Closure Of Gap Research Articles

The effectiveness of demineralized cortical bone matrix in a chronic rotator cuff tear model

The purpose of this study was to assess the effect of demineralized bone matrix (DBM) on rotator cuff tendon-bone healing. The hypothesis was that compared with a commercially available dermal matrix scaffold, DBM would result in a higher bone mineral density and regenerate a morphologically superior enthesis in a rat model of chronic rotator cuff degeneration. Eighteen female Wistar rats underwent unilateral detachment of the supraspinatus tendon. Three weeks later, tendon repair was carried out in animals randomized into 3 groups: group 1 animals were repaired with DBM (n = 6); group 2 received augmentation with the dermal scaffold (n = 6); and group 3 (controls) underwent nonaugmented tendon-bone repair (n = 6). Specimens were retrieved at 6 weeks postoperatively for histologic analysis and evaluation of bone mineral density. No failures of tendon-bone healing were noted throughout the study. All groups demonstrated closure of the tendon-bone gap with a fibrocartilaginous interface. Dermal collagen specimens exhibited a disorganized structure with significantly more abnormal collagen fiber arrangement and cellularity than in the DBM-based repairs. Nonaugmented repairs exhibited a significantly higher bone mineral density than in DBM and the dermal collagen specimens and were not significantly different from control limbs that were not operated on. The application of DBM to a rat model of chronic rotator cuff degeneration did not improve the composition of the healing enthesis compared with nonaugmented controls and a commercially available scaffold. However, perhaps the most important finding of this study was that the control group demonstrated a similar outcome to augmented repairs.

The Power of Packing: Metallization of an Organic Semiconductor.

Benzoquino-bis-1,2,3-dithiazole 5 is a closed shell, antiaromatic 16π-electron zwitterion with a small HOMO-LUMO gap. Its crystal structure consists of planar ribbon-like molecular arrays packed into offset layers to generate a "brick-wall" motif with strong 2D interlayer electronic interactions. The spread of the valence and conduction bands, coupled with the narrow HOMO-LUMO gap, affords a small band gap semiconductor with σRT = 1 × 10-3 S cm-1 and Eact = 0.14 eV for transport within the brick-wall arrays. Closure of the band gap to form an all-organic molecular metal with σRT > 101 S cm-1 can be achieved by the application of pressure to 8 GPa.

MINIMALLY INVASIVE METHODS OF SURGICAL TREATMENT OF ENDOCRINE OPHTHALMOPATHY

“Balanced” bone decompression of the orbit was performed in a patient with endocrine ophthalmopathy, CAS3, OD=30 mm, OS=31 mm with the use of minimally invasive transconjunctival approaches and frameless neuronavigation. At the first stage the preoperative computed tomography of the orbits was imported into the navigation software, and then marked the area of the proposed resection of the orbit walls. Further, in the operating room, the patient was registered in the navigation system. To perform bone decompression of the orbit and lipectomy, we used preseptal, transcaruncular and lateral retrocanthal approaches. These approaches are transconjunctival and do not leave postoperative scars. Upon completion of the orbitotomy, its accuracy and dimensions were determined by the intraoperative pointer of the neuronavigation system. Results. The postoperative period was uneventful. In the early postoperative period there was a regression of exophthalmus OD=26 mm, OS=27 mm, closure of the eye gap, but retraction of the eyelids remained. When examined 3 months after the operation, the exophthalmic regression was OD=23 mm, OS=24 mm, retraction of the eyelids — 1 mm, with lead — finishing to the lateral adhesion. When examined after 6 months — the position of the eyeballs in orbit: ОD=21 mm, ОS=22 mm, retraction of the eyelids is not present, there is no violation of oculomotorics, complications were not recorded. A satisfactory result was obtained. Conclusion. Minimally invasive transorbital approaches allow the transconjunctival acces to all orbital walls to perform decompression of the orbit and lipectomy without cutaneous incisions, to achieve good cosmetic and functional results. And the intraoperative use of the neuronavigation system ensures the bone decompression of the orbit in full. The technique is promising and requires further randomized studies.

