bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quantitative Analysis for the Change in Lengths of the Radius and Ulna in Missed Bado Type I Monteggia Fracture
Authors: Oka Kunihiro , Tanaka Hiroyuki , Shigi Atsuo , Abe Shingo , Miyamura Satoshi , Shiode Ryoya , Kazui Arisa , Murase Tsuyoshi 
Published: August 2020

Background:
In missed Monteggia fracture (MMF) cases, ulnar angulation and lengthening by osteotomy are required to reduce the dislocated radial head. This study aimed to clarify the abnormal discrepancy in length between the radius and ulna in MMF. We tested the hypothesis that the increase in the abnormal discrepancy in length between the radius and ulna relates with the duration of radial head dislocation.

Methods:
In total, 24 patients with MMF were studied and classified into 2 groups, according to the duration of radial head dislocation, including the early group (n=9, within 3 y) and the long-standing group (n=15, older than 3 y). The lengths of the radius (Lr) and ulna (Lu) were measured. The difference in length between the ulna and radius (DL=Lu−Lr) was calculated on both the affected (DLaff) and normal (DLnor) sides. DLnor−DLaff, which represented an abnormal discrepancy in both bones, was analyzed for correlation with the duration of radial head dislocation and the age at initial injury.

Results:
The affected and normal sides had no differences in the Lr of both the groups and in the Lu of the early group. However, in the long-standing group, Lu was significantly smaller in the affected side than in the normal side (P=0.001). In the long-standing group, DLaff was significantly smaller, owing to decreased length of the ulna, than DLnor (P=0.003). The DLnor−DLaff was positively correlated with the duration of radial head dislocation and was negatively correlated with the age at injury.

Conclusions:
In chronic MMF cases, the length of the ulna was shorter in the affected side than in the normal side. Therefore, ulnar lengthening is necessary to resolve this abnormal discrepancy and reduce the radial head. Because excessive ulnar lengthening has risks of postoperative complications, one of the surgical options is gradual ulnar lengthening or shortening osteotomy of the radius.

Level of Evidence:
Level III—Prognosis study.
Proprotein Convertase Subtilisin/Kexin Type 9 Loss-of-Function Is Detrimental to the Juvenile Host With Septic Shock*
Authors: Atreya Mihir R. , Whitacre Brynne E. , Cvijanovich Natalie Z. , Bigham Michael T. , Thomas Neal J. , Schwarz Adam J. , Weiss Scott L. , Fitzgerald Julie C. , Allen Geoffrey L. , Lutfi Riad , Nowak Jeffrey E. , Quasney Michael W. , Shah Amy S. , Wong Hector R. 
Published: August 2020

Objectives:
Proprotein convertase subtilisin/kexin type 9 is a central regulator of lipid metabolism and has been implicated in regulating the host response to sepsis. Proprotein convertase subtilisin/kexin type 9 loss-of-function is associated with improved sepsis outcomes in the adult host through increased hepatic bacterial clearance. Thus, there is interest in leveraging proprotein convertase subtilisin/kexin type 9 inhibitors as a therapeutic strategy in adults with sepsis. We sought to validate this association in children with septic shock and in a juvenile murine model of sepsis.

Design:
Prospectively enrolled cohort of children with septic shock; experimental mice.

Setting:
Seventeen participating institutions; research laboratory.

Patients and Subjects:
Five-hundred twenty-two children with septic shock; juvenile (14 d old) and adult (10–14 wk) mice with constitutive proprotein convertase subtilisin/kexin type 9 null and wildtype control mice (C57BL/6).

Interventions:
Proprotein convertase subtilisin/kexin type 9 single-nucleotide polymorphisms, serum proprotein convertase subtilisin/kexin type 9, and lipid profiles in patients. Cecal slurry murine model of sepsis; survival studies in juvenile and adult mice, assessment of lipoprotein fractions, bacterial burden, and inflammation in juvenile mice.

Measurements and Main Results:

PCSK9 loss-of-function genetic variants were independently associated with increased odds of complicated course and mortality in children with septic shock. PCSK9, low-density lipoprotein, and high-density lipoprotein concentrations were lower among patients with complicated course relative to those without. PCSK9 concentrations negatively correlated with proinflammatory cytokine interleukin-8. Proprotein convertase subtilisin/kexin type 9 loss-of-function decreased survival in juvenile mice, but increased survival in adult mice with sepsis. PCSK9 loss-of-function resulted in low lipoproteins and decreased hepatic bacterial burden in juvenile mice.

