bluuebunny/crossref_metadata_2025 huggingface dataset:
Should We Resect Hoffa's Fat Pad during Total Knee Replacement?
Authors: Yewlett Alun , Trickett Ryan , Forster Mark , Ghandour Adel , Sellars Hannah
Published: February 2017

Resection of Hoffa's fat pad during total knee arthroplasty is sometimes performed to improve access and view. Opponents of this technique argue that sacrificing the fat pad potentially compromises blood supply to the patellar tendon and it can subsequently shorten. Our objective was to identify any difference in the Insall-Salvati ratio of knees undergoing total knee arthroplasty between a cohort that had Hoffa's fat pad preserved and the one that had Hoffa's fat pad completely excised. The total knee arthroplasties by two surgeons at our institution were reviewed over a 3-year period. Surgeon A routinely preserves the fat pad and surgeon B routinely excises the fat pad. Radiographs preoperatively, immediately postoperatively, and at a minimum of 1-year follow up were analyzed for the Insall-Salvati ratio. A total of 161 knees were reviewed, 65 in the preserved group and 96 in the excised group with a mean age of 67 and 70 years, respectively. The mean preoperative Insall-Salvati ratio for the preserved group was 1.12 (±0.145) and excised group 1.16 (±0.168) (p = 0.094). The mean immediate postoperative Insall-Salvati ratio for the preserved group was 1.10 (±0.154) and for excised group 1.18 (±0.194). The difference in Insall-Salvati ratio from preoperative to the immediate postoperative period in the preserved group compared with the excised group demonstrated a significant difference (p = 0.010). However, the change of Insall-Salvati ratio at 1 year did not significantly differ between the groups (p = 0.059). There does not appear to be any difference in the Insall-Salvati ratios of both groups at 1 year's follow up; therefore, this study radiologically at least supports the use of either technique.
Clinical Efficacy and Safety of Negative-Pressure Wound Therapy on Flaps: A Systematic Review
Authors: Yu Panxi , Yu Nanze , Yang Xiaonan , Jin Xiaolei , Lu Haibin , Qi Zuoliang
Published: February 2017

Background Although flap transfer is a popular reconstructive procedure with a high success rate, it is associated with a high complication rate and low salvage rate. During the past decade, negative-pressure wound therapy (NPWT) has been increasingly applied to facilitate flap transfer and salvage flaps threatened by complications. It has achieved some success, but its efficacy and safety remain controversial because of the limited number of reports and lack of systematic reviews.

Methods English-language articles describing the application of NPWT on flaps were screened using predetermined inclusion and exclusion criteria. The articles were summarized and divided into groups based on the purpose of NPWT application. The complication rate, success rate, and salvage rate were obtained.

Results Among the 3,395 articles searched, 16 articles describing 137 flaps were eligible. NPWT was applied on 105 (76.4%) newly transferred flaps to facilitate flap attachment and on 32 (23.4%) complication-threatened flaps to relieve flap infection and venous congestion. In total, complications developed in six flaps, three of which were lost; thus, the complication rate was 5.7% (6/105) and the success rate was 97.1% (102/105). Only 1 of the 32 threatened flaps was not successfully salvaged; thus, the salvage rate was 96.9% (31/32).

Conclusion NPWT may facilitate flap transfer with few side effects and help to rescue flaps threatened by infection and venous congestion with a high salvage rate. Further studies are needed to test the safety of NPWT application on flaps with arterial compromise.
Rapid longitudinal relaxation measurement of hyperpolarized 129Xe by a highly sensitive atomic magnetometer
Authors: Li Yingying , Wang Zhiguo , Jin Shilong , Yuan Jie , Zhao Hongchang , Luo Hui
Published: February 2017

A fast and accurate determination of longitudinal relaxation time is put forward for hyperpolarized 129Xe. The theoretical framework for the method is developed. Measurement of the longitudinal relaxation time is by the determination of a close-loop response of 129Xe magnetization to the external magnetic fields and is implemented with a highly sensitive Rb magnetometer. The indirect measurement dramatically reduces the time consuming than the conventional inversion-recovery method and is more suitable for the samples with long longitudinal relaxation time.
A novel CMOS transducer for giant magnetoresistance sensors
Authors: Luong Van Su , Lu Chih-Cheng , Yang Jing-Wen , Jeng Jen-Tzong
Published: February 2017

In this work, an ASIC (application specific integrated circuits) transducer circuit for field modulated giant magnetoresistance (GMR) sensors was designed and fabricated using a 0.18-μm CMOS process. The transducer circuits consist of a frequency divider, a digital phase shifter, an instrument amplifier, and an analog mixer. These comprise a mix of analog and digital circuit techniques. The compact chip size of 1.5 mm × 1.5 mm for both analog and digital parts was achieved using the TSMC18 1P6M (1-polysilicon 6-metal) process design kit, and the characteristics of the system were simulated using an HSpice simulator. The output of the transducer circuit is the result of the first harmonic detection, which resolves the modulated field using a phase sensitive detection (PSD) technique and is proportional to the measured magnetic field. When the dual-bridge GMR sensor is driven by the transducer circuit with a current of 10 mA at 10 kHz, the observed sensitivity of the field sensor is 10.2 mV/V/Oe and the nonlinearity error was 3% in the linear range of ±1 Oe. The performance of the system was also verified by rotating the sensor system horizontally in earth’s magnetic field and recording the sinusoidal output with respect to the azimuth angle, which exhibits an error of less than ±0.04 Oe. These results prove that the ASIC transducer is suitable for driving the AC field modulated GMR sensors applied to geomagnetic measurement.
Portable pyroelectric electron probe microanalyzer with a spot size of 40 μm
Authors: Imashuku Susumu , Wagatsuma Kazuaki
Published: February 2017

