bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes of Computer-Assisted Surgery Compared with Conventional Instrumentation in 19,221 Total Knee Arthroplasties
Authors: Roberts Timothy D. , Frampton Christopher M. , Young Simon W. 
Published: January 2020

Background:
Studies have shown improved alignment in association with the use of computer-assisted surgery (CAS) as compared with conventional instrumentation during total knee arthroplasty (TKA) but have failed to show a consistent clinical benefit. The aim of the present study was to compare the revision rates and functional outcomes following TKA performed with either CAS or conventional instrumentation. Recognizing that selection bias may arise from the preferential use of CAS in difficult or complex cases, the implant survival data and postoperative functional scores were analyzed with reference to whether the surgeon routinely performed TKA with use of CAS or conventional instrumentation.

Methods:
Revision rates and functional data in terms of the Oxford Knee Score (OKS) at 6 months, 5 years, and 10 years were obtained from the New Zealand Joint Registry (NZJR) for 19,221 TKAs performed from 2006 to 2018.These data were analyzed by comparing 2 cohorts of patients: those managed by high-volume surgeons who routinely used CAS (“routine CAS” surgeons) and those managed by high-volume surgeons who routinely used conventional instrumentation (“routine conventional” surgeons). The mean duration of follow-up was 4.5 years (range, 0 to 12 years).

Results:
The revision rate per 100 component-years was 0.437 for the “routine CAS” surgeons, compared with 0.440 for the “routine conventional” surgeons (p = 0.724). For patients <65 years of age, the revision rate per 100 component-years was equivalent for the “routine CAS” and “routine conventional” surgeons (0.585 compared with 0.508; p = 0.524). The OKS scores were similar at 6 months (38.88 compared with 38.52; p = 0.172), 5 years (42.26 compared with 41.77; p = 0.206), and 10 years (41.59 compared with 41.74; p = 0.893) when comparing the 2 cohorts. Surgeons who had performed >50 TKAs with use of CAS took 10 minutes longer on average than those who used conventional instrumentation (92 compared with 82 minutes; p = 0.012).

Conclusions:
The present study demonstrated no difference in survivorship or functional outcome scores to support using CAS for TKA. Experienced surgeons using CAS had longer operative durations than comparable surgeons using conventional instrumentation.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Intravenous Tranexamic Acid Safely and Effectively Reduces Transfusion Rates in Revision Total Knee Arthroplasties
Authors: Hines Jeremy T. , Petis Stephen M. , Amundson Adam W. , Pagnano Mark W. , Sierra Rafael J. , Abdel Matthew P. 
Published: January 2020

Background:
The efficacy and safety of tranexamic acid (TXA) in primary total knee arthroplasty (TKA) have been well established. However, there have been limited data for revision TKAs. The primary aim was to assess the impact of intravenous TXA on transfusion rates and symptomatic venous thromboembolic events (VTEs) in a large revision TKA cohort with or without intravenous TXA utilization.

Methods:
A retrospective review of revision TKAs performed from 2005 to 2014 was performed, identifying 2,951 procedures (2,219 patients), in which TXA was utilized in 1,144 procedures (39%). The mean age was 65 years with 52% female patients in the TXA revision group and 67 years with 52% female patients in the non-TXA revision group. Transfusion rates and symptomatic VTEs were the primary outcomes assessed. Comparisons were performed between cohorts, utilizing a unique propensity model to mitigate bias, on the basis of TXA use and subsequently for aseptic or septic revision etiology.

Results:
Significant reductions in transfusion rates with use of TXA were identified in revision TKAs overall (13% compared with 39%; p < 0.001 [adjusted relative risk, 1.7]), including revisions for both aseptic etiology (6% with TXA compared with 28% without TXA; p < 0.001) and septic etiology (31% with TXA compared with 54% without TXA; p < 0.001). The risk of a postoperative symptomatic VTE was not significantly different (adjusted p = 0.63) with use of TXA at 11 events (1.0%) compared with 24 events (1.3%) in the non-TXA group).

