Subject: Engineering, Biomedical & Chemical Engineering Keywords: total hip arthroplasty; intra-operative femur fracture risk; bone elastic-plastic behavior
Online: 23 July 2020 (09:41:30 CEST)
Total Hip Arthroplasty is one of the most successful surgery. However, due to the worldwide growing population life expectancy and the related incidence of age-dependent bone diseases, a growing number of cases of intra-operative fractures lead to revision surgery with high rates of morbidity and mortality. Surgeons choose the type of the implant, either cemented or cementless prosthesis, on the basis of the age, the quality of the bone and the general medical conditions of the patients. Generally, no quantitative measures are available to assess the intra-operative fracture risk. Consequently, the decision-making process is mainly based on medical operators’ expertise and qualitative information obtained by imaging. Motivated by this scenario, we here propose a mechanical-supported strategy to assist surgeons in their decisions, by giving intelligible maps of the risk fracture which take into account the interplay between actual strength distribution inside the bone tissue and its response to the forces exerted by the implant. To this end, we produce charts and patient-specific synthetic “traffic-light” indicators of fracture risk, by making use of ad hoc analytical solutions to predict the stress levels in the bone by means of CT-based mechanical and geometrical parameters of the patient. We felt that, if implemented in a friendly software or proposed as an app, the strategy could constitute a practical tool to help the medical decision-making process, in particular with respect to the choice of adopting cemented or cementless implant
ARTICLE | doi:10.20944/preprints202208.0301.v1
Subject: Medicine & Pharmacology, Oncology & Oncogenics Keywords: corticospinal tract; optic radiations; tractography; transcranial magnetic stimulation; subdural strip electrodes; intra-operative neuro-monitoring; parietal lobe
Online: 17 August 2022 (05:08:09 CEST)
Background: The role played by the non-dominant parietal lobe in motor cognition, attention and spatial awareness networks has potentiated the use of awake surgery. When this is not feasible, asleep monitoring and mapping techniques should be used to achieve an onco-functional balance. Objective: This study aims to assess the feasibility of a dual-strip method to obtain direct cortical stimulation for continuous real-time cortical monitoring and subcortical mapping of motor and visual pathways simultaneously in parietal lobe tumour surgery. Methods: Single-centre prospective study between May’19-November’20 of patients with intrinsic non-dominant parietal-lobe tumours. Two subdural strips were used to simultaneously map and monitor motor and visual pathways. Results: Fifteen patients were included. With regards to motor function, a large proportion of patients had abnormal interhemispheric resting motor threshold ratio (iRMTr) (71.4%), abnormal Cortical Excitability Score (CES) (85.7%), close distance to the corticospinal tract – Lesion-To-Tract Distance (LTD) – 4.2mm, Cavity-To-Tract Distance (CTD) – 7mm and intraoperative subcortical distance - 6.4mm. Concerning visual function, the LTD and CTD for optic radiations (OR) were 0.5mm and 3.4mm, respectively; the mean intensity for positive subcortical stimulation of OR was 12mA±2.3mA and 5/6 patients with deterioration of VEPs>50% had persistent hemianopia and transgression of ORs. 12 patients remained stable, one patient had a de-novo transitory hemiparesis, and two showed improvements in motor symptoms. A higher iRMTr for lower limbs was related with a worse motor outcome (p=0.013) and a longer CTD to OR was directly related with a better visual outcome (p=0.041). At 2 weeks after hospital discharge, all patients were ambulatory at home and all proceeded to have oncological treatment. Conclusion: We propose motor and visual function boundaries for asleep surgery of intrinsic non-dominant parietal tumours. Pre-operative abnormal cortical excitability of the motor cortex, deterioration of the VEP recordings and CTD<2mm from the OR were related to poorer outcomes.
Subject: Medicine & Pharmacology, Allergology Keywords: liquid biopsy; ctDNA; cell free DNA; non-operative management; neoadjuvant therapy
Online: 10 December 2020 (12:52:27 CET)
As non-operative management (NOM) of esophageal and rectal cancer is becoming more prevalent, blood-biomarkers such as circulating tumor DNA (ctDNA) may provide clinical information in addition to endoscopy and imaging to aid in treatment decisions following chemotherapy and radiation therapy. In this feasibility study, we prospectively collected plasma samples from locally advanced esophageal (n=3) and rectal cancer (n=2) patients undergoing multimodal neoadjuvant therapy to assess the feasibility of serial ctDNA monitoring throughout neoadjuvant therapy. Using the DIDA-Seq error-correction method, we serially interrogated plasma cell-free DNA at 28-41 tumor-specific genomic loci throughout therapy and in surveillance with an average limit of detection of 0.016% mutant allele frequency. In both rectal cancer patients, ctDNA levels were persistently elevated following total neoadjuvant therapy with eventual detection of clinical recurrence prior to salvage surgery. Among the esophageal cancer patients, ctDNA levels closely correlated with tumor burden throughout and following neoadjuvant therapy, which was associated with a pathologic complete response in one patient. In this feasibility study, patient and tumor-specific ctDNA levels correlated with clinical outcomes throughout multi-modality therapy suggesting that serial monitoring of patient ctDNA has the potential to serve as a highly sensitive and specific biomarker to risk-stratify esophageal and rectal cancer patients eligible for NOM. Further prospective investigation is warranted.
ARTICLE | doi:10.20944/preprints202106.0114.v2
Subject: Engineering, Biomedical & Chemical Engineering Keywords: virtual reality; pre-operative imaging; echocardiography
Online: 18 August 2021 (10:02:51 CEST)
The intricate nature of congenital heart disease requires understanding of complex, patient-specific three-dimensional dynamic anatomy of the heart, from imaging data such as three-dimensional echocardiography for successful outcomes from surgical and interventional procedures. Conventional clinical systems use flat screens and therefore display remains two-dimensional, which undermines the full understanding of the three-dimensional dynamic data. Additionally, control of three-dimensional visualisation with two-dimensional tools is often difficult, so used only by imaging specialists. In this paper we describe a virtual reality system for immersive surgery planning using dynamic three-dimensional echocardiography, which enables fast prototyping for visualisation such as volume rendering, multi-planar reformatting, flow visualisation, and advanced interaction such as three-dimensional cropping, windowing, measurement, haptic feedback, automatic image orientation, and multi-user interactions. The available features were evaluated by imaging and non-imaging clinicians, showing that the virtual reality system can help improve understanding and communication of the three-dimensional echocardiography imaging and potentially benefit congenital heart disease treatment.
REVIEW | doi:10.20944/preprints202112.0479.v1
Subject: Medicine & Pharmacology, Other Keywords: CEUS; blunt trauma; non operative management; follow-up.