We report a method of reducing the spot size of an electron beam in a portable pyroelectric electron probe microanalyzer (EPMA) and its application to on-site microanalysis. An electron beam with a spot size of 40 μm full width at half maximum was achieved by preventing the production of an electric field on the side of a needle tip set on the pyroelectric crystal in the EPMA by coating the side of the tip with an insulating material. This spot size was approximately 10 times smaller than that previously reported. We were able to acquire a line scan profile of a thin copper line sputtered on a silicon substrate using the portable pyroelectric EPMA. The width of the sputtered copper evaluated from the line scan profile (120 μm) corresponded to that from a line scan profile obtained by conventional stationary scanning electron microscope-energy dispersive X-ray spectroscopy equipment.
History effect on the Reynolds stress in turbulent swirling flow
Authors: Hamba Fujihiro
Published: February 2017

The eddy-viscosity model for turbulence has some difficulty in predicting rotating and swirling flows. Turbulent swirling flow in a straight pipe is a typical example. A rapidly rotating core in the pipe decays too quickly in results obtained from the standard k–ε model. The eddy viscosity needs to be reduced to predict the velocity profiles well; the mechanism of the decrease in the eddy viscosity has not been clarified yet. In this work, the eddy-viscosity model was investigated using a temporally nonlocal expression for the Reynolds stress that represents the history effect. A simple transport equation for the Reynolds stress was integrated along a mean-flow pathline to obtain a temporally nonlocal model for the Reynolds stress. The nonlocal model was applied to simple swirling flows for which the time integral can be further calculated to investigate the history effect. It was shown that the history effect associated with the rotating motion gives rise to a small factor in the expression for the eddy viscosity. In order to confirm the history effect, the present model and the linear eddy-viscosity model were used to simulate a swirling pipe flow. The velocity profiles obtained from the present model agree well with experimental results; the reduced eddy viscosity can account for the slow decay of the swirling motion in the core region. The anisotropic nature of the eddy viscosity was also discussed in relation to the small factor caused by the history effect.
Enhanced infrared-to-visible up-conversion emission and temperature sensitivity in (Er3+,Yb3+, and W6+) tri-doped Bi4Ti3O12 ferroelectric oxide
Authors: Bokolia Renuka , Mondal Manisha , Rai V. K. , Sreenivas K.
Published: February 2017

Strong up conversion (UC) luminescence at 527, 550, and 662 nm is compared under an excitation of 980 nm in single doped (Er3+), co-doped (Er3+/Yb3+), and (Er3+/Yb3+/W6+) tri-doped bismuth titanate (Bi4Ti3O12). For the co-doped system, the frequency (UC) emission intensity due to Er3+ ions is enhanced significantly in the green bands due to the efficient energy transfer from Yb3+ to Er3+ ions. Further increase in the emission intensity is seen with non-luminescent W6+ ions in the tri-doped system due to the modification in the local crystal field around the Er3+ ions, and is evidenced through a gradual change in the crystal structure of the host lattice with increasing W6+ content. The observed changes in the fluorescence lifetime and the associated energy transfer mechanisms are discussed. A progressive reduction of the lifetime of the 4S3/2 levels of Er3+ ions from 72 to 58.7 μs with the introduction of Yb3+ and W6+ dopant increases the transition probability and enhances the UC emission intensity. The efficiency of the energy transfer process (η) in the co-doped and tri-doped systems is found to be 9.4% and 18.6%, respectively, in comparison to the single doped system. Temperature sensing based on the fluorescence intensity ratio (FR) technique shows high sensitivity (0.0123 K−1) in the high temperature range (293 to 523 K) for an optimum content of Er3+, Yb3+, and W6+ with x = 0.03, y = 0.18, and z = 0.06 at. % in the tri-doped Bi4−x−yErxYbyTi3−zWzO12 ferroelectric composition, and is found useful for potential applications in optical thermometry.
Preparation of one-dimensional diluted magnetic semiconducting Cr0.046Zn0.954O and properties tuning with H2 atmospheric annealing
Authors: Li Jian-Min , Zeng Xian-Lin
Published: February 2017

Cr0.046Zn0.954O nanowires (NWs) were synthesized by electrospinning and treated with different atmosphere (O2 and H2) annealings. Our work demonstrates that not all the oxygen vacancies can really contribute to the ferromagnetism of cationic Cr3+-doped ZnO (Cr0.046Zn0.954O) electrospun NWs. The photoluminescence measurements show that the single positively charged oxygen vacancy (i.e., Vo+ or F+ centers (Fc)) bound defect states are quite stable in Cr0.046Zn0.954O NWs. Upon hydrogen-annealing, the specifically deep-level defect Fc was annihilated; thus, an electron transfer may occur from shallow donor H+ (e−) to deep donor Fc. An electron paramagnetic resonance signal at g ∼2.0583 was found in the Cr0.046Zn0.954O NWs, which is responsible for Cr3+−Fc complex formation, and a weak broad signal at g ∼15.5807 is considered as another paramagnetic center of Cr-Cr impurity pairs generated in the H2-annealed Cr0.046Zn0.954O NWs. The hydrogen-annealing offers an easier way to Fc engineering where a precise control of magnetic properties of diluted magnetic semiconducting oxide NWs is sought.
Chaotic region of elastically restrained single-walled carbon nanotube
Authors: Hu Weipeng , Song Mingzhe , Deng Zichen , Zou Hailin , Wei Bingqing
Published: February 2017

