bluuebunny/crossref_metadata_2025 huggingface dataset:
Effective collaboration and governance processes to underpin large-scale natural resource management projects: the Australian Feral Camel Management Project experience
Authors: Hart Quentin , Bubb Andrew
Published: April 2016

The Australian Feral Camel Management Project involved a large number of diverse formal collaborators and broader stakeholders. Establishing and maintaining formal and informal collaborations was key to the success of the project. Good governance and communication processes underpin such collaboration and support the ability of projects to be flexible and to respond to unexpected changes in operating environment and/or stakeholder concerns. A priority for the project was to establish enduring relationships that would facilitate ongoing feral camel management.
Pulmonary Arterial Hypertension in Primary Amyloidosis
Authors: Cirulis Meghan M. , Emerson Lyska L. , Bull David A. , Hatton Nathan , Nativi‐Nicolai Jose , Hildebrandt Gerhard C. , Ryan John J.
Published: April 2016

Amyloidosis involves extravascular deposition of fibrillar proteins within tissues and organs. Primary light chain amyloidosis represents the most common form of systemic amyloidosis involving deposition of monoclonal immunoglobulin light chains. Although pulmonary amyloid deposition is common in primary amyloidosis, clinically significant pulmonary amyloidosis is uncommon, and elevated pulmonary artery pressures are rarely observed in the absence of other underlying etiologies for pulmonary hypertension, such as elevated filling pressures secondary to cardiac amyloid. In this case report, we present a patient with primary light chain amyloidosis and pulmonary arterial hypertension in the setting of pulmonary vascular and right ventricular myocardial amyloid deposition.
ProbFold: a probabilistic method for integration of probing data in RNA secondary structure prediction
Authors: Sahoo Sudhakar , Świtnicki Michał P. , Pedersen Jakob Skou
Published: April 2016

Motivation: Recently, new RNA secondary structure probing techniques have been developed, including Next Generation Sequencing based methods capable of probing transcriptome-wide. These techniques hold great promise for improving structure prediction accuracy. However, each new data type comes with its own signal properties and biases, which may even be experiment specific. There is therefore a growing need for RNA structure prediction methods that can be automatically trained on new data types and readily extended to integrate and fully exploit multiple types of data.

Results: Here, we develop and explore a modular probabilistic approach for integrating probing data in RNA structure prediction. It can be automatically trained given a set of known structures with probing data. The approach is demonstrated on SHAPE datasets, where we evaluate and selectively model specific correlations. The approach often makes superior use of the probing data signal compared to other methods. We illustrate the use of ProbFold on multiple data types using both simulations and a small set of structures with both SHAPE, DMS and CMCT data. Technically, the approach combines stochastic context-free grammars (SCFGs) with probabilistic graphical models. This approach allows rapid adaptation and integration of new probing data types.

Availability and Implementation: ProbFold is implemented in C ++. Models are specified using simple textual formats. Data reformatting is done using separate C ++ programs. Source code, statically compiled binaries for x86 Linux machines, C ++ programs, example datasets and a tutorial is available from http://moma.ki.au.dk/prj/probfold/ .

Contact : jakob.skou@clin.au.dk

Supplementary information:  Supplementary data are available at Bioinformatics online.
Optimizing transmit interval and logging range while avoiding aliased seabed echoes
Authors: Renfree Josiah S. , Demer David A.
Published: April 2016

Echosounder surveys of fish and zooplankton are typically conducted using fixed values of the echosounder transmit-pulse (“ping”) interval and data-logging range. The transmit-pulse interval must be long enough to sample to the range of the farthest (deepest) species under study, potentially causing undersampling of closer (shallower) species. We present an algorithm to dynamically minimize both the logging range and transmit-pulse interval while ensuring that the logging range equals or exceeds the range to the seabed up to a chosen maximum data-logging range. The algorithm also allows avoidance of aliased seabed echoes (“false bottoms”) by adjusting the minimized transmit interval such that seabed reverberation from a previous transmission is not present in the data logged for an ensuing transmission. Additionally, periodic measures of ambient noise allow evaluations of signal quality and useful range. This optimization scheme (“adaptive logging”) effectively increases the horizontal resolution and signal-to-noise ratio of the data, and may reduce the total data volume and storage-space requirement. The efficacy of the adaptive logging algorithm is quantified using simulations. Furthermore, an example implementation of the algorithm is demonstrated for a commonly used scientific echosounder (Simrad EK60).
Correction of elbow flexion contracture by means of olecranon resection and anterior arthrolysis in obstetrical brachial plexus palsy sequelae
Authors: Senes Filippo M. , Catena Nunzio , Dapelo Emanuela , Senes Jacopo
Published: April 2016

The authors have developed a particular surgical technique (olecranon bone resection together with anterior elbow arthrolysis) to increase the elbow’s range of motion in adolescents and young adults suffering from elbow flexion contracture in obstetrical palsy sequelae. The surgical procedure was carried out in a preliminary group of 11 patients. The original procedure included a double incision: first of all by means of a posterior approach to resect the tip of the olecranon and then another incision carried out through the anteromedial aspect of the elbow, with a view to performing the anterior capsulotomy. Preoperatively, the average clinical elbow extension was 64.9°, whereas after surgery, the value increased to 43.63°. The average DASH score was 38.27 points before surgery, whereas it decreased to 29.98 points after surgery. A statistical analysis was also carried out to confirm the outcome. The procedure is reliable, is not time-consuming, and does not lead to any major complications.
Sex and growth effect on pediatric hip injuries presenting to sports medicine clinic
Authors: Stracciolini Andrea , Yen Yi-Meng , d’Hemecourt Pierre A. , Lewis Cara L. , Sugimoto Dai
Published: April 2016

