bluuebunny/crossref_metadata_2025 huggingface dataset:
Insulin/IGF-1 enhances intestinal epithelial crypt proliferation through PI3K/Akt, and not ERK signaling in obese humans
Authors: Zhou Weinan , Rowitz Blair M , Dailey Megan J
Published: June 2018

The intestinal epithelium is continuously regenerated through proliferation and differentiation of stem cells located in the intestinal crypts. Obesity affects this process and results in greater stem cell proliferation and altered tissue growth and function. Obesity-induced high levels of insulin and insulin-like growth factor-1 in the stem cell niche are found to impact proliferation in rodents indicating that insulin and insulin-like growth factor-1 receptors may play a role in modulating intestinal epithelial stem cell proliferation. To determine whether insulin or insulin-like growth factor-1 can induce proliferation in human intestinal epithelial stem cells, and if two downstream insulin and insulin-like growth factor-1 receptor signaling pathways, PI3K/Akt and ERK, are involved, we used primary small intestinal epithelial crypts isolated from obese humans and investigated (1) the effect of insulin or insulin-like growth factor-1 on crypt proliferation, and (2) the effect of insulin and insulin-like growth factor-1 signaling inhibitors on insulin or insulin-like growth factor-1-induced proliferation. We found that insulin and insulin-like growth factor-1 enhanced the proliferation of crypt cells, including intestinal epithelial stem cells. Inhibition of the PI3K/Akt pathway attenuated insulin and insulin-like growth factor-1-induced proliferation, but inhibition of the ERK pathway had no effect. These results suggest that the classical metabolic PI3K pathway and not the canonical proliferation ERK pathway is involved in the insulin/insulin-like growth factor-1-induced increase in crypt proliferation in obese humans, which may contribute to abnormal tissue renewal and function.

Impact statement

This study investigates if insulin or insulin-like growth factor-1 (IGF-1) induces intestinal epithelial proliferation in humans, and if insulin and IGF-1 receptor signaling is involved in this process in obesity. Although obesity-induced high levels of insulin and IGF-1 in the stem cell niche are found to impact the proliferation of intestinal epithelial stem cells in rodents, we are the first to investigate this effect in humans. We found that insulin and IGF-1 enhanced the proliferation of intestinal crypts (including stem cells and other crypt cells) isolated from obese humans, and PI3K/Akt, and not ERK signaling was involved in insulin or IGF-1-induced proliferation. The imbalance in signaling between PI3K/Akt and ERK pathways may point to a pathway-specific impairment in insulin/IGF-1 receptor signaling. We propose that this may contribute to reciprocal relationships between insulin/IGF-1 receptor resistance and intestinal epithelial proliferation that leads to abnormal tissue renewal and function.
An Exploratory Study of Washout Rate Analysis for Thallium-201 Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging Using Cadmium Zinc Telluride Detectors
Authors: Ishihara Masaru , Onoguchi Masahisa , Shibutani Takayuki
Published: June 2018

The aim of this study was to assess the washout rate (WOR) for thallium-201-chloride single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) using cadmium zinc telluride detectors for SPECT (CZT SPECT) versus conventional Anger-type SPECT (conventional SPECT). A total of 52 Japanese patients were examined using CZT SPECT and conventional SPECT, and the global WORs were compared. Additionally, the MPI WORs were compared for patients with a normal MPI versus those in whom MPI reflected the patients’ multivessel disease (MVD) MPI. Washout rates were similar when approximated by CZT SPECT versus conventional SPECT 12.59 ± 2.26%/h vs 12.57 ± 2.27%/h ( P = .997), respectively. The WOR values for CZT SPECT versus conventional SPECT were 13.42%/h (1.53%/h) vs 13.93%/h (1.24%/h) ( P = .337), respectively, for 7 normal MPI patients, and 10.64 ± 2.20%/h vs 10.84 ± 2.26%/h ( P = .848), respectively, for 7 MVD-MPI patients. The WOR values for normal MPI versus MVD-MPI patients for CZT SPECT were 13.42 ± 1.53%/h vs 10.64 ± 2.20%/h ( P = .025), respectively. Thallium-201-chloride WOR values obtained with high-efficiency CZT SPECT, which enabled significantly reduced imaging times and use of a low-dose protocol, were similar to those obtained with conventional SPECT.
Radiophobia: 7 Reasons Why Radiography Used in Spine and Posture Rehabilitation Should Not Be Feared or Avoided
Authors: Oakley Paul A. , Harrison Deed E.
Published: June 2018

