Miracle-dz/UniFAR-FTUs huggingface dataset:
Reverse Dynamization: Influence of Fixator Stiffness on the Mode and Efficiency of Large-Bone-Defect Healing at Different Doses of rhBMP-2.

BACKGROUND Reverse dynamization is a technology for enhancing the healing of osseous defects. With use of an external fixator, the axial stiffness across the defect is initially set low and subsequently increased. The purpose of the study described in this paper was to explore the efficacy of reverse dynamization under different conditions. METHODS Rat femoral defects were stabilized with external fixators that allowed the stiffness to be modulated on living animals. Recombinant human bone morphogenetic protein-2 (rhBMP-2) was implanted into the defects on a collagen sponge. Following a dose-response experiment, 5.5 μg of rhBMP-2 was placed into the defect under conditions of very low (25.4-N/mm), low (114-N/mm), medium (185-N/mm), or high (254-N/mm) stiffness. Reverse dynamization was evaluated with 2 different starting stiffnesses: low (114 N/mm) and very low (25.4 N/mm). In both cases, high stiffness (254 N/mm) was imposed after 2 weeks. Healing was assessed with radiographs, micro-computed tomography (μCT), histological analysis, and mechanical testing. RESULTS In the absence of dynamization, the medium-stiffness fixators provided the best healing. Reverse dynamization starting with very low stiffness was detrimental to healing. However, with low initial stiffness, reverse dynamization considerably improved healing with minimal residual cartilage, enhanced cortication, increased mechanical strength, and smaller callus. Histological analysis suggested that, in all cases, healing provoked by rhBMP-2 occurred by endochondral ossification. CONCLUSIONS These data confirm the potential utility of reverse dynamization as a way of improving bone healing but indicate that the stiffness parameters need to be selected carefully. CLINICAL RELEVANCE Reverse dynamization may reduce the amount of rhBMP-2 needed to induce healing of recalcitrant osseous lesions, reduce the time to union, and decrease the need for prolonged external fixation.
Biomedical dental waste management and awareness of waste management policy among private dental practitioners in Mangalore city, India

Aim: To assess (1) Awareness towards waste management policy and practices. (2) Approach towards waste management policy and practices. (3) Performance in waste management policy and practices among the private dental practitioners in the city of Mangalore, India. Study Design: A cross sectional study. Study subjects and methods: Ninety six private dental practitioners of Mangalore city responded to the self administered questionnaire on biomedical dental waste disposal. Questionnaire contained seventeen closed end type of questions. The questionnaire was designed in an appropriate way such that the objectives of the study were met. Data was analyzed using SPSS version 15. Results: A survey was conducted among 109 private dental practitioners in the city of Mangalore with a self administered questionnaire out of which 96 responded (88.07%). Overall 97.9% of the practitioners were aware of the waste management policy, 47.9 % were handing over the waste to municipal garbage collectors, 54.2% felt that there was a lack of awareness regarding the existing health care waste management services within the city, 44.8% contacted the certified waste carrier services, 42.7% discarded blood soaked swabs and gauze in specific colour coded plastics during disposal. Conclusion: From the study it was found that a large number of practitioners are aware of the legislation policy but have failed to contact and register their clinic under certified waste management services of the city. Lack of professional training has been a major cause for the same. Hence there is a need to educate the dental practitioners regarding proper practice measures. Key words: Bio medical waste, private dental practitioners, Dental office waste, self administered questionnaire.
Plate Fixation Compared with Nonoperative Treatment for Displaced Midshaft Clavicular Fractures: A Multicenter Randomized Controlled Trial