The occurrence of chaos in the transverse oscillation of the carbon nanotube in all of the precise micro-nano mechanical systems has a strong impact on the stability and the precision of the micro-nano systems, the conditions of which are related with the boundary restraints of the carbon nanotube. To generalize some transverse oscillation problems of the carbon nanotube studied in current references, the elastic restraints at both ends of the single-walled carbon nanotube are considered by means of rotational and translational springs to investigate the effects of the boundary restraints on the chaotic properties of the carbon nanotube in this paper. Based on the generalized multi-symplectic theory, both the generalized multi-symplectic formulations for the governing equation describing the transverse oscillation of the single-walled carbon nanotube subjected to the transverse load and the constraint equations resulting from the elastic restraints are presented firstly. Then, the structure-preserving scheme with discrete constraint equations is constructed to simulate the transverse oscillation process of the carbon nanotube. Finally, the chaotic region of the carbon nanotube is captured, and the oscillations of the two extreme cases (including simply supported and cantilever) are investigated in the numerical investigations. From the numerical results, it can be concluded that the relative bending stiffness coefficient and the absolute bending stiffness coefficients at both ends of the carbon nanotube are two important factors that affect the chaotic region of the carbon nanotube, which provides guidance on the design and manufacture of precise micro-nano mechanical systems. In addition, the different routes to the chaos of the carbon nanotube in two extreme cases are revealed.
Enhancing the blocking temperature of perpendicular-exchange biased Cr2O3 thin films using buffer layers
Authors: Shimomura Naoki , Pati Satya Prakash , Nozaki Tomohiro , Shibata Tatsuo , Sahashi Masashi
Published: February 2017

In this study, we investigated the effect of buffer layers on the blocking temperature (TB) of perpendicular exchange bias of thin Cr2O3/Co exchange coupled films with a Ru spacer and revealed a high TB of 260 K for 20-nm-thick Cr2O3 thin films. By comparing the TB values of the 20-nm-thick Cr2O3 films on Pt and α-Fe2O3 buffers, we investigated the lattice strain effect on the TB. We show that higher TB values can be obtained using an α-Fe2O3 buffer, which is likely because of the lattice strain-induced increase in Cr2O3 magnetocrystalline anisotropy.
Ligand binding to telomeric G-quadruplex DNA investigated by funnel-metadynamics simulations
Authors: Moraca Federica , Amato Jussara , Ortuso Francesco , Artese Anna , Pagano Bruno , Novellino Ettore , Alcaro Stefano , Parrinello Michele , Limongelli Vittorio
Published: February 2017

Significance

A thorough characterization of the binding interaction between a drug and its molecular target is fundamental to successfully lead drug design. We demonstrate that this characterization is also possible using the recently developed method of funnel-metadynamics (FM), here applied to investigate the binding of berberine to DNA G-quadruplex. We computed a quantitatively well-characterized free-energy landscape that allows identifying two low-energy ligand binding modes and the presence of higher energy prebinding states. We validated the accuracy of our calculations by steady-state fluorescence experiments. The good agreement between the theoretical and experimental binding free-energy value demonstrates that FM is a most reliable method to study ligand/DNA interaction.
Inflammation and Arterial Stiffness in Chronic Kidney Disease: Findings From the CRIC Study
Authors: Peyster Eliot , Chen Jing , Feldman Harold I. , Go Alan S. , Gupta Jayanta , Mitra Nandita , Pan Qiang , Porter Anna , Rahman Mahboob , Raj Dominic , Reilly Muredach , Wing Maria R. , Yang Wei , Townsend Raymond R. ,   on behalf of the CRIC Study Investigators
Published: February 2017

BACKGROUND

Chronic kidney disease (CKD) and arterial stiffness are associated with increased cardiovascular morbidity and mortality. Inflammation is proposed to have a role in the development of arterial stiffness, and CKD is recognized as a proinflammatory state. Arterial stiffness is increased in CKD, and cross-sectional data has suggested a link between increased inflammatory markers in CKD and higher measures of arterial stiffness. However, no large scale investigations have examined the impact of inflammation on the progression of arterial stiffness in CKD.

METHODS

We performed baseline assessments of 5 inflammatory markers in 3,939 participants from the chronic renal insufficiency cohort (CRIC), along with serial measurements of arterial stiffness at 0, 2, and 4 years of follow-up.

RESULTS

A total of 2,933 participants completed each of the follow-up stiffness measures. In cross-sectional analysis at enrollment, significant associations with at least 2 measures of stiffness were observed for fibrinogen, interleukin-6, high-sensitivity C-reactive protein, proteinuria, and composite inflammation score after adjustment for confounders. In longitudinal analyses, there were few meaningful correlations between baseline levels of inflammation and changes in metrics of arterial stiffness over time.

