bluuebunny/crossref_metadata_2025 huggingface dataset:
Study on the micro direct ethanol fuel cell (Micro-DEFC) performance
Authors: Saisirirat Penyarat , Joommanee Bordindech
Published: February 2018

The direct ethanol fuel cell (DEFC) is selected for this research. DEFC uses ethanol in the fuel cell instead of the more toxic methanol. Ethanol is more attractive than methanol by many reasons. Ethanol is a hydrogen-rich liquid and it has a higher specific energy (8.0 kWh/kg) compared to that of methanol (6.1 kWh/kg). Ethanol can be obtained in great quantity from biomass through a fermentation process from renewable resources such as sugar cane, wheat, corn, and even straw. The use of ethanol would also overcome both the storage and infrastructure challenge of hydrogen for fuel cell applications. The experimental apparatus on the micro direct ethanol fuel cell for measuring the cell performance has been set for this research. The objective is to study the micro direct ethanol fuel cell performance for applying with the portable electronic devices. The cell performance is specified in the terms of cell voltage, cell current and power of the cell at room operating temperature and 1 atm for the pressure and also includes the ethanol fuel consumption. The effect of operating temperature change on the electrical production performance is also studied. The steady-state time for collecting each data value is about 5-10 minutes. The results show that with the increase of concentrations of ethanol by volume, the reactant concentration at the reaction sites increases so the electrochemical rate also increases but when it reaches the saturated point the performance gradually drops.
The Proteomic Analysis of Pancreatic Exocrine Insufficiency Protein Marker in Type 2 Diabetes Mellitus Patients
Authors: Srihardyastutie Arie , Soeatmadji DW , Fatchiyah  , Aulanni’am
Published: February 2018

Type 2 Diabetes Mellitus (T2D) is the vast majority case of diabetes. Patient with T2D is at higher risk for developing acute or chronic pancreatitis. Prolonged hyperglycemia results in damages to tissue, which also causes dysfunctions of some organ systems, including enzyme or hormone secretions. Commonly, dysfunction or insufficiency of pancreatic exocrine is evaluated by increasing activity of serum pancreatic enzyme, such as amylase and lipase. Although incidence of pancreatitis was found in Indonesian T2D, the pathogenic mechanism still unclear. The aim of this study was to characterize the marker protein that indicated the correlation of pancreatic exocrine insufficiency with progression of T2D. Proteomic analysis using LC-MS/MS was used in identification and characterization of protein marker which indicates insufficiency pancreatic exocrine. First step, protein profile was analyzed by SDS-PAGE methods using serum sample of T2D compared with normal or healthy control, as negative control, and pancreatitis patients, as positive control. Protein with 18 kDa was found as a candidate protein marker which indicated the pancreatic exocrine insufficiency in T2D. The further identification of that protein using LC-MS/MS showed 4 peptide fragments. In silico analysis of the peptide fragment indicated the correlation of pancreatic exocrine insufficiency with progression of T2D was METTL10 – methyltransferase like protein-10.
Effect of Evaporation Time on Separation Performance of Polysulfone/Cellulose Acetate (PSF/CA) Membrane
Authors: Syahbanu Intan , Piluharto Bambang , Khairi Syahrul , Sudarko
Published: February 2018

Polysulfone and cellulose acetate are common material in separation. In this research, polysulfone/cellulose actetate (PSF/CA) blend membrane was prepared. The aim of this research was to study effect of evaporation time in casting of PSF/CA membrane and its performance in filtration. CA was obtained by acetylation process of bacterial cellulose (BC) from fermentation of coconut water. Fourier Transform Infra Red (FTIR) Spectroscopy was used to examine functional groups of BC, CA and commercial cellulose acetate. Subtitution of acetyl groups determined by titration method. Blend membranes were prepared through phase inversion technique in which composition of PSF/PEG/CA/NMP(%w) was 15/5/5/75. Polyethyleneglycol (PEG) and N-methyl-2-pyrrolidone (NMP) were act as pore forming agent and solvent, respectively. Variation of evaporation times were used as parameter to examine water uptake, flux, and morphology of PSF/CA blend membranes. FTIR spectra of CA show characteristic peak of acetyl group at 1220 cm−1 indicated that BC was acetylated succesfully. Degree of subtitution of BCA was found at 2.62. Highest water flux was performed at 2 bar obtained at 106.31 L.m-2.h-1 at 0 minute variation, and decrease as increasing evaporation time. Morphology of PSF/BCA blend membranes were investigated by Scanning Electron Microscopy (SEM) showed that porous asymetric membrane were formed.
WDL-RF: predicting bioactivities of ligand molecules acting with G protein-coupled receptors by combining weighted deep learning and random forest
Authors: Wu Jiansheng , Zhang Qiuming , Wu Weijian , Pang Tao , Hu Haifeng , Chan Wallace K B , Ke Xiaoyan , Zhang Yang
Published: February 2018

Motivation

Precise assessment of ligand bioactivities (including IC50, EC50, Ki, Kd, etc.) is essential for virtual screening and lead compound identification. However, not all ligands have experimentally determined activities. In particular, many G protein-coupled receptors (GPCRs), which are the largest integral membrane protein family and represent targets of nearly 40% drugs on the market, lack published experimental data about ligand interactions. Computational methods with the ability to accurately predict the bioactivity of ligands can help efficiently address this problem.

