bluuebunny/crossref_metadata_2025 huggingface dataset:
Fallhäufungen von Skabies an Schulen und Einsatz von Ivermectin
Authors: Weigl Josef
Published: February 2018

Hintergrund Zu Pfingsten 2017 kam es an 3 Schulen im Kreis Plön, zu einer Häufung von Skabies. Mehrere Klassen sollten auf Klassenfahrt gehen oder kamen von einer Fahrt mit symptomatischen Schülern zurück.

Methode Die Fallhäufungen wurden mittels schnellem Ermitteln, Fallbestätigung vor Ort, Hausbesuche im Umfeld der Indexpatienten und Einsatz von Ivermectin simultan als Behandlung und Postexpositionsprophylaxe, je nach den Charakteristika des Ausbruchs, bekämpft.

Ergebnisse Der Indexfall in Schule A war seit 5 Monaten symptomatisch, aber als Ekzem diagnostiziert worden. Nicht alle Fälle ließen sich auf diesen Indexfall zurückführen. Eine Behandlung der ganzen Schule wurde in 3 Schritten binnen 10 Tagen durchgeführt – Schritt 1 begann 48 h nach Meldung. Die „attack rate“ betrug 6,4% (19 von 298 Schülern). Insgesamt wurden 93% der Schüler und 100% der Lehrer behandelt. Für Schule B mit 2 sporadischen, von einander unabhängigen, Fällen wurde nur ein Warnhinweis herausgegeben. In Schule C wurden die beiden betroffenen Klassen behandelt und 2 Hauptkontaktklassen reihenuntersucht – 7 von 39 (18%) der betroffenen Klassen waren symptomatisch, aber kein Schüler in den Kontaktklassen.

Schussfolgerung Die Endemizität an Skabies scheint viel höher zu sein als bisher vermutet. Mittels Einsatz von Ivermectin konnte das Gesundheitsamt schnell agieren und belegen, dass interventionelles Public Health möglich ist. Allerdings galt es zahlreiche Hindernisse zu überkommen. Eltern und Lehrer waren überaus kooperativ und dankbar.
Incidence of Autoimmune and Related Disorders After Resolution of Endogenous Cushing Syndrome in Children
Authors: Tatsi Christina , Keil Meg , Lyssikatos Charalampos , Belyavskaya Elena , Stratakis Constantine , Lodish Maya
Published: February 2018

Glucocorticoids are widely used for immunosuppression in autoimmune diseases. After the resolution of hypercortisolemia, the immune system recovers allowing for autoimmune diseases to manifest. Here we investigated the presence of autoimmune and related diseases that developed after cure of endogenous Cushing syndrome (CS) in children. We identified 129 children who were diagnosed and successfully treated for endogenous CS at the National Institutes of Health from 1997 until 2017, and who were followed for at least 6 months after treatment. We performed a retrospective chart review analysis to identify the presence of autoimmune or related diseases after cure. Ten children were diagnosed with a new autoimmune or related disorder after resolution of hypercortisolemia. This results in a frequency of 7.8% of our pediatric CS population. The identified patients had a shorter duration of hypercortisolemia prior to diagnosis, but did not otherwise differ from the remaining patients. The various identified diseases were: celiac disease (n=1), psoriasis (n=1), Hashimoto thyroiditis (n=1), Graves disease (n=1), optic neuritis (n=2), skin hypopigmented lesions/vitiligo (n=2), allergic rhinitis/asthma (n=1), and neuropathy responding to glucocorticoid treatment (n=1). The reported time between the treatment of CS and diagnosis of autoimmune disorder ranged from 6 to 19 months. The presence of autoimmune or related diseases might be masked by the hypercortisolemic state in endogenous CS. After resolution of hypercortisolemia, the presentation of new autoimmune diseases or recurrence of previously known autoimmune conditions should be considered when concerning symptoms arise.
Effects of Curcuminoids Plus Piperine on Glycemic, Hepatic and Inflammatory Biomarkers in Patients with Type 2 Diabetes Mellitus: A Randomized Double-Blind Placebo-Controlled Trial
Authors: Panahi Yunes , Khalili Nahid , Sahebi Ebrahim , Namazi Soha , Simental-Mendía Luis , Majeed Muhammed , Sahebkar Amirhossein
Published: February 2018

Introduction Curcuminoids have been shown to reduce glycemia and related complications in diabetes. In the present study, we evaluated the impact of curcuminoids plus piperine administration on glycemic, hepatic and inflammatory biomarkers in type 2 diabetes (T2D) patients.

Methods T2D patients aged 18–65 years were enrolled in a randomized double-blind placebo-controlled trial and randomly allocated to standard-of-care treatment and dietary advises plus either curcuminoids (daily dose of 500 mg/day co-administered with piperine 5 mg/day) or placebo for a period of 3 months. Glycemic, hepatic and inflammatory parameters were measured at baseline and final conditions.

Results A total of 100 subjects (50 in each group) completed the 3-month period of trial. A significant reduction was found in serum levels of glucose (−9±16 mg/dL vs. −3±11 mg/dL in curcuminoids and placebo groups, respectively; p=0.048), C-peptide (−0.6±0.8 ng/mL vs. 0.02±0.6 ng/mL; p<0.001) and HbA1c (−0.9±1.1% vs. −0.2±0.5%; p<0.001) after curcuminoids supplementation versus placebo group. Additionally, participants in the intervention group showed lower serum alanine aminotransferase (−2±6 vs. −1±5; p=0.032) and aspartate aminotransferase (−3±5 vs. −0.3±4; p=0.002) levels compared with the placebo group. Finally, no significant differences in high-sensitivity C-reactive protein (hs-CRP) concentrations were observed between curcuminoids and placebo groups (p>0.05).

