bluuebunny/crossref_metadata_2025 huggingface dataset:
The net as a knowledge machine: How the Internet became embedded in research
Authors: Meyer Eric T , Schroeder Ralph , Cowls Josh
Published: May 2016

In this article, we examine the growth of the Internet as a research topic across the disciplines and the embedding of the Internet into the very fabric of research. While this is a trend that ‘everyone knows’, prior to this study, no work had quantified the extent to which this common sense knowledge was true or how the embedding actually took place. Using scientometric data extracted from Scopus, we explore how the Internet has become a powerful knowledge machine which forms part of the scientific infrastructure across not just technology fields, but also right across the social sciences, sciences and humanities.
A guild culture of ‘casual raiding’ enhances its members’ online gaming experiences: A cognitive anthropological and ethnographic approach to World of Warcraft
Authors: Snodgrass Jeffrey G , Batchelder Greg , Eisenhauer Scarlett , Howard Lahoma , Dengah HJ Francois , Thompson Rory Sascha , Bassarear Josh , Cookson Robert J , Defouw Peter Daniel , Matteliano Melanie , Powell Colton
Published: May 2016

We document the norms and practices of a “casual raiding guild” pursuing a balanced approach to World of Warcraft gaming under the banner “offline life matters.” Confirming insights in the problematic online gaming literature, our ethnography reveals that some guild members experience gaming distress. However, this guild’s normative culture helps its members better self-regulate and thus protect themselves from, among other things, their own impulses to over-play and thus compromise their offline lives. We suggest that cognitive anthropological “culture as socially transmitted knowledge” theories—combined with ethnographic methods—illuminate how socially learned gaming patterns shape online experiences. Our approach helps us refine theories judging socially motivated Internet activity as harmful. We affirm the potential for distress in these social gaming contexts, but we also show how a specific guild culture can minimize or even reverse such distress, in this case promoting experiences that strike a nice balance between thrill and comradery.
Responsible epistemic technologies: A social-epistemological analysis of autocompleted web search
Authors: Miller Boaz , Record Isaac
Published: May 2016

Information providing and gathering increasingly involve technologies like search engines, which actively shape their epistemic surroundings. Yet, a satisfying account of the epistemic responsibilities associated with them does not exist. We analyze automatically generated search suggestions from the perspective of social epistemology to illustrate how epistemic responsibilities associated with a technology can be derived and assigned. Drawing on our previously developed theoretical framework that connects responsible epistemic behavior to practicability, we address two questions: first, given the different technological possibilities available to searchers, the search technology, and search providers, who should bear which responsibilities? Second, given the technology’s epistemically relevant features and potential harms, how should search terms be autocompleted? Our analysis reveals that epistemic responsibility lies mostly with search providers, which should eliminate three categories of autosuggestions: those that result from organized attacks, those that perpetuate damaging stereotypes, and those that associate negative characteristics with specific individuals.
Effect of the tank car thickness on the nonlinear dynamics of railroad vehicles
Authors: Wang Liang , Shi Huailong , Shabana Ahmed A
Published: May 2016

The expression of the centrifugal forces resulting from a flexible body negotiating a curve differs significantly from the expression of the centrifugal forces used in rigid body dynamics. In rigid body railroad vehicle dynamics, the balance speed does not depend on the body inertia; it depends on the vehicle speed, super elevation, track gauge, and gravity constant. This is not, however, the case when the structural flexibility is considered. In this paper, a general multibody system (MBS) approach that accounts for the nonlinear dynamic coupling between the wheel–rail contact forces and the tank car structural flexibility is used to examine the effect of increasing the tank car thickness on the nonlinear dynamics of railroad vehicles. The flexible tank cars are modelled in this investigation using the nonlinear finite element (FE) floating frame of reference (FFR) formulation. The tank car FE model is integrated with a computational railroad vehicle algorithm in which a three-dimensional elastic contact formulation is used to describe the rail–wheel interaction in order to allow for wheel–rail separations. A complete expression for the centrifugal and Coriolis forces is used with triangular shell finite elements to develop the tank car models with different thicknesses. The effect of the coupling between different modes of displacements is examined by comparing the results of the simulations of the flexible and rigid tank car models. A parametric study is performed in order to explain the effect of the thickness increase on the tank car natural frequencies. Furthermore, the effect of increasing the tank car thickness on the critical speed as well as on the nonlinear dynamics of the railroad vehicle during curve negotiation is examined. The FE/FFR formulation allows for accurately capturing the effect of the change of the tank car thickness on the centrifugal and Coriolis inertia forces that define the balance speed during curve negotiations. The analysis presented in this paper shows that there is a strong dynamic coupling between different modes of displacements of the tank car, the plate thickness, and the wheel–rail contact parameters. The effect of increasing the tank car thickness on the wheel wear is also examined in this paper.
Families’ roles in children’s literacy in the UK throughout the 20th century
Authors: Nutbrown Cathy , Clough Peter , Levy Rachael , Little Sabine , Bishop Julia , Lamb Terry , Yamada-Rice Dylan
Published: May 2016