Online: 30 December 2021 (07:48:03 CET)
Trauma is one of the most common causes of death or permanent disability in young people, so a timely diagnostic approach is crucial. In polytrauma patients, CEUS has been shown to be more sensitive than US for the detection of solid organ injuries, improving the identification and grading of traumatic abdominal lesions with levels of sensitivity and specificity similar to those seen with MDCT. CEUS is recommended for the diagnostic evaluation of hemodynamically stable patients with isolated blunt moderate-energy abdominal traumas and for the diagnostic follow-up of conservatively managed abdominal traumas. In this pictorial review we illustrate the advantages and disadvantages of CEUS and the procedure details with tips and tricks during investigation of blunt moderate-energy abdominal trauma as well as during follow-up in non-operative management.
ARTICLE | doi:10.20944/preprints201809.0142.v3
Subject: Engineering, Civil Engineering Keywords: radiator efficiency; energy; operative temperature; analytical model; computer simulations
Online: 5 December 2018 (12:44:58 CET)
Heat emitters constitute the primary devices used in space heating and cover a fundamental role in the energy efficient use of buildings. In the search for an optimized design, heating devices should be compared with a benchmark emitter with maximum heat emission efficiency. However, such an ideal heater still needs to be defined. In this paper we perform an analysis of heat transfer in a European reference room, considering room side effects of thermal radiation and computing the induced operative temperature both analytically and numerically. By means of functional optimization, we analyse trends such as the variation of operative temperature with radiator panel dimensions, finding optimal configurations. In order to make our definitions as general as possible, we address panel radiators, convectors, underfloor (UFH) and ceiling heater. We obtain analytical formulas for the operative temperature induced by panel radiators and identify the 10-type as our ideal radiator, while the UFH provides the best performance overall. Regarding specifically UFH and ceiling heaters, we find optimal sizes that identify the according ideal emitters. The analytical method and quantitative results reported in this paper can be generalized and adopted in most studies concerning the efficiency of different heat emitter types in building enclosures.
ARTICLE | doi:10.20944/preprints202205.0157.v1
Subject: Life Sciences, Virology Keywords: feline; panleukopenia; canine parvovirus; metagenomics; diversity; intra-host
Online: 12 May 2022 (04:07:11 CEST)
Feline panleukopenia (FPL), a highly contagious and frequently fatal disease of cats, is caused by Feline parvovirus (FPV) and Canine parvovirus (CPV). We characterized the diversity of these Carnivore protoparvovirus 1 variants in 18 faecal samples collected from domestic cats with FPL during an outbreak, using targeted parvoviral DNA metagenomics to a mean depth of >10,000 X coverage per site. All samples comprised FPV alone. Compared to the reference FPV genome, isolated in 1967, 44 mutations were detected. Ten of these were non-synonymous, including 9 in non-structural genes and one in VP1/VP2 (Val232Ile), which was the only one to exhibit inter-host diversity, being present in five sequences. There were five other polymorphic nucleotide positions, all with synonymous mutations. Intra-host diversity at all polymorphic positions was low with sub-consensus variant frequencies (SVF) of >1% except for two positions (2108 and 3208) in two samples with SVF of 1.1 – 1.3%. Intra-host nucleotide diversity was measured across the whole genome (0.7 - 1.5%) and for each gene, and was highest in the NS2 gene of four samples (1.2 – 1.9%). Overall, intra-host viral genetic diversity was limited and most mutations observed were synonymous, indicative of a low background mutation rate and strong selective constraints.
ARTICLE | doi:10.20944/preprints201908.0321.v1
Subject: Earth Sciences, Other Keywords: Intra–Seasonal rain fall characteristics; Short rains; WRF Model
Online: 30 August 2019 (09:57:58 CEST)
Rainfall is a major climate parameter whose variation in space and time influences activities in different weather sensitive sectors such as agriculture, transport, and energy among others. Therefore, accurately forecasting rainfall is of paramount importance to the development of these sectors. In this regard, this study sought to contribute to quantitative forecasting of rainfall over Eastern Uganda through assessing the Weather Research and Forecasting model’s ability to simulate the intra–seasonal characteristics of the September to December rain season. These were: onset and cessation dates; wet days and lengths of the wet spells. The data used in the study included daily ground rainfall observations and lateral and boundary conditions data from the National Centers for Environmental Prediction (NCEP) final analysis at 1 0 horizontal resolution and at a temporal resolution of 6 hours for the entire study period were used to initialize the Weather Research and Forecasting (WRF) model. The study considered four weather synoptic weather stations namely; Jinja, Serere, Soroti and Tororo. The results show that the WRF model generally simulated fewer wet days at each station except for Tororo. Also, the WRF model simulated earlier onset and cessation dates of the rainfall season and overestimated the length of the wet spells.
REVIEW | doi:10.20944/preprints202008.0090.v2
Subject: Medicine & Pharmacology, Veterinary Medicine Keywords: Piglet; castration; pain; behaviour; peri-operative; vocalisation; nociception; neonate; anaesthesia; analgesia.
Online: 11 August 2020 (10:10:24 CEST)
Analgesic products for piglet castration are critically needed. This requires extensive animal experimentation such as to meet regulatory-required proof of efficacy. At present, there are no validated methods of assessing pain in neonatal piglets. This poses challenges for investigators to optimize trial design and to meet ethical obligations to minimize the number of animals needed. Pain in neonatal piglets may be subtle, transient and / or variably expressed and, in the absence of validated methods, investigators must rely on using a range of biochemical, physiological and behavioural variables, many of which appear to have very low (or unknown) sensitivity or specificity for documenting pain, or pain-relieving effects. A previous systematic review of this subject was hampered by the high degree of variability in the literature base both in terms of methods used to assess pain and pain mitigation, as well as in outcomes reported. In this setting we provide a narrative review, to assist in determining the optimal methods currently available to detect piglet pain during castration and methods to mitigate castration-induced pain. In overview, the optimal outcome variables identified are nociceptive motor and vocal response scores during castration, and quantitative sensory-threshold response testing and pain-associated behaviour scores following castration.