Conclusion The results of the present trial revealed a beneficial effect of curcuminoids plus piperine supplementation on glycemic and hepatic parameters but not on hs-CRP levels in T2D patients.
Autophagy is associated with male sterility in pistillate flowers of Maytenus obtusifolia (Celastraceae)
Authors: Haddad Isabella Veríssimo Nader , Ribeiro de Santiago-Fernandes Lygia Dolores , Machado Silvia Rodrigues
Published: February 2018

Programmed cell death (PCD) is defined as a sequence of genetically regulated events leading to controlled and organised cellular degradation. It plays a vital role in plant development; however, little is known about the role of PCD in reproductive development. Sterility in pistillate flowers of Maytenus obtusifolia Mart. has been shown to be related to cytoplasmic male sterility (CMS) based on reproductive biology and anatomical analysis. The recurrent PCD led us to investigate changes in the tapetum and sporogenic tissue during the establishment of male sterility using light and transmission electron microscopy combined with the use of TUNEL (terminal deoxynucleotidyl transferase mediated dUDP end-labelling) assay. The interruption of pollen development in pistillate flowers is a result of premature PCD in the tapetum and consequently in the sporogenic cells. Autophagy, via macroautophagy, occurs in the sporogenic cells and involves the formation of autophagosomes, through rough endoplasmic reticulum, and of complex macroautophagic structures. In the final stage of PCD, massive autophagy takes place. Male sterility in female individuals is thus reasonably interpreted as sporophytic CMS associated to autophagy.
Seed germination response of a noxious agricultural weed Echium plantagineum to temperature, light, pH, drought stress, salinity, heat and smoke
Authors: Florentine Singarayer , Weller Sandra , King Alannah , Florentine Arunthathy , Dowling Kim , Westbrooke Martin , Chauhan Bhagirath S.
Published: February 2018

Echium plantagineum is a significant pasture weed in the Mediterranean climatic zone of several countries, including Australia. This invasive weed, introduced as an ornamental into Australia (where it is known as Paterson’s curse), quickly became established and is now a significant weed of agriculture. Although E. plantagineum is a well-established, highly competitive weed that thrives under disturbance and is tolerant of a wide variety of conditions, including varying soil moisture and drought, and some aspects of its ecology remain unknown. This study investigated germination response to temperature and light, pH, soil moisture, salinity, and pre-germination exposure of seed to heat and smoke. Temperature was found to be more influential on germination than light and the species is tolerant to a wide range of pH. However, available moisture may limit germination, as may elevated salinity. Management of this weed requires approaches that minimise soil seedbank input or prevent germination of soil seedbanks.
Biological aspects of the associations of biting midges (Diptera: Ceratopogonidae) in two saline rivers of the Elton Lake Basin, Russia
Authors: Golovatyuk Larisa V. , Zinchenko Tatiana D. , Sushchik Nadezhda N. , Kalachova Galina S. , Gladyshev Michail I.
Published: February 2018

We studied species composition, density, biomass and production of larvae of the family Ceratopogonidae in two saline rivers (Volgograd region, Russia). Ceratopoponids make up an important part of macroinvertebrate community in these rivers. Average monthly production (dry weight) of ceratopogonid larvae in the rivers was 3.5–4.8gm–2 month–1 in May and ~0.9gm–2 month–1 in August. For the first time, feeding spectra of ceratopogonid larvae, Palpomyia schmidti Goetghebuer, 1934, was studied using fatty acid analyses. The larvae of P. schmidti appeared to selectively consume diatoms and other algae and to avoid bacteria and decomposed dead organic matter (detritus) of low nutritive quality.
Horseshoe crabs as potential sentinel species for coastal health: juvenile haemolymph quality and relationship to habitat conditions
Authors: Kwan Billy K. Y. , Un Virginia K. Y. , Cheung S. G. , Shin Paul K. S.
Published: February 2018

As an interface between terrestrial and marine environments, coastal and estuarine areas are particularly prone to various pollution stresses. Identification of sentinel species is, therefore, essential to provide precautionary information on coastal health conditions. Given their significant ecological roles in estuarine ecosystems, horseshoe crabs are a potential species to indicate the general health status of coastal habitats. The present study demonstrated that the changes in haemolymph composition pattern of two Asian juvenile horseshoe crab species (Tachypleus tridentatus and Carcinoscorpius rotundicauda) are sensitive to reflect heavy metal (lead, nickel and iron) and nutrient (nitrate and ammonia) concentrations of intertidal sediments. In particular, a significant negative correlation was found for the amebocyte viability and ratio of granular–spherical to granular–flattened and degranulated dendritic-like morphological states of amebocytes in juvenile haemolymph with nitrate and lead concentrations respectively. There were also significantly higher concentrations of haemolymph haemocyanin and plasma protein in juvenile C. rotundicauda than in T. tridentatus on the same shore, possibly being related to the difference in foraging habitats of these two horseshoe crab species. Such non-lethal sampling of haemolymph from juvenile horseshoe crabs can be useful for a further development of the monitoring program in assessing potential environmental impacts by anthropogenic activities.
Representing ethical reality: a guide for worldly non-naturalists
Authors: FitzPatrick William J.
Published: February 2018

