bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment of Ipsilateral Femoral Neck and Shaft Fractures With Cannulated Screws and Antegrade Reconstruction Nail
Authors: Spitler Clay A. , Kiner Dirk , Swafford Rachel , Bruce Jeremy , Nowotarski Peter 
Published: November 2019

Summary:
Ipsilateral femoral neck and shaft fractures are challenging injuries, and there are different fixation options but no consensus on a superior construct. Our preferred method is cannulated screw fixation of the femoral neck and antegrade reconstruction nailing of the shaft. Compressive fixation of the femoral neck fracture with cancellous lag screws followed by reconstruction nail placement provides compressive fixation and fixed angle support of the neck fracture while allowing for more optimal treatment of femoral shaft fractures at or above the isthmus. The purpose of this submission is to describe the surgical decision-making, surgical technique, and all surgically related complications of this technique.
Rates of Contralateral SCFE in the United States: Analysis of the Pediatric Health Information System
Authors: Swarup Ishaan , Williams Brendan A. , Talwar Divya , Sankar Wudbhav N. 
Published: November 2019

Background:
Slipped capital femoral epiphysis (SCFE) is relatively common in pediatric patients. Subsequent contralateral SCFE is also common and rates of bilateral SCFE have been reported to range from 12% to 80% in the literature. The purpose of this study was to determine the rates of subsequent contralateral SCFE in patients who present with unilateral SCFE in the United States and determine risk factors for the development of subsequent contralateral SCFE.

Methods:
The authors performed a retrospective study using data from the Pediatric Health Information System (PHIS). Patients who underwent in situ pinning of a unilateral SCFE between 2004 and 2016 were included in this study and followed prospectively to determine subsequent contralateral SCFE. They excluded patients who underwent bilateral pinning at index admission. Descriptive, univariate, and multivariate statistics were used to determine rates of subsequent contralateral SCFE and identify factors associated with contralateral SCFE.

Results:
This study included 9755 patients who underwent in situ pinning for unilateral SCFE. The mean age at the time of index SCFE was 11.9 years (SD, 1.7) and ~62% of patients were male individuals. Subsequent contralateral SCFE occurred in 1077 (11%) patients at an average of 277 days (range, 7 to 1523 d) after the index procedure. Patients who developed a subsequent contralateral SCFE were younger at the time of index SCFE than patients who did not develop a contralateral SCFE (11.3 vs. 12 y old, P<0.01). In multivariate analysis, older children had a lower risk of subsequent contralateral SCFE (adjusted odds ratio, 0.8; 95% confidence interval, 0.77-0.83), and the odds of subsequent contralateral SCFE decreased by 20% with each increasing year in age.

Conclusions:
The rate of subsequent contralateral SCFE is ~11% in the United States, and younger patients are more likely to develop a contralateral SCFE than older patients. Prophylactic pinning should be considered in younger patients with unilateral SCFE, and patients should be followed until skeletal maturity to monitor for subsequent contralateral SCFE.

Level of Evidence:
Level III.
Evaluation of Spanish Language Proficiency and Resources Available in Academic Pediatric Orthopaedic Centers
Authors: Sobel Andrew D. , Ramirez Jose M. , Walsh Devin F. , Defroda Steven F. , Cruz Aristides I. 
Published: November 2019

Introduction:
Given the rapidly increasing population of Spanish-speaking patients in the United States, medical providers must have the capability to effectively communicate both with pediatric patients and their caregivers. The purpose of this study was to query the Spanish language proficiency of pediatric orthopaedic surgeons, assess the educational resources available to Spanish-speaking patients and their families, and identify the barriers to care at academic pediatric orthopaedic centers.

Methods:
The Web sites of medical centers within the United States that have pediatric orthopaedic surgery fellowships recognized by the Pediatric Orthopaedic Society of North America (POSNA) were accessed. Web sites were investigated for a health library as well as the availability of interpreter services. Profiles of attending surgeons within each Pediatric Orthopaedic Department were evaluated for evidence of Spanish proficiency as well as educational qualifications. Centers were contacted by phone to determine if the resources and physicians who could converse in Spanish were different than what was readily available online and if automated instructions in Spanish or a person who could converse in Spanish were available.