To compare sports-related hip injuries on the basis of sex and age in a cohort of young athletes. A 5% random probability sample of all new patients’ charts over a 10-year time period was selected for investigation. The most common hip injury diagnoses, sport at time of injury, mechanism (acute/traumatic vs. overuse), and types (bony vs. soft tissue) were compared by sex and age (preadolescent vs. adolescent). Descriptive and χ
2-analyses were carried out. The interaction of sex and age with respect to hip injury over time was examined by two-way (sex, age) analysis of variance. A total of 2133 charts were reviewed; N=87 hip injuries. The main diagnoses for males included labral tear (23.1%), avulsion fracture (11.5%), slipped capital femoral epiphysis (11.5%), dislocation (7.7%), and tendonitis (7.7%). The main diagnoses for females were labral tear (59.0%), tendonitis (14.8%), snapping hip syndrome (6.6%), strain (4.9%), and bursitis (4.9%). The five most common sports/activities at the time of hip injury were dancing/ballet (23.0%), soccer (18.4%), gymnastics (9.2%), ice hockey (8.1%), and track and field (6.9%). Age by sex comparisons showed a greater proportion of the total hip injuries (38.5%) in males compared with females (8.2%) during preadolescence (5–12 years). However, in adolescence (13–17 years), the hip injury proportion was significantly higher in females (91.8%) compared with males (61.5%; P<0.001). Injury mechanism and type differed by sex, with females sustaining more chronic/overuse (95.1%) and soft tissue type injuries (93.4%) compared with males (50.0 and 53.8%, respectively; P<0.001). Females were found to have a sharper increase in hip injury proportion as they progressed through puberty compared with males (analysis of variance sex-by-age interaction; P<0.001). Hip injury mechanism and type differed significantly between males and females during growth. Notably, the proportion of hip injuries in the young female athletes showed a significantly greater increase with advancing age compared with males. Hip injuries in children and the interplay with growth, as it relates to injury predisposition, require further investigation to facilitate efforts aimed at prevention. Level of Evidence III: Cross–sectional epidemiological study.
Treatment of complex idiopathic clubfoot using the modified Ponseti method: up to 11 years follow-up
Authors: Matar Hosam E. , Beirne Peter , Bruce Colin E. , Garg Neeraj K.
Published: April 2016

Complex idiopathic clubfeet are distinguished by significant shortening, rigid equinus with a deep crease above the heel, severe plantar flexion of all metatarsals, a deep plantar crease seven across the full width of the sole of the foot and high cavus with a short and hyperextended big toe. Ponseti has devised a modified technique for treating complex clubfeet. We retrospectively identified 11 children (nine males and two females) with 17 complex clubfeet who were treated with the modified Ponseti method. Demographics, severity of clubfoot, number of casts, rate of tendoachilles tenotomy, relapse rate and their management, any additional procedures and data on complications were collected. The average follow-up was 7 years (range 3–11 years) and the average Pirani score was 5.5 (range 4.5–6.0). Initial correction was achieved in all children, with an average of 7 (range 5–10) Ponseti casts. Tendoachilles tenotomy was performed in all 17 feet (100%). The overall relapse rate was 53% (nine feet). Five relapses were managed successfully with repeat casting and four feet were subjected to a second tendoachilles tenotomy. Four feet required extensive surgical releases. A satisfactory outcome was achieved at the final follow-up in 13 of 17 feet (76.5%). Two of these children (two feet) required an additional tibialis anterior transfer. In our experience, the modified Ponseti method is an effective first-line treatment for complex idiopathic clubfoot; however, such children will often require more casts than usual and have a higher rate of tendoachilles tenotomy and a higher risk of relapse requiring surgical procedures. Level of Evidence: level IV.
Physeal separation and complete resorption of femoral head associated with chronic osteomyelitis of femoral diaphysis in a young child: rare case report
Authors: Pandey Praveen K. , Pawar Inder , Gupta Jyoti
Published: April 2016

We report the case of a two and a half-year-old girl who presented with injury to the right thigh along with a discharging sinus in the midthigh region following a nonorthopaedic surgical procedure. Radiographs of the thigh indicated osteomyelitis of the femoral diaphysis with pathological fracture. During follow-up examination, shortening was observed in the affected limb, along with complete separation of the femoral epiphysis with partial resorption of the femoral head. A few cases of physeal separation of the femoral head following osteomyelitis of the femoral diaphysis have been reported in the published literature, but still it may go undiagnosed until late stages because of the lack of awareness among orthopaedicians about this entity. There was no history of any precipitating trauma to the hip. This case is of interest because of the difficulty in making differential diagnosis at the first evaluation; there was an orthopaedic misdiagnosis on the basis of the lack of complete preoperative imaging. Because of the devastating sequelae on immature skeleton including limb shortening, osteomyelitis, epiphyseal separation of proximal epiphysis and pathological fracture of shaft femur, the importance of early diagnosis, complete preoperative imaging and prompt treatment must be overemphasized.
Fine Configuration of Thoracic Type II Meningeal Cysts
Authors: Thorpe Lowis Casper G. , Zhang Ming , Amin Nahid F.
Published: April 2016

Study Design.