Ethical realists hold (i) that our ethical concepts, thoughts, and claims are in the business of representing ethical reality, by representing evaluative or normative properties and facts as aspects of reality, and (ii) that such representations are at least sometimes accurate. Non-naturalist realists add the further claim that ethical properties and facts are ultimately non-natural, though they are nonetheless worldly. My aim is threefold: to elucidate the sort of representation involved in ethical evaluation on realist views; to clarify what exactly is represented and how non-naturalism comes into the picture for non-naturalists; and to defend worldly non-naturalism against some objections. The first question addressed is how we should model evaluation on any realist view, which should in turn guide the identification of which properties and facts are credibly regarded as ‘evaluative’ ones. Then the question is: what role might non-natural properties and facts play, and how are they related to what is represented in ethical evaluation? Once that is clear, we will be in a position to answer certain objections to non-naturalist realism from Jackson, Gibbard, Bedke, and Dreier. I argue that the objections all mischaracterize the role played by non-natural properties and facts on plausible versions of non-naturalist realism.
Effect of water-cooling treatment times on properties of friction stir welded joints of 7N01-T4 aluminum alloy
Authors: Zhang T H , Wang Y , Fang X F , Liang P , Zhao Y , Li Y H , Liu X M
Published: February 2018

Due to the deformation caused by residual stress in the welding process, welded components need treatment to reduce welding distortion. In this paper, several different times of flame-heating and water-cooling treatment were subjected to the friction stir welding joints of 15mm thick 7N01P-T4 aluminum alloy sheets to study the microstructure variation of friction stir welding joints of 7N01P-T4 aluminum alloy, and to analyze the effect on micro-hardness, tensile and fracture mechanical properties. This investigation will be helpful to optimize treatment methods and provide instruction on industrial production.
MUGAN: multi-GPU accelerated AmpliconNoise server for rapid microbial diversity assessment
Authors: Lee Byunghan , Min Hyeyoung , Yoon Sungroh
Published: February 2018

Motivation

Metagenomic sequencing has become a crucial tool for obtaining a gene catalogue of operational taxonomic units (OTUs) in a microbial community. A typical metagenomic sequencing produces a large amount of data (often in the order of terabytes or more), and computational tools are indispensable for efficient processing. In particular, error correction in metagenomics is crucial for accurate and robust genetic cataloging of microbial communities. However, many existing error-correction tools take a prohibitively long time and often bottleneck the whole analysis pipeline.

Results

To overcome this computational hurdle, we analyzed and exploited the data-level parallelism that exists in the error-correction procedure and proposed a tool named MUGAN that exploits both multi-core central processing units and multiple graphics processing units for co-processing. According to the experimental results, our approach reduced not only the time demand for denoising amplicons from approximately 59 h to only 46 min, but also the overestimation of the number of OTUs, estimating 6.7 times less species-level OTUs than the baseline. In addition, our approach provides web-based intuitive visualization of results. Given its efficiency and convenience, we anticipate that our approach would greatly facilitate denoising efforts in metagenomics studies.

Availability and implementation

http://data.snu.ac.kr/pub/mugan

Supplementary information

Supplementary data are available at Bioinformatics online.
Star formation induced by cloud–cloud collisions and galactic giant molecular cloud evolution
Authors: Kobayashi Masato I N , Kobayashi Hiroshi , Inutsuka Shu-ichiro , Fukui Yasuo
Published: February 2018

Recent millimeter/submillimeter observations towards nearby galaxies have started to map the whole disk and to identify giant molecular clouds (GMCs) even in the regions between galactic spiral structures. Observed variations of GMC mass functions in different galactic environments indicates that massive GMCs preferentially reside along galactic spiral structures whereas inter-arm regions have many small GMCs. Based on the phase transition dynamics from magnetized warm neutral medium to molecular clouds, Kobayashi et al. (2017, ApJ, 836, 175) proposes a semi-analytical evolutionary description for GMC mass functions including a cloud–cloud collision (CCC) process. Their results show that CCC is less dominant in shaping the mass function of GMCs than the accretion of dense H i gas driven by the propagation of supersonic shock waves. However, their formulation does not take into account the possible enhancement of star formation by CCC. Millimeter/submillimeter observations within the Milky Way indicate the importance of CCC in the formation of star clusters and massive stars. In this article, we reformulate the time-evolution equation largely modified from Kobayashi et al. (2017, ApJ, 836, 175) so that we additionally compute star formation subsequently taking place in CCC clouds. Our results suggest that, although CCC events between smaller clouds are more frequent than the ones between massive GMCs, CCC-driven star formation is mostly driven by massive GMCs $\gtrsim 10^{5.5}\,M_{\odot }$ (where M⊙ is the solar mass). The resultant cumulative CCC-driven star formation may amount to a few 10 percent of the total star formation in the Milky Way and nearby galaxies.
Students’ mathematical performance, metacognitive experiences and metacognitive skills in relation to integral-area relationships
Authors: Radmehr Farzad , Drake Michael
Published: February 2018

Previous studies have explored students’ understanding of the relationship between definite integrals and areas under curves, but not their metacognitive experiences and skills while solving such problems. This paper explores students’ mathematical performance, metacognitive experiences and metacognitive skills when solving integral-area tasks by interviewing nine university and eight Year 13 students using a think-aloud protocol. The findings show that the students could have benefitted from their teachers and lecturers placing greater emphasis on both their conceptual understanding of integral-area relationships and their metacognitive experiences and skills.
Impact of Anesthesia on Hospital Mortality and Morbidities in Geriatric Patients Following Emergency Hip Fracture Surgery
Authors: Qiu Chunyuan , Chan Priscilla H. , Zohman Gary L. , Prentice Heather A. , Hunt Jessica J. , LaPlace Diana C. , Nguyen Vu T. , Diekmann Glenn R. , Maletis Gregory B. , Desai Vimal
Published: February 2018

Objectives:

To determine the impact of anesthesia type on in-hospital mortality and morbidity for geriatric fragility hip fracture surgery.