CONCLUSION

In a large cohort of CKD participants, we observed multiple significant correlations between initial markers of inflammation and metrics of arterial stiffness, but baseline inflammation did not predict changes in arterial stiffness over time. While well-described biologic mechanisms provide the basis for our understanding of the cross-sectional results, continued efforts to design longitudinal studies are necessary to fully elucidate the relationship between chronic inflammation and arterial stiffening.
Discriminating the reaction types of plant type III polyketide synthases
Authors: Shimizu Yugo , Ogata Hiroyuki , Goto Susumu
Published: February 2017

Motivation

Functional prediction of paralogs is challenging in bioinformatics because of rapid functional diversification after gene duplication events combined with parallel acquisitions of similar functions by different paralogs. Plant type III polyketide synthases (PKSs), producing various secondary metabolites, represent a paralogous family that has undergone gene duplication and functional alteration. Currently, there is no computational method available for the functional prediction of type III PKSs.

Results

We developed a plant type III PKS reaction predictor, pPAP, based on the recently proposed classification of type III PKSs. pPAP combines two kinds of similarity measures: one calculated by profile hidden Markov models (pHMMs) built from functionally and structurally important partial sequence regions, and the other based on mutual information between residue positions. pPAP targets PKSs acting on ring-type starter substrates, and classifies their functions into four reaction types. The pHMM approach discriminated two reaction types with high accuracy (97.5%, 39/40), but its accuracy decreased when discriminating three reaction types (87.8%, 43/49). When combined with a correlation-based approach, all 49 PKSs were correctly discriminated, and pPAP was still highly accurate (91.4%, 64/70) even after adding other reaction types. These results suggest pPAP, which is based on linear discriminant analyses of similarity measures, is effective for plant type III PKS function prediction.

Availability and Implementation

pPAP is freely available at ftp://ftp.genome.jp/pub/tools/ppap/

Supplementary information

Supplementary data are available at Bioinformatics online.
Information needs of physicians, care coordinators, and families to support care coordination of children and youth with special health care needs (CYSHCN)
Authors: Ranade-Kharkar Pallavi , Weir Charlene , Norlin Chuck , Collins Sarah A , Scarton Lou Ann , Baker Gina B , Borbolla Damian , Taliercio Vanina , Del Fiol Guilherme
Published: February 2017

Objectives: Identify and describe information needs and associated goals of physicians, care coordinators, and families related to coordinating care for medically complex children and youth with special health care needs (CYSHCN).

Materials and Methods: We conducted 19 in-depth interviews with physicians, care coordinators, and parents of CYSHCN following the Critical Decision Method technique. We analyzed the interviews for information needs posed as questions using a systematic content analysis approach and categorized the questions into information need goal types and subtypes.

Results: The Critical Decision Method interviews resulted in an average of 80 information needs per interview. We categorized them into 6 information need goal types: (1) situation understanding, (2) care networking, (3) planning, (4) tracking/monitoring, (5) navigating the health care system, and (6) learning, and 32 subtypes.

Discussion and Conclusion: Caring for CYSHCN generates a large amount of information needs that require significant effort from physicians, care coordinators, parents, and various other individuals. CYSHCN are often chronically ill and face developmental challenges that translate into intense demands on time, effort, and resources. Care coordination for CYCHSN involves multiple information systems, specialized resources, and complex decision-making. Solutions currently offered by health information technology fall short in providing support to meet the information needs to perform the complex care coordination tasks. Our findings present significant opportunities to improve coordination of care through multifaceted and fully integrated informatics solutions.
Outcomes of Transferring a Healthy Motor Fascicle From the Radial Nerve to a Branch for the Triceps to Recover Elbow Extension in Partial Brachial Plexus Palsy
Authors: Flores Leandro Pretto
Published: February 2017

BACKGROUND: Triceps reinnervation is an important objective to pursue when repairing the brachial plexus for cases with upper roots injuries, and a number of different techniques have been developed in order to restore elbow extension in such cases.

OBJECTIVE: To demonstrate the surgical outcomes associated with the technique of transferring a single healthy motor fascicle from the radial nerve of the affected arm to a branch innervating 1 of the 3 heads of the triceps.

METHODS: A retrospective study of 13 adult patients sustaining an upper trunk syndrome associated with total elbow extension palsy who underwent the proposed technique as part of the surgical planning for reconstruction of the brachial plexus.

RESULTS: Outcomes scored as M4 for elbow extension were noted in 9 cases (70%), M3 in 3 (23%), and M1 in 1 subject (7%). No patient considered the postoperative strength for carpal or finger extension as impaired. There were no differences in outcomes by using a fascicle activating carpal or finger extension as donor, as well as regarding the use of the branch to the medial or lateral head of the triceps as the recipient.

CONCLUSION: The technique of transferring a healthy motor fascicle from the radial nerve of the affected side to one of its nonfunctional motor branches to the triceps is an effective and safe procedure for recovering elbow extension function in patients sustaining partial injuries of the brachial plexus.
Chronic Pain and Itch are Common, Morbid Sequelae Among Individuals Who Receive Tissue Autograft After Major Thermal Burn Injury
Authors: Mauck Matthew C. , Smith Jennifer , Liu Andrea Y. , Jones Samuel W. , Shupp Jeffrey W. , Villard Marie A. , Williams Felicia , Hwang James , Karlnoski Rachel , Smith David J. , Cairns Bruce A. , Kessler Ronald C. , McLean Samuel A.
Published: February 2017

Objective:

Pain and itch symptoms are common after major thermal burn injury (MThBI)—requiring tissue autografting. To our knowledge, no prospective longitudinal studies have characterized pain and itch outcomes after tissue autografting and associations between and functional interference caused by such symptoms.

Materials and Methods:

We prospectively evaluated burn graft site and tissue donor site pain and itch severity (0 to 10, numeric rating scale) over 1 year among a representative cohort of MThBI survivors (n=96) who received tissue autografting within 14 days of MThBI.