A cadaveric study

Objective.

The aim of this study was to analyze the in situ macro- and microscopic configuration of the type II cyst and its anatomic relationship with surrounding structures.

Summary of Background Data.

The lack of consensus of surgical strategy to manage symptomatic type II meningeal cysts (Tarlov cysts) is because our knowledge of type II cyst anatomy remains incomplete. It has been assumed that the cyst communicates with the subarachnoid space via microconnections. Till date, however, no direct evidence demonstrates the existence of the microconnections, although delayed contrast filling of type II cysts is commonly observed in CT myelography.

Methods.

Three type II meningeal cysts analyzed in this study were incidentally found in one of 16 plastinated spines. The spine was from an 89-year-old female cadaver and plastinated as a set of 164 transverse sections with a thickness of 2.5 mm. The sections were examined under a stereomicroscope.

Results.

Three type II cysts were in the thoracic spine and had a common feature that a clearly identifiable cyst neck connected the cyst body to the subarachnoid space. The dorsal root of the spinal nerve was centered in the cyst neck but spread over the cyst body or traversed the cyst cavity. The meningeal opening of the cyst was located above the inferior border of the vertebral pedicle, thus, the cyst neck hugged around the pedicle and sharply turned inferolaterally into the intervertebral foramen. The cyst body was halted by the dorsal ganglion.

Conclusion.

This study reveals in situ macro- and microscopic configuration of the type II cyst and its relationship with the structures and suggests that it may be feasible to localize and ligate the cyst neck for surgical management of type II cysts.

Level of Evidence: 3
Clinical Features and Prognostic Factors of Patients With Nerve Sheath Tumors in the Cervical Spine
Authors: Li Bo , Yin Huabin , Meng Tong , Zhou Pingting , Han Zhitao , Jia Qi , Cai Weiluo , Han Shuai , Wang Ting , Chen Tianrui , Zhou Wang , Xiao Jianru
Published: April 2016

Study Design.

A retrospective study was performed.

Objective.

The aim of the study was to illustrate the long-term follow-up results and discuss the possible factors that may affect outcomes of patients with cervical spinal nerve sheath tumors (CSNSTs).

Summary of Background Data.

Nerve sheath tumors are the most common neoplasms in the spine, but minimal information was published in the literature, especially when regarding to prognostic factors due to the benign nature. The objective of our study was to present long-term follow-up results and discuss the possible factors that may affect outcomes of patients with CSNSTs.

Methods.

A retrospective analysis of patients with CSNSTs was performed by survival analysis. The local relapse-free survival (LRFS) and overall survival (OS) rates were estimated using the Kaplan-Meier method to identify potential prognostic factors. Factors with P values ≤0.1 were subjected to multivariate analysis by Cox regression analysis. P values ≤0.05 were considered statistically significant.

Results.

A total of 169 patients with CSNSTs were included in the study. All patients received surgical treatment. The mean follow-up period was 72.1 months (median 62.0, range 1–158). Local recurrence was detected in 14 patients after surgery in our center, whereas death occurred in 9 patients with a mean follow-up of 27.2 months (median 24, range 1–84). The statistical analyses suggested that resection mode and pathology type were independent prognostic factors for LRFS and OS. In addition, postoperative recurrence was an adverse independent factor to OS.

Conclusion.

Total resection could significantly improve the LRFS and OS for patients with CSNSTs, whereas malignant CSNST was associated with worse prognosis. Moreover, postoperative recurrence was an adverse independent factor to OS.

Level of Evidence: 4
Relationship Between Kyphotic Posture and Falls in Community-Dwelling Men and Women
Authors: Tominaga Ryoji , Fukuma Shingo , Yamazaki Shin , Sekiguchi Miho , Otani Koji , Kikuchi Shin-ichi , Sasaki Sho , Kobayashi Susumu , Fukuhara Shunichi , Konno Shin-ichi
Published: April 2016

Study Design.

A cohort study using data from the Locomotive Syndrome and Health Outcome in Aizu Cohort Study, a population-based prospective cohort study of residents of the towns of Tadami and Minamiaizu in Fukushima Prefecture, Japan.

Objective.

The aim of this study was to clarify the association between kyphotic posture and falls, and to investigate the presence or absence of sex differences.

Summary of Background Data.

In our literature review, we found no studies focusing on sex differences in the association between kyphotic posture and falls.

Methods.

We included subjects aged more than 40 years who participated in annual health check-ups from 2009 to 2010. We analyzed the effects of kyphotic posture, measured using the wall-occiput test (WOT), on falls, adjusting for potential confounders, such as age, body mass index, symptoms of depression, sedative medication, and other comorbidities.

Results.

We enrolled a total of 1418 subjects into primary analyses (593 men, 825 women; mean [standard deviation] age, 68.1 [7.7] yrs). We then stratified subjects into the following groups according to the degree of kyphotic posture: nonkyphotic posture (n = 1138, 80.3%), mild kyphotic posture (n = 172, 12.1%), and severe kyphotic posture (n = 108, 7.6%). We observed no significant difference in the severity of kyphotic posture between men and women (P = 0.18). Overall, 284 subjects (20.0%) experienced at least one fall during the one-year period. After adjustment for potential confounders using a logistic regression model, we observed a significant association between severe kyphotic posture and falls for men [odds ratio (OR) 2.14 (1.01–4.57); P = 0.048]. In contrast, we observed no significant association for women [OR for severe kyphotic posture 0.80 (0.43–1.50), OR for mild kyphotic posture 0.91 (0.53–1.57)].