ARTICLE | doi:10.20944/preprints201912.0122.v1
Subject: Engineering, Civil Engineering Keywords: emission eﬃciency; heat emission; setpoint variation; operative temperature; European Reference Room
Online: 9 December 2019 (10:44:18 CET)
Estimating heat emission losses of heating systems is an important task of energy efficiency assessments in buildings. To this aim, the present international standards contain tabulated values for different emitter and control system configurations, without however explaining how to compute the effect of increased setpoint temperatures on the system losses. Moreover, the effects of each component are treated as independent, while e.g. vertical stratification and temperature control of the system are cross-related. In this paper we attempt to fill this gap by proposing a calculation method to calculate the product category specific setpoint variations for space heating emitters, accounting for the overall heat balance in the enclosure and including the cross-correlations of each component as well. The emission losses of a heating system are computed using a temperature setpoint variation method that is imposed on annual energy calculations. This complements the procedure presented in the Standard EN15316-2, also providing the possibility to use product-specific values of setpoint variations instead of tabulated values. As the main finding of the study, the calculation process is defined for a European Reference Room, namely for a specific enclosure that allows an accurate and transparent evaluation of the total setpoint variation. The product-specific values of setpoint variations are calculated from measured vertical stratification and control parameters with an annual simulation model of the European Reference Room. The total setpoint variations were simulated for a set of heat emitters and controllers in order to quantify and compare the energy performance of a new and an old type building located in Strasbourg. We find that the total setpoint variation required to overcome emission losses is up to 2.00 °C in the old building and 1.20 °C in the new building, corresponding respectively to an increase in total heating energy usage of up to 22% and 20%.
ARTICLE | doi:10.20944/preprints201810.0678.v1
Subject: Medicine & Pharmacology, Pediatrics Keywords: post-operative death; unstructured data; logistic regression; text mining; surgery outcome
Online: 29 October 2018 (11:46:18 CET)
Text fields in electronic medical records (EMR) contain information on important factors that influence health outcomes, however, they are underutilized in clinical decision making due to their unstructured nature. We analyzed 6,497 inpatient surgical cases with 719,308 free text notes from Le Bonheur Children’s Hospital EMR. We used a text mining approach on preoperative notes to obtain the text-based risk score algorithm as predictive of death within 30 days of surgery. We studied the additional performance obtained by including text-based risk score as a predictor of death along with other structured data based clinical risk factors. The C-statistic of a logistic regression model with 5-fold cross-validation significantly improved from 0.76 to 0.92 when text-based risk scores were included in addition to structured data. We conclude that preoperative free text notes in EMR include significant information that can predict adverse surgery outcomes.
ARTICLE | doi:10.20944/preprints202205.0127.v1
Subject: Medicine & Pharmacology, Pathology & Pathobiology Keywords: hypertension; obesity; body composition; intra-abdominal fat; sleep apnea; obstructive
Online: 10 May 2022 (04:45:21 CEST)
Background: Elevated fasting plasma glucose and visceral fat area (VFA) is highly prevalent in obese adults. This study investigated the associations between systemic arterial hypertension (SAH) and laboratory, anthropometric, heart rate variability (HRV), and obstructive sleep apnea markers. Methods: Cross-sectional study with 95 obese patients treated at Obesity Treatment and Surgery Center, located in Salvador, BA, Brazil. SAH data were obtained from electronic medical records of patients. To evaluate the association of SAH with the predictor variables, the sample was stratified in Normotense Group (NG) and Hypertensive Group (HG), and laboratory markers, body composition, polysomnography data, and HRV were measured. Results: The average age of the NG was 36.3 ± 10.1 and HG 40.4 ± 10.6 years, 73.7% were women in the NG and 57.9% in HG; 82.4% in HG had insulin resistance. In the multivarious logistics regression model with adjustments age, sex, height, and oxyhemoglobin saturation, SAH was inversely associated with fasting plasma glucose mg/dL (odds ratio [OR] = 0.96; 95% interval confidence [CI] = 0.92 - 0.99) and VFA cm2 (OR = 0.98; 95% CI = 0.97 - 0.99). The area under curve the VFA was 0.728; CI 95% (0.620 - 0.836) and fasting plasma glucose 0.693; CI 95% (0.582 - 0.804). Conclusions: Lower VFA and fasting plasma glucose concentrations were inversely associated with SAH. These results indicate opportunities to improve the outcome in obese patients through counseling and clinical interventions.
ARTICLE | doi:10.20944/preprints201912.0376.v1
Subject: Medicine & Pharmacology, Ophthalmology Keywords: dry eye; tear break-up time; intra-ocular pressure; seasonality
Online: 29 December 2019 (09:17:39 CET)
Purpose: To evaluate seasonal variation in intra-ocular pressure (IOP) with and without short tear break-up time (SBUT, BUT ≤ 5 s). Methods: This study enrolled 176 patients who visited one of six eye clinics in Japan for IOP measurement at every season. The mean patient age was 67.9 years, including 79 males. We compared the seasonal variation in IOP (mean ± SD) across spring (Mar-May), summer (Jun-Aug), fall (Sep-Nov), and winter (Dec-Feb). Results: The IOP (mmHg) in winter and summer, respectively, was 12.8 ± 3.7 and 12.8 ± 3.1 for non-glaucoma patients without SBUT (n = 47, P = 0.964), 14.8 ± 3.4 and 13.3 ± 3.4 for non-glaucoma patients with SBUT (n = 57, P < 0.001), 14.3 ± 3.2 and 14.1 ± 3.4 for glaucoma patients without SBUT (n = 36, P = 0.489), and 13.3 ± 3.0 and 11.6 ± 2.9 for glaucoma with SBUT (n = 36, P < 0.001). Seasonal variation was largest across the seasons in the glaucoma with SBUT group, and the magnitude of seasonal variation correlated with BUT (β = 0.228, P = 0.003). Conclusions: Seasonal variation tended to be larger in patients with SBUT than those without SBUT.
ARTICLE | doi:10.20944/preprints201805.0110.v1
Subject: Medicine & Pharmacology, Oncology & Oncogenics Keywords: oral cancer; radiotherapy; intra-arterial chemotherapy; head and neck cancer
Online: 7 May 2018 (08:48:20 CEST)
Purpose: The aim of present study was to compare the treatment results of daily cisplatin (CDDP), weekly docetaxel (DOC) intra-arterial infusion chemotherapy combined with radiotherapy (DIACRT) regimen and weekly CDDP intra-arterial infusion chemotherapy combined with radiotherapy (WIACRT) for patients with tongue cancer. Materials and Methods: Between January 2007 and December 2016, a total of 11 patients treated with WIACRT and 45 patients treated with DIACRT were enrolled in present study. In DIACRT group, 25 patients had T2, 20 patients had T3. A total of 9 patients had T2 and 2 had T3 in WIACRT (p = NS). In DIACRT, the treatment schedule consisted of intra-arterial chemotherapy (DOC, total 60 mg/m2; CDDP, total 150 mg/m2) and daily concurrent radiotherapy (RT) (total, 60 Gy). In WIACRT, the treatment schedule consisted of intra-arterial chemotherapy (CDDP, total 360 mg/m2) and daily concurrent RT (total, 60 Gy). Results: The median follow-up periods for DIACRT and WIACRT were 61 and 66 months respectively. The 5-year local control (LC) and overall survival (OS) rate were 94.5% and 89.6% for DIACRT group, 60.6% and 63.6% for WIACRT group respectively. The LC rate and OS of DIACRT group were significantly higher than that of WIACRT group. As regards toxicities, no treatment-related deaths were observed during the follow-up periods both in two groups. Conclusions: DIACRT was found to be feasible and effective for patients with tongue cancer and could become a new treatment modality.
