bluuebunny/crossref_metadata_2025_split huggingface dataset:
Plate-Assisted Intramedullary Nailing of Proximal Third Tibia Fractures
Authors: Cinats David J. , Perey Bertrand , Moola Farhad , Boyer Dory , Lemke Helmut M. , Stone Trevor , Apostle Kelly , Viskontas Darius 
Published: December 2019

Objectives:
To report on the safety of unicortical plate stabilization in conjunction with intramedullary nailing (IMN) of proximal third tibia fractures.

Design:
Retrospective cohort.

Setting:
A Level I trauma center.

Patients/Participants:
All Orthopaedic Trauma Association 41A and 42A/B/C proximal tibia fractures treated with IMN from January 2011 to May 2018 were reviewed. Fifty-three proximal tibia fractures in 50 patients were included in the study. Twenty-four patients were treated with plate-assisted reduction and IMN, and 29 were treated with IMN alone. The plate-assisted IMN cohort was subdivided into patients with plate retention and those that had the plate removed.

Intervention:
Plate-assisted IMN and IMN only.

Main Outcome Measurements:
Patients were followed up for evidence of nonunion, reduction quality, postoperative infection, and rate of implant removal.

Results:
There were no statistically significant differences between plate-assisted IMN and IMN only for age, fracture type, mechanism of injury, quality of reduction, or implant removal rate. Open fractures were treated more often with plate-assisted IMN (88%) compared with the number of open fractures treated with IMN only (12%). There were no differences in nonunion rate or rate of postoperative infection between the 2 groups.

Conclusions:
Plate-assisted IMN of proximal third tibia fractures can safely be performed even in open tibia fractures with similar rates of nonunion, infection, and implant removal rates to patients treated with IMN only.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Determinants of Direct Discharge Home From Critical Care Units: A Population-Based Cohort Analysis*
Authors: Martin Claudio M. , Lam Melody , Allen Britney , Richard Lucie , Lau Vincent , Ball Ian M. , Wunsch Hannah , Fowler Rob A. , Scales Damon C. 
Published: December 2019

Objective:
To describe trends and patient and system factors associated with direct discharge from critical care to home in a large health system.

Design:
Population-based cohort study of direct discharge to home rates annually over 10 years. We used a multivariable, multilevel random-effects regression model to analyze current factors associated with direct discharge home in a subcohort from the most recent 2 years.

Setting:
One hundred seventy-four ICUs in 101 hospitals in Ontario.

Patients:
All patients discharged from an ICU between April 1, 2007, and March 31, 2017.

Interventions:
None.

Measurements and Main Results:
Overall, 237,200 patients (21.1%) were discharged directly home from an ICU. The rate of direct discharge to home increased from 18.6% in 2007 to 23.1% in 2017 (annual increase of 1.02; 95% CI, 1.02–1.03). There were marked variations in rates of direct discharge to home across all critical care units. For medical and surgical units, the median odds ratio was 1.76 (95% CI, 1.59–1.92). In these units, direct discharge to home was associated with younger age (odds ratio, 0.36; 95% CI, 0.34–0.39 for age 80–105 vs age 18–39), fewer comorbidities (odds ratio, 1.74; 95% CI, 1.63–1.85 for Charlson comorbidity index of 0 vs 2), diagnoses of overdose/poisoning (odds ratio, 1.35; 95% CI, 1.23–1.47) and diabetic complications (odds ratio, 1.35; 95% CI, 1.2–1.51), and admission after a same-day procedure (odds ratio, 2.82; 95% CI, 2.46–3.23 compared with emergency department). ICU occupancy was inversely associated with direct discharge to home with an odds ratio of 0.88 (95% CI, 0.87–0.88) for each 10% increase.

Conclusions:
High rates of direct discharge to home with evidence of significant practice variation combined with identifiable patient characteristics suggest that further evaluation of this increasingly common transition in care is warranted.
Loss of the posteromedial support: a risk factor for implant failure after fixation of AO 31-A2 intertrochanteric fractures
Authors: Ye Kai-Feng , Xing Yong , Sun Chuan , Cui Zhi-Yong , Zhou Fang , Ji Hong-Quan , Guo Yan , Lyu Yang , Yang Zhong-Wei , Hou Guo-Jin , Tian Yun , Zhang Zhi-Shan 
Published: December 2019

Abstract

Background:
The purpose of this study was to analyze cases of AO31-A2 intertrochanteric fractures (ITFs) and to identify the relationship between the loss of the posteromedial support and implant failure.