Background: The use of operative treatment for clavicular fractures is increasing, despite varying results in previous studies. The aim of this study was to compare plate fixation and nonoperative treatment for displaced midshaft clavicular fractures with respect to nonunion, adverse events, and shoulder function. Methods: In this multicenter, prospective, randomized controlled trial, patients between 18 and 60 years old with a displaced midshaft clavicular fracture were randomized between nonoperative treatment and open reduction with internal plate fixation. The primary outcome was evidence of nonunion at 1 year. Other outcomes were secondary operations, arm function as measured with the Constant shoulder score and Disabilities of the Arm, Shoulder and Hand (DASH) score, pain, cosmetic results, and general health status. Outcomes were recorded at 6 weeks, 3 months, and 1 year following trauma. Results: One hundred and sixty patients were randomized. The rate of nonunion was significantly higher in the nonoperatively treated group than in the operatively treated group (23.1% compared with 2.4%; p < 0.0001), as was the rate of nonunion for which secondary plate fixation was performed (12.9% compared with 1.2%; p = 0.006). The rate of secondary operations was 27.4% in the operatively treated group (16.7% for elective plate removal) and 17.1% in the nonoperatively treated group (p = 0.18). Nineteen percent of the patients in the operatively treated group had persistent loss of sensation around the scar. No difference was found between the groups with respect to the Constant and DASH scores at all time points. Conclusions: For patients with a diaphyseal fracture of the clavicle displaced at least 1 shaft width, plate fixation improves the chances that the bone will heal; however, the rate of patients who need a second operation is considerable. In addition, the procedure does not improve shoulder function or general symptoms, and it does not decrease limitations compared with nonoperative treatment in a sling. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
SOME ALTERATIONS IN THE PATTERN OF DRUG METABOLISM ASSOCIATED WITH PREGNANCY, ORAL CONTRACEPTIVES, AND THE NEWLY-BORN

SUMMARY Studies of the pattern of urinary excretion of pethidine and promazine, and of a selection of their primary metabolites, suggest that metabolism of these agents is rendered somewhat deficient during pregnancy, during the neonatal period and under the influence of certain oral contraceptive agents. Some general conclusions have been drawn from these observations. Increased caution in the administration of drugs to patients known to be taking oral contraceptives is recommended.
Senicapoc (ICA-17043): a potential therapy for the prevention and treatment of hemolysis-associated complications in sickle cell anemia

Sickle cell disease (SCD) is characterized by hemolytic as well as vaso-occlusive complications. The development of treatments for this inherited disease is based on an understanding of its pathophysiology. Polymerization of sickle hemoglobin is dependent on several independent factors, including the intracellular hemoglobin concentration. The hydration state (and intracellular hemoglobin concentration) of the sickle erythrocyte depends on the loss of solute and osmotically obliged water through specific pathways. Senicapoc (also known as ICA-17043) is a potent blocker of the Gardos channel, a calcium-activated potassium channel of intermediate conductance, in the red blood cell. Preclinical studies and studies in transgenic models of SCD show that inhibition of potassium efflux through the Gardos channel is associated with an increased hemoglobin level, decreased dense cells and decreased hemolysis. Senicapoc is well tolerated when administered to SCD patients and produces dose-dependent increases in hemoglobin and decreases in markers of hemolysis. Despite the lack of a reduction in the frequency of pain episodes, the increasing recognition that hemolysis contributes to the development of several SCD-related complications suggests that by decreasing hemolysis, senicapoc may yet prove to be beneficial in this disease.
Pre-Hypertrophy Reduction of Diastolic Deformation in Fabry Disease

Background: Fabry disease (FD) is a rare, X-linked deficiency of the lysosomal enzyme α-galactosidase, resulting in cardiomyopathy predominantly affecting hemizygous men and manifesting as left ventricular hypertrophy (LVH). Heterozygous females, long believed to have less cardiac involvement than male patients, can present with severe cardiomyopathy. We sought to evaluate eardiac mechanics in patients with Fabry disease.Methods: Conventional and strain echocardiography was performed in 21 subjects (mean age 39±12 years, 9symptomatic men and 12 asymptomatic women) with genetically confirmed FD and healthy female controls. Two-dimensional speckle strain echocardiography was analyzed off-line and averaged.Results: Five subjects had LVH. The longitudinal early diastolic strain rate (SRe) was significantly reduced in FD compared with the controls (1.5±0.3 vs. 2.0±0.1 s^(-1), P=0.001), despite no difference in tissue velocity and other strain measurement s. Longitudinal SRe was lower in male patients than female carriers (1.3±0.3 vs. 1.7±0.2 s^(-1), P=0.006). In female carriers, longitudinal SRe was lower compa red with the controls (1.7 ±0.2 vs. 2.0 ±0.1 S^(-1), P = 0.004). Furth ermore, longitudinal SRc was significantly lower in FD without LVH compared with the control group (1.6±0.3 vs. 2.0±0.1 s^(-1), P=0.002). Conclusion: Early diastolic strain rate is reduced in non-hypertrophied female carriers and pre-hypertrophy male Fabry patients. These data indicates that SRe is a sensitive and early marker of Fabry cardiomyopathy, and suggests a potential role for strain echocardiography in evaluation and management of patients with FD.
Characteristics of children presenting with newly diagnosed type 1 diabetes