This paper explores the changing roles of families in children’s developing literacy in the UK in the last century. It discusses how, during this time, understandings of reading and writing have evolved into the more nuanced notion of literacy. Further, in acknowledging changes in written communication practices, and shifting attitudes to reading and writing, the paper sketches out how families have always played some part in the literacy of younger generations; though reading was frequently integral to the lives of many families throughout the past century, we consider in particular the more recent enhancement of children’s literacy through targeted family programmes. The paper considers policy implications for promoting young children’s literacy through work with families.
Impact of the Repositionable C3 Excluder System on the Endovascular Treatment of Abdominal Aortic Aneurysms With Unfavorable Neck Anatomy
Authors: Hernández Mateo Manuela M. , Martínez López Isaac , Revuelta Suero Sergio , Marqués de Marino Pablo , Cernuda Artero Iñaki , Cabrero Fernández Maday , Serrano Hernando Francisco J.
Published: May 2016

Purpose: To analyze the midterm clinical outcomes among patients with favorable and unfavorable neck morphology for endovascular aneurysm repair (EVAR), specifically the impact of the repositionable C3 Excluder stent-graft on type I endoleak in patients with unfavorable neck. Methods: A retrospective review was conducted of 249 patients (mean age 74.3 years; 241 men) who underwent successful EVAR from January 2000 to December 2014 using either the traditional Excluder (n=140) or the C3 repositionable system (n=109). Unfavorable proximal aortic neck anatomy was defined by length <15 mm, angulation >60°, >50% circumferential thrombus, or >50% neck calcification. By these criteria, unfavorable neck anatomy was present in 71 (28.5%) patients (41 traditional Excluder and 30 C3 Excluder). The main endpoint was the incidence of type Ia endoleak and the need for a proximal cuff according to the type of neck anatomy. Comparisons between groups are reported as the odds ratio (OR) and 95% confidence interval (CI). Results: A proximal extension cuff for type Ia endoleak was needed in 4 (2.2%) patients with favorable neck anatomy compared to 7 (9.9%) patients with unfavorable neck (OR 4.76, 95% CI 1.3 to 16.8, p=0.014). Among the patients with unfavorable neck, a proximal cuff was implanted in 6/41 (14.6%) traditional Excluder stent-grafts vs 1/30 (3.3%) in the C3 Excluder group (OR 4.39, 95% CI 0.55 to 34.58, p=0.23). Median follow-up was 30.5 and 38 months for favorable vs unfavorable neck groups, respectively (p=0.29). Only 1 case of type Ia endoleak was registered at 6.5 years’ follow-up (traditional Excluder), with no device migration. Conclusion: Both Excluder stent-grafts provide good midterm clinical outcomes after EVAR in patients with unfavorable neck anatomy. Investigation of a larger cohort will be needed to identify if the C3 Excluder device offers any improvement over the traditional Excluder in terms of freedom from endoleaks.
Social, Economic, and Political Issues Affecting End-of-Life Care
Authors: Sopcheck Janet
Published: May 2016

For many decades, Americans showed a preference for delaying death through a technological imperative that often created challenges for nurses in caring for dying patients and their families. Because of their vast knowledge of health and healing, and their proximity to patients' bedsides, nurses are often well positioned to advocate for healthcare reform and legislation to improve end-of-life care. This article provides an overview of the social, economic, and political factors that are shaping end-of-life care in the United States. First, historical perspectives on end-of-life care are presented to enhance understanding of why some clinicians and patients seem to resist change to current practices. Second, end of care issues related to advanced technology utilization, societal expectations of care, clinical practices, financial incentives, palliative care services, and policy reforms are discussed. Finally, future recommendations are provided to encourage nurses and other healthcare providers to improve care for individuals facing end-of-life care decisions.
Perioperative Rehabilitation in Operable Lung Cancer Patients (PROLUCA)
Authors: Sommer Maja S. , Trier Karen , Vibe-Petersen Jette , Missel Malene , Christensen Merete , Larsen Klaus R. , Langer Seppo W. , Hendriksen Carsten , Clementsen Paul Frost , Pedersen Jesper H. , Langberg Henning
Published: May 2016

Introduction. Surgical resection in patients with non–small cell lung cancer (NSCLC) may be associated with significant morbidity, functional limitations, and decreased quality of life. Objectives. The safety and feasibility of a preoperative and early postoperative rehabilitation program in patients operated for NSCLC was determined in a nonhospital setting, with focus on high-intensity interval exercise. Methods. Forty patients with biopsy-proven NSCLC stages I to IIIa referred for surgical resection at the Department of Cardiothoracic Surgery RT, Rigshospitalet, University of Copenhagen, were randomly assigned to 1 of 4 groups (3 intervention groups and 1 control group). The preoperative intervention consisted of a home-based exercise program, while the postoperative exercise program comprised a supervised group exercise program involving resistance and high-intensity interval cardiorespiratory exercise 2 hours weekly for 12 weeks combined with individual counseling. The study endpoints were inclusion rate, adherence, and number of adverse events. Results. Forty patients (of 124 screened; 32%) were included and randomized into the 4 groups. The postoperative exercise was completed by 73% of the patients randomized to this intervention. No adverse events were observed, indicating that the early postoperative exercise program is safe. The preoperative home-based exercise program was not feasible due to interfering diagnostic procedures and fast-track surgery that left only 1 to 2 weeks between diagnosis and surgery. Conclusion. The early postoperative exercise program for patients with NSCLC was safe and feasible, but in a fast-track set up, a preoperative home-based exercise program was not feasible for this population.
Chinese Herbal Medicine and Fluorouracil-Based Chemotherapy for Colorectal Cancer
Authors: McCulloch Michael , Ly Helen , Broffman Michael , See Caylie , Clemons Jen , Chang Raymond
Published: May 2016

