bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of different strength training frequencies during reduced training period on strength and muscle cross‐sectional area
Authors: Tavares Lucas Duarte , de Souza Eduardo Oliveira , Ugrinowitsch Carlos , Laurentino Gilberto Candido , Roschel Hamilton , Aihara André Yui , Cardoso Fabiano Nassar , Tricoli Valmor
Published: March 2017

This study investigated the effects of different reduced strength training (RST) frequencies on half‐squat 1 RM and quadriceps cross‐sectional area (QCSA). Thirty‐three untrained males (24.7 ± 3.9 years; 1.73 ± 0.08 m; 74.6 ± 8.4 kg) underwent a 16‐week experimental period (i.e. eight weeks of strength training [ST] followed by additional eight weeks of RST). During the ST period, the participants performed 3–4 sets of 6–12 RM, three sessions/week in half‐squat and knee extension exercises. Following ST, the participants were randomly allocated to one of three groups: reduced strength training with one (RST1) or two sessions per week (RST2), and ceased training (CT). Both RST1 and RST2 groups had their training frequency and total training volume‐load (i.e. RST1 = 50.3% and RST2 = 57.1%) reduced, while the CT group stopped training completely. Half‐squat 1 RM (RST1 = 27.9%; RST2 = 26.7%; and CT = 28.4%) and QCSA (RST1 = 6.1%; RST2 = 6.9%; and CT = 5.8%) increased significantly (p < .05) in all groups after eight weeks of ST. No significant changes were observed in 1 RM and QCSA for RST1 and RST2 groups after the RST period, while the CT group demonstrated a decrease in half‐squat 1 RM (22.6%) and QCSA (5.4%) when compared to the ST period (p < .05). In conclusion, different RST frequencies applied were able to maintain muscle mass and strength performance obtained over the regular ST period. Thus, it appears that RST frequency does not affect the maintenance of muscle mass and strength in untrained males, as long as volume‐load is equated between frequencies.
Tribute to Dr Jacques Rogge: muscle activity and fatigue during hiking in Olympic dinghy sailing
Authors: Bourgois Jan G. , Dumortier Jasmien , Callewaert Margot , Celie Bert , Capelli Carlo , Sjøgaard Gisela , De Clercq Dirk , Boone Jan
Published: March 2017

‘A tribute to Dr J. Rogge’ aims to systematically review muscle activity and muscle fatigue during sustained submaximal quasi‐isometric knee extension exercise (hiking) related to Olympic dinghy sailing as a tribute to Dr Rogge's merits in the world of sports. Dr Jacques Rogge is not only the former President of the International Olympic Committee, he was also an orthopaedic surgeon and a keen sailor, competing at three Olympic Games. In 1972, in fulfilment of the requirements for the degree of Master in Sports Medicine, he was the first who studied a sailors’ muscle activity by means of invasive needle electromyography (EMG) during a specific sailing technique (hiking) on a self‐constructed sailing ergometer. Hiking is a bilateral and multi‐joint submaximal quasi‐isometric movement which dinghy sailors use to optimize boat speed and to prevent the boat from capsizing. Large stresses are generated in the anterior muscles that cross the knee and hip joint, mainly employing the quadriceps at an intensity of 30–40% maximal voluntary contraction (MVC), sometimes exceeding 100% MVC. Better sailing level is partially determined by a lower rate of neuromuscular fatigue during hiking and for ≈60% predicted by a higher maximal isometric quadriceps strength. Although useful in exercise testing, prediction of hiking endurance capacity based on the changes in surface EMG in thigh and trunk muscles during a hiking maintenance task is not reliable. This could probably be explained by the varying exercise intensity and joint angles, and the great number of muscles and joints involved in hiking.

Highlights

Dr Jacques Rogge, former president of the International Olympic Committee and Olympic Finn sailor, was the first to study muscle activity during sailing using invasive needle EMG to obtain his Master degree in Sports Medicine at the Ghent University.

Hiking is a critical bilateral and multi‐joint movement during dinghy racing, accounting for >60% of the total upwind leg time. Hiking generates large stresses in the anterior muscles that cross the knee and hip joint.

Hiking is considered as a quasi‐isometric bilateral knee extension exercise. Muscle activity measurements during sailing, recorded by means of EMG, show a mean contraction intensity of 30‐40% maximal voluntary contraction with peaks exceeding 100%.

Hiking performance is strongly related to the development of neuromuscular fatigue in the quadriceps muscle. Since maximal strength is an important determinant of neuromuscular fatigue during hiking, combined strength and endurance training should be incorporated in the training program of dinghy sailors.
Semantic transparency affects morphological priming . . . eventually
Authors: Heyer Vera , Kornishova Dana
Published: March 2017

Semantic transparency has been in the focus of psycholinguistic research for decades, with the controversy about the time course of the application of morpho-semantic information during the processing of morphologically complex words not yet resolved. This study reports two masked priming studies with English - ness and Russian - ost’ nominalisations, investigating how semantic transparency modulates native speakers’ morphological priming effects at short and long stimulus onset asynchronies (SOAs). In both languages, we found increased morphological priming for nominalisations at the transparent end of the scale (e.g. paleness – pale) in comparison to items at the opaque end of the scale (e.g. business – busy) but only at longer prime durations. The present findings are in line with models that posit an initial phase of morpho-orthographic (semantically blind) decomposition.
Cytoplasmic flows as signatures for the mechanics of mitotic positioning
Authors: Nazockdast Ehssan , Rahimian Abtin , Needleman Daniel , Shelley Michael
Published: March 2017