ARTICLE | doi:10.20944/preprints202106.0599.v2
Subject: Medicine & Pharmacology, Allergology Keywords: Clinical Study; Retrospective Studies; Surgical Procedures, Operative; Postoperative Period; Follow-Up Studies.
Online: 28 July 2021 (16:56:31 CEST)
Background In this study, we describe our clinical experience with the fifth-generation of a breast implant with a smooth, fine surface from a Korean manufacturer (BellaGelÒ SmoothFine; HansBiomed Co. Ltd., Seoul, Korea) in Asian women. Methods We analyzed 223 women (mean age=35.28±9.45 years and mean follow-up period=12.03±2.48 months), comprising 118 bilateral cases and 109 unilateral ones, who received breast augmentation using the BellaGelÒ SmoothFine at our hospital between June 4, 2018 and February 28, 2019. For safety assessment, we analyzed frequencies of postoperative complications and overall survival of the BellaGelÒ SmoothFine. Results Postoperatively, complications (12 cases, 5.38%) include asymmetry (3 cases, 1.35%), hematoma (2 cases, 0.90%), hypertrophic scars (2 cases, 0.90%), wound disruption (2 cases, 0.90%), rippling (1 case, 0.45%), capsular contracture (1 case, 0.45%), stretch deformities with skin excess (1 case, 0.45%). In addition, time-to-events were calculated as 10.94±0.64 months (95% CI 9.69-12.19) and the survival rate reached 0.290±0.168 (95% CI 0.094-0.901) at 12 months postoperatively. Conclusions Here, we describe our clinical experience with the BellaGelÒ SmoothFine. Our results are of significance in that this is the first report about the fifth-generation of a breast implant with a smooth, fine surface from a Korean manufacturer in Asian women.
ARTICLE | doi:10.20944/preprints202001.0342.v2
Subject: Mathematics & Computer Science, Algebra & Number Theory Keywords: cluster based routing; FLOC clustering method; weighting algorithm; intra-cluster communication
Online: 25 November 2020 (14:46:02 CET)
Cluster-based routing in Mobile Ad-Hoc Networks is considered one of the convenient methods of routing. The existence of Cluster Head (CH) in a group of nodes for data forwarding improves the performance of routing in terms of routing overhead and power consumption. In this paper, a clustering algorithm using hierarchical routing for mobile ad hoc networks is proposed. In the proposed method, first, clusters are formed by the FLOC clustering method with low overlapping. Then, according to the most important network criteria, including hop count, noise ratio, distance, remaining energy, and link expiration time, head clusters are selected based on the weighting algorithm. To transfer data in the proposed method, two types of communication are used, e.g., inter-cluster communication and intra-cluster communication in which the shortest path to the target cluster is selected. The proposed P-METHOD technique is based on hierarchy and clustering as well as using a weighted algorithm that reduces delay in data transmission on the network. Moreover, P-METHOD is evaluated here via extensive simulations carried out in NS-2. The simulation results indicate that the MANET network performance metrics are improved in terms of average throughput, Packet Delivery Ratio (PDR), delay, residual energy, and lifetime.
ARTICLE | doi:10.20944/preprints201610.0084.v1
Subject: Biology, Agricultural Sciences & Agronomy Keywords: intra row spacing; intercropping; land equivalent ratio; sorghum (Teshale); groundnut (Fetene)
Online: 20 October 2016 (08:45:36 CEST)
In eastern part of Ethiopia groundnut is very commonly intercropped with sorghum. Even though intercropping of sorghum with groundnut is practiced in the eastern part of Ethiopia the population density at what ratio should not be known. Therefore determining the population ratio is found to be crucial to draw management options. The study was conducted at two locations at Fadis (on station) and Babile (sub- station). Sorghum variety (Teshale) and groundnut (Fetene) were used as planting materials. All agronomic data were collected and analyzed by using GenStat software. Significant different were obtained among the treatments. The research result showed that, there were significance difference for both sorghum and ground nut yield per hectare in the years (2014 and 2015) among treatments. The result over time(in 2014 and 2015) at Fadis and Erer showed that the highest sorghum and groundnut yield per hectare were obtained/harvested from the intra row spacing of 25cmx20cm and 30cmx20cm intercropping sorghum with ground nut system with (1.27 and 1.31) respectively. The highest LER (1.31) and highest GMV (10218.00 ETBr/ha) were obtained from the intercropping of 30cmx20cm (Sorghum & groundnut). Clearly showed that, with intercropping of sorghum and Groundnut, it is possible to produce additional yield of sorghum without significant reduction in groundnut yield. As a result of this, the intra spacing of the main crop (sorghum) 25cm and 30cm and for the subsidiary crop (groundnut) 20cm was recommended for further production in the study areas of eastern Harerghe zone and similar agro-ecologies.
ARTICLE | doi:10.20944/preprints201803.0031.v1
Subject: Social Sciences, Economics Keywords: co-operative enterprises; indivisible reserves; common resources; rivalry; non-excludability; capital accumulation; governance
Online: 5 March 2018 (04:45:36 CET)
Contemporary literature dealing with the governance and exploitation of common-pool natural resources was initiated by Elinor Ostrom in 1990, and has been growing fast ever since. On the contrary, within the same research stream, the study of the presence and economic role of common resources in entrepreneurial organizations is, to date, under-researched. This work endeavors to fill some gaps in this research perspective by: (i) spelling out a new-institutionalist framework for the analysis of the accumulation and governance of common capital resources within organizational boundaries; (ii) considering co-operative enterprises as the organizational form that, on the basis of historical record, and of behavioral and institutional characteristics, demonstrated to be most compatible with a substantial role for common and non-divided asset-ownership and with its governance thereof; (iii) evidencing and explaining the strong connection between cooperative longevity and the presence of non-divided asset ownership. The economic forces influencing the optimal level of self-financed common capital resources in co-operatives are enquired. Conclusions to the paper evidence the main reasons why the new approach can better explain than preceding ones the economic sustainability and longevity of cooperative enterprises.
