bluuebunny/crossref_metadata_2025 huggingface dataset:
Tracheostomy Following Surgery for Congenital Heart Disease
Authors: Benneyworth Brian D. , Shao Jenny M. , Cristea A. Ioana , Ackerman Veda , Rodefeld Mark D. , Turrentine Mark W. , Brown John W.
Published: May 2016

Background:

Tracheostomy following congenital heart disease (CHD) surgery is a rare event and associated with significant mortality. Hospital survival has been reported from 20% to 40%. Late mortality for these patients is not well characterized.

Methods:

We performed a retrospective observational study of patients who had a tracheostomy following CHD surgery (excluding isolated patent ductus arteriosus ligation) between January 2000 and December 2013. Patients were categorized into single-ventricle or biventricular physiology groups. Demographics, genetic syndromes, pulmonary disease, and comorbidities were collected. Outcomes including hospital survival, long-term survival, and weaning from positive pressure ventilation are reported. Bivariate and time-to-event models were used.

Results:

Over a 14-year period, 61 children (0.9% incidence) had a tracheostomy placed following CHD surgery. There were 12 single-ventricle patients and 49 biventricular patients. Prematurity, genetic syndromes, lung/airway disease, and other comorbidities were common in both CHD groups. Gastrostomy tubes were used more frequently in biventricular physiology patients (91.8%) versus single-ventricle patients (66.7%, P = .04). Survival to hospital discharge was 50% in the single-ventricle group compared to 86% in biventricular patients ( P = .01). Long-term survival continued to be poor in the single-ventricle group comparatively (three years, 27.8% vs 64.8%, P = .01). Gastrostomy tube placement was independently associated with survival in both groups ( P = .002).

Conclusion:

Tracheostomy is performed following many types of surgery for CHD and is commonly associated with other comorbidities. Both hospital and long-term survival are substantially lower in children with single-ventricle physiology as compared to patients with biventricular physiology.
Double Root Switch Repair for Taussig-Bing Anomaly
Authors: Furlanetto Gláucio , Furlanetto Beatriz H. S. , Teixeira Eduardo M. , Henriques Sandra
Published: May 2016

The double root switch was used to repair a Taussig-Bing anomaly in a two-month-old child. The surgery was performed with translocation of the aortic root to the left ventricular outflow tract and the pulmonary root to the right ventricular outflow tract, after closure of the ventricular septal defect with a patch that ultimately directed flow from the left ventricle to the aorta. This surgical approach has the theoretical advantage of reducing the likelihood of subneopulmonary obstruction, left ventricular outflow obstruction, neoaortic dilatation, and regurgitation and therefore has the potential to minimize the mortality and morbidity related to reintervention and reoperation.
Effectiveness of a Multidisciplinary Clinical Pathway for Elderly Patients With Hip Fracture
Authors: Kalmet P. H. S. , Koc B. B. , Hemmes B. , ten Broeke R. H. M. , Dekkers G. , Hustinx P. , Schotanus M. G. , Tilman P. , Janzing H. M. J. , Verkeyn J. M. A. , Brink P. R. G. , Poeze M.
Published: May 2016

Introduction:

The use of a multidisciplinary clinical pathway (MCP) for patients with hip fracture tends to be more effective than usual care (UC). The aim of this study was to evaluate the effects of an MCP approach on time to surgery, length of stay, postoperative complications, and 30-day mortality, compared to UC.

Materials and Methods:

This multicenter retrospective cohort study included patients aged 50 years or older with a proximal hip fracture who underwent surgery in one of the 6 hospitals in the Limburg trauma region of the Netherlands in 2012. Data such as demographics, process outcome measures, and clinical outcome were collected.

Results:

This study included a total of 1193 patients (665 and 528 patients in the MCP and UC groups, respectively). There were no differences in patient demographics present. Time to surgery was significantly shorter in the MCP compared to the UC group (19.2 vs 24.4 hours, P < .01). The mean length of stay was 10 versus 12 days ( P < .01). In the MCP group, significantly lower rates of postoperative complications were observed and significantly more patients were institutionalized than in the UC group. Mortality within 30 days after admission was comparable between the groups (overall mortality 6%).

Conclusion:

An MCP approach is associated with reduced time to surgery, postoperative complications, and length of stay, without a significant difference in 30-day mortality. The institutionalization rate was significantly higher in the MCP group.
Immune Thrombocytopenia (ITP) Secondary to Subclinical Hashimoto’s Thyroiditis
Authors: Tahir Hassan , Sheraz Faizan , Sagi Jahnavi , Daruwalla Vistasp
Published: May 2016

Immune thrombocytopenia (ITP) is the most common cause of isolated thrombocytopenia in healthy people. ITP may rarely coexist with autoimmune thyroid disorders, which may indicate more complex defect in immune system. Primary ITP usually responds well to steroids and intravenous immunoglobulins. However, ITP may be difficult to treat when associated with thyroid autoimmune disorders. In such cases, treating the underlying thyroid disorder may significantly improve platelet count and can either cause remission of disease or improve response to standard ITP therapy. We report a case of 47-year-old male who was diagnosed with ITP and was also found to have subclinical Hashimoto’s thyroiditis. Treatment of subclinical hypothyroidism with levothyroxine in our patient significantly improved the platelets, thus successfully bringing the disease in remission.
Agrarian production processes, and rural inequality in nineteenth-century Malabar
Authors: Ravindran Gopinath
Published: May 2016