Stapes Surgery Using Stapedotomy versus Partial Stapedectomy

Objectives: To compare the audiological outcomes of two different approaches of stapes surgery, stapedotomy versus partial stapedectomy. Specifically, our experience in this area will be reviewed and compared to results from other centers performing this kind of surgery. Methods: A retrospective chart review of patients who underwent a stapes surgery between 1997 and 2015. A total of 84 surgeries were performed during this period. Seventy-seven subjects were included in the present study. The audiological results as well as the postoperative vertigo were compared. Results: There is significant improvement demonstrated in postoperative closure of Air Bone Gap in both groups. The partial stapedectomy group showed a significant improvement of air–bone gap closure of 10 dB or more (500 Hz to 2000 Hz) compared with the stapedotomy group, which was achieved in 53.1% and 42.2% of both group respectively. Interestingly, by including the full range of speech frequencies (500 Hz to 4000 Hz), the stapedotomy procedure showed better audiological results than partial stapedectomy. The postoperative vertigo was higher in the partial stapedectomy group. Conclusion: The results of this study clearly show that stapedotomy provides good audiometric results and a lower incidence of complications compared to partial stapedectomy.

The Dynamics of the Interest Rate in the Austrian Business Cycle Theory

This study investigates the behaviour of the interest rate over the business cycle that is predicted by the Austrian theory of economic fluctuations. The first part briefly introduces the Austrian approach and develops some of its basic tools. The second part focuses on the gap between the market rate of interest and the natural rate. The sources and consequences of this gap are studied in detail. Much emphasis is put on processes that eventually bring about a closure of this gap. Monetary policy is then identified as the main creator of this gap. Subsequent parts of the paper investigate limits of its power to keep this gap opened. The following sections find additional reasons why the market interest rate may deviate from its natural counterpart. The last section discusses the influence of the monetary policy on the natural rate itself and concludes with recommendations of great caution the central bank should follow in conducting the monetary policy.

Topological phase transition and evolution of edge states in In-rich InGaN/GaN quantum wells under hydrostatic pressure

Combining the k · p method with the third-order elasticity theory, we perform a theoretical study of the pressure-induced topological phase transition and the pressure evolution of topologically protected edge states in InN/GaN and In-rich InGaN/GaN quantum wells. We show that for a certain range of the quantum well parameters, thanks to a negative band gap pressure coefficient, it is possible to continuously drive the system from the normal insulator state through the topological insulator into the semimetal phase. The critical pressure for the topological phase transition depends not only on the quantum well thickness but also on the width of the Hall bar, which determines the coupling between the edge states localized at the opposite edges. We also find that in narrow Hall bar structures, near the topological phase transition, a significant Rashba-type spin splitting of the lower and upper branches of the edge state dispersion curve appears. This effect originates from the lack of the mirror symmetry of the quantum well potential caused by the built-in electric field, and can be suppressed by increasing the Hall bar width. When the pressure increases, the energy dispersion of the edge states becomes more parabolic-like and the spin splitting decreases. A further increase of pressure leads to the transition to a semimetal phase, which occurs due to the closure of the indirect 2D bulk band gap. The difference between the critical pressure at which the system becomes semimetallic, and the pressure for the topological phase transition, correlates with the variation of the pressure coefficient of the band gap in the normal insulator state.

Pressure dependence of the band-gap energy in BiTeI

The evolution of the electronic structure of BiTeI, a layered semiconductor with a van der Waals gap, under compression is studied by employing semilocal and dispersion-corrected density-functional calculations. Comparative analysis of the results of these calculations shows that the band-gap energy of BiTeI decreases till it attains a minimum value of zero at a critical pressure, after which it increases again. The critical pressure corresponding to the closure of the band gap is calculated, at which BiTeI becomes a topological insulator. Comparison of the critical pressure to the pressure at which BiTeI undergoes a structural phase transition indicates that the closure of the band gap would not be hindered by a structural transformation. Moreover, the band-gap pressure coefficients of BiTeI are computed, and an expression of the critical pressure is devised in terms of these coefficients. Our findings indicate that the semilocal and dispersion-corrected approaches are in conflict about the compressibility of BiTeI, which result in overestimation and underestimation, respectively. Nevertheless, the effect of pressure on the atomic structure of BiTeI is found to be manifested primarily as the reduction of the width of the van der Waals gap according to both approaches, which also yield consistent predictions concerning the interlayer metallic bonding in BiTeI under compression. It is consequently shown that the calculated band-gap energies follow qualitatively and quantitatively the same trend within the two approximations employed here, and the transition to the zero-gap state occurs at the same critical width of the van der Waals gap.