Evidence-based contemporary spinal rehabilitation often requires radiography. Use of radiography (X-rays or computed tomography scans) should not be feared, avoided, or have their exposures lessened to decrease patient dose possibly jeopardizing image quality. This is because all fears of radiation exposures from medical diagnostic imaging are based on complete fabrication of health risks based on an outdated, invalid linear model that has simply been propagated for decades. We present 7 main arguments for continued use of radiography for routine use in spinal rehabilitation: (1) the linear no-threshold model for radiation risk estimates is invalid for low-dose exposures; (2) low-dose radiation enhances health via the body’s adaptive response mechanisms (ie, radiation hormesis); (3) an X-ray with low-dose radiation only induces 1 one-millionth the amount of cellular damage as compared to breathing air for a day; (4) radiography is below inescapable natural annual background radiation levels; (5) radiophobia stems from unwarranted fears and false beliefs; (6) radiography use leads to better patient outcomes; (7) the risk to benefit ratio is always beneficial for routine radiography. Radiography is a safe imaging method for routine use in patient assessment, screening, diagnosis, and biomechanical analysis and for monitoring treatment progress in daily clinical practice.
Grime: Criminal subculture or public counterculture? A critical investigation into the criminalization of Black musical subcultures in the UK
Authors: Fatsis Lambros
Published: June 2018

This article sets out to (re-)introduce Black urban musical subcultures as valuable forms of creativity and public expression in an attempt to resist, criticize and expose their criminalization by the London Metropolitan Police. Focusing primarily on grime, a host of unfair and illegitimate practices adopted by the London Metropolitan Police will be discussed. This will demonstrate how the routine monitoring, surveillance and curtailment of Black people’s public identity (re)produces stereotypical associations of Black, Asian and Minority Ethnic (BAME) groups with violent, criminal and problematic behaviour. In order to challenge openly discriminatory attitudes towards Black urban cultural forms by the police, a counterargument which calls for their understanding as viable sources of positive and constructive public engagement will be offered.
The Rise of Trump and the Death of Civility
Authors: Bybee Keith J.
Published: June 2018

According to supporters and opponents alike, Donald Trump has been an unconventional candidate and president. In this article, I evaluate the relationship between Trump’s unconventional behavior and the requirements of civility. I provide a definition of civility, and I explain why it makes sense to relate Trump’s actions to civil norms. I then discuss how civility is enacted, I examine criticisms of civility’s triviality, and I explore the ways in which civility may repress dissent and maintain hierarchy. Although I consider the degree to which Trump’s actions are strategic, I ultimately argue that Trump’s incivilities should be understood as an effort to initiate a revolution in manners. In this regard, Trump’s behavior is not unprecedented. He is participating in a longstanding American tradition of determining standards of appropriate conduct through political conflict.
Children’s human rights and diversity in schools: Framing and measuring
Authors: Osler Audrey , Solhaug Trond
Published: June 2018

We report on the development of an instrument to measure attitudes to children’s human rights and diversity in schools. It was developed to investigate perceptions of human rights and diversity among students and then teachers in two contrasting areas of Norway. The instrument draws on human rights standards articulated in the United Nations Convention on the Rights of the Child. It is intended for use in future baseline studies, allowing for transnational and comparative analysis of child rights in education. The near-universal ratification of the United Nation Convention on the Rights of the Child provides an agreed international framework for evaluating rights implementation strategies over time. We contextualise the measurement instrument, focusing on rights provision, child protection, and participation in schools. We consider its strengths and possible limitations and discuss the need for a sound human rights conceptual model through which child rights in school settings can be interpreted.
Doing adult education as tertium comparationis: Comparative research in cross-border regions at Germany’s peripheries through the lens of social spatiality
Authors: Schreiber-Barsch Silke , Bernhard-Skala Christian
Published: June 2018

Comparing places represents one of the most traditional threads of comparative inquiry. However, international and comparative (adult) education research has to date focused on comparing places more in the sense of territorial entities. In contrast, this paper moves away from understandings of national or regional territories as given, container-like units, criticised as methodological nationalism. It draws instead on theoretical approaches of social spatiality and, in particular, on Werlen’s works on action-centred geography. Findings of qualitative research on organisations providing adult education in two cross-border regions at Germany’s territorial periphery serve as an empirical framework, analysing the programme planning activities of their managerial staff. The paper argues that it is the pedagogical actions and practices of these professionals, rather than the territorial entities, that become the tertium comparationis, eliciting the professionals’ share in the overall process of (re)producing social space and, ultimately, territory.
Learning in the chaos: A political economy analysis of education in Afghanistan
Authors: Pherali Tejendra , Sahar Arif
Published: June 2018

Afghanistan is often characterised as a ‘failed’ or ‘fragile’ state in terms of state ‘functionality’, lacking in capacity to provide security and wellbeing to its citizens and failing to prevent violent conflict and terrorism. Since 2001, education has become a major victim of Afghanistan’s protracted crisis that involves international military interventions, fragile democracy and growing radicalisation. Drawing upon qualitative interviews with educational officials and practitioners in Afghanistan and critically examining the literature in education and conflict, we argue that Afghanistan’s education is caught in the nexus between deteriorating security conditions, weak governance and widespread corruption, resulting in rebel capture of educational spaces for radicalisation and violent extremism. More broadly, we contend that education faces the risk of capture for radicalisation in contexts where state fragility and fundamentalism intersect. Finally, we highlight some critical issues relating to educational programming in conflict-affected contexts.
A comparison of dart thrower’s range of motion following radioscapholunate fusion, four-corner fusion and proximal row carpectomy
Authors: Rust Philippa A. , Manojlovich Larissa M. , Wallace Robert
Published: June 2018