Results:

Nearly all participants had moderate or severe burn pain at the time of enrollment. Most individuals experienced an upper extremity burn with donor tissue taken from thigh. Persistent moderate or severe burn graft site pain declined thereafter, but remained common, with 25/90 (28%), 24/77 (31%), and 17/82 (21%) experiencing moderate or severe pain at 6 weeks, 3 months, and 6 months, respectively. Although there was improved function after immediate postinjury decline in all participants, those who had moderate or severe pain showed worse functional outcomes at each timepoint. Significant correlations were present between itch and pain burden over time at the same site (ie, autograft site r=0.629, P<0.01) and also across sites (ie, autograft and donor site itch r=0.552, P<0.01).

Discussion:

Pain and itch are common after MThBI, are temporally and spatially concordant and cause significant impact on daily function. Further studies are needed to better understand pain and itch symptom pathogenesis after MThBI, to reduce the tremendous suffering and decline.
Serial Radiographs Do Not Change the Clinical Course of Nonoperative Stable OTA/AO 44-B1 Ankle Fractures
Authors: Marchand Lucas S. , Working Zachary M. , Rane Ajinkya A. , Jacobson Lance G. , Kubiak Erik N. , Higgins Thomas F. , Rothberg David L.
Published: February 2017

Objective:

To assess radiographic markers of ankle stability in stable OTA/AO 44-B1 ankle fractures.

Design:

Retrospective review.

Setting:

Academic Level-I trauma hospital.

Patients:

One hundred thirty-four patients with stable OTA/AO 44-B1 (Danis–Weber B, Supination-External Rotation-II) ankle fractures.

Intervention:

Analysis of mortise view radiographs at the time of initial evaluation and final follow-up. Variables measured: (1) medial clear space; (2) Mueller-Nose Distance.

Main Outcome Measure:

Change in radiographic measurements resulting in conversion to operative intervention.

Results:

Patients followed up an average of 2.6 visits in our clinics (SD 1.06). Patients received an average of 11.2 individual radiographic images to evaluate their injury (SD 3.9, maximum 29). No patients progressed to surgery in this cohort. Mean medial clear space at the time of injury was 3.4 mm (SD 0.8) and was 3.3 mm (SD 0.7) at the time of final follow-up (P = 0.1). Mean Mueller-Nose measurement at the time of injury was 3.5 mm (SD 1.0) and was 3.5 mm (SD 0.8) at the time of final follow-up (P = 0.47).

Conclusions:

No patients with stable OTA/AO 44-B1 fractures proceeded to surgery for loss of tibiotalar reduction or any other cause. Radiographic relationships were conserved during the follow-up, and serial radiographs may not be needed when managing these patients.

Level of Evidence:

Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Recurrence After Surgical Intervention for Infantile Tibia Vara: Assessment of a New Modified Classification
Authors: LaMont Lauren E. , McIntosh Amy L. , Jo Chan Hee , Birch John G. , Johnston Charles E.
Published: February 2017

Background:

To propose a modified classification of infantile tibia vara based on the morphology of the metaphyseal/epiphyseal tibial slope that better correlates with treatment outcomes than the traditional Langenskiold classification.

Methods:

We performed a retrospective review of 82 patients and 115 limbs that underwent surgery for infantile tibia vara over a 22-year period (1990 to 2012) at a single institution. A modified Langenskiold classification was applied to all patients preoperatively and the outcomes were assessed. The modified system created a 3-stage classification (types A, B, and C): type A has a partially lucent medial metaphyseal defect, with or without “beaking”; type B deformity has downward-sloping curvature of the lateral and inferior rim of a completely lucent metaphyseal defect, which then has an upslope at the medial rim, resembling a ski-jump, with no epiphyseal downward slope; type C has vertical, downsloping deformity of both the epiphysis and metaphysis, with no upward curvature projecting medially at the inferior extent, while the epiphysis slopes downward into the metaphyseal defect.

Results:

Sixty-seven limbs did not develop recurrence following corrective osteotomy, whereas 48 limbs required at least 1 repeat surgery for recurrent deformity. Preoperative mechanical axis deviation, medial proximal tibial angle, lateral distal tibial angle, and body mass index did not differ significantly between those with recurrence and those with without. Mean age at surgery was significantly different for those who developed recurrence compared with those who did not. Patients without recurrence were 4.3 years of age (range, 2.4 to 10.3 y) compared with 6.2 years of age (range, 2.9 to 10.1 y) for those who recurred (P<0.01). Of patients who developed recurrent deformity, there were significantly more patients with type C changes (71.7%, P<0.01) then either type A (22.5%) or type B (20.7%). High rates of recurrence were seen for both Langenskiold stage III (50%) and stage IV (69.6%).

Conclusions:

Consistent with prior studies, age 5 seems to be a critical transition in the risk for recurrent deformity after tibial osteotomy. Extreme vertical sloping of the medial metaphyseal defect, as in some classic Langenskiold III lesions and more precisely described by type C in a newer, modified classification, carries a poor prognosis for successful correction by high tibial osteotomy alone or in combination with epiphysiolysis.

Level of Evidence:

Level II.
The Effects of Delays in Diagnosis and Surgical Reconstruction of ACL Tears in Skeletally Immature Individuals on Subsequent Meniscal and Chondral Injury
Authors: Crawford Eileen A. , Young Laura J. , Bedi Asheesh , Wojtys Edward M.
Published: February 2017

Background:

Although studies have shown increased rates of chondral injury with delayed surgical treatment of pediatric anterior cruciate ligament (ACL) injuries, it is unknown if this is related to a delay in diagnosis and appropriate activity restrictions. The purpose of this study was to determine if the time from injury to diagnosis, time from diagnosis to reconstruction, and preoperative activity level correlate with the degree of cartilage injury seen intraoperatively.