The proper positioning of mitotic spindle in the single-cell Caenorhabditis elegans embryo is achieved initially by the migration and rotation of the pronuclear complex (PNC) and its two associated astral microtubules (MTs). Pronuclear migration produces global cytoplasmic flows that couple the mechanics of all MTs, the PNC, and the cell periphery with each other through their hydrodynamic interactions (HIs). We present the first computational study that explicitly accounts for detailed HIs between the cytoskeletal components and demonstrate the key consequences of HIs for the mechanics of pronuclear migration. First, we show that, because of HIs between the MTs, the cytoplasm-filled astral MTs behave like a porous medium, with its permeability decreasing with increasing the number of MTs. We then directly study the dynamics of PNC migration under various force-transduction models, including the pushing or pulling of MTs at the cortex and the pulling of MTs by cytoplasmically bound force generators. Although achieving proper position and orientation on reasonable time scales does not uniquely choose a model, we find that each model produces a different signature in its induced cytoplasmic flow. We suggest that cytoplasmic flows can be used to differentiate between mechanisms.
Introduction
Authors: Pollmann Karla
Published: March 2017

The Introduction offers a broad setting of the stage regarding the state of research in the still under-researched field of early Christian poetry. By challenging both classicists for whom this literature tends to be ‘too late’, and theologians for whom this literature does not bear sufficient relevance regarding exegetical and dogmatic issues it emphasizes the need for an unbiased look at late antiquity and its insufficient qualification as a period of ‘decline’. Inter- and transdisciplinary literary theories like reception aesthetics and intertextuality, littérature au second degré and the general blossoming of reception studies in classics in recent years enable the fruitful study of early Christian poetry from a fresh perspective. This will not only fill a considerable gap in our knowledge of the history of European literature, mentality, and thought, but will also enable a better understanding of later literature in this tradition, from Beowulf to Milton’s Paradise Lost.
The Test Case of Epic Poetry in Late Antiquity
Authors: Pollmann Karla
Published: March 2017

This chapter examines how epic, considered the grandest of all classical literary genres, was transformed in late antiquity in order to make its cultural potential serve (not only) Christian ends. The rich spectrum of possible uses for the epic genre is illustrated through concrete examples organized into five (not necessarily exhaustive) types: (1) Mythological epic: Dracontius, Medea (Romulea 10); (2) (Pagan) panegyric epic: Claudian, De Bello Gildonico; (3) Allegorical epic: Prudentius, Psychomachia; (4) Biblical epic: Avitus, De Spiritalis Historiae Gestis; and (5) Hagiographical epic: Venantius Fortunatus, Vita S. Martini. The chapter concludes that Vergil maintains his dominant position as the Latin epicist that later epicists had to attempt to emulate. Likewise, epic style, figures of thought (like personifications, or the Muse) are either transformed or Christianized, but rarely abandoned. Moreover, the authoritative function of epic as pure explanation of the world yields to political and ecclesiastical purposes.
Culture as Curse or Blessing? Prudentius and Avitus on the Origins of Culture
Authors: Pollmann Karla
Published: March 2017

The theories about the origins of culture discussed in this chapter are instances of a way of systematically thinking about the nature of culture that was developed in classical times, either in verse or in prose. In such so-called foundation narratives, the origins of culture can be explained either in a mythological or a rationalizing fashion. Early Christianity also engaged with these lines of thought, demonstrated in this chapter by looking at the poets Prudentius and Avitus, and by investigating how pagan models were received in varying Christian contexts. The chapter concludes that from the fourth to the sixth century one can observe a shift from a critical to an increasingly positive attitude towards the possibility of establishing a Christian culture, and that both attitudes are developed with recourse to pagan classical cultural traditions.
How Far Can Sainthood Go? St Martin of Tours in Two Hagiographical Epics of Late Antiquity
Authors: Pollmann Karla
Published: March 2017

Although recent research in particular has, under the significant influence of Peter Brown, given an increasing amount of attention to the phenomenon of the ‘holy man’ and ‘holy woman’ in late antiquity, the focus has been primarily on socio-historical aspects. The hagiographic epic of Latin late antiquity has so far been ignored in most investigations of hagiography. In order to explain the rich and as yet nearly unexplored dimension of this particular form of hagiographical discourse, this chapter illustrates two different concepts of holiness by analysing Paulinus of Périgueux (fifth century) and Venantius Fortunatus (sixth century), who both paraphrased the prose Vita Sancti Martini and Dialogi of Sulpicius Severus (fourth century) in hexametrical verse. In doing so, they represented their different theological world-views which are also analysed.
An introduction to topological phases of electrons
Authors: Moore Joel E.
Published: March 2017

These lecture notes seek to present a coherent picture of some key aspects of topological insulators and the quantum Hall effect. Rather than aiming for completeness or historical accuracy, the goal is to show that a few important ideas, such as the Berry phase and Chern and Chern–Simons differential forms, occur repeatedly and serve as links between superficially different areas of physics. Non-interacting topological phases, electrical polarization, and some transport phenomena in metals can all be understood in a unified framework as consequences of Abelian and non-Abelian Berry phases. The fractional quantum Hall effect is discussed as an example of topological order, and its description by (Abelian) Chern–Simons topological field theory is introduced.
Topological insulators and related phases with strong interactions
Authors: Vishwanath Ashvin
Published: March 2017

