bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognosis of Incomplete Avulsion of the Proximal Hamstring Tendon Is Determined by the Avulsion Location of the Proximal Hamstring Tendon Footprint
Authors: Saito Masayoshi , Niga Sadao , Suzuki Kaoru , Ikezawa Yuji , Tsukada Sachiyuki 
Published: December 2019

Objective:
To test the hypothesis that prognosis of incomplete avulsion of the proximal hamstring tendon would be worse whether avulsion location reached the proximal part of the conjoined tendon (CJ) footprint or not.

Design:
Retrospective chart review.

Setting:
Outpatient specialty clinic.

Patients:
We reviewed 345 consecutive athletes with hamstring injury.

Interventions:
Based on magnetic resonance imaging, incomplete avulsion of the proximal hamstring tendon was divided into 2 cases according to avulsion location without (cases A) or with (cases B) avulsion of the proximal part of the CJ footprint.

Outcome Measures:
We compared the time until return to play, subjective outcomes, and success rate of avoiding surgery between cases.

Results:
Incomplete avulsion of the proximal hamstring tendon was detected in 47 athletes (13.6%). Thirty-four athletes were classified as cases A, and 13 as cases B. Forty-two athletes (89.4%) were followed up until return to play. The median time from pain onset to return to play was significantly longer in cases B than in cases A (B, 39.3 weeks; A, 8.0 weeks; P = 0.00015). Subjective outcomes at return to play were significantly poorer in cases B than in cases A (P = 0.00054). Success rate of avoiding surgery were significantly poorer in cases B (55%) than in cases A (100%) (P = 0.00062).

Conclusions:
Incomplete avulsion of the proximal hamstring tendon was observed in 13.6% of hamstring injuries. Return to play, subjective outcomes, and success rate of avoiding surgery were significantly poorer with avulsion of the proximal part of the CJ footprint.
Test Order Does Not Affect Vestibular/Ocular Motor Screening Item Scores in High School Athletes
Authors: D'Amico Nathan R. , Elbin R. J. , Sufrinko Alicia , Schatz Philip , Mucha Anne , Collins Michael W. , Kontos Anthony P. 
Published: December 2019

Objective:
To compare VOMS item scores between a fixed and randomized administration order in a sample of nonconcussed high school athletes.

Design:
Post-test only, quasi-experimental design.

Setting:
Local high schools in a mid-west region of the United States.

Patients:
Fifty nonconcussed high school athletes (M = 15.64; SD = 1.12 years) completed the VOMS in a randomized testing order (RANDOM), and 49 (M = 15.64; SD = 1.12 years) completed the VOMS in the fixed testing order (FIXED). The groups were matched on age, sex, learning disorder, attention-deficit/hyperactivity disorder, concussion history, and baseline concussion symptoms.

Interventions:
The Vestibular/Ocular Motor Screening (VOMS) tool comprises pretest symptoms, smooth pursuit (SP), horizontal/vertical saccade (HSAC/VSAC), average near-point of convergence (NPC) distance, convergence symptoms, horizontal/vertical vestibular ocular reflex (HVOR/VVOR), and visual motion sensitivity (VMS).

Main Outcome Measures:
Mann–Whitney U tests were performed to examine differences between FIXED and RANDOM groups on VOMS items. RANDOM scores were rearranged in order of administration and combined with the FIXED group scores, and a Freidman test was performed for repeated measures.

Results:
There were no significant differences between FIXED and RANDOM groups on VOMS pretest symptoms (U = 1171, P = 0.57), SP (U = 1122.5, P = 0.35), HSAC (U = 1128.5, P = 0.44), VSAC (U = 1055.5, P = 0.16), convergence symptoms (U = 1129.0, P = 0.41), average NPC distance (U = 979.0, P = 0.06), HVOR (U = 1085.0, P = 0.25), VVOR (U = 1126.0, P = 0.41), and VMS scores (U = 1101.0, P = 0.32). When VOMS items were rearranged and the sample was combined, there were no differences for repeated measures [χ2 (6) = 9.92, P = 0.13].