This article is an attempt to understand the interactive and reciprocal processes through which structures of inequality in agrarian society were reproduced and transformed in concrete historical contexts and how these in turn impacted upon history to produce varying trajectories of change between different agro-economic zones or regions. The area taken up for study here is the erstwhile British Malabar (northern Kerala), from the early nineteenth to the early twentieth century. It attempts to relate the requirements of varied agrarian production regimes to the prevailing state system, tenurial systems and inequalities in land holding as well as social disparities represented by forms of caste differentiation.
Review Article: Shireen Moosvi, The Economy of the Mughal Empire c. 1595
Authors: Patnaik Prabhat
Published: May 2016

Shireen> Moosvi, The Economy of the Mughal Empire c. 1595, Revised and Enlarged Edition (New Delhi: Oxford University Press), 1987, pp. xii + 476, ₹695 (Paperback).
SEG News
Authors: Swiney Mick
Published: May 2016

Many people think of developers, programmers, and IT professionals as builders: they draw up plans, gather resources, and put their skills to work creating complex structures a “brick” at a time. Indeed, IT even includes building-related terms into its workflow (from software “engineers” to enterprise “architecture”).
Prestack 3D and 4D seismic inversion for reservoir static and dynamic properties
Authors: Nasser Mosab , Maguire Dan , Hansen Henrik Juhl , Schiott Christian
Published: May 2016

We present a successful case study in which prestack 3D and 4D simultaneous AVO inversion is used in conjunction with rock-physics analysis to estimate saturation and pressure changes in a West Africa brownfield using time-lapse (4D) seismic as input. We show that, in 4D seismic, there can be many competing production effects that can be difficult to disentangle using traditional 4D interpretation methods, such as amplitude differences between the base and monitors. This begs the need for a more sophisticated approach to decouple these competing effects, such as the use of prestack simultaneous 3D and 4D inversions. Multiple substack seismic data are used to estimate a variety of 3D and 4D petroelastic attributes for mapping static and dynamic reservoir properties with the primary objective of influencing the continuous infill drilling and the overall reservoir management strategy. Facies-specific low-frequency models were used as priors for the 3D inversion, while velocity changes from time-lapse time shifts were used as priors for the 4D inversion. We also demonstrate the use of rock-physics templates coupled with a lithology-specific Gassmann fluid-substitution method to establish a nonlinear regression-based rock-physics model that obeys bound theory from classical rock physics and honors single and multimineral fluid-substitution theory. The resulting templates, when integrated with the prestack AVO-inversion technique, produce a set of attributes that accurately explain the time-lapse production effects observed on seismic.
Rock-physics relationships between inverted elastic reflectivities
Authors: Thomas Michelle , Ball Vaughn , Blangy J. P. , Tenorio Luis
Published: May 2016

Quantitative relationships between true elastic properties are not always applicable to inverted elastic properties. We use the important example of two-term AVO reflectivity inversion to demonstrate this. AVO literature includes many examples of two-term AVO equations, and we provide a general relationship to convert between inverted reflectivities obtained when using these various equations. Conversion between inverted reflectivities should be based on this equation, rather than standard elastic-property relationships. This is of immediate importance when applying the method of chi-angle projections to estimate elastic reflectivities.
Full-waveform inversion as a game changer: Are we there yet?
Authors: Mancini Fabio , Prindle Kenton , Ridsdill-Smith Tom , Moss Jenny
Published: May 2016

Full-waveform inversion (FWI) has the potential to be a game changer for the seismic industry since it produces accurate velocity models at a resolution that cannot be matched by conventional traveltime tomography, with the additional advantage that it runs on basically raw data. Today, these two features should be better exploited to maximize the business value that FWI can deliver to an oil and gas operator. Provided that we acquire adequate data sets, FWI can be run starting from a smooth velocity model so that traveltime tomography is completely bypassed. As very little processing is required, FWI can be executed in parallel with the main preprocessing efforts, with the results of shortening considerably the overall project turnaround. For imaging purposes, FWI can be limited to the low-frequency range (∼ 10 Hz) but if run in the high-frequency range (∼ 30 Hz), FWI velocities have such a resolution that they can be used directly for interpretation. In particular, applications in the field of pore-pressure prediction and shallow hazard have great potential. In the current implementation, the main limitations are linked to data quality and computational power, but both these issues can be adequately addressed.
GSH-SEG Symposium honors Alistair Brown for career in interpreting 3D seismic data
Authors: Blythe Natalie
Published: May 2016

Each year, the Geophysical Society of Houston (GSH) and SEG hold a spring symposium to highlight innovations in the field and also to honor an outstanding member of the geophysics community. This year's GSH-SEG Symposium, “Interpretation Technology: Inspiring Innovation, Advancing Discoveries,” featured four sessions on interpretation technology and honored Alistair Brown for his contributions to seismic interpretation.
Erwin: Raising the science to greater heights through collaboration
Authors: Geary Andrew
Published: May 2016

This SEG Wiki interview, the third of the 2016 series, features Maitri Erwin, senior geophysicist and manager at Nexen Petroleum USA and chair of the Women's Network Committee (WNC). Erwin joins Andrew Geary, SEG publications outreach editor, to discuss how SEG members can contribute to the Society and elevate the science.