These lecture notes are mainly concerned with how the concept of topological insulators is generalized when interactions are included. More generally, the interplay of symmetry and topology is discussed. Traditionally, phases of matter were distinguished on the basis of symmetry alone. On the other hand, fractional quantum Hall phases are examples of topological states whose essential character does not require a discussion of symmetry. However, topological insulators are an example of a new phase of matter that combines both symmetry and topology.
What is life?—70 years after Schrödinger
Authors: Niemi Antti J.
Published: March 2017

In February 1943, Erwin Schröodinger presented a series of lectures at the Dublin Institute for Advanced Studies with the title What is Life? The Physical Aspect of the Living Cell. The lectures at Les Houches were a celebration of the anniversary of Schrödinger’s lectures, with the underlying theme being that of proteins as an exciting example of a physical system. These lecture notes begin with an explanation of the basic facts about proteins and then turn to addressing proteins from the point of view of a physicist, illustrating how their study brings physics together in a unique fashion with biology, chemistry, applied mathematics, even medical research, with the goal of understanding living matter.
Information and Communication Technology
Authors: Kaila Heidi
Published: March 2017

The emergence and development of the information and communication sector has been rapid in rural Viet Nam over 2006–14, and a true information and communication technology (ICT) revolution has taken place. This chapter examines household ownership and use of ICT. It studies the geographic and demographic differences across ownership of technology, especially phones and the Internet, and the determinants of ICT adoption. First, it finds that expansion of telephones has been much more rapid than the expansion of the Internet. Second, it finds that even though in 2014 internet users were relatively wealthier and more educated than households with phones on average, the adoption patterns of these two technologies are very similar. ICT adoption is driven by education and income, as well as wealth and ownership of other technology.
Welfare Dynamics:2006–14
Authors: McKay Andy , Tarp Finn
Published: March 2017

Using the five-wave VARHS panel dataset, this chapter analyses the dynamics of household welfare between 2006 and 2014. Welfare is measured based on real per capita food consumption and income, as well as an asset index. A descriptive analysis is presented, along with an econometric analysis of welfare changes according to each measure, comparing the beginning and end of the panel and looking at mobility between waves. While the overall pattern is of strong upward mobility over the period for most households, a significant minority in fact became worse off. Some important factors identified for positive improvements in welfare include education and having household members who migrated elsewhere, while ethnic minority households often have significantly lower welfare growth.
Educational outcomes of a medical physicist program over the past 10 years in Japan
Authors: Kadoya Noriyuki , Karasawa Kumiko , Sumida Iori , Arimura Hidetaka , Kakinohana Yasumasa , Kabuki Shigeto , Monzen Hajime , Nishio Teiji , Shirato Hiroki , Yamada Syogo
Published: March 2017

The promotion plan for the Platform of Human Resource Development for Cancer (Ganpro) was initiated by the Ministry of Education, Culture, Sports, Science and Technology of Japan in 2007, establishing a curriculum for medical physicists. In this study, we surveyed the educational outcomes of the medical physicist program over the past 10 years since the initiation of Ganpro. The Japan Society of Medical Physics mailing list was used to announce this survey. The questionnaire was created by members of the Japanese Board for Medical Physicist Qualification, and was intended for the collection of information regarding the characteristics and career paths of medical physics students. Students who participated in the medical physics program from 2007 to 2016 were enrolled. Thirty-one universities (17 accredited and 14 non-accredited) were represented in the survey. In total, 491, 105 and 6 students were enrolled in the Master's, Doctorate and Residency programs, respectively. Most students held a Bachelor's degree in radiological technology (Master's program, 87%; Doctorate program, 72%). A large number of students with a Master's degree worked as radiological technologists (67%), whereas only 9% (n = 32) worked as medical physicists. In contrast, 53% (n = 28) of the students with a Doctorate degree worked as medical physicists. In total, 602 students (from 31 universities) completed the survey. Overall, although the number of the graduates who worked as medical physicists was small, this number increased annually. It thus seems that medical institutions in Japan are recognizing the necessity of licensed medical physicists in the radiotherapy community.
Hyperglycemia Aggravates Cerebral Vasospasm after Subarachnoid Hemorrhage in a Rat Model
Authors: Huang Yu-Hua , Chung Chia-Li , Tsai Hung-Pei , Wu Shu-Chuan , Chang Chih-Zen , Chai Chee-Yin , Lee Tao-Chen , Kwan Aij-Lie
Published: March 2017

BACKGROUND: Hyperglycemia is common and showed to be risky for poor prognosis in patients with subarachnoid hemorrhage (SAH). However, the causality and mechanism underlying this observation are not well established.

OBJECTIVE: To investigate the relationship between hyperglycemia and cerebral vasospasm with its pathogenesis in a rat model of SAH.

METHODS: One-shot SAH model was employed in male Sprague-Dawley rats. Hyperglycemia was triggered by intraperitoneal streptozotocin administration (50 mg/kg) 7 days before SAH induction. The severity of cerebral vasospasm was determined by the cross-sectional area of basilar artery (BA) in male rats randomly assigned to 1 of 4 groups: control, hyperglycemia only, SAH only, and SAH with hyperglycemia. The expression of endothelial nitric oxide synthase (eNOS) and induced nitric oxide synthase (iNOS) in the BA were analyzed by immunohistochemistry.