Dart thrower’s motion is the functional coupled movement of the wrist from radial extension to ulnar flexion. The aim of this study was to evaluate dart thrower’s motion following three surgeries: radioscapholunate fusion, four-corner fusion and proximal row carpectomy. Six fresh-frozen cadaver forearms were dissected. Sequential loading of tendons resulted in radial extension and ulnar flexion allowing dart thrower’s motion measurements at end range before and then again after each surgery. After radioscapholunate fusion, 74% of both radial extension and ulnar flexion were maintained. After four-corner fusion, radial extension decreased to 53% and ulnar flexion to 84% of control motion. Proximal row carpectomy did not statistically significantly alter radial extension, but decreased ulnar flexion to 87%. We found that dart thrower’s motion is well maintained in three of these commonly used surgical treatments. These results may aid surgeons in managing patients by providing comparative functional movement following these procedures.
Intravenous thrombolysis for acute ischemic stroke in Greece: the Safe Implementation of Thrombolysis in Stroke registry 15-year experience
Authors: Tsivgoulis Georgios , Kargiotis Odysseas , Rudolf Jobst , Komnos Apostolos , Tavernarakis Antonios , Karapanayiotides Theodoros , Ellul John , Katsanos Aristeidis H. , Giannopoulos Sotirios , Gryllia Maria , Safouris Apostolos , Papamichalis Panagiotis , Vadikolias Konstantinos , Mitsias Panayiotis , Hadjigeorgiou Georgios
Published: June 2018

Background:

Intravenous thrombolysis (IVT) remains the only approved systemic reperfusion treatment for acute ischemic stroke (AIS), however there are scarce data regarding outcomes and complications of IVT in Greece. We evaluated safety and efficacy outcomes of IVT for AIS in Greece using the Safe Implementation of Thrombolysis in Stroke: International Stroke Thrombolysis Register (SITS-ISTR) dataset.

Methods:

All AIS patients treated with IVT in Greece between December 2002 and July 2017 and recorded in the SITS-ISTR were evaluated. Demographics, risk factors, baseline stroke severity [defined using National Institutes of Health Stroke Scale (NIHSS)], and onset-to-treatment time (OTT) were recorded. Safety outcomes included symptomatic intracranial hemorrhage (sICH) and 3-month mortality rates. The efficacy outcomes evaluated a reduction in baseline NIHSS score at 2 and 24 h following IVT onset, 3-month favorable functional outcome [FFO; modified Rankin scale (mRS) scores of 0–1] and 3-month functional independence (FI; mRS-scores of 0–2). The safety and efficacy outcomes were assessed comparatively with previously published data from SITS national and international registries.

Results:

A total of 523 AIS patients were treated with IVT in 12 Greek centers participating in the SITS-ISTR during the study period (mean age 62.4 ± 12.7; 34.6% women; median baseline NIHSS score: 11 points; median OTT: 150 min). The rates of sICH were 1.4%, 2.3%, and 3.8% according to the SIST-MOST, ECASS II, and NINDS criteria respectively. The median reduction in NIHSS score at 2 and 24 h was 3 [interquartile range (IQR): 1–5] and 5 (IQR: 2–8) points respectively. The 3-month FI, FFO and mortality were 66.5%, 55.6% and 7.9%. All safety and efficacy outcomes were comparable with available data from SITS-ISTR in other European countries.

Conclusions:

Our study underscores the safety and efficacy of IVT for AIS in Greece. Additional action is necessary in order to increase the availability of IVT in the Greek population and to include more centers in the SITS-ISTR.
Occupational performance problems identified by 507 patients: An insight that can guide occupation-based hand therapy
Authors: Poulsen Helle S , Hansen Alice Ø
Published: June 2018

Introduction

Several barriers challenge the use of occupation-based interventions in hand therapy. An outpatient clinical setting can be prepared in such a way as to address the most common occupational performance problems which might promote an occupation-based intervention. To this end, more knowledge is needed about which problems patients with hand-related disorders consider most important.

Methods

Interviews using the Canadian Occupational Performance Measure (COPM)were conducted with 507 patients. Data were entered into Microsoft Excel in the COPM categories: Self-care, productivity and leisure and analysed using descriptive statistics. Data concerning main problem areas were categorized according to the Taxonomic Code of Occupational Performance (TCOP). The analysis included the number of prioritized occupational performance problems (NPOPP) in each COPM category/subcategory; the NPOPP in each category is relative to gender and age and the most frequent problems.

Results

The total NPOPP was 2384. Problems within productivity and self-care constituted the largest proportion, respectively, 46% and 40%. Gender or age affected the NPOPP in each category to a limited extend. Problems were expressed at all levels in the TCOP, except the lowest level. The most frequently expressed problem was use of utensils when eating.