Results

We proposed a new method, WDL-RF, using weighted deep learning and random forest, to model the bioactivity of GPCR-associated ligand molecules. The pipeline of our algorithm consists of two consecutive stages: (i) molecular fingerprint generation through a new weighted deep learning method, and (ii) bioactivity calculations with a random forest model; where one uniqueness of the approach is that the model allows end-to-end learning of prediction pipelines with input ligands being of arbitrary size. The method was tested on a set of twenty-six non-redundant GPCRs that have a high number of active ligands, each with 200–4000 ligand associations. The results from our benchmark show that WDL-RF can generate bioactivity predictions with an average root-mean square error 1.33 and correlation coefficient (r2) 0.80 compared to the experimental measurements, which are significantly more accurate than the control predictors with different molecular fingerprints and descriptors. In particular, data-driven molecular fingerprint features, as extracted from the weighted deep learning models, can help solve deficiencies stemming from the use of traditional hand-crafted features and significantly increase the efficiency of short molecular fingerprints in virtual screening.

Availability and implementation

The WDL-RF web server, as well as source codes and datasets of WDL-RF, is freely available at https://zhanglab.ccmb.med.umich.edu/WDL-RF/ for academic purposes.

Supplementary information

Supplementary data are available at Bioinformatics online.
Endometriosis alters brain electrophysiology, gene expression and increases pain sensitization, anxiety, and depression in female mice†
Authors: Li Tian , Mamillapalli Ramanaiah , Ding Sheng , Chang Hao , Liu Zhong-Wu , Gao Xiao-Bing , Taylor Hugh S
Published: February 2018

Endometriosis is an estrogen-dependent inflammatory disorder among reproductive-aged women associated with pelvic pain, anxiety, and depression. Pain is characterized by central sensitization; however, it is not clear if endometriosis leads to increased pain perception or if women with the disease are more sensitive to pain, increasing the detection of endometriosis. Endometriosis was induced in mice and changes in behavior including pain perception, brain electrophysiology, and gene expression were characterized. Behavioral tests revealed that mice with endometriosis were more depressed, anxious and sensitive to pain compared to sham controls. Microarray analyses confirmed by qPCR identified differential gene expression in several regions of brain in mice with endometriosis. In these mice, genes such as Gpr88, Glra3 in insula, Chrnb4, Npas4 in the hippocampus, and Lcn2 in the amygdala were upregulated while Lct, Serpina3n (insula), and Nptx2 (amygdala) were downregulated. These genes are involved in anxiety, locomotion, and pain. Patch clamp recordings in the amygdala were altered in endometriosis mice demonstrating an effect of endometriosis on brain electrophysiology. Endometriosis induced pain sensitization, anxiety, and depression by modulating brain gene expression and electrophysiology; the effect of endometriosis on the brain may underlie pain sensitization and mood disorders reported in women with the disease.
Flow fuel cell powered by combustible agricultural waste
Authors: Liu Congmin , Zhang Zhe , Liu Wei , Xu Dong , Guo Hua , He Guangli , Li Xianming , Deng Yulin
Published: February 2018

Combustible agricultural waste is a potential source of energy because of its high organic content and heating value. As China’s economy develops, energy demand increases while environmental protection becomes more stringent. These competing demands make it urgent to find environmentally acceptable ways to extract energy from agricultural wastes. In this study, a liquid catalyst flow fuel cell (FFC) directly powered by combustible agricultural waste is investigated. This type of flow fuel cell can directly convert combustible agricultural waste at atmospheric pressure to electricity at 80–150℃ and it is environmentally friendly. Polyoxometalates act as catalysts and charge carriers to drive the FFC. Wheat straw and wine residues were used to represent the main components of combustible agricultural waste. Experiment results indicated that the power density reached as high as 111 mW/cm2, hundreds of times higher than the output of a microbial cell.
Infectivity of Chronic Malaria Infections and Its Consequences for Control and Elimination
Authors: Aguas Ricardo , Maude Richard J , Gomes M Gabriela M , White Lisa J , White Nicholas J , Dondorp Arjen M
Published: February 2018

The relative infectiousness of chronic malaria infections determines the likelihood of success of different malaria elimination strategies.
Thom–Sebastiani Theorems for Filtered 𝒟-Modules and for Multiplier Ideals
Authors: Maxim Laurentiu , Saito Morihiko , Schürmann Jörg
Published: February 2018

We give a proof of the Thom–Sebastiani type theorem for holonomic filtered D-modules satisfying certain good conditions (including Hodge modules) by using algebraic partial microlocalization. By a well-known relation between multiplier ideals and V-filtrations of Kashiwara and Malgrange, the argument in the proof implies also a Thom–Sebastiani type theorem for multiplier ideals, which cannot be deduced from an already known proof of the Thom–Sebastiani theorem for mixed Hodge modules (since the latter gives only the information of graded pieces of multiplier ideals). We also sketch a more elementary proof of the Thom–Sebastiani type theorem for multiplier ideals (as communicated to us by M. Mustaţǎ), which seems to be known to specialists, although it does not seem to be stated explicitly in the literature.
Improving galaxy morphologies for SDSS with Deep Learning
Authors: Domínguez Sánchez H , Huertas-Company M , Bernardi M , Tuccillo D , Fischer J L
Published: February 2018