[Figure: see text]
SAS Focus
Authors: Que Bui Cong
Published: May 2016

The science and application of geophysics in Vietnam will soon turn 60 years old, and, in October, the Vietnam Association of Geophysicists (VAG) will host an international scientific conference in Hanoi to celebrate this anniversary.
Evolving eating disorder psychopathology: Conceptualising
muscularity-oriented disordered eating
Authors: Murray Stuart B. , Griffiths Scott , Mond Jonathan M.
Published: May 2016

Eating disorders, once thought to be largely confined to females, are
increasingly common in males. However, the presentation of disordered eating
among males is often distinct to that observed in females and this diversity
is not accommodated in current classification schemes. Here, we consider the
diagnostic and clinical challenges presented by these distinctive
presentations.
Deinstitutionalisation does not increase imprisonment or
homelessness
Authors: Salisbury Tatiana Taylor , Thornicroft Graham
Published: May 2016

Closing long-stay psychiatric beds remains contentious. The review by
Winkler et al in this issue examines 23 studies of
deinstitutionalisation for the outcomes of people discharged from
psychiatric hospitals after an admission of 1 year or longer. The majority
of these studies identified no cases of homelessness, incarceration or
suicide after discharge from hospital.
Responses of a 58-Story RC Dual Core Shear Wall and Outrigger Frame Building Inferred from Two Earthquakes
Authors: Çelebi Mehmet
Published: May 2016

Responses of a dual core shear-wall and outrigger-framed 58-story building recorded during the Mw6.0 Napa earthquake of 24 August 2014 and the Mw3.8 Berkeley earthquake of 20 October 2011 are used to identify its dynamic characteristics and behavior. Fundamental frequencies are 0.28 Hz (NS), 0.25 Hz (EW), and 0.43 Hz (torsional). Rigid body motions due to rocking are not significant. Average drift ratios are small. Outrigger frames do not affect average drift ratios or mode shapes. Local site effects do not affect the response; however, response associated with deeper structure may be substantial. A beating effect is observed from data of both earthquakes but beating periods are not consistent. Low critical damping ratios may have contributed to the beating effect. Torsion is relatively larger above outriggers as indicated by the time-histories of motions at the roof, possibly due to the discontinuity of the stiffer shear walls above level 47.
Pembrolizumab in Patients With Advanced Triple-Negative Breast Cancer: Phase Ib KEYNOTE-012 Study
Authors: Nanda Rita , Chow Laura Q.M. , Dees E. Claire , Berger Raanan , Gupta Shilpa , Geva Ravit , Pusztai Lajos , Pathiraja Kumudu , Aktan Gursel , Cheng Jonathan D. , Karantza Vassiliki , Buisseret Laurence
Published: May 2016

Purpose

Immune checkpoint inhibition has been demonstrated to be an effective anticancer strategy. Several lines of evidence support the study of immunotherapy in triple-negative breast cancer (TNBC). We assessed the safety and antitumor activity of the programmed cell death protein 1 (PD-1) inhibitor pembrolizumab in patients with advanced TNBC.

Methods

KEYNOTE-012 ( ClinicalTrials.gov identifier: NCT01848834) was a multicenter, nonrandomized phase Ib trial of single-agent pembrolizumab given intravenously at 10 mg/kg every 2 weeks to patients with advanced PD-L1–positive (expression in stroma or ≥ 1% of tumor cells by immunohistochemistry) TNBC, gastric cancer, urothelial cancer, and head and neck cancer. This report focuses on the TNBC cohort.

Results

Among 111 patients with TNBC whose tumor samples were screened for PD-L1 expression, 58.6% had PD-L1–positive tumors. Thirty-two women (median age, 50.5 years; range, 29 to 72 years) were enrolled and assessed for safety and antitumor activity. The median number of doses administered was five (range, 1 to 36 doses). Common toxicities were mild and similar to those observed in other tumor cohorts (eg, arthralgia, fatigue, myalgia, and nausea), and included five (15.6%) patients with grade ≥ 3 toxicity and one treatment-related death. Among the 27 patients who were evaluable for antitumor activity, the overall response rate was 18.5%, the median time to response was 17.9 weeks (range, 7.3 to 32.4 weeks), and the median duration of response was not yet reached (range, 15.0 to ≥ 47.3 weeks).

Conclusion

This phase Ib study describes preliminary evidence of clinical activity and a potentially acceptable safety profile of pembrolizumab given every 2 weeks to patients with heavily pretreated, advanced TNBC. A single-agent phase II study examining a 200-mg dose given once every 3 weeks ( ClinicalTrials.gov identifier: NCT02447003) is ongoing.
Development and Validation of a Radiomics Nomogram for Preoperative Prediction of Lymph Node Metastasis in Colorectal Cancer
Authors: Huang Yan-qi , Liang Chang-hong , He Lan , Tian Jie , Liang Cui-shan , Chen Xin , Ma Ze-lan , Liu Zai-yi
Published: May 2016

Purpose

To develop and validate a radiomics nomogram for preoperative prediction of lymph node (LN) metastasis in patients with colorectal cancer (CRC).

Patients and Methods

The prediction model was developed in a primary cohort that consisted of 326 patients with clinicopathologically confirmed CRC, and data was gathered from January 2007 to April 2010. Radiomic features were extracted from portal venous–phase computed tomography (CT) of CRC. Lasso regression model was used for data dimension reduction, feature selection, and radiomics signature building. Multivariable logistic regression analysis was used to develop the predicting model, we incorporated the radiomics signature, CT-reported LN status, and independent clinicopathologic risk factors, and this was presented with a radiomics nomogram. The performance of the nomogram was assessed with respect to its calibration, discrimination, and clinical usefulness. Internal validation was assessed. An independent validation cohort contained 200 consecutive patients from May 2010 to December 2011.