Design:

Retrospective cohort study.

Setting:

Integrates health care delivery system across 38 facilities in the United States.

Patients/Participants:

We identified 16,695 patients 65 years of age and older who underwent emergent hip fracture repairs between 2009 and 2014 through the Kaiser Permanente hip fracture registry and excluded pathologic or bilateral fractures.

Intervention:

Hip fracture surgery with general or regional anesthesia.

Main Outcomes Measures:

Data on in-hospital mortality, time to death, discharge disposition, and length of stay (LOS) were analyzed among the following anesthesia types: general anesthesia (GA), regional anesthesia (RA), and intraoperative conversions from regional to general (Cv).

Results:

Compared with RA, the hazard ratio for GA for in-hospital mortality was 1.38 and 2.23 for the Cv group; the time ratio for GA-associated time to death was 0.97 and 0.89 for the Cv group. The GA-associated time ratio for LOS before discharge was 1.01, and the hazard ratio for home discharge was 0.86, but no significance was found with the Cv group.

Conclusions:

RA may offer advantages over GA for fragility hip fracture surgeries when possible. In-hospital mortality, time to death, increased LOS, and discharge to an institute rather than home were all adversely influenced by GA. Furthermore, the previously understudied Cv group demonstrated adverse outcomes for in-hospital mortality and time to death.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Evaluating the Utility of the Lateral Elbow Radiograph in Central Articular Olecranon Reduction: An Anatomic and Radiographic Study
Authors: Kubik Jeremy , Schneider Prism , Buckley Richard , Korley Robert , Duffy Paul , Martin Ryan
Published: February 2018

Objectives:

The surgical reduction of intra-articular olecranon fractures is judged primarily on the lateral elbow radiograph, as orthogonal imaging of the articular surface is not obtainable. We sought to determine surgeon accuracy in identifying intra-articular olecranon malreductions on the lateral elbow radiograph.

Methods:

Six human fresh-frozen cadaveric elbow specimens were sagittally sectioned in 5-mm increments after olecranon dissection, preservation of soft tissue envelope, and rigid fixation of the elbow in an external fixator. Three patterns of central intra-articular olecranon malreduction were created in each elbow using a ruler and bone saw. Perfect lateral elbow radiographs were taken of each malreduction, and these images were randomized along with x-rays of normal cadaveric olecranons. The image series was presented to 4 masked trauma-trained surgeons to determine whether the olecranon was malreduced or anatomic. Surgeons interpreted the same image series on 2 separate occasions separated by 6 weeks. Percent correct was recorded, and the interobserver and intraobserver reliability was calculated.

Results:

Orthopedic trauma surgeons correctly identified olecranon malreductions only 73% of the time on the lateral elbow radiograph. Interobserver agreement was moderate for the first review of images and fair for the second review, with respective Fleiss Kappa values of 0.43 and 0.28. Intrarater reliability revealed moderate agreement with Cohen's Kappa value ranging from 0.56 to 0.66.

Conclusions:

Intra-articular olecranon malreductions are inconsistently recognized by trauma surgeons on the lateral elbow radiograph. Therefore, articular incongruity may still be present after surgical fixation of comminuted olecranon fractures. We must further define the radiographic anatomic representation of the articular olecranon to improve surgical reduction and clinical outcomes.
Diagnosis and Management of Polytraumatized Patients With Severe Extremity Trauma
Authors: McKinley Todd O. , Gaski Greg E. , Vodovotz Yoram , Corona Benjamin T. , Billiar Timothy R.
Published: February 2018

Multiply injured patients with severe extremity trauma are at risk of acute systemic complications and are at high risk of developing longer term orthopaedic complications including soft-tissue infection, osteomyelitis, posttraumatic osteoarthritis, and nonunion. It is becoming increasingly recognized that injury magnitude and response to injury have major jurisdiction pertaining to patient outcomes and complications. The complexities of injury and injury response that affect outcomes present opportunities to apply precision approaches to understand and quantify injury magnitude and injury response on a patient-specific basis. Here, we present novel approaches to measure injury magnitude by adopting methods that quantify both mechanical and ischemic tissue injury specific to each patient. We also present evolving computational approaches that have provided new insight into the complexities of inflammation and immunologic response to injury specific to each patient. These precision approaches are on the forefront of understanding how to stratify individualized injury and injury response in an effort to optimize titrated orthopaedic surgical interventions, which invariably involve most of the multiply injured patients. Finally, we present novel methods directed at mangled limbs with severe soft-tissue injury that comprise severely injured patients. Specifically, methods being developed to treat mangled limbs with volumetric muscle loss have the potential to improve limb outcomes and also mitigate uncompensated inflammation that occurs in these patients.
Critical-Size Bone Defects: Is There a Consensus for Diagnosis and Treatment?
Authors: Nauth Aaron , Schemitsch Emil , Norris Brent , Nollin Zachary , Watson J. Tracy
Published: February 2018