Conclusions:
There were no significant differences on VOMS items between FIXED and RANDOM groups for repeated measures. The testing order of VOMS items does not affect VOMS scores in nonconcussed high school athletes.
Assessment of Isometric Knee Flexor Strength Using Hand-Held Dynamometry in High-Level Rugby Players Is Intertester Reliable
Authors: van der Made Anne D. , Paget Liam D. A. , Altink J. Nienke , Reurink Gustaaf , Six Willem R. , Tol Johannes L. , Kerkhoffs Gino M. 
Published: December 2019

Objective:
To assess intertester reliability of isometric knee flexor strength testing in high-level rugby players with testers of different physical capacity and different methods of dynamometer fixation.

Design:
Reliability study.

Patients:
Thirty noninjured high-level (Tegner Activity Score ≥9) rugby players, free from hamstring injury in the previous 2 months.

Assessment:
Isometric knee flexor strength (in N) in prone 0/15 degrees (hip/knee flexion) and supine 90/90 degrees position. Tests were performed by 1 female and 2 male testers whose upper-body strength was measured with a 6-repetition maximum bench press test. The prone 0/15 degrees measurement was performed with manual and external belt fixation of the dynamometer.

Main Outcome Measures:
Absolute and relative intertester reliability were calculated using intraclass correlation coefficient (ICC) and minimal detectable change. Paired t-tests were used to identify systematic measurement error between testers and to test for a difference in recorded knee flexor strength between methods of dynamometer fixation.

Methods:
Isometric knee flexor strength was measured in prone 0/15 degrees (hip/knee flexion) and supine 90/90 degrees position.

Results:
Good intertester reliability was found for all pairwise comparisons (ICC 0.80-0.87). MDCs (as percentage of mean strength) ranged from 15.2% to 25.4%. For tester couples where systematic error was identified, Bland–Altman plots and Pearson correlation coefficients demonstrated no statistically significant correlation between mean knee flexor strength and between-tester difference. There was no significant difference in isometric knee flexor strength between manual and belt fixation of the dynamometer.

Conclusions:
In strong high-level rugby players, hand-held dynamometry for isometric knee flexor strength assessment in prone 0/15 degrees and supine 90/90 degrees position is intertester reliable.
PET/computed tomography shows association between subjective pain in knee joints and fluorine-18-fluorodeoxyglucose uptake
Authors: Kamasaki Toshihiko , Mori Keisuke , Taira Yasuyuki , Orita Makiko , Miyamoto Izumi , Usui Toshiya , Chiba Kenya , Kudo Takashi , Takamura Noboru 
Published: December 2019

Objective
The aim of this study was to evaluate the capability of fluorine-18-fluorodeoxyglucose (18F-FDG)-PET/computed tomography (CT) in screening for musculoskeletal inflammation and injury in the knee region.

Methods
The study included 12 subjects (6 men and 6 women) who complained of knee pain at rest and 94 controls who did not. Maximum standardized uptake value (SUV)max was calculated for the right and left knees and compared via a 4-point numerical rating scale (NRS) for subjective knee pain. Correlations between SUV values were also evaluated.

Results
SUVmax was significantly higher in knee joints with resting and/or walking pain than in pain-free knee joints. SUVmax in knee joints with walking pain were significantly correlated with NRS category (β = 0.129, P < 0.001).

Conclusion

18F-FDG-PET/CT may be useful in screening for musculoskeletal inflammation and injury in the knee region. As knee pain is common, especially among elderly individuals, we should consider conducting further examinations when 18F-FDG uptake is identified in knee joints.
Linear and Nonlinear Measures of Postural Control in a Toddler With Cerebral Palsy: Brief Report
Authors: Pierce Samuel R. , Paremski Athylia C. , Skorup Julie , Stergiou Nicholas , Senderling Benjamin , Prosser Laura A. 
Published: December 2019

Purpose:
The purpose of this study was to describe changes in linear and nonlinear measures of postural control along with motor outcomes in a young child with cerebral palsy.

Summary of Key Points:
Posturography in sitting and standing, the Gross Motor Function Measure-66 (GMFM-66), and the Early Clinical Assessment of Balance (ECAB) were performed prior to, during, and after physical therapy. The child demonstrated independent sitting throughout the study and developed independent standing during the study. He made improvements in the GMFM-66 and ECAB throughout the study. Higher average values were found in all linear and nonlinear measures in standing when compared to sitting, which may indicate less predictable movement due to less experience with standing.