Background. The clinical presentation of type 1 diabetes in children can be acute or insidious, and symptoms may be subtle and frequently misinterpreted. Presentation with diabetic keto-acidosis (DKA) may be associated with significant morbidity and mortality in the paediatric population. This study set out to determine the characteristics of children presenting to the paediatric endocrine service at Inkosi Albert Luthuli Central Hospital (IALCH) with DKA at the time of diagnosis, and to determine the frequency of missed diagnoses in the previous month. Methods. A retrospective study was done at IALCH, the paediatric tertiary referral centre for KwaZulu-Natal, South Africa. The study sample included all children with an initial diagnosis of type 1 diabetes between January 2008 and June 2010. Children presenting with DKA were compared with those who presented without DKA. Results. During the period under review, 63 children presented with type 1 diabetes. Of these, 44 (69.8%) had DKA at the time of diagnosis. The median duration of symptoms preceding diagnosis in the DKA group was 2 weeks, versus 4 weeks in the non-DKA group ( p =0.002). There was no significant difference between the groups when ethnicity, gender and age at presentation were compared. Of 42 patients who presented to healthcare facilities in the month preceding diagnosis, 27 (64.3%) were misdiagnosed. Conclusion. Patients who presented with DKA had a shorter duration of symptoms than the non-DKA group. Ethnicity had no effect on characteristics at presentation. There was an unacceptable rate of missed diagnoses of type 1 diabetes in both the private and public sectors.
Performance of PROMIS for Healthy Patients Undergoing Meniscal Surgery

Background: The Patient-Reported Outcomes Measurement Information System (PROMIS) was developed as an extensive question bank with multiple health domains that could be utilized for computerized adaptive testing (CAT). In the present study, we investigated the use of the PROMIS Physical Function CAT (PROMIS PF CAT) in an otherwise healthy population scheduled to undergo surgery for meniscal injury with the hypotheses that (1) the PROMIS PF CAT would correlate strongly with patient-reported outcome instruments that measure physical function and would not correlate strongly with those that measure other health domains, (2) there would be no ceiling effects, and (3) the test burden would be significantly less than that of the traditional measures. Methods: Patients scheduled to undergo meniscal surgery completed the PROMIS PF CAT, Knee injury and Osteoarthritis Outcome Score (KOOS), Marx Knee Activity Rating Scale, Short Form-36 (SF-36), and EuroQol-5 Dimension (EQ-5D) questionnaires. Correlations were defined as high (≥0.7), high-moderate (0.61 to 0.69), moderate (0.4 to 0.6), moderate-weak (0.31 to 0.39), or weak (⩽0.3). If ≥15% respondents to a patient-reported outcome measure obtained the highest or lowest possible score, the instrument was determined to have a significant ceiling or floor effect. Results: A total of 107 participants were analyzed. The PROMIS PF CAT had a high correlation with the SF-36 Physical Functioning (PF) (r = 0.82, p < 0.01) and KOOS Sport (r = 0.76, p < 0.01) scores; a high-moderate correlation with the KOOS Quality-of-Life (QOL) (r = 0.63, p < 0.01) and EQ-5D (r = 0.62, p < 0.01) instruments; and a moderate correlation with the SF-36 Pain (r = 0.60, p < 0.01), KOOS Symptoms (r = 0.57, p < 0.01), KOOS Activities of Daily Living (ADL) (r = 0.60, p < 0.01), and KOOS Pain (r = 0.60, p < 0.01) scores. The majority (89%) of the patients completed the PROMIS PF CAT after answering only 4 items. The PROMIS PF CAT had no floor or ceiling effects, with 0% of the participants achieving the lowest and highest score, respectively. Conclusions: The PROMIS PF CAT correlates strongly with currently used patient-reported outcome measures of physical function and demonstrates no ceiling effects for patients with meniscal injury requiring surgery. It may be a reasonable alternative to more burdensome patient-reported outcome measures.
Patient Outcomes After Observation Versus Debridement of Unstable Chondral Lesions During Partial Meniscectomy: The Chondral Lesions And Meniscus Procedures (ChAMP) Randomized Controlled Trial