RESULTS: The mean (standard deviation) blood glucose level was 433.0 (98.3) and 156.5 (31.7) mg/dL in streptozotocin -treated and untreated rats, respectively. Hyperglycemic rats exhibited poorer neurobehavioral performance than normoglycemic rats when subjected to SAH. Hyperglycemia-mediated exacerbation of vasospasm was evident by the greater decrease in the BA cross-sectional area in the hyperglycemic SAH group than in the SAH only group. Furthermore, there was more decreased expression of eNOS and increased expression of iNOS within the vessels of the hyperglycemic SAH rats.

CONCLUSION: Hyperglycemia exacerbated cerebral vasospasm and was associated with poorer neurological outcomes following SAH. Our findings also suggested the nitric oxide pathway as a potential underlying mechanism via the dysregulation of eNOS and iNOS.
Asymptomatic Extracranial Vertebral Artery Disease in Patients with Internal Carotid Artery Stenosis
Authors: Qureshi Adnan I. , Chaudhry Saqib A. , Eckstein Henning , Jansen Olav , Ringleb Peter A.
Published: March 2017

BACKGROUND: Extracranial vertebral artery disease is seen in patients with internal carotid artery stenosis, although the clinical significance is not well understood.

OBJECTIVE: To determine the prevalence and natural history of extracranial vertebral artery disease in patients with recently symptomatic internal carotid artery stenosis.

METHODS: We analyzed data collected for patients with recently symptomatic internal carotid artery stenosis in the Stent-Protected Angioplasty vs Carotid Endarterectomy trial. We used Cox proportional hazards analysis to compare the relative risk of various endpoints (any stroke, ipsilateral stroke, and death) between the 3 categories of extracranial vertebral artery disease (normal/hypoplastic, moderate/severe stenosis, occlusion) adjusting for age, gender, severity of internal carotid artery stenosis at baseline (<70% and ≥70%), allocated procedure (carotid angioplasty and stent placement or carotid endarterectomy) and hypertension.

RESULTS: Moderate to severe stenosis and occlusion of 1 of both extracranial vertebral arteries were diagnosed in 152 (12.9%) and 57 (4.8%) of 1181 subjects, respectively. Comparing subjects with normal or hypoplastic vertebral artery, there was nonsignificant 30%, 40%, and 50% higher risk of any stroke (hazard ratio [HR] 1.3, 95% confidence interval [CI] 0.7-2.3), ipsilateral stroke (HR 1.4, 95% CI 0.7-2.5), and death (HR 1.5, 95% CI 0.7-3.1) among subjects with moderate to severe vertebral artery stenosis after adjusting for potential confounders.

CONCLUSIONS: There may be an increased risk of stroke and death in patients with symptomatic internal carotid artery stenosis with concurrent asymptomatic extracranial vertebral artery stenosis.
Seizure Outcomes in Occipital Lobe and Posterior Quadrant Epilepsy Surgery: A Systematic Review and Meta-Analysis
Authors: Harward Stephen C , Chen William C , Rolston John D , Haglund Michael M , Englot Dario J
Published: March 2017

BACKGROUND:

Occipital lobe epilepsy (OLE) is an uncommon but debilitating focal epilepsy syndrome with seizures often refractory to medical management. While surgical resection has proven a viable treatment, previous studies examining postoperative seizure freedom rates are limited by small sample size and patient heterogeneity, thus exhibiting significant variability in their results.

OBJECTIVE

To review the medical literature on OLE so as to investigate rates and predictors of both seizure freedom and visual outcomes following surgery.

METHODS

We reviewed manuscripts exploring surgical resection for drug-resistant OLE published between January 1990 and June 2015 on PubMed. Seizure freedom rates were analyzed and potential predictors were evaluated with separate meta-analyses. Postoperative visual outcomes were also examined.

RESULTS

We identified 27 case series comprising 584 patients with greater than 1 yr of follow-up. Postoperative seizure freedom (Engel class I outcome) was observed in 65% of patients, and was significantly predicted by age less than 18 yr (odds ratio [OR] 1.54, 95% confidence interval [CI] 1.13-2.18), focal lesion on pathological analysis (OR 2.08, 95% CI 1.58-2.89), and abnormal preoperative magnetic resonance imaging (OR 3.24, 95% 2.03-6.55). Of these patients, 175 also had visual outcomes reported with 57% demonstrating some degree of visual decline following surgery. We did not find any relationship between postoperative visual and seizure outcomes.

CONCLUSION

Surgical resection for OLE is associated with favorable outcomes with nearly two-thirds of patients achieving postoperative seizure freedom. However, patients must be counseled regarding the risk of visual decline following surgery.
Early Cranioplasty is Associated with Greater Neurological Improvement: A Systematic Review and Meta-Analysis
Authors: Malcolm James G , Rindler Rima S , Chu Jason K , Chokshi Falgun , Grossberg Jonathan A , Pradilla Gustavo , Ahmad Faiz U
Published: March 2017

BACKGROUND

Cranioplasty after decompressive craniectomy is a common neurosurgical procedure, yet the optimal timing of cranioplasty has not been well established.

OBJECTIVE

To investigate whether the timing of cranioplasty is associated with differences in neurological outcome.