Results

The radiomics signature, which consisted of 24 selected features, was significantly associated with LN status (P < .001 for both primary and validation cohorts). Predictors contained in the individualized prediction nomogram included the radiomics signature, CT-reported LN status, and carcinoembryonic antigen level. Addition of histologic grade to the nomogram failed to show incremental prognostic value. The model showed good discrimination, with a C-index of 0.736 (C-index, 0.759 and 0.766 through internal validation), and good calibration. Application of the nomogram in the validation cohort still gave good discrimination (C-index, 0.778 [95% CI, 0.769 to 0.787]) and good calibration. Decision curve analysis demonstrated that the radiomics nomogram was clinically useful.

Conclusion

This study presents a radiomics nomogram that incorporates the radiomics signature, CT-reported LN status, and clinical risk factors, which can be conveniently used to facilitate the preoperative individualized prediction of LN metastasis in patients with CRC.
Phase III Trial Evaluating Letrozole As First-Line Endocrine Therapy With or Without Bevacizumab for the Treatment of Postmenopausal Women With Hormone Receptor–Positive Advanced-Stage Breast Cancer: CALGB 40503 (Alliance)
Authors: Dickler Maura N. , Barry William T. , Cirrincione Constance T. , Ellis Matthew J. , Moynahan Mary Ellen , Innocenti Federico , Hurria Arti , Rugo Hope S. , Lake Diana E. , Hahn Olwen , Schneider Bryan P. , Tripathy Debasish , Carey Lisa A. , Winer Eric P. , Hudis Clifford A.
Published: May 2016

Purpose

To investigate whether anti–vascular endothelial growth factor therapy with bevacizumab prolongs progression-free survival (PFS) when added to first-line letrozole as treatment of hormone receptor–positive metastatic breast cancer (MBC).

Patients and Methods

Women with hormone receptor–positive MBC were randomly assigned 1:1 in a multicenter, open-label, phase III trial of letrozole (2.5 mg orally per day) with or without bevacizumab (15 mg/kg intravenously once every 3 weeks) within strata defined by measurable disease and disease-free interval. This trial had 90% power to detect a 50% improvement in median PFS from 6 to 9 months. Using a one-sided α = .025, a target sample size of 352 patients was planned.

Results

From May 2008 to November 2011, 350 women were recruited; 343 received treatment and were observed for efficacy and safety. Median age was 58 years (range, 25 to 87 years). Sixty-two percent had measurable disease, and 45% had de novo MBC. At a median follow-up of 39 months, the addition of bevacizumab resulted in a significant reduction in the hazard of progression (hazard ratio, 0.75; 95% CI, 0.59 to 0.96; P = .016) and a prolongation in median PFS from 15.6 months with letrozole to 20.2 months with letrozole plus bevacizumab. There was no significant difference in overall survival (hazard ratio, 0.87; 95% CI, 0.65 to 1.18; P = .188), with median overall survival of 43.9 months with letrozole versus 47.2 months with letrozole plus bevacizumab. The largest increases in incidence of grade 3 to 4 treatment-related toxicities with the addition of bevacizumab were hypertension (24% v 2%) and proteinuria (11% v 0%).

Conclusion

The addition of bevacizumab to letrozole improved PFS in hormone receptor–positive MBC, but this benefit was associated with a markedly increased risk of grade 3 to 4 toxicities. Research on predictive markers will be required to clarify the role of bevacizumab in this setting.
RGMB and neogenin control cell differentiation in the developing olfactory epithelium
Authors: Kam Joseph Wai Keung , Dumontier Emilie , Baim Christopher , Brignall Alexandra C. , Mendes da Silva David , Cowan Mitra , Kennedy Timothy E. , Cloutier Jean-François
Published: May 2016

Cellular interactions are key for the differentiation of distinct cell types within developing epithelia, yet the molecular mechanisms engaged in these interactions remain poorly understood. In the developing olfactory epithelium (OE), neural stem/progenitor cells give rise to odorant-detecting olfactory receptor neurons (ORNs) and glial-like sustentacular (SUS) cells. Here, we show in mice that the transmembrane receptor neogenin (NEO1) and its membrane-bound ligand RGMB control the balance of neurons and glial cells produced in the OE. In this layered epithelium, neogenin is expressed in progenitor cells, while RGMB is restricted to adjacent newly born ORNs. Ablation of Rgmb via gene-targeting increases the number of dividing progenitor cells in the OE and leads to supernumerary SUS cells. Neogenin loss-of-function phenocopies these effects observed in Rgmb−/− mice, supporting the proposal that RGMB-neogenin signaling regulates progenitor cell numbers and SUS cell production. Interestingly, Neo1−/− mice also exhibit increased apoptosis of ORNs, implicating additional ligands in the neogenin-dependent survival of ORNs. Thus, our results indicate that RGMB-neogenin-mediated cell-cell interactions between newly born neurons and progenitor cells control the ratio of glia and neurons produced in the OE.
Case Report: Filtering the data on IVC filters
Authors: Khan Hina , Jilani Usman
Published: May 2016