We present a morphological catalogue for ∼670 000 galaxies in the Sloan Digital Sky Survey in two flavours: T-type, related to the Hubble sequence, and Galaxy Zoo 2 (GZ2 hereafter) classification scheme. By combining accurate existing visual classification catalogues with machine learning, we provide the largest and most accurate morphological catalogue up to date. The classifications are obtained with Deep Learning algorithms using Convolutional Neural Networks (CNNs). We use two visual classification catalogues, GZ2 and Nair & Abraham (2010), for training CNNs with colour images in order to obtain T-types and a series of GZ2 type questions (disc/features, edge-on galaxies, bar signature, bulge prominence, roundness, and mergers). We also provide an additional probability enabling a separation between pure elliptical (E) from S0, where the T-type model is not so efficient. For the T-type, our results show smaller offset and scatter than previous models trained with support vector machines. For the GZ2 type questions, our models have large accuracy (>97 per cent), precision and recall values (>90 per cent), when applied to a test sample with the same characteristics as the one used for training. The catalogue is publicly released with the paper.
High-Intensity Ultrasound Treatment for Vincristine-Induced Neuropathic Pain
Authors: Youn Youngwon , Hellman Abigail , Walling Ian , Gee Lucy , Qian Jiang , Burdette Clif , Frith Lance , Pilitsis Julie G
Published: February 2018

BACKGROUND

Vincristine is a commonly used chemotherapeutic agent that results in debilitating untreatable peripheral neuropathy.

OBJECTIVE

To determine the effects of pulsed high-intensity focused ultrasound (HIFU) on sensory thresholds in a validated vincristine-induced neuropathy (VIN) rodent model.

METHODS

VIN was induced and mechanical allodynia was confirmed by nociceptive testing. von Frey fibers and Randall-Sellito test were used as measures of innocuous and noxious mechanical thresholds, respectively, and the hot plate test for thermal thresholds. Tests were performed before VIN, after 2 wk of vincristine, at 24, 48, 72, and 120 h after HIFU applied to the left L5 dorsal root ganglia at 3 Watts for 3 min. Comparisons were made between a VIN cohort who underwent HIFU, a VIN cohort who underwent sham HIFU, and naïve rodents who underwent HIFU.

RESULTS

VIN HIFU rats had significantly increased mechanical thresholds at 24 h (P < .001), 48 h (P = .008), 72 h (P = .003), and 120 h (P = .03) after treatment, when compared to pre-HIFU thresholds. Furthermore, at 24 and 48 h following treatment, VIN HIFU rats had significantly higher innocuous and noxious mechanical thresholds and thermal thresholds than VIN sham HIFU rats (P < .001). Thresholds were not altered in naïve rodents who underwent HIFU. Histological data of L5 dorsal root ganglia of VIN HIFU rats suggest that transient cellular edema resolves by 48 h.

CONCLUSION

Our data suggest that HIFU increases mechanical and thermal thresholds in VIN rodents. Whether HIFU can preclude the development of reduced thresholds in the VIN model warrants further study.
Palivizumab Prophylaxis for Respiratory Syncytial Virus: Examining the Evidence Around Value
Authors: Olchanski Natalia , Hansen Ryan N , Pope Elle , D’Cruz Brittany , Fergie Jaime , Goldstein Mitchell , Krilov Leonard R , McLaurin Kimmie K , Nabrit-Stephens Barbara , Oster Gerald , Schaecher Kenneth , Shaya Fadia T , Neumann Peter J , Sullivan Sean D
Published: February 2018

Respiratory syncytial virus (RSV) infection is the most common cause of lower respiratory tract infection and the leading cause of hospitalization among young children, incurring high annual costs among US children under the age of 5 years. Palivizumab has been found to be effective in reducing hospitalization and preventing serious lower respiratory tract infections in high-risk infants. This paper presents a systematic review of the cost-effectiveness studies of palivizumab and describes the main highlights of a round table discussion with clinical, payer, economic, research method, and other experts. The objectives of the discussion were to (1) review the current state of clinical, epidemiology, and economic data related to severe RSV disease; (2) review new cost-effectiveness estimates of RSV immunoprophylaxis in US preterm infants, including a review of the field’s areas of agreement and disagreement; and (3) identify needs for further research.
Immediate Physical Therapy Initiation in Patients With Acute Low Back Pain Is Associated With a Reduction in Downstream Health Care Utilization and Costs
Authors: Liu Xinliang , Hanney William J , Masaracchio Michael , Kolber Morey J , Zhao Mei , Spaulding Aaron C , Gabriel Meghan H
Published: February 2018

Background

Physical therapy is an important treatment option for patients with low back pain (LBP). However, whether to refer patients for physical therapy and the timing of initiation remain controversial.

Objective

The objective of this study was to evaluate the impact of receiving physical therapy and the timing of physical therapy initiation on downstream health care utilization and costs among patients with acute LBP.

Design

The design was a retrospective cohort study.

Methods

Patients who had a new onset of LBP between January 1, 2009, and December 31, 2013, in New York State were identified and grouped into different cohorts on the basis of whether they received physical therapy and the timing of physical therapy initiation. The probability of service use and LBP-related health care costs over a 1-year period were analyzed.

Results

Among 46,914 patients with acute LBP, 40,246 patients did not receive physical therapy and 6668 patients received physical therapy initiated at different times. After controlling for patient characteristics and adjusting for treatment selection bias, health care utilization and cost measures over the 1-year period were the lowest among patients not receiving physical therapy, followed by patients with immediate physical therapy initiation (within 3 days), with some exceptions. Among patients receiving physical therapy, those receiving physical therapy within 3 days were consistently associated with the lowest health care utilization and cost measures.

Limitations

This study was based on commercial insurance claims data from 1 state.