Background: It is unknown whether unstable chondral lesions observed during arthroscopic partial meniscectomy (APM) require treatment. We examined differences at 1 year with respect to knee pain and other outcomes between patients who had debridement (CL-Deb) and those who had observation (CL-noDeb) of unstable chondral lesions encountered during APM. Methods: Patients who were ≥30 years old and undergoing APM were randomized to receive debridement (CL-Deb group; n = 98) or observation (CL-noDeb; n = 92) of unstable Outerbridge grade-II, III, or IV chondral lesions. Outcomes were evaluated preoperatively and at 8 to 12 days, 6 weeks, 3 months, 6 months, and 1 year postoperatively. Outcome measures included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), visual analog scale (VAS) pain score, Short Form-36 (SF-36) health survey, range of motion, quadriceps circumference, and effusion. The primary outcome was the WOMAC pain score at 1 year. T tests were used to examine group differences in outcomes, and the means and standard deviations are reported. Results: There were no significant differences between the groups with respect to any of the 1-year outcome scores. Compared with the CL-Deb group, the CL-noDeb group had improvement in the KOOS quality-of-life (p = 0.04) and SF-36 physical functioning scores (p = 0.01) as well as increased quadriceps circumference at 8 to 12 days (p = 0.02); had improvement in the pain score on the WOMAC (p = 0.02) and KOOS (p = 0.04) at 6 weeks; had improvement in SF-36 physical functioning scores at 3 months (p = 0.01); and had increased quadriceps circumference at 6 months (p = 0.02). Conclusions: Outcomes for the CL-Deb and CL-noDeb groups did not differ at 1 year postoperatively. This suggests that there is no benefit to arthroscopic debridement of unstable chondral lesions encountered during APM, and it is recommended that these lesions be left in situ. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Low Prevalence of Hip and Knee Arthritis in Active Marathon Runners

Background: Existing evidence on whether marathon running contributes to hip and knee arthritis is inconclusive. Our aim was to describe hip and knee health in active marathon runners, including the prevalence of pain, arthritis, and arthroplasty, and associated risk factors. Methods: A hip and knee health survey was distributed internationally to marathon runners. Active marathoners who completed ≥5 marathons and were currently running a minimum of 10 miles per week were included (n = 675). Questions assessed pain, personal and family history of arthritis, surgical history, running volume, personal record time, and current running status. Multivariable analyses identified risk factors for pain and arthritis. Arthritis prevalence in U.S. marathoners was compared with National Center for Health Statistics prevalence estimates for a matched group of the U.S. population. Results: Marathoners (n = 675) with a mean age of 48 years (range, 18 to 79 years) ran a mean distance of 36 miles weekly (range, 10 to 150 miles weekly) over a mean time of 19 years (range, 3 to 60 years) and completed a mean of 76 marathons (range, 5 to 1,016 marathons). Hip or knee pain was reported by 47%, and arthritis was reported by 8.9% of marathoners. Arthritis prevalence was 8.8% for the subgroup of U.S. marathoners, significantly lower (p < 0.001) than the prevalence in the matched U.S. population (17.9%) and in subgroups stratified by age, sex, body mass index (BMI), and physical activity level (p < 0.001). Seven marathoners continued to run following hip or knee arthroplasty. Age and family and surgical history were independent risk factors for arthritis. There was no significant risk associated with running duration, intensity, mileage, or the number of marathons completed (p > 0.05). Conclusions: Age, family history, and surgical history independently predicted an increased risk for hip and knee arthritis in active marathoners, although there was no correlation with running history. In our cohort, the arthritis rate of active marathoners was below that of the general U.S. population. Longitudinal follow-up is needed to determine the effects of marathon running on developing future hip and knee arthritis. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Implantação da sistematização da assistência de enfermagem: opinião de uma equipe de enfermagem hospitalar