Venous thromboembolic disease is associated with high rates of morbidity and mortality. First line therapy for thromboembolic disease remains anticoagulation. However, certain populations warrant consideration of an inferior vena cava (IVC) filter. This case report discusses an example of a patient who presented with an acute pulmonary embolism and highlights the utilization of the inferior vena cava (IVC) filter as patient therapy. Thus, in this case report we will review the indications for IVC filter placement and compare the compliance of IVC filter placement to established guidelines of use.
The natural defense system and the normative self model
Authors: Kourilsky Philippe
Published: May 2016

Infectious agents are not the only agressors, and the immune system is not the sole defender of the organism. In an enlarged perspective, the ‘normative self model’ postulates that a ‘natural defense system’ protects man and other complex organisms against the environmental and internal hazards of life, including infections and cancers. It involves multiple error detection and correction mechanisms that confer robustness to the body at all levels of its organization. According to the model, the self relies on a set of physiological norms, and NONself (meaning : Non Obedient to the Norms of the self) is anything ‘off-norms’. The natural defense system comprises a set of ‘civil defenses’ (to which all cells in organs and tissues contribute), and a ‘professional army ‘, made of a smaller set of mobile cells. Mobile and non mobile cells differ in their tuning abilities. Tuning extends the recognition capabilities of NONself by the mobile cells, which increase their defensive function. To prevent them to drift, which would compromise self/NONself discrimination, the more plastic mobile cells need to periodically refer to the more stable non mobile cells to keep within physiological standards.
Sustainability of Healthcare Information Exchanges: A Game-Theoretic Approach
Authors: Demirezen Emre M. , Kumar Subodha , Sen Arun
Published: May 2016

Based on our interactions with the key personnel of three different healthcare information exchange (HIE) providers in Texas, we develop models to study the sustainability of HIEs and participation levels in these networks. We first examine how heterogeneity among healthcare practitioners (HPs) (in terms of their expected benefit from the HIE membership) affects participation of HPs in HIEs. We find that, under certain conditions, low-gain HPs choose not to join HIEs. Hence, we explore several measures that can encourage more participation in these networks and find that it might be beneficial to (i) establish a second HIE in the region, (ii) propose more value to the low-gain HPs, or (iii) offer or incentivize value-added services. We present several other interesting and useful results that are somewhat counterintuitive. For example, increasing the highest benefit the HPs can get from the HIE might decrease the number of HPs that want to join the HIE. Furthermore, since the amount of funds from the government and the other agencies often changes (and will eventually cease), we analyze how the changes in the benefit HPs obtain from the HIE affect (i) participation in the network, (ii) the HIE subscription fee and the fee for value-added service, (iii) the number of HPs that request value-added service, and (iv) the net values of the HIE provider and HPs. We also provide guidelines for policy makers and HIE providers that may help them improve the sustainability of HIEs and increase the participation levels in these networks.
Private Equity and Industry Performance
Authors: Bernstein Shai , Lerner Josh , Sorensen Morten , Strömberg Per
Published: May 2016

The growth of the private equity industry has spurred concerns about its impact on the economy. This analysis looks across nations and industries to assess the impact of private equity on industry performance. We find that industries where private equity funds invest grow more quickly in terms of total production and employment and appear less exposed to aggregate shocks. Our robustness tests provide some evidence that is consistent with our effects being driven by our preferred channel.

This paper was accepted by Amit Seru, finance.
Unravelling the Motor of Patterning Work: Toward an Understanding of the Microlevel Dynamics of Standardization and Flexibility
Authors: Danner-Schröder Anja , Geiger Daniel
Published: May 2016

This paper examines how routine patterns are recognized as either stable or flexible and which mechanisms are enacted to maintain this patterning work. We address this question through an ethnographic case study analyzing how a catastrophe management organization enacts routines in a highly dynamic setting. Our findings first of all reveal that patterns described by the participants as either stable or flexible were nevertheless both performed differently in each iteration of the routine. Our microlevel analysis shows that to enact patterns that participants perceive as stable, participants had to carry out specific aligning and prioritizing activities that lock-stepped performances. In contrast, participants perceive patterns as flexible when they enact specific selecting and recombining activities. Building on these observations, we add to extant routine literature by (1) differentiating between stability, standardization, flexibility, and change of routines and by (2) providing new insights on mindfulness in accounting for the microlevel activities enacted to orient toward a pattern that enhances standardization or flexibility in dynamic contexts. Moreover, (3) our insights point to the centrality of knowing for the enactment and recognition of patterning work.
Tongue-tie division. Is it worth it? A retrospective cohort study
Authors: Braccio Serena , Chadderton Zoe , Sherridan Angela , Upadhyaya Manasvi
Published: May 2016

Background:

Breastfeeding is a complex process, influenced by various factors. Tongue tie may be an impediment to breastfeeding, so division of tongue tie (frenotomy) is routinely recommended to improve breastfeeding.

Aims:

This study aimed to assess the value of frenotomy based on its impact on breastfeeding-related problems.

Methods:

A 1-year retrospective cohort study was undertaken of all the patients referred to a London-based tongue-tie service with breastfeeding difficulties. A telephone survey was performed using a standardised questionnaire.

Findings:

The rate of exclusively breastfed babies increased from 36.7% before frenotomy to 53.8% at 48 hours post-procedure. All the breastfeeding-related problems significantly reduced by 48 hours post-procedure. There was no major bleeding, infection or ulceration reported. Of babies that had frenotomy, 3.2% underwent a second procedure.