Recommendations for Clinical Practice:
Greater variability and lower predictability in postural control likely reflect early stages of skill acquisition. Research is needed to understand the optimal levels of movement variability and predictability.
Use of the Lean Manufacturing Principles to Improve Total Parenteral Nutrition Logistics and Clinical Outcomes in the Neonatal Patient Population
Authors: Mangum Christopher D. , Stanley Andrew J. , Peterson Catherine C. , Biava Laura , Dice James , Khan Jamil , Godambe Sandip A. 
Published: December 2019

Introduction:
Total parenteral nutrition (TPN) is one of the most frequently used pharmaceuticals administered to patients in our Neonatal Intensive Care Unit (NICU). Initially, the total interdepartmental processing time (ordering, manufacturing, and delivery between NICU and Pharmacy) averaged 15.2 hours. Inefficiencies in this process only allowed TPN to infuse 8.8 hours on average before labs were collected the next morning. Given the short administration-to-laboratory collection time, we hypothesized that laboratory samples would not adequately reflect the effect of the current TPN infusion. Furthermore, clinicians would be making decisions based on suboptimal data and ultimately nourish this patient population inadequately.

Methods:
The project team and the frontline staff created an efficient process for the manufacture and delivery of TPN. They removed waste in the process associated with manufacturing TPN and created capacity for change upstream (ordering process) and downstream (TPN infusion process) of the internal pharmacy process. The use of selection criteria and new standard operating procedures allowed for controlled PDSA testing of changes on a subset of patients. After we attained proven, sustainable results, we scaled the improvement efforts to the entire NICU patient population.

Results:
After 4 cycles of change, patients now receive TPN on average 14.2 hours before new labs are collected. The interventions over the continuum of this project yielded statistically significant results, increased infusion times to our patients by 61.4% (P < 0.001), improved glucose homeostasis, and decreased average length of stay.

Conclusions:
In conclusion, creating process capacity from incremental changes and iterative PDSA cycles has yielded sustained results.
Economic Benefit of Hand Surgical Efforts in Low- and Middle-Income Countries: A Cost-Benefit Analysis
Authors: Billig Jessica I. , Nasser Jacob S. , Sue Gloria R. , Chang James , Chung Kevin C. 
Published: December 2019

Background:
Hand surgeons can alleviate the burden associated with various congenital anomalies, burn sequelae, and trauma that debilitate individuals in low- and middle-income countries. Because few surgeons in these areas have the necessary resources to perform complex hand surgery, surgical trips provide essential surgical care. The authors aimed to determine the economic benefit of hand surgical trips to low- and middle-income countries to comprehensively determine the economic implications of hand surgery trips in low-resource settings.

Methods:
The authors collected data from two major global hand surgery organizations to analyze the economic benefit of hand surgery trips in low- and middle-income countries. The authors used both the human capital approach and the value of a statistical life-year approach to conduct this cost-benefit analysis. To demonstrate the economic gain, the authors subtracted the budgeted cost of each trip from the economic benefit.

Results:
The authors analyzed a total of 15 trips to low- and middle-income countries. The costs of the trips ranged from $3453 to $87,434 (average, $24,869). The total cost for all the surgical trips was $373,040. The authors calculated a net economic benefit of $3,576,845 using the human capital approach and $8,650,745 using the value of a statistical life-year approach.

Conclusions:
The authors found a substantial return on investment using both the human capital approach and the value of a statistical life-year approach. In addition, the authors found that trips emphasizing education had a net economic benefit. Cost-benefit analyses have substantial financial implications and will aid policy makers in developing cost-reduction strategies to promote surgery in low- and middle-income countries.
Secondary Suture Fusion after Primary Correction of Nonsyndromic Craniosynostosis: Recognition of the Problem and Identification of Risk Factors
Authors: Vaca Elbert E. , Sheth Neil , Purnell Chad A. , McGrath Jennifer L. , Gosain Arun K. 
Published: December 2019

Background:
Secondary fusion of initially patent cranial sutures after primary correction of nonsyndromic craniosynostosis is rarely reported. This study’s aim is to report the incidence and analyze whether there are variables that may predispose to such fusion.

Methods:
A single-institution, retrospective, case-control study was conducted of all nonsyndromic patients who underwent operative treatment for craniosynostosis from April of 2008 to May of 2017. Patients with less than 1 year of follow-up and/or without a 1-year postoperative computed tomographic scan were excluded. Preoperative, intraoperative, and postoperative variables were analyzed using univariate and multivariate analyses.