Methods:
Three hundred ninety-four patients who underwent operative treatment for ITF from January 2003 to December 2017 were enrolled. Focusing on posteromedial support, the A2 ITFs were divided into two groups, namely, those with (Group A, n = 153) or without (Group B, n = 241) posteromedial support post-operatively, and the failure rates were compared. Based on the final outcomes (failed or not), we allocated all of the patients into two groups: failed (Group C, n = 66) and normal (Group D, n = 328). We separately analyzed each dataset to identify the factors that exhibited statistically significant differences between the groups. In addition, a logistic regression was conducted to identify whether the loss of posteromedial support of A2 ITFs was an independent risk factor for fixation failure. The basic factors were age, sex, American Society of Anesthesiologists (ASA) score, side of affected limb, fixation method (intramedullary or extramedullary), time from injury to operation, blood loss, operative time and length of stay.

Results:
The failure rate of group B (58, 24.07%) was significantly higher than that of group A (8, 5.23%) (χ
2 = 23.814, P < 0.001). Regarding Groups C and D, the comparisons of the fixation method (P = 0.005), operative time (P = 0.001), blood loss (P = 0.002) and length of stay (P = 0.033) showed that the differences were significant. The logistic regression revealed that the loss of posteromedial support was an independent risk factor for implant failure (OR = 5.986, 95% CI: 2.667–13.432) (P < 0.001).

Conclusions:
For AO31-A2 ITFs, the loss of posteromedial support was an independent risk factor for fixation failure. Therefore, posteromedial wall reconstruction might be necessary for the effective treatment of A2 fractures that lose posteromedial support.
New treatment standards for vulvar cancer 2020
Authors: Woelber Linn , Jaeger Anna , Prieske Katharina 
Published: December 2019

Purpose of review
To highlight the recent advances regarding molecular mechanisms and therapeutic strategies in vulvar squamous cell carcinoma (VSCC), a rare but continuously rising disease.

Recent findings
Clinical research focuses on deescalation especially with regard to surgery. Recurrence patterns have been analyzed to further understand the course of disease showing a persistent risk for local recurrence even several years after the initial diagnosis. The main focuses of recent translational research are the distinct molecular mechanisms behind human papillomavirus (HPV)-positive and -negative VSCC. Next-generation sequencing analyses have highlighted TP53 as central driver mutation in HPV-negative disease. For HPV-independent VSCC, an impaired prognosis with limited disease-free and overall survival has been reported from a large multicenter analysis. Although no targeted agent has been granted approval, the impact of immunotherapy in vulvar cancer has been investigated in basket trials. Therapy response, however, was limited.

Summary
Further clinical research should focus on deciphering the molecular mechanisms of tumor development further. Detailed understanding of the molecular landscape will help to find novel therapy targets, fight the disease in advanced stages and thereby improve the quality of life for affected patients.
Finger-Prick Autologous Blood in the Treatment of Persistent Corneal Epithelial Defects
Authors: Balal Shafi , Nitiahpapand Rynda , Hassan Ali , Than Jonathan , Patel Amit , Kumar Bimal , Sharma Anant 
Published: December 2019

Purpose:
Autologous hemoderivative eye drops have a role in the management of persistent epithelial defects (PEDs), but their use may be limited by cost and availability. Finger-prick autologous blood (FAB) treatment uses whole capillary blood, obtained from a sterilized fingertip, as an alternative form of hemoderivative eye drop therapy. To date, 1 report has described the safe and effective use of FAB for dry eye and PEDs. We report the results of 10 eyes (10 patients) treated with FAB for PEDs.

Methods:
Ten patients with PEDs in 1 eye for a mean of 259 ± 201 days due to diabetic neurotrophic keratopathy (n = 3), herpetic keratitis (n = 3), postpenetrating keratoplasty (n = 1), keratoconjunctivitis sicca (n = 1), postradiotherapy (n = 1), and neuropathic ulcer (n = 1) were treated with FAB 4 times a day for 28 days in addition to conventional therapies. All patients had been unsuccessfully treated with conventional therapy before commencing on FAB. None of the patients had received any surgical treatment for PED.