Conclusions

When referral for physical therapy is warranted for patients with acute LBP, immediate referral and initiation (within 3 days) may lead to lower health care utilization and LBP-related costs.
Cassava Brown Streak Disease and Ugandan cassava brown streak virus Reported for the First Time in Zambia
Authors: Mulenga Rabson M. , Boykin Laura M. , Chikoti Patrick C. , Sichilima Suwilanji , Ng’uni Dickson , Alabi Olufemi J.
Published: February 2018

A diagnostic survey was conducted in July 2017 in two northern districts of Zambia to investigate presence or absence of cassava brown streak disease (CBSD) and its causal viruses. In total, 29 cassava fields were surveyed and cassava leaf samples were collected from 116 plants (92 symptomatic and 24 nonsymptomatic). CBSD prevalence was approximately 79% (23 of 29) across fields. Mean CBSD incidence varied across fields but averaged 32.3% while mean disease severity was 2.3 on a 1-to-5 rating scale. Reverse-transcription polymerase chain reaction screening of all 116 samples with one generic and two species-specific primer pairs yielded DNA bands of the expected sizes from all symptomatic plants with the generic (785 bp) and Ugandan cassava brown streak virus (UCBSV)-specific (440 bp) primers. All 24 nonsymptomatic samples were negative for UCBSV and all samples tested negative with primers targeting Cassava brown streak virus. The complete genome of a representative isolate of UCBSV (WP282) was determined to be 9,050 nucleotides in length, minus the poly A tail. A comparative analysis of this isolate with global virus isolates revealed its nature as a sequence variant of UCBSV sharing 94 and 96% maximum complete polyprotein nucleotide and amino acid identities, respectively, with isolates from Malawi (MF379362) and Tanzania (FJ039520). This is the first report of CBSD and UCBSV in Zambia, thus expanding the geographical distribution of the disease and its causal virus and further reinforcing the need to strengthen national and regional phytosanitary programs in Africa.
Evaluation of a Combination of Waveform Amplitude and Peak Latency in Intraoperative Spinal Cord Monitoring
Authors: Kobayashi Kazuyoshi , Ando Kei , Shinjo Ryuichi , Ito Kenyu , Tsushima Mikito , Morozumi Masayoshi , Tanaka Satoshi , Machino Masaaki , Ota Kyotaro , Ishiguro Naoki , Imagama Shiro
Published: February 2018

Study Design.

Retrospective study.

Objective.

The goal of the study was to investigate the significance of a change in latency in monitoring of transcranial muscle-action potential (Tc-MsEP) waveforms.

Summary of Background Data.

Tc-MsEP has become a common approach in spine surgery due to its sensitivity and importance in motor function. Many reports have defined the alarm point of Tc-MsEP waveform as a particular decrease in amplitude, but evaluation of the waveform latency has not attracted as much attention.

Methods.

The subjects were 70 patients who underwent spine surgery using intraoperative Tc-MsEP monitoring. The peak latency was defined as the period from stimulation until the waveform amplitude reached its peak. Relationships with postoperative paralysis were examined separately for latency delays of 5% or more and 10% or more, and in combination with a decrease in amplitude of 70% or more from baseline.

Results.

Acceptable baseline Tc-MsEP responses were obtained from 1225 of 1372 muscles in the extremities (89.3%). Seven of the 70 patients (10%) had postoperative paralysis. A decrease in intraoperative amplitude of 70% or more from baseline occurred in 25 cases, with sensitivity 100%, specificity 71%, false positive rate 29%, and positive predictive value (PPV) 28% for prediction of postoperative paralysis. Compared to baseline, 15 cases had a latency delay of 5% or more, which gave a sensitivity of 100%, specificity of 87%, false positive rate of 0%, and PPV 47%, and 8 cases had a delay of 10% or more, which gave a sensitivity of 86%, specificity of 97%, false positive rate of 3%, and PPV 75%. A combination of a decrease in amplitude of 70% or more from baseline and a delay in latency of 10% or more from baseline had a sensitivity of 86%, specificity of 98%, and a false positive rate of 2%, and PPV 86%.

Conclusion.

Combined use of latency and amplitude could lead to reduction of false positives and increase of PPV in Br(E)-MsEP monitoring.

Level of Evidence: 3
The Impact of Comorbid Mental Health Disorders on Complications Following Adult Spinal Deformity Surgery With Minimum 2-Year Surveillance
Authors: Diebo Bassel G. , Lavian Joshua D. , Murray Daniel P. , Liu Shian , Shah Neil V. , Beyer George A. , Segreto Frank A. , Bloom Lee , Vasquez-Montes Dennis , Day Louis M. , Hollern Douglas A. , Horn Samantha R. , Naziri Qais , Cukor Daniel , Passias Peter G. , Paulino Carl B.
Published: February 2018

Study Design.

Retrospective analysis.

Objective.

To compare long-term outcomes between patients with and without mental health comorbidities who are undergoing surgery for adult spinal deformity (ASD).

Summary of Background Data.

Recent literature reveals that one in three patients admitted for surgical treatment for ASD has comorbid mental health disorder. Currently, impacts of baseline mental health status on long-term outcomes following ASD surgery have not been thoroughly investigated.

Methods.

Patients admitted from 2009 to 2013 with diagnoses of ASD who underwent more than or equal to 4-level thoracolumbar fusion with minimum 2-year follow-up were retrospectively reviewed using New York State's Statewide Planning and Research Cooperative System (SPARCS). Patients were stratified by fusion length (short: 4–8-level; long: ≥9 level). Patients with comorbid mental health disorder (MHD) at time of admission were selected for analysis (MHD) and compared against those without MHD (no-MHD). Univariate analysis compared demographics, complications, readmissions, and revisions between cohorts for each fusion length. Multivariate binary logistic regression models identified independent predictors of outcomes (covariates: fusion length, age, female sex, and Deyo score).

Results.