Background. Chinese herbal medicines reportedly increase efficacy and minimize toxicity of chemotherapy; however, little attention has been paid to how poor study quality can bias outcomes. Methods. We systematically searched MEDLINE, TCMLARS, EMBASE, and Cochrane Library for randomized controlled trials of Chinese herbal medicines combined with fluorouracil-based chemotherapy compared with the same chemotherapy alone. We screened for eligibility, extracted data, and pooled data with random-effects meta-analysis. Outcome measures were survival, toxicity, tumor response, performance status, quality of life, and Cochrane Risk of Bias (ROB) criteria to critically evaluate the quality of reporting in the randomized trials included in the meta-analysis. Results. We found 36 potentially eligible studies, with only 3 (those with low ROB) qualifying for meta-analysis. Two reported chemotherapy-related diarrhea reduced by 57% (relative risk [RR] = 0.43; 95% CI = 0.19-1.01; I2 test for variation in RR due to heterogeneity = 0.0%), with nonsignificant results. Two reported white blood cell toxicity reduced by 66% (RR = 0.34; 95% CI = 0.16-0.72; I2 test for variation in RR due to heterogeneity = 0.0%), with statistically significant results. Stratifying analysis by studies with high versus low ROB, we found substantial overestimation of benefit: Studies with high ROB overestimated by nearly 2-fold reduction of platelet toxicity by Chinese herbal medicines (RR = 0.35, 95% CI = 0.15-0.84 vs RR = 0.65, 95% CI = 0.11-3.92). Studies with high ROB overestimated by nearly 2-fold reduction of vomiting toxicity (RR = 0.45, 95% CI = 0.33-0.61 vs RR = 0.87, 95% CI = 0.48-1.58). And, studies with high ROB overestimated by 21% the reduction in diarrhea toxicity (RR = 0.34, 95% CI = 0.20-0.58 vs RR = 0.43, 95% CI = 0.19-1.01). Studies with high ROB also overestimated by 16% improvement in tumor response (RR = 1.39, 95% CI = 1.18-1.63 vs RR = 1.20; 95% CI = 0.81-1.79). Not accounting for ROB would have exaggerated evidence of benefit and failed to detect nonsignificance of results. Conclusions. In the present analysis, involving 36 studies, 2593 patients, 20 outcomes, 36 medical institutions, and 271 named research authors, 92% of the data points were from studies at high ROB. Given the poor quality of the data in studies identified, it cannot be concluded whether combining Chinese herbs with chemotherapy reduces toxicity of chemotherapy.
Individualized Integrative Cancer Care in Anthroposophic Medicine
Authors: Kienle Gunver S. , Mussler Milena , Fuchs Dieter , Kiene Helmut
Published: May 2016

Background. Cancer patients widely seek integrative oncology which embraces a wide variety of treatments and system approaches. Objective. To investigate the concepts, therapeutic goals, procedures, and working conditions of integrative oncology doctors in the field of anthroposophic medicine. Methods. This qualitative study was based on in-depth interviews with 35 highly experienced doctors working in hospitals and office-based practices in Germany and other countries. Structured qualitative content analysis was applied to examine the data. Results. The doctors integrated conventional and holistic cancer concepts. Their treatments aimed at both tumor and symptom control and at strengthening the patient on different levels: living with the disease, overcoming the disease, enabling emotional and cognitive development, and addressing spiritual or transcendental issues according to the patient’s wishes and initiatives. Therapeutic procedures were conventional anticancer and symptom-relieving treatments, herbal and mineral remedies, mistletoe therapy, art therapies, massages and other external applications, nutrition and lifestyle advice, psychological support, and multiple forms of empowerment. The approach emphasised good patient-doctor relationships and sufficient time for patient encounters and decision-making. Individualization appeared in several dimensions and was interwoven with standards and mindlines. The doctors often worked in teams and cooperated with other cancer care–related specialists. Conclusion. Integrative cancer care pursues an individualized and patient-centered approach, encompassing conventional and multimodal complementary interventions, and addressing, along with physical and functional needs, the emotional and spiritual needs of patients. This seems to be important for tumor and symptom control, and addresses major challenges and important goals of modern cancer care.
Complementary and Alternative Medicine Use at a Comprehensive Cancer Center
Authors: Luo Qianlai , Asher Gary N.
Published: May 2016