Conclusion

The problems mostly concern productivity and self-care, regardless of gender or age. Patients consider problems at the levels of occupation, activities, tasks and actions to be important and meaningful to address in their intervention. This study provides useful knowledge that can be applied when preparing a setting to address the most common problems, which could lead to the promotion of occupation-based interventions.
Are Free Will Believers Nicer People? (Four Studies Suggest Not)
Authors: Crone Damien L. , Levy Neil L.
Published: June 2018

Free will is widely considered a foundational component of Western moral and legal codes, and yet current conceptions of free will are widely thought to fit uncomfortably with much research in psychology and neuroscience. Recent research investigating the consequences of laypeople’s free will beliefs (FWBs) for everyday moral behavior suggests that stronger FWBs are associated with various desirable moral characteristics (e.g., greater helpfulness, less dishonesty). These findings have sparked concern regarding the potential for moral degeneration throughout society as science promotes a view of human behavior that is widely perceived to undermine the notion of free will. We report four studies (combined N = 921) originally concerned with possible mediators and/or moderators of the abovementioned associations. Unexpectedly, we found no association between FWBs and moral behavior. Our findings suggest that the FWB–moral behavior association (and accompanying concerns regarding decreases in FWBs causing moral degeneration) may be overstated.
Relationship between DAPK methylation and gene inactivation in papillary thyroid carcinoma
Authors: Sun Dawei , Sun Wenhai , Zhou Rui , Dong Anbin , Zhang Hongmei
Published: June 2018

To investigate the relationship between the methylation of death-associated protein kinase (DAPK) promoter and gene inactivation in papillary thyroid carcinoma, the technique of methylation-specific polymerase chain reaction (PCR (MSP)) was applied to detect the methylation status of DAPK gene promoter in 70 cases of papillary thyroid carcinoma (study group) and in 50 cases of corresponding adjacent tissues (control group). Immunohistochemical method was used to detect the protein expression; besides, the relationship of DAPK methylation and gene inactivation with pathological factors of papillary thyroid cancer was analyzed. The methylation rate of DAPK was 16% (8/50) in the control group and 71.4% (50/70) in the study group with the difference being statistically significant (χ2 = 19.724, P < 0.01). The methylation of DAPK gene promoter was not associated with age, sex, tumor size, TNM stage, and thyroid capsular infiltration in the study group with papillary thyroid carcinoma ( P > 0.05), but was associated with lymph node metastasis ( P < 0.05). Spearman’s rank correlation analysis showed that the methylation of DAPK promoter was negatively correlated with the expression of DAPK (r = −0.793, P < 0.01). The methylation of CpG island in the promoter region of DAPK gene can lead to gene inactivation and may be involved in the occurrence of papillary thyroid carcinoma.
Is There a Role for Early Palliative Intervention in Frail Older Patients With a Neck of Femur Fracture?
Authors: Davies Andrew , Tilston Thomas , Walsh Katherine , Kelly Michael
Published: June 2018

Background:

Patients with a neck of femur fracture have a high mortality rate. National outcomes have improved significantly as the management of this patient group is prioritized. In 2016, however, 4398 (6.7%) patients died within 30 days of admission.

Objective:

To investigate whether palliative care could be integrated early in the care plan for high-risk patients.

Methods:

All cases of inpatient mortality following neck of femur fracture at North Bristol Major Trauma Centre over a 24-month period were reviewed. A comprehensive assessment of care was performed from the emergency department until death. All investigations, interventions, and management decisions were recorded. A consensus decision regarding expected mortality was made for each case at a multidisciplinary meeting which included surgical, orthogeriatric, nursing, and anesthetic team input.

Results:

A total of 1033 patients were admitted following a neck of femur fracture. There were 74 inpatient deaths, and 82% were considered predictable at our multidisciplinary meeting. The mean length of stay was 18 days (range: 0-85, median 14). In 42% of cases, mortality was considered predictable on admission, and 40% were considered predictable following acute deterioration. These patients received on average 28 blood tests (range: 4-114) and 6.8 X-rays and computed tomographies (range: 2-20). Of this, 66% received end-of-life care; mean duration 2.3 days (range: 0-17).

Conclusions:

Mortality rates remain high in a subset of patients. This study demonstrates that intensive investigation and medical management frequently continues until death, including in patients with predictably poor outcomes. Early palliative care input has been integrated successfully into patient management in other specialties. We demonstrate that it is feasible to identify patients with hip fracture who may benefit from this expertise.
The Content and Evolution of Practical Theories of Teaching: Experiences of Professionally Unqualified Teachers in Rural Zimbabwe Secondary Schools
Authors: Mukeredzi Tabitha Grace , Nyachowe Monica S.
Published: June 2018

Practical theories of teaching are critical for teacher effectiveness as they provide basis for their actions and choices of pedagogies, learner activities, and curriculum materials. This study explored the content of professionally unqualified practicing teachers’ practical theories and the changes that occurred as they progressed through a school-based Postgraduate Diploma in Education program. Drawing on concepts around practical theories, qualitative data generated through interviews and photo elicitation from six professionally unqualified teachers in rural Zimbabwe secondary schools were inductively analyzed. Findings indicate that content of the teachers’ practical theories gradually evolved and developed as they progressed through three stages in the program: (a) Survival or “self-concerns” where content was composed of mediocre pedagogy—relationship focus, lesson preparation and delivery, and classroom management; (b) “task-concerns,” where content constituted effective performance of teaching tasks portrayed by thorough lesson preparation, learner-centered pedagogies, student assessment, lesson evaluation, collaboration, creating conducive teaching/learning environments, and teacher enthusiasm; (c) “pupil and teacher learning concerns” with content encompassing identification and handling of student diversity, student engagement, moving students from known to unknown, self-evaluation, reflection, and research. Data further indicate individualistic and dynamic nature of practical theories through the nonuniform elements of fully developed theories after completing the program. This article illustrates that emersion in practice can promote professionally unqualified teachers’ understandings of and attendance to underlying principles of teaching/learning which enhances modification of their views of teaching and development of well-developed practical theories.
Trends in Indigenous and Non-Indigenous Multidomain Well-Being: Decomposing Persistent, Maturation, and Period Effects in Emerging Adulthood
Authors: Parker Philip D. , Bodkin-Andrews Gawaian , Parker Rhiannon B. , Biddle Nicholas
Published: June 2018