Conclusions:
Intravenous TXA significantly reduced transfusion rates in revision TKAs by approximately twofold, including cohorts revised for aseptic and septic etiologies. There was a very low rate of VTEs (1.2%) with no significant difference in the number of VTEs between groups after adjusting risk utilizing propensity modeling.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Critical Limit of Lower-Extremity Lengthening in Total Hip Arthroplasty
Authors: Bayram Serkan , Akgül Turgut , Özmen Emre , Kendirci Alper Şükrü , Demirel Mehmet , Kılıçoğlu Önder İsmet 
Published: January 2020

Background:
The effect of limb lengthening on neural structures was assessed with use of intraoperative neuromonitoring (IONM) during primary total hip arthroplasty (THA). The relationship between the critical limit of lengthening and anthropometric measurements was evaluated.

Methods:
Motor evoked potentials (MEPs) from the deep peroneal nerve (tibialis anterior muscle), tibial nerve (gastrocnemius muscle), and femoral nerve (quadriceps muscle), as well as somatosensory evoked potentials (SEPs) from the posterior tibial nerve, were recorded in 16 patients undergoing THA. Height, weight, the distance between the anterior superior iliac spine and the medial malleolus (ASIS-MM distance), and the total femoral length were measured preoperatively. Lower-extremity traction was performed after resection of the femoral head, and the amount of extremity lengthening was measured with use of an image intensifier. A maximum of 50% reduction in any one of the SEP or MEP amplitudes or a 10% increase in the SEP latency were considered to be indicative of the critical limit of lengthening.

Results:
Initial IONM changes (indicating the safe limit of lengthening) and maximum allowed IONM changes (indicating the critical limit of lengthening) were reached in the deep peroneal nerve in all cases. The mean safe limit of lengthening (and standard deviation) was 14.9 ± 6.2 mm (3% relative to femoral length and 1.7% relative to ASIS-MM distance), whereas the critical limit of lengthening was exceeded at a mean of 22.4 ± 5.6 mm (5% relative to femoral length and 2.6% relative to ASIS-MM distance). When the critical limit was reached in the deep peroneal nerve, the mean decrease in MEP amplitudes was 27% (95% confidence interval [CI], 22.1% to 32.7%) for the tibial nerve and 12% (95% CI, 6.9% to 18.1%) for the femoral nerve. There was a positive correlation between critical lengthening and femoral length (r = 0.782; p < 0.001), ASIS-MM distance (r = 0.811; p < 0.001), and height (r = 0.835; p = 0.001). No correlation existed between the critical lengthening amount and the decrease in amplitude in the tibial and femoral nerves.

Conclusions:
The critical limit of nerve lengthening was directly correlated with anthropometric measurements. Nerve lengthening of 5% relative to femoral length and of 2.6% relative to ASIS-MM distance was found to be critical; however, these limits depended on the predetermined threshold values for IONM.

Level of Evidence:
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Vascular Injuries in Total Knee Arthroplasty
Authors: Sundaram Kavin , Udo-Inyang Inyang , Mont Michael A. , Molloy Robert , Higuera-Rueda Carlos , Piuzzi Nicolas S. 
Published: January 2020

Background:
Vascular injuries associated with total knee arthroplasty can have limb and life-threatening consequences. The aims of this study were to conduct a meta-analysis of the overall rate of vascular injuries after total knee arthroplasty and to conduct a systematic review of specific major and minor vessel injuries.

Methods:
All English-language literature published from January 1, 1998, to November 30, 2018, was queried in 4 unique databases using a common search term. This yielded 404 results, of which 270 were unique. Two reviewers then assessed studies for eligibility. All non-human studies, cadaver studies, studies describing only human images, and human studies with non-acute pathology were excluded. The final study included 10 large epidemiological studies and 68 case series or studies. Data from the literature were abstracted into a comma-separated database spreadsheet using Microsoft Excel. A meta-analysis was then performed. Pooled statistics were calculated with weighting by inverse variance assuming a random effect model. I2 was calculated as a quantifier of heterogeneity and interpreted according to the Cochrane manual. All data analysis was performed using R software.

Results:
Among the 1,419,557 total knee arthroplasties reported in 10 studies, there were 767 major vascular injuries (0.05% [54 per 100,000 total knee arthroplasties]). Amputation or long-term neurological complications occurred in approximately 21% of patients after major vascular injury. Presentation after 24 hours occurred in 36% of cases. The most frequently injured vessels were the geniculate arteries, popliteal artery, superficial femoral artery, and anterior tibial artery. The injuries that were most likely to result in amputation were femoral artery occlusion, popliteal artery transection, and popliteal artery arteriovenous fistula.