Conclusion.

We identified a sex difference in the association between kyphotic posture and falls in community-dwelling adults. In particular, severe kyphotic posture might only increase the incidence of falls in men.

Level of Evidence: 3
Atlantoaxial Fusion: Sixteen Years of Epidemiology, Indications, and Complications in New York State
Authors: Derman Peter B. , Lampe Lukas P. , Lyman Stephen , Kueper Janina , Pan Ting Jung , Girardi Federico P. , Albert Todd J. , Hughes Alexander P.
Published: April 2016

Study Design.

A retrospective state database analysis.

Objective.

The aim of this study was to describe the epidemiology and complications of as well as indications for primary isolated atlantoaxial fusion.

Summary of Background Data.

Atlantoaxial fusion involves unique indications, techniques, and complications. There is limited epidemiologic literature focused specifically on this procedure.

Methods.

New York's Statewide Planning and Research Cooperative System database, an all-payer hospitalization reporting system, was queried to identify all patients undergoing primary isolated atlantoaxial fusion in the state from 1997 to 2012. Demographic and clinical data were extracted and analyzed. United States Census Bureau figures were used to calculate population-adjusted surgical rates.

Results.

One thousand five hundred fifty-nine patients underwent isolated primary atlantoaxial fusion during the study period. The overall population-adjusted annual surgical rate did not change significantly over time. By 2012, individuals aged ≥70 years had the highest incidence of surgery [2.37 per 100,000 population; 95% confidence interval (95% CI) 1.68–3.07]. Medicare was the most common payer (44.0% of claims). Approximately 85% of patients had a Charlson/Deyo Comorbidity Index of zero or one. Over time, a significantly lower proportion of atlantoaxial fusions were attributable to rheumatic disease, and a significantly higher proportion were due to fracture. By 2012, management of fractures was the most common indication for C1-C2 fusion (44.1% of cases). Dysphagia or dysphonia occurred after 0.8% of cases, dural tear after 0.3%, infection after 0.5%, and seroma, hematoma, or hemorrhage after 0.5%. In-hospital mortality was 2.7%, of which 76% had fracture as the surgical indication.

Conclusion.

Isolated atlantoaxial fusions have been performed at a stable, low level over the past 16 years in New York. Although most of these patients are relatively healthy pre-operatively, approximately one in 10 experience an in-hospital complication and nearly 3% die in-hospital. Knowledge of these risks will hopefully spur further efforts to minimize them and allow for more accurate counseling of patients and their families.

Level of Evidence: 4
Analysis of Segmental Mobility Following a Novel Posterior Apical Short-Segment Correction for Adolescent Idiopathic Scoliosis
Authors: Hosseini Pooria , Nnadi Colin , Rehák Ľuboš , Repko Martin , Grevitt Michael , Aydinli Ufuk , Carl Allen , Pawelek Jeff , Crandall Dennis , Akbarnia Behrooz A.
Published: April 2016

Study Design.

A prospective, nonrandomized, multicenter study.

Objectives.

The purpose of this study was to evaluate the amount of motion present at instrumented but unfused segments and at motion segments adjacent to the instrumentation following application of a new posterior apical short-segment correction technique for correcting adolescent idiopathic scoliosis (AIS).

Summary of Background Data.

High-density pedicle screw instrumentation and posterior arthrodesis of all instrumented levels is the most common surgical treatment for AIS stabilization. The consequence of long fusion is an abnormal load on adjacent levels with an increased risk of future adjacent segment degeneration.

Methods.

This new system applied translational and derotational forces over a short apical segment. The short apical region was prepared for fusion while maintaining motion of unfused vertebral segments. Radiographic data were collected pre-operatively, at surgery, and at 3, 6, and 12 months after surgery.

Results.

Twenty-one female patients, mean age of 14.2 years (10.6–16.9 years) with Lenke 1A/1B curves, were enrolled. The range of motion in the unfused instrumented segment was significantly higher than the apical fused segment (11 vs. 0.9, P < 0.001). The range of motion of unfused vertebral levels distal to the construct at one year did not differ significantly from their respective pre-op values. When the analysis was extended to understand the impact of lower instrumented vertebra (LIV) on motion of unfused segments distal to the construct, it appeared that (1) the change in motion from pre-op to 12 months post-op as a function of LIV is not statistically significant; and (2) The motion of the unfused distal vertebral segments at 12 months does not statistically increase with a lower LIV.

Conclusion.

Through one year, this novel technique achieved and maintained similar AIS correction to current posterior fusion techniques while maintaining the mobility of unfused motion segments with less implant density.

Level of Evidence: 4
Fontan Fenestration Closure Prior to Posterior Spinal Fusion in Patients With Single-Ventricle Heart Disease
Authors: Schwartz Matthew C. , Nykanen David , Fleishman Craig , Munro Hamish M. , Phillips Jonathan , Knapp Raymond D. , Felix Donald
Published: April 2016

Study Design.

Case series.

Objective.

To describe transcatheter closure of the Fontan fenestration prior to posterior spinal fusion in two children to prevent paradoxical venous air embolism during the operation.

Summary of Background Data.