Conclusions:
In contrast to the adult host, proprotein convertase subtilisin/kexin type 9 loss-of-function is detrimental to the juvenile host with septic shock. PCSK9 loss-of-function, in the context of low lipoproteins, may result in reduced hepatic bacterial clearance in the juvenile host with septic shock. Our data indicate that children should be excluded in sepsis clinical trials involving proprotein convertase subtilisin/kexin type 9 inhibitors.
Impact of Videolaryngoscopy Expertise on First-Attempt Intubation Success in Critically Ill Patients
Authors: Amalric Matthieu , Larcher Romaric , Brunot Vincent , Garnier Fanny , De Jong Audrey , Moulaire Rigollet Valerie , Corne Philippe , Klouche Kada , Jung Boris 
Published: August 2020

Objectives:
The use of a videolaryngoscope in the ICU on the first endotracheal intubation attempt and intubation-related complications is controversial. The objective of this study was to evaluate the first intubation attempt success rate in the ICU with the McGrath MAC videolaryngoscope (Medtronic, Minneapolis, MN) according to the operators’ videolaryngoscope expertise and to describe its association with the occurrence of intubation-related complications.

Design:
Observational study.

Setting:
Medical ICU.

Subjects:
Consecutive endotracheal intubations in critically ill patients.

Interventions:
Systematic use of the videolaryngoscope.

Measurements and Main Outcomes:
We enrolled 202 consecutive endotracheal intubations. Overall first-attempt success rate was 126 of 202 (62%). Comorbidities, junior operator, cardiac arrest upon admission, and coma were associated with a lower first-attempt success rate. The first-attempt success rate was less than 50% in novice operators (1–5 previous experiences with videolaryngoscope, independently of airway expertise with direct laryngoscopies) and 87% in expert operators (> 15 previous experiences with videolaryngoscope). Multivariate analysis confirmed the association between specific skill training with videolaryngoscope and the first-attempt success rate. Severe hypoxemia and overall immediate intubation-related complications occurred more frequently in first-attempt failure intubations (24/76, 32%) than in first-attempt success intubations (14/126, 11%) (p < 0.001).

Conclusions:
We report for the first time in the critically ill that specific videolaryngoscopy skill training, assessed by the number of previous videolaryngoscopies performed, is an independent factor of first-attempt intubation success. Furthermore, we observed that specific skill training with the McGrath MAC videolaryngoscope was fast. Therefore, future trials evaluating videolaryngoscopy in ICUs should consider the specific skill training of operators in videolaryngoscopy.
Sequencing of Adjuvant Chemoradiation for Advanced Stage Endometrial Cancer
Authors: Arden Jessica D. , Marvin Kimberly , Nandalur Sirisha R. , Al-Wahab Zaid , Field Jayson , Gadzinski Jill , Rakowski Joseph A. , Rosen Barry , Jawad Maha S. 
Published: August 2020

Objectives:
Radiation is frequently added to chemotherapy for adjuvant treatment of advanced stage endometrial cancer. Multiple adjuvant therapy sequencing options exist, and little data is available to compare these. We compared outcomes and toxicities after “sandwich” chemoradiation (chemotherapy, then radiation, then chemotherapy) and nonsandwich sequences (chemotherapy then radiation, radiation then chemotherapy, or concurrent chemoradiation).

Materials and Methods:
We recorded baseline characteristics, adjuvant treatment details, clinical outcomes, and toxicities for stage III to IVA patients who underwent surgical staging followed by both adjuvant chemotherapy and radiation therapy at our institution. Effects of adjuvant treatment order (sandwich or nonsandwich) on these outcomes were analyzed. Toxicities were graded according to CTCAE v4.0.

Results:
We identified 107 patients with a median follow-up of 3.2 years. Five-year local, regional, and distant recurrence were 7%, 15%, and 33%; disease-free and overall survival were 61% and 68%, respectively. Outcomes did not differ by sequence group. The overall rate of acute toxicity did not differ by sequence group. The overall rate of chronic toxicity was significantly lower for sandwich patients (P<0.001), as were overall rates of chronic genitourinary (P=0.048) and gynecologic (P<0.001) toxicities. There were no grade 4 or 5 acute or chronic toxicities.