Results:
At day 28, the PED had healed in 60% (n = 6) of the eyes. In 1 eye, the PED reduced in size by half. Thirty percent (n = 3) of patients had incomplete follow-up data at the end of the study.

Conclusions:
FAB in combination with conventional treatment may be successfully used in the management of refractory PEDs. No adverse effects arising from FAB treatment were observed.
Morphological and Optical Determinants of Visual Disability in Fuchs Endothelial Corneal Dystrophy
Authors: Wacker Katrin , Grewing Viviane , Fritz Marianne , Böhringer Daniel , Reinhard Thomas 
Published: December 2019

Purpose:
To identify determinants of visual disability in patients with advanced Fuchs endothelial corneal dystrophy.

Methods:
This prospectively sampled cross-sectional study at a tertiary referral center included participants with clinically advanced Fuchs dystrophy requiring endothelial keratoplasty and no other vision-limiting pathologies. We quantified visual disability using the Fuchs dystrophy-specific Visual Function and Corneal Health Status (V-FUCHS) visual disability instrument. We calculated Fuchs dystrophy-specific glare and diurnal variation (Glare Factor) scores and visual acuity-related disability (Visual Acuity Factor) scores. To assess corneal morphology and optics, all participants underwent standardized Scheimpflug imaging and tests for disability glare and best-corrected visual acuity on Early Treatment Diabetic Retinopathy Study charts after subjective refraction. Associations of morphological and optical parameters with V-FUCHS scores were assessed adjusting for age, sex, and lenticular status.

Results:
Participants with more posterior corneal backscatter had more visual disability (higher scores), with participants in the highest quartile of backscatter (median, 1409 scatter units) having 0.57 higher Glare Factor scores (95% confidence interval, 0.14–1.00) and 0.61 higher Visual Acuity Factor scores (95% confidence interval, 0.15–1.06) compared with participants in the lowest quartile of backscatter (median, 812 scatter units). Other morphological and optical factors such as anterior corneal backscatter, higher-order aberrations, or edematous surface changes were not empirical contributors to visual disability, especially when accounting for posterior corneal backscatter.

Conclusions:
Corneal backscatter is a driver of characteristic visual disability in Fuchs dystrophy. Comprehensive assessments of morphology and direct quantification of disease-related disability may help identify the best candidates for endothelial keratoplasty.
Cost–Benefit and Cost–Utility Analysis of Amphotericin B Supplementation of Corneal Storage Media With Endothelial Keratoplasty-Prepared Tissue
Authors: Chiang Trent Tsun-Kang , Shtein Roni M. , McCoy Kristen , Hurlbert Susan , Grossman Gregory H. 
Published: December 2019

Purpose:
To determine the cost-effectiveness of amphotericin B supplementation, we analyzed both current costs to treat postendothelial keratoplasty (EK) fungal infections and potential costs associated with amphotericin B supplementation.

Methods:
We collected 19 US cases of post-EK fungal eye infections from the published literature and assessed the associated costs from the literature. A survey of surgeons was also conducted with questions regarding their experiences in managing these infections.

Results:
We estimated that the costs to diagnose, manage, and treat post-EK fungal keratitis and post-EK fungal endophthalmitis are USD $21,113 and $34,850, respectively. The largest portion of the costs can be attributed to the need for additional surgical management, which is required in 79% of the cases. We estimated the total cost of amphotericin B supplementation to be $44.39 per graft with use of conventional amphotericin B and conservative assumptions regarding supplementation processes. Cost-effectiveness analysis demonstrated that amphotericin B supplementation is cost-effective at $100,000 per quality-adjusted life-year level only if amphotericin B supplementation can prevent more than 69.62% of post-EK fungal infections, assuming the incidence of post-EK fungal infection remains at the level it was between 2012 and 2017.