Results:
Sixty-six patients were included in the study, with a mean 2.57-year postoperative follow-up. Six patients (8.8 percent) were found to have secondary craniosynostosis, all of whom had fusion of sutures that were initially patent and refusion of the primary pathologic suture(s). Fifty percent of secondary fusions presented as pansynostosis. On univariate analysis, suturectomy with barrel staving (p < 0.01) was significantly associated with secondary suture fusion. On multivariate analysis, bilambdoid suture involvement (p = 0.03) and suturectomy with barrel staving (p = 0.01) were significantly associated with secondary suture fusion.

Conclusions:
Secondary cranial suture fusion may be a relatively common complication after primary craniosynostosis correction. Suturectomy with barrel staving was independently associated with secondary craniosynostosis. Wide surgical separation of the dura from the cranium and osteotomies across patent sutures may predispose to secondary craniosynostosis.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
Is There Gender Inequality in Plastic Surgery? Evaluation of Society Leadership and Composition of Editorial Boards
Authors: Chen Kevin , Ha Grace , Schultz Benjamin D. , Zhang Ben , Smith Mark L. , Bradley James P. , Thorne Charles H. , Kasabian Armen K. , Pusic Andrea L. , Tanna Neil 
Published: December 2019

Background:
Women now constitute 40.5 percent of integrated plastic surgery residents; however, in 2007, women represented only 11.3 percent of the leadership positions in plastic surgery societies and journal editorial boards. The authors analyzed female representation in these societies and editorial boards over the past 10 years.

Methods:
Names of board members from the major plastic surgery societies (American Society of Plastic Surgeons, The Plastic Surgery Foundation, and American Society for Aesthetic Plastic Surgery, among others) for the past 10 years and the major plastic journals (Plastic and Reconstructive Surgery, Annals of Plastic Surgery, and so on) from the past 5 years were extracted from their websites. The yearly percentage of female plastic surgery residents was obtained from Accreditation Council for Graduate Medical Education published data. The proportions of women in society leadership, editorial boards, and residency were compared with data analyses of time series trend and linear and Auto Regressive Integrated Moving Average time series modeling.

Results:
Over the past 10 years, the percentage of female residents has grown steadily, from 21.84 percent to 37.31 percent. Similarly, female representation in society leadership has grown from 6.78 percent to 20.29 percent. Both growth coefficients were statistically significant and showed no statistical difference between the two. In contrast, editorial board leadership over the past 5 years showed statistically insignificant growth and showed a statistically significant difference when compared to the growth of the percentage of female residents and female representation in society leadership.

Conclusion:
Female representation in plastic surgery society leadership shows promising growth, whereas their representation on editorial boards showed significantly less growth, which may reflect the slower turnover on these boards.
Surgical Strategies for Multicystic Ameloblastoma
Authors: Laino Luigi , Cicciù Marco , Russo Diana , Cervino Gabriele 
Published: December 2019

Abstract
Ameloblastoma is the second most common odontogenic tumor arising in the maxillary bones. The WHO classified ameloblastoma in: solid/multicystic (SMA); unicystic; peripheral and desmoplastic. A conservative or radical approach may be performed for SMA treatment to achieve total excision of the lesion.
In this case report, a 47-year-old woman, presented a deformation of the left mandibular region and paresthesia of the left hemi-labium, at the ortopanoramic x-ray (OPT) a multilocular osteolytic lesion and the rhizalysis of dental elements 3.7, 3.6, 3.5, 3.4 and the inclusion of 3.8 was appreciated; the CT exam showed erosion of the mandibular canal roof and of the vestibular cortex in the mental nerve region. The patient was subjected to the extraction of the elements in rhizalysis and of 3.8 and subsequently to the enucleation of the lesion followed by an extensive peripheral ostectomy performed with a piezoelectric device. The patient underwent to OPT and CT examinations follow-up and after 5 years was subjected to implant surgery, at the same time of the implant's placement, bone biopsies were performed using core drills in order to evaluate the bone histologically. The patient showed complete clinical and radiographic healing; the histological examination demonstrates the formation of lamellar bone.
New Histopathologic Evidence for the Parasympathetic Innervation of the Kidney and the Mechanism of Hypertension Following Subarachnoid Hemorrhage
Authors: Kepoglu Umit , Kanat Ayhan , Aydin Mehmet Dumlu , Akca Nezih , Kazdal Hizir , Zeynal Mete , Kantarci Mecit , Sipal Sare Altas 
Published: December 2019

Background:
The Cushing response was first described in 1901. One of its components is elevated systemic blood pressure secondary to raised intracranial pressure. However, controversy still exists in its pathophysiologic mechanism. Hypertension is attributed to sympathetic overactivity and vagotomy increased renal-based hypertension. However, the role of the parasympathetic system in hypertension has not been investigated. This subject was investigated following subarachnoid hemorrhage (SAH).