Results:
Forty-six centers with 44 fellowship programs were identified. The profiles of 12 of 334 (3.6%) surgeons who completed pediatric orthopaedic fellowships indicated Spanish proficiency. Seventeen physicians (5.1%) were identified as proficient in Spanish after phone calls. Thirty-eight pediatric orthopaedic centers (82.6%) noted interpreter service availability online, although services varied from around-the-clock availability of live interpreters to interpreter phones. When contacted by phone, 45 of 46 centers (97.8%) confirmed the availability of any interpreter service for both inpatient and outpatient settings. Sixteen centers (34.8%) had online information on orthopaedic conditions or surgical care translated into Spanish. Twenty centers (43.5%) did not have automated phone messages in Spanish or live operators that spoke Spanish.

Conclusions:
There is a scarcity of surgical providers in pediatric orthopaedic centers proficient in Spanish, demonstrating a large discrepancy with the growing Hispanic population. Interpreter services are widely available, although there is variability in the services provided. Considerable barriers exist to Spanish-speaking patients who attempt to access care by phone or online.
Development and Validation of a Mobile Application for Measuring Femoral Anteversion in Patients With Cerebral Palsy
Authors: Sung Ki Hyuk , Youn Kibeom , Chung Chin Youb , Kitta Muhammad I. , Kumara Hendra C. , Min Jae Jung , Lee Jehee , Park Moon Seok 
Published: November 2019

Background:
Computed tomography (CT) provides benefits for 3-dimensional (3D) visualization of femur deformities. However, the potential adverse effects of radiation exposure have become a concern. Consequently, a biplanar imaging system EOS has been proposed to enable reconstruction of the 3D model of the femur. However, this system requires a calibrated apparatus, the cost of which is high, and the area occupied by it is substantial. The purpose of this study was to develop a mobile application that included a new method of 3D reconstruction of the femur from conventional radiographic images and to evaluate the validity and reliability of mobile the application when measuring femoral anteversion.

Methods:
The statistical shape model, graph-cut algorithm, and iterative Perspective-n-Point algorithm were utilized to develop the application. The anteroposterior and lateral images of a femur can be input using the embedded camera or by file transfer, and the touch interface aids accurate contouring of the femur. Regarding validation, the CT scans and conventional radiographic images of 36 patients with cerebral palsy were used. To evaluate concurrent validity, the femoral anteversion measurements on the images reconstructed from the mobile application were compared with those from the 3D CT images. Three clinicians assessed interobserver reliability.

Results:
The mobile application, which reconstructs the 3D image from conventional radiographs, was successfully developed. Regarding concurrent validity, the correlation coefficient between femoral anteversion measured using 3D CT and the mobile application was 0.968 (P<0.001). In terms of interobserver reliability, the intraclass correlation coefficient among the 3 clinicians was 0.953.

Conclusions:
The measurement of femoral anteversion with the mobile application showed excellent concurrent validity and reliability in patients with cerebral palsy. The proposed mobile application can be used with conventional radiographs and does not require additional apparatus. It can be used as a convenient technique in hospitals that cannot afford a CT machine or an EOS system.

Level of Evidence:
Level III—diagnostic.
Online Learning and Residents’ Acquisition of Mechanical Ventilation Knowledge: Sequencing Matters
Authors: Wolbrink Traci A. , van Schaik Sandrijn M. , Turner David A. , Staffa Steven J. , Keller Eleanor , Boyer Donald L. , Chong Grace , Cross Jarrod , del Castillo Sylvia , Feng Andrew , Hum R. Stanley , Jacob James Ebor , Johnson Amanda , Kandil Sarah , Kneyber Martin , Rameshkumar Ramachandran , Levin Amanda , Lodha Rakesh , Jayashree Muralidharan , Olivero Anthony , Oberender Felix , Panesar Rahul S. , Pooni Puneet A. , Rehder Kyle J. , Sankaranarayanan Shuba , Scheffler Margaret , Sharara-Chami Rana , Siems Ashley L. , Padur Sivaraman Rajakumar , Tegtmeyer Ken , Valentine Stacey , Villois Florencia , von Saint Andre-von Arnim Amelie , Winkler Margaret , Dede Chris , Burns Jeffrey P. 
Published: November 2019