Scoliosis is common among patients with single-ventricle congenital heart disease who have undergone Fontan operation and spinal surgery can offer physiologic benefits. Venous air embolism is a rare, but important reported complication during spinal surgery performed in the prone position. Patients with Fontan circulation can have significant right to left shunting via a patent Fontan fenestration that can increase the risk of paradoxical systemic embolization of any entrained venous air.

Methods.

We retrospectively reviewed the charts of two patients with single-ventricle congenital heart disease who had undergone fenestrated Fontan operation and underwent transcatheter fenestration closure prior to spinal fusion.

Results.

Two patients with Fontan circulation underwent successful transcatheter fenestration closure with Amplatzer Ductal Occluder II devices. Five to 6 months after closure, both underwent uncomplicated posterior spinal fusion.

Conclusion.

Transcatheter closure of the Fontan fenestration prior to spinal fusion in two with Fontan circulation and scoliosis is a rare, but important indication for fenestration closure that warrants emphasis.

Level of Evidence: N/A
Potential Involvement of Obesity-Associated Chronic Inflammation in the Pathogenesis of Idiopathic Spinal Epidural Lipomatosis
Authors: Fujita Nobuyuki , Hosogane Naobumi , Hikata Tomohiro , Iwanami Akio , Watanabe Kota , Shiono Yuta , Okada Eijiro , Ishikawa Masayuki , Tsuji Takashi , Shimoda Masayuki , Horiuchi Keisuke , Nakamura Masaya , Matsumoto Morio , Ishii Ken
Published: April 2016

Study Design.

Multicenter case-control study.

Objective.

To characterize the pathogenesis of idiopathic spinal epidural lipomatosis (SEL).

Summary of Background Data.

SEL is often associated with the history of steroid use or endocrine disorders; however, the pathogenesis of idiopathic SEL remains poorly understood.

Methods.

Sixteen patients who underwent lumbar decompression surgery due to severe idiopathic SEL were included in the study (L group, 15 men and 1 woman; mean age, 71.5 yrs). Fifteen patients without SEL, who underwent decompression surgery for lumbar canal stenosis, were selected as controls (C group, 14 men and 1 woman; mean age, 70.3 yrs). The following parameters were analyzed in these two groups: body mass index (BMI), medical history, histology, the size of adipocytes in the epidural fat (EF) tissues, and the expression level of the transcripts for adiponectin, leptin, tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, IL-6, and IL-8.

Results.

The mean BMI of the L group was significantly higher than that of the C group (29.1vs.25.2 kg/m2,P = 0.006), and there was a significant correlation between BMI and the width of EF in both groups. The average adipocyte size in the EF was significantly larger in the L group than in the C group (2846.8vs.1699.0 μm2,P = 0.017). Furthermore, the expression levels of the transcripts for TNF-α and IL-1β in the L group were significantly higher than those in the C group [2.59-fold increase (P = 0.023) and 2.60-fold increase (P = 0.015), respectively].

Conclusion.

Our data suggest that the pathogenesis of idiopathic SEL is associated with obesity. In addition, the increased expression of two major inflammatory cytokines in the EF in the L group may indicate that SEL is causally related to chronic inflammation.

Level of Evidence:3
Preventive Effect of Dynamic Stabilization Against Adjacent Segment Degeneration After Posterior Lumbar Interbody Fusion
Authors: Tachibana Naohiro , Kawamura Naohiro , Kobayashi Daiki , Shimizu Takaki , Sasagawa Takeshi , Masuyama Shigeru , Hirao Yujiro , Kunogi Junichi
Published: April 2016

Study Design.

Retrospective cohort study.

Objective.

To investigate the effects of dynamic stabilization with sublaminar taping (ST) on the upper segment adjacent to posterior lumbar interbody fusion (PLIF).

Summary of Background Data.

Hybrid procedures such as dynamic stabilization for adjacent segment in addition to spinal fusion have been developed for reduction of the mechanical stress and prevention of adjacent segment pathology (ASP). However, a few reports are available on hybrid procedures and their efficacy is still controversial.

Methods.

Of the 116 patients who underwent L4/5 PLIF between August 2006 and September 2012, 76 patients with minimum 2-year follow up were included in this study. Fifty three patients underwent L4/5 PLIF with hybrid procedure using ST on L3 lamina (group U), and 23 patients underwent conventional L4/5 PLIF (group C). The adjacent segment degeneration (ASDeg) was determined by measurements of radiograph, computed tomography, and magnetic resonance imaging; the adjacent segment disease (ASDis) was evaluated on medical records.

Results.

The incidence of ASDeg at L3/4 segment of group U (3.7%) was significantly less than that of group C (30.4%) (P = 0.003), although there were no significant differences at L2/3 (group U, 7.5%; group C, 13%) or L5/S1 segment (group U, 5.7%; group C, 8.7%). On the other hand, no significant difference was found between two groups in the incidence of ASDis in L2/3 to L5/S1 levels, and no patient underwent reoperation. Bivariable and multivariable logistic regression analyses for L3/4 segment ASDeg revealed that the difference of surgical procedure was the only significant factor.

Conclusion.

The current study showed that L4/5 PLIF with hybrid procedure using ST on L3 lamina significantly reduced the incidence of L3/4 ASDeg as compared with the conventional L4/5 PLIF without compromising L2/3 or L5/S1 segment. Although further studies and longer follow up are necessary, the hybrid procedure is expected to be effective for preventing ASP.