We explore whether disadvantage exists in domain-specific happiness with Indigenous youth of Australia. Data were collected from 52,270 Australians aged 15–28 years, 4% of whom were Indigenous, and came from four birth cohorts with data collected between the years 1997 and 2013. Random and fixed effects decomposed differences in well-being into persistent (present at the earliest wave and consistent over time), maturation (changes over age), and period (changes in response to a particular year) components. Results suggested that happiness differences were small to moderate but favored non-Indigenous groups. There were small, persistent differences in happiness with social and future prospects and developmental differences for happiness with life and government. Period effects were observed for happiness with the government. This research reveals that a nuanced approach to Indigenous well-being is needed including not just a multidimensional approach but also one that is sensitive of the means by which disadvantage may emerge.
Rapidly Resolving Nonalcoholic Marchiafava-Bignami Disease in the Setting of Malnourishment After Gastric Bypass Surgery
Authors: Bachar Moshe , Fatakhov Eduard , Banerjee Christopher , Todnem Nathan
Published: June 2018

Objectives. We describe a rare case of nonalcoholic Marchiafava-Bignami disease (MBD) in the setting of malnourishment after gastric bypass. Methods. A 44-year-old nonalcoholic Caucasian woman with malnutrition after gastric bypass presented with 2 weeks of weakness. The patient acutely became stuporous. Brain magnetic resonance imaging showed lesions in the corpus callosum and internal capsules consistent with MBD. After 10 days of treatment, the patient had resolution of her encephalopathy with return to baseline mental function, with radiological improvement. Results. MBD is a rare neurological disorder seen in alcoholics and can rapidly progress to coma or death. Our patient was successfully treated with a regimen typically used in alcoholics. We discuss the relevant literature supporting this regimen. Conclusions. This case demonstrates that since the pathophysiological etiology of the disease is malnutrition, MBD patients can be effectively treated with this regimen regardless of the underlying cause.
ANCA-Associated Vasculitis Co-Occurrence With Systemic Sclerosis: A Case Report of a Rare Diagnostic Dilemma
Authors: Cheta Jordana , Binder Michael , Kowalewska Jolanta , Magoon Sandeep
Published: June 2018

Systemic sclerosis (SSc) is a rare autoimmune disorder that is typically divided into limited cutaneous systemic sclerosis and diffuse cutaneous systemic sclerosis. Scleroderma renal crisis (SRC) is a severe complication of SSc and typically presents with new-onset hypertension and a reduction in renal functioning. In patients presenting with typical features of SRC, treatment with an angiotensin-converting enzyme inhibitor along with dialysis as needed is typically initiated empirically. Renal biopsy is not recommended in patients with SSc presenting with typical features of SRC. Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a rare co-occurrence with SSc, in around 2.5% to 9% of patients. AAV is an inflammatory condition that can result in renal failure due to mononuclear cell infiltration and destruction of blood vessels. Treatment of AAV is drastically different from SRC and typically consists of immunosuppressants and dialysis if needed. SRC and AAV can only reliably be distinguished by renal biopsy. We present a rare case of a 70-year-old female with limited cutaneous systemic sclerosis who presented to the emergency department with new-onset renal failure. Her serology was found to be positive for antinuclear antibodies and myeloperoxidase antibodies, resulting in a renal biopsy, which revealed an acute necrotizing vasculitis consistent with AAV. We suggest consideration of a renal biopsy in patients with SSc who present with new-onset renal failure, especially with nonresponse to SRC treatment or positive serology.
Is Edema at the Posterior Medial Tibial Plateau Indicative of a Ramp Lesion? An Examination of 307 Patients With Anterior Cruciate Ligament Reconstruction and Medial Meniscal Tears
Authors: Kumar Neil S. , Spencer Tiahna , Cote Mark P. , Arciero Robert A. , Edgar Cory
Published: June 2018

Background:

Medial meniscal tears are commonly seen during anterior cruciate ligament reconstruction (ACLR). A subset of these injuries includes posterior meniscocapsular junction or “ramp” tears. One criterion that may correlate with a ramp lesion is the presence of posterior medial tibial plateau (PMTP) edema.