REVIEW | doi:10.20944/preprints202103.0383.v1
Subject: Medicine & Pharmacology, Allergology Keywords: Inflammatory; cytokines; biomarkers; intra-articular fracture; cartilage; joint injury; synovial fluid; osteoarthritis
Online: 15 March 2021 (13:08:12 CET)
Intra-articular fractures are a major cause of post-traumatic osteoarthritis (PTOA). Despite adequate surgical treatment, the long-term risk for PTOA is high. Previous studies reported that joint injuries initiate an inflammatory cascade characterized by elevation of synovial pro-inflammatory cytokines, which can lead to cartilage degradation and PTOA development. This review summarizes the literature on the post-injury regulation of pro-inflammatory cytokines and the markers of cartilage destruction in patients suffering from intra-articular fractures. METHODS We searched Medline, Embase, and Cochrane databases (1960–February 2020) and included studies that were performed on human participants and included control groups. Two investigators assessed the quality of the included studies using Covidence and the Newcastle-Ottawa Scale. RESULTS Based on the surveyed literature, several synovial pro-inflammatory cytokines, including interleukin (IL)-1β, IL-2, IL-6, IL-8, IL-12p70, interferon-y, and tumor necrosis factor-α, were significantly elevated in patients suffering from intra-articular fractures compared to control. A simultaneous elevation of anti-inflammatory cytokines such as IL-10 and IL-1RA was also observed. In contrast, IL-13, CTX-II, and aggrecan concentrations did not differ significantly between the compared cohorts. CONCLUSIONS Overall, intra-articular fractures are associated with an increase in inflammation-related synovial cytokines. However, more standardized studies which focus on the ratio of pro- and anti-inflammatory cytokines at different time points are needed.
Subject: Life Sciences, Biochemistry Keywords: Ribosomal DNA; ribosomal RNA; mammalian genome; intra- and inter-individual variations; development; diseases.
Online: 26 February 2021 (11:35:55 CET)
Repetitive nature of the ribosomal DNA (rDNA) gene makes the sequencing of hundreds copies of mammalian 45S rDNA (about 45-kb per copy) extremely difficult and its assembly is often excluded. Increasing evidence shows that 45S rDNA variations (copy number or single nucleotide), structural ribosomal RNA (rRNA) transcript variants, and non-structural rRNA transcripts (sense and anti-sense long noncoding rRNAs that include promoter rRNAs, and rRNA-derived fragments) play essential roles in mammalian development and diseases. Complete pictures of the hundreds copies of 45S rDNA and their rRNA transcripts require further innovation in sequencing techniques that include bioinformatics. The advancements in mammalian rDNA and rRNA sequencings and the discoveries of novel functions of the rDNA variants and rRNA transcripts are discussed here.
ARTICLE | doi:10.20944/preprints201809.0428.v1
Subject: Biology, Other Keywords: inter- and intra-host nucleotide variations; Hepatitis A virus; next-generation sequencing; pyrosequencing
Online: 21 September 2018 (04:59:34 CEST)
The accurate virus detection, strain discrimination, and source attribution of contaminated food items remains a persistent challenge because of the high mutation rates anticipated to occur in foodborne RNA viruses, such as Hepatitis A virus (HAV). This has led to predictions of the existence of more than one sequence variant between the hosts (inter-host) or within an individual host (intra-host). However, there have been no reports of intra-host variants from an infected single individual, and little is known about the accuracy of the single nucleotide variations (SNVs) calling with various methods. In this study, the presence and identity of viral SNVs, either between HAV clinical specimens or among a series of samples derived from HAV clone1-infected FRhK4 cells, were determined following analyses of nucleotide sequences generated using next-generation sequencing (NGS) and pyrosequencing methods. The results demonstrate the co-existence of inter- and intra-host variants both in the clinical specimens and the cultured samples. The discovery and confirmation of multi-viral RNAs in an infected individual is dependent on the strain discrimination at the SNV level, and critical for successful outbreak traceback and source attribution investigations. The detection of SNVs in a time series of HAV infected FRhK4 cells improved our understanding on the mutation dynamics determined probably by different selective pressures. Additionally, it demonstrated that NGS could potentially provide a valuable investigative approach toward SNV detection and identification for other RNA viruses.
REVIEW | doi:10.20944/preprints201912.0152.v1
Subject: Social Sciences, Organizational Economics & Management Keywords: land expropriation; intra-racial tension; social cohesion; political and traditional elitism; marginalised landless majority
Online: 11 December 2019 (11:38:36 CET)
Section 25(2) of the Constitution of South Africa protects property rights and the White Paper on Land Reform demonstrate tolerance and wisdom in the application of land reform policies. The central argument to this research was whether amendment of Section 25 (2) of the constitution to allow expropriation of land without compensation redresses redistribution of land for social cohesion and political stability. The researcher argues that, currently, Section 25 of the constitution provides for expropriation without compensation but at the same time protects property rights reducing the pace of redistribution. Hence, an amendment of section 25 (2) may remove the property right clause and accelerate expropriation without compensation. But whether the removal of the property right clause and acceleration of the process of expropriation without compensation will result to equitable and fair distribution of land to the majority of landless South Africans is not certain. The study concludes that, amendment of Section 25(2) is a justifiable process and priorities must be given to equity in redistribution to the majority landless at the margins of communities and not elites. If the amendment of Section 25 (2) cannot guarantee equity in redistribution for all ill respective of race, social cohesion, political stability and economic growth, intra-racial tensions may emerge. Such tensions may further compound the land question and affects investors’ confidence in South Africa.
ARTICLE | doi:10.20944/preprints201801.0100.v1
Subject: Medicine & Pharmacology, Other Keywords: intra-abdominal pressure; abdominal compartment syndrome; pressure sensor; negative pressure wound therapy; open abdomen;
Online: 11 January 2018 (09:17:10 CET)
1) Introduction: Negative pressure wound therapy (NPWT) is a frequently applied open abdomen (OA) treatment. There are only a few experimental data supporting this method and describing the optimal settings and pressure distribution in the abdominal cavity during this procedure. The aim of our study was to evaluate pressure values at different points of the abdominal cavity during NPWT in experimental abdominal compartment syndrome (ACS) animal model. 2) Methods: In this study (permission Nr. 13/2014/UDCAR) 27 Hungahib pigs (15.4- 20.2 kg) were operated. ACS was generated by implanting a plastic bag in the abdomen through mini-laparotomy and filled with 2100- 3300 ml saline solution (37 C°) to an intraabdominal pressure (IAP) of 30 mmHg. After 3 hours, NPWT (Vivano Med ® Abdominal Kit, Paul Hartmann AG, Germany) or Bogota bag was applied. NPWT group was divided into -50, -100 and 150 mmHg suction group. Pressure distribution to the abdominal cavity was monitored at 6 different points of the abdomen via a multichannel pressure monitoring system. 3) Results: The absolute pressure levels were significantly higher above than below the layer. The values of the pressure were similar in the midline than laterally. Amongst the bowels, the pressure values changed periodically between 0 and -12 mmHg which might be caused by the peristaltic movements. 4) Conclusions: The porcine model of the present study seems to be well applicable for investigating ACS and NPWT. It was possible to provide valuable for clinicians. The pressure was well distributed by the protective layer to the lateral parts of the abdomen and this phenomenon did not change considerably during the therapy.
