bluuebunny/crossref_metadata_2025 huggingface dataset:
Knee Chondrolysis by Infusion of Bupivacaine With Epinephrine Through an Intra-Articular Pain Pump Catheter After Arthroscopic ACL Reconstruction
Authors: Buchko Jordan Z. , Gurney-Dunlop Tanner , Shin Jason J.
Published: November 2014

Background:

Postoperative knee chondrolysis caused by continuous intra-articular pain pumps infusing bupivacaine with epinephrine is a rare but serious complication.

Purpose:

To determine the association between postoperative intra-articular infusion of bupivacaine with epinephrine and the development of knee chondrolysis in patients who have undergone arthroscopic anterior cruciate ligament reconstruction (ACLR). The authors hypothesized that the development of knee chondrolysis after ACLR is associated with postoperative high-dose intra-articular bupivacaine with epinephrine infusion.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

In this retrospective cohort study, the charts of all patients treated with arthroscopic ACLR by a single surgeon between January 1, 2004, and December 31, 2006, were reviewed. Patients with severe articular cartilage damage at the time of the index procedure, with known knee joint infection, inflammatory arthritis, multiligament knee injury, bilateral knee injury, or any previous knee surgery, were excluded. Patients were grouped into 2 cohorts: the exposure group (those who had postoperative infusion of bupivacaine with epinephrine via an intra-articular pain pump [IAPP]) and the nonexposure group (those without postoperative infusion).

Results:

A total of 105 patients met the inclusion and exclusion criteria. There were 57 male and 48 female patients with a mean age at surgery of 25.5 ± 8.6 years (range, 13-52 years). The exposure group consisted of 46 patients and the control group of 59 patients. Thirteen of 46 patients (28.3%) who received an IAPP developed chondrolysis. There were no cases of chondrolysis in the control group. Of those in the exposure group, 32 patients were exposed to 0.5% bupivacaine with epinephrine and 12 developed chondrolysis (37.5%), while 14 patients were exposed to 0.25% bupivacaine with epinephrine and 1 developed chondrolysis (7.1%). Patients exposed to 0.5% bupivacaine with epinephrine had a significantly higher incidence of chondrolysis compared with those exposed to 0.25% ( P = .03). Patients with chondrolysis had severe pain and limitations in daily activity.

Conclusion:

The development of knee chondrolysis was associated with the intra-articular infusion of bupivacaine with epinephrine postoperatively. Furthermore, the presented evidence suggests that this occurs in a dose-dependent manner. The risk of knee chondrolysis might be reduced by avoidance of intra-articular infusion of bupivacaine with epinephrine. We recommend against continuous intra-articular infusion of local anesthetic postoperatively.
Effect of Distal Ulnar Collateral Ligament Tear Pattern on Contact Forces and Valgus Stability in the Posteromedial Compartment of the Elbow
Authors: Hassan Sheref E. , Parks Brent G. , Douoguih Wiemi A. , Osbahr Daryl C.
Published: November 2014

Background:

It is not known whether the pattern of ulnar collateral ligament (UCL) tear affects elbow biomechanics.

Hypothesis:

There will be a significant change in elbow biomechanics with 50% proximal but not 50% distal simulated rupture of the UCL.

Study Design:

Controlled laboratory study.

Methods:

Pressure sensors in the posteromedial elbow joint of 25 male cadaveric elbows (average age, 54.9 years; range, 26-66 years) were used to measure contact area, pressure, and valgus torque at 90° and 30° of elbow flexion. Thirteen specimens were tested with the UCL intact, then with proximal-to-distal detachment of 50%, and then with proximal-to-distal detachment of 100% of the anterior band of the UCL from the ulnar attachment. This method was repeated in the remaining 12 specimens in a distal-to-proximal direction.

Results:

With 50% proximal-to-distal detachment, contact area decreased significantly versus intact at 90° (91.3 ± 23.6 vs 112.2 ± 26.0 mm2; P < .001) and 30° (69.3 ± 14.8 vs 83.1 ± 21.6 mm2; P < .001) of elbow flexion; the center of pressure (COP) moved significantly proximally versus intact at 90° (3.8 ± 2.5 vs 5.4 ± 2.3 mm; P < .001) and 30° (5.9 ± 2.8 vs 7.4±1.9 mm; P < .001). With 50% distal-to-proximal UCL detachment versus intact, no significant change was observed in contact area, movement of the COP, or valgus laxity at either flexion position. With 100% proximal-to-distal and distal-to-proximal detachment, significant change in contact area, movement of the COP, and valgus laxity versus intact was found at 90° and 30° of elbow flexion ( P < .05). No significant difference in contact pressure was observed in any test conditions.

Conclusion:

Significant change in contact area and proximal movement of the COP with 50% proximal UCL detachment and the lack of significant change with 50% distal UCL detachment suggest that the proximal half of the UCL ulnar footprint has a primary role in maintaining posteromedial elbow biomechanics.