METHODS

A systematic literature review and meta-analysis was performed using MEDLINE, Scopus, and the Cochrane databases for studies reporting timing and neurological assessment for cranioplasty after decompressive craniectomy. Pre- and postcranioplasty neurological assessments for cranioplasty performed within (early) and beyond (late) 90 d were extracted. The standard mean difference (SMD) was used to normalize all neurological measures. Available data were pooled to compare pre-cranioplasty, postcranioplasty, and change in neurological status between early and late cranioplasty cohorts, and in the overall population.

RESULTS

Eight retrospective observational studies were included for a total of 528 patients. Studies reported various outcome measures (eg, Barthel Index, Karnofsky Performance Scale, Functional Independence Measure, Glasgow Coma Scale, and Glasgow Outcome Score). Cranioplasty, regardless of timing, was associated with significant neurological improvement (SMD .56, P = .01). Comparing early and late cohorts, there was no difference in precranioplasty neurological baseline; however, postcranioplasty neurological outcome was significantly improved in the early cohort (SMD .58, P = .04) and showed greater magnitude of change (SMD 2.90, P = .02).

CONCLUSION

Cranioplasty may improve neurological function, and earlier cranioplasty may enhance this effect. Future prospective studies evaluating long-term, comprehensive neurological outcomes will be required to establish the true effect of cranioplasty on neurological outcome.
C1 Lateral Mass Displacement and Transverse Atlantal Ligament Failure in Jefferson's Fracture: A Biomechanical Study of the “Rule of Spence”
Authors: Woods Rafeek O , Inceoglu Serkan , Akpolat Yusuf T , Cheng Wayne K , Jabo Brice , Danisa Olumide
Published: March 2017

BACKGROUND

Jefferson's fracture, first described in 1927, represents a bursting fracture of the C1 ring with lateral displacement of the lateral masses. It has been determined that if the total lateral mass displacement (LMD) exceeds 6.9 mm, there is high likelihood of transverse atlantal ligament (TAL) rupture, and if LMD is less than 5.7 mm TAL injury is unlikely. Several recent radiographic studies have questioned the accuracy and validity of the “rule of Spence” and it lacks biomechanical support.

OBJECTIVE

To determine the amount of LMD necessary for TAL failure using modern biomechanical techniques.

METHODS

Using a universal material testing machine, cadaveric TALs were stretched laterally until failure. A high-resolution, high-speed camera was utilized to measure the displacement of the lateral masses upon TAL failure.

RESULTS

Eleven cadaveric specimens were tested (n = 11). The average LMD upon TAL failure was 3.2 mm (±1.2 mm). The average force required to cause failure of the TAL was 242 N (±82 N). From our data analysis, if LMD exceeds 3.8 mm, there is high probability of TAL failure.

CONCLUSION

Our findings suggest that although the rule of Spence is a conceptually valid measure of TAL integrity, TAL failure occurs at a significantly lower value than previously reported (P < .001). Based on our literature review and findings, LMD is not a reliable independent indicator for TAL failure and should be used as an adjunctive tool to magnetic resonance imaging rather an absolute rule.
Considerations for Medical Students and Advisors After an Unsuccessful Match
Authors: Bumsted Tracy , Schneider Benjamin N. , Deiorio Nicole M.
Published: March 2017

Increasing numbers of graduating U.S. medical students are not securing a graduate medical education (GME) position, even after participating in the National Resident Matching Program (also known as “the Match”) and the Supplemental Offer and Acceptance Program. The reasons for an unsuccessful Match include increasing numbers of applicants compared with nearly unchanging numbers of available GME positions, academic problems or professionalism lapses, and a poor fit between applicants and their first-choice specialty.

In this Perspective, the authors (1) examine the current Match landscape; (2) discuss the environmental factors that affect that Match landscape such as increasing medical school enrollment without a corresponding increase in GME positions; (3) review historical data on unmatched MD students; (4) discuss medical schools’ responsibilities to unmatched students and to society; (5) explore controversial issues related to unmatched students, including graduation delays and altering the Medical Student Performance Evaluation for subsequent Match applications; and (6) outline various pathways for unmatched students to secure a GME position in the future or to pursue an alternative, nonclinical position. Finally, they share guidelines for advising unmatched students in the weeks and months following an unsuccessful Match. These recommendations aim to clarify what options exist, and are practical, for unmatched students, with the hope that further study will enable the development of best practices in this area.
How to Get to the Distal Posterior Tibial Malleolus? A Cadaveric Anatomic Study Defining the Access Corridors Through 3 Different Approaches
Authors: Assal Mathieu , Dalmau-Pastor Miki , Ray Adrien , Stern Richard
Published: March 2017

Objective:

Our objective is to review the anatomy and exposure of the posterior column and posterior tibial malleolus (the posterior tibial plafond) by defining the access corridors through 3 different approaches—posteromedial, posterolateral, and modified posteromedial.

Methods:

Cadaveric dissection with percentage of posterior tibial malleolus exposed, and strain gauge measurements to evaluate traction on the neurovascular bundle.

Results:

The 3 different approaches are applicable for exposure of different portions of the distal posterior tibial malleolus. Strain gauge measurements reveal the least traction on the flap containing the neurovascular bundle with the modified posteromedial approach (7.0 N) compared with the posteromedial (21.5 N) and posterolateral (16.8 N) approaches. Exposure of the posterior tibial malleolus was greater with the modified posteromedial approach (91%) compared with the other 2 approaches (posteromedial = 64%, posterolateral = 40%).