There is a significant burden of disease associated with bone defects, and their management is challenging. These injuries have a profound clinical and economic impact, and outcomes are limited by high rates of complication and reoperation, as well as poor functional outcomes. There remains a lack of consensus around definitions, reliable models, and best practices for the surgical management of bone defects. The current state of the literature on bone defects is reviewed here, with a focus on defining critical-size bone defect, the use of the induced membrane technique, the role of biologics, and the management of infected bone defects.
Outside the Bone: What Is Happening Systemically to Influence Fracture Healing?
Authors: Kates Stephen L. , Satpathy Jibanananda , Petrisor Brad A. , Konda Sanjit R. , McKee Michael D. , Schemitsch Emil H.
Published: February 2018

This article summarizes presentations of a symposium on bone health–related hot topics of the 2016 Basic Science Focus Forum. Taken together, these topics emphasize the critical importance of bone health in fracture management, the systemic factors that influence fracture healing, and the need to focus on issues other than simply the technical aspects of fracture repair.
Management of Mangled Extremities and Orthopaedic War Injuries
Authors: McKinley Todd O. , D'Alleyrand Jean-Claude , Valerio Ian , Schoebel Seth , Tetsworth Kevin , Elster Eric A.
Published: February 2018

In 16 years of conflict, primarily in Iraq and Afghanistan, wounded warriors have primarily been subjected to blast type of injuries. Evacuation strategies have led to unprecedented survival rates in blast-injured soldiers, resulting in large numbers of wounded warriors with complex limb trauma. Bone and soft tissue defects have resulted in increased use of complex reconstructive algorithms to restore limbs and function. In addition, in failed salvage attempts, advances in amputation options are being developed. In this review, we summarize state-of-the-art limb-salvage methods for both soft tissue and bone. In addition, we discuss advances in diagnostic methods with development of personalized clinical decision support tools designed to optimize outcomes after severe blast injuries. Finally, we present new advances in osteointegrated prostheses for above-knee amputations.
Principles of Nonunion Management: State of the Art
Authors: Nauth Aaron , Lee Mark , Gardner Michael J. , Brinker Mark R. , Warner Stephen J. , Tornetta Paul , Leucht Philipp
Published: February 2018

A substantial proportion of fractures can present with nonunion, and the management of nonunion continues to present a challenge for orthopaedic surgeons. A variety of biological, mechanical, patient, and injury factors can contribute to the occurrence of nonunion, and often the cause of nonunion may be multifactorial. Successful management often requires assessment and treatment of more than one of these factors. This article reviews common factors that may contribute to nonunion including infection, impaired biology, and metabolic disorders. In addition, new and evolving strategies for diagnosing the cause and effectively treating nonunion including the diagnosis of infection, metabolic workup, bone grafting, cell-based therapies, and biological adjuvants are reviewed and discussed.
Biomechanics—Hot Topics Part I
Authors: Bottlang Michael , Lorich Dean G. , Dvorzhinskiy Aleksey , Gausden Elizabeth , Slobogean Gerard P. , Schemitsch Geoffrey W. , Sanders David W. , Schemitsch Emil H.
Published: February 2018

This study summarizes presentations of a symposium on biomechanically related hot topics of the 2015 Basic Science Focus Forum. Each topic emphasizes a biomechanical challenge common to all 4 of these presentations: an ideal fixation technique should deliver ample stability and sufficient flexibility to prevent fixation failure and to restore normal function.
Absolute Versus Relative Fracture Fixation: Impact on Fracture Healing
Authors: Norris Brent L. , Lang Gerald , Russell Thomas A. (Toney) , Rothberg David L. , Ricci William M. , Borrelli Joseph
Published: February 2018

The goals of all orthopaedic surgeons treating fractures are, and will remain, obtaining union of the fracture with a well-aligned and functional limb while minimizing the risk of complications. This requires us to understand how the biomechanical environment of the fracture affects healing and to be able to discern which mechanical environment is preferred over another. Understanding the spectrum of stability imparted by our current surgical devices is paramount to giving our patients the best opportunity to heal and recover from their injury. Gone are the simplistic views of plates and screws being applied for absolute stability and nails and external fixators being applied for relative stability. This review sheds new light on how the use of different implants provides the appropriate stability to encourage fracture healing and limit the risk of complication and loss of function.
What Is Important Besides Getting the Bone to Heal? Impact on Tissue Injury Other Than the Fracture
Authors: Gardner Michael J. , Higgins Thomas A. , Harvin William H. , Stannard James P. , Lee Mark A. , Crist Brett D.
Published: February 2018

Fracture surgeons do a great job of managing bone issues, but they may overlook the associated soft tissue injuries that play a significant role in the final outcome after musculoskeletal injury. The soft tissue reconstruction ladder can help guide reconstructive procedures based on the least complex procedure that allows the best chance of fracture healing. Muscle injury, volume loss, and deconditioning occur with traumatic injury and during the recovery phase. Neuromuscular stimulation, nutrition, and strength training are potential ways to aid in recovery. Complex periarticular knee injuries have a high rate of associated soft tissue injuries that may affect outcome if associated with knee instability. Identifying and addressing these injuries can increase the likelihood of a good outcome. Articular cartilage loss can make articular reconstruction impossible. Large fresh osteoarticular allografts can be a reconstructive option. Addressing all the damaged structures involved with a fracture may be the next step in improving patient outcomes.
Biomechanics—Hot Topics Part II
Authors: Finkemeier Christopher , Adams John D. , Bernstein Mitchell , Lee Mark A. , Harvey Ed , Crist Brett D.
Published: February 2018