Conclusions:

Frenotomy is a well-tolerated surgical procedure accompanied by very low complication rates. It significantly increases the exclusive breastfeeding rate in the short-term period and reduces breastfeeding-related problems.
Antiepileptic drug management during pregnancy: A shared decision approach
Authors: Morley Kim
Published: May 2016

There is an increased risk of morbidity and mortality associated with sudden withdrawal of antiepileptic drugs (AEDs). A decision to change adherence behaviour in pregnancy may be related to overestimating the risk of teratogenicity, lack of pregnancy-related knowledge and a failure by health professionals to facilitate individualised, proactive pre-conception counselling for women with epilepsy of childbearing potential. To demonstrate how women can take part in the active management of their condition, this article explores a complex decision to reintroduce AEDs following the first trimester of pregnancy. The decision has been unravelled and the complexity behind it outlined by gathering pertinent information. The risks and benefits of recommencing AEDs were identified and the evidence critically appraised. The choice of alternatives was discussed and the consequences and clinical judgement related to the decision-making process explored. The decision was evaluated for potential health outcome, impact and implications for future practice.
Maternal autonomy
Authors: Murphy Madeleine
Published: May 2016

Policing Pregnancy, a conference focusing on the issues of risk and choice in maternal autonomy, raised interesting questions about how best to support pregnant women.
Medium- and long-term results of high tibial osteotomy using Garches external fixator and gait analysis for dynamic correction in varus osteoarthritis of the knee
Authors: McClelland D. , Barlow D. , Moores T. S. , Wynn-Jones C. , Griffiths D. , Ogrodnik P. J. , Thomas P. B. M.
Published: May 2016

In arthritis of the varus knee, a high tibial osteotomy (HTO) redistributes load from the diseased medial compartment to the unaffected lateral compartment.

We report the outcome of 36 patients (33 men and three women) with 42 varus, arthritic knees who underwent HTO and dynamic correction using a Garches external fixator until they felt that normal alignment had been restored. The mean age of the patients was 54.11 years (34 to 68). Normal alignment was achieved at a mean 5.5 weeks (3 to 10) post-operatively. Radiographs, gait analysis and visual analogue scores for pain were measured pre- and post-operatively, at one year and at medium-term follow-up (mean six years; 2 to 10). Failure was defined as conversion to knee arthroplasty.

Pre-operative gait analysis divided the 42 knees into two equal groups with high (17 patients) or low (19 patients) adductor moments. After correction, a statistically significant (p < 0.001, t-test,) change in adductor moment was achieved and maintained in both groups, with a rate of failure of three knees (7.1%), and 89% (95% confidence interval (CI) 84.9 to 94.7) survivorship at medium-term follow-up.

At final follow-up, after a mean of 15.9 years (12 to 20), there was a survivorship of 59% (95% CI 59.6 to 68.9) irrespective of adductor moment group, with a mean time to conversion to knee arthroplasty of 9.5 years (3 to 18; 95% confidence interval ± 2.5).

HTO remains a useful option in the medium-term for the treatment of medial compartment osteoarthritis of the knee but does not last in the long-term.

Cite this article: Bone Joint J 2016;98-B:601–7.
Long-term results of uncemented total hip arthroplasty with the Taperloc femoral component in patients with Dorr type C proximal femoral morphology
Authors: McLaughlin J. R. , Lee K. R.
Published: May 2016

Aims

To investigate the longevity of uncemented fixation of a femoral component in total hip arthroplasty (THA) in patients with Dorr type C proximal femoral morphology.

Patients and Methods

A total of 350 consecutive uncemented THA in 320 patients were performed between 1983 and 1987, by a single surgeon using the Taperloc femoral component. The 63 patients (68 hips) with Dorr type C proximal femoral morphology were the focus of this review. The mean age of the patients was 69 years (24 to 88) and mean follow-up was 16.6 years (ten to 29). Survival analysis included eight patients (eight hips) who died without undergoing revision surgery prior to obtaining ten years follow-up. All 55 surviving patients (60 hips) were available for clinical assessment and radiographic review. As a comparator group, the survival and implant fixation in the remaining 282 THAs (257 patients) with Dorr type A and B morphology were evaluated. The mean age of these patients was 52 years (20 to 82).

Results

In the Dorr C patient group the mean Harris hip score improved from 51 points (21 to 69 points) pre-operatively to 89 (74 to 100) at final follow-up. No femoral component was loose by radiological criteria and osteolysis was only identified around two stems (3.3%). There was one revision (1.6%) of a well-fixed femoral component for sepsis at 11 years. The survival of the Taperloc femoral component at 20 years with revision for any reason as the endpoint was 98% (95% confidence interval; 87 to 99). A total of ten (3.5%) of the Dorr A and B patient group of 282 THAs required revision surgery. Only one (0.4%) for aseptic loosening. A total of two hips (1%) were loose by radiographic criteria and osteolysis occurred around 12 hips (4%).

Conclusion

This study demonstrates that excellent fixation can be achieved using the Taperloc stem in patients with Dorr type A and B, and Dorr type C bone. Take home message: The Taperloc stem demonstrated equivalent results in Dorr type A and B and Dorr type C bone. Cite this article: Bone Joint J 2016;98-B:595–600.
Revision surgery for the stiff total knee arthroplasty
Authors: Donaldson J. R. , Tudor F. , Gollish J.
Published: May 2016

Aims

The aim of this study was to examine the results of revision total knee arthroplasty (TKA) undertaken for stiffness in the absence of sepsis or loosening.