Clinical Relevance:

The findings suggest that surgical reconstruction should aim to reestablish at least the proximal 50% of the UCL ulnar footprint.
Production d’identités et modes d’engagement dans les débats médiatiques sur la migration en Europe: Le cas de la Roumanie
Authors: Beciu Camelia , Lazar Mirela
Published: November 2014

One structuring aspect of today’s media culture targets the way the media act both as agents and as instruments of identity construction. Taking a socio-discursive approach to the public space, this article demonstrates the media’s auctorial activity in terms of the production of identity and engagement modes. Analysis of Romanian political talk-shows on labor migration in European countries reveals the substitute function of the journalist for political decision-making when it comes to resolving this public problem. These emerging practices exposing political responsibility build on journalists’ auctorial identities, which break down into prescriptive positions. Hence the instrumentalization of the migration problem and its actors through essentialist mechanisms of inclusion and a rhetoric of identity underpinned by a neoliberal agenda.
Sociotechnical Transitions and Urban Planning
Authors: Boyer Robert
Published: November 2014

The sociotechnical transitions framework describes how novel practice emerges from marginal “niche” contexts to the mainstream. Scholars of various fields have used sociotechnical transitions to explain processes of structural change for sustainability, yet little research examines the role of local plans or planners in transition processes. The author offers an in-depth case study following the evolution of an eco-cohousing model from its grassroots origins to its current application in the housing market of Ithaca, New York. Planners used existing planning documents to translate innovative practices to the public, defying assumptions of the rational-linear model still common in planning scholarship.
Damage Control Resuscitation
Authors: Bogert James N. , Harvin John A. , Cotton Bryan A.
Published: November 2014

Resuscitation of the hemorrhaging patient has undergone significant changes in the last decade resulting in the concept of damage control resuscitation (DCR). Hemostatic resuscitation aims to address the physiologic derangements found in the hemorrhaging patient, namely coagulopathy, acidosis, and hypothermia. Strategies to achieve this are permissive hypotension, high ratio of plasma and platelet transfusion to packed red blood cell transfusion, and limitation of crystalloid administration. Damage control surgery aims for early hemorrhage control and minimizing operative time by delaying definitive repair until the patient’s physiologic status has normalized. Together these strategies constitute DCR and have led to improved outcomes for hemorrhaging patients over the last 2 decades. Recently, DCR has been augmented by both pharmacologic and laboratory adjuncts to improve the care of the hemorrhaging patient. These include thrombelastography as a detailed measure of the clotting cascade, tranexamic acid as an antifibrinolytic, and the procoagulant activated factor VII. In this review, we discuss the strategies that makeup DCR, their adjuncts, and how they fit into the care of the hemorrhaging patient.
Barriers to Increasing Donor Support
Authors: Faulkner Margaret , Truong Oanh , Romaniuk Jenni
Published: November 2014

This study examines individuals’ refusal to support, or rejection, of charity brands. Drawing from an online survey of 490 Australian respondents, we find a low incidence of charity rejection. At brand level, the average rejection is 3%, with Greenpeace (19%) and World Vision (9%) showing the highest levels of rejection. The majority of respondents (71%) did not reject any of the 29 charity brands listed. The results show that for any specific charity, rejection is rare and that non-awareness levels are 14 times higher than rejection levels. This has important strategic implications for recruiting supporters, with non-awareness providing greater explanation of non-support than rejection. Charities should focus on raising knowledge and salience of the charity brand rather than trying to negate objections.
Effect of external magnetic field on weld pool flow conditions in high-speed gas metal arc welding
Authors: Wu CS , Yang Fengzhao , Gao Jinqiang
Published: November 2014

In high-speed gas metal arc welding process, weld defects like humping bead and undercutting appear and the weld bead quality worsens when welding speed exceeds a critical value. The previous investigations have proved that the backward flowing molten jet with high momentum in the weld pool is responsible for the formation of humping bead in high-speed gas metal arc welding. In this study, an external electromagnetic field generator is developed to change and control the flow condition in the weld pool and suppress the occurrence tendency of the humping bead. Bead-on-plate welding experiments are performed on mild steel Q235 test-pieces, and the influences of the exerted magnetic strength on the arc behavior, the fluid flow inside the weld pool, the weld bead shape and the weld penetration and width are investigated. The reason why the external electromagnetic field can suppress the humping bead is explained. The results show that external magnetic field can remarkably adjust the weld pool fluid flow field and decrease the momentum of the backward flowing molten jet. Therefore, weld defects like humping bead and undercutting can be effectively suppressed, the quality of weld bead is remarkably improved, and the critical welding speed is notably increased.
Dynamic performances analysis of hybrid press based on dependent generalized coordinates
Authors: Gong Jinliang , Wang Xiaoming , Huang Fengan , Zhang Yanfei
Published: November 2014

A kind of multi-link hybrid press mechanism is brought forth. It adopts three motors as actuations to fulfill the single degree of freedom output of end effector. For hybrid press mechanism, the forward kinematics is usually complicated and its numerical solution is computation-intensive and time-consuming. Therefore, the dynamic model is difficult to build up when it needs to analyze the input function’s effect on system dynamic performances. Concept of dependent generalized coordinates is adpoted here and a kind of dynamic modeling method of multi-link hybrid mechanism is presented based on the virtual work principle. The linear and angular displacements of every component can be expressed concisely in the form of dependent generalized coordinates. They are much simpler than that of independent generalized coordinates. Accordingly, linear and angular velocities will be derived by differentiating with respect to displacements. Velocity Jacobian matrix will be simplified under dependent generalized coordinates system and the virtual work principle-based dynamic model will also be simplified accordingly. Then it needs to introduce constraint conditions and multiplier in order to acquire actuation forces. Introduction of the constraints guarantees the real kinetic characteristics of mechanism. In the end, the curves of actuation forces and spherical joints’ inner forces variations are presented using Matlab. By comparing with Adams simulation results, validity of the method has been proved.
Simplified electromagnetic actuation system for three dimensional locomotive and drilling microrobot
Authors: Choi Hyunchul , Jeong Semi , Lee Cheong , Go Gwangjun , Zhen Jin , Ko Seong Young , Park Jong-oh , Park Sukho
Published: November 2014