Conclusions:
Advanced stage endometrial cancer is an aggressive disease and adjuvant chemotherapy and radiation therapy are indicated. Clinical outcomes were similar amongst the different sequences; however, sandwich therapy led to less chronic toxicity, offering an opportunity for improved quality of life in survivorship.
Ganglion Cysts of the Proximal Tibiofibular Joint: Low Risk of Recurrence After Total Cyst Excision
Authors: Papanastassiou Ioannis D. , Tolis Konstantinos , Savvidou Olga , Fandridis Emmanouil , Papagelopoulos Panayiotis , Spyridonos Sarantis 
Published: August 2020

Abstract

Background
Peroneal nerve neuropathy due to compression from tumors or tumor-like lesions such as ganglion cysts is rare. Few case series have been published and reported local recurrence rates are high, while secondary procedures are frequently employed.

Questions/purposes
(1) What are the demographics of patients with ganglion cysts of the proximal tibiofibular joint, and what proportion of them present with intraneural cysts and peroneal nerve palsy? (2) What Musculoskeletal Tumor Society (MSTS) scores do patients with this condition achieve after decompression surgery with removal of the ganglion cyst, but no arthrodesis of the tibiofibular joint? (3) What proportion of patients experience local recurrence after surgery?

Methods
Between 2009 to 2018, 30 patients (29 primary cases) were treated for chronic peroneal palsy or neuropathy due to ganglion cysts of the proximal tibiofibular joint at two tertiary orthopaedic medical centers with total resection of the cystic lesion. MRI with contrast and electromyography (EMG) were performed preoperatively in all patients. The minimum follow-up for this series was 1 year (median 48 months, range 13 to 120); 14% (4 of 29) were lost to follow-up before that time. The MSTS score was recorded preoperatively, at 6 weeks postoperatively, and at most-recent follow-up.

Results
A total of 90% of the patients were male (26 of 29 patients) and the median age was 67 years (range 20 to 76). In all, 17% (5 of 29) were treated due to intraneural ganglia. Twenty-eight percent (8 of 29) presented with complete peroneal palsy (foot drop). The mean MSTS score improved from 67 ± 12% before surgery to 89 ± 12% at 6 weeks postoperative (p < 0.001) and to 92 ± 9% at final follow up (p = 0.003, comparison with 6 weeks postop). All patients improved their scores. A total of 8% (2 of 25 patients) experienced local recurrence after surgery.

Conclusion
Ganglion cysts of the proximal tibiofibular joint occurred more often as extraneural lesions in older male patients in this small series. Total excision was associated with improved functional outcome and low risk of neurologic damage and local recurrence, and we did not use any more complex reconstructive procedures. Tendon transfers may be performed simultaneously in older patients to stabilize the ankle joint, while younger patients may recover after decompression alone, although larger randomized studies are needed to confirm our preliminary observations.

Level of Evidence
Level IV, therapeutic study.
A Randomized, Double-Blinded Study Evaluating the Safety and Efficacy of AbobotulinumtoxinA Injections for Oily Skin of the Forehead: A Dose–Response Analysis
Authors: Kesty Katarina , Goldberg David J. 
Published: August 2020

BACKGROUND
AbobotulinumtoxinA has been investigated for applications beyond facial rhytides, including the treatment of oily skin.

OBJECTIVE
The authors sought to investigate the optimal number of units and the duration of abobotulinumtoxinA for the treatment of oily skin.

MATERIALS AND METHODS
This randomized, double-blinded, placebo-controlled study included 50 male and female subjects that got either 0, 15, 30, or 45 units of abobotulinumtoxinA injected into their forehead. For the 6 months after treatment, subjects were evaluated for the effectiveness of the treatment in decreasing the oiliness of their skin and the duration of this effect.

RESULTS
Subjects in the treatment groups that received either 30 or 45 units of neurotoxin experienced a significant reduction in oily skin. This effect was present for the 6-month duration of the study. No treatment-related adverse events were reported during this study, and both subjects and investigators reported a high level of satisfaction with the treatment.