Patients and Methods

We present the results of revision surgery for stiff TKA in 48 cases (35 (72.9%) women and 13 (27.1%) men). The mean age at revision surgery was 65.5 years (42 to 83). All surgeries were performed by a single surgeon. Stiffness was defined as an arc of flexion of < 70° or a flexion contracture of > 15°. The changes in the range of movement (ROM) and the Western Ontario and McMasters Osteoarthritis index scores (WOMAC) were recorded.

Results

At a mean follow up of 59.9 months (12 to 272) there was a mean improvement in arc of movement of 45.0°. Mean flexion improved from 54.4° (5° to 100°) to 90° (10° to 125°) (p <  0.05) and the mean flexion contracture decreased from 12.0° (0° to 45°) to 3.5° (0° to 25°) (p < 0.05). The mean WOMAC scores improved for pain, stiffness and function. In patients with extreme stiffness we describe a novel technique, which we have called the ‘sloppy’ revision. This entails downsizing the polyethylene insert by 4 mm and using a more constrained liner to retain stability.

Conclusion

To our knowledge, this is the largest series of revision surgeries for stiffness reported in the literature where infection and loosening have been excluded. Take home message: Whilst revision surgery is technically demanding, improvements in ROM and outcome can be achieved, particularly when the revision is within two years of the primary surgery. Cite this article: Bone Joint J 2016;98-B:622–7.
Graft salvage following infected anterior cruciate ligament reconstruction
Authors: Kuršumović K. , Charalambous C. P.
Published: May 2016

Aims

To examine the rates of hamstring graft salvage with arthroscopic debridement of infected anterior cruciate ligament (ACL) reconstruction as reported in the literature and discuss functional outcomes.

Materials and Methods

A search was performed without language restriction on PubMed, EMBASE, Ovid, CINAHL and Cochrane Register of Controlled Trials (CENTRAL) databases from their inception to April 2015. We identified 147 infected hamstring grafts across 16 included studies. Meta-analysis was performed using a random-effects model to estimate the overall graft salvage rate, incorporating two different definitions of graft salvage.

Results

The graft salvage rate was 86% (95% confidence intervals (CI) 73% to 93%; heterogeneity: tau2= 1.047, I2= 40.51%, Q = 25.2, df = 15, p < 0.001), excluding ACL re-ruptures. Including re-ruptures as failures, the graft salvage rate was 85% (95% CI 76% to 91%; heterogeneity: tau2 = 0.099, I2= 8.15%, Q = 14.15, df = 13, p = 0.36).

Conclusions

Arthroscopic debridement combined with antibiotic treatment can lead to successful eradication of infection and graft salvage, with satisfactory functional outcomes in many cases of septic arthritis following ACL reconstruction. Persistent infection despite repeat arthroscopic debridements requires graft removal with the intention of revision ACL surgery at a later stage. Take home message: Arthroscopic debridement combined with antibiotic therapy is an appropriate initial approach in most cases of septic arthritis following ACL reconstruction, achieving graft salvage rates of about 85%. Cite this article: Bone Joint J 2016;98-B:608–15.
The lognormal age of onset distribution in Perthes’ disease
Authors: Perry D. C. , Skellorn P. J. , Bruce C. E.
Published: May 2016

Aims

To explore the of age of onset distribution for Perthes’ disease of the hip, with particular reference to gender, laterality and conformity to the lognormal distribution.

Patients and Methods

A total of 1082 patients were identified from the Liverpool Perthes’ Disease Register between 1976 and 2010, of which 992 had the date of diagnosis recorded. In total, 682 patients came from the geographical area exclusively served by Alder Hey Hospital, of which 673 had a date of diagnosis. Age of onset curves were analysed, with respect to the predefined subgroups.

Results

The age of onset demonstrated a positive skew with a median of 5.8 years (interquartile range 4.6 to 7.5). Disease onset was a mean five months earlier in girls (p = 0.01) and one year earlier in those who went on to develop bilateral disease (p < 0.001). There was no difference in the age of onset between geographical districts with differing incidence rates. The entire dataset (n = 992) conformed to a lognormal distribution graphically and with the chi-squared test of normality (p = 0.10), but not using the Shapiro-Wilk test (p = 0.01). The distribution for the predefined geographical subgroup (n = 673) conformed well to a lognormal distribution (chi-squared p = 0.16, Shapiro-Wilk p = 0.08). Given the observed lognormal distribution it was assumed that Perthes’ disease followed on incubation period consistent with a point-source disease exposure. The incubation period was further examined using Hirayama’s method, which suggested that the disease exposure may act in the prenatal period.

Conclusion

The age of onset in Perthes’ disease conforms to a lognormal distribution, which allows comparisons with infectious disease epidemiology. Earlier onset in girls and those who develop bilateral disease may offer clues to understanding the aetiological determinants of the disease. The analysis suggests that an antenatal aetiological determinant may be responsible for disease. Take home message: Perthes’ disease age of onset conforms to a lognormal model, which is most typical of infectious diseases. The shape of the distribution suggests that an aetiological trigger in the pre-natal period may be an important determinant of disease. Cite this article: Bone Joint J 2016;98-B:710–14.
Asymmetrical ossification in the epiphyseal ring of patients with adolescent idiopathic scoliosis
Authors: Makino T. , Kaito T. , Sakai Y. , Kashii M. , Yoshikawa H.
Published: May 2016

Aims

To clarify the asymmetrical ossification of the epiphyseal ring between the convex and concave sides in patients with adolescent idiopathic scoliosis (AIS).