Methods:
A total of 24 rabbits were used: control group (n = 5), SHAM group (n = 5), and an SAH group (n = 14; bolus injection of blood into the cisterna magna). Blood pressures were examined before, during, and after the experiment. After 3 weeks, animals were decapitated under general anesthesia. Vagal nodose ganglion, axonal degeneration, and renal artery vasospasm (RAV) indexes of all animals were determined histopathologically.

Results:
Significant degenerative changes were detected in the vagal axons and nodose ganglia following SAH in animals with severe hypertension. The mean degenerated neuron density of nodose ganglions, vasospasm index (VSI) values of renal arteries of control, SHAM, and study groups were estimated as 9.0 ± 2.0 mm3, 1.87 ± 0.19; 65.0 ± 12.0 mm3, 1.91 ± 0.34; and 986.0 ± 112.0 mm3, 2.32 ± 0.89, consecutively. Blood pressure was measured as 94.0 ± 10.0 mmHg in control group, 102.0 ± 12.0 mmHg in SHAM; 112.0 ± 14.0 mmHg in middle (n = 9); and >122.0 ± 10.0 mmHg in severe RAV-developed animals (n = 5). Differences VSI values and blood pressure between groups were statistically significant (P < 0.05).

Conclusion:
The degeneration of vagal nodose ganglion has an important role in RAV and the development of RAV and hypertension following SAH.
The Effect of Hyaluronidase on the Fat Graft
Authors: Kim Seung Ki , Yang Jun Young , Kim Chan Woo , Baek Seung Hwa , Kim Uigeon , Hwang Euna 
Published: December 2019

Background:
Fat grafting has been widely used for facial rejuvenation and soft tissue reconstruction. However, it is associated with a lower retention rate than expected and complications such as fat necrosis or calcification. Several techniques that may increase the survival rate of fat grafts have been proposed. The techniques that promote the recipient sites vascularity to increase the survival rate of fat grafts include administration of growth factors, platelet- rich plasma, and adipose derived-stem cells or preconditioning of the recipient fat graft site.

Methods:
In this study, the authors evaluated the effect of hyaluronidase on autologous fat graft survival by pretreatment with hyaluronidase at the recipient site by using an animal model. In the experimental group, the recipient site of the fat graft was pretreated with hyaluronidase before fat grafting, whereas the control group was pretreated with normal saline.

Results:
After 8 weeks of fat grafting, the average volume retention was 78.2% in the experimental group and 68.6% in control group. Considerable fibrosis between the fat globules in the control group was confirmed with Masson trichrome staining. CD31 immunofluorescence staining was performed and stained vessels were counted. Counted vessel number was significantly greater in the experimental group than in the control group.

Conclusions:
Pretreatment of hyaluronidase on the fat graft recipient site is a good option to enhance the outcome of the fat graft in the clinical setting.
Digital interventions for adolescent and young adult cancer survivors
Authors: Viola Adrienne , Panigrahi Gargi , Devine Katie A. 
Published: December 2019

Purpose of review
AYA patients with cancer have a unique set of psychosocial and support needs to compared with their younger and older counterparts. Digital health interventions overcome many of the barriers to AYA participation in behavioral health interventions. Due to the rapid shifts in digital health, it is important to continually assess the state of the field.

Recent findings
There has been a sharp increase in the number of digital health interventions published in the literature. Interventions are using a variety of modalities and targeting many health behaviors and psychosocial outcomes. Most studies are focused on feasibility and acceptability, and use single-arm and prepost methodologies.

Summary
Although randomized controlled trials remain an important design for evaluating efficacy of interventions, the field of digital health interventions would benefit from employing alternative methodologies and analytic approaches to develop and optimize digital health interventions aligned with rapidly evolving technology.