Conclusions:
We found that amphotericin B supplementation can be cost-effective under conservative assumptions if it is moderately effective in preventing post-EK fungal infections.
Iterative Development of an mHealth Intervention to Support Antiretroviral Therapy Initiation and Adherence Among Female Sex Workers in Mombasa, Kenya
Authors: Aunon Frances M. , Okada Elena , Wanje George , Masese Linnet , Odeny Thomas A. , Kinuthia John , Mandaliya Kishorchandra , Jaoko Walter , Simoni Jane M. , McClelland R. Scott 
Published: December 2019

Abstract
Nurses have an integral role to play in achieving the 95-95-95 goals to stem the HIV epidemic. We used the Information–Motivation–Behavioral Skills (IMB) theoretical model to develop a nurse-delivered, mHealth intervention to support antiretroviral therapy adherence among female sex workers living with HIV in Mombasa, Kenya. Twenty-three purposively sampled female sex workers living with HIV participated in 5 focus group discussions to iteratively develop the message content as well as the format and structure of the nurse-delivered, text-based intervention. Focus group discussion interview guides were developed in accordance with the IMB model. Transcripts were analyzed according to IMB themes, and findings were used to develop the intervention. Information-oriented texts addressed concerns and misconceptions; motivation-oriented texts reinforced women's desires to feel healthy enough to engage in activities; and behavioral skills-oriented texts included strategies to remember medication doses. The nurse-delivered, theory-based, culturally tailored intervention to support medication adherence was evaluated.
Increasing nurse practitioner students' comfort levels in caring for veterans with post-traumatic stress disorder
Authors: Cannady Jolene , Adams Judith 
Published: December 2019

ABSTRACT
Few nurse practitioner programs integrate education on care of veterans into their curriculum. Because more veterans are seeking health care outside of the Veteran Affairs system, all advanced practice nurses need to be prepared to meet the unique needs of veterans with post-traumatic stress disorder (PTSD). The authors developed an education session on military-to-civilian transition and screening and treatment of veterans with PTSD. The session was provided to a convenience sample of students. Case studies were included to allow student participation and active learning. Students completed pre-education and post-education surveys to measure their comfort level in caring for this specific population and their understanding of PTSD. The participant scores on comfort level with identifying and managing PTSD after the education session were significantly increased. Placing veteran-specific education into nurse practitioner programs enhances the comfort level with identifying and managing PTSD. Adding this veteran-specific education could enhance the overall care for veterans in the civilian sector.
Diagnostic Yield and Bleeding Complications Associated With Bronchoscopic Biopsy of Endobronchial Carcinoid Tumors
Authors: Gao Yang , Moua Teng , Midthun David E. , Mullon John J. , Decker Paul A. , Ryu Jay H. 
Published: December 2019

Background:
Bronchial carcinoid often appears hypervascular on bronchoscopic visualization and may be associated with hemoptysis. The diagnostic yield and bleeding complications associated with bronchoscopic biopsy of bronchial carcinoid tumors remain unclear.

Materials and Methods:
Patients with bronchial carcinoid tumors that were bronchoscopically visualized and biopsied at our tertiary referral medical center, over an 8-year period from 2010 to 2017, were retrospectively identified and reviewed to assess diagnostic yield and bleeding complications. Correlations with patient characteristics and carcinoid tumor features were analyzed.

Results:
Forty-nine patients were included (57% female). Tumors were predominantly (71%) located in proximal airways (mainstem and lobar bronchi). Bronchoscopic biopsy was diagnostic in 45 patients (92%). Thirteen patients (27%) experienced moderate (n=12, 25%) or severe (n=1, 2%) bleeding. Among these, 6 tumors (46%) had a vascular appearance and 4 patients (31%) had experienced recent hemoptysis. However, neither vascularity nor hemoptysis was associated with bleeding at biopsy (P=0.68 and 0.73, respectively). Carcinoid tumors were classified as typical in 79% and atypical in 21% with no difference in diagnostic yield or bleeding risk (P=0.28 and 0.92, respectively). Tumor size was also not associated with increased diagnostic yield or bleeding risk (P=0.54 and 0.39, respectively).

Conclusion:
Bronchoscopic biopsy of endobronchial carcinoid is associated with a high diagnostic yield and severe bleeding is rarely encountered. Diagnostic yield and bleeding seemed independent of vascular tumor appearance or history of recent hemoptysis.
Balloon-occluded Retrograde Transvenous Obliteration Versus Transjugular Intrahepatic Portosystemic Shunt for Gastric Varices
Authors: Yu Qian , Liu Chenyu , Raissi Driss 
Published: December 2019

Introduction:
Balloon-occluded retrograde transvenous obliteration (BRTO) and transjugular intrahepatic portosystemic shunt (TIPS) are well-validated techniques in the management of portal hypertensive gastric variceal bleeding when medical management alone is not sufficient. However, despite their effectiveness, the adverse effects from both procedures make each technique more suitable to different cohorts of patient’s depending on presence or lack of certain comorbidities. This study aims to compare clinical outcomes of patients who have undergone both procedures for portal hypertensive gastric variceal bleeding.