Purpose:

To compare patients with ramp lesions to patients with nonramp (meniscal body) medial meniscal tears and correlate PMTP edema on preoperative magnetic resonance imaging (MRI) to the incidence of ramp tears.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

From 2006 to 2016, a total of 852 patients underwent ACLR and had operative reports available for review. Age, sex, laterality, mechanism of injury (contact/noncontact), sport, revision procedure, multiligament injury, time to MRI, and time to surgery were recorded. Preoperative MRI scans were reviewed for PMTP edema using axial, coronal, and sagittal T2 and proton-density sequences. Differences between groups were analyzed using a 2-sample t test and chi-square test. Univariate and multivariate logistic regression models examined correlations with tear type.

Results:

Overall, 307 patients had medial meniscal tears identified during ACLR (127 ramp lesions, 180 meniscal body lesions). The ramp group was 7.5 years younger than the meniscal body group ( P < .01). The groups were not different regarding sex, contact injury, revision surgery, laterality, or multiligament injury. Patients with delayed ACLR were significantly more likely to have a meniscal body tear than a ramp lesion (odds ratio, 3.3 [95% CI, 1.9-5.6]; P < .01). The sensitivity of PMTP edema for a ramp tear was 66.3%, and 54.5% of patients with ACLR and a medial meniscal tear had PMTP edema. Patients with PMTP edema were significantly more likely to have a ramp tear than a meniscal body tear (odds ratio, 2.1 [95% CI, 1.1-4.1]; P < .03).

Conclusion:

The overall incidence of ramp tears in patients undergoing ACLR was 14.9%, and these tears were more prevalent in younger patients. Meniscal body tears were significantly more likely than ramp tears with delayed ACLR. In patients undergoing ACLR with an associated medial meniscal tear, the presence of PMTP edema demonstrated significantly greater odds for ramp lesions compared with meniscal body tears.
Efficacy and Tolerability of a Dietary Supplement Containing Collagen, Hyaluronic Acid, Chondroitin Sulfate and Plasma Proteins in the Recovery After Anterior Cruciate Ligament Reconstruction
Authors: López Vidriero E , Olivé Vilas R , López Capapé D , Alonso Rodríguez J , Varela Sende L , López Vidriero R , Ramoneda Salas J
Published: June 2018

Introduction:

Arthroscopic reconstruction of the anterior cruciate ligament (ACL) is common in patients with ACL injuries. To enhance recovery after surgery, various nutritional supplements have been proposed as adjuvant treatments to physical therapy.

Objectives:

Efficacy and tolerability of a nutritional supplement containing hydrolyzed collagen, a complex of HA and CS (HC-15), and a plasma protein concentrate as adjuvant treatment to physical therapy in healing augmentation after ACL reconstruction.

Methods:

Prospective, multicenter, randomized, open-label trial including patients who underwent arthroscopic ACL reconstruction after injury. 80 patients were randomized into two groups to receive physical therapy only (control group) or combined with a nutritional supplement (composed of hydrolyzed collagen, a complex of hyaluronic acid and chondroitin sulfate, and plasma proteins) (Progen group). Efficacy assessments included a pain VAS score and the International Knee Documentation Committee (IKDC) index. Indirect measures of efficacy included analgesic consumption, the number of days to return to pre-injury activities, the number of rehabilitation sessions needed, and MRI graft maturation. The perceived efficacy and tolerability were assessed by patients and physicians.

Results:

At baseline, the demographic and clinical characteristics of both groups showed no significant differences. Both interventions showed efficacy in reducing the VAS and IKDC scores, with no significant differences between groups. Compared with patients in the control group, those in the Progen group required fewer rehabilitation sessions (mean [SD] of 48.4 [11.3] sessions vs. 38.0 [9.3] sessions; p < 0.001), thus returning earlier to their pre-injury activities. At the end of the follow-up, analgesic consumption was lower in the Progen group (8.6% of patients vs. 50.0%). According to the MRI findings, 61.8% and 38.2% of patients showed a high or complete maturation of the graft in the Progen and control groups, respectively. No serious adverse events were recorded. Both physicians and patients showed a trend towards a better perceived efficacy and tolerability in the Progen group.

Conclusion:

Adjuvant oral supplementation may increase the efficacy of physical therapy by shortening the time needed to return to pre-injury activity and the analgesic consumption. Also, MRI assessment revealed that more patients in the Progen group experienced a high or complete maturation of the graft, in line with the consistent trend observed in indirect measures of efficacy and patients’ quality of life at three months of treatment.
Proposal of a rehabilitation protocol for a Type II Mason radius head fracture following surgical intervention OSTEOSYNTHESIS with cannulated screws in an elite triathlete. Case study
Authors: Ibañez Martin LI , Ogando Berea H
Published: June 2018

A 33-year-old man suffers a radius head fracture after a bicycle fall. Surgically operation with OSTEOSYNTHESIS with two cannulated screws was performed. These fractures, can be a complication in this sport for the technical gesture necessary for the practice of swimming, which needs the recovery of the strength and the complete articular range.

Objectives:

The objective of the present work is make a proposal of a rehabilitation program focused on the recovery of joint range, strength and adaptation work to swimming.

Methods:

A systematic review of the scientific literature of the databases of Medline, PubMed, Scopus, PEDRO and SPORTDiscus was carried out.