Background. Complementary and alternative medicine (CAM) use is common among cancer patients, but the majority of CAM studies do not specify the time periods in relation to cancer diagnoses. We sought to define CAM use by cancer patients and investigate factors that might influence changes in CAM use in relation to cancer diagnoses. Methods. We conducted a cross-sectional survey of adults diagnosed with breast, prostate, lung, or colorectal cancer between 2010 and 2012 at the Lineberger Comprehensive Cancer Center. Questionnaires were sent to 1794 patients. Phone calls were made to nonrespondents. Log binomial/Poisson regressions were used to investigate the association between cancer-related changes in CAM use and conversations about CAM use with oncology providers. Results. We received 603 (33.6 %) completed questionnaires. The mean age (SD) was 64 (11) years; 62% were female; 79% were white; and 98% were non-Hispanic. Respondents reported the following cancer types: breast (47%), prostate (27%), colorectal (14%), lung (11%). Eighty-nine percent reported lifetime CAM use. Eighty-five percent reported CAM use during or after initial cancer treatment, with category-specific use as follows: mind-body medicine 39%, dietary supplements 73%, body-based therapies 30%, and energy medicine 49%. During treatment CAM use decreased for all categories except energy medicine. After treatment CAM use returned to pretreatment levels for most CAMs except chiropractic. Initiation of CAM use after cancer diagnosis was positively associated with a patient having a conversation about CAM use with their oncology provider, mainly driven by patient-initiated conversations. Conclusions. Consistent with previous studies, CAM use was common among our study population. Conversations about CAM use with oncology providers appeared to influence cessation of mind-body medicine use after cancer diagnosis.
Tryptophan PET Imaging of the Kynurenine Pathway in Patient-Derived Xenograft Models of Glioblastoma
Authors: Guastella Anthony R. , Michelhaugh Sharon K. , Klinger Neil V. , Kupsky William J. , Polin Lisa A. , Muzik Otto , Juhász Csaba , Mittal Sandeep
Published: May 2016

Increasing evidence demonstrates the immunosuppressive kynurenine pathway’s (KP) role in the pathophysiology of human gliomas. To study the KP in vivo, we used the noninvasive molecular imaging tracer α-[11C]-methyl-l-tryptophan (AMT). The AMT-positron emission tomography (PET) has shown high uptake in high-grade gliomas and predicted survival in patients with recurrent glioblastoma (GBM). We generated patient-derived xenograft (PDX) models from dissociated cells, or tumor fragments, from 5 patients with GBM. Mice bearing subcutaneous tumors were imaged with AMT-PET, and tumors were analyzed to detect the KP enzymes indoleamine 2,3-dioxygenase (IDO) 1, IDO2, tryptophan 2,3-dioxygenase, kynureninase, and kynurenine 3-monooxygenase. Overall, PET imaging showed robust tumoral AMT uptake in PDX mice with prolonged tracer accumulation over 60 minutes, consistent with AMT trapping seen in humans. Immunostained tumor tissues demonstrated positive detection of multiple KP enzymes. Furthermore, intracranial implantation of GBM cells was performed with imaging at both 9 and 14 days postimplant, with a marked increase in AMT uptake at 14 days and a corresponding high level of tissue immunostaining for KP enzymes. These results indicate that our PDX mouse models recapitulate human GBM, including aberrant tryptophan metabolism, and offer an in vivo system for development of targeted therapeutics for patients with GBM.
A Validation of the Group-Based Medical Mistrust Scale in Formerly Incarcerated Black and Latino Men
Authors: Valera Pamela , Boyas Javier F. , Bernal Camila , Chiongbian Victoria Briones , Chang Yvonne , Shelton Rachel C.
Published: May 2016

While there is a growing body of literature on medical mistrust and its relevance to public health, research on formerly incarcerated Black and Latino men and their perception of mistrust toward medical providers and medical institutions remains scant. Very little is known about whether formerly incarcerated Black and Latino men mistrust medical and clinical providers given their previous experiences with the criminal justice system. It is important to determine whether medical mistrust play a key role in the health and health behaviors of released Black and Latino men. The purpose of this study is to validate and assess the psychometric properties of the Group-Based Medical Mistrust Scale for use among formerly incarcerated Black and Latino men in New York City. The findings of the exploratory and confirmatory factor analyses state that a two-factor structure fit the data best. Two dimensions emerged as important subscales: discrimination and suspicion. The current findings suggest the two-factor Group-Based Medical Mistrust Scale is a valid and reliable assessment tool to discern medical mistrust levels among formerly incarcerated Black and Latino men.
A Survey on Main Semen Parameters in Natural Pregnancy and Intrauterine Insemination: Are There Any Significant Differences?
Authors: Aboutorabi Roshanak , Zamani Soudabeh , Zarrin Yasaman , Mostafavi Fatemeh Sadat
Published: May 2016

Intrauterine insemination (IUI) is a treatment of choice compared with other invasive and expensive techniques of assisted reproduction. Sperm quality is used to predict its outcome and success. Establishing threshold levels for sperm parameters is useful to avoid spending time and money to do other assisted reproductive techniques. This study was carried out to compare various semen parameters in a group of men eligible to participate in an IUI program with those of fertile men whose wives were pregnant at the time of the study. Two hundred and thirty-four semen samples were evaluated from subfertile men whose partners were candidates for IUI and 234 semen samples were evaluated from fertile men whose partners were pregnant less than 12 weeks. To assess the sensitivity and specificity of the main semen parameters, receiver operating characteristic (ROC) curves were used. Normal sperm morphology is more sensitive and specific compared with its progressive motility and concentration. No significant differences in various semen parameters of fertile men and those of the male partners of IUI candidates were observed. ROC analysis identified that sperm normal morphology using strict criteria may be a good indicator of fertility status in men. No significant difference in various semen parameters between the male partners of IUI candidates and the fertile men was seen. However, utilizing ROC curves, sperm morphology using strict criteria could be a good predictor of fertility.
The Incidence of Positive Modifications to Nerve Conduits in Rodent Nerve Repair Models
Authors: Patel Tejas T. , Isaacs Jonathan
Published: May 2016