Methods:

A retrospective review of skeletally immature patients who underwent ACL reconstruction was performed. Patients were stratified based on the time from injury to diagnosis (≤6 vs. >6 wk), diagnosis to surgery (≤6 vs. >6 wk), and injury to surgery (≤12 vs. >12 wk). Weight-bearing status, brace usage, athletic participation, and meniscus tears were characterized as binary variables. Articular cartilage injury was graded on a scale of 0 to 3. Differences between groups were analyzed using the χ2 test.

Results:

In total, 91 subjects with mean age of 13 years (range, 9 to 16 y) were included. In total, 71% were diagnosed within 6 weeks of injury and 40% underwent surgery within 6 weeks of diagnosis. No differences were found in the presence of medial or lateral meniscus tears or the grade of articular cartilage damage when groups were analyzed by time from injury to diagnosis, diagnosis to surgery, and injury to surgery (P>0.05 in all cases). When stratified by weight-bearing status, brace status, and athletic activity, there were no significant differences between groups for meniscal tears or cartilage injury in any compartment (P>0.05).

Conclusions:

Diagnosis of ACL rupture within 6 weeks of injury and surgical reconstruction within 6 weeks of diagnosis or 12 weeks of injury do not appear to affect the rate of cartilage injury in skeletally immature patients. Weight-bearing status, brace use, and participation in athletic activities between the time of injury and diagnosis also did not impact the rate of intra-articular injury following ACL tear.

Level of Evidence:

Level IV.
Delays From First Medical Contact to Antibiotic Administration for Sepsis*
Authors: Seymour Christopher W. , Kahn Jeremy M. , Martin-Gill Christian , Callaway Clifton W. , Yealy Donald M. , Scales Damon , Angus Derek C.
Published: February 2017

Objective:

To evaluate the association between total medical contact, prehospital, and emergency department delays in antibiotic administration and in-hospital mortality among patient encounters with community-acquired sepsis.

Design:

Retrospective cohort study.

Setting:

Nine hospitals served by 21 emergency medical services agencies in southwestern Pennsylvania from 2010 through 2012.

Patients:

All emergency medical services encounters with community acquired sepsis transported to the hospital.

Measurements and Main Results:

Among 58,934 prehospital encounters, 2,683 had community-acquired sepsis, with an in-hospital mortality of 11%. Median time from first medical contact to antibiotic administration (total medical contact delay) was 4.2 hours (interquartile range, 2.7–8.0 hr), divided into a median prehospital delay of 0.52 hours (interquartile range, 0.40–0.66 hr) and a median emergency department delay of 3.6 hours (interquartile range, 2.1–7.5 hr). In a multivariable analysis controlling for other risk factors, total medical contact delay was associated with increased in-hospital mortality (adjusted odds ratio for death, 1.03 [95% CI, 1.00–1.05] per 1-hr delay; p < 0.01), as was emergency department delay (p = 0.04) but not prehospital delay (p = 0.61).

Conclusions:

Both total medical contact and emergency department delay in antibiotic administration are associated with in-hospital mortality in community-acquired sepsis.
A second wind for the cholinergic system in Alzheimer’s therapy
Authors: Douchamps Vincent , Mathis Chantal
Published: February 2017

Notwithstanding tremendous research efforts, the cause of Alzheimer’s disease (AD) remains elusive and there is no curative treatment. The cholinergic hypothesis presented 35 years ago was the first major evidence-based hypothesis on the etiology of AD. It proposed that the depletion of brain acetylcholine was a primary cause of cognitive decline in advanced age and AD. It relied on a series of observations obtained in aged animals, elderly, and AD patients that pointed to dysfunctions of cholinergic basal forebrain, similarities between cognitive impairments induced by anticholinergic drugs and those found in advanced age and AD, and beneficial effects of drugs stimulating cholinergic activity. This review revisits these major results to show how this hypothesis provided the drive for the development of anticholinesterase inhibitor-based therapies of AD, the almost exclusively approved treatment in use despite transient and modest efficacy. New ideas for improving cholinergic therapies are also compared and discussed in light of the current revival of the cholinergic hypothesis on the basis of two sets of evidence from new animal models and refined imagery techniques in humans. First, human and animal studies agree in detecting signs of cholinergic dysfunctions much earlier than initially believed. Second, alterations of the cholinergic system are deeply intertwined with its reactive responses, providing the brain with efficient compensatory mechanisms to delay the conversion into AD. Active research in this field should provide new insight into development of multitherapies incorporating cholinergic manipulation, as well as early biomarkers of AD enabling earlier diagnostics. This is of prime importance to counteract a disease that is now recognized to start early in adult life.
THE IMPORTANCE OF THE PERIPHERAL RETINA IN PATIENTS WITH CENTRAL SEROUS CHORIORETINOPATHY
Authors: Oztas Zafer , Akkin Cezmi , Ismayilova Nergiz , Nalcaci Serhad , Afrashi Filiz
Published: February 2017

Purpose:

This research investigated the peripheral retinas of patients with central serous chorioretinopathy (CSCR).

