bluuebunny/crossref_metadata_2025 huggingface dataset:
The Surgical Management of Central Metatarsalgia
Authors: O'Kane Claire , Kilmartin T.E.
Published: January 2017

Seventeen patients (20 feet) underwent Weil osteotomies of the second and third metatarsals for the treatment of central metatarsalgia and were reviewed at an average of 18 months postoperatively. Fourteen patients were completely satisfied with the results of their surgery (85%), one patient was satisfied, one patient satisfied with reservations and one patient was dissatisfied. The American Orthopaedic Foot and Ankle Society clinical rating scale improved by an average of 44 points. One patient had complete recurrence of symptoms, eight out of the 40 toes involved in surgery were floating, four toes were stiff, there were three cases of infection, and transfer metatarsalgia affected the fourth metatarsal in one case. The Weil osteotomy is an effective and safe procedure for the treatment of central metatarsalgia.
Forefoot Narrowing with External Fixation for Problem Cleft Wounds
Authors: Strauss Michael B. , Bryant Brandon J. , Hart Jack D.
Published: January 2017

Healing of forefoot cleft wounds can be a difficult management problem in patients with peripheral vascular disease, diabetes or both. This is a prospective review of 15 patients with these conditions with nonhealing middle-ray cleft wounds managed with a temporary mini-external fixator to close the cleft wound. Fourteen (93%) of the 15 patients had a successful obliteration of the cleft and skin coverage. Twelve (80%) of 15 were able to resume their previous level of activity with the reconstructed, mechanically sound forefoot. Fourteen (93%) of the 15 patients received hyperbaric oxygen treatments as an adjunct to wound healing. All patients avoided a transmetatarsal or higher amputation.
Surgical Treatment of Superficial Peroneal Neuroma
Authors: Chiodo Christopher P. , Miller Stuart D.
Published: January 2017

Background:

Several techniques have been described for the surgical treatment of symptomatic superficial peroneal neuromas, including transection of the nerve with burial in muscle or bone to prevent recurrence.

Methods:

We compared in 27 consecutive patients the results of transection and burial of the proximal peroneal nerve stump into muscle (group A) with results of transection and burial of the proximal stump into bone (group B).

Results:

The perceived pain relief and improvement in mean pain score were significantly higher ( p < .05) in group B than in group A. In addition, four patients in group A required revision neurotomy compared to none in group B.

Conclusion:

For symptomatic superficial peroneal neuromas, transection with transposition of the proximal nerve stump into bone provides superior results compared with those of neurotomy with transposition of the proximal stump into muscle.
The Obliquity of the First Metatarsal Base
Authors: Hyer Christopher F. , Philbin Terrence M. , Berlet Gregory C. , Lee Thomas H.
Published: January 2017

Background:

The degree of obliquity of the base of the first metatarsal is thought to predispose to metatarsus primus varus deformity. Radiographs currently are used to interpret the obliquity of the proximal first metatarsal but are subject to error. A ‘normal’ obliquity of the first metatarsal base has not yet been established.

Methods:

Direct measurements of 77 human first metatarsals were used to establish mean values for the proximal first metatarsal obliquity angle with respect to age, gender, and ethnicity in this sample population. The overall length of the first metatarsal and the width of the base were measured. The measured values were compared in relation to age, gender, and ethnicity of the specimens.

Results:

The overall mean obliquity angle was 3.42 degrees (range, −3 to 8 degrees, SD 2.54). The mean obliquity angle in females was 3.67 degrees (range, −3 to 8 degrees, SD 2.91). The mean obliquity angle in males was 3.30 degrees (range, −2 to 7 degrees, SD 2.24). Mean base obliquity angle in the African-American specimens was 3.0 degrees (range, 3 to 7 degrees, SD 2.59), while the average first obliquity angle in the Caucasian specimens was 3.83 degrees (range, −2 to 8 degrees, SD 2.34). The obliquity of the first metatarsal base increased with age from a mean of 3.5 degrees in the youngest group to 5.13 degrees in the oldest.

Conclusions:

Exaggerated obliquity of the first metatarsal base is a proposed cause for metatarsus primus varus. No average values had been established for the proximal first metatarsal obliquity. These mean values are useful in determining if pathologic obliquity is present. In this study group, the mean medial obliquity angle was 3.42 degrees.
Functional Outcome (SF-36) of Patients with Displaced Calcaneal Fractures Compared to SF-36 Normative Data
Authors: van Tetering Elisabeth A. A. , Buckley Richard E.
Published: January 2017

Background:

The purpose of this study was to demonstrate the general health status after treatment of displaced intraarticular calcaneal fractures compared to normative data, other orthopaedic procedures, and other medical conditions.

Methods:

Three hundred and twelve patients between 25 and 64 years of age were treated for displaced intraarticular calcaneal fractures at a Level I trauma center. Followup ranged from 2 to 8 years. The Short Form 36 Health Status Survey (SF-36) was used for outcome measurement.

Results:

The scores in eight SF-36 categories in patients with displaced intraarticular calcaneal fractures differed by more than five points from the population norms. This suggests that there is clinical and social relevance to this injury. Outcomes in patients with displaced intraarticular calcaneal fractures were not as good across most SF-36 categories as were outcomes of patients with other orthopaedic conditions. Outcomes in patients with intraarticular calcaneal fractures also were worse across most categories than outcomes in patients who had organ transplants or myocardial infarctions.

