation at C2–7. The neurofibroma was resected by durotomy and intradural neurofibromas were extirpated through O-C6 laminectomy. Anterior fusion with VFG was performed 6 months later, and bone union was confirmed after 4 months. Cervical alignment was maintained with 50° kyphosis 15 years after the operation. The man suffered a subarachnoid hemorrhage 22 years after the operation. Case 2 was a 23-year-old woman with diastematomyelia at C6–T1 who was treated by anterior fusion with VFG at C4–T1. The diastematomyelia septum was resected through a C4–T1 laminectomy with simultaneous posterolateral fusion at C3–T2. Cervical alignment was maintained with 50° kyphosis 18 years later. The left vertebral artery ruptured and was embolized 10 years after the operation.
Conclusion: Anterior fusion with VFG can achieve good bone union and maintains long-term alignment. However, it is important to watch for vascular events related to NF-1.
Keywords: Vascularized fibular graft, cervical kyphosis, neurofibromatosis type 1.
A Rare Case of Vanishing Bone Disease of Metacarpals
Authors: Kamble Prashant , Sathe Ashwin , Mohanty Shubhranshu , Rathod Tushar
Published: May 2021

Introduction: Vanishing bone disease is rare phenomenon of idiopathic origin that leads to extensive osteolysis of bone. Prognosis of disease is unpredictable and definitive guidelines for management are still unknown. The vanishing bone disease has been reported for multiple other bones, however, this probably is the 1st time that vanishing bone disease of the metacarpals is being reported.
Case Report: A 22-year-old male presented with shortening middle finger and poor grip strength of the left hand. Serial radiographs revealed progressive concentric reduction of third and then fourth metacarpal shaft, with a sucked candy appearance. All the blood parameters were normal including calcium and parathormone levels. There was no evidence of any tumor elsewhere in the body. Biopsy showed myxoid areas, proliferating vessels interposed with skeletal muscles. Thus, based on clinical, radiological, and histopathological findings, we made the diagnosis of vanishing bone disease. The patient was treated with autologous non-vascularized fibula graft and was fixed with transverse k-wires to adjacent metacarpals. At 2-year follow-up, graft was completely incorporated and the patient gained full functional recovery.
Conclusion: Vanishing bone disease affecting the metacarpals is very rarely reported in the literature. The diagnosis should be made by excluding all the other conditions such as primary bone tumors or secondary from other sites. There are no fixed treatment guidelines. However, we could treat this condition successfully with autologous non-vascularized fibular graft.
Keywords: Vanishing bone disease, osteolysis, metacarpal, hand surgery.
Letter to Editor - A Clinical ‘PIC- Perspectives, issues & Concerns” on Idiopathic Transient Osteoporosis during Pregnancy with alarm bells on its Idiopathic nature - Response
Authors: Agarwal Sharat
Published: May 2021

Dear Editor,
At the outset, I would like to congratulate the authors of the article published in your journal in the current issue entitled- Idiopathic Transient Osteoporosis during Pregnancy – Report of a Clinical Case JOCR November – December 2019 Volume 9 Issue 6 Page 54-57. However, I regret to mention that the workup mentioned in this article needs to be improved, before one can come to definitive diagnosis of Idiopathic Transient Osteoporosis during Pregnancy. I would like to highlight various perspectives, issues & concerns, the knowledge of which are must for the readers of this journal pertaining to this disorder.
It is pertinent to mention no doubt the increasing utilization of magnetic resonance imaging (MRI) has allowed physicians to investigate edematous changes in bone marrow, a clinically important entity which was previously undetected on conventional radiographs. The first use of the term “bone marrow edema” was by Wilson et al in 1988, and the term “bone marrow edema syndrome” was described in 1993 after the investigation of histological specimens [1]. Later on, importantly Hayes et al. advocated that the term “transient bone marrow edema syndrome” should be used for patients in whom the bone marrow edema pattern was not accompanied by radiographic evidence of osteopenia [2]. And thus separating the two entities i.e. “the transient bone marrow edema syndrome” and “Transient Osteoporosis”
Occurrence of hip pain during pregnancy is quite common, although transient osteoporosis as a condition causing this symptom is uncommonly seen. Clinicians should also be aware of intra-articular disorders such as loose bodies, and labral tears; peri-articular pathology such as tendinitis and bursitis; or extra-articular conditions such as referred pain from the lumbar spine, the sacroiliac joint, and or from nerve entrapment syndromes. So, a detailed history and physical examination is helpful to narrow the differential diagnoses, which, in turn, dictate the modal
The History behind the Discovery of Root Tension Signs and the Invention of the Lumbar Discectomy Surgery
Authors: Chaudhary Kshitij
Published: May 2021