Patients and Methods

A total of 29 female patients (mean age, 14.4 years; 11 to 18) who underwent corrective surgery for AIS (Lenke type 1 or 2) were included in our study. In all, 349 vertebrae including 68 apical vertebrae and 87 end vertebrae in the main thoracic (MT) curve and thoracolumbar/lumbar (TL/L) curve were analysed. Coronal sections (anterior, middle and posterior) of the vertebral bodies were reconstructed from pre-operative CT scans (320-row detector; slice thickness, 0.5 mm) and the appearances of the ossification centre in the epiphyseal ring at four corners were evaluated in three groups; all vertebrae excluding end vertebrae, apical vertebrae and end vertebrae. The appearance rates of the ossification centre at the concave and convex sides were calculated and compared.

Results

The appearance rates of the ossification centres in all vertebrae excluding end vertebrae and apical vertebrae were significantly lower on the concave side than on the convex side in both MT and TL/L curves irrespective of curve flexibility. There was no significant difference in the rate of appearance of the ossification centres on the concave or convex sides in end vertebrae.

Conclusion

The asymmetric bony growth of vertebral body came into existence at both structural and non-structural curves, and was more apparent around the apical vertebrae. Evaluation of the ossification centre in the epiphyseal ring could be a measure of the effectiveness of brace treatment. Take home message: The ossification of the epiphyseal ring in patients with AIS was delayed or absent on the concave side particularly around the apical vertebrae. Cite this article: Bone Joint J 2016;98-B:666–71.
Short and medium-term outcomes for general surgery in nonagenarian patients in a district general hospital
Authors: Hayes AJ , Davda A , El-Hadi M , Murphy P , Papettas T
Published: May 2016

Introduction

Surgeons are increasingly performing surgery on older patients. There are currently no tools specifically for risk prediction in this group. The aim of this study was to review general surgical operations carried out on patients aged over 90 years and their outcome, before comparing these with predictors of morbidity and mortality.

Methods

A retrospective review was carried out at our district general hospital of all general surgery patients aged over 90 years who underwent a general surgical operation over a period of 14 years. Information collected included demographics, details of procedures, P-POSSUM (Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity), complications and outcomes.

Results

A total of 119 procedures were carried out, 72 involving entry into the peritoneal cavity. Overall, 14 patients (12%) died within 30 days and 34 (29%) died within one year. Postoperative complications included infection (56%), renal failure (24%), need for transfusion (17%) and readmission within 30 days (11%). Logistical regression analysis showed that the P-POSSUM correlated well with observed mortality and infection was a significant predictor of in-hospital mortality (p=0.003).

Conclusions

The P-POSSUM correlates significantly with outcome and should be used when planning major elective or emergency surgery in patients over 90 years of age. Infective complications appear to be a significant predictor of postoperative mortality. This study supports operative intervention as an option in this extreme age group but we emphasise the importance of appropriate patient selection and judicious clinical care.
Determinants of return to work 12 months after total hip and knee arthroplasty
Authors: Leichtenberg CS , Tilbury C , Kuijer PPFM , Verdegaal SHM , Wolterbeek R , Nelissen RGHH , Frings-Dresen MHW , Vliet Vlieland TPM
Published: May 2016

Introduction

A substantial number of patients undergoing total hip or knee arthroplasty (THA or TKA) do not or only partially return to work. This study aimed to identify differences in determinants of return to work in THA and TKA.

Methods

We conducted a prospective, observational study of working patients aged <65 years undergoing THA or TKA for osteoarthritis. The primary outcome was full versus partial or no return to work 12 months postoperatively. Factors analysed included preoperative sociodemographic and work characteristics, alongside the Hip Disability and Osteoarthritis Outcome Score (HOOS)/Knee Injury and Osteoarthritis Outcome Score (KOOS), and Oxford Hip and Knee Scores.

Results

Of 67 THA and 56 TKA patients, 9 (13%) and 10 (19%), respectively, returned partially and 5 (7%) and 6 (11%), respectively, did not return to work 1 year postoperatively. Preoperative factors associated with partial or no return to work in THA patients were self-employment, absence from work and a better HOOS Activities of Daily Living (ADL) subscale score, whereas only work absence was relevant in TKA patients. Type of surgery modified the impact of ADL scores on return to work.

Conclusions

In both THA and TKA, absence from work affected return to work, whereas self-employment and better preoperative ADL subscale scores were also associated in THA patients. The impact of ADL scores on return to work was modified by type of surgery. These results suggest that strategies aiming to influence modifiable factors should consider THA and TKA separately.
Neonatal compartment syndrome
Authors: Martin B , Treharne L
Published: May 2016

A term neonate was born with a grossly swollen and discoloured left hand and forearm. He was transferred from the local hospital to the plastic surgical unit, where a diagnosis of compartment syndrome was made and he underwent emergency forearm fasciotomies at six hours of age. Following serial debridements of necrotic tissue, he underwent split-thickness skin grafting of the resultant defects of his forearm, hand and digits. At the clinic follow-up appointment two months after the procedure, he was found to have developed severe flexion contractures despite regular outpatient hand therapy and splintage. He has had further reconstruction with contracture release, use of artificial dermal matrix, and K-wire fixation of the thumb and wrist. Despite this, the long term outcome is likely to be an arm with poor function. The key learning point from this case is that despite prompt transfer, diagnosis and appropriate surgical management, the outcome for neonatal compartment syndrome may still be poor.