Stapedectomy in Teunissen-Cremers Syndrome: Intraoperative Findings and Hearing Outcomes.

To describe the intraoperative findings and outcomes of stapedectomy surgery in Teunissen-Cremers syndrome. A family of three patients with bilateral conductive hearing loss because of Teunissen-Cremers syndrome. Six exploratory tympanotomies and stapedectomies, including one revision operation. Intraoperative findings and postoperative hearing results. There was an increased distance between the incus and the vestibule, a thicker long process of the incus, and slight variation in the relative position of the ossicles in all patients. Surgery resulted in closure of the air-bone gap to less than 10 dB in all five operated ears. We describe anatomic abnormalities of the ossicular chain in Teunissen-Cremers syndrome. Prosthesis availability should include prostheses that can adapt to these potential anatomic abnormalities. Stapedectomy resulted in good long-term hearing outcomes in this series.

SGLT2 Inhibitors: Mind the Gap

SESSION TITLE: Fellow Case Report Slide: Critical Care II SESSION TYPE: Affiliate Case Report Slide PRESENTED ON: Tuesday, October 25, 2016 at 07:30 AM - 08:30 AM INTRODUCTION: Sodium Glucose Co-transporter 2 (SGLT2) inhibitors are being increasingly prescribed for Type 2 diabetes mellitus (DM). Our case describes euglycemic diabetic ketoacidosis (DKA) in a patient with Type 1 DM in the setting of SGLT2 inhibitor use. CASE PRESENTATION: A 20-year old woman presented with polydipsia, anorexia and a blood glucose level of 300 mg/dL on her home blood glucose monitor. She had type 1 DM controlled on insulin pump for the past 10 years. Two weeks prior to admission she was started on Canagliflozin, an oral SGLT2 inhibitor. She was admitted with DKA, anion gap of 29 mmol/dL and serum glucose of 289 mg/dL. Insulin pump was discontinued and she was initiated on insulin infusion. Within 12 hours, anion gap closed and she was transitioned to long acting insulin. However, DKA relapsed within 1 day. She had no precipitating factors for DKA except persistent heavy glycosuria. We hypothesized that she had insulin deficiency despite near normal blood glucose level likely due to persistent glycosuria as a result of ongoing SGLT2 inhibition and impaired glucose reabsoprtion in the proximal renal tubules. She was subsequently initiated on higher insulin infusion with 10 % Dextrose infusion to allow metabolism of ketones and prevent hypoglycemia. She required insulin infusion for 4 days before closure of anion gap. Large level of glycosuria persisted for 7 days before showing a declining trend. She was discharged on subcutaneous insulin regimen. DISCUSSION: SGLT2 inhibitors promote weight loss and may have cardiovascular benefits. While SGLT2 use may be feasible1, no randomized trials have established their efficacy or safety in Type 1 DM. SGLT2 use in T2 DM precipitating euglycemic DKA is well described.2 DKA in the setting of SGLT2 inhibitor use may be diagnosed late due to relatively normal blood glucose level. Insulin infusion may be required at a higher dose and for prolonged periods with dextrose infusion due to continued glycosuria and relative normoglycemia. CONCLUSIONS: With recent popularity of this drug class, physicians should be aware of refractory euglycemic DKA and persistent glycosuria precipitated by SGLT2 inhibitors. Reference #1: Henry RR, et al. Exploring the Potential of the SGLT2 Inhibitor Dapagliflozin in Type 1 Diabetes: A Randomized, Double Blind, Placebo-Controlled Pilot Study. Diabetes Care 2015; 38:412-419. Reference #2: Hayami T, et al. Case of ketoacidosis by a SGLT2 inhibitor in a diabetic patient with a low carbohydrate diet. Journal of Diabetes Investigation 2015; 6:587-590. DISCLOSURE: The following authors have nothing to disclose: Chuan Jiang, Atul Palkar, Jonathan Caronia, Eric Gottesman No Product/Research Disclosure Information