Conclusion:

By comparing treatment for displaced intraarticular calcaneal fractures with treatment for orthopaedic problems or other disease processes, we concluded that intraarticular calcaneal fractures are serious life-changing events.
Informed Consent for Ankle Fracture Surgery: Patient Comprehension of Verbal and Videotaped Information
Authors: Rossi Michael , McClellan Robert , Chou Loretta , Davis Kristin
Published: January 2017

Background:

The purpose of our study was to evaluate the effectiveness of using a videotape to give patients information about the risks, benefits, alternatives, and treatment of a common orthopaedic procedure before they sign consent forms.

Methods:

During a 9-month period, 48 patients with isolated closed ankle fractures requiring surgical intervention were randomized into two groups that received either videotaped or conventional verbal information regarding consent for surgery. The study group watched a videotape containing information about the risks, benefits, and treatment alternatives, while the control group obtained this information verbally. To determine comprehension and retention, all patients completed a multiple-choice questionnaire immediately after receiving the information, and 37 patients (77%) were available to complete a questionnaire at an average of 10 weeks later.

Results:

The videotape group outperformed the verbal consent group by 40.1% on the initial questionnaire ( p = .0002) and by 27.2% on the followup questionnaire ( p = 0.0139). Patients with educational levels of less than or equal to the 12th grade performed 67.8% better on the initial questionnaire after watching the video than after receiving the information verbally. ( p = .0001).

Conclusion:

Patients who received information about their surgery on a videotape before giving their consent demonstrated a significant increase in comprehension compared to patients who received this information verbally. The benefit was even greater for patients with lower education levels.
Reliability and Validity of the American Orthopaedic Foot and Ankle Society Clinical Rating Scale: A Pilot Study for the Hallux and Lesser Toes
Authors: Baumhauer Judith F. , Nawoczenski Deborah A. , DiGiovanni Benedict F. , Wilding Gregory E.
Published: January 2017

Background:

The use of clinical outcomes instruments is essential for the effective interpretation of individual patient progress as well as the comparison of treatment groups. An outcomes instrument must be reliable and valid to obtain any meaningful data. The purpose of the present study was to examine the reliability and validity of the American Orthopaedic Foot and Ankle Society (AOFAS) clinical rating scale for the hallux metatarsophalangeal-interphalangeal and lesser toes metatarsophalangeal-interphalangeal joints.

Methods:

Eleven patients (one man, 10 women) with an average age of 54 (range 40 to 72) years and with classic rheumatoid arthritis not currently treated for foot complaints were enrolled in the present study. The average duration of rheumatoid arthritis was 14 years. Each patient completed a set of two outcomes instruments and had a physical examination by a single clinician at the initial visit and returned at 1 week for completion of the same scales and examination. The outcomes scales used were the AOFAS clinical rating scale for the hallux, the AOFAS clinical rating scale for the lesser toes, and the previously validated Foot Function Index (FFI). Test-retest reliability was evaluated using intraclass correlation coefficients between week 1 and week 2 for the summary scores as well as for the subscales of pain and activity. Consistency between the two instruments was evaluated with Pearson correlation coefficients.

Results:

The AOFAS clinical rating scale for the hallux and lesser toes is repeatable between 1-week trials (ICC 0.95; p < 0.05; ICC 0.80; p < 0.05, respectively). Moderately strong correlations were found between the mean values for the AOFAS hallux and FFI (r = −0.81; p < 0.05). Weaker correlations were seen between the mean values for the AOFAS lesser toes and FFI scales (r = −0.69; p < 0.05).

Conclusions:

The hallux subscale for pain correlates strongly with the FFI subscale for pain, suggesting high content validity (r = −0.94; p < 0.001). Ceiling effects were seen with the AOFAS lesser toe subscale for activity, limiting its usefulness in a general patient population. The AOFAS lesser toe subscale for pain and the AOFAS hallux subscale for activity correlated weakly with the FFI values (r = −0.31; r = −0.37; p > 0.05, respectively).

Conclusions:

Although the AOFAS hallux and lesser toe scales were found to be reliable in a rheumatoid patient population, their validity remains in question. These findings must be confirmed with larger subject numbers, with the inclusion of symptomatic patients before recommended routine use of the hallux clinical rating and lesser toe clinical rating scales.
Surgical Treatment of Severe Hallux Valgus: The State of Practice among Academic Foot and Ankle Surgeons
Authors: Pinney Stephen J. , Song Kyle R. , Chou Loretta B.
Published: January 2017

Background:

The purpose of this study was to evaluate the operative procedures used for treatment of severe hallux valgus by academic foot and ankle surgeons practicing in the United States.

Methods:

A patient with severe hallux valgus deformity was developed as a hypothetical case: a 50-year-old woman with a severe deformity (intermetatarsal angle = 20 degrees; hallux valgus angle = 42 degrees). The patient was symptomatic with pain, did not improve with conservative measures, and wanted the deformity corrected. This case was sent to academic foot and ankle surgeons in a survey to determine their preferred operative treatment for this case. The overall response rate was 84% (128 of 153). To be included in the study group each surgeon had to have 1) foot and ankle patients comprising 50% or more of his clinical practice and 2) direct responsibility for teaching orthopaedic residents. One hundred and five respondents met the inclusion criteria and formed the study group; however, three surveys with invalid responses were deleted.