Orthopaedic surgery and biomechanics are intimately partnered topics in medicine. Biomechanical principles are used to design implants and fashion treatment protocols. Although it would seem that biomechanical principles in the design of fixation devices and fracture repair constructs have been already finalized, there are several points of controversy remaining. New technology has raised new questions, while at the same time, we still do not fully understand simple clinical principles such as time of fracture healing depending on the construct used. This review looks at several of these current controversies to better understand what work is needed in fracture care going forward.
Fracture Healing Adjuncts–The World's Perspective on What Works
Authors: Giannoudis Peter V. , Krettek Christian , Lowenberg David W. , Tosounidis Theodoros , Borrelli Joseph
Published: February 2018

Treatment of bone defects remains a challenging clinical problem. Despite our better understanding of bone repair mechanisms and advances made in microsurgical techniques and regenerative medicine, the reintervention rates and morbidity remain high. Surgical techniques such as allograft implantation, free vascularized fibular graft, distraction osteogenesis, loaded titanium cages, and the induced membrane technique continue to evolve, but the outcome can be affected by a number of parameters including the age of the patient, comorbidities, systemic disorders, the location of the defect, and the surgeon's preference and experience. In the herein article, a brief summary of the most currently used techniques for the management of bone defects is presented.
How Does Orthopaedic Research Affect Patient Care?
Authors: Archdeacon Michael T. , Papp Steven R. , Bernstein Mitchell , Giannoudis Peter V. , Bhandari Mohit , Harvey Edward J.
Published: February 2018

Academic medicine hinges on high-quality results from research. Surgeon scientists spend their career acquiring grants, writing papers, and educating a next generation of scientists. The real question is how well are we at playing this game? Does our research change surgical practice or affect patient care or government policy? Ideally, published research does and will continue to shape the way care is delivered. Key questions remain, however; what is the return on research investment in orthopaedics? How can surgeons decide which “evidence” matters, and does practice-change only refer to Level I evidence (randomized trials)? This review considers all these questions.
Risk Factors of Impaired Pulmonary Function in Arthrogryposis Multiplex Congenital Patients With Concomitant Scoliosis
Authors: Li Yetian , Sheng Fei , Xia Chao , Xu Leilei , Qiu Yong , Zhu Zezhang
Published: February 2018

Study Design.

A retrospective study.

Objective.

To investigate the severity of pulmonary function impairment for arthrogryposis multiplex congenital (AMC) patients with concomitant scoliosis and to determine risk factors associated with the impaired pulmonary function in these patients.

Summary of Background Data.

AMC patients are generally believed to have impaired pulmonary function. However, the severity of respiratory morbidity and the associated risk factors have not been reported.

Methods.

The pulmonary function tests data including the percentage predicted values of forced vital capacity (%FVC), forced expiratory volume in 1 second (%FEV1), and the ratio of FEV1 to FVC (%FEV1/FVC) were reviewed and compared for 48 AMC patients with secondary scoliosis and 48 patients with adolescent idiopathic scoliosis. The radiographic parameters of coronal and sagittal plane deformities and body mass index (BMI) were measured and correlated with impaired pulmonary function in these AMC patients.

Results.

AMC patients with concomitant scoliosis had significant lower mean %FVC, %FEV1, and %FEV1/FVC than adolescent idiopathic scoliosis patients (48.8 vs. 70.3 for %FVC, P < 0.001; 45.3 vs. 69.7 for %FEV1, P < 0.001; 92.1 vs. 96.9 for %FEV1/FVC, P < 0.05, respectively). Seventy percent of AMC patients had severe pulmonary function impairment. A positive correlation was found between BMI and %FVC and %FEV1 (P < 0.01) and between hypokyphosis and %FVC and %FEV1 (P < 0.05). A negative correlation was found between coronal angle and pulmonary function (P < 0.05). Multiple regression analysis showed that all of the three variables were independent predictors associated with a reduced pulmonary function. With a combination of these variables, the multiple regression model could account for 38.7% of the variance in %FVC and 41.5% in %FEV1.

Conclusion.

There exists severe impairment of pulmonary function in AMC patients with concomitant scoliosis. The scoliotic curve, hypokyphosis, and BMI were independent risk factors associated with the pulmonary dysfunction in these patients. As the majority of the variability of impaired pulmonary function tests are still poorly understood, more risk factors await to be uncovered in future studies.

Level of Evidence: 4
Effects of Ultra-early Hyperbaric Oxygen Therapy on Femoral Calcitonin Gene-Related Peptide and Bone Metabolism of Rats With Complete Spinal Transection
Authors: Liu Min , Chen Huan , Tong Min , Zhou Jinping , Wu Xiyu
Published: February 2018

Study Design.

Seventy-five Sprague-Dawley rats were randomly divided into sham, complete spinal cord transection (CSCT) and hyperbaric oxygen (HBO) groups. Among them, rats in HBO group were further divided into 3 hours group (HBO1) and 12 hours group (HBO2).