Building a Fast Lane for Mg Diffusion in α-MoO3 by Fluorine Doping

Following previous experimental work examining a layered oxyfluoride as cathode material for Mg-ion batteries [Incorvati et al., Chem. Mater. 2016, 28, 17], we study the role of fluorination on the structural and electronic properties of molybdenum trioxide and its impact on Mg intercalation and diffusion using first-principles methods. Although bulk α-MoO3 is a 2D layered compound, we find that it provides 3D channels for Mg diffusion. When F atoms are incorporated into the α-MoO3 lattice, they replace the O atoms sitting at a specific crystallographic site that is linked by two nearest Mo atoms within a single Mo–O layer. As a consequence of F substitution, the local Mo-anion bonds are distorted, which leads to closure of the electronic band gap. From the analysis of zone center phonon vibrational frequencies, it is found that the local Mo-anion bonding strength is weakened by replacing O2– with F–, which ultimately facilitates Mg diffusion through the F-substituted lattice. For example, it is shown tha...

Comparison of outcomes of palisade cartilage with temporalis fascia following tympanoplasty at a tertiary care centre in Nepal

<p class="abstract"><strong>Background:</strong> Mucosal type of chronic otitis media is a common disease worldwide with 5.2% prevalence in Nepal. Cartilage material is criticized in terms of hearing results due to its thickness. The objective of this study was to compare graft uptake and post-operative hearing of palisade cartilage with temporalis fascia following tympanoplasty.</p><p class="abstract"><strong>Methods:</strong> A prospective randomized study conducted over 12 months included subjects of chronic otitis media mucosal inactive having dry ear for at least 4 weeks. 76 subjects were enrolled and reviewed on 6<sup>th</sup> post-operative day, 6<sup>th</sup> and 12<sup>th</sup> post-operative week. The graft uptake and post-operative hearing were evaluated. The results were compared within and between the groups. </p><p class="abstract"><strong>Results:</strong> The graft uptake on 42<sup>nd</sup> and 90<sup>th </sup>post-operative days were comparable with no statistical difference. The difference of mean pre-operative, 42<sup>nd </sup>and 90<sup>th</sup> post-operative air bone gaps in palisade cartilage and temporalis fascia were also comparable. The results were statistically significant, showing improvement in hearing after surgery. Closure of air-bone gap within 30 dB was achieved in 71.87% in temporalis fascia and 88.89% in palisade cartilage. The intergroup difference was not statistically significant.</p><p><strong>Conclusions:</strong> The graft uptake rates and hearing results after palisade cartilage are similar to temporalis fascia.</p>

Does stapes surgery improve tinnitus in patients with otosclerosis?

IntroductionOtosclerosis (OS) is the primary disease of the human temporal bone characterized by conductive hearing loss and tinnitus. The exact pathogenesis of tinnitus in otosclerosis patients is not known and factors affecting the tinnitus outcome in otosclerosis patients are still controversial. ObjectivesTo find the effect of stapedotomy on tinnitus for otosclerosis patients. MethodsFifty-six otosclerosis patients with preoperative tinnitus were enrolled to the study. Pure tone average Air-Bone Gap values, preoperative tinnitus pitch, Air-Bone Gap closure at tinnitus frequencies were evaluated for their effect on the postoperative outcome. ResultsLow pitch tinnitus had more favorable outcome compared to high pitch tinnitus (p=0.002). Postoperative average pure tone thresholds Air-Bone Gap values were not related to the postoperative tinnitus (p=0.213). There was no statistically significant difference between postoperative Air-Bone Gap closure at tinnitus frequency and improvement of high pitch tinnitus (p=0.427). There was a statistically significant difference between Air-Bone Gap improvement in tinnitus frequency and low pitch tinnitus recovery (p=0.026). ConclusionLow pitch tinnitus is more likely to be resolved after stapedotomy for patients with otosclerosis. High pitch tinnitus may not resolve even after closure of the Air-Bone Gap at tinnitus frequencies.