Conclusions:
Amputation and long-term neurological complications are common complications after a vascular injury associated with a total knee arthroplasty. Preoperative consultation with vascular surgery physicians may be a prudent approach before a surgical procedure for patients with known peripheral vascular disease, diabetes, hypertension, or smoking; however, more data on risk factors are needed. Awareness by the surgical team and implementation of specific strategies during a surgical procedure such as gentle manipulation of the knee and careful retraction may further reduce the rate of injuries.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Kualitas Pelayanan Transportasi di PT Kereta Api Indonesia (Persero) Kabupaten Sidoarjo
Authors: Ismianingtyas Rizka , Agustina Isna Fitria 
Published: January 2020

Purpose of this research is analyze and describe ticketing service effectiveness at Sidoarjo Railway Station, describe factors that impact service effectiveness. Type of this research is descriptive qualitative with informant act of determining technique snowball sampling. Primary data will be obtained from in-depth interview with key informant i.e chief of Sidoarjo railway station, 2 ticketing officers and 5 passengers in Sidoarjo railway station as informant.Result of this research reveals that service, delivered Sidoarjo railway station is effective. In terms of the responsive and polite officers, they have good capability to serve passengers, proper service deliverance, in addition to put empathy on their passengers. Yet, the provision of self-service ticket printing machine (CTM) and waiting room facility are still lack, specifically for days off. local railway ticket which can’t be purchased by online. Factors influencing service effectivity, namely, First, awareness factor, the service officers carry out their responsibility properly. Secondly, regulation factor, Sidoarjo railway station itself runs with the regulation. Thirdly, officials revenue is above the regional minimum wages (UMR). Fourthly, officers’ competency, the ticketing service officers are competent. Fifthly, facility factor the facility waiting room self-service ticket printing machine (CTM) and for passengers are not fairly yet.
Drill Cutting Transport in Full Scale Vertical Annuli
Authors: Sifferman Thomas R. , Myers George M. , Haden Elard L. , Wahl Harry A. 
Published: January 2020

ABSTRACT
The absence of the basic data needed to fully evaluate present field practices and current concepts on drill cutting transport prompted this full scale study. Several drill pipe and casing sizes were used in a 140-ft vertical flow system to define the variables affecting drill cutting transport under steady state conditions.
Variables evaluated were annular velocity (4 to 200 ft/min), fluid rheological properties (mud, water, oils), cutting size (3–6 mesh), fluid weight (12–15 ppg), rotary speed (0–200 rpm), drilling rate (cutting feed concentration), drill pipe position (centered-eccentric), and annular size. Annular velocity and fluid rheological properties were the most significant variables. Annular velocities well below the 120 ft/min used in most hydraulic programs were found adequate to clean the hole. Increasing apparent viscosity dramatically improved cutting transport. The other variables showed 2nd and 3rd order effects. Terminal slip velocities were a good indicator for the velocities required to initiate transport, but observed transport was 75 to 90% of the theoretical values.
These findings should destroy many myths on drill cutting transport and provide a factual basis for improving drilling hydraulics.
Frailty index–predicted mortality is moderated by health-related behaviors: a 4-year community-based longitudinal-cohort study
Authors: Huang Limei , Chen Hao , Ye Bo , Qi Shige , Ruan Ye , Chen Xiuqin , Ding Guomei , Fei Jihui , Shen Yongquan , Gao Junling , Shi Yan 
Published: January 2020