Objective.

To study the effects of ultra-early HBO therapy on femoral calcitonin gene–related peptide (CGRP) and bone metabolism of rats with CSCT.

Summary of Background Data.

Complete spinal cord injury (SCI) is still an unresolved problem in clinical practice. Studies on changes in (calcitonin gene-related peptide) CGRP and bone metabolism and osteoporosis prevention after SCI have important clinical significance.

Methods.

Rats in the sham group underwent laminectomy alone, whereas rats in the other three groups underwent laminectomy and CSCT at the level of the 10th thoracic vertebra. Six weeks after operation, rat blood samples and femoral samples from CSCT area were taken and prepared for immunohistochemical staining of CGRP, quantitative polymerase chain reaction (qPCR) of CGRP mRNA, enzyme-linked immunosorbent assay (ELISA) for the levels of serum bone–specific alkaline phosphatase (sBAP), serum osteocalcin (sOC), serum type-I collagen amino-terminal peptide (sNTX), and urinary deoxypyridinoline (uDPD). These data were statistically analyzed using paired LSD or Tamhane.

Results.

The number of CGRP-positive cells and expression of CGRP mRNA in femur were significantly reduced, and the levels of sBAP, sOC, sNTX, and uDPD were significantly increased in CSCT, HBO1, and HBO2 groups than in the sham group, (P < 0.05–0.01). In addition, the number of CGRP-positive cells, expression of CGRP mRNA in femur, and the levels of sBAP and sOC were significantly enhanced, but the levels of sNTX and uDPD were significantly lowered in HBO1 group than in HBO2 and CSCT groups (P < 0.05).

Conclusion.

Ultra-early HBO therapy could improve bone turnover, promote bone formation, and prohibit bone resorption by enhancing CGRP synthesis in the sensory neurons in posterior horn of spinal cord.

Level of Evidence: N/A
Biomechanical Comparison of Four Different Atlantoaxial Posterior Fixation Constructs in Adults
Authors: Chun Dong Hyun , Yoon Do Heum , Kim Keung Nyun , Yi Seong , Shin Dong Ah , Ha Yoon
Published: February 2018

Study Design.

Finite element analysis.

Objective.

To compare the biomechanical stability imparted to the C1 and C2 vertebrae by the transarticular (TA), C1 lateral mass (LM)-C2 pedicle (PS), C1LM-C2 pars, and C1LM-C2 translaminar (TL) screw fixation techniques.

Summary of Background Data.

Cadaveric biomechanical studies of several atlantoaxial posterior fixation techniques have been performed, showing significant heterogeneity in biomechanical properties among the studies.

Methods.

From computed tomography images, a nonlinear intact three-dimensional C1–2 finite element model was developed and validated. Four finite element models were reconstructed from different C1–2 fixation techniques. The range of motion (ROM) and maximum von Misses stresses for the four screw techniques were compared under flexion, extension, lateral bending, and axial rotation.

Results.

C1LM-C2PS showed the greatest decrease in ROM with flexion/extension and lateral bending. C1–2TA and C1LM-C2 pars showed less ROM reduction than the other techniques, in flexion/extension. C1LM-C2TL showed the least decrease in ROM during axial rotation. For C1–2TA, the maximum stress was in the C1–2 joint region. In the C1LM-C2PS, the C1 rod head, C2 pars screw, and C2TL screw were stressed at the C2 rod head. The maximal von Mises stress on the C1–2TA at the C1–2 joint site was the highest at flexion/extension, whereas the C1LM-C2PS had the lowest stress on the screw at flexion/extension and lateral bending. The C1LM-C2TL showed the highest stress in axial rotation and lateral bending.

Conclusion.

In this study, C1LM-C2PS fixation was the most stable technique. If surgeons have to use other fixation methods besides the C2 pedicle screw, they need to be aware that additional fixation or postoperative immobilization may be required to achieve ROM restriction. Careful observation at the maximum stress site on the screw including screw loosening, screw-bone interface disruption or screw fracture will be necessary during follow-up imaging examinations (x-ray and computed tomography scan) after atlantoaxial fixation.

Level of Evidence: N/A
Back Pain and Co-occurring Conditions
Authors: Badley Elizabeth M. , Millstone Dov B. , Perruccio Anthony V.
Published: February 2018

Study Design.

Cross-sectional population-level health survey.

Objective.

To describe the frequency of co-occurring conditions with back pain; to identify risk factors for back pain controlling for co-occurring conditions; and to examine the association between back pain and individual co-occurring conditions.

Summary of Background Data.

Back pain shares risk factors with a range of other conditions. Most studies have considered risk factors for back pain without taking into account the potential influence of co-occurring conditions.

Methods.

Analysis of the 2013 Canadian Community Health Survey (n = 61,854, age ≥15 yr). Back pain status and co-occurring conditions were determined from questions about long-term health conditions diagnosed by a health profession. Multivariable log-Poisson regression analysis was used to assess the adjusted association of back pain with demographic and lifestyle characteristics and co-occurring conditions.

Results.

The population prevalence of reported back pain was 19.3%. Most (71%) reported at least one co-occurring condition. Most frequently reported were arthritis (35%), high blood pressure (26%), migraine (18%), and mood disorders (14%). Following the addition of co-occurring condition count to the regression model, being female and being overweight/obese were no longer significantly associated with back pain, and the associations with ages 45 to 54 years and older, low-income, smoking, and being physical inactive were significantly attenuated. The highest prevalence ratio, 3.32 (95% confidence interval: 3.06–3.59), was for 3+ co-occurring conditions. In multivariable regression all but a few individual chronic conditions remained significant associated with back pain.