Positivistic Management Accounting Research : Recent Issues and Future Directions

The mainstream positivistic approach to management accounting research seeks to provide essentially rational explanations to social phenomena. Reviewing the recent issues in this approach to provide some directions for future research is the main aim of this paper. Various recent issues surrounding the use of this approach in management accounting research have been reviewed in this paper, including the recent debate around empirical positivistic research in management accounting, the sound definition of management accounting constructs, the closure of gap between surveys and case studies in management accounting research, the appropriate use of statistical methods for testing hypotheses in management accounting and the use of graphics to map theory-consistent empirical research. Based on this review, some guidelines and recommendations have been offered.

Effect of Type 1 Tympanoplasty on the Quality of Life of CSOM Patients.

Chronic suppurative otitis media (CSOM) continues to be an important public health problem despite significant advances in medical science. Ear discharge, pain, discomfort, difficulty in hearing, limitation of routine activities and emotional problems due to CSOM cause a significant impact on the health and general well being of the patient. We have done Type 1 tympanoplasty in tubotympanic type of COM to reconstruct the tympanic membrane and alleviate the symptoms of the patients. This study presents an analysis of the impact of the surgery on the patient subjectively and its correlation with objective outcomes. 45 patients were selected to fill the chronic otitis media-5 (COM-5) questionnaire and underwent pure tone audiometry preoperatively. All the patients underwent Type 1 tympanoplasty by using temporalis fascia graft. The status of the ossicles was checked and documented intraoperatively. Patients requiring ossicular reconstruction or with attico antral disease were excluded. Patients were followed up for a period of 6months and those with an intact graft after 6months were included in the study. These patients were again made to fill the questionnaire and undergo pure tone audiometry postoperatively. 37 out of 45 patients (82%) had an intact graft 6months after surgery. Marked improvement was observed in subjective scores as documented by the questionnaire, pre- and postoperatively with the mean improvement in total scores being 7.89±4.81 on a Visual Analogue Scale. Also significant improvement was achieved in closure of air-bone gap with the mean improvement being 14.73±8.58dB. Significant correlation was found between subjective and objective scores in most patients. This study showed that Type 1 tympanoplasty brings about a significant improvement in the quality of life of chronic suppurative otitis media patients. Most patients showed a marked improvement in subjective scores which correlated well with the objective findings of the status of the graft and improvement in air-bone gap. Asymptomatic patients with less preoperative scores showed less improvement in subjective scores which did not correlate with the objective outcomes.

Pressure-Resistant Intermediate Valence in the Kondo Insulator SmB_{6}.

Resonant x-ray emission spectroscopy was used to determine the pressure dependence of the f-electron occupancy in the Kondo insulator SmB_{6}. Applied pressure reduces the f occupancy, but surprisingly, the material maintains a significant divalent character up to a pressure of at least 35GPa. Thus, the closure of the resistive activation energy gap and onset of magnetic order are not driven by stabilization of an integer valent state. Over the entire pressure range, the material maintains a remarkably stable intermediate valence that can in principle support a nontrivial band structure.

Management of epi- and mesotympanic cholesteatomas by one-stage trans-canal atticotomy in adults.

Surgical management of cholesteatoma limited to the attic and/or mesotympanum remains controversial. The aim of this study is to evaluate the anatomical and the functional results of trans-canal atticotomy in this pathological condition. The records of 27 adult patients treated from 2008 to 2014 who underwent trans-canal atticotomy for primary cholesteatoma surgery were reviewed. Pre-operative physical examination, audiometry, and CT-scan have been analyzed. Intraoperative findings have been described as well as the surgical technique. Anatomical and functional results have been evaluated with a mean follow-up of 24±12.2months, and the results of a CT-scan performed 1year after surgery were examined to assess the presence of residual disease. Surgeries were uneventful. During the follow-up, 1 patient (4%) experienced a retraction of the attical reconstruction; all the other patients had a well-healed tympanic drum with stable attical reconstruction. The mean air-bone gap was 19±12.2 and 10±7.3dB pre-operatively and post-operatively, respectively (mean±SD, p=0.001, paired t test). Twenty-two patients (81%) had no opacity suggesting residual cholesteatoma in CT-scan. Four patients (15%) presenting an opacity at CT-scan underwent MRI study that was negative for residual cholesteatoma. One patient (4%) had displacement of the ossicular prosthesis. In conclusion, cholesteatomas restricted to the attic and/or mesotympanum can be removed in a one-stage technique with no visible residual at 1year, and with closure of the air-bone gap by 50%.