Objective:
Rapid advancements in medicine and changing standards in medical education require new, efficient educational strategies. We investigated whether an online intervention could increase residents’ knowledge and improve knowledge retention in mechanical ventilation when compared with a clinical rotation and whether the timing of intervention had an impact on overall knowledge gains.

Design:
A prospective, interventional crossover study conducted from October 2015 to December 2017.

Setting:
Multicenter study conducted in 33 PICUs across eight countries.

Subjects:
Pediatric categorical residents rotating through the PICU for the first time. We allocated 483 residents into two arms based on rotation date to use an online intervention either before or after the clinical rotation.

Interventions:
Residents completed an online virtual mechanical ventilation simulator either before or after a 1-month clinical rotation with a 2-month period between interventions.

Measurements and Main Results:
Performance on case-based, multiple-choice question tests before and after each intervention was used to quantify knowledge gains and knowledge retention. Initial knowledge gains in residents who completed the online intervention (average knowledge gain, 6.9%; sd, 18.2) were noninferior compared with those who completed 1 month of a clinical rotation (average knowledge gain, 6.1%; sd, 18.9; difference, 0.8%; 95% CI, –5.05 to 6.47; p = 0.81). Knowledge retention was greater following completion of the online intervention when compared with the clinical rotation when controlling for time (difference, 7.6%; 95% CI, 0.7–14.5; p = 0.03). When the online intervention was sequenced before (average knowledge gain, 14.6%; sd, 15.4) rather than after (average knowledge gain, 7.0%; sd, 19.1) the clinical rotation, residents had superior overall knowledge acquisition (difference, 7.6%; 95% CI, 2.01–12.97;p = 0.008).

Conclusions:
Incorporating an interactive online educational intervention prior to a clinical rotation may offer a strategy to prime learners for the upcoming rotation, augmenting clinical learning in graduate medical education.
Epithelioid Rhabdomyosarcoma: Report of a Cutaneous Case and Literature Review of a Recently Described Variant of Rhabdomyosarcoma
Authors: Valério Ediel , Almeida Gisele C. , Neotti Tatiane , Nascimento Antonio G. , Bezerra Stephania M. , Costa Felipe D. 
Published: November 2019

Abstract:
Rhabdomyosarcoma affects mainly pediatric patients and is currently classified into 4 categories: embryonal, alveolar, pleomorphic, and spindle cell/sclerosing. Epithelioid rhabdomyosarcoma is a recently described variant of rhabdomyosarcoma in which primary cutaneous presentation is infrequent. In this brief report, we describe a rare case of epithelioid rhabdomyosarcoma in an 81-year-old man, presenting as a skin lesion in the neck, which increased in size in 1 month. After imaging evaluation, a solid cervical mass was discovered. A biopsy was performed, and the diagnosis of epithelioid rhabdomyosarcoma was rendered. The patient died due to rapid progression of the tumor. To make an accurate diagnosis and ensure appropriate patient management, it is necessary to be aware of this variant and use proper immunohistochemical stains when facing an epithelioid malignancy, expanding the differential diagnosis of epithelioid neoplasms.
More than Mental Health: Parent Physical Health and Early Childhood Behavior Problems
Authors: Poppert Cordts Katrina M. , Wilson Anna C. , Riley Andrew R. 
Published: November 2019

ABSTRACT:

Objective:
Caring for young children is a physically demanding task, and some evidence suggests parental physical limitations may impact the parent-child relationship and child behavioral development, but research examining this dynamic is nascent.