Results:

It was designed a rehabilitation protocol specialized in elbow joint mobilization in flexo-extension and prono-supination, joint and soft-tissue manual therapy, electrotherapy and analgesic measures, muscular strengthening work (isometric, concentric and eccentric) and proprioceptive work In different joint ranges. Spine and shoulders: Manual joint and soft tissue therapy in cervical-dorsal spine, scapular and glenohumeral articulations, strengthening of the external rotator shoulder and scapular stabilizers muscles and flexibilization of the dorsal spine. Integration in technical movements: in water (Swimming technique and swimming simulation), functional work (with elastic bands), integration of the elbow movements in the lumbopelvic stabilization work and functional movements (ball launches and receptions). The program was evaluated by goniometric measurement, recordings of the technical gesture and comparative evaluation of the strength.

Conclusion:

The triathlete recovered the ROM and strength necessary to make the gesture of swimming correctly as well as the return to the competition of high level, reason why the protocol proposed can be useful.Limitation of the work: lack of research on this topic (which limits its justification).
Femoral neck stress fracture in a young female recruit: case report
Authors: Fonte Hélder , Rodrigues-Pinto Ricardo
Published: June 2018

Introduction

Stress fractures of the femoral neck are rare, representing 5% of all stress fractures, and most prevalent among runners and military recruits. Women seem to be at higher risk. Most of these fractures are undisplaced. Early diagnosis with appropriate imaging in patients with a history of groin pain during training might be crucial in detecting the fractures at early stages. The goal of this paper is to report a case of femoral neck stress fracture in a young female recruit and to highlight the importance of early suspicion of this kind of lesions in military and athlete populations, especially in females, providing the right treatment and avoiding possible complications.

Materials and Methods

A 27-year-old female, who was enrolled in military recruit, reported left groin pain after a strenuous running exercise. After one week taking NSAIDs and without relief, she presented at medical facility. Left hip active and passive range of motion was painful.The patient reported history of amenorrhea that had started a few weeks after the onset of the recruit. An X-Ray was performed, and interpreted as normal, but MRI and CT scans revealed a nondisplaced compression-type femoral neck fracture with fatigue line <50% width.

Results

Female athlete triad was not present. The patient was advised to a six-week period of non-weightbearing, using crutches and restriction from physical activity. The follow-up imaging study revealed union of the femoral neck fracture. At three months, she started light impact activities and seven months after she had no pain and no daily-life limitations.

Conclusion

Stress fractures have been described extensively in the runner as well as military recruit population.They typically involve the lower extremity. Although relatively rare, unrecognized or untreated stress fractures of the femoral neck carry amuch higher morbidity rate than other stress fractures. If X-ray is inconclusive, MRI can be useful. Treatment depends on the location and the type of fracture. It is important to keep in mind when evaluating soldiers and athletes who present with activity-related pain that stress fractures are not uncommon and should be given significant consideration.
Is suture cut-out damage reduced by the use of tape instead of thread in transtibial posterior root repair? Influence on the biomechanical properties of the meniscus-suture complex in a porcine model
Authors: Espejo-Reina A , Lombardo Torre M , Pérez de la Blanca A , Ezquerro-Juanco F , Prado-Novoa M , Dalla Rosa-Nogales J , Espejo-Reina MJ , Espejo-Baena A
Published: June 2018

Objectives:

To assess the influence of suture shape, tape or thread, in the development of suture cut-out damage by modifying the contact area at the tissue-suture interface in transtibial repair of the posterior meniscal root, and to analyze its relation with the initial biomechanical properties of the meniscus-suture complex.

Methods:

Twenty medial porcine menisci were randomized in two groups depending on the suture shape: thread or tape. The sutured menisci were first subjected to 1000 cycles of [10,30]N load at 0.5 Hz; stiffness, residual displacement and displacement at 30 N were computed. Following this, load-to-failure testing was conducted at 0.5mm/s and stiffness, ultimate failure load and displacement were determined. During tests, the tissue-suture interface was recorded using a high-resolution camera.

Results:

In cyclic tests, cut-out progression at suture insertion points was not observed for any specimen of either group and no differences were found between groups for any parameter. In load-to-failure test, all specimens failed by suture cut-out and suture tape had a greater ultimate load (221.61(sd=43.77)N vs 291.58(sd=78.98)N, p=0.03) with no other differences.

Conclusions:

In a porcine model simulating a repaired posterior meniscal root, there is no evidence of suture cut-out progression using thread or tape of the same material until high loading levels close to the ultimate load. Accordingly, the larger meniscus-suture contact area of tape compared to thread does not reduce displacements under cyclic loads representative of current rehabilitation protocols in the early postoperative period but increases resistance to tissue cut-through during load-to-failure, producing a higher ultimate load.
Urban configurations of carbon neutrality: Insights from the Carbon Neutral Cities Alliance
Authors: Tozer Laura , Klenk Nicole
Published: June 2018