Boundaryless Careers: The Undestined Solution to the Gender Salary Gap Closure

In the present study we explore and compare the effects of inter-organisational boundaryless careers on gender-wise real salary growth. We analyse career paths of over 10600 individuals from the German Socio Economic Panel by utilizing the latent basis growth curve modelling, and find that (i) boundaryless careers result in real salary growth for both genders, yet (ii) women’s salaries grow faster in boundaryless careers than men’s. Furthermore, we find no evidence that boundaryless careers contribute to the narrowing or closure of the gender salary gap, because both genders benefit equally well from boundaryless careers, yet under certain conditions the salary gap can actually widen. Lastly, we find support for arguments from previous research that intra-organisational careers are more desirable, considering that overall they result in higher attained salaries. We provide implications for HR managers and professionals on how to manage their internal labour market with regard to the boundaryless careers, ...

Abnormal Congenital Location of Stapes' Superstructure: Clinical and Embryological Implications.

Congenital middle ear malformations are rare. Most part of them are usually associated with other malformations, such as aural atresia, microtia, and dysmorphic craniofacial features. A clinical case of a 24-year-old male with a right-sided conductive hearing loss since his childhood, without craniofacial malformation, is presented. He was proposed for exploratory tympanotomy under the suspicious diagnosis of otosclerosis. The surgery revealed an abnormal location of stapes' superstructure, which was attached to the promontory and had an isolated and mobile osseous footplate in the oval window. A stapes prosthesis was inserted and resulted in closure of the air-bone gap by 25 dB. A review of the literature was also performed using MEDLINE. Two theories diverge on the embryologic origin of the stapes. Our findings seem to be in favour of the theory that defines two different embryologic origins to the stapes.

Computer simulations of 3C-SiC under hydrostatic and non-hydrostatic stresses.

The response of 3C-SiC to hydrostatic pressure and to several uni- and bi-axial stress conditions is thoroughly investigated using first principles calculations. A topological interpretation of the chemical bonding reveals that the so-called non-covalent interactions enhance only at high pressure while the nature of the covalent Si-C bonding network keeps essentially with the same pattern. The calculated low compressibility agrees well with experimental values and is in concordance with the high structural stability of this polymorph under hydrostatic pressure. Under uniaxial [001] stress, the c/a ratio shows a noticeable drop inducing a closure of the band gap and the emergence of a metallic state around 40 GPa. This behavior correlates with a plateau of the electron localization function exhibiting a roughly constant and non-negligible value surrounding CSi4 and SiC4 covalent bonded units.

A Case of Superior Semicircular Canal Dehiscence Syndrome with Coexisting Otosclerosis

Superior semicircular canal dehiscence (SSCD) syndrome and otosclerosis have overlapping clinical manifestations that can be difficult to distinguish. Audiovestibular symptoms are caused by noise or straining in SSCD, which is associated with the presence of an air-bone gap that overlaps with the characteristic of otosclerosis. We recently examined a 51-year-old woman presenting with unilateral pulsatile tinnitus and ipsilateral hearing loss in the left ear. Computerized tomography, audiometry and vestibular function test confirmed the diagnosis of ipsilat eral SSCD syndrome with coexisting ipsilateral otosclerosis. The patient underwent surgical repair of dehiscence by middle fossa approach and stapes surgery for otosclerosis sequentially. She has not had pulsatile tinnitus postoperatively, and hearing improved with the closure of airbone gap at most frequencies. In conclusion, when SSCD syndrome and otosclerosis coexist and patient has representative symptoms of both ear pathologies, a sequential surgery can be an effective treatment option. Korean J Otorhinolaryngol-Head Neck Surg 2016;59(1):68-72 Key WordsZZOtosclerosis ㆍSemicircular canal ㆍ Superior semicircular canal dehiscence syndrome.