REVIEW | doi:10.20944/preprints202207.0100.v1
Subject: Life Sciences, Virology Keywords: omicron; alpha; delta; deltacron; recombination; RNA editing; intra-host variants; tropisms; ox-idative damage; Wuhan
Online: 6 July 2022 (15:27:32 CEST)
The successive waves of the Covid-19 pandemic are driven by SARS-CoV-2 variants that reached critical detection levels in different parts of the world. But how evolved the Wuhan virus since its detection in December 2019 into the Alpha (B.1.1.7), Beta (B.1.351), Gamma (P.1), Delta (B.1.617.2) and Omicron (B.1.1.529) variants of concern? This is a story of mice and men, of up to 1,000,000 infected cells in one person, where each cell produces between 105 and 106 viral RNAs, of immune-compromised patients, the digestive tract and viral recombination.
ARTICLE | doi:10.20944/preprints202105.0165.v1
Subject: Medicine & Pharmacology, Allergology Keywords: Intraoral Scanners; Intra-Oral Scanners; CAD/CAM; Digital Dentistry; Trueness; Precision; Accuracy; Scanners; Lab Scanners
Online: 10 May 2021 (10:44:19 CEST)
(1) Background: The purpose of this study is to evaluate the full arch scan accuracy (precision and trueness) of nine digital intra-oral scanners and four lab scanners. Previous studies have compared the accuracy of some intra-oral scanners, but as this is a field of quickly developing technologies, a more up-to-date study was needed to assess the capabilities of currently available models.; (2) Methods: The present in vitro study compared nine different intraoral scanners (Omnicam 4.6; Omnicam 5.1; Primescan; CS 3600; Trios 3; Trios 4; Runyes; i500 and DL206) as well as four lab light scanners (Einscan SE; 300e; E2 and Ineos X5) to investigate the accuracy of each scanner by examining the overall trueness and precision. Ten aligned and cut scans from each of the intra-oral and lab scanners in the in vitro study were brought into CloudCompare. A comparison was made with the master STL using the CloudCompare 3D analysis best-fit algorithm. The results were recorded along with individual standard deviation and a colorimetric map of the deviation across the surface of the STL mesh; a comparison was made to the master STL, quantified at specific points. ; (3) Results: In the present study, the Primescan had the best overall trueness (17.3 ± 4.9). Followed by (in order of increasing deviation) the Trios 4 (20.8 ± 6.2), i500 (25.2 ± 7.3), CS3600 (26.9 ± 15.9), Trios 3 (27.7 ± 6.8), Runyes (47.2 ± 5.4), Omnicam 5.1 (55.1 ± 9.5), Omnicam 4.6 (57.5 ± 3.2) and Launca DL206 (58.5 ± 22.0). Regarding the lab light scanners, the Ineos X5 had the best overall trueness with (0.0 ± 1.9). Followed by (in order of increasing deviation) the 3Shape E2 (3.6 ± 2.2), Up3D 300E (12.8 ± 2.7), and Einscan SE (14.9 ± 9.5); (4) Conclusions: This study confirms that all current generations of intra-oral digital scanners can capture a reliable, reproducible full arch scan in dentate patients. Out of the intra-oral scanners tested, no scanner produced results significantly similar in trueness to the Ineos X5. However, the Primescan was the only one to be statistically of a similar level of trueness to the 3Shape E2 lab scanner. All scanners in the study had mean trueness of under 60-micron deviation. While this study can compare the scanning accuracy of this sample in a dentate arch, the scanning of a fully edentulous arch is more challenging. The accuracy of these scanners in edentulous cases should be examined in further studies.
ARTICLE | doi:10.20944/preprints202004.0030.v1
Subject: Medicine & Pharmacology, Pathology & Pathobiology Keywords: salivary glands, minor salivary glands, salivary gland carcinoma, mucoepidermoid carcinoma, in situ carcinoma, intra-cystic carcinoma
Online: 8 April 2020 (14:46:41 CEST)
Aims: To report on the clinico-pathological features of a series of 12 intra-oral mucoepidermoid carcinomas showing exclusive intra-cystic growth. Methods and methods: All mucoepidermoid carcinomas diagnosed in the period 1990-2012 were retrieved, the original histological preparations were reviewed to confirm the diagnosis, and from selected cases, showing exclusive intra-cystic neoplastic component, additional sections were cut at 3 subsequent 200m intervals and stained with Hematoxylin-Eosin, PAS and Alcian Blue, to possibly identify tumor invasion of the adjacent tissues, which could have been overlooked in the original histological preparations. Also, pertinent findings collected from the clinical charts and follow-up data were analyzed. Results: We identified 14 intraoral mucoepidermoid carcinomas treated by conservative surgery and with a minimum follow up of 5 years. The neosplasm were located in the hard palate (9 cases), the soft palate (2), the cheeck (2) and the retromolar trigone (1). In all instances histological examination was revealed the presence of a single cystic space, containing clusters of columnar, intermediate, epidermoid, clear and mucous-producing cells, the latter exhibiting distinct intra-cytoplasmic mucin production, as confirmed by PAS and Alcian Blue stains. The cysts were entirely circumscribed by fibrous connective tissue and no solid areas or infiltrating tumour clusters were detected. Conservative surgical resection was performed in all cases and no recurrences or nodal metastases were observed during the follow up period. Conclusions: Mucoepidermoid carcinomas showing prominent (>20%) intra-cystic proliferation currently are considered low-grade tumours. In addition, we also unveil the possibility that mucoepidermoid carcinomas, at least in their early growth phase, may display an exclusive intra-cystic fashion and might be considered as in situ carcinomas, unable to infiltrate adjacent tissues or metastasize.