Results:

Fifty-two percent (54 of 102) of the respondents chose a metatarsal osteotomy, 26% (26 of 102) a first metatarsophalangeal (MTP) joint arthrodesis, and 24% (24 of 102) a Lapidus procedure. Two respondents chose both an arthrodesis and a metatarsal osteotomy. Among the 54 respondents who chose metatarsal osteotomies, 24 used a Ludloff, 16 a proximal crescentic, eight a proximal chevron, two a scarf, two a distal chevron, and two other. In addition, secondary procedures to enhance the correction included a Weil osteotomy in 46% (47 of 102) and an Akin osteotomy in 30% (31 of 102).

Conclusions:

There was a wide variation in the type of procedure used to correct this severe hallux valgus deformity; approximately 50% of the respondents chose a metatarsal osteotomy, 25% chose a first MTP joint arthrodesis, and 25% a Lapidus procedure.
Positive Hindfoot Valgus and Osteoarthritis of the First Metatarsophalangeal Joint
Authors: Mahiquez Melissa Y. , Wilder Frances V. , Stephens Heidi M.
Published: January 2017

Background:

The aim of this retrospective cohort study was to evaluate the association between increased hindfoot valgus and the subsequent development of osteoarthritis of the first metatarsophalangeal (MTP) joint. Specifically, our hypothesis was that among individuals free from first MTP joint osteoarthritis, those who have positive hindfoot valgus are more likely to develop first MTP joint osteoarthritis than are those individuals with normal hindfoot alignment.

Methods:

Our sample consisted of 1592 men and women, 40 years of age or older, participating in the Clearwater Osteoarthritis Study (1988 to 2001). Biennial physical examinations, including serial radiographs, were conducted. The Kellgren and Lawrence ordinal scale was used to determine radiographic evidence (grades 2+) of the study outcomes and incidence of first MTP joint osteoarthritis. Standing hindfoot valgus was assessed visually by a registered nurse, with a hindfoot valgus measurement of more than 5 degrees classified as a positive hindfoot valgus.

Results:

Individuals with hindfoot valgus were 23% more likely to subsequently develop first MTP joint osteoarthritis than were those without hindfoot malalignment (risk ratio = 1.23; p- value < 0.006). This risk estimate reflects the potential influence of age, gender, and body mass index.

Conclusions:

Our data suggest that hindfoot valgus may increase the risk of developing foot osteoarthritis. The association of hindfoot valgus with first MTP joint osteoarthritis in this epidemiological assessment is supportive of the mechanical theory for the development of osteoarthritis. The authors speculate that future, related studies may determine that osteoarthritis prevention strategies can be broadened to include individuals with positive hindfoot valgus.
Stretching for Prevention of Achilles Tendon Injuries: A Review of the Literature
Authors: Park Don Young , Chou Loretta
Published: January 2017

Professional and recreational athletes commonly perform preexercise stretching to prevent musculoskeletal injuries. Little definitive evidence exists that clearly demonstrates the efficacy of stretching in reducing injury. Achilles tendon injuries are among the most common injuries affecting active individuals in the United States today. Clinicians commonly recommend stretching the Achilles tendon without concrete scientific evidence to support such a claim. Few studies have addressed the effect of stretching in Achilles tendon injuries, and it is unclear if the conclusions made for musculoskeletal injuries can be applied to the Achilles tendon. Biomechanical studies of the Achilles tendon and measurements of the tendon's reflex activity have demonstrated possible mechanisms for the potential benefit of stretching, including load-induced hypertrophy and increased tendon tensile strength. Recent prospective studies have contended that reductions in plantarflexor strength and increases in ankle dorsiflexion range of motion from stretching the Achilles tendon may increase the risk of injury. Studies examining stretching in injury prevention, the biomechanical properties of injuries to the Achilles tendon were compiled and reviewed. Although many theories have been published regarding the potential benefits and limitations of stretching, few studies have been able to definitively demonstrate its utility in injury prevention.
Detection of Orthopaedic Foot and Ankle Implants by Security Screening Devices
Authors: Bluman Eric M. , Tankson Cedric , Myerson Mark S. , Jeng Clifford L.
Published: January 2017

Background:

A common question asked by patients contemplating foot and ankle surgery is whether the implants used will set off security screening devices in airports and elsewhere. Detectability of specific implants may require the orthopaedic surgeon to provide attestation regarding their presence in patients undergoing implantation of these devices. Only two studies have been published since security measures became more stringent in the post-9/11 era. None of these studies specifically focused on the large numbers of orthopaedic foot and ankle implants in use today. This study establishes empiric data on the detectability by security screening devices of some currently used foot and ankle implants.

Methods:

A list of foot and ankle procedures was compiled, including procedures frequently used by general orthopaedists as well as those usually performed only by foot and ankle specialists. Implants tested included those used for open reduction and internal fixation, joint fusion, joint arthroplasty, osteotomies, arthroreisis, and internal bone stimulation. A test subject walked through a gate-type security device and was subsequently screened using a wand-type detection device while wearing each construct grouping. The screening was repeated with the implants placed within uncooked steak to simulate subcutaneous and submuscular implantation.