Introduction
Sciatica, a common affliction, has been a well known scourge throughout recorded history of mankind and finds a mention in the writings of Hippocrates [1]. The clinical root tension signs were described in the late 19th century, and their discovery preceded the development of surgical techniques for this disorder. As surgeries became safe at the beginning of the 20th century, surgeons incorrectly diagnosed the pathology as cartilaginous tumors in these operated patients. Finally, by the 1930s, they had started connecting the dots and discovered that lumbar disc herniation was responsible for the clinical syndrome of sciatica. In this report, we trace an interesting history from the discovery of the root tension signs for sciatica to the invention of lumbar discectomy surgery for a herniated lumbar disc. There is a great deal of confusion in the eponymous naming of the passive SLR test in various textbooks. Bruce Reider’s The Orthopaedic Physical Examination, a book popular among orthopedic residents, describes the forced dorsiflexion maneuver as the Laségue’s test [2]. While Todd Albert’s Physical Examination of the Spine describes the same maneuver as Bragard’s test [3]. Most textbooks, however, refrain from using eponymous names to describe these neurological signs, especially because there is so much confusion about them. Nevertheless, the medical history behind these root tension signs is no less fascinating. Many attribute the first description of the passive SLR to Ernst Charlie Laségue (Fig. 1), who was a Professor of Medicine in Paris. In his 1864 paper, he described a syndrome of radicular pain which sometimes was associated with muscle atrophy [4]. However, in this paper, he did not describe the leg raising test. Robert Wartenberg, the owner of a few eponymous signs and syndromes himself, worte in 1956: “it is highly embarrassing to state the plain fact that all authors who quoted Lasègue’s article of 1864 as a source of Lasègue’s sign did not
40Ar/39Ar geochronology of Burdigalian paleobotanical localities in the central Paratethys (south Slovakia)
Authors: Šarinová Katarína , Rybár Samuel , Jourdan Fred , Mayers Celia , Frew Adam , Kováčová Marianna , Nováková Petronela , Lichtman Barbara , Kováč Michal
Published: May 2021

The Lipovany and Mučín paleobotanical localities contain important floral associations within the tuff horizons, which were used for determination of subtropical to tropical climatic conditions during the Early Miocene. Based on the combination of results from plagioclase and biotite 40Ar/39Ar dating, the age of the tuff deposition is around 17.3Ma. For the Lipovany locality, single-grain 40Ar/39Ar convergent ages of 17.49±0.54Ma and 17.28±0.06Ma, for plagioclase and biotite were obtained, respectively. The Mučín locality only provide an imprecise convergent age of 16.5±1.4Ma due to the small size of the analyzed plagioclase crystals. The results thus allowed to include the fossil subtropical flora of the studied localities in the late Ottnangian regional stage (upper part of the Burdigalian). Additionally, these age data indicate that deposition of the overlaying Salgótarján Formation starts much later than originally thought (during Ottnangian-Karpatian boundary).
L’alumnat de cicle inicial de primària millora la
concentració jugant a tennis taula
Authors: Segura-Meix Míriam , Moratalla-Blanch Mònica
Published: May 2021

INTRODUCCIÓ. La concentració de l’alumnat a l’escola és
motiu d’ocupació i preocupació dels docents. Són molts els
professionals que intenten trobar estratègies acadèmiques adequades
per augmentar-la i permetre a l’alumnat assolir un nivell
d’aprenentatge superior i amb menys temps. MÈTODE. L’estudi,
realitzat a partir del test CARAS-R de Thurstone i Yela de 2012, ha
permès verificar i donar suport a la hipòtesi plantejada per mitjà
d’una metodologia quantitativa. Al mateix temps s’ha analitzat
l’índex de control de la impulsivitat i s’ha vist una millora en el
seu grau de reflexió davant les situacions quotidianes. RESULTATS.
La concentració de l’alumnat participant en la recerca ha augmentat
un 27,98 % en el grup experimental (26 participants) i un 5,05 % en
el grup de control. DISCUSSIÓ. En aquesta recerca hem demostrat que
la pràctica del tennis taula ha contribuït a la millora de la
concentració dels infants que han estat sotmesos a una proposta
d’introducció d’aquest esport respecte a un grup de control amb les
mateixes característiques. Finalment, es planteja la possibilitat de
fer un estudi ampliant la mostra i allargant-lo en el temps per
analitzar els resultats a llarg termini.
Multicomponent garnet phosphor (LuYGd)(Al4Ga)O12:Ce3+,V3+: trap modulation via reductive gas annealing and an optical information storage property
Authors: Wang Caiyan , Deng Mingxue , Zhang Ying , Liu Qian , Zhou Zhenzhen , Xu Xiaoke , He Huan
Published: May 2021