Abstract
To explore the separate and joint associations between frailty and long-term, all-cause mortality with health-related behaviors in older adults. We enrolled a total of 4050 community residents age ≥60 years from Songjiang District, Shanghai, China, and followed up with them every year from 2015 to 2018.Based on the standard procedure for creating an FI, we developed one containing 28 measured variables. Survival analyses were used to examine the risk ratios (RRs) between frailty and 4-year mortality; hazard ratios (HRs) were obtained and adjusted for gender and age. Over an average follow-up time of 1107.56 ± 144.43 days, 216 (5.4%) participants died. Of all participants, 71.7% were non-frail (FI = 0–0.1), 23.2% were pre-frail (FI = 0.1–0.2), and 5.1% were frail (FI ³0.2). Multivariate HRs (with 95% confidence intervals [CIs]) for all-cause mortality were 1.58 (1.06–2.34) and 2.63 (1.52 –4.55) for moderate (FI 0.1–0.2) and severe (FI >0.2) frailty, respectively, compared with mild frailty (<0.1). Risk of death for severely frail participants who were physically inactive (HR = 3.40; 95% CI, 1.78–6.50; P < 0.001) was 105%, much higher than for severely frail participants who performed physical exercise (HR = 2.34; 95% CI, 1.35–4.09; P < 0.01). Similarly, among severely frail participants, those who were socially inactive (HR = 5.77; 95% CI, 2.69–12.38; P < 0.01) were 344% more likely to die than those who regularly participated in social activities (HR = 2.33; 95% CI, 1.42–3.86; P < 0.01).
Retrospective analysis of misdiagnosis of cytomegalovirus retinitis
Authors: Du Kuifang , Huang Xiaojie , Chen Chao , Wenjun Kong , Xie Lianyong , Wei WenBin 
Published: January 2020

Abstract
Background Initial misdiagnosis of cytomegalovirus retinitis (CMVR) may lead to irreversible loss of vision and systemic deterioration. We retrospectively reported some misdiagnosis related to CMVR. Methods The medical records of 92 consecutive patients diagnosed or misdiagnosed as CMVR were reviewed retrospectively at the ophthalmology department of Beijing youan hospital from July 2017 to October 2019. The primary outcome measure was to evaluate cases with CMVR who were initially misdiagnosed or who were misdiagnosed as CMVR. Results In 8 (8.7%) out of the 92 patients, the initial diagnosis was incorrect. The median age of the eight patients was 37.5 years (range 20-46 yeas). All (7/7, 100%) patients were male. Patients with CMVR were initially misdiagnosed as diabetic retinopathy (1/92,1.1%), branch retinal vein occlusion (1/92,1.1%), ischemic optic neuropathy (1/92,1.1%), Behcet′s disease (1/92,1.1%), iridocyclitis (2/92, 2.3%), and progressive outer retinal necrosis (1/92,1.1%). One patient with binocular renal retinopathy and chronic renal insufficiency was misdiagnosed as CMVR (1/92,1.1%). All patients presented binocular involvement (sixteen eyes), and two patients (four eyes) presented pan-retinal involvement. Fourteen eyes (14/16, 87.5%) had optic disc or macular area involved. One patient is blind, and two patients had a low vision when the diagnosis is finally clear. Five patients had systemic symptoms. Seven patients were finally diagnosed with AIDS showing an extremely low level of CD4 + T lymphocyte: median of 5 cells/ul (range 1-9 cells/ul). Conclusion The misdiagnosis of CMVR can occur in young male patients. The ophthalmologist should pay more attention to CMVR and systemic symptoms insulting to avoid deterioration of vision and delaying in the management of systemic conditions.
Spatial Distribution and factors associated with childhood anemia in Ethiopia
Authors: Tadesse Erkihun , Ayele Tiruneh 
Published: January 2020

Abstract
Introduction The magnitude of childhood anemia has increased from 44% in 2011 to 56% in 2016. Thus, even if the Ethiopian government tried remarkable solutions, anemia among under-five children still continues as a serious health issue. So, exploring spatial distribution and identifying factors associated with childhood anemia helps to design appropriate strategies for control and prevention.Methods For this study data from the recent 2016 Ethiopian Demographic Health Survey were employed. The sample size was 8602 children aged 6–59 months. They were selected by stratified two-stage cluster sampling techniques. Sat Scan version 9.4 was also used to identify childhood anemia by geographic clusters and ArcGIS version10.1 was used to show anemia cases through Regions of Ethiopia. Thus to declare factors that are statistically related with anemia among under-five children a Mixed effect logistic regression model was utilized.Result This study showed there is spatial clustering of childhood anemia throughout Ethiopia (Moran’s I: 0.65, p<0.001). Statistically significant clusters were detected in Somali, Afar, Harari and southern part of Oromia regions (P<0.001). Age of child, wealth index, mother’s current working status, maternal anemic status, number of living children in the family, history of fever, and stunting were significant factors associated with anemia among under-five children.Conclusion In the country childhood anemia showed spatial clustering. Regions high risk of childhood anemia should be emphasized by allocating additional resources and providing appropriate interventions which have public health implications.
Evaluating the Impact of Ventilator-Associated Parameters on Ventilation Free Days of non-ARDS Patients in ICU.
Authors: Liu Na , Ren Jingxuan , Yu Lina , Xie Junran 
Published: January 2020