Results:

None of the implants were detected by the gate-type security device. Specific implants that triggered the wand-type detection device regardless of coverage with the meat were total ankle prostheses, implantable bone stimulators, large metatar-sophalangeal hemiarthroplasty, large arthroreisis plugs, medial distal tibial locking construct, supramalleolar osteotomy fixation, stainless steel bimalleolar ankle fracture fixation, calcaneal fracture plate and screw constructs, large fragment blade plate constructs, intramedullary tibiotalocalcaneal fusion constructs, and screw fixation for calcaneal osteotomies, ankle arthrodeses, triple arthrodeses, and stainless steel first metatar-sophalangeal joint arthrodeses. The placement of implants in meat prevented the detectability of only the stainless steel Jones fracture implant (stainless steel 6.5-mm cannulated screw) and the stainless steel midfoot fusion construct (four stainless steel 4.0-mm cannulated screws).

Conclusions:

These data may help the orthopaedic surgeon in counseling patients as to the detectability of some orthopaedic foot and ankle implants in use today. Specific constructs for which documentation may need to be provided to the patient are identified. As security standards evolve and the environments in which they are practiced change, empiric testing of many of these devices may need to be repeated.
Radiographic Changes and Clinical Results of Osteochondral Defects of the Talus with and without Subchondral Cysts
Authors: Han Seung Hwan , Lee Jin Woo , Lee Dae Young , Kang Eung Shick
Published: January 2017

Background:

Subchondral cysts are a type of osteochondral defect of the talus and can be a source of chronic ankle pain. The treatment modality of this cystic lesion is similar to that of other osteochondral defects, but results from previous reports are controversial. Therefore, we compared the clinical results and radiographic changes in small subchondral talar cystic lesions (less than 1.5 cm 2 ) to other noncystic defects after arthroscopic operations without bone grafting.

Methods:

The review covered about 2 years (January, 2001 to April, 2003) and included 38 patients with an average age of 36.9 years. Followup ranged from 24 to 36 months. Arthroscopic microfracture or abrasion arthroplasty was performed on 20 defects with subchondral cysts and 18 defects without cysts. Clinical results were assessed by the ankle-hindfoot scale of the American Orthopaedic Foot and Ankle Society (AOFAS); radiographic changes were assessed by the transverse long diameter and the area (mm 2 ) of the cyst on digital radiographs using a PACS (Picture Archiving Communication System).

Results:

At the last followup, AOFAS clinical scores improved similarly in cystic and noncystic defects. The average diameter of the cysts decreased from 8 ± 2 mm to 6 ± 2 mm ( p < 0.01). The area attributed to the cyst also decreased, from 49 ± 17 mm 2 (24 to 84 mm 2 ) to 23 ± 8 mm 2 (4 to 34 mm 2 ) ( p < 0.01). There were no differences in the clinical results between the cystic and noncystic defects.

Conclusions:

Good clinical and radiographic results were obtained after arthroscopic treatment of osteochondral defects with a small subchondral cyst. Our results suggest that a small cystic lesion can be treated by arthroscopic microfracture or abrasion arthroplasty and that the existence of a small cyst in an osteochondral defect lesion may not affect the postoperative prognosis.
Intramedullary Nail Fixation with Posterior-to-Anterior Compared to Transverse Distal Screw Placement for Tibiotalocalcaneal Arthrodesis: A Biomechanical Investigation
Authors: Means Kenneth R. , Parks Brent G. , Nguyen Augustine , Schon Lew C.
Published: January 2017

Background:

Biomechanical studies on retrograde intramedullary fixation for tibiotalocalcaneal fusion have been reported, but no studies have investigated dorsiflexion stiffness, load-to-failure, fatigue endurance, and plastic deformation using different distal screw orientations. Also, no studies have examined the effect of bone density on different distal screw orientations while using a fatigue loading mode.

Methods:

Eight matched pairs of cadaver legs were used. In one leg from each pair an intramedullary nail was inserted with lateral-to-medial distal screws and in the other with posterior-to-anterior screws. These samples underwent dorsiflexion fatigue testing with determination of initial and final stiffness, load-to-failure, and degree of plastic deformation at failure. DEXA scanning was done of each cadaver specimen to determine bone mineral density. Statistical analysis was performed using the Student t-test and a Pearson correlation. Significance level was set at p < 0.05.

Results:

The specimens with posterior-to-anterior screws had a significantly higher fatigue endurance load-to-failure (1130.0 ± 362.0 N compared to 801.0 ± 227 N, p = 0.01). They also had significantly higher final stiffness (203.1 ± 23.1 N/mm compared to 146.6 ± 46.2 N/mm, p = 0.05) and lower plastic deformation (2.4 ± 1.5 mm compared to 3.8 ± 2.3 mm, p = 0.04). There was a statistically significant correlation between bone mineral density and the difference in construct deformation with posterior-to-anterior and lateral-to-medial screw orientation ( r = 0.76, p = 0.03).