Methods:

Sixty patients with CSCR and 60 age- and gender-matched controls were included in this prospective cross-sectional study. All 120 participants underwent ocular examinations and peripheral retinal evaluations using a Goldmann three-mirror lens.

Results:

The examinations demonstrated peripheral retinal degeneration, atrophic or hyperplastic retinal pigment epithelial changes, and retinal breaks. The peripheral retinal degeneration rate was 39% in the CSCR group and 15% in the control group, and the CSCR group reported significantly more lattice degeneration than the control group (22 vs. 3%) (P = 0.004, odds ratio = 1.97, confidence interval = 0.68–5.65 and P = 0.002, odds ratio = 4.55, confidence interval = 0.77–26.83, respectively). Symptomatic U-shaped retinal breaks were found in three eyes (5%) in the CSCR group, and the rate of peripheral retinal degeneration was higher in the patients with chronic CSCR (vs. acute CSCR). However, this difference was not significant (P = 0.244).

Conclusion:

This study showed that peripheral retinal abnormalities, particularly lattice degeneration, are more common in patients with CSCR. Therefore, the authors recommend regular retinal examinations, with the inclusion of peripheral retinal assessments, for patients with CSCR.
In Vivo Evaluation of Physiologic Control Algorithms for Left Ventricular Assist Devices Based on Left Ventricular Volume or Pressure
Authors: Ochsner Gregor , Wilhelm Markus J. , Amacher Raffael , Petrou Anastasios , Cesarovic Nikola , Staufert Silvan , Röhrnbauer Barbara , Maisano Francesco , Hierold Christofer , Meboldt Mirko , Schmid Daners Marianne
Published: February 2017

Turbodynamic left ventricular assist devices (LVADs) provide a continuous flow depending on the speed at which the pump is set, and do not adapt to the changing requirements of the patient. The limited adaptation of the pump flow (PF) to the amount of venous return can lead to ventricular suction or overload. Physiologic control may compensate such situations by an automatic adaptation of the PF to the volume status of the left ventricle. We evaluated two physiologic control algorithms in an acute study with eight healthy pigs. Both controllers imitate the Frank–Starling law of the heart and are based on a measurement of the left ventricular volume (LVV) or pressure (LVP), respectively. After implantation of a modified Deltastream DP2 blood pump as an LVAD, we tested the responses of the physiologic controllers to hemodynamic changes and compared them with the response of the constant speed (CS) mode. Both physiologic controllers adapted the pump speed (PS) such that the flow was more sensitive to preload and less sensitive to afterload, as compared with the CS mode. As a result, the risk for suction was strongly reduced. Five suction events were observed in the CS mode, one with the volume-based controller and none with the pressure-based controller. The results suggest that both physiologic controllers have the potential to reduce the number of adverse events when used in the clinical setting.
Assessing asthma in the otolaryngologist's office
Authors: Luk Lauren J. , Rotella Melissa R. , Stillman Leisa J. , Wise Sarah K.
Published: February 2017

Purpose of review

To familiarize otolaryngologists and other practitioners with basic diagnosis and treatment of asthma in adults and children based on current literature.

Recent findings

Increased fractional excretion of nitrous oxide and sputum eosinophils have been identified in asthmatic patients being evaluated for chronic cough and appear to be more sensitive in diagnosis than traditional spirometry. Both sublingual and subcutaneous immunotherapy modalities are effective in decreasing symptoms and medication use in patients with allergic rhinitis and allergic asthma.

Undiagnosed comorbid asthma is prevalent among patients with chronic rhinosinusitis and allergic rhinitis and control of all diseases processes greatly improves quality of life. Office spirometry is a helpful tool in the evaluation and management of asthma. Otolaryngologists should be able to recognize undiagnosed or poorly controlled asthma, initiate and improve medical therapy, and treat rhinosinusitis to improve asthma control.
Bacterial Infections in Children With Acute Myeloid Leukemia Receiving Ciprofloxacin Prophylaxis
Authors: Al Omar Suha , Anabtawi Nadine , Al Qasem Wiam , Rihani Rawad
Published: February 2017

Background:

The aim of the study was to describe the incidence and type of bacterial infections associated with the use of ciprofloxacin prophylaxis as single agent in pediatric patients with acute myeloid leukemia (AML).

Procedure:

This was a retrospective review of all patients with AML, who were treated according to the AML02 protocol between 2011 and 2015. The medical records were reviewed for any positive cultures from the initiation of the protocol until death or protocol discontinuation. Patient demographics, type of infections, type of isolated bacteria, and intensive care unit admissions were recorded.

Results:

A total of 50 patients were evaluated, who were of a mean age of 8 years±5.1 (SD). We identified 77 episodes of bacterial infections in 42 (84%) patients. Among those bacterial infections, 73 episodes were with bacteremia and included 45 (62%) gram-positive bacterial infections, 24 (33%) gram-negative bacterial infections, and 4 (6%) mixed gram-negative and gram-positive bacterial infections. Coagulase-negative Staphylococcus and Viridans streptococci were the most commonly isolated bacteria in 33% and 30% of the episodes, respectively. Seventeen (45%) patients with bacteremia required intensive care unit admission.

Conclusions:

A high rate of bacterial infection was detected in patients who received the AML02 protocol, mainly gram-positive bacterial infections. The prophylactic regimen should be reconsidered for its efficacy, and other antibacterial prophylaxis may be used.
The Association of Oral Vitamin D and Calcium Supplementation With Bone Mineral Density in Pediatric Acute Lymphoblastic Leukemia Patients
Authors: Demirsoy Ugur , Sarper Nazan , Aylan Gelen Sema , Zengin Emine , Kum Tugba , Demir Hakan
Published: February 2017

Aim:

To investigate the association of calcium (Ca) and vitamin D (vit D) supplementation with bone mineral density (BMD) in pediatric acute lymphoblastic leukemia (ALL).