Many researchers have studied and developed various types of medical microrobots using an external electromagnetic field and a permanent magnet. Most microrobots are very small and remotely controlled. Their medical applications include minimally invasive surgery (MIS), capsule endoscopy, drug delivery system (DDS), and cell based therapy. Two-dimensional (2D) or 3D locomotion of microrobots using different electromagnetic actuation (EMA) systems has been studied. In this paper, we propose a simplified EMA system having the same functions as our previous proposed EMA system. Because the simplified EMA system has a smaller coils structure, it consumes less power than the previous EMA system. First, through basic locomotive tests, we demonstrate that the microrobot using the proposed EMA system can move along a desired path in 2D and 3D space. Second, a drilling performance test was carried out on the microrobot. Finally, through quantitative comparison, it was verified that the proposed EMA system consumed 58% less power than the previous EMA system.
Integrated vehicle mass estimation for vehicle safety control using the recursive least-squares method and adaptation laws
Authors: Kim Daeil , Choi Seibum B. , Choi Mooryong
Published: November 2014

The purpose of this study is to estimate the vehicle mass for vehicle safety control. The vehicle mass is considered to be a constant parameter for some vehicle safety control systems, but it changes according to the number of the passengers or the load weight that the vehicle carries. This paper suggests an integrated vehicle mass estimation algorithm using the recursive least-squares method and adaptation laws. First, the vehicle mass is estimated from the longitudinal dynamics using the recursive least-squares method. Second, three kinds of estimation algorithm are suggested from the roll dynamics. Two of the algorithms are designed using the adaptation law from a Lyapunov stability analysis and the roll angle observer, and the last algorithm is designed using the recursive least-squares method. Finally, the multiple-observer synthesis integrates the estimated mass values calculated using the longitudinal dynamics and the roll dynamics. The proposed vehicle mass estimation algorithm is evaluated via simulation using CarSim and via experimentation using a test vehicle.
Study of regulated emissions and nanoparticle characteristics of light-duty direct-injection vehicles fuelled with gasoline and liquefied petroleum gas in the New European Driving Cycle and the Federal Test Procedure 75 driving cycle
Authors: Jang Wonwook , Ko Ahyun , Baek Sungha , Jin Dongyoung , Choi Kwanhee , Myung Cha-Lee , Park Simsoo
Published: November 2014

This study evaluated the pollutants and nanoparticles, the fuel economy and the levels of carbon dioxide emissions of vehicles equipped with a 1.6 l direct-injection spark ignition engine fuelled by gasoline or by liquefied petroleum gas. The nanoparticles were analysed using a particle measurement system that is used in Europe for regulatory purposes. A fast-response particle size and number spectrometer (model DMS500) were used to characterize the size-resolved particle distributions. The vehicle was tested on a chassis dynamometer for the New European Driving Cycle and Federal Test Procedure 75 in its factory default state (gasoline version) and modified state (for liquefied petroleum gas fuel), and the results were compared. The liquefied-petroleum-gas direct-injection vehicle emitted significantly lower levels of total hydrocarbons than did the gasoline direct-injection vehicle. However, the levels of nitrogen oxide emissions from the liquefied-petroleum-gas direct-injection vehicle were equivalent to those from the gasoline direct-injection vehicle. Because of the higher combustion and exhaust temperatures and relatively higher loads imposed during the driving cycles, the liquefied-petroleum-gas direct-injection vehicle showed a slightly higher level of nitrogen oxide emissions. The particle emissions from the vehicles were mainly affected by the vehicle driving conditions of the test driving cycles. In particular, the particle emissions from the vehicle were pronounced in the cold-start and accelerating phases of the emission certification standards. The nanoparticles from the liquefied-petroleum-gas direct-injection vehicle were significantly fewer in number, exhibiting a reduction of over 99%.
A novel method to assess primary stability of press-fit acetabular cups
Authors: Crosnier Emilie A , Keogh Patrick S , Miles Anthony W
Published: November 2014

Initial stability is an essential prerequisite to achieve osseointegration of press-fit acetabular cups in total hip replacements. Most in vitro methods that assess cup stability do not reproduce physiological loading conditions and use simplified acetabular models with a spherical cavity. The aim of this study was to investigate the effect of bone density and acetabular geometry on cup stability using a novel method for measuring acetabular cup micromotion. A press-fit cup was inserted into Sawbones® foam blocks having different densities to simulate normal and osteoporotic bone variations and different acetabular geometries. The stability of the cup was assessed in two ways: (a) measurement of micromotion of the cup in 6 degrees of freedom under physiological loading and (b) uniaxial push-out tests. The results indicate that changes in bone substrate density and acetabular geometry affect the stability of press-fit acetabular cups. They also suggest that cups implanted into weaker, for example, osteoporotic, bone are subjected to higher levels of micromotion and are therefore more prone to loosening. The decrease in stability of the cup in the physiological model suggests that using simplified spherical cavities to model the acetabulum over-estimates the initial stability of press-fit cups. This novel testing method should provide the basis for a more representative protocol for future pre-clinical evaluation of new acetabular cup designs.
Roman and Pontic Intelligence Strategies: Politics and War in the Time of Mithradates VI
Authors: Ñaco del Hoyo Toni
Published: November 2014