Conclusions:

Depending on the location of the principal fracture fragments, particularly in high energy ankle and pilon fractures, each of the posterior approaches has its indication, with the modified posteromedial approach revealing more of the posterior anatomy than the other 2 approaches. The latter approach places the least traction on the flap containing the neurovascular bundle.
Improving Pain Management and Long-Term Outcomes Following High-Energy Orthopaedic Trauma (Pain Study)
Authors: Castillo Renan C. , Raja Srinivasa N. , Frey Katherine P. , Vallier Heather A. , Tornetta Paul , Jaeblon Todd , Goff Brandon J. , Gottschalk Allan , Scharfstein Daniel O. , O'Toole Robert V. ,   METRC
Published: March 2017

Poor pain control after orthopaedic trauma is a predictor of physical disability and numerous negative long-term outcomes. Despite increased awareness of the negative consequences of poorly controlled pain, analgesic therapy among hospitalized patients after orthopaedic trauma remains inconsistent and often inadequate. The Pain study is a 3 armed, prospective, double-blind, multicenter randomized trial designed to evaluate the effect of standard pain management versus standard pain management plus perioperative nonsteroidal anti-inflammatory drugs or pregabalin in patients of ages 18–85 with extremity fractures. The primary outcomes are chronic pain, opioid utilization during the 48 hours after definitive fixation and surgery for nonunion in the year after fixation. Secondary outcomes include preoperative and postoperative pain intensity, adverse events and complications, physical function, depression, and post-traumatic stress disorder. One year treatment costs are also compared between the groups.
Predicting Acute Compartment Syndrome (PACS): The Role of Continuous Monitoring
Authors: Schmidt Andrew H. , Bosse Michael J. , Frey Katherine P. , O'Toole Robert V. , Stinner Daniel J. , Scharfstein Daniel O. , Zipunnikov Vadim , MacKenzie Ellen J. ,   METRC
Published: March 2017

The diagnosis of acute compartment syndrome (ACS) is a common clinical challenge among patients who sustain high-energy orthopaedic trauma, largely because no validated criteria exist to reliably define the presence of the condition. In the absence of validated diagnostic standards, concern for the potential clinical and medicolegal impact of a missed compartment syndrome may result in the potential overuse of fasciotomy in “at-risk” patients. The goal of the Predicting Acute Compartment Syndrome Study was to develop a decision rule for predicting the likelihood of ACS that would reduce unnecessary fasciotomies while guarding against potentially missed ACS. Of particular interest was the utility of early and continuous monitoring of intramuscular pressure and muscle oxygenation using near-infrared spectroscopy in the timely diagnosis of ACS. In this observational study, 191 participants aged 18–60 with high-energy tibia fractures were prospectively enrolled and monitored for up to 72 hours after admission, then followed for 6 months. Treating physicians were blinded to continuous pressure and oxygenation data. An expert panel of 9 orthopaedic surgeons retrospectively assessed the likelihood that each patient developed ACS based on data collected on initial presentation, clinical course, and known functional outcome at 6 months. This retrospectively assigned likelihood is modeled as a function of clinical data typically available within 72 hours of admission together with continuous pressure and oxygenation data. This study will improve our understanding of the natural history of compartment syndrome and examine the utility of early and continuous monitoring of the physiologic status of the injured extremity in the timely diagnosis of ACS.
Does Orientation of the Femoral Head Affect Acetabular Development? An Experimental Study in Lamb
Authors: Moraleda Luis , Bravo Christian , Forriol Francisco , Albiñana Javier
Published: March 2017

Background:

Derotational osteotomy of the proximal femur has proved to be effective in the treatment of residual acetabular dysplasia. However, the reason why this osteotomy is effective remains debatable. The purpose of this study is to investigate if an alteration of femoral head orientation affects acetabular growth.

Methods:

A proximal femoral osteotomy was performed in 21 lambs aged 3 months: 5 varus osteotomies (110 degrees), 4 valgus osteotomies (150 degrees), and 12 derotation osteotomies. Results were compared with a control group (5 animals). Osteotomy was fixed with a screw-plate device. Version was controlled intraoperatively with K-wires. Animals were killed 3 months after surgical procedure. A morphometric study of both proximal femur and acetabulum was performed, including deepness, volume and diameters of the acetabulum, neck-shaft angle and femoral version.

Results:

The average neck-shaft angle for the normal, anteversion, and retroversion groups was 129 degrees, whereas it was 110 degrees for the varus group and 149 degrees for the valgus group. The average femoral version for the normal, valgus, and varus groups was 21 degrees of anteversion, whereas it was 38 degrees of anteversion for the so-called anteversion group and 17 degrees of retroversion for the retroversion group. Nor the neck-shaft angle, nor the femoral version correlated with the acetabular anteroposterior diameter (P=0.698, 0.6, respectively), the acetabular inferosuperior diameter (P=0.083, 0.451, respectively) or the acetabular deepness (P=0.14, 0.371, respectively). The neck-shaft angle correlated significantly with acetabular volume (P=0.023), so that the lower the neck-shaft angle, the higher the acetabular volume (r=−0.453). The femoral version did not correlated with acetabular volume (P=0.381).