Abstract
Background: Critically ill patients are not only mechanically ventilated because of ARDS, what kind of ventilation parameter setting is the optimal ventilation strategy for non-ARDS ICU patients?Methods: A retrospective cohort study for non-ARDS patients who received mechanical ventilation (MV), performed univariate, multivariate regression analysis, covariate balancing propensity score and inverse–probability–of–treatment weighting, and machines learning models to predict different outcomes. The included predicted factors are four parameters of mechanical ventilation (Driving pressure (DP) and its mediation of tidal volumes (VT) and positive end-expiratory pressure (PEEP), mechanical power (MP)), and the primary outcome was the ventilator-free days (VFD) at day 28.Results: The study included 2932 patients, low DP, low PEEP and low MP for non-ARDS patients could prolong VFD at day 28, reduce in-hospital mortality and length of hospital stay. However, the VT has no prognostic significance for the population. Among machine learning models with VFD, the randomforest had the best prediction.Conclusions: For non-ARDS patients who receive invasive ventilation for at least 48 hours, low DP, low PEEP and low MP are beneficial to the population. However, the effect of VT is inconclusive.
Potential drug-drug interactions among patients with chronic kidney disease admitted at National Hospital: a retrospective study in Tanzania
Authors: Mikomangwa Wigilya , Malifa Jephter E. , Mlyuka Hamu , Mutagonda Ritah , Kilonzi Manase , Kibanga Wema , Marealle Alphonce Ignace , Bwire George Msema 
Published: January 2020

Abstract
Background: Drug related problems such as drug-drug interactions (DDI) are likely to occur in chronic kidney disease (CKD) patients due to polypharmacy practice. The DDI increases the risk of morbidity, mortality, prolonged hospital and cost of treatment. In most cases, the potential drug-drug interactions (pDDI) are not checked during prescribing or dispensing of polypharmacy for CKD patients in developing countries like Tanzania. Therefore, we documented the pattern and potential drug-drug interactions (DDIs) among CKD patients admitted at Muhimbili National Hospital (MNH).Methods: The study retrospectively reviewed 198 files for CKD patients admitted at MNH between January 2017 and December 2018. The social-demographic characteristics and comorbidities were documented using a checklist. Prescriptions with polypharmacy were reviewed and prescribed medicines were documented. Medscape drug interaction checker was used for pDDIs. The SPSS version 23.0 was used to carry out statistical analysis. Results: The study involved a total of 306 prescriptions with polypharmacy with a mean(±SD) of 6.21(±1.22) medicines per prescription. Majority of patients (77.2%) were in stage 5 of chronic kidney disease. Frequently prescribed medicines were pantoprazole 135(44.1%), furosemide 133(43.5%), ferrotone 101(33.0%), calcium carbonate 91(29.7%), amlodipine 121(39.5%), nifedipine 83(27.1%), bisoprolol 46(15.0%) and clonidine 38(12.4). The prevalence of pDDIs was 94.1%. The total of 1743 potential drug-drug interactions was observed with a mean of 6.03(±2.12) interactions per prescription. Majority of the pDDIs were moderate (67.5%) whereas, 29.5%, 2.6% and 0.3 were minor, serious and contraindicated respectively. The occurrence of pDDIs was associated with stroke (P-value=0.038), diabetes mellitus (p-value=0.049) and hypertension with diabetes mellitus (p-value=0.047).Conclusion: The prevalence of pDDIs was high among the CKD patients. The determinants of pDDIs among CKD patients were hypertension, diabetes mellitus and stroke. Interaction checkers should be incorporated in health system to guide the prescribing and dispensing of medicine for CKD patients.