This paper deals with the political and military use of confidential information gathered on behalf of the Roman Republic and the kingdom of Pontus during the reign of King Mithradates VI ( c.120–63 bc). Unlike the Roman Empire, when spies worked for well-organized intelligence agencies, in this period the available sources mention several other methods of gathering sensitive information which served such secretive purposes as well. This paper explores non-professional intelligence strategies employed in ancient politics and war at a time of extreme political and military turmoil.
British Blacklists in Spain during the First World War: The Spanish Case Study as a Belligerent Battlefield
Authors: García Sanz Carolina
Published: November 2014

This article deals with the implementation of British blacklists in Spain, leading to a case study not widely seen before in the international historiography of the First World War. It shows how British intervention in the southern and eastern Spanish markets set a de facto model for the operation of the embargo system. Under the strong stimulus of economic nationalism, the British actions regarding the commercial vetoes were tested against Spanish local interests during the short war (1914–15). The initiative was supposedly fuelled by a sense of revenge against pre-war Germany’s commercial progress as well as the desire to control a very appetizing market share, for the British and French alike. In a climate of inter-Allied commercial rivalry, this study focuses on the key role played by members of the consular service. It explains the spurious motivations that in many cases underlay the practical implementation of the blockade from below, and analyses how partisan procedures which lacked homogenized and clarified criteria for collecting and applying commercial intelligence challenged British strategies and the inter-Allied united front in Spain until well into 1917.
Studies on Mounted Warfare in Asia I: Continuity and Change in Middle Eastern Warfare, c. ce 550–1350 – What Happened to the Horse Archer?
Authors: Alofs Eduard
Published: November 2014

In this article the author rejects the common model for the description of pre-modern warfare as a constant process of technological advances, and argues that both the sources and the pictorial and archaeological record seem to show that, during the period and in the region under consideration, warfare remained essentially unchanged. He postulates the existence of two military traditions, the ‘Turanian’ tradition of the pastoral nomads of Inner Asia and the ‘Iranian’ tradition of sedentary populations under the nomad influence.
Book Review: Ranganathan, C.V. and Kumar, Sanjeev (Eds), The 18th National Congress of the Communist Party of China: A Major Turning Point for China
Authors: Kondapalli Srikanth
Published: November 2014

Ranganathan, C.V. and Kumar, Sanjeev (Eds), The 18th National Congress of the Communist Party of China: A Major Turning Point for China (New Delhi: Indian Council of World Affairs and Pentagon Press, 2013). Pp. xiv + 341, Price ₹ 1,295.
The Elizabeth Wisner Social Welfare Research Center for Families and Children at Tulane University
Authors: Moon Katie Lauve , Buttell Frederick
Published: November 2014

The Elizabeth Wisner Social Welfare Center for Families and Children is a community-based research center within the School of Social Work at the Tulane University. The Wisner Center primarily supports research projects that examine the causes and consequences of intimate partner violence, promote the development of new frameworks for understanding family violence, and utilize findings from research to inform interventions directed at reducing violence in families and communities. This article describes the history, structure, and funding resources of the Wisner Center and offers an overview of affiliated research projects and publications. Finally, this article illustrates the vital role of the Wisner Center in promoting the research agendas of junior faculty competing for funding within the Tulane University’s decentralized management center model.
Comparison of Two Fixation Methods for Arthrodesis of the Calcaneocuboid Joint
Authors: Milshteyn Michael A. , Dwyer Mark , Andrecovich Christopher , Bir Cynthia , Needleman Richard L.
Published: November 2014

Background:

The traditional fixation for a calcaneocuboid (CC) arthrodesis in triple arthrodesis is with a 6.5-mm cancellous screw. This procedure can be technically challenging. Fixation with a locking compression plate (LCP) may be easier to perform while achieving compression perpendicular to the fusion site. The purpose of this study was to compare the load to failure and the stiffness for each fixation method.

Methods:

Five matched-pair cadaver feet had an arthrodesis of the CC joint. For each matched pair, one was fixed with a screw and the other with an LCP. Surface bead markers were applied. Each specimen was then secured to a material testing machine through the calcaneus. The plantar surface of the cuboid faced the hydraulic ram to simulate weightbearing. A force was applied while the specimen was recorded with a high-resolution camera. The endpoint was maximal force at 2-mm separation between the calcaneus and cuboid measured along a horizontal axis.

Results:

The average force to failure and the average stiffness in the screw group were significantly less than the LCP group ( P < .05). The screw construct failed in pullout from the cuboid; the LCP construct failed by plastic deformation of the plate.

Conclusion:

Calcaneocuboid joint fixation with the LCP withstood a higher load until failure and demonstrated greater stiffness than with a 6.5-mm cancellous lag screw.