Level of Evidence: 4
Entrapment of the Flexor Digitorum Profundus in the Callus after a Closed Distal Radial Fracture
Authors: Thione Alessandro , Cavadas Pedro C. , Rubi Carlo G.
Published: April 2016

A 17-year-old boy sustained a closed distal radius fracture; a closed reduction and external fixation was performed. After failed rehabilitation for digital flexion restriction, a surgical exploration was decided, revealing entrapment of flexor digitorum profundus in the bony callus; tendons were freed, obtaining a full range of motion.
Advancements in Imaging Technology for Detection and Diagnosis of Palpable Breast Masses
Authors: JAEGER BARBARA M. , HONG ANDREA S. , LETTER HALEY , ODELL MATTHEW C.
Published: April 2016

Breast cancer is the most commonly diagnosed cancer among women worldwide and the most common cause of cancer death in women. The most common presentation of breast cancer is the presence of a palpable mass, whether noted by the patient during breast self-examination or noted during clinical breast examination. There are a variety of imaging modalities now available for the evaluation of a palpable abnormality. A thorough understanding of the indications, risks, and benefits can help the clinician guide the patient through an appropriate, comprehensive imaging work up.
A Prospective Comparison of Noninvasive Methods in the Assessment of Liver Fibrosis and Esophageal Varices in Pediatric Chronic Liver Diseases
Authors: Voutilainen Silja , Kivisaari Reetta , Lohi Jouko , Jalanko Hannu , Pakarinen Mikko P.
Published: April 2016

Goals and Background:

We compared liver stiffness (LS), the aspartate aminotransferase-to-platelet ratio index (APRi), and the platelet-to-spleen size z score ratio (P/SZC) in the prediction of liver fibrosis and esophageal varices in children.

Study:

LS, APRi, SZC, and P/SZC were prospectively determined in 99 unselected consecutive children, who underwent liver biopsy for the follow-up of chronic liver disorders. LS was assessed by transient elastography. The spleen size was evaluated as the SD from age-specific and gender-specific normative values. Varices were assessed endoscopically (n=64). Biopsies were staged according to Metavir.

Results:

The median patient age was 6.0 (interquartile range, 1.8 to 12.9) years. Underlying diagnoses included intestinal failure (n=31), biliary atresia (n=24), and others (n=44). LS showed the strongest correlation with the fibrosis stage (r=0.639, P<0.001) compared with P/SZC (r=−0.427, P=0.003), APRi (r=0.419, P=0.001), or SZC (r=0.396, P=0.004). LS clearly performed the best in predicting fibrosis with area under the receiver operator curve (AUROC) values of 0.789 [95% confidence interval (CI), 0.698-0.879; P<0.001] for any (Metavir≥1), and 0.831 (95% CI, 0.745-0.918; P<0.001) for significant (Metavir≥2) fibrosis. For the prediction of the presence of esophageal varices, APRi had a higher AUROC of 0.832 (95% CI, 0.730-0.934; P<0.001), when compared with LS, SZC, or P/SZC with AUROCs of 0.818 (95% CI, 0.706-0.930; P<0.001), 0.795 (95% CI, 0.683-0.904; P=0.001), and 0.760 (95% CI, 0.610-0.909; P=0.004), respectively.

Conclusions:

LS performed the best in predicting liver fibrosis, whereas APRi had the highest predictive accuracy for esophageal varices. An LS value over 7.7 kPa identified significant liver fibrosis with high accuracy, whereas low APRi ascertained the absence of esophageal varices.
MRI characteristics for the differential diagnosis of benign and malignant small solitary hypovascular hepatic nodules
Authors: Qian Haizhen , Li Shihong , Ji Ming , Lin Guangwu
Published: April 2016

Purpose

To compare the MRI findings of benign and malignant solitary hypovascular hepatic nodules and identify the differentiating features.

Materials and methods

A total of 135 patients with solitary hypovascular hepatic lesions up to 3 cm (mass forming intrahepatic cholangiocarcinoma, n=29; metastases, n=26; inflammatory pseudotumors and solitary necrotic nodule, n=48; and hemangioma, n=32) were assessed. MRI findings were analyzed, and lesions were scored for peripheral and intratumoral appearance and enhancement patterns.

Results

Univariate and multivariate analyses showed that the most common findings for benign lesions were subcapsular, sharp margin, homogeneous, marked high signal on T2WI, mild hyperintensity on T2WI, increasing intensity of peripheral globular enhancement, and persistent central septum-like linear enhancement on delayed phase (P<0.05). An area under the curve of 0.955 was obtained for differentiating malignant from benign nodules using the combined imaging features of ill-defined margins, heterogeneity, decreasing intensity of peripheral rim-like enhancement, and central increasing intensity of patchy enhancement. Interobserver agreement was good, ranging from 0.72 to 1.00.

Conclusion

MRI may be a useful noninvasive method for determining whether hypovascular hepatic nodules are malignant or benign.
Aluminum and Phthalates in Calcium Gluconate
Authors: Yokel Robert A. , Unrine Jason M.
Published: April 2016

Background:

Aluminum contamination of parenteral nutrition solutions has been documented for 3 decades. It can result in elevated blood, bone, and whole body aluminum levels associated with neurotoxicity, reduced bone mass and mineral content, and perhaps hepatotoxicity. The primary aluminum source among parenteral nutrition components is glass‐packaged calcium gluconate, in which aluminum concentration in the past 3 decades has averaged approximately 4000 μg/L, compared with <200 μg/L in plastic container‐packaged calcium gluconate. A concern about plastic packaging is leaching of plasticizers, including phthalates, which have the potential to cause endocrine (male reproductive system) disruption and neurotoxicity.