Annealing treatments are an effective strategy to modulate trap depth and trap concentration in electronic materials. Herein, we have found that annealing in a weak reducing atmosphere is a good way to tailor the trap depth and trap concentration of the (LuYGd)(Al4Ga)O12:Ce3+,V3+ multicomponent phosphor. The characterization results show that the annealing atmosphere has no effect on the crystal structure and the photoluminescence peak position, but strengthens the trap depth and trap concentration. Especially, after annealing in a weak reducing atmosphere, the thermoluminescence (TL) integrated area of the phosphor is 7.46 times that of the unannealed phosphor, and the TL peaks obviously shift to a higher temperature region, which could be promoted to enhance optical information storage properties. Moreover, the peak position of photo-stimulated luminescence (PSL) is consistent with that of photoluminescence (PL), indicating that (LuYGd)(Al4Ga)O12:Ce3+,V3+ phosphor annealed in a weak reducing atmosphere possesses optical information read-in and read-out characteristics, and suggests that the multicomponent phosphor is a good candidate for optical information storage materials.
Zonificación agroecológica del partido de Benito Juárez (Argentina): agriculturización y consecuencias ambientales en una porción de la Región Pampeana Argentina
Authors: Sequeira Nahuel David , Vazquez Patricia , Sacido Mónica , Daga Daiana Yael
Published: May 2021

La región Pampeana Argentina presenta un notable proceso de agriculturización, cuya distribución e impactos ambientales no se manifiestan homogéneamente. El partido de Benito Juárez conforma un claro ejemplo del mencionado escenario en la región. Los objetivos del presente trabajo fueron realizar una Zonificación Agroecológica (ZAE) del partido para los períodos comprendidos entre las campañas agroproductivas 1989/90-2002/03 y 2002/03-2014/15, definiendo Unidades Agroecológicas (UAE); y estimar algunos de los potenciales impactos ambientales negativos del proceso, a partir de tres Indicadores de Sustentabilidad (IdS). Metodológicamente, la ZAE fue efectuada en el marco de un sistema de información geográfica, mediante datos antecedentes acerca de las características ecológicas del área y la variación de la superficie agrícola en los períodos abordados. Respecto a los IdS, se empleó el riesgo de contaminación por plaguicidas, el riesgo de intervención del hábitat y el balance aparente de nitrógeno y fósforo, adaptados del software AgroEcoIndex. Los resultados demuestran la presencia de cinco UAE para cada período, las cuales evidencian diferentes niveles de agriculturización y exhiben una profundización de los impactos ambientales negativos a lo largo del tiempo. Esta situación exige el desarrollo de una correcta planificación tendiente a alcanzar la sustentabilidad ambiental de los sistemas agroproductivos.
The combination of Elephantopus scaber and Sauropus androgynus promotes erythroid lineages and modulates follicle-stimulating hormone and luteinizing hormone levels in pregnant mice infected with Escherichia coli
Authors: Djati Muhammad Sasmito , Christina Yuyun Ika , Rifa'i Muhaimin
Published: May 2021

Background and Aim: Escherichia coli infection produces an adverse effect on the erythrocyte lineage and hormone levels during pregnancy. This study aimed to evaluate the effects of Elephantopus scaber (ES) and Sauropus androgynus (SA) in combination on circulating follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels and erythropoiesis changes in E. coli-infected pregnant mice.

Materials and Methods: Female Balb/c mice were mated with normal male mice and pregnancies were identified by the formation of vaginal plugs. Twenty-eight pregnant mice were divided randomly into seven groups: A control group (N), E. coli-infected pregnant mice (K+), and infected pregnant mice received the following five treatments: (1) Only ES; (2) ESSA1 (75:25); (3) ESSA2 (50:50); (4) ESSA3 (25:75); and (5) only SA, beginning from the 1st to the 16th day of pregnancy. Pregnant mice were infected with 107 CFU/mL of E. coli on day 4. Blood serum was collected on days 8, 12, and 16 of pregnancy and LH and FSH levels were measured by enzyme-linked immunosorbent assay. Bone marrow was isolated to determine the relative number of TER-119+VLA4+ and TER-119+CD34+ using flow cytometry.