Clinical Relevance:

The use of LCP fixation can be considered as an alternative to oblique lag screw fixation for CC arthrodesis in a triple arthrodesis. It remains to be determined if LCP fixation leads to better clinical outcomes.
Operative Treatment of Primary Hyperparathyroidism in Daycare Surgery
Authors: Dulfer R. R. , van Ginhoven T. M. , Geilvoet W. , de Herder W. W. , van Eijck C. H. J.
Published: November 2014

Objective:

The standard of care for primary hyperparathyroidism is surgical removal of hyperfunctional parathyroid tissue. Here, we describe 20 patients with primary hyperparathyroidism who were treated surgically in the setting of daycare surgery.

Design:

Prospective observational study.

Methods:

A total of 20 patients with primary hyperparathyroidism were operated between March 2005 and May 2010. The follow-up period had a median of 41 weeks (5–245 weeks). Results are presented as mean (± standard deviation) or median (minimum–maximum).

Results:

A total of 20 patients (15 women, mean age 54 ± 14 years) were included. Nine patients were provided with post-operative calcium supplementation. One of the patients visited the emergency department the next day with paresthesia and normocalcemia; this patient was sent home. Four patients, without prophylaxis, also reported themselves to the emergency department. Only one had mild hypocalcemia (2.09 mmol/L) and was supplemented. Comparing the emergency department group (n = 5) with the others, we found that pre-operative calcium levels were similar (p = 0.40); however, the emergency department group had significantly lower post-operative calcium levels (2.27 ± 0.14 vs 2.55 ± 0.25, p = 0.008) and the decrease-percentage was significantly higher (17.5% ± 5.4% vs 10.5% ± 6.4%, p = 0.21).

Conclusion:

Parathyroidectomy in the daycare setting is feasible and safe. However, many patients return to the emergency department. This could be related to the strict information that is provided or due to a large decrease in their calcium levels, albeit normocalcemia. Calcium supplementation is cheap and safe, so we will provide all future patients with calcium supplementation and herewith aim to reduce the amount of emergency department visits.
An approach of optimal designing of nonwoven air filter media: Effect of fibre fineness
Authors: Pradhan Arun Kumar , Das Dipayan , Chattopadhyay R , Singh Sidh Nath
Published: November 2014

This article reports on an optimal design of nonwoven air filter media produced from fibres of different finenesses. A series of nonwoven filter media was prepared from polypropylene fibres of three different finenesses. The entire media were evaluated for filtration efficiency and pressure drop. A three-component augmented simplex lattice design was used for media preparation, and response surface methodology was employed for data analysis. A set of expressions was obtained for predicting the filtration efficiency and pressure drop of nonwoven filter media as a function of fibre composition. The composition in the media was optimized by desirability function approach to achieve maximum filtration efficiency and minimum pressure drop simultaneously.
Paretic Propulsion and Trailing Limb Angle Are Key Determinants of Long-Distance Walking Function After Stroke
Authors: Awad Louis N. , Binder-Macleod Stuart A. , Pohlig Ryan T. , Reisman Darcy S.
Published: November 2014

Background. Elucidation of the relative importance of commonly targeted biomechanical variables to poststroke long-distance walking function would facilitate optimal intervention design. Objectives. To determine the relative contribution of variables from 3 biomechanical constructs to poststroke long-distance walking function and identify the biomechanical changes underlying posttraining improvements in long-distance walking function. Methods. Forty-four individuals >6 months after stroke participated in this study. A subset of these subjects (n = 31) underwent 12 weeks of high-intensity locomotor training. Cross-sectional (pretraining) and longitudinal (posttraining change) regression quantified the relationships between poststroke long-distance walking function, as measured via the 6-Minute Walk Test (6MWT), and walking biomechanics. Biomechanical variables were organized into stance phase (paretic propulsion and trailing limb angle), swing phase (paretic ankle dorsiflexion and knee flexion), and symmetry (step length and swing time) constructs. Results. Pretraining, all variables correlated with 6MWT distance ( rs = .39 to .75, Ps < .05); however, only propulsion (Prop) and trailing limb angle (TLA) independently predicted 6MWT distance, R2 = .655, F(6, 36) = 11.38, P < .001. Interestingly, only ΔProp predicted Δ6MWT; however, pretraining Prop, pretraining TLA, and ΔTLA moderated this relationship (moderation model R2s = .383, .468, .289, respectively). Conclusions. The paretic limb’s ability to generate propulsion during walking is a critical determinant of long-distance walking function after stroke. This finding supports the development of poststroke interventions that target deficits in propulsion and trailing limb angle.
Intranasal Glucagon
Authors: Pontiroli Antonio E.
Published: November 2014

Prevention of diabetic complications is mainly obtained through optimal control of blood glucose levels. With hypoglycemic drugs like beta-cell stimulating drugs and especially insulin, the limit to treatment is represented by hypoglycemia, a life-threatening occurrence that is dangerous itself and can induce fear of other episodes. Glucagon, injected subcutaneously (SC) or intramuscularly (IM), is the treatment of choice for severe hypoglycemia outside of the hospital setting. However, due to practical aspects such as preparation of solutions for administration and injection by untrained persons, there are obstacles to its routine use. This review focuses on the current status of alternative routes of administration of peptide hormones, and in particular the intranasal (IN) route of glucagon, as a promising approach for the treatment of severe hypoglycemia.
Are You Ready for More Insulin Concentrations?
Authors: Segal Alissa R. , El Sayed Nuha
Published: November 2014