Methods:
This study aims to explicate the role of general parent physical health problems in child disruptive behavior outcomes. A model that included physical and mental health, parenting style and self-efficacy, and child behavior symptom ratings was derived. The tenability of the model was assessed using Pearson's correlations, followed by structural equation modeling using data from 375 parents with a child between 18 months and 5 years.

Results:
After several modifications to the initial model, findings revealed that higher levels of parent self-reported physical and mental health concerns indirectly influence child behavior symptoms through different pathways. Impaired parent physical health was associated with poorer parental self-efficacy and more disruptive child behavior, whereas increased parent mental health concerns were associated with a more negative parenting style and lower self-efficacy, which was related to more child behavior symptoms.

Conclusion:
Findings elucidate the need for increased awareness and screening of parent physical health limitations in pediatric primary care. Furthermore, appropriate interventions among parents with physical health problems may target different aspects of parenting than routinely discussed.
Quantitative Analysis of Frozen Section Histology in Mohs Micrographic Surgery
Authors: LeBoeuf Matthew , Bieber Karen , Cooper Sherrie , Isenor Amanda 
Published: November 2019

BACKGROUND
Mohs micrographic surgery (MMS) relies on complete frozen tissue sections for the unique combination of high cure rates and tissue preservation.

OBJECTIVE
To quantify and characterize the tissue sectioning process in MMS.

MATERIALS AND METHODS
Two hundred eighty-four tissue blocks were analyzed. The histotechnician measured the depth cut into the tissue block for every section placed on the slide. The surgeon identified complete sections.

RESULTS
First-stage complete sections were achieved at 285 μm. The ear and hair-bearing cheek required increased depth of sectioning compared with other sites. Small pieces of tissue achieved complete sections at a decreased depth compared with medium or large pieces of tissue. The methodology used in this study was able to identify statistically significant differences between histotechnicians.

CONCLUSION
More than 2,000 measurements on 284 tissue blocks provided quantitative data of the tissue sectioning process in MMS, confirming that MMS allows evaluation of both peripheral and deep margins within hundreds of microns of the margin. Results from this study indicate a methodology that is easily implemented providing interpretable data that can be used to assess and improve tissue sectioning ensuring MMS remains the gold standard for removal of challenging cutaneous tumors.
Effect of Cytochrome P450 7A1 (CYP7A1) Polymorphism on Lipid Responses to Simvastatin Treatment
Authors: Liu Na , Yang Guihua , Liu Yingping , Hu Mei , Cai Yuyu , Hu Zhiying , Jia Chundi , Zhang Man 
Published: November 2019

Background:
Identifying patients with high risk of low response to statin therapy is important for optimization of lipid-lowering therapy. Cholesterol 7α-hydroxylase, a rate-limiting enzyme encoded by cytochrome P450 7A1 (CYP7A1) gene, is considered to be associated with statin efficacy. This study aimed to investigate the association between a novel CYP7A1 single nucleotide polymorphism rs3824260 and statin treatment response for hypercholesteremic patients in Chinese Han population.

Methods:
A total of 336 subjects were prescribed with simvastatin for 12 weeks after enrollment. Plasma lipid parameters were measured at enrollment and after 12-week simvastatin treatment separately. Subjects were classified into high- and low-response groups depending on their total cholesterol, low-density lipoprotein cholesterol (LDL-C) and TG changes and increase or reduction groups according to their high-density lipoprotein cholesterol (HDL-C) levels changing after simvastatin treatment. The CYP7A1 rs3824260 was genotyped from blood samples with a SNaPshot assay.

Results:
At baseline, the LDL-C level and TG level were significantly higher in the AA genotype, while the HDL-C level was significantly higher in the GG genotype of CYP7A1 rs3824260. Patients carrying AA genotype are at an increased risk of low response for LDL-C reduction (odds ratio = 2.295, 95% confidence interval = 1.164–4.524, P = 0.016). Furthermore, the GG genotype of rs3824260 was significantly associated with a high risk of HDL-C reduction response after simvastatin therapy (odds ratio = 2.240, 95% confidence interval = 1.137–4.413, P = 0.025).