Six thousand twenty patients (MHD: n = 1631; no-MHD: n = 4389) met inclusion criteria. Mental health diagnoses included disorders of depression (59.0%), sleep (28.0%), anxiety (24.0%), and stress (2.3%). At 2-year follow-up, MHD patients with short fusion had significantly higher complication rates (P = 0.001). MHD patients with short or long fusion also had significantly higher rates of any readmission and revision (all P ≤ 0.002). Regression modeling revealed that comorbid MHD was a significant predictor of any complication (odds ratio [OR]: 1.17, P = 0.01) and readmission (OR: 1.32, P < 0.001). MHD was the strongest predictor of any revision (OR: 1.56, P < 0.001). Long fusion most strongly predicted any complication (OR: 1.87, P < 0.001).

Conclusion.

ASD patients with comorbid depressive, sleep, anxiety, and stress disorders were more likely to experience surgical complications and revision at minimum of 2 years following spinal fusion surgery. Proper patient counseling and psychological screening/support is recommended to complement ASD treatment.

Level of Evidence: 3
Minimally Invasive Surgery for Neuromuscular Scoliosis
Authors: Miladi Lotfi , Gaume Mathilde , Khouri Nejib , Johnson Michael , Topouchian Vicken , Glorion Christophe
Published: February 2018

Study Design.

A retrospective review.

Objective.

To report the results of an alternative technique using a minimally invasive fusionless surgery. The originality is based on the progressive correction of the deformities with proximal and distal fixation and on the reliability of the pelvic fixation using iliosacral screws on osteoporotic bones.

Summary of Background Data.

Spinal deformities are common in neuromuscular diseases. Conventional treatment involves bracing, followed by spinal instrumented fusion. Growing rod techniques are increasingly advocated but have a high rate of complications.

Methods.

The technique relies on a bilateral double rod sliding construct anchored proximally by four hooks claws and distally to the pelvis by iliosacral screws through a minimally invasive approach. Hundred patients with neuromuscular scoliosis underwent the same fusionless surgery extended from T1 to the pelvis. The average age at initial surgery was 11 + 6 years. Diagnoses included cerebral palsy (61), spinal muscular atrophy (22), muscular dystrophy (10), and other neurological etiologies (7). Cobb angle and pelvic obliquity were measured before and after initial surgery, and at final follow-up. Complications were reviewed.

Results.

At latest follow-up 3 + 9 years (range 2 yr–6 + 3 yr), the mean Cobb angle improved from 89° to 35° which corresponds to 61% correction. Mean pelvic obliquity improved from 29° to 5°, which corresponds to 83% correction. Mean T1-S1 length increased from 30.02 to 37.28 cm. Mean preoperative hyper kyphosis was reduced from 68.44° to 33.29°. Complications occurred in 26 patients including mechanical complications (12) and wound infections (16). No arthrodesis was required at last follow-up.

Conclusion.

This original fusionless technique is safe and effective, preserving spinal and thoracic growth. It provides a significant correction of spinal deformities and pelvic obliquity with a reduced complications rate. The strength and stability of this modular construct over time allow the avoidance of final arthrodesis.

Level of Evidence: 4
Incidence, Risk Factors, and Evolution of Proximal Junctional Kyphosis After Posterior Hemivertebra Resection and Short Fusion in Young Children With Congenital Scoliosis
Authors: Chen Xi , Xu Liang , Qiu Yong , Chen Zhong-hui , Zhu Ze-zhang , Li Song , Sun Xu
Published: February 2018

Study Design.

A retrospective study.

Objective.

To investigate the incidence, risk factors, and evolution of proximal junctional kyphosis (PJK) in young children who underwent posterior hemivertebra resection and short fusion.

Summary of Background Data.

PJK is an undesired, but common complication following posterior spinal fusion. However, there is a paucity of data on PJK in young children after posterior hemivertebra resection and short fusion.

Methods.

This study included 189 children who had undergone posterior hemivertebra resection and short fusion (≤4 vertebra) from January 2008 and May 2015 at a single institution. Medical records were reviewed and radiographic assessments were made preoperatively and throughout the follow-up period. Risk factors for PJK were evaluated by correlation analysis and logistic regression analysis.

Results.

The mean age at surgery was 4.5 years (range, 3–10 yr) and the average follow-up was 48.4 months (range, 24–87 mo). Twenty-two (11.6%) patients experienced PJK. PJK was identified within 6 months after surgery in 21 cases (95%), and the most common type was ligamentous failure. In comparison with the non-PJK group, the PJK group had greater preoperative segmental kyphosis (26.9° vs. 16.7°, P < 0.01), longer fusion levels (3.4 vs. 2.5, P < 0.01), and larger postoperative sagittal vertical axis (SVA; 18.9 vs. 8.6 mm, P < 0.01). Preoperative segmental kyphosis >30°(odds ratio, 4.426), and postoperative SVA of more than 20 mm (odds ratio, 3.580) were identified as independent risk factors for PJK. In PJK group, the average proximal junctional angle increased from 4.9° to 18.5° at 6 months postoperatively, but significantly decreased to 14.8° at final follow-up. Eleven patient received brace treatment, and no patients required revision surgery.

Conclusion.

Despite the incidence of PJK in 11.6% of young children undergoing posterior hemivertebra resection and short fusion, no significant deterioration of proximal junctional angle were found till the last follow-up. Its risk factors include preoperative segmental kyphosis, a larger postoperative SVA and ligamentous failure. Early detection and active management may be helpful for minimizing the progression of PJK.