ARTICLE | doi:10.20944/preprints201909.0145.v1
Subject: Engineering, Civil Engineering Keywords: decentralized water systems; cluster approach; intra-cluster homogeneity; Water Supply Systems (WSS); Urban Water Systems (UWS)
Online: 14 September 2019 (19:33:09 CEST)
Abstract: Current models in design of urban water management systems and their corresponding infrastructure using centralized designs have commonly failed from the perspective of cost effectiveness and inability to adapt to the future changes. These challenges are driving cities towards using decentralized systems. While there is great consensus on the benefits of decentralization; currently no methods exist which guide decision-makers to define the optimal boundaries of decentralized water systems. A new clustering methodology and tool to decentralize water supply systems (WSS) into small and adaptable units is presented. The tool includes two major components: (i) minimization of the distance from source to consumer by assigning demand to the closest water source, and (ii) maximization of the intra-cluster homogeneity by defining the cluster boundaries such that the variation in population density, land use, socio-economic level, and topography within the cluster is minimized. The methodology and tool are applied to Arua Town in Uganda. Four random cluster scenarios and a centralized system were created and compared with the optimal clustered WSS. It was observed that the operational cost of the four cluster scenarios is up to 13.9 % higher than the optimal, and the centralized system is 26.6% higher than the optimal clustered WSS, consequently verifying the efficacy of the proposed method to determine an optimal cluster boundary for WSS. In addition, optimal homogeneous clusters improve efficiency by encouraging reuse of wastewater and stormwater within a cluster and by minimizing leakage through reduced pressure variations.
ARTICLE | doi:10.20944/preprints202101.0361.v1
Subject: Earth Sciences, Atmospheric Science Keywords: Paleozoic granitoids; pegmatites; age; collisional; intra-plate; magmatism; mineralogical and geochemical types; mineralization; minerals; post-collisinal; amazonite; genesis
Online: 18 January 2021 (16:14:03 CET)
The paper presents new data on mineralogical-geochemical peculiarities of the granites and pegmatites of the Baikal area (Olkhon Region) with implications for the age, generation conditions and geodynamic settings of magmatism. The early Paleozoic granitoids of the Olkhon region are syncollisional formations produced from the gneiss-schistose substratum of the Olkhon metamorphic sequences. Pegmatoid granites and pegmatites of the Region were generated within a wide age range (458-390 Ma) and include different mineralogical and geochemical types. Amongst the Early Paleozoic granitoids, pegmatoid rocks are products of the collisional magmatism evolution and are similar to granites in terms of the mineral composition and distribution patterns of rare and rare earth elements. On the Olkhon island (Baikal lake) the pegmatite of the Tashkiney vein belong to the Be-Nb-Ta mineralogical-geochemical type demonstrating high contents of W, Sn U, Th and very low concentrations of Li and volatile components (F, B). In the Pryolkhonye area, vein pegmatite Iliksin is with Li, Be, Nb, Ta mineralization (lepidolite, vorobyevite, samarskite et al). The studied pegmatite veins are similar both by the profound negative Ba, Sr, Eu, and Zr anomalies. The zircons from the Tashkiney vein (390±5.0 Ma) and of the Iliksin vein (430.1±2.2 Ma, U-Pb isotope LA ICP MS metod) indicate the formation of pegmatite at the late post-collisional stage of magmatism in the Olkhon Region. As regard to mineralogical and geochemical characteristics, vein pegmatites with amazonite (Ainsky and Ulan-Nur) belong to the Li-F type. The tantalum mineralization, represented by microlites and minerals of the columbite-tantalite group is associated with the Ainsky amazonite pegmatite. As opposed to the Early Paleozoic syncollisional granitoids and pegmatoid formations, the middle Paleozoic vein bodies of pegmatites (Tashkiney, Iliksin, Ainsky, Ulan-Nur) are regarded as rare-metal pegmatites. In terms of geochemical characteristics, they are similar to the rare-metal pegmatoid granites and pegmatites of the intra-plate setting widespread in Mongolia and Transbaikalia. The rare-metal mineralization in the Olkhon region may be genetically related to the evolution of Be-Nb-Ta and Li-F types of the post-collisional granites and pegmatites.
ARTICLE | doi:10.20944/preprints201910.0235.v1
Subject: Life Sciences, Genetics Keywords: African locust bean; climate change; cluster analysis; genetic intra-specific diversity; polymorphic information content; food and nutrition security
Online: 20 October 2019 (16:01:21 CEST)
African locust bean (Parkia biglobosa (Jacq.) is a multi-purpose economic tree with genetic potentials in sub-Saharan Africa. Its cultivation and production is declining with increased aging and genetically threatened throughout its natural ranges. Research efforts are needed to change the present scenario to sustainable cultivation and utilization, hence this present study. This study was aimed at evaluating genetic diversity and geographical spread relationships of twenty landraces collected from different ecological zones of Nigeria using simple sequence repeat (SSR) markers. Ten SSR markers were screened and five primers (PbL02, PbL03, PbL04, PbL05 and PbL09) were selected based on clear amplification products and reproducible scorable bands. The SSR primers detected a total of 55 alleles ranged from 10 to 14 alleles with a mean of 11. The percentage polymorphisms were high and ranged from 68.75 % in PbL04 to 84.21 % in PbL05 with a mean of 74.16 %. The polymorphic information content (PIC) was in the range of 0.31 in PbL02 to 0.37 in PbL09. The genetic diversity and heterozygosity values ranged from 0.39 to 0.50 and 0.00 to 0.68 while the average genetic distance for all pair wise comparisons was 0.31.The first five Principal Component (PC) accounted for 70.20 % of the total variation out of which PC1 (31.50%) and PC2 (19.20%) extracted 49.70% molecular similarity. The dendrogram resulted in separation of the 19 landraces into three major clusters based on unweighted pair group method with arithmetic average. Cluster I comprised of five landraces: ABNo130 and BENo023; OYNo11, KANo125 and NiNo262 while cluster II had only one (BANo116). Cluster III was diverse comprising 13 landraces: ZANo188, KNNo162, KENo220, GMNo076 and EbNo260, ADNo64, EdNo164, KANo137, KENo217, KwNo270, NiNo241, OsNo206 and PLNo120. The homogeneity of alleles among the studied landraces suggested suspicion of loss of genetic intra-specific variation among the landraces of P. biglobosa which calls for concerted efforts toward better cultivation, conservation, management, utilization and genetic improvement of the species in Nigeria.
ARTICLE | doi:10.20944/preprints201807.0053.v1
Subject: Engineering, Electrical & Electronic Engineering Keywords: Intra-body communication; path loss; microwave probes; channel characterization; fat tissue; ex-vivo; phantom; dielectric properties; topology optimization.