CONCLUSION
Thirty or 45 units of abobotulinumtoxinA are safe and effective doses in treating oily skin for improved cosmetic appearance.
Opioid Prescribing Recommendations After Mohs Micrographic Surgery and Reconstruction: A Delphi Consensus
Authors: Donigan Jessica M. , Srivastava Divya , Maher Ian , Abdelmalek Mark , Bar Anna A. , Blalock Travis W. , Bordeaux Jeremy S. , Brodland David G. , Carroll Bryan T. , Council MARTHA Laurin , Duffy Keith , Fathi Ramin , Golda Nicholas , Johnson-Jahangir Hillary , Konda Sailesh , Leitenberger Justin J. , Moye Molly , Nelson Jenny L. , Patel Vishal A. , Shaffer Joseph J. , Soltani-Arabshahi Razieh , Tristani-Firouzi Payam , Tschetter Amanda J. , Nijhawan Rajiv I. 
Published: August 2020

BACKGROUND
Prescription opioids play a large role in the opioid epidemic. Even short-term prescriptions provided postoperatively can lead to dependence.

OBJECTIVE
To provide opioid prescription recommendations after Mohs micrographic surgery (MMS) and reconstruction.

METHODS
This was a multi-institutional Delphi consensus study consisting of a panel of members of the American College of Mohs Surgery from various practice settings. Participants were first asked to describe scenarios in which they prescribe opioids at various frequencies. These scenarios then underwent 2 Delphi ratings rounds that aimed to identify situations in which opioid prescriptions should, or should not, be routinely prescribed. Consensus was set at ≥80% agreement. Prescription recommendations were then distributed to the panelists for feedback and approval.

RESULTS
Twenty-three Mohs surgeons participated in the study. There was no scenario in which consensus was met to routinely provide an opioid prescription. However, there were several scenarios in which consensus were met to not routinely prescribe an opioid.

CONCLUSION
Opioids should not be routinely prescribed to every patient undergoing MMS. Prescription recommendations for opioids after MMS and reconstruction may decrease the exposure to these drugs and help combat the opioid epidemic.
Dermatofibrosarcoma Protuberans: A Clinicopathologic and Therapeutic Analysis of 254 Cases at a Single Institution
Authors: Jing Changyou , Zhang Hongtu , Zhang Xinxin , Yu Shengji 
Published: August 2020

BACKGROUND
Dermatofibrosarcoma protuberans (DFSP) is a rare low-grade tumor that typically does not metastasize but often recurs. Fibrosarcomatous DFSP (FS-DFSP) is associated with a substantially higher rate of metastasis and a poorer prognosis.

OBJECTIVE
This study sought to investigate the epidemiological, histopathological, and clinical characteristics of DFSP, especially with a particular focus on FS-DFSP.

MATERIALS AND METHODS
Clinical data from 254 patients treated between January 1999 and July 2018 were retrospectively reviewed. Endpoints of the study were the incidence of significant disease-related clinical events.

RESULTS
Follow-up data from 211 patients were available for analysis, with a median follow-up time of 38 months (range: 1–196 months). The 5-year recurrence-free survival rate of patients underwent wide-local excision (WLE) was 97.1%. Patients underwent WLE exhibited a significantly decreased recurrence rate relative to patients treated through local excision (2.9% vs 37.7%; p < .001). Fibrosarcomatous DFSP had significantly higher rates of distant metastasis (66.7% [n = 4] vs 2.0% [n = 4]; p < .001) and long-term mortality (50.0% [n = 3] vs 1.5% [n = 3]; p < .001), compared with classical DFSP (C-DFSP).

CONCLUSION
Wide-local excision is an effective means of reducing DFSP recurrence. Rates of metastasis are higher for FS-DFSP than for C-DFSP, with the former having significantly poorer outcomes.
Influence of Neutralization Accelerated by the Soak Method on the Radon Exhalation of Cement-based Materials
Authors: Yang Rong , Zhang Xiaowen , Feng Shengyang , Li Xiangyang 
Published: August 2020

Abstract
Radon is considered a significant contaminant that affects indoor air quality. Neutralization is one of the most important environmental factors in changing pore structure of cement-based materials that may release radon. Therefore, it is necessary to study the radon exhalation of cement-based materials impacted by neutralization, which is extremely lacking. Some concrete blocks were accelerated to neutralization by soaking in sodium bicarbonate solution, and the radon activity concentrations over the blocks were measured to investigate the effect of neutralization on radon exhalation. Controlled experiments were conducted with blocks in the initial dry state and soaked in pure water. The results show that the radon activity concentration exhaled from block is promoted by neutralization, and the promoting role of water is quite limited. The radon surface exhalation rate increases by increasing the sodium bicarbonate solution concentration from 0.5% to saturation.
Evaluating the Cross-Sectional and Longitudinal Relationships Predicting Suicidal Ideation Following Traumatic Brain Injury
Authors: Awan Nabil , DiSanto Dominic , Juengst Shannon B. , Kumar Raj G. , Bertisch Hilary , Niemeier Janet , Fann Jesse R. , Kesinger Matthew R. , Sperry Jason , Wagner Amy K. 
Published: August 2020

Objective:
Characterize relationships among substance misuse, depression, employment, and suicidal ideation (SI) following moderate to severe traumatic brain injury (TBI).