Practitioners need to prepare for a rapid expansion of new concentrated insulins. For many years, the treatment regimens for patients have been limited to 2 concentrations (100 units/mL and 500 units/mL), which pose challenges to both patients and providers. As the new concentrated insulins are at various stages of development, this manuscript reviews the available information on the new concentrated products. This information was obtained from publications, poster presentations, abstracts, and the manufacturers for the products in earlier stages of development. To have a basis for comparison, it is important to understand the activity profile and the challenges with use of the currently available concentrated insulin, regular insulin 500 units/mL (U500R). We also examine how the newer products may assist clinicians and patients with the difficulties faced with the use of U500R.
Perceived Accuracy in Continuous Glucose Monitoring
Authors: Polonsky William H. , Hessler Danielle
Published: November 2014

In terms of accuracy and reliability, the technology of real-time (RT) continuous glucose monitoring (CGM) is advancing quickly. Still, current devices are imperfect; as a result, patient complaints and frustrations are not uncommon. How do patients’ perceptions of device accuracy affect their experience with RT-CGM? In this article, we argue that patients’ satisfaction, or dissatisfaction, with accuracy has a major impact on how much they are likely to trust the device and how confident they may feel in using the information that is displayed. The available data suggest that greater satisfaction with accuracy is linked to better RT-CGM adherence, more confident and aggressive insulin adjustments, improvements in quality of life, reduced reliance on self-monitoring of blood glucose, and—potentially—less alarm fatigue. As the technology continues to mature, RT-CGM will become increasingly accurate and patients’ confidence and trust in the available devices will likely grow, leading to greater uptake and more proactive use of RT-CGM.
Reducing the rates of prescribing high-dose antipsychotics and polypharmacy on psychiatric inpatient and intensive care units: results of a 6-year quality improvement programme
Authors: Mace Shubhra , Taylor David
Published: November 2014

Background:

There is no conclusive evidence that either high doses or combinations of antipsychotics are more effective than standard doses or monotherapy alone. Nonetheless, prescription of both remains prevalent in the UK. In 2006 the South London and Maudsley NHS Foundation Trust (SLAM) participated in a national survey of prescription of antipsychotic medications, organized by the Prescribing Observatory for Mental Health. Over half of the patients on SLAM inpatient or psychiatric intensive care units were prescribed a high-dose antipsychotic or a combination of antipsychotics. Prescribing high-dose antipsychotics and polypharmacy in SLAM was found to be among the highest in the UK.

Aim:

To assess the impact of a 6-year quality improvement programme aimed at reducing the rates of prescribing high-dose antipsychotics and polypharmacy on SLAM inpatients and psychiatric intensive care units.

Results:

There was a significant reduction between baseline and final survey in the rates of prescription of both high-dose antipsychotics and polypharmacy on SLAM inpatients and intensive care units (58% versus 10% p < 0.0001 and 57% versus 16%, p < 0.0001 respectively). The proportion of patients at final survey prescribed a high-dose antipsychotic and a combination was substantially lower in SLAM than in the national sample (10% versus 28%, p < 0.0001 and 16% versus 38%, p < 0.0001 respectively).

Clinical implications:

A sustained change in the prescribing culture of an organization can be achieved through a targeted improvement programme.
Neuro-Behçets in a Child
Authors: Vesoulis Zachary A. , Galindo Rafael , Ornstein Bradley W. , White Andrew J.
Published: November 2014

We describe a case of neuro-Behçet disease diagnosed in a 12-year-old girl. This patient presented with recurrent oral ulcers, incontinence, spastic gait, blurry vision, and asymmetrical lower extremity hypertonia. Extensive testing revealed punctate lesions through the central nervous system, vitritis, papillitis, and uveitis. A thorough infectious and neoplastic workup was negative. She was treated with pulse steroids and azathioprine with gradual improvement in her gait and ophthalmologic findings. Although rare, primary neuro-Behçet should be considered in pediatric patients with neurologic abnormalities and recurrent aphthous ulcers without other explanation.
Childhood-Onset Progressive Dystonia With Mitochondrial DNA G14459A Mutation
Authors: Koide Ayaka , Ozawa Hiroshi , Kubota Masaya , Goto Yuichi
Published: November 2014

This article reports the case of an 11-year-old boy with progressive dystonia caused by the homoplasmic G14459A mitochondrial DNA mutation. The patient presented with focal dystonia in the right upper limb at 3 years of age, which progressed over 4 years to exhibit dystonia in both the upper and lower limbs. At 7 years of age, high signal intensity lesions in the bilateral striata and the midbrain were observed on fluid-attenuated inversion recovery images. It was observed on diffusion-weighted images that with time, these high signal intensity lesions migrated from the putamen to the caudate nuclei, which closely correlated with disease progression. Because his symptoms and abnormal magnetic resonance imaging findings progressed despite treatment with coenzyme Q10 and l-carnitine, at 7 years of age he was then started on sodium succinate, hoping to improve his complex I deficiency. After treatment, progression of MRI abnormalities appeared to have been suppressed for 4 years, although no improvement was observed in dystonia.
Study of heat treatment parameters and kinetics of quenching and partitioning cycles
Authors: De Knijf D. , Da Silva E. P. , Föjer C. , Petrov R.
Published: November 2014