Online: 3 July 2018 (15:08:56 CEST)
In this paper, we investigate the use of fat tissue as a communication channel between in-body, implanted devices at R-band frequencies (1.7–2.6 GHz). The proposed fat channel is based on an anatomical model of the human body. We propose a novel probe that is optimized to efficiently radiate the R-band frequencies into the fat tissue. We use our probe to evaluate the path loss of the fat channel by studying the channel transmission coefficient over the R-band frequencies. We conduct extensive simulation studies and validate our results by experimentation on phantom and ex-vivo porcine tissue, with good agreement between simulations and experiments. We demonstrate a performance comparison between the fat channel and similar waveguide structures. Our characterization of the fat channel reveals propagation path loss of 1.4 dB and 3.8 dB per 20 mm for phantom and ex-vivo porcine tissue, respectively. These results demonstrate that fat tissue can be used as a communication channel for high data rate intra-body networks.
REVIEW | doi:10.20944/preprints202201.0407.v1
Subject: Mathematics & Computer Science, Probability And Statistics Keywords: Bayesian nonlinear hierarchical model; Bayesian nonlinear mixed effects models; Inter-individual variation; Intra-individual variation; Markov chain Monte Carlo technique
Online: 27 January 2022 (04:55:25 CET)
Bayesian nonlinear mixed effects models for data in the form of continuous, repeated measurements from a population, also known as Bayesian hierarchical nonlinear models, are a popular platform for analysis when interest focuses on individual specific characteristics and relevant uncertainty quantification. Due to the limitation of computational power, this framework was relatively dormant until the late 1980s, but in recent years, the statistical research community saw vigorous development of new methodological and computational techniques for these models, the emergence of software, and wide application of the models in numerous industrial and academic fields. This article presents an overview of the formulation, interpretation, and implementation of Bayesian nonlinear mixed effects models and surveys recent advances and applications.
REVIEW | doi:10.20944/preprints202204.0166.v1
Subject: Medicine & Pharmacology, General Medical Research Keywords: acute kidney injury; intra-abdominal pressure; oxidative stress; renal cortical blood flow; renal medullar blood flow; renal lymphatic drainage; venous congestion
Online: 18 April 2022 (10:45:36 CEST)
Acute kidney injury (AKI), especially if recurring represents a risk factor for future chronic kidney disease. In intensive care units, increased intraabdominal pressure is well-recognized as a significant contributor of AKI. However, the importance of transiently increased intra-abdominal pressures procedures is less commonly appreciated during laparoscopic surgery, the use of which has rapidly increased over the last few decades. Unlike the well-known autoregulation of the renal cortical circulation, medulla perfusion is modulated via partially independent regulatory mechanisms and strongly impacted by changes in venous and lymphatic pressures. In our review paper, we will provide a comprehensive overview of this evolving topic, covering a broad range from basic pathophysiology up to and including current clinical relevance. Key regulators of oxidative stress such as ischemia-reperfusion injury, the activation of inflammatory response and humoral changes interacting with procedural pneumoperitoneum formation and AKI risk will be recounted. Moreover, we present an in-depth review of the interaction of pneumoperitoneum formation with general anesthetic agents and animal models of congestive heart failure. A better understanding of the relationship between pneumoperitoneum formation and renal perfusion will support basic and clinical research, leading to improved clinical care and collaboration among specialists.
ARTICLE | doi:10.20944/preprints202204.0183.v1
Subject: Medicine & Pharmacology, Oncology & Oncogenics Keywords: resistant TNBC; intra-tumoral heterogeneity; breast cancer relapse; breast cancer epigenome; me-tastasis prevention; intrinsic resistance of cancer; tumor adaptability; targeting resistant cancer
Online: 20 April 2022 (04:16:31 CEST)
We previously described a model of deep intrinsic resistance of breast cancer wherein we used a function-based approach to selection of cancer cells that can survive a variety of challenges in prolonged but reversible quiescence. Our experimental results suggested that resistant cancer cells possess a variety of mechanisms, including modifications of the epigenome and transcriptome, for generating a high degree of cellular heterogeneity. In the present study, we evaluated JIB-04, a small-molecule epigenetic inhibitor initially discovered to inhibit cancer growth, to determine its ability to affect deep intrinsic resistance in our breast cancer model. We found that long pretreatment with JIB-04 sensitized resistant triple-negative inflammatory breast cancer cells and their parental cell line SUM149 to the chemotherapeutic drugs doxorubicin and paclitaxel. Resistant cancer cells derived from another inflammatory breast cancer cell line, FC-IBC02, were considerably more sensitive to JIB-04 than was the parental cell line. Investigating a mechanism of sensitization, we found that JIB-04 exposure increased the expression of PD-L1 in resistant cells, suggesting that JIB-04 may also sensitize resistant breast cancer cells to anti-PD-L1 immune therapy. Finally, these results support the usefulness of our experimental strategy for evaluating anticancer agents such as JIB-04 that may halt cancer evolution and prevent development of cancer resistance to currently used therapies.
ARTICLE | doi:10.20944/preprints202207.0361.v1
Subject: Medicine & Pharmacology, Anesthesiology Keywords: PSPS; FBSS; SCS; surgical lead; SCS implantation; MAST (for Minimal Access Spine Technologies); TCIVA (for Target Controlled Intra-Veinous Anesthesia); composite score; pain mapping; neuropathic pain; chronic pain; quality of life; anesthesia; hypnosis
Online: 25 July 2022 (08:34:26 CEST)
Spinal Cord Stimulation (SCS) is an effective and validated treatment to address chronic refractory neuropathic pain in Persistent Spinal Pain Syndrome-Type 2 (PSPS-T2) patients. Surgical SCS lead placement is traditionally performed under general anesthesia due to its invasiveness. In parallel, recent works have suggested that Awake Anesthesia (AA), consisting in Target Controlled Intra-Veinous Anesthesia (TCIVA), could be an interesting tool to optimize lead anatomical placement using patient intra-operative feedback. We hypothesized that combining AA with Minimal Invasive Surgery (MIS) could improve SCS outcomes. The goal of this study was to evaluate SCS lead performance (defined by the area of pain adequately covered by paraesthesia generated via SCS), using an intraoperative objective quantitative mapping tool, and secondarily to assess pain relief, functional improvement and change in quality of life with a composite score. We analyzed data from a prospective multicenter study (ESTIMET) to compare the outcomes of 115 patients implanted with MIS under AA (MISAA group) or General Anesthesia (MISGA group), or by Laminectomy under General Anesthesia (LGA group). All in all, MISAA appears to show significantly better performance in terms of patient pain coverage, as well as improved secondary outcomes. One step further, our results suggest that MISAA combined with intra-operative hypnosis could potentialize patient intraoperative cooperation and could be proposed as a personalized package offered to PSPS-T2 patients eligible for SCS implantation in highly dedicated neuromodulation centers.