Conclusions:

In this biomechanical investigation of tibiotalocalcaneal arthrodesis with intramedullary nail fixation, posterior-to-anterior distal screw orientation provided more stable fixation than lateral-to-medial screw orientation.
Vascularized Bone Graft from the Medial Calcaneus for Treatment of Large Osteochondral Lesions of the Medial Talus
Authors: Tanaka Yasuhito , Omokawa Shohei , Fujii Tadashi , Kumai Tsukasa , Sugimoto Kazuya , Takakura Yoshinori
Published: January 2017

Background:

Operative treatment of large osteochondral lesions of the talus is difficult because the blood supply is poor in the talar dome. The purpose of this study was to evaluate the results of a vascularized bone graft transfer from the medial calcaneus to the large osteochondral lesion.

Methods:

Four ankles in four patients with medial osteochondral lesions were treated through a medial transmalleolar approach. Vascularized bone graft was harvested from the medial calcaneus using the calcaneal branch of the posterior tibial artery and was placed through a fenestration of the medial aspect of the talar dome. The mean duration of postoperative followup was 34 (range 24 to 48) months. Clinical and radiographic evaluations were made before surgery and at final followup.

Results:

According to the AOFAS ankle-hindfoot scale, mean pain and function scores improved from 20 to 33 points and 30 to 43 points, respectively. The mean total score improved from 60 to 83 points. Plain radiography at followup showed slight osteosclerosis in all patients, but joint space narrowing was not seen in any patient. Cysts seen preoperatively on MRI or CT resolved after 12 months postoperatively, and MRI or CT did not reveal any findings indicative of osteonecrosis.

Conclusions:

Clinical and radiographic results were satisfactory. Vascularized bone grafts harvested from the calcaneus were successful for the treatment of large osteochondral lesions of the medial talus.
Neuroinflammation, Mast Cells, and Glia: Dangerous Liaisons
Authors: Skaper Stephen D. , Facci Laura , Zusso Morena , Giusti Pietro
Published: January 2017

The perspective of neuroinflammation as an epiphenomenon following neuron damage is being replaced by the awareness of glia and their importance in neural functions and disorders. Systemic inflammation generates signals that communicate with the brain and leads to changes in metabolism and behavior, with microglia assuming a pro-inflammatory phenotype. Identification of potential peripheral-to-central cellular links is thus a critical step in designing effective therapeutics. Mast cells may fulfill such a role. These resident immune cells are found close to and within peripheral nerves and in brain parenchyma/meninges, where they exercise a key role in orchestrating the inflammatory process from initiation through chronic activation. Mast cells and glia engage in crosstalk that contributes to accelerate disease progression; such interactions become exaggerated with aging and increased cell sensitivity to stress. Emerging evidence for oligodendrocytes, independent of myelin and support of axonal integrity, points to their having strong immune functions, innate immune receptor expression, and production/response to chemokines and cytokines that modulate immune responses in the central nervous system while engaging in crosstalk with microglia and astrocytes. In this review, we summarize the findings related to our understanding of the biology and cellular signaling mechanisms of neuroinflammation, with emphasis on mast cell-glia interactions.
β-Blockers, Cocaine, and the Unopposed α-Stimulation Phenomenon
Authors: Richards John R. , Hollander Judd E. , Ramoska Edward A. , Fareed Fareed N. , Sand I. Charles , Izquierdo Gómez María Manuela , Lange Richard A.
Published: January 2017

Cocaine abuse remains a significant worldwide health problem. Patients with cardiovascular toxicity from cocaine abuse frequently present to the emergency department for treatment. These patients may be tachycardic, hypertensive, agitated, and have chest pain. Several pharmacological options exist for treatment of cocaine-induced cardiovascular toxicity. For the past 3 decades, the phenomenon of unopposed α-stimulation after β-blocker use in cocaine-positive patients has been cited as an absolute contraindication, despite limited and inconsistent clinical evidence. In this review, the authors of the original studies, case reports, and systematic review in which unopposed α-stimulation was believed to be a factor investigate the pathophysiology, pharmacology, and published evidence behind the unopposed α-stimulation phenomenon. We also investigate other potential explanations for unopposed α-stimulation, including the unique and deleterious pharmacologic properties of cocaine in the absence of β-blockers. The safety and efficacy of the mixed β-/α-blockers labetalol and carvedilol are also discussed in relation to unopposed α-stimulation.
On elastic growth modelling of straight hair
Authors: Soldatos Kostas P
Published: January 2017

Certain macroscopic similarities of the nail and hair elongation mechanisms enable the mass-growth activity that takes place within a straight hair follicle to be modelled through a suitable extension of a relevant small-strain pseudo-elasticity model of human nail growth. Basic differences which are taken into consideration are the facts that straight hair (a) resembles the form of a cylindrical rod, rather than a plate, while (b) its material constitution seems microscopically transversely isotropic, rather than isotropic. A complete analytical solution of the obtained governing differential equations is detailed for the case where incompressible mass-growth conditions prevail within the hair matrix. In addition to estimating displacement and stress distributions that develop within the growing matrix, and the resulting hair elongation, that solution enables prediction of a clinically observed zone of hair-fibre hardening that lies between the matrix soft tissue and the hard keratinous hair shaft. It also predicts that the longitudinal dimension of the hair matrix and that of the hair-fibre hardening zone depend on the material properties of the soft tissue of the follicle. Consideration of more advanced micro- or macro-scopic features of the hair follicle, such as layered structure or curved form, can be handled mathematically in a similar manner at the expense of analytical simplicity.
Obamacare Confronts a Fiscal Crisis
Authors: Angell Marcia
Published: January 2017