This paper examines configurations of carbon neutrality in the building and energy sector as expressed in the urban governance documents of the members of the Carbon Neutral Cities Alliance (CNCA). ‘Carbon neutrality’ is a mutable idea, which makes it unclear what kinds of future urban systems are imagined. As self-identified pioneers of deep decarbonization, the CNCA members are constructing ideas about what carbon neutral means and how urban systems should be changed to reduce greenhouse gas emissions. In this paper, climate governance policy documents provide a window to understand how these carbon neutral imaginaries are being constructed. The analysis draws on discourse analysis and textual network analysis to unpack the sociotechnical configurations that are planned to be mobilized to constitute carbon neutral built environments. Concept map visualizations are used to scrutinize planned configurations of objects (e.g. solar photovoltaics, district energy and energy efficiency technology) and policy instruments (e.g. energy use benchmarking and urban planning tools). The analysis shows three key building and energy configurations: (1) The District Energy City, (2) The Zero Net Energy City and (3) The Natural Gas Transition City. Furthermore, the findings demonstrate that urban imaginaries of carbon neutrality are incorporating complex configurations of socio-technical objects while, at the same time, distinct socio-technical configurations are being favoured in individual places. These configurations inform socio-technical imaginaries that will continue to drive policy outcomes over time.
Unintended consequences of quality improvement programs on the prevention of hospital-acquired conditions: Avoiding the temptation to bite into low-hanging fruit
Authors: Padula William V , Davidson Patricia M , Jackson Debra , Pedreira Rachel , Pronovost Peter J
Published: June 2018

Hospital-acquired conditions such as pressure injuries, falls, and infections are common, costly, and deadly. Addressing the simultaneous needs of evidence-based prevention guidelines for multiple conditions can be challenging for clinical teams. Current payment incentives created by The Centers for Medicare and Medicaid Services using the Agency for Healthcare Research and Quality Patient Safety Indicator 90 (PSI90) measure impact how clinical resources are allocated by prioritizing conditions that are simpler and less costly to prevent. Pressure injury prevention guidelines may be one of the more complex programs for hospitals to implement due to the financial investment in nursing time and technology. However, a quality improvement program focused around pressure injury prevention holds good value by tackling many of the tangential conditions caused by issues related to the decubitus patient and mobility, including fall injury, venous thromboembolism, catheter-associated urinary tract infection, and sepsis. Hospitals should reconsider their prioritization of different patient safety indicators, and The Centers for Medicare and Medicaid Services should create more focused payment incentives on harmful hospital-acquired conditions such as pressure injury that are independent of composite measures of harm, including PSI90.
Case study: Reducing preventable maternal mortality in Rwandan healthcare facilities through improvements in WASH protocols
Authors: Guzman Andrea
Published: June 2018

Problem

A lack of proper water, sanitation, and hygiene (WASH) infrastructure and poor hygiene practices reduce the preparedness and response of health care facilities (HCFs) in low-income countries to infection and disease outbreaks. According to a World Bank Service Provision Assessment conducted in 2007, only 28% of HCFs in Rwanda had water access throughout the year supplied by tap and 58% of HCFs provided functioning latrines. 1 This evaluation of services and infrastructure in HCFs in Rwanda indicates that targets for WASH in-country need to be enhanced.

Objectives

To present a case study of the causes and management of sepsis during delivery that led to the death of a 27-year-old woman, and propose a WASH protocol to be implemented in HCFs in Rwanda.

Methods

The state of WASH services used by staff, caregivers, and patients in HCFs was assessed in 2009 in national evaluations conducted by the Ministry of Infrastructure of Rwanda. Site selection was purposive, based on the presence of both water and power supply. Direct observation was used to assess water treatment, presence and condition of sanitation facilities and sterile equipment in the delivery room, provision of soap and water, gloves, alcohol-based hand rub, and WASH-related record keeping.

Results

All healthcare facilities met Ministry policies for water access, but WHO guidelines for environmental standards, including for water quality, were not fully satisfied.

Conclusions

The promotion and provision of low-cost technologies that enable improved WASH practices could help to reduce high rates of morbidity and mortality due to infection in low-income countries.
CK1α and IRF4 are essential and independent effectors of immunomodulatory drugs in primary effusion lymphoma
Authors: Patil Ajinkya , Manzano Mark , Gottwein Eva
Published: June 2018

Key Points

CK1α is essential for the survival of PEL cell lines, and its degradation mediates toxicity of IMiDs. Loss of IRF4 expression is a CK1α-, IKZF1-, and IKZF3-independent arm of IMiD toxicity in PEL cell lines.
Structural aspects of plasticity in the nervous system of Drosophila
Authors: Sugie Atsushi , Marchetti Giovanni , Tavosanis Gaia
Published: June 2018

Neurons extend and retract dynamically their neurites during development to form complex morphologies and to reach out to their appropriate synaptic partners. Their capacity to undergo structural rearrangements is in part maintained during adult life when it supports the animal’s ability to adapt to a changing environment or to form lasting memories. Nonetheless, the signals triggering structural plasticity and the mechanisms that support it are not yet fully understood at the molecular level. Here, we focus on the nervous system of the fruit fly to ask to which extent activity modulates neuronal morphology and connectivity during development. Further, we summarize the evidence indicating that the adult nervous system of flies retains some capacity for structural plasticity at the synaptic or circuit level. For simplicity, we selected examples mostly derived from studies on the visual system and on the mushroom body, two regions of the fly brain with extensively studied neuroanatomy.