Level of Evidence: 3
Acupuncture and Cardiovascular Disease
Authors: Ni Yu-Ming , Frishman William H.
Published: February 2018

Symptomatic heart failure is managed with interdisciplinary approaches to reduce acute exacerbations and to improve mortality. Acupuncture is a standardized treatment of Traditional Chinese Medicine that has been shown to have beneficial effects on the cardiovascular system via a neurohumoral pathway known as the long-loop pathway. This article serves to examine recent evidence supporting the long-loop pathway as the physiologic mechanism of acupuncture and the sympatholytic, vasodilatory, and cardioprotective effects of acupuncture that could specifically improve cardiac function and quality of life measures in the management of congestive heart failure.
Malpractice Litigation in Cornea and Refractive Surgery: A Review of the WestLaw Database
Authors: Engelhard Stephanie B. , Shah Christopher T. , Sim Austin J. , Reddy Ashvini K.
Published: February 2018

Purpose:

To report and analyze the causes and outcomes of malpractice litigation in cornea and refractive surgery.

Methods:

The WestLaw database was reviewed for all malpractice litigation related to ophthalmology in the United States between 1930 and 2014. Search terms included ophthalmology or ophthalmologist and malpractice anywhere in the retrieved results. All cases involving cornea and refractive surgery were included in this analysis, and results were compared with ophthalmology as a whole.

Results:

One hundred fifty-nine cornea and refractive surgery cases between the years 1964 and 2014 were included. Ninety-three cases (58.5%) were resolved through a jury trial, 21.5% of which were associated with plaintiff verdicts with a median adjusted jury award of $588,896 (mean $1,518,686). Nineteen cases (11.9%) resulted in settlements with a median adjusted indemnity of $782,533 (mean $761,963). Commonly litigated scenarios included laser-assisted in situ keratomileusis (74.2%) and corneal transplantation (8.2%). Overall, 88.7% of cases involved surgical or procedural claims, 8.8% involved noninterventional claims, and 2.5% involved medical claims only.

Conclusions:

Cornea and refractive surgery is a high-risk subspecialty of ophthalmology. Laser-assisted in situ keratomileusis and corneal transplant claims were the most commonly litigated entities in this series. Many cases focus on failure to achieve patients' desired expectations after elective refractive procedures or the negligent performance of refractive surgery on patients with contraindications to surgery, both highlighting the importance of detailed informed consent discussions, realistic goal setting with patients, and thorough examinations and preoperative evaluation.
Evaluation of different treatment and management options for chondrosarcoma; the prognostic factors determining the outcome of the disease
Authors: Abbas Kiran , Siddiqui Amber T.
Published: February 2018

Importance:

This review provides an in-depth discussion of the different treatment and management strategies adopted for chondrosarcoma, the various outcomes and the prognostic factors of the disease. Chondrosarcoma is the third most common malignant bone tumor after myeloma and osteosarcoma. It is characterized by the production of a cartilaginous matrix by malignant cells. It can be classified according to the source of its origin, histopathologic grade, site of occurrence, and rarity. Chondrosarcomas that are de novo in nature are classified as primary chondrosarcomas, while those derived from pre-existing enchondromas or osteochondromas are regarded as secondary chondrosarcomas. Other rare forms of chondrosarcoma include dedifferentiated, mesenchymal, and clear cell chondrosarcomas.

Observations/Findings:

Early diagnosis, accurate interpretation of histopathology, precise grading, and careful localization are crucial in the management of chondrosarcoma. Surgery is the treatment of choice. Three forms of surgical interventions are present; curettage, radical resection, and amputation. The choice of procedure depends on the size and site of the lesion and degree of malignancy. Radical procedures give the most promising outcomes with wider margins yielding better prognosis. Recurrence is usually seen with delayed surgery, high histopathologic grading, inadequate surgical procedures, marginal excision or curettage, tumor present in inaccessible sites such as sacrum and metastasis.

Conclusion:

Chondrosarcoma is responsible for placing a significant burden on pediatric as well as adult orthopedic oncology. Optimum diagnosis, accurate interpretation of histopathology, precise grading, careful localization, and timely as well as adequate management is crucial to successfully manage and prevent recurrence of the disease. Surgery is the most effective form of treatment. The main goal of treatment and management is to keep well ahead of the growth of the neoplasm and to prevent recurrences.
Functional imaging in microfluidic chambers reveals sensory neuron sensitivity is differentially regulated between neuronal regions
Authors: Clark Alex J. , Menendez Guillermo , AlQatari Mona , Patel Niral , Arstad Erik , Schiavo Giampietro , Koltzenburg Martin
Published: February 2018

Primary afferent sensory neurons are incredibly long cells, often traversing distances of over 1 m in humans. Cutaneous sensory stimuli are transduced in the periphery by specialised end organs or free nerve endings, which code the stimulus into electrical action potentials that propagate towards the central nervous system. Despite significant advances in our knowledge of sensory neuron physiology and ion channel expression, many commonly used techniques fail to accurately model the primary afferent neuron in its entirety. In vitro experiments often focus on the cell somata and neglect the fundamental processes of peripheral stimulus transduction and action potential propagation. Despite this, these experiments are commonly used as a model for cellular investigations of the receptive terminals. We demonstrate that ratiometric calcium imaging performed in compartmentalised sensory neuron cultures can be used to directly and accurately compare the sensitivity and functional protein expression of isolated neuronal regions in vitro. Using microfluidic chambers, we demonstrate that the nerve terminals of cultured dorsal root ganglion neurons can be depolarised to induce action potential propagation, which has both tetrodotoxin-resistant and tetrodotoxin-sensitive components. Furthermore, we show that there is a differential regulation of proton sensitivity between the sensory terminals and somata in cultured sensory neurons. We also demonstrate that capsaicin sensitivity is highly dependent on embryonic dissection age. This approach enables a comprehensive method to study the excitability and regional sensitivity of cultured sensory neurons on a single-cell level. Examination of the sensory terminals is crucial to further understand the properties and diversity of dorsal root ganglion sensory neurons.
Psychological factors predict an unfavorable pain trajectory after hysterectomy: a prospective cohort study on chronic postsurgical pain
Authors: Pinto Patrícia R. , McIntyre Teresa , Araújo-Soares Vera , Almeida Armando , Costa Patrício
Published: February 2018