Methods:

Aluminum was quantified in samples collected periodically for more than 2 years from 3 calcium gluconate sources used to prepare parenteral nutrition solutions; 2 packaged in glass (from France and the United States) and 1 in plastic (from Germany); in a recently released plastic‐packaged solution (from the United States); and in the 2 glass containers. Phthalate concentration was determined in selected samples of each product and leachate of the plastic containers.

Results:

The initial aluminum concentration was approximately 5000 μg/L in the 2 glass‐packaged products and approximately 20 μg/L in the plastic‐packaged product, and increased approximately 30%, 50%, and 100% in 2 years, respectively. The aluminum concentration in a recently released Calcium Gluconate Injection USP was approximately 320 μg/L. Phthalates were not detected in any calcium gluconate solutions or leachates.

Conclusions:

Plastic packaging greatly reduces the contribution of aluminum to parenteral nutrition solutions from calcium gluconate compared with the glass‐packaged product.
Pediatric Irritable Bowel Syndrome Patient and Parental Characteristics Differ by Care Management Type
Authors: Hollier John M. , Czyzewski Danita I. , Self Mariella M. , Weidler Erica M. , Smith E. O'Brian , Shulman Robert J.
Published: April 2016

Objectives:

This study evaluates whether certain patient or parental characteristics are associated with gastroenterology (GI) referral versus primary pediatrics care for pediatric irritable bowel syndrome (IBS).

Methods:

A retrospective clinical trial sample of patients meeting pediatric Rome III IBS criteria was assembled from a single metropolitan health care system. Baseline socioeconomic status (SES) and clinical symptom measures were gathered. Various instruments measured participant and parental psychosocial traits. Study outcomes were stratified by GI referral versus primary pediatrics care. Two separate analyses of SES measures and GI clinical symptoms and psychosocial measures identified key factors by univariate and multiple logistic regression analyses. For each analysis, identified factors were placed in unadjusted and adjusted multivariate logistic regression models to assess their impact in predicting GI referral.

Results:

Of the 239 participants, 152 were referred to pediatric GI, and 87 were managed in primary pediatrics care. Of the SES and clinical symptom factors, child self‐assessment of abdominal pain duration and lower percentage of people living in poverty were the strongest predictors of GI referral. Among the psychosocial measures, parental assessment of their child's functional disability was the sole predictor of GI referral. In multivariate logistic regression models, all selected factors continued to predict GI referral in each model.

Conclusions:

Socioeconomic environment, clinical symptoms, and functional disability are associated with GI referral. Future interventions designed to ameliorate the effect of these identified factors could reduce unnecessary specialty consultations and health care overutilization for IBS.
Clinical Characteristics Associated With Treatment-Resistant Bipolar Disorder
Authors: Parker Gordon B. , Graham Rebecca K.
Published: April 2016

There has been limited consideration and empirical studies on treatment-resistant bipolar disorder (TRBD). This exploratory study was designed to identify factors contributing to TRBD in patients with a bipolar (I or II) disorder. Patients were categorized with “low,” “medium,” or “high” levels of treatment resistance based on a) the total number of psychiatric medications received and, for a second analysis, b) the number of mood stabilizer medications received. The study identified a number of factors associated with TRBD, such as being female and older and having an older age at illness onset, a higher incidences of family depression, less likelihood of being in paid employment, a higher number of lifetime stressors, medical conditions and comorbid anxiety disorders, a different personality and temperament profile, and more regular use of benzodiazepines. There were few factors associated with TRBD when defined by number of mood stabilizers trialed. Potential explanations for these findings were explored.
Personal Recovery as a Protective Factor Against Suicide Ideation in Individuals With Schizophrenia
Authors: Jahn Danielle R. , DeVylder Jordan E. , Drapalski Amy L. , Medoff Deborah , Dixon Lisa B.
Published: April 2016

Suicide rates are elevated in individuals with schizophrenia, yet evidence is mixed regarding the roles of positive and negative symptoms as risk factors for suicide in this population, suggesting that there may be other influential variables. One such variable may be personal recovery. Therefore, the purpose of this study was to test the hypothesis that personal recovery would moderate the relationship between symptoms of schizophrenia and suicide ideation. This hypothesis was tested in a sample of 169 individuals diagnosed with schizophrenia or schizoaffective disorder using a Poisson regression model. Results suggested that there was no significant interaction between recovery and symptoms of schizophrenia. However, recovery was a significant predictor of suicide ideation after controlling for psychiatric symptoms. These findings indicate that recovery is associated with lower suicide ideation and thus may protect against it. Thus, recovery should be assessed, and potentially intervened upon, to reduce suicide risk in individuals with schizophrenia.
Score for Neonatal Acute Physiology-II Predicts Outcome in Congenital Diaphragmatic Hernia Patients*
Authors: Snoek Kitty G. , Capolupo Irma , Morini Francesco , van Rosmalen Joost , Greenough Anne , van Heijst Arno , Reiss Irwin K. M. , IJsselstijn Hanneke , Tibboel Dick
Published: April 2016

Objective:

Accurate and validated predictors of outcome for infants with congenital diaphragmatic hernia are needed. Score for Neonatal Acute Physiology-II has been validated to predict mortality in newborns. We investigated whether Score for Neonatal Acute Physiology-II scores in congenital diaphragmatic hernia could predict mortality, need for extracorporeal membrane oxygenation (in patients born in a center with extracorporeal membrane oxygenation availability), and development of bronchopulmonary dysplasia (oxygen dependency beyond 28 d after birth) in survivors.