O estudo objetiva analisar a opiniao da equipe de enfermagem acerca do processo de implantacao da Sistematizacao da Assistencia de Enfermagem em uma instituicao hospitalar. Trata-se de um estudo descritivo exploratorio, qualitativo. Os resultados apontaram que os profissionais reconhecem a importância da Sistematizacao da Assistencia de Enfermagem como instrumento para eficiencia e eficacia das acoes, organizacao e padronizacao da assistencia, individualizacao e continuidade do cuidado. E esperado que a sua implantacao traga beneficios para pacientes, profissionais e instituicao. As dificuldades referem-se ao deficit de recursos materiais e humanos. Espera-se que estes dados possam subsidiar acoes que minimizem estes obstaculos. Descritores: Enfermagem, Equipe de Enfermagem, Processos de Enfermagem. Implementation of nursing care systematization: a view hospital nursing team The study aims to analyze the opinion of the nursing team about the process of implementation of the nursing care systematization in a hospital. This is a qualitative descriptive exploratory study. The results indicated that the team recognizes the importance of the nursing care systematization as a tool for efficiency and effectiveness of actions, organization and standardization of care, individualization and continuity of care. It’s expected that its implementation will bring benefits to patient, professionals and institution. The difficulties relate to lack of material and human resources. It’s hoped that these data may support actions to minimize these obstacles. Descriptors: Nursing, Nursing Team, Nursing Process. Aplicacion de la sistematizacion de la asistencia de enfermeria: opinion del equipo de enfermeria de un hospital El estudio tiene como objetivo analizar la opinion del equipo de enfermeria sobre el proceso de implementacion de la sistematizacion de la asistencia de enfermeria en un hospital. Este es un estudio descriptivo exploratorio cualitativo. Los resultados indicaron que el personal reconozca la importancia de la sistematizacion de la asistencia de enfermeria como una herramienta para la eficiencia y la eficacia de las acciones, la organizacion y estandarizacion de los cuidados, la individualizacion y la continuidad de la atencion. Se espera que su aplicacion traiga beneficios para pacientes, profesionales e institucion. Las dificultades se relacionan con la falta de recursos materiales y humanos. Se espera que estos datos podrian apoyar las acciones para minimizar estos. Descriptores: Enfermeria, Grupo de Enfermeria, Procesos de Enfermeria.
Estratégia Saúde da Família e internações hospitalares em menores de 5 anos no Piauí, Brasil

Internacoes hospitalares por algumas condicoes de saude podem ser reduzidas por uma atencao primaria oportuna e com qualidade, especialmente na populacao infantil. Analisou-se a evolucao das internacoes hospitalares de menores de 5 anos no Piaui, Brasil, de 2000 a 2010, segundo grupos de causas (CID-10) e das internacoes de 2010, com base na lista brasileira de Internacoes por Condicoes Sensiveis a Atencao Primaria. O objetivo foi identificar mudancas no perfil de morbidade hospitalar e discutir sua relacao com a expansao da ESF no estado. O Piaui apresentou a maior expansao proporcional da ESF, alcancando a cobertura estimada de 97,2%, em 2010. No periodo de 2000 a 2010, a frequencia e as taxas de internacoes em menores de 5 anos foram reduzidas, porem, a proporcao de hospitalizacoes nos principais grupos de causas se manteve ou aumentou, ao longo da decada analisada. Em 2010, 60% das internacoes em menores de 5 anos foram por causas sensiveis a atencao primaria, em especial gastrenterites infecciosas, infeccoes respiratorias e asma.