Design:
Prospective cohort study.

Setting:
Inpatient rehabilitation centers with telephone follow-up; level I/II trauma centers in the United States.

Participants:
Individuals with moderate to severe TBI with data in both the National Trauma Data Bank and the Traumatic Brain Injury Model Systems National Database, aged 18 to 59 years, with SI data at year 1 or year 2 postinjury (N = 1377).

Main Outcome Measure:
Primary outcome of SI, with secondary employment, substance misuse, and depression outcomes at years 1 and 2 postinjury.

Results:
Cross-lagged structural equation modeling analysis showed that year 1 unemployment and substance misuse were associated with a higher prevalence of year 1 depression. Depression was associated with concurrent SI at years 1 and 2. Older adults and women had a greater likelihood of year 1 depression. More severe overall injury (injury severity score) was associated with a greater likelihood of year 1 SI, and year 1 SI was associated with a greater likelihood of year 2 SI.

Conclusions:
Substance misuse, unemployment, depression, and greater extracranial injury burden independently contributed to year 1 SI; in turn, year 1 SI and year 2 depression contributed to year 2 SI. Older age and female sex were associated with year 1 depression. Understanding and mitigating these risk factors are crucial for effectively managing post-TBI SI to prevent postinjury suicide.
Return to School Following TBI: Educational Services Received 1 Year After Injury
Authors: Lundine Jennifer P. , Todis Bonnie , Gau Jeff M. , McCart Melissa , Wade Shari L. , Yeates Keith Owen , Glang Ann 
Published: August 2020

Background:
Many children who experience a traumatic brain injury (TBI) return to school without receiving needed support services.

Objective:
To identify services received and predictors of formal special education services (ie, Individualized Education Plan [IEP]) for students with TBI 1 year after returning to school.

Setting and Participants:
A total of 74 students with TBI recruited from children's hospitals in Colorado, Ohio, and Oregon.

Design:
Secondary analysis of previously reported randomized control trials with surveys completed by caregivers when students returned to school (T1) and 1 year later (T2). This study reports data collected at T2.

Results:
While 45% of students with TBI reported an IEP 1 year after returning to school, nearly 50% of students received informal or no services. Male students, those who sustained a severe TBI, and students whose parents reported domain-specific concerns were more likely to receive special education services at 1 year. In a multivariate model, sex remained the only significant predictor of IEP services at T2.

Conclusions:
Females and students with less severe or less visible deficits were less likely to receive special education services. While transition services may help students obtain special education for the first year after TBI, identifying students with TBI who have subtle or later-developing deficits remains a challenge.
Understanding the Link Between Traumatic Brain Injury Accompanied by Loss of Consciousness and Well-Being: A Sample of UK Military Veterans
Authors: Hendrikx Laura Josephine , Murphy Dominic 
Published: August 2020

Objective:
To investigate the association between reported traumatic brain injury plus loss of consciousness (TBI + LOC) and a range of demographic, military, and physical and mental health factors among a sample of UK veterans seeking support for mental health difficulties.

Design:
The present study was a cross-sectional study.

Participants:
Clinical records were used to identify a sample of treatment-seeking UK veterans (N = 3335), of which a total of 403 took part.

Main Measures:
Information on demographic characteristics, military experiences, and a range of physical and mental health difficulties was collected.

Results:
Almost half of the sample (48%) reported a TBI + LOC, which was most strongly associated with drug use and childhood adversity. More modest associations also emerged with earlier service termination, likelihood of unemployment, as well as chronic pain and poor mobility.

Conclusion:
The findings suggested that TBI + LOC may not specifically be associated with symptoms of posttraumatic stress in a sample of treatment-seeking veterans. The demonstrated links between TBI + LOC and adverse childhood, drug use, physical health, and employment may be useful in improving the assessment and rehabilitation of veterans with TBI + LOC.