This article was written shortly after the U.S. Supreme Court’s decision upholding the Affordable Care Act (Obamacare) and reflects my view of the situation at that time. As it turned out, Obamacare was not much of an issue in the 2012 election campaign, which focused mainly on jobs and fairness for the middle class. Still, I believe that it is extremely unlikely that Obamacare will be fully implemented, for the reasons discussed herein, and that the only way to provide universal health care at an affordable cost is through a nonprofit single-payer system. A version of this article first appeared in the Huffington Post.
A Sisterhood Made of Steel
Authors: Doro Sue , De Graaf-Smith Donna
Published: January 2017

In the mid-1970s, Sue Doro began work as a machinist in Milwaukee, Wisconsin, and Donna De Graaf-Smith became a mill worker in East Chicago, Indiana. On-the-job sex-based discrimination (way beyond catcalls, lewd leering, and getting renamed “sweetheart”) quickly ensued. What follows are two stories (Doro’s in regular typeface, De Graaf-Smith’s in italics) detailing how female employees were received in heavy industry as recently as thirty years ago. The extent to which the two narratives overlap is remarkable, which is why we’ve chosen to run them as one.
Wellness and multiple sclerosis: The National MS Society establishes a Wellness Research Working Group and research priorities
Authors: Motl Robert W , Mowry Ellen M , Ehde Dawn M , LaRocca Nicholas G , Smith Kathy E , Costello Kathleen , Shinto Lynne , Ng Alexander V , Sullivan Amy B , Giesser Barbara , McCully Kevin K , Fernhall Bo , Bishop Malachy , Plow Matthew , Casaccia Patrizia , Chiaravalloti Nancy D
Published: January 2017

Background:

People with multiple sclerosis (MS) have identified “wellness” and associated behaviors as a high priority based on “social media listening” undertaken by the National MS Society (i.e. the Society).

Objective:

The Society recently convened a group that consisted of researchers with experience in MS and wellness-related research, Society staff members, and an individual with MS for developing recommendations regarding a wellness research agenda.

Method:

The members of the group engaged in focal reviews and discussions involving the state of science within three approaches for promoting wellness in MS, namely diet, exercise, and emotional wellness.

Results:

That process informed a group-mediated activity for developing and prioritizing research goals for wellness in MS. This served as a background for articulating the mission and objectives of the Society’s Wellness Research Working Group.

Conclusion:

The primary mission of the Wellness Research Working Group is the provision of scientific evidence supporting the application of lifestyle, behavioral, and psychosocial approaches for promoting optimal health of mind, body, and spirit (i.e. wellness) in people with MS as well as managing the disease and its consequences.
Hippocampal dysfunction is associated with memory impairment in multiple sclerosis: A volumetric and functional connectivity study
Authors: González Torre Julio Alberto , Cruz-Gómez Álvaro Javier , Belenguer Antonio , Sanchis-Segura Carla , Ávila César , Forn Cristina
Published: January 2017

Background:

Previous studies have suggested a relationship between neuroanatomical and neurofunctional hippocampal alterations and episodic memory impairments in multiple sclerosis (MS) patients.

Objective:

We examined hippocampus volume and functional connectivity (FC) changes in MS patients with different episodic memory capabilities.

Methods:

Hippocampal subfield volume and FC changes were compared in two subgroups of MS patients with and without episodic memory impairment (multiple sclerosis impaired (MSi) and multiple sclerosis preserved (MSp), respectively) and healthy controls (HC). A discriminant function (DF) analysis was used to identify which of these neuroanatomical and neurofunctional parameters were the most relevant components of the mnemonic profiles of HC, MSp, and MSi.

Results:

MSi showed reduced volume in several hippocampal subfields compared to MSp and HC. Ordinal gradation (MSi > MSp > HC) was also observed for FC between the posterior hippocampus and several cortical areas. DF-based analyses revealed that reduced right fimbria volume and enhanced FC at the right posterior hippocampus were the main neural signatures of the episodic memory impairments observed in the MSi group.

Conclusion:

Before any sign of episodic memory alterations (MSp), FC increased on several pathways that connect the hippocampus with cortical areas. These changes further increased when the several hippocampal volumes reduced and memory deficits appeared (MSi).
Liver injury associated with dimethyl fumarate in multiple sclerosis patients
Authors: Muñoz Monica A , Kulick Corrinne G , Kortepeter Cindy M , Levin Robert L , Avigan Mark I
Published: January 2017

Background:

In pre-approval trials, there was an increased incidence of mild, transient elevations of liver aminotransferases in study subjects treated with dimethyl fumarate (DMF).

Objective/methods:

To evaluate post-marketing cases of drug-induced liver injury associated with DMF.

Results:

We identified 14 post-marketing cases of clinically significant liver injury. Findings included newly elevated serum liver aminotransferase and bilirubin levels that developed as early as a few days after the first dose of DMF. The pattern of liver injury was primarily hepatocellular. No cases resulted in liver failure.

Conclusion:

Health professionals should be alerted to possible serious liver injury in patients receiving DMF.
The role of paediatric nurses in medication safety prior to the implementation of electronic prescribing: a qualitative case study
Authors: Farre Albert , Heath Gemma , Shaw Karen , Jordan Teresa , Cummins Carole
Published: January 2017

Objectives

To explore paediatric nurses’ experiences and perspectives of their role in the medication process and how this role is enacted in everyday practice.