Cold rolled sheets of a low carbon quenching and partitioning (Q&P) steel grade were subjected to heat treatment cycles, which were designed by dilatometric experiments and optimised with respect to the quenching temperature, partitioning temperature and partitioning time. Characterisation of the retained austenite was carried out by electron backscattered diffraction, whereas the carbides were studied by scanning electron microscopy (SEM) and differential scanning calorimetry. The mechanical properties were evaluated by tensile testing and linked with retained austenite fractions and carbon contents, determined by X-ray diffraction. Conclusions are drawn concerning the influence of the kinetics of partitioning on the microstructure in terms of optimal austenite fraction in the martensitic matrix, its C content and ensuing mechanical properties.
“Barcelona or die”: understanding illegal migration from Senegal
Authors: Mbaye Linguère Mously
Published: November 2014

Fatalities from illegal immigration from Africa to Europe are a grave reality. The phenomenon represents a major challenge for both home and host countries. Nonetheless, almost nothing is known about how the motivations of potentially illegally migrating individuals are formed. This paper aims to explain the factors behind the formation of the willingness to migrate illegally knowing that death might occur during the trip. I focus on the role of expectations, friends and relatives who have migrated and host countries policies. By using an original survey among Senegalese residing in Dakar in 2006-2007, I show that potential illegal migrants are willing to accept a substantial risk of death. I find that high expectations and migrant networks are positively related with illegal migration motivations. Surprisingly, I find that stricter immigration policies deter potential legal migrants much more than potential illegal migrants.

Finally, I find that the price of illegal migration is negatively correlated with the willingness to migrate illegally.

JEL Code: F22, O15
Human liver stem cells and derived extracellular vesicles improve recovery in a murine model of acute kidney injury
Authors: Sanchez Maria Beatriz Herrera , Bruno Stefania , Grange Cristina , Tapparo Marta , Cantaluppi Vincenzo , Tetta Ciro , Camussi Giovanni
Published: November 2014

Introduction

Several cellular sources of stem cells have been tested in the attempt to yield innovative interventions in acute kidney injury (AKI). Human liver stem cells (HLSCs) are cells isolated from the normal adult human liver which are gaining attention for their therapeutic potential. In the present study, we investigated whether HLSCs and the derived extracellular vesicles may promote tubular regeneration after AKI induced by glycerol injection in severe-combined immune-deficient mice.

Methods

HLSCs were expanded and conditioned medium (CM) and extracellular vesicles (EVs) were purified. HLSCs and their bioproducts were tested in a model of AKI induced by intra-muscle glycerol injection. Renal function and morphology were evaluated five days after induction of damage. The effect of EVs on proliferation and apoptosis of murine renal tubular cells was tested in vitro.

Results

We found that intravenous injection of 3.5×105 HLSCs into mice three days after induction of AKI significantly improved functional and morphological recovery. The injection of HLSCs decreased creatinine and urea, as well as hyaline cast formation, tubular necrosis and enhanced in vivo tubular cell proliferation. The effect of soluble factors release by HLSCs in the regenerative processes was also studied. CM produced by HLSCs, mimicked the effect of the cells. However, depletion of EVs significantly reduced the functional and morphological recovery of CM. Moreover, we found that purified HLSC-derived EVs ameliorated renal function and morphology in a manner comparable to the cells. In vitro HLSC-derived EVs were shown to stimulate proliferation and inhibit apoptosis of murine renal tubular cells.

Conclusions

These results indicate that HLSCs increase recovery after AKI. EVs are the main component of HLSC-derived CM capable of promoting regeneration in experimental AKI.
Randomized Phase III Trial of Amrubicin Versus Topotecan As Second-Line Treatment for Patients With Small-Cell Lung Cancer
Authors: von Pawel Joachim , Jotte Robert , Spigel David R. , O'Brien Mary E.R. , Socinski Mark A. , Mezger Jörg , Steins Martin , Bosquée Léon , Bubis Jeffrey , Nackaerts Kristiaan , Trigo José M. , Clingan Philip , Schütte Wolfgang , Lorigan Paul , Reck Martin , Domine Manuel , Shepherd Frances A. , Li Shaoyi , Renschler Markus F.
Published: November 2014

Purpose

Amrubicin, a third-generation anthracycline and potent topoisomerase II inhibitor, showed promising activity in small-cell lung cancer (SCLC) in phase II trials. This phase III trial compared the safety and efficacy of amrubicin versus topotecan as second-line treatment for SCLC.

Patients and Methods

A total of 637 patients with refractory or sensitive SCLC were randomly assigned at a ratio of 2:1 to 21-day cycles of amrubicin 40 mg/m2 intravenously (IV) on days 1 to 3 or topotecan 1.5 mg/m2 IV on days 1 to 5. Primary end point was overall survival (OS); secondary end points included overall response rate (ORR), progression-free survival (PFS), and safety.

Results

Median OS was 7.5 months with amrubicin versus 7.8 months with topotecan (hazard ratio [HR], 0.880; P = .170); in refractory patients, median OS was 6.2 and 5.7 months, respectively (HR, 0.77; P = .047). Median PFS was 4.1 months with amrubicin and 3.5 months with topotecan (HR, 0.802; P = .018). ORR was 31.1% with amrubicin and 16.9% with topotecan (odds ratio, 2.223; P < .001). Grade ≥ 3 treatment-emergent adverse events in the amrubicin and topotecan arms were: neutropenia (41% v 54%; P = .004), thrombocytopenia (21% v 54%; P < .001), anemia (16% v 31%; P < .001), infections (16% v 10%; P = .043), febrile neutropenia (10% v 3%; P = .003), and cardiac disorders (5% v 5%; P = .759); transfusion rates were 32% and 53% (P < .001), respectively. NQO1 polymorphisms did not influence safety outcomes.