Background: The nerve conduit is a generally accepted tool to facilitate the repair of short nerve gaps. Limitations in effectiveness have been recognized, and a steady stream of possible conduit improvements has been published in the scientific literature. Analysis of this information, particularly when small animal models have been utilized, seems to indicate that nearly any modification of a nerve conduit improves outcomes in repairs of short gaps over standard nerve conduits. This seems statistically and biologically improbable and suggests a bias in the literature. Methods: A standardized systemic review of the scientific literature on rodent model studies assessing conduit modifications was undertaken to determine the incidence of positive or supportive outcomes. Results: Modifications were deemed superior in 97.3% of studies when compared with unmodified conduits and deemed equivalent or superior in 52.1% of studies when compared with autograft. Conclusions: A seemingly disproportionate number of positive results suggest that the literature on nerve conduit modifications may be skewed. We believe that there is a publication bias in the literature, and this warrants further investigation.
Assessment of Intra-articular Screw Penetration During Radial Head and Olecranon Locking Plate Fixation
Authors: Dizdarevic Ismar , Eden Claire M. , Bengard Matthew , Barron O. Alton , Catalano Louis W. , Glickel Steven Z.
Published: May 2016

Background: The purpose of this study is to evaluate the role of radiographic and clinical exams in predicting screw penetration into the proximal radioulnar joint and ulnohumeral joint during open reduction and internal fixation of the radial head and proximal ulna. Methods: Olecranon and radial head plates were applied to 15 cadaveric elbows. Screws were assessed for intra-articular joint penetration using both clinical exam and radiographic evaluation. Clinical exam consisted of evaluation for crepitus. Radiographs demonstrating screws positioned near the joint surface were evaluated for penetration by 3 fellowship trained hand surgeons. Elbows were disarticulated and screw prominence was determined and recorded using standardized calipers. The ability of clinical and radiographic exams to correctly predict a breach in the articular surface was determined by calculating sensitivity, specificity, and predictive values. Consideration was given to screw position. Results: The sensitivity of crepitus was 81.1% for screws in the radial head plate and 72.6% for screws in the olecranon plate. The sensitivity of radiographs was 72.4% for the screws in the radial head plate and 55.0% for screws in the olecranon plate. Correct radiographic assessment of penetration varied but position o-2 on the olecranon plate consistently resulted in the lowest sensitivity of 30.3%. Conclusions: The study evaluates sensitivity and specificity of clinical and radiographic means when assessing for articular penetration of screws during olecranon and radial head locking plate fixation. Certain screw locations are more difficult to evaluate than others and may go undetected by standard means of assessment used in a surgical setting.
Mechanical Evaluation of Four Internal Fixation Constructs for Scaphoid Fractures
Authors: Beutel Bryan G. , Melamed Eitan , Hinds Richard M. , Gottschalk Michael B. , Capo John T.
Published: May 2016

Background: The objective of this study was to compare the mechanical performance of 4 different constructs for fixation of oblique scaphoid fractures. Methods: Twenty-eight synthetic scaphoids underwent an oblique osteotomy along the dorsal sulcus. Each was randomly assigned to fixation by 1 of 4 methods: two 1.5-mm headless compression screws, one 2.2-mm screw, one 3-mm screw, or a 1.5-mm volar variable-angle plate. After fixation, scaphoids were potted at a 45° angle and loaded at the distal pole by a hydraulically driven mechanical testing system plunger until the fixation failed. Excursion and load were measured with a differential transformer and load cell, respectively. From these data, the stiffness, load-to-failure, and maximum displacement of each construct were calculated. Results: The 2.2-mm screw demonstrated the highest stiffness and the two 1.5-mm screws had the lowest. However, there were no significant differences among the fixation methods in terms of stiffness. Both 2.2- and 3-mm screw constructs had significantly higher loads-to-failure than two 1.5-mm screws. The maximum load for the plate approached, but did not achieve, statistical significance compared with the 1.5-mm screws. There was no significant difference among constructs in displacement. Conclusions: All constructs demonstrated similar mechanical properties that may provide sufficient stability for effective clinical use. Given their significantly higher loads-to-failure, a 2.2- or 3-mm screw may be superior to two 1.5-mm screws for fixation of unstable scaphoid fractures. The volar plate did not have superior mechanical characteristics to the compression screws.
Correlations of Median Nerve Area, Strain, and Nerve Conduction in Carpal Tunnel Syndrome Patients
Authors: Yoshii Yuichi , Tanaka Toshikazu , Ishii Tomoo
Published: May 2016

Background: The objective of this study was to see if ultrasound-interpreted median nerve strain and cross-sectional area correlate with abnormal nerve conduction studies and thumb opposition strength in patients with carpal tunnel syndrome (CTS). Methods: Sixty wrists of 30 idiopathic CTS patients were assessed by ultrasound and nerve conduction study. Distal motor latency, cross-sectional area, and strain ratio of the median nerve were measured. In addition, thumb opposition strength was classified using the manual muscle testing grade from 0 to 5, clinically. The strain ratio was defined as the strain of the reference coupler divided by the strain of the median nerve. The correlations between clinical examinations of distal motor latency, cross-sectional area, strain ratio, and thumb opposition strength were estimated with the Spearman rank correlation coefficients. Results: The correlation coefficients between distal motor latency and strain ratio, distal motor latency and cross-sectional area, and strain ratio and cross-sectional area were .597, .352, and .324, respectively. The correlation coefficients between thumb opposition strength and distal motor latency, thumb opposition and cross-sectional area, and thumb opposition and strain ratio were −.523, −.307, and −.358, respectively. All of the correlations showed statistical significance. The correlation coefficients between distal motor latency and strain ratio, and thumb opposition and distal motor latency, were relatively high. Conclusions: The results of this study suggest that the nerve conduction delay is related to changes in the material properties of the median nerve. In addition, nerve conduction study was the principal indicator of the thumb opposition strength.
Significance of a Pronator Quadratus–Sparing Approach for Volar Locking Plate Fixation of Comminuted Intra-articular Fractures of the Distal Radius
Authors: Itoh Soichiro , Yumoto Myu , Kanai Misa , Yoshida Wataru , Yoshioka Taro
Published: May 2016