Results: The ESSA1 and SA groups exhibited a marked increase in LH levels. The combination of ES and SA administered at a 25:75 ratio (ESSA3) altered FSH levels and the relative number of TER-119+VLA4+ in infected pregnant mice. Combined with SA at an equal ratio (50:50), ESSA2 group exhibited a significant increase in the expression of TER119+CD34+ compared with the other treatment groups.

Conclusion: ES and SA combined at a ratio of 25:75 exhibited optimal results in altering hormonal and erythropoiesis in infected pregnant mice.
Social influence and impact of social media on users’ mobility decisions
Authors: Karatsoli Maria , Nathanail Eftihia
Published: May 2021

Social media are deemed influential in making decisions and seeking advice. Due to their explosive growth as critical channels for information, their content can trigger a place visit, a change of transport mode or destination, or plans’ cancellation. The main objective of this paper is to investigate the influence of social media on users’ activity and mobility planning. Responses of 738 participants in a digital survey were used to formulate ordinal regression models. The developed models determine the contribution of users’ demographic characteristics, travel characteristics and social media usage to mobility decisions after using social media as a source of information. These decisions were expressed in two dependent variables; (i) the impact of social media use in activity and mobility planning; (ii) the impact of the proposed transport mode by social media information, on mode choice. Analysis of the results indicated that the models, which considered all the characteristics together, could better predict the two variables.
Essência versus Aparência? Perspectivas Teóricas sobre os Transtornos Psicológicos numa “Sociedade do Espetáculo” / Essence versus Appearance? Theoretical Perspectives about Psychological Disorders in a “Spectacle Society”
Authors: Gomes Lidiane Bernardo , Leite Junior Francisco Francinete
Published: May 2021

O presente artigo tem por objetivo elaborar uma análise sobre a relação entre os transtornos psicológicos e o uso das redes sociais (WhatsApp, Facebook, Instagram, Twitter e Tinder) a partir de uma leitura da sociedade apresentada nas ideias de Guy Debord (1967), traçando um paralelo com a sociedade contemporânea, e obras da atualidade sobre o tema considerando os últimos 12 anos. Para tanto objetivamos investigar como a espetacularização da sociedade apresentada por Debord interfere na compreensão dos transtornos psicológicos na atualidade. Nesse sentido, metodologicamente seguimos o seguinte percurso: 1- da delimitação do tema inserindo à temática transtornos psicológicos: 2 -  levantamento  das  publicações em artigo de bases de dados da internet e livros; 3 – análises e classificações das informações encontradas. Nessa fase foram considerados livros e artigos que apresentavam uma correlação entre sociedade atual e sua relação com as mídias e transtornos psicológicos; 4 – organização e escrita das ideias pré-estabelecidas.  Diante deste estudo concluímos que, de acordo com o levantamento bibliográfico, existem pesquisas que mostram a relação entre selfies, em grande quantidade, com o transtorno de personalidade narcísico. Além disso, alguns estudos pesquisados sugerem o lado perigoso das selfies, quando a pessoa ultrapassa todos os limites para conseguir a selfie perfeita.
Sistema de Logística Integrado: Uma Revisão da Literatura / Integrated Logistics System: A Literature Review
Authors: Souza Daniel Antônio de
Published: May 2021

A definição de logística integrada, em alguns aspectos, parece idêntica à logística. Porém, contém uma diferença fundamental: a integração de cada etapa, tanto com a fase de planejamento quanto com a fase de controle. Ou seja, a logística integrada, além de tratar de tudo relacionado à logística tradicional, se conecta também com as áreas de produção, marketing e todas as demais áreas da empresa. A logística integrada é, portanto, ainda mais orientada para otimizar custos e tempos de produção, bem como melhorar a qualidade. Trata-se de uma revisão da literatura, a partir da busca de artigos publicados entre 2011 e 2021. As bases de dados utilizadas serão: SCIELO (Scientific Electronic Library Online); Google Acadêmico.
A Importância das Atividades Logísticas como Fator Organizacional / The Importance of Logistics Activities as an Organizational Factor
Authors: Silva Adriano Vitor da , Macêdo Maria Erilúcia Cruz
Published: May 2021