Conclusions:

Decreasing the neck-shaft angle provokes an increase in acetabular volume, whereas changes in femoral version do not affect the acetabular growth. Extra-articular osteotomies that alter femoral orientation affect intra-articular gross morphology.

Level of Evidence:

Level II—therapeutic study.
Variation in National ACGME Case Log Data for Pediatric Orthopaedic Fellowships: Are Fellow Coding Practices Responsible?
Authors: McClure Philip K. , Woiczik Marcella , Karol Lori , Sankar Wudbhav N.
Published: March 2017

Background:

The introduction of the 80-hour work week for Accreditation Council for Graduate Medical Education (ACGME) accredited fellowship programs initiated many efforts to optimize surgical training. One particular area of interest is on recording and tracking surgical experiences. The current standard is logging cases based on Current Procedural Terminology codes, which are primarily designed for billing. Proposed guidelines from the ACGME regarding logging exist, but their implementation is unknown, as is the variation in case volume across fellowship programs. The purpose of this study was to investigate variability in the national case log data, and explore potential sources of variation using fellow surveys.

Methods:

National ACGME case log data for pediatric orthopaedic fellowships from 2012 to 2015 were reviewed, with particular attention to the domains of spine, pelvis/hip, arthroscopy, trauma, and other (which includes clubfoot casting). To explore potential sources of case log variability, a survey on case logging behavior was distributed to all pediatric orthopaedic fellows for the academic year 2015 to 2016.

Results:

Reported experiences based on ACGME case logs varied widely between fellows with percentage difference of up to 100% in all areas. Similarly, wide variability is present in coding practices of pediatric orthopaedic fellows, who often lack formal education on the topic of appropriate coding/logging. In the survey, hypothetical case scenarios had an absolute difference in recorded codes of up to 13 and a percentage difference of up to 100%.

Conclusions:

ACGME case log data for pediatric orthopaedic fellowships demonstrates wide variability in reported surgical experiences. This variability may be due, in part, to differences in logging practices by individual fellows. This observation makes meaningful interpretation of national data on surgical volume challenging. Proposed surgical experience minimums should be interpreted in light of these data, and may not be advisable unless accompanied by standardized and specific guidelines for case log entry. Efforts to optimize training in the post 80-hour era will require accurate data to serve as a starting point for future educational efforts.
A Significant Influence of Metronidazole on Busulfan Pharmacokinetics: A Case Report of Therapeutic Drug Monitoring
Authors: Chung Hyewon , Yu Kyung-Sang , Hong Kyung Taek , Choi Jung Yoon , Hong Che Ry , Kang Hyoung Jin , Park Kyung Duk , Shin Hee Young , Lee SeungHwan
Published: March 2017

Busulfan is a cytotoxic agent used in preconditioning for hematopoietic stem cell transplantation. Therapeutic drug monitoring of busulfan is necessary owing to its narrow therapeutic range. Patients undergoing preconditioning are susceptible to infection and might require coadministration of antibiotics. We present a case study of a 3-year-old girl with precursor T-cell acute lymphoblastic leukemia who received intravenous busulfan before hematopoietic stem cell transplantation. Metronidazole was coadministered before the third dose of busulfan because of Clostridium difficile infection. The daily pharmacokinetic analysis revealed that the clearance reduced to 57% of that before the coadministration. Although the underlying mechanism is unclear, a significant pharmacokinetic interaction was observed between busulfan and metronidazole, underscoring the importance of therapeutic drug monitoring.
CHANGES IN METAMORPHOPSIA AND OPTICAL COHERENCE TOMOGRAPHY FINDINGS AFTER SUCCESSFUL RETINAL DETACHMENT SURGERY
Authors: Murakami Tomoya , Okamoto Fumiki , Sugiura Yoshimi , Okamoto Yoshifumi , Hiraoka Takahiro , Oshika Tetsuro
Published: March 2017

Purpose:

To investigate changes in metamorphopsia after rhegmatogenous retinal detachment surgery and to evaluate the relationship between metamorphopsia and retinal microstructures assessed with optical coherence tomography.

Methods:

The study included 47 eyes of 47 patients undergoing retinal detachment surgery. We examined the severity of metamorphopsia using M-CHARTS, best-corrected visual acuity, and optical coherence tomography images. All data were recorded before and 3, 6, and 12 months after surgery, except for M-CHARTS which were recorded only postoperatively.

Results:

Metamorphopsia scores at 3, 6, and 12 months postoperatively were 0.46 ± 0.51, 0.41 ± 0.44, and 0.28 ± 0.37, respectively, with significant improvement from 3 months to 12 months after surgery. Significant metamorphopsia (score ≥0.2) was present in 49% of patients at 12 months postoperatively. Multiple regression analysis revealed that metamorphopsia score at 12 months was significantly related to the status of macula and interdigitation zone. In patients with macula-off retinal detachment, improvement of metamorphopsia scores was associated with an increase in thickness of external limiting membrane-retinal pigment epithelium.

Conclusion:

After successful retinal detachment surgery, metamorphopsia gradually improved, but nearly half of the patients still exhibited metamorphopsia at 12 months postoperatively. Disruption of interdigitation zone and external limiting membrane-retinal pigment epithelium thickness was related to metamorphopsia.
INTRAVITREAL AFLIBERCEPT INJECTION FOR CHOROIDAL NEOVASCULARIZATION DUE TO PRESUMED OCULAR HISTOPLASMOSIS SYNDROME
Authors: Toussaint Brian W. , Kitchens John W. , Marcus Dennis M. , Miller Daniel M. , Kingdon Megan L. , Holcomb Diana , Ivey Ken
Published: March 2017

Purpose:

To evaluate intravitreal aflibercept injection (IAI) in patients with presumed ocular histoplasmosis syndrome and choroidal neovascularization.