Conclusion.

Established risk factors for back pain may be largely a reflection of shared risk factors with co-occurring conditions. The high frequency of co-occurring conditions likely reflects diverse mechanisms related to heterogeneity of back pain. The extent of association of co-occurring conditions with back pain has implications for clinical management and need for further research to characterize subgroups.

Level of Evidence: 2
Visual Loss Following Spine Surgery
Authors: Shillingford Jamal N. , Laratta Joseph L. , Sarpong Nana O. , Swindell Hasani , Cerpa Meghan , Lehman Ronald A. , Lenke Lawrence G. , Fischer Charla R.
Published: February 2018

Study Design.

A retrospective review of the Scoliosis Research Society (SRS) morbidity and mortality (M&M) database.

Objective.

The aim of this study was to investigate visual related complications in spinal deformity patients undergoing spine surgery.

Summary of Background Data.

The SRS compiles surgeon-reported complications into an M&M database, tracking postoperative complications including visual loss, neurological deficits, infections, and death. Limited literature exists on postoperative visual complications, a rare but devastating complication following spine surgery.

Methods.

We utilized the SRS M&M database to determine demographics, perioperative risk factors, and prognosis for visual related complications in spinal deformity patients undergoing corrective spine surgery from 2009 to 2012.

Results.

A total of 167,972 spinal deformity patients from 2009 to 2012 were identified with a visual acuity complication (VAC) rate of 0.01%, or 12.5 per 100,000 patients. VAC rates for patients with kyphosis were significantly higher than patients with scoliosis (0.049% vs. 0.010%, P = 0.002) and spondylolisthesis (0.049% vs. 0.005%, P = 0.001). Postoperative visual loss rates significantly decreased from 2010 to 2012 (0.022% vs. 0.004%, P = 0.029). Twenty-one patients identified with VACs had a mean age of 34.8 ± 24.3 years. Two (9.5%) patients had preoperative vision changes, two (9.5%) were diabetic, two (9.5%) had vascular disease, one (4.8%) had a history of thromboembolic disease, and five (23.8%) had hypertension. Extent of VAC was bilateral-partial in four (19.0%), bilateral-total in five (23.8%), unilateral-partial in eight (38.1%), and unilateral-total in three (14.3%) patients. Four (19.0%) patients developed anterior ischemic optic neuropathy, four (19.0%) had posterior ischemic optic neuropathy (PION), five (23.8%) had central retinal artery occlusion, and five (23.8%) developed cortical blindness (CB). Greater than 50% of the VACs occurred on, or before, the first postoperative day. Ten (47.6%) patients recovered complete vision and four (19.0%) improved. All patients with CB and 50% with posterior ischemic optic neuropathy experienced complete resolution.

Conclusion.

VACs occur in approximately 12.5 per 100,000 deformity patients, with a rate five times higher in patients with kyphosis. More than 50% of these complications occur within 24 hours postoperatively. Nearly half of these complications resolve completely, and another 19% improve postoperatively.

Level of Evidence: 4
Postoperative Walking Ability of Non-ambulatory Cervical Myelopathy Patients
Authors: Takeoka Yoshiki , Kaneyama Shuichi , Sumi Masatoshi , Kasahara Koichi , Kanemura Aritetsu , Takabatake Masato , Hirata Hiroaki , Tsubosaka Masanori
Published: February 2018

Study Design.

A retrospective analysis.

Objective.

The aim of this study was to clarify the postoperative improvement of walking ability and prognostic factors in nonambulatory patients with cervical myelopathy.

Summary of Background Data.

Many researchers have reported the surgical outcome in compressive cervical myelopathy. However, regarding severe gait disturbance,, it has not been clarified yet how much improvement can be expected.

Methods.

One hundred thirty-one nonambulatory patients with cervical myelopathy were treated surgically and followed for an average of 3 years. Walking ability was graded according to the lower-extremity function subscore (L/E subscore) in Japanese Orthopedic Association score. We divided patients based on preoperative L/E subscores: group A, L/E subscore of 1 point (71 patients); and group B, 0 or 0.5 point (60 patients). The postoperative walking ability was graded by L/E subscore: excellent, ≥2 points; good, 1.5 points; fair, 1 point; and poor, 0.5 or 0 points. We compared preoperative and postoperative scores. The cutoff value of disease duration providing excellent improvement was investigated.

Results.

Overall, 50 patients were graded as excellent (38.2%), and 21 patients were graded as good (16.0%). In group B, 17 patients (28.3%) were graded as excellent. Seventeen patients who were graded as excellent had shorter durations of myelopathic symptoms and/or gait disturbance (7.9 and 3.8 months respectively) than the others (29.5 and 8.9 months, respectively) (P < 0.05). Receiver-operating characteristic curve showed that the optimal cutoff values of the duration of myelopathic symptoms and gait disturbance providing excellent improvement were 3 and 2 months, respectively.

Conclusion.

Even if the patients were nonambulatory, 28.3% of them became able to walk without support after operation. If a patient becomes nonambulatory within 3 months from the onset of myelopathy or 2 months from the onset of gait disturbance, surgical treatment should be performed immediately to raise the possibility to improve stable gait.

Level of Evidence: 3