Background: The preservation of the integrity of the pronator quadratus (PQ) muscle is expected to have many benefits, particularly in cases of highly comminuted intra-articular fractures of the distal radius. Therefore, we examined the significance of a PQ muscle–sparing approach for volar locking plate (VLP) fixation of these types of fractures. Methods: Sixty-five patients who sustained AO Foundation and Orthopaedic Trauma Association (AO/OTA) type C2 and C3 distal radius fractures were treated with VLP fixation using either a PQ muscle release and repair (PQ-releasing group, n = 30) or a PQ muscle–sparing approach (PQ-sparing group, n = 35). Radiographic parameters, active range of motion (ROM), percentage of the grip power of the injured hand compared with that of the opposite hand, wrist pain visual analog scale (VAS) score, and Quick Disability of the Arm, Shoulder, and Hand (DASH) score (disability/symptom) were evaluated monthly up to 12 months after surgery. Results: The mean VAS score was significantly lower in the PQ-sparing group at 2, 3, and 4 months postoperatively than in the PQ-releasing group. Furthermore, the mean Quick DASH score in the PQ-sparing group was significantly lower than that in the PQ-releasing group at 1 and 2 months postoperatively. There were no significant differences, however, in the other functional parameters in the groups through the observation period. Conclusions: The PQ muscle–sparing approach appears to achieve satisfactory results in patients undergoing VLP fixation of comminuted intra-articular fractures of the distal radius.
Robust Axonal Regeneration in a Mouse Vascularized Composite Allotransplant Model Undergoing Delayed Tissue Rejection
Authors: Yan Ying , Wood Matthew D. , Moore Amy M. , Snyder-Warwick Alison K. , Hunter Daniel A. , Newton Piyaraj , Poppler Louis , Tung Thomas H. , Johnson Philip J. , Mackinnon Susan E.
Published: May 2016

Background: Nerve regeneration in vascularized composite allotransplantation (VCA) is not well understood. Allogeneic transplant models experience complete loss of nerve tissue and axonal regeneration without immunosuppressive therapy. The purpose of this study was to determine the impact of incomplete immunosuppression on nerve regeneration. Methods: In this study, transgenic mice (4 groups in total) with endogenous fluorescent protein expression in axons (Thy1-YFP) and Schwann cells (S100-GFP) were used to evaluate axonal regeneration and Schwann cell (SC) migration in orthotopic-limb VCA models with incomplete immunosuppression using Tacrolimus (FK506). Survival and complication rates were assessed to determine the extent of tissue rejection. Nerve regeneration was assessed using serial imaging of axonal progression and SC migration and viability. Histomorphometry quantified the extent of axonal regeneration. Results: Incomplete immunosuppression with FK506 resulted in delayed rejection of skin, muscle, tendon, and bone in the transplanted limb. In contrast, the nerve demonstrated robust axonal regeneration and SC viability based on strong fluorescent protein expression by SCs and axons in transgenic donors and recipients. Total myelinated axon numbers measured at 8 weeks were comparable in all VCA groups and not statistically different from the syngeneic donor control group. Conclusions: Our data suggest that nerve and SCs are much weaker antigens compared with skin, muscle, tendon, and bone in VCA. To our knowledge, this study is the first to prove the weak antigenicity of nerve tissue in the orthotopic VCA mouse model.
Factors Affecting Hand Surgeon Operating Room Turnover Time
Authors: Gottschalk Michael B. , Hinds Richard M. , Muppavarapu Raghuveer C. , Brock Kenneth , Sapienza Anthony , Paksima Nader , Capo John T. , Yang S. Steven
Published: May 2016

Background: The purpose of this study was to determine the factors that affect hand surgeon operating room (OR) turnover time. We hypothesized that surgeon presence in the OR, decreased American Society of Anesthesiologists (ASA) class, smaller case type, and earlier case time, as well as other factors, decreased OR turnover time. Methods: A total of 685 hand surgery cases performed by 5 attending hand surgeons between September 2013 and December 2014 were identified. Turnover time, patient comorbidities (ASA class), surgeon, prior OR surgical procedure, current OR surgical procedure, location of the surgery (ambulatory surgical center [ASC] vs orthopedic specialty hospital [OSH]), time of surgery, and order of OR cases were recorded. The effect of surgeon routine variables, OR case factors, and patient health status on OR turnover was analyzed. Results: Turnover time was significantly shorter in cases where the surgeon remained in the OR during turnover (27.5 minutes vs 30.4 minutes) and when the surgeon incentivized OR staff (24 minutes vs 29 minutes). The ASC was found to have shorter turnover times than the OSH (27.9 minutes vs 36.4 minutes). In addition, ASA class, type of prior OR procedure, type of current OR procedure, and case order all significantly affected turnover time. Comparison of OR turnover time among the 5 surgeons revealed a statistically significant difference at the OSH but not at the ASC. Conclusion: OR turnover time is significantly affected by surgeon routine, location of surgery, patient ASA class, procedure type, and case order. Interestingly, the effect of hand surgeon routine on OR turnover time may be amplified at an academic OSH versus an ASC.
The Association of Complementary Health Approaches With Mood and Coping Strategies Among Orthopedic Patients
Authors: O’Connor Casey , Braun Yvonne , Nota Sjoerd P. F. T. , Baloda Timothy , Ring David
Published: May 2016