Methods

A qualitative case study on a general surgical ward of a paediatric hospital in England, one year prior to the planned implementation of ePrescribing. Three focus groups and six individual semi-structured interviews were conducted, involving 24 nurses. Focus groups and interviews were audio-recorded, transcribed, anonymized and subjected to thematic analysis.

Results

Two overarching analytical themes were identified: the centrality of risk management in nurses’ role in the medication process and the distributed nature of nurses’ medication risk management practices. Nurses’ contribution to medication safety was seen as an intrinsic feature of a role that extended beyond just preparing and administering medications as prescribed and placed nurses at the heart of a dynamic set of interactions, practices and situations through which medication risks were managed. These findings also illustrate the collective nature of patient safety.

Conclusions

Both the recognized and the unrecognized contributions of nurses to the management of medications needs to be considered in the design and implementation of ePrescribing systems.
Reconstructing a supervisory identity
Authors: Amaral-da-Cunha Mariana , Batista Paula , MacPhail Ann , Graça Amândio
Published: January 2017

Cooperating teachers’ teaching perspectives and participation in initial teacher education have been frequently considered as ways to understand teachers’ learning trajectories and professional identity at workplace settings (Clarke and Jarvis-Selinger, 2005; Clarke et al.2014; Lave and Wenger, 1991). A case study approach was employed to examine the challenging supervisory experiences of a highly experienced physical education cooperating teacher that led to the reconstruction of her professional identity. Data were collected throughout a one-year school placement and included three semi-structured interviews with the cooperating teacher and the cooperating teacher’s daily journals entries. Analysis was informed by grounded theory coding procedures. Themes included: (i) the challenge of changing entrenched teaching and mentoring practices to connect with pre-service teachers; (ii) reconfiguring mentorship to expand pre-service teachers’ limited teaching ideias and range of teaching tools; and (iii) the possibility of practicing different mentoring strategies for different ‘types’ of pre-service teachers. We infer that contextual factors and teaching perspectives play a role in the cooperating teacher’s legitimate peripheral participation in teacher education and constitutes elements of her professional identity development.
Effect of telehealth intervention on breast cancer patients’ quality of life and psychological outcomes: A meta-analysis
Authors: Chen Yan-Ya , Guan Bing-Sheng , Li Ze-Kai , Li Xing-Yi
Published: January 2017

Introduction

Telehealth intervention has been proposed as an innovative intervention approach to breast cancer patients, but there are still conflicting results in the literature about its effect.

Methods

PubMed, EMBASE, CENTRAL and China National Knowledge Infrastructure (CNKI) were searched from inception to 3 October 2016 for randomized controlled trials (RCTs) which assessed the effect of telehealth intervention versus usual care in breast cancer patients. No language restrictions were used. Standardized mean difference (SMD) with corresponding 95% confidence interval (95% CI) was pooled when needed. Subgroup and sensitivity analyses were conducted if necessary and feasible.

Results

Twenty RCTs with a total of 2190 participants were included into this meta-analysis. Compared with usual care, telehealth intervention was associated with higher quality of life (SMD = 0.60, 95% CI 0.18–1.01, p = 0.005) and self-efficacy (SMD = 0.59, 95% CI 0.19–0.98, p = 0.003), with less depression (SMD = −1.29, 95% CI −2.28 to −0.30, p = 0.01), distress (SMD = −0.25, 95% CI −0.40 to −0.10, p = 0.001) and perceived stress (SMD = −0.30, 95% CI, −0.59 to −0.02, p = 0.04). However, anxiety score did not differ significantly between the two groups (SMD = −0.09, 95% CI −0.22 to 0.04, p = 0.17).

Discussion

Telehealth intervention is superior to usual care in breast cancer patients for improved quality of life, higher self-efficacy and less depression, distress, and perceived stress. However, these results should be recognized cautiously due to between-study heterogeneity, indicating that further well-designed RCTs are warranted.
Radial Artery Compliance in Patients with Peripheral Vascular Disease
Authors: Catalano Maria , Scandale Giovanni , Jun Tao , Minola Marzio , Recchia Martino , Annoni Massimo
Published: January 2017

Compliance in largely central arteries of patients with peripheral vascular disease (PVD) has been reported to be reduced. However, the arterial tree is an inhomogeneous system, and there remains uncertainty about whether the peripheral arteries (e.g. the medium-sized muscular radial artery) undergo a similar change to the central arteries. The aim of this study was to investigate the radial artery elasticity in 19 patients with PVD compared with 18 normal subjects of comparable age and sex. Using a noninvasive high-resolution echo-tracking device coupled to a photoplethysmograph (Finapres system) allowing simultaneous arterial diameter and finger blood pressure monitoring, we measured the radial artery compliance by determining the diameter–pressure, compliance–pressure and distensibility–pressure curves. The results showed that the diameter of the radial artery was similar in the two groups, but that the compliance and distensibility were not further reduced in patients with PVD than in the normal controls at 100 mmHg and for a common blood pressure range. The present studies demonstrate that in patients with PVD the radial arterial compliance is not reduced, which indicates that the change in arterial elasticity is not identical. The potential mechanisms involved in this change in radial artery compliance are discussed.
Changes in the Amplitude of Cyclic Load Biphasically Modulate Endothelial Cell DNA Synthesis and Division
Authors: Upchurch Gilbert R , Loscalzo Joseph , Banes Albert J
Published: January 2017