Methods:

Open-label randomized Phase I/II study of IAI in patients with presumed ocular histoplasmosis syndrome–related choroidal neovascularization. Thirty-nine eyes from 39 patients were randomized in a 1:1 ratio to 2 groups. The Sustained Group eyes (n = 19) underwent monthly IAI for 3 months, then mandatory IAI every 2 months for 12 months (with an option for monthly PRN dosing, if needed). The PRN Group eyes (n = 20) received 1 IAI at randomization, then monthly PRN IAI for 12 months.

Results:

Thirty-nine eyes (19 eyes Sustained Group and 20 eyes PRN Group) were randomized. Average age of participants was 50 years (19–75), with 16 men and 23 women. Ten, 12, and 17 eyes demonstrated extrafoveal, juxtafoveal, and subfoveal choroidal neovascularization, respectively. All eyes in both groups received IAI at baseline, with the Sustained and PRN groups receiving on an average 7.5 (5–11) and 4.6 (1–10) injections, respectively, over the 12 months. At baseline, overall average visual acuity was 68 letters (13–87 letters) with Snellen equivalent of 20/42 (20/20–20/160). At 12-month follow-up, Sustained Group's average visual acuity was 84.9 letters (74–94) and Snellen equivalent was 20/21 (20/13–20/32), indicating an average improvement of 12 letters (6 letters loss to 36 letters gain) (P < 0.01). The PRN Group's 12-month average visual acuity was 80.9 letters (60–94) and Snellen equivalent was 20/26 (20/13–20/63), indicating an average gain of 19 letters (4–75) (P < 0.01). Mean baseline central subfield thickness (CST) was 374 μm and mean 1-year CST was 260 μm (P < 0.01) among all study participants. The Sustained Group's mean baseline CST was 383 μm and mean 12-month CST was 268 μm (P < 0.01). Mean baseline CST of the PRN Group was 360.8 μm, with the final mean CST of 260.5 μm (P < 0.01). No reported endophthalmitis, retinal tears, detachments, vitreous hemorrhage, nor adverse thrombotic events were reported.

Conclusion:

Intravitreal aflibercept resulted in improved visual and anatomical outcomes with a favorable safety profile. PRN IAI dosing required less injections with similar visual and anatomical outcomes compared with sustained dosing.
Clinical Outcomes and Contact Lens Case Contamination Using a Povidone–Iodine Disinfection System
Authors: Tan Jacqueline , Datta Ananya , Wong Katherine , Willcox Mark D. P. , Vijay Ajay K.
Published: March 2017

Objective:

To assess the incidence of adverse events during the use of a povidone–iodine disinfecting solution (cleadew) and the microbial contamination in contact lens cases.

Methods:

A prospective, single-center, open-label, controlled study evaluating the use of cleadew cleaning and disinfecting system in existing daily wear soft contact lens wearers over a 3-month period was conducted. Ocular signs and symptoms during lens wear were assessed at baseline and after 1 and 3 months of using cleadew. Contact lens cases were assessed for the frequency of microbial contamination and the types of microbes, using traditional microbial culture, followed by identification of bacteria using 16S rRNA sequencing.

Results:

Use of cleadew was well tolerated. There was reduction in corneal staining (0.5±0.5 at 3 months of use) compared with the participant's habitual multipurpose disinfecting system (1.1±1.0); all other clinical signs were not significantly different. There were no cases of solution-induced corneal staining. There was a low adverse event rate of 0.8% per 100 participant-months. Contact lens case contamination was low, with 30% of cases having no culturable microbes. Comparison with previously published data showed that use of cleadew resulted in low frequencies of Gram-positive (49%) and fungal (8%) contamination and a low, but higher than some other disinfecting solutions, level of Gram-negative bacteria.

Conclusions:

Cleadew cleaning and disinfecting system was associated with low levels of adverse events during use. Contact lens cases were significantly less frequently contaminated than for some other types of disinfecting solutions.
Spontaneous splenic artery rupture in a patient with an unclassified malignant spindle cell tumor of the spleen: report of a case
Authors: Swaid Forat , Shulman Katerina , Alfici Ricardo , Kessel Boris
Published: March 2017

The purpose of this paper was to describe an unusual manifestation of a sarcoma of the spleen and to raise awareness for spontaneous rupture of the splenic vessels in patients with splenic tumors. A 70-year-old man was admitted to our institution, suffering from left upper quadrant abdominal pain. Upon physical examination, a large and tender abdominal mass was palpated. Abdominal computed tomography showed a heterogenous enlarged spleen with active contrast extravasation from the splenic artery, free intraperitoneal fluid, and a retroperitoneal hematoma. The patient was treated with angioembolization of the splenic artery. Because of rebleeding, splenectomy was performed. Pathology revealed the spleen to be involved with an unclassified malignant spindle cell neoplasm. We concluded that in the case of spontaneous rupture of the splenic artery, accompanied with a radiologic appearance of an enlarged spleen, the diagnosis of sarcoma should be included in the differential diagnosis.