Background: Variation in pain intensity and magnitude of disability among patients with musculoskeletal illness is largely accounted for by variations in symptoms of depression, catastrophic thinking, and heightened illness concern. It is possible that patients with greater stress, distress, and less effective coping strategies might be more likely to seek the use of Complementary Health Approaches (CHA). This study addressed the primary null hypothesis that there are no demographic, illness-related, or psychological factors associated with CHA use among patients with upper extremity illness. Methods: A cohort of 170 patients completed a web-based Complementary and Alternative Medicine (CAM) questionnaire the Patient Reported Outcomes Measurement Information System (PROMIS) Depression and Pain Interference questionnaires. We evaluated differences between patients who sought CAM treatment regarding the PROMIS Pain Interference and PROMIS Depression scores. Ninety-four patients (56%) use or plan to use CAM treatment. A CAM provider was consulted by 61 patients (37%): most commonly a massage therapist (30/61), chiropractor (26/61), or acupuncturist (14/61). Results: In bivariate analysis patients who sought CAM reported greater average PROMIS Pain Interference than those who did not. In multivariable logistic regression, CAM use was associated with a higher Pain Interference Score and the specific surgeon. Conclusion: In conclusion, CHA use is prevalent amongst orthopaedic patients and associated with less effective coping strategies. Orthopaedic surgeons might consider asking patients about CHA use and determining whether those patients are interested in cognitive behavioral therapy.
Baseline Characteristics of the Median Nerve on Ultrasound Examination
Authors: Pan Tiffany J. , White Richard J. , Zhang Caiyan , Hagberg William C. , Imbriglia Joseph E. , Fowler John R.
Published: May 2016

Background: Previous studies using ultrasound for diagnosis of carpal tunnel syndrome have reported on relatively small series of patients, leading to large standard deviations and/or confidence intervals for the mean cross-sectional area of the median nerve. The purpose of this study is to define the CSA of the median nerve in a large cohort of patients. Methods: Patients (n = 175) without history of carpal tunnel release were recruited. All participants were evaluated using the Carpal Tunnel Syndrome-6 questionnaire, a validated clinical diagnostic tool, with a score of 12 or greater considered positive for CTS. Ultrasound examination was performed on both wrists of all participants using a 13-6 MHz linear array transducer. Results: The mean median nerve CSA was significantly larger (P < .001) for patients with a positive (mean = 11.16, SD = 2.51) versus negative CTS-6 result (mean = 6.91, SD = 2.06). There was a significant correlation (.527, P < .001, n = 349) between CSA and CTS-6 score. Logistic regression analysis determined that a CSA of 10 mm2 optimized sensitivity and specificity at 80% and 88%, respectively. Accuracy was 87.9%. Conclusions: A significant difference in mean CSA was found between patients with and without CTS. Median nerve CSA showed a statistically significant positive correlation with CTS-6. Similar to prior studies, a CSA of 10 mm2 was determined to be the optimal cutoff. In this large series of patients, ultrasound was a sensitive, specific, and accurate test for confirmation of a clinical diagnosis of CTS.
Biomechanical Analysis of Internal Fixation Methods for Distal Interphalangeal Joint Arthrodesis
Authors: Rigot Stephanie K. , Diaz-Garcia Rafael , Debski Richard E. , Fowler John
Published: May 2016

Background: The biomechanical performance of distal interphalangeal joint (DIPJ) fixation techniques in response to cyclic and load-to-failure bending loads is generally unknown. The purpose of this study is to assess the performance of 4 commonly used techniques for DIP arthrodesis. Methods: Phalanges were fixed by one of the following techniques: (1) 2 parallel Kirschner wires (K-wires), (2) 1 longitudinal K-wire and 1 oblique K-wire, (3) an Acutrak® 2 Micro headless compression screw, or (4) 90-90 wiring. The phalanges were loaded in cantilever bending on the palmar side of the phalange for 3000 cycles, then loaded-to-failure. Results: The 90-90 wiring was significantly worse than the other 3 methods in 9 of 10 parameters analyzed. Both K-wire methods and the screw produced similar results in nearly all parameters. Conclusions: Given the lack of difference in biomechanical performance between K-wires and compression screws, consideration should be given to other factors such as cost and complication profiles when choosing an implant for DIPJ fusion.
The Trapeziometacarpal Arthrosis Symptoms and Disability Questionnaire
Authors: Becker Stéphanie J. E. , Teunis Teun , Ring David , Vranceanu Ana-Maria
Published: May 2016