Materials and Methods:

Group I (n=11): de novo ALL patients aged 1 to 18 years. Group II (n=46): pediatric ALL survivors in first complete remission and ALL patients on maintenance chemotherapy. We stratified group II into 3 subgroups according to the postdiagnosis period (group IIa: 8 to 24 mo, group IIb: 24 to 48 mo, group IIc: >48 mo). Group III (n=22): healthy siblings of group II. Daily oral vit D3 and Ca carbonate was given only to group I. In group I, BMD was measured at diagnosis and after completion of intensive chemotherapy (TP1 and TP2).

Results:

A significant increase in Ca (P=0.024) and 25-OH vit D (P=0.01), and a decrease in magnesium (P=0.023) were detected at TP2 compared with TP1 in group I. Mean plasma levels of 25-OH vit D were <20 ng/mL in all the groups. Total body (P=0.005), total body less head (P=0.005), and L1 to L4 BMD Z scores (P=0.025) decreased significantly at TP2 compared with TP1. The lowest BMD scores were found at 8 to 24 months after diagnosis in unsupplemented patients. A gradual increase in BMD Z scores was shown, with the highest scores in group IIc.

Conclusion:

Vit D and Ca supplementation in pediatric ALL patients during intensive chemotherapy may not prevent bone mineral loss. BMD scores of pediatric ALL patients described by other studies, as a major decrease in the first 2 years and gradual increase afterward, was also observed in our patients.
Efficacy and Safety of Dapsone Versus Trimethoprim/Sulfamethoxazol for Pneumocystis Jiroveci Prophylaxis in Children With Acute Lymphoblastic Leukemia With a Background of Ethnic Neutropenia
Authors: Nazir Hanan F. , Elshinawy Mohamed , AlRawas Abdulhakim , Khater Doaa , Zadjaly Sherin , Wali Yasser
Published: February 2017

Study Objective:

To study dapsone in comparison with trimethoprim/sulfamethoxazole (TMP/SMX) for Pneumocystis jiroveci (PJP) prophylaxis in children with acute lymphoblastic leukemia (ALL).

Design:

A retrospective study with a prospective follow-up.

Patients:

Pediatric ALL patients diagnosed between May 2009 and May 2014, who are still receiving or have completed their maintenance chemotherapy. Patients who completed chemotherapy were prospectively followed up for neutropenia.

Methods:

TMP/SMX was used as the initial PJP prophylaxis. An alternative drug was indicated if the patient remained cytopenic for >3 weeks. Average absolute neutrophilic count (ANC), average % of oral mercaptopurine (6-MP), and methotrexate doses were calculated over a period of 6 months before and after shifting to dapsone.

Results:

Sixty-two ALL patients were eligible for analysis. Twenty-four patients (38.7%) received TMP/SMX for PJP prophylaxis, whereas 34 patients received Dapsone (54.8%). Only 3 patients received IV pentamidine (4.8%), whereas 1 patient (1.6%) received atovaquone. The incidence of prophylaxis failure was 1/1041 months on TMP/SMX and 1/528 months on dapsone. After shifting to dapsone, patients maintained significantly higher ANC (1.46±0.46 vs. 1.17±0.40, P=0.0053), and received significantly higher doses of 6-MP (62.61%±11.45 vs. 57.45±10.14, P=0.0081) and methotrexate (64.9%±14.29 vs. 56.5%±9.9, P=0.0176), with a significantly shorter duration of chemotherapy interruption (1.94±1.2 vs. 3.25±1.29 wk, P=0.0002).

Conclusions:

Dapsone for PJP prophylaxis in ALL allowed patients to maintain higher ANC and to receive higher doses of chemotherapy, while maintaining a low incidence of PJP breakthrough infection.
The Effects of Bar-coding Technology on Medication Errors: A Systematic Literature Review
Authors: Hutton Kevin , Ding Qian , Wellman Gregory
Published: February 2017

Background

The bar-coding technology adoptions have risen drastically in U.S. health systems in the past decade. However, few studies have addressed the impact of bar-coding technology with strong prospective methodologies and the research, which has been conducted from both in-pharmacy and bedside implementations.

Objective

This systematic literature review is to examine the effectiveness of bar-coding technology on preventing medication errors and what types of medication errors may be prevented in the hospital setting.

Methods

A systematic search of databases was performed from 1998 to December 2016. Studies measuring the effect of bar-coding technology on medication errors were included in a full-text review. Studies with the outcomes other than medication errors such as efficiency or workarounds were excluded. The outcomes were measured and findings were summarized for each retained study.

Results

A total of 2603 articles were initially identified and 10 studies, which used prospective before-and-after study design, were fully reviewed in this article. Of the 10 included studies, 9 took place in the United States, whereas the remaining was conducted in the United Kingdom. One research article focused on bar-coding implementation in a pharmacy setting, whereas the other 9 focused on bar coding within patient care areas. All 10 studies showed overall positive effects associated with bar-coding implementation.

Conclusions

The results of this review show that bar-coding technology may reduce medication errors in hospital settings, particularly on preventing targeted wrong dose, wrong drug, wrong patient, unauthorized drug, and wrong route errors.