Conclusions:
The CYP7A1 gene polymorphism rs3824260 is related to inappropriate response of simvastatin treatment for hypercholesterolemia patients in Chinese Han population.
Identification and management of urinary incontinence in midlife women
Authors: Brubaker Linda 
Published: November 2019

Abstract
Urinary incontinence is a common bladder health problem that disproportionately affects women, especially midlife women. In the absence of alarming signs or symptoms, a step-wise evaluation aligned with patient treatment preferences is appropriate. Initial interventions can include simple behavior therapies, lifestyle modifications, and toileting habits. Systemic medication, surgery, and specialty treatment also can be offered.
Patient-reported Outcome Measures: The FACE-Q Skin Cancer Module: The Dutch Translation and Linguistic Validation
Authors: Ottenhof Maarten J. , Lardinois Aimee J.P.M. , Brouwer Philip , Lee Erica H. , Deibel Dionne S. , van der Hulst René R.W.J. , Pusic Andrea , Sidey-Gibbons Chris , Hoogbergen Maarten M. 
Published: November 2019

Background:
Patient-reported outcome measures are becoming a standard component in the evaluation of surgical treatments. In 2010, the FACE-Q skin cancer module was developed: an English psychometric validated questionnaire that measures both patient quality of life and satisfaction with the surgical experience. The questionnaire consists of 11 subscales with a total of 96 questions. An officially translated version in Dutch is needed for accepted use in the Netherlands.

Methods:
We translated the FACE-Q skin cancer module from English into Dutch in accordance with to the International Society for Pharmacoeconomics and Outcomes Research and World Health Organization guidelines. The translation occurs in three stages. First, a forward translation is performed by two independent professional translators, where discrepancies are solved by a third translator, a subject area expert. Secondly, a backward translation is performed and is compared with the original. Any discrepancies are solved by an expert panel. Version two is then pretested (cognitive debriefing) by 30 patients who have had a resection (Mohs surgery) of non-melanoma skin cancer in the face followed by reconstruction. The results of the pretesting exercise are evaluated and a final version of the translation was produced by the expert panel.

Results:
In the first step, a conceptually equivalent Dutch translation of the FACE-Q was translated. In the second phase, the comparison between the forward and backward translation led to multiple retranslations. In step three, 48 annotations were evaluated by the expert panel, which led to 26 minor changes in items or instructions.

Conclusion:
We created a conceptually and linguistically similar translation of the FACE-Q Skin Cancer Module through a thorough translation and linguistic validation process.
Personality Traits, Anxiety, and Self-esteem in Patients Seeking Cosmetic Surgery in Mexico City
Authors: Del Aguila Estephania , Martínez Jorge R. , Pablos José L. , Huánuco Marino , Encina Victor M. , Rhenals Ana L. 
Published: November 2019

Background:
There are reports on high psychological morbidity, mainly personality disorders, among people opting for cosmetic surgery. This study aims to describe the personality traits, level of self-esteem, and anxiety in women seeking cosmetic surgery with body contouring, such as liposculpture or lipoabdominoplasty with or without placement of breast implants.

Methods:
Subjects were 87 women between 18 and 60 years of age in Mexico City who went to a private clinic with the intention of undergoing cosmetic surgery with body contouring. A psychiatric interview was performed using three scales: the Salamanca questionnaire for screening for personality disorders, the Hamilton Anxiety Rating Scale, and the Rosenberg Self Esteem Scale.

Results:
The average age was 31 years, with 35% of participants having previously undergone body-contouring surgery. Regarding personality, the patients did not show a psychopathology level for diagnosing a personality disorder. Regarding anxiety, 92% of the patients showed an average level of anxiety. High level of self-esteem was exhibited by 81 participants (93.15%), and six participants (6.9%) exhibited average self-esteem. Notably, no participant exhibited low self-esteem.

Conclusions:
The level of psychopathology of the patients was lower than expected, the self-esteem was not affected prior to the surgical procedure, and the level of anxiety did not cause dysfunction.