Background: Symptoms and disability at the trapeziometacarpal (TMC) joint are typically assessed with general measures that may not be able to accurately discriminate between TMC arthrosis–specific versus other hand and arm condition concerns. The objective was to develop and preliminary validate the Trapeziometacarpal Arthrosis Symptoms and Disability (TASD) questionnaire designed to assess symptoms and disability at the TMC joint. Methods: English-speaking patients (50 years or older) were enrolled in 1 of 2 samples (sample 1, 64 patients specifically presented for treatment of TMC arthrosis; sample 2, 64 patients received an incidental diagnosis of previously undiagnosed TMC arthrosis when presenting for treatment of another, not thumb-related condition). Principal component analysis identified the number of subscales (factors) and factor loadings of all items (ie, structural construct validity). Internal consistency was assessed with Cronbach alpha. Convergent, discriminant, and known-groups construct validity of the subscales were assessed with Spearman correlations. Results: The final TASD has 12 items and 2 subscales, as confirmed by principal component analysis: symptoms (7 items) and disability (5 items). The subscales’ internal consistency was good to excellent in both samples. The TASD showed good convergent validity as evidenced by moderate to strong correlations between both subscales and upper extremity disability, pain intensity, depression, self-efficacy, and key pinch strength (sample 1). The TASD also showed good discriminant, and good known-groups validity. Conclusions: The concise TASD is useful in assessing symptoms and disability related to TMC arthrosis, has a simple scoring system and administration mode (self-administered), and is free.
Translation and Cross-Cultural Adaptation of the 6-Item Carpal Tunnel Syndrome Symptoms Scale and Palmar Pain Scale Questionnaire Into Brazilian Portuguese
Authors: Matsuo Rodrigo Pires , Fernandes Carlos Henrique , Meirelles Lia Miyamoto , Raduan Neto Jorge , dos Santos João Baptista Gomes , Fallopa Flávio
Published: May 2016

Background: There are several medical questionnaires to evaluate the quality of life of carpal tunnel syndrome patients. However, most measures are only available in English. We chose to translate and culturally adapt to Portuguese the Six-Item Carpal Tunnel Syndrome Symptoms Scale and Palmar Pain Scale (CTS-6) questionnaire because it provides objective assessment using a small number of questions. Methods: The translation and cultural adaptation were carried out according to the medical literature and consisted of five steps: (1) initial translation by two translators fluent in both languages, (2) association of initial translations, (3) back translation to Portuguese by two native speakers of English, (4) association of back translation and (5) comparison with the original version. Results: The Portuguese version was administered to patients with carpal tunnel syndrome and difficulties were noted concerning the comprehension and completion of the translated questionnaire. Patients had difficulty in understanding the horizontal layout of the response choices. Without altering the content, we changed the response choices to a vertical layout and re-administered the questionnaire to a new sample of patients followed up in the same ambulatory care service. We noted a substantial improvement in comprehension and completion of the questionnaire after the modifications. Conclusions: Availability of a Portuguese version of the Six-Item Carpal Tunnel Syndrome Symptoms Scale and Palmar Pain Scale (CTS-6) questionnaire will allow an objective evaluation of the treatment of a syndrome that is very prominent in medical practice.
Bilateral Legg-Calve-Perthes Disease and Kienbock’s Disease in a Child With Factor V Leiden Thrombophilia
Authors: Baltzer Heather L. , Riester Scott , Moran Steven L.
Published: May 2016

Background: The etiology of multifocal osteonecrosis is not definitively known; however, hypercoagulable state is a very plausible cause. Methods: We present an unusual case of a 12-year-old boy with a history of Legg-Calve-Perthes disease presenting with right wrist pain who was subsequently diagnosed with Kienbock’s disease. The finding of multifocal osteonecrosis prompted testing for a hypercoagulable state that was positive for Factor V Leiden thrombophilia. A thorough literature review using Medline database was conducted to investigate associations between inherited hypercoagulable states and multifocal osteonecrosis. Results: Our literature review identified 2 similar cases of multifocal osteonecrosis associated with a hypercoagulable disorder in adult patients. There were no reports among the pediatric patient population. Meta-analysis has demonstrated a potential link between Legg-Calve-Perthes disease and Factor V Leiden thrombophilia. Conclusions: This study offers further evidence to support the theory that multifocal osteonecrosis may be linked to a hypercoagulable state. Patients presenting with multifocal osteonecrosis should undergo screening for hypercoagulable states. Further investigation is needed to ascertain the potential benefit of prophylactic anticoagulation in patients with a known hypercoagulable state and multifocal osteonecrosis.
Proximal Interphalangeal Joint Fibromatosis After Pyrocarbon Implant Insertion
Authors: Rinkinen Jacob , Chetta Matthew D. , Chung Kevin C.
Published: May 2016

Background: Pyrocarbon implants represent an increasingly popular method to treat proximal interphalangeal joint dysfunction. To this point, no association has been shown between pyrocarbon biomaterials and fibromatosis. We present a potentially serious and destructive complication associated with pyrocarbon arthroplasty. Methods: We demonstrate a clinical case involving pyrocarbon arthroplasty and subsequent fibromatosis development in an otherwise healthy 23-year-old female. To present this association, we illustrate the diagnostic workup involved in a rapidly expanding soft tissue mass of the hand and explain the appropriate treatment. Results: Pyrocarbon arthroplasty was associated with development of locally destructive fibromatosis confirmed by histopathological examination. Treatment involved wide resection with preservation of local structures. Conclusion: We describe the first association between fibromatosis and pyrocarbon biomaterial. Due to fibromatosis destructive effects, clinicians should be aware of potential complications associated with these materials and know how to accurately diagnose and treat these lesions.