Chronic postsurgical pain (CPSP) is a well-recognized potential complication with negative personal, social, and health care consequences. However, limited data exist on CPSP and on the course of pain over time after hysterectomy. Using data from a prospective cohort study on a consecutive sample assessed at 4 time points, presurgery (T1), 48 hours (T2), 4 months (T3), and 5 years postsurgery (T4), we sought to examine women's PSP trajectories using assessments of pain at T3 and T4. In addition, this study aimed to investigate presurgical and postsurgical risk factors associated with an unfavourable pain trajectory (PT). Based on pain data collected at T3 and T4, 3 distinct trajectories of PSP emerged: no CPSP (PT1; n = 88), prolonged PSP (PT2; n = 53), and CPSP (PT3; n = 29). Moreover, reported CPSP prevalence at 5 years was 17.1%. Multinomial logistic regression models controlling for age, presurgical pain, and type of hysterectomy tested for baseline and acute postsurgical predictive variables. Membership in PT2 and PT3 was predicted by presurgical anxiety (odds ratio [OR] = 1.131,P= 0.015; OR = 1.175,P= 0.009, respectively), emotional representation of the surgical disease (OR = 1.155,P= 0.034; OR = 1.213,P= 0.020, respectively), and pain catastrophizing (OR = 1.079,P= 0.043; OR = 1.143,P= 0.001, respectively). Furthermore, acute PSP intensity and frequency determined membership of women in PT3 (OR = 1.211,P= 0.033; OR = 3.000,P= 0.029, respectively), and postsurgical anxiety (OR = 1.182,P= 0.026) also played a key predictive role. This study identified factors that can be easily screened before and after surgery and are amenable to change through carefully designed timely and tailored interventions for women at risk of an unfavorable PSP trajectory posthysterectomy.
Chemotherapy-induced pain is promoted by enhanced spinal adenosine kinase levels through astrocyte-dependent mechanisms
Authors: Wahlman Carrie , Doyle Timothy M. , Little Joshua W. , Luongo Livio , Janes Kali , Chen Zhoumou , Esposito Emanuela , Tosh Dilip K. , Cuzzocrea Salvatore , Jacobson Kenneth A. , Salvemini Daniela
Published: February 2018

Development of chemotherapy-induced neuropathic pain (CINP) compromises the use of chemotherapy and greatly impacts thousands of lives. Unfortunately, there are no Food and Drug Administration–approved drugs to prevent or treat CINP. Neuropathological changes within CNS, including neuroinflammation and increased neuronal excitability, are driven by alterations in neuro-glia communication; but, the molecular signaling pathways remain largely unexplored. Adenosine is a potent neuroprotective purine nucleoside released to counteract the consequences of these neuropathological changes. Adenosine signaling at its adenosine receptors (ARs) is dictated by adenosine kinase (ADK) in astrocytes, which provides a cellular sink for the removal of extracellular adenosine. We now demonstrate that chemotherapy (oxaliplatin) in rodents caused ADK overexpression in reactive astrocytes and reduced adenosine signaling at the A3AR subtype (A3AR) within the spinal cord. Dysregulation of ADK and A3AR signaling was associated with increased proinflammatory and neuroexcitatory interleukin-1β expression and activation of nucleotide-binding oligomerization domain-like receptor protein 3 inflammasome, but not putative oxaliplatin-associated GSK3β transcriptional regulation. Intrathecal administration of the highly selective A3AR agonist MRS5698 attenuated IL-1β production and increased the expression of potent anti-inflammatory and neuroprotective IL-10. The effects of MRS5698 were blocked by attenuating IL-10 signaling in rats with intrathecal neutralizing IL-10 antibody and in IL-10−/− knockout mice. These findings provide new molecular insights implicating astrocyte-based ADK-adenosine axis and nucleotide-binding oligomerization domain-like receptor protein 3 in the development of CINP and IL-10 in the mechanism of action of A3AR agonists. These findings strengthen the pharmacological rationale for clinical evaluation of A3AR agonists already in advanced clinical trials as anticancer agents as an adjunct to chemotherapy.
Extracorporeal Membrane Oxygenation in a Patient with Biliary Atresia: Case and Review of Extracorporeal Life Support Organization Data
Authors: Lobeck Inna N. , Bondoc Alexander , Nolan Heather , Frischer Jason S. , Campbell Kathleen M. , Ryan Thomas D. , Goldstein Stuart L. , Nathan Jaimie D. , Alonso Maria H. , Tiao Greg M.
Published: February 2018

Biliary atresia is a newborn cholangiopathy that may lead to portopulmonary hypertension and cirrhosis-induced cardiomyopathy while awaiting liver transplantation. Extracorporeal life support and hepatic toxin filtration are life-saving interventions that provide cardiopulmonary support and hepatic dialysis to allow resolution of a child’s illness. We utilized a combination of these extreme measures to bridge an infant with biliary atresia to transplantation. We reviewed cases of extracorporeal life support utilization in transplantation recipients in the Extracorporeal Life Support Organization database and determined that ours was the only use of pretransplant extracorporeal life support in biliary atresia.
Ceftaroline for Suspected or Confirmed Invasive Methicillin-Resistant Staphylococcus aureus: A Pharmacokinetic Case Series
Authors: Cies Jeffrey J. , Moore Wayne S. , Enache Adela , Chopra Arun
Published: February 2018

Objectives:

To describe the ceftaroline pharmacokinetics in critically ill children treated for suspected or confirmed methicillin-resistant Staphylococcus aureus infections, including blood stream infection and describe the microbiological and clinical outcomes.