Several phiysical factors, including shear stress and cyclic load, modulate the ability of endothelial cells to respond to injury. The objective of these experiments was to test the hypothesis that cyclic mechanical load stimulates endothelial cell DNA synthesis and division in vitro. Rabbit aortic endothelial cells were cultured on Flex I® flexible-bottomed culture plates, and subjected to load amplitudes of increasing magnitude (0, 0.18, 0.24 and 0.27 load at 1 Hz) using a Flexercell® strain unit. Cells were harvested enzymatically and cell numbers determined on days 1, 3 and 5 after initiating the load regimen. DNA synthesis was quantified after trichloroacetic acid precipitation of [3H]thymidine-labeled cells from: (1) whole culture wells and (2) areas of minimum and maximum strain in culture cells. Data were analyzed using analysis of variance and a Tukey's test ( n = 6 observations/strain regimen per day in triplicate). Results from analysis of endothelial cells in whole, subconfluent cultures showed that cells subjected to strains of 0.18 had a decreased rate of cell division (76% of control) and DNA synthesis (63% of control), while cells subjected to strains of 0.24 and 0.27 had an increased rate of cell division (108 and 83% increase, respectively, compared with control; p < 0.001) and DNA synthesis (39 and 172% increase, respectively, compared with control; p < 0.001 for 0.27) on day 3 when compared with control cells. The results indicate that endothelial cells respond to various physiologic levels of cyclic load in a biphasic manner to initiate DNA synthesis and cell division. These data suggest that endothelial cell mitogenesis may be modulated by specific levels of cyclic load.
Cost-Effective Strategies for the Management of Vascular Disease
Authors: West Jeffrey A
Published: January 2017

Cardiovascular disease accounts for over 950 000 deaths and an estimated $151 billion in direct and indirect costs. Because of this escalating clinical and financial burden, economic analysis has become essential for the evaluation of preventative therapies for vascular disease. Economic analysis compares competing interventions or management strategies for costs and benefits; more specifically, cost-effectiveness analysis compares cost in financial terms like dollars to measures of effectiveness like years of life saved. Important concepts in the creation of a valid cost-effectiveness analysis include perspective, time horizon, measurement of costs and effectiveness and sensitivity analysis. In patients with peripheral arterial occlusive disease, most morbidity and mortality arises from complications of coronary artery disease. Because coronary artery disease and peripheral arterial occlusive disease commonly occur together and share risk factors, pathophysiology and response to preventative therapy, economic evaluations of preventative therapies for coronary artery disease have relevance for patients with vascular disease. Cost-effectiveness analysis reveals that modification of vascular risk factors like tobacco use, hypertension and hypercholesterolemia improve clinical outcomes at acceptable cost-effectiveness ratios, usually less than $20 000 per year of life saved. More importantly, interventions like smoking cessation or lipid modification in high-risk groups may be cost saving, with treatment costs outweighed by financial benefits. From the patient, clinician and societal perspective, cost-effectiveness analysis supports the aggressive modification of cardiovascular risk factors in patients with peripheral arterial occlusive disease.
Intravenous Thrombolytic Therapy in Acute Stroke
Authors: Tong David C , Yenari Midori A , Albers Greg W
Published: January 2017

The article reviews the experimental basis of thrombolytic therapy, and summarizes the results of the recent trials of thrombolysis. Five large clinical trails have evaluated intravenous thrombolytic therapy for the treatment of hyperacute (< 6 h) stroke. Three of these studies were negative, one was equivocal, and one was strongly positive. The failure to demonstrate efficacy definitively in four of these trials may be related to a number of methodological factors, including the type and dose of drug administered, the timing of drug administered, and the method of patient selection for treatment.

The NINDS recombinant tissue plasminogen activator (rt-PA) study showed that thrombolytic therapy can be of substantial benefit when administered within 3 h of stroke onset using strict patient selection criteria and rt-PA is now FDA approved for treatment of acute stroke. However, the risk of clinically significant bleeding is elevated. To achieve the favorable risk/benefit ratio demonstrated in the NINDS trial, patients must be screened by experienced clinicians for contraindications to thrombolysis and the acute computerized tomography (CT) brain scan must be carefully, evaluated for radiographic features that increase the risk of cerebral hemorrhage. Guidelines for the use of rt-PA are provided, as well as insights into future thrombolytic treatment strategies.
European foreign policy since the Cold War: How ambitious, how inhibited?
Authors: Wallace William
Published: January 2017

The European Union has declared ambitious objectives for a common European foreign policy since the end of the cold war. Through successive revisions of its constitutional treaties, it has built may of the institutions that might support such a common policy. Incremental changes and adaptation through experience of successive crises have strengthened practices of cooperation and consultation. Yet the retention of sovereignty over foreign and defence policy by national governments, and the unwillingness of national governments and parliaments to engage in any EU-wide reconsideration of strategic needs and objectives has left these common institutions without the permissive consensus needed to support effective shared action. National inhibitions about subordinating particular interests and assumptions to a wider European consensus have left the EU institutions without the ability either to promote shared European interests or to act effectively when those interests are threatened.