Design:

Data were obtained from a prospective, multicenter randomized controlled trial of initial ventilation strategy carried out by the Congenital Diaphragmatic Hernia EURO Consortium (NTR 1310).

Setting:

ICUs of level III university children’s hospitals.

Patients:

Congenital diaphragmatic hernia infants without severe chromosomal anomalies or severe cardiac anomalies born between November 2008 and December 2013.

Interventions:

Randomization for initial ventilation strategy (high-frequency oscillation/ conventional mechanical ventilation.

Measurements and Main Results:

Logistic regression analyses were used to evaluate associations between Score for Neonatal Acute Physiology-II and outcome parameters. Of the 171 included patients, 46 died (26.9%), 40 of 108 (37.0%) underwent extracorporeal membrane oxygenation, and 39 of 125 survivors (31.2%) developed bronchopulmonary dysplasia. In nonsurvivors, the median Score for Neonatal Acute Physiology-II was 42.5 (interquartile range, 33.5–53.8) and 16.5 (interquartile range, 9.0–27.5) in survivors (p < 0.001). Score for Neonatal Acute Physiology-II also significantly differed between extracorporeal membrane oxygenation and non–extracorporeal membrane oxygenation-treated patients (p < 0.001), and survivors with and without bronchopulmonary dysplasia (p < 0.001). Multivariable logistic regression analyses adjusted for hernia side, liver position, ventilation mode, gestational age, center and observed-to-expected lung-to-head-ratio showed that Score for Neonatal Acute Physiology-II was associated with mortality (odds ratio, 1.16 [1.09–1.23]; p < 0.001) and need for extracorporeal membrane oxygenation support (odds ratio, 1.07 [1.02–1.13]; p = 0.01), but not for the development of bronchopulmonary dysplasia (odds ratio, 1.04 [0.99–1.09]; p = 0.14).

Conclusions:

The Score for Neonatal Acute Physiology-II predicts not only mortality but also need for extracorporeal membrane oxygenation in congenital diaphragmatic hernia patients. We, therefore, recommend to implement this simple and rapid scoring system in the evaluation of severity of illness in patients with congenital diaphragmatic hernia and thereby have insight into the prognosis within 1 day after birth.
Randomized Factorial Trial of Phone-Delivered Support Counseling and Daily Text Message Reminders for HIV Treatment Adherence
Authors: Kalichman Seth C. , Kalichman Moira O. , Cherry Chauncey , Eaton Lisa A. , Cruess Dean , Schinazi Raymond F.
Published: April 2016

Background:

HIV infection is clinically managed with antiretroviral therapy (ART), but only with sustained adherence. Cost-efficient interventions to improve and sustain ART adherence remain a pressing priority for populations challenged by nonadherence. The aim of this study was to test the independent and interactive effects of (1) brief phone-delivered self-regulation counseling and (2) daily phone-delivered text message medication reminders on HIV adherence and HIV viral suppression.

Method:

A randomized 2 (5 sessions of phone-delivered adherence support counseling vs. contact-matched control) × 2 (daily ART text reminders vs. no reminders) trial with primary end points of monthly phone-based unannounced pill count-determined ART adherence and HIV viral suppression monitored over 12 months.

Results:

Self-regulation adherence counseling demonstrated significant improvements in achieving 90% ART adherence relative to the control group over the first 6 months of follow-up. Effects remained significant in sensitivity analyses conducted at 85% and 95% adherence. Counseling also demonstrated modest but significant effects on HIV suppression. There were no main effects or interactions for daily text message reminders, with some evidence for adverse effects on adherence self-efficacy.

Conclusions:

Brief adherence support counseling delivered by phone demonstrates clinically meaningful improvements in ART adherence and HIV suppression, although these benefits were not evidenced in all patients or in the long-term. Advancing adherence interventions along with an effective means for sustaining gains in adherence remain priorities if ART is to achieve its potential clinical and public health benefits.
Pneumothorax in the Supine Patient
Authors: Rierson Davis , Bueno Juliana
Published: April 2016

Routine posteroanterior chest radiographs and computed tomography scans are more sensitive for detecting pneumothoraces than anteroposterior chest radiographs. However, supine chest radiographs are commonly performed as part of the initial and routine assessment of trauma and critically ill patients. Rates of occult pneumothorax can be as high as 50% and have a significant impact in the mortality of these patients; thus, a prompt diagnosis of this entity is important. This pictorial essay will illustrate the pleural anatomy, explain the distribution of air within the pleural space in the supine position, and review the radiologic findings that characterize this entity.
Idiopathic Intracranial Hypertension Induced by Topical Application of Vitamin A
Authors: Mohammad Yousef M. , Raslan Ismail R. , Al-Hussain Fawaz A.
Published: April 2016

A 21-year-old nonobese woman developed headaches and papilledema while excessively using 3 topical preparations of vitamin A. Neuroimaging studies were unremarkable and opening pressure on lumbar puncture was 300 mm H2O with normal cerebrospinal fluid composition. After discontinuation of the topical vitamin A preparations, the symptoms and signs of increased intracranial pressure resolved. The association of intracranial hypertension and topical vitamin A application has only been reported once previously.