Design:

Retrospective electronic medical record review.

Settings:

Free-standing tertiary/quaternary pediatric children’s hospital.

Patients:

Critically ill children receiving ceftaroline monotherapy or combination therapy for suspected or confirmed methicillin-resistant S. aureus infections in the PICU.

Intervention:

None.

Measurements and Main Results:

Seven patients, three females (43%), and four males (57%), accounted for 33 ceftaroline samples for therapeutic drug management. A median of four samples for therapeutic drug management was collected per patient (range, 2–9 samples). The median age was 7 years (range, 1–13 yr) with a median weight of 25.5 kg (range, 12.6–40.1 kg). Six of seven patients (86%) demonstrated an increase in volume of distribution, five of seven patients (71%) demonstrated an increase in clearance, and 100% of patients demonstrated a shorter half-life estimate as compared with the package insert estimate. Six of seven patients (85.7%) had documented methicillin-resistant S. aureus growth from a normally sterile site with five of six (83.3%) having documented BSI, allowing six total patients to be evaluated for the secondary objective of microbiological and clinical response. All six patients achieved a positive microbiological and clinical response for a response rate of 100%.

Conclusions:

These data suggest the pharmacokinetics of ceftaroline in PICU patients is different than healthy pediatric and adult patients, most notably a faster clearance and larger volume of distribution. A higher mg/kg dose and a more frequent dosing interval for ceftaroline may be needed in PICU patients to provide appropriate pharmacodynamic exposures. Larger pharmacokinetic, pharmacodynamic, and interventional treatment trials in the PICU population are warranted.
Brief Report: HIV Postexposure Prophylaxis-in-Pocket (“PIP”) for Individuals With Low-Frequency, High-Risk HIV Exposures
Authors: Tumarkin Ethan , Heendeniya Amila , Murphy Pauline , Placido Tania , Tan Darrell H. S. , Bogoch Isaac I.
Published: February 2018

Background:

On-demand preexposure prophylaxis may reduce one's risk of HIV acquisition; however, it is unclear if individuals with a very low frequency of HIV exposures are conferred adequate protection. We evaluated a novel approach dubbed HIV postexposure prophylaxis-in-pocket (“PIP”), for individuals with a low frequency of high-risk HIV exposures.

Setting:

Two HIV clinics in Toronto, Canada, managing HIV prevention cases.

Methods:

A retrospective evaluation of patients referred to HIV clinics for preexposure prophylaxis between January 1, 2013, and September 30, 2017, inclusive. After counseling and education, selected patients were initiated on PIP if they were having very infrequent HIV exposures.

Results:

Thirty patients were prescribed PIP. Four patients (13.3%) used PIP during this study. There were no HIV seroconversions in 21.8 cumulative patient-years of PIP.

Conclusions:

PIP may be a useful HIV prevention modality for individuals with a very low frequency of HIV exposures.
Orbital Schwannoma With Atypical Presentation
Authors: Young Stephanie M. , Kim Yoon-Duck , Hwang Sung Soon , Woo Kyung In
Published: February 2018

Orbital schwannomas are characteristically slow-growing benign tumors arising from peripheral sensory nerves. However, the authors’ case illustrates the atypical presentation of such a tumor.

A 71-year-old male presented with proptosis, visual loss, and periorbital inflammation. Sequential imaging showed continuous and rapid growth of an intraconal mass arising from the medial rectus. Excision of the mass was performed and it was histopathologically proven to be an orbital schwannoma.

This patient demonstrates the atypical presentation of an orbital schwannoma, arising from an extraocular muscle with rapid progressive growth and inflammation, indicating it should be considered a differential diagnosis in orbital masses presenting as such.
Evaluation of the Characteristics and Association Between Schneiderian Membrane Thickness and Nasal Septum Deviation
Authors: Bayrak Seval , Ustaoğlu Gülbahar , Demiralp Kemal Özgür , Kurşun Çakmak Emine Şebnem
Published: February 2018

Objective:

Nasal septum deviation (NSD) is an anomaly that disturbs normal mucus drainage in sinuses, leading to recurrent sinusitis. Sinusitis, infections, and mucosal irritations are the potential causes of Schneiderian membrane thickening (SMT). The aim of this study was to evaluate the characteristics and association between NSD and SMT along with factors such as age, gender, and tooth groups using cone-beam computed tomography (CBCT) imaging.

Methods:

The maxillary sinus and nasal cavity of 249 patients (136 females and 113 males) were examined retrospectively using CBCT. The statistical analysis was performed to determine the association between SMT, NSD, gender, and age.

Results:

No statistically significant relation was detected between NSD and SMT. The NSD was found in 50.6% of patients without gender predilection. Age was not associated with the presence of NSD. The mean thickness of the membrane was least in the third molar region and highest in the first molar region. The average SMT was found to be higher in males for all the examined tooth areas (P ≤ 0.05).

Conclusion:

A retrospective evaluation of CBCT images emphasized the concept that NSD was not a factor that affected the thickening of maxillary sinus mucosa. The CBCT imaging could be used for evaluating the maxillary sinuses and nasal septum.