Resumo: O referido trabalho teve como objetivo, compreender as possibilidades que as organizações precisam para executar as atividades logísticas como fator diferencial no varejo, embasado no entendimento da importância das atividades logísticas como fator organizacional. De uma forma específica avaliar a cultura das organizações quanto ao uso das atividades logísticas, mostrando o que pode ser benéfico para ter sucesso, identificar os pontos importantes que auxiliem as organizações executarem de maneira eficiente as atividades logísticas como diferencial e demonstrar os resultados que se pode vislumbrar quando usado as atividades logísticas de forma eficiente. O estudo se determinou por uma pesquisa qualitativa e mediante aos fins descritiva e seus meios se determinou bibliograficamente. O trabalho teve como ponto forte demonstrar o quanto é possível ver a importância das atividades logísticas como diferencial e quando utilizadas o quanto podem ser consideradas como diferencial no atingimento das metas, beneficiando a organização e os clientes. Assim como possibilitando futuros estudos na temática de uma forma mais exploratória e até mesmo através de um estudo de caso específico dentro de uma organização. Assim, de uma forma prática os objetivos do estudo foram alcançados mediante os resultados adquiridos através do estudo e o entendimento da temática em busca de ajudar as organizações em atingir suas metas.
Logística Interna no Varejo de Eletrodomésticos: Um Estudo Bibliométrico dos últimos 10 anos (2011-2020) / Internal Logistics in the Retail of Home Appliances: A Bibliometric Study of the last 10 years (2011-2020)
Authors: Silva Mauricio Alexandre da
Published: May 2021

Resumo: Atualmente o mercado de trabalho não tem exigido das empresas apenas investimento, mas o desenvolvimento de estratégias que conduza o negócio à sua sustentabilidade. A logística interna por sua vez, tem sido uma grande investida para fortalecer o processo de gerenciamento, as empresas em buscado a cada dia estruturar seus espaços físicos e sempre se colocarem a disposição para acréscimos futuros, tendo como foco principal estarem preparadas para a competitividade global.O presente estudo tem como objetivo identificar e descrever as publicações no Brasil sobre o tema: a importância da logística interna no varejo de eletrodomésticos. Este trabalho constitui-se emum estudo bibliométrico sobre varejo e gestão de estoque de eletrodomésticos no Brasil nos últimos dez anos (2011-2020) com base em artigos e periódicos encontrados nas bases de artigos da SciELO e do Google Acadêmico.
A Importância da Formação Continuada nos Processos de Ensino e Aprendizagem / The Importance of Continuing Education in the Teaching and Learning Processes
Authors: Alves Alzenir Teixeira , Miguel Joelson Rodrigues
Published: May 2021

Resumo: O ato de educar, assim como o processo de alfabetização como um todo engloba inúmeros fatores políticos, constitucionais e educacionais, onde esses aspectos incluem em especial a perspectiva pedagógicas nos processos de ensino-aprendizagem. O estudo em tela discute a importância da formação continuada nos processos de ensino e aprendizagem que, diga-se de passagem, quando levados em consideração tem grande impacto na evolução da formação do educando. A metodologia utilizada é de natureza bibliográfica básica, baseada nos pressupostos teóricos de:  Libâneo (2015); Freire, (1996); Castro, (2014); Tardiff (2002) e demais pesquisadores da área de educação. Concluiu-se que ainda há lacunas que precisam ser repensadas e melhoradas, como a realização de formações que permitam aos docentes estratégias mais adaptadas e contextualizadas com a realidade dos discentes, bem como ações que aproximem mais a escola da família. Políticas públicas mais efetivas que garantam atualização constante dos educadores é importantes estratégia para que se garanta uma educação de qualidade mais atualizada, em sintonia com as novas tecnologias educacionais.
Deficiência e Inclusão: Novos Desafios na Contemporaneidade / Disability and Inclusion: New Challenges in Contemporaneity
Authors: Sousa Francisco Gilberto Braga de , Miguel Joelson Rodrigues
Published: May 2021

Resumo: A inserção do aluno com deficiência no ensino regular pode ser um caminho para a construção e reconstrução de conhecimento e, para o desenvolvimento cognitivo. Desta forma contribui para a formação de sua identidade e promovendo uma maior integração social.     Este trabalho discute a deficiência e a inclusão como novos desafios na contemporaneidade, á luz da literatura, mais especificamente dos autores: Mantoan e Prieto (2003); Effgen (2017); Freire e Bianchetti (2017); Marcotti e Marques (2017); Coutinho (2018) e, Sousa (2020). Concluiu-se que a inclusão da pessoa com deficiência precisa ser compreendida através da valorização do outro e do respeito às diferenças e a diversidade. Para isso, é preciso implantar políticas educacionais de capacitação continuada de educadores, com base na inclusão, de forma a que o poder público possa prover os meios necessários para efetivação da garantia à uma educação inclusiva e de qualidade.