Conclusion

Amrubicin did not improve survival when compared with topotecan in the second-line treatment of patients with SCLC. OS did not differ significantly between treatment groups, although an improvement in OS was noted in patients with refractory disease treated with amrubicin.
Young Patients With Non–Germinal Center B-Cell–Like Diffuse Large B-Cell Lymphoma Benefit From Intensified Chemotherapy With ACVBP Plus Rituximab Compared With CHOP Plus Rituximab: Analysis of Data From the Groupe d'Etudes des Lymphomes de l'Adulte/Lymphoma Study Association Phase III Trial LNH 03-2B
Authors: Molina Thierry Jo , Canioni Danielle , Copie-Bergman Christiane , Recher Christian , Brière Josette , Haioun Corinne , Berger Françoise , Fermé Christophe , Copin Marie-Christine , Casasnovas Olivier , Thieblemont Catherine , Petrella Tony , Leroy Karen , Salles Gilles , Fabiani Bettina , Morschauser Franck , Mounier Nicolas , Coiffier Bertrand , Jardin Fabrice , Gaulard Philippe , Jais Jean-Philippe , Tilly Hervé
Published: November 2014

Purpose

To determine whether any tumor biomarkers could account for the survival advantage observed in the LNH 03-2B trial among patients with diffuse large B-cell lymphoma (DLBCL) and low-intermediate risk according to the International Prognostic Index when treated with dose-intensive rituximab, doxorubicin, cyclophosphamide, vindesine, bleomycin, and prednisone (R-ACVBP) compared with standard rituximab, doxorubicin, cyclophosphamide, vincristine, and prednisone (R-CHOP).

Patients and Methods

Using immunohistochemistry, expression of CD10, BCL6, MUM1, MYC, and BCL2 and coexpression of MYC/BCL2 were examined. The interaction effects between each biomarker and treatment arm on survival were studied in a restricted model and a full model incorporating clinical parameters.

Results

Among the 379 patients analyzed in the trial, 229 tumors were evaluable for germinal center B-cell–like (GCB)/non-GCB subclassification according to the Hans algorithm. Among all the biomarkers, only the interaction between the Hans algorithm and the treatment arm was significant for progression-free survival (PFS) and overall survival (OS) in univariable (PFS, P = .04; OS, P = .01) and multivariable (PFS, P = .03; OS, P = .01) analyses. Non-GCB tumors predicted worse PFS (hazard ratio [HR], 3.21; 95% CI, 1.29 to 8.00; P = .01) and OS (HR, 6.09; 95% CI, 1.37 to 27.03; P = .02) among patients treated with R-CHOP compared with patients who received R-ACVBP, whereas there were no significant survival differences between these regimens among patients with GCB tumors.

Conclusion

The survival benefit related to R-ACVBP over R-CHOP is at least partly linked to improved survival among patients with non-GCB DLBCL. Therefore, the Hans algorithm could be considered a theragnostic biomarker for selecting young patients with DLBCL who can benefit from an intensified R-ACVBP immunochemotherapy regimen.
Identification of Independent Primary Tumors and Intrapulmonary Metastases Using DNA Rearrangements in Non–Small-Cell Lung Cancer
Authors: Murphy Stephen J. , Aubry Marie-Christine , Harris Faye R. , Halling Geoffrey C. , Johnson Sarah H. , Terra Simone , Drucker Travis M. , Asiedu Michael K. , Kipp Benjamin R. , Yi Eunhee S. , Peikert Tobias , Yang Ping , Vasmatzis George , Wigle Dennis A.
Published: November 2014

Purpose

Distinguishing independent primary tumors from intrapulmonary metastases in non–small-cell carcinoma remains a clinical dilemma with significant clinical implications. Using next-generation DNA sequencing, we developed a chromosomal rearrangement–based approach to differentiate multiple primary tumors from metastasis.

Methods

Tumor specimens from patients with known independent primary tumors and metastatic lesions were used for lineage test development, which was then applied to multifocal tumors. Laser capture microdissection was performed separately for each tumor. Genomic DNA was isolated using direct in situ whole-genome amplification methodology, and next-generation sequencing was performed using an Illumina mate-pair library protocol. Sequence reads were mapped to the human genome, and primers spanning the fusion junctions were used for validation polymerase chain reaction.

Results

A total of 41 tumor samples were sequenced (33 adenocarcinomas [ADs] and eight squamous cell carcinomas [SQCCs]), with a range of three to 276 breakpoints per tumor identified. Lung tumors predicted to be independent primary tumors based on different histologic subtype did not share any genomic rearrangements. In patients with lung primary tumors and paired distant metastases, shared rearrangements were identified in all tumor pairs, emphasizing the patient specificity of identified breakpoints. Multifocal AD and SQCC samples were reviewed independently by two pulmonary pathologists. Concordance between histology and genomic data occurred in the majority of samples. Discrepant tumor samples were resolved by genome sequencing.

Conclusion

A diagnostic lineage test based on genomic rearrangements from mate-pair sequencing demonstrates promise for distinguishing independent primary from metastatic disease in lung cancer.