Materials and Methods:
We conducted a search of electronic databases from their establishment to April 2019. The goal was to compare the efficacy of BRTO and TIPS in preventing variceal rebleeding and the risk of adverse events such as ascites and hepatic encephalopathy. Predictors of overall survival and rebleeding were also analyzed. Meta-analysis was performed with STATA 15.1.

Results:
Five randomized controlled trials and retrospective cohort studies were included in our meta-analysis. The number of patients who underwent BRTO and TIPS were 308 and 127, respectively. BRTO and TIPS have similar technical success rates (91.4% vs. 89.7%, P=0.995) and immediate bleeding control rates (97.7% vs. 95.9%, P=0.836). However, compared with TIPS, BRTO has lower likelihood of future cumulative rebleeding (10.6% vs. 18.7%, P=0.027) and hepatic encephalopathy (0.00% vs. 23.1%, P<0.001) but is more likely to aggravate ascites (22.4% vs. 4.3%, P=0.009). Serum albumin level and presence of hepatocellular carcinoma are both independent predictors of increased likelihood of rebleeding and overall survival (P<0.001).

Conclusions:
Both BRTO and TIPS are safe and effective interventions in the management algorithm of portal hypertensive gastric variceal bleeding. Although BRTO may be more effective at the prevention of future variceal rebleeding, the choice of BRTO versus TIPS should be tailored according to patient’s comorbidities.
Round Robin Evaluation of MET Protein Expression in Lung Adenocarcinomas Improves Interobserver Concordance
Authors: Boyle Theresa A. , Khalil Farah K. , Mino-Kenudson Mari , Sica Gabriel L. , Moreira Andre L. , Sholl Lynette M. , Knight Mirna Z. , Zhang Liping , Saller James , Varella-Garcia Marileila , Berry Lynne D. , Chen Heidi , Ellison Kim E. , Rivard Christopher J. , Kugler Kelly , Wistuba Ignacio I. , Fujimoto Junya , Kwiatkowski David J. , Bunn Paul A. , Kris Mark G. , Haura Eric B. , Hirsch Fred R. 
Published: December 2019

Introduction:
Overexpression of the mesenchymal-epithelial transition (MET) receptor, a receptor tyrosine kinase, can propel the growth of cancer cells and portends poor prognoses for patients with lung cancer. Evaluation of MET by immunohistochemistry is challenging, with MET protein overexpression varying from 20% to 80% between lung cancer cohorts. Clinical trials using MET protein expression to select patients have also reported a wide range of positivity rates and outcomes.

Materials and Methods:
To overcome this variability, the Lung Cancer Mutation Consortium Pathologist Panel endeavored to standardize the evaluation of MET protein expression with “Round Robin” conferences. This panel used randomly selected Aperio-scanned formalin-fixed paraffin-embedded lung cancer specimens stained by MET immunohistochemistry for the Lung Cancer Mutation Consortium 2.0 study (N=838). Seven pathologists in separate laboratories scored images of 5 initial cases and 2 subsequent rounds of 39 cases. The pathologists’ scores were compared for consistency using the intraclass correlation coefficient. Issues affecting reproducibility were discussed in Round Robin conferences between rounds, and steps were taken to improve scoring consistency, such as sharing reference materials and example images.

Results:
The overall group intraclass correlation coefficient comparing the consistency of scoring improved from 0.50 (95% confidence interval, 0.37-0.64) for the first scoring round to 0.74 (95% confidence interval, 0.64-0.83) for the second round.

Discussion:
We found that the consistency of MET immunohistochemistry scoring is improved by continuous training and communication between pathologists.
Should We Stick with Surgical Glues? The Incidence of Dermatitis after 2-Octyl Cyanoacrylate Exposure in 102 Consecutive Breast Cases
Authors: Nigro Lauren C. , Parkerson Jamie , Nunley Julia , Blanchet Nadia 
Published: December 2019

Summary:
Skin adhesives have become standard in wound closure as alternatives to traditional sutures or as sterile occlusive dressings after surgery of all types. The literature is replete with case reports of contact dermatitis following exposure to cyanoacrylate-based adhesives, such as 2-octyl cyanoacrylate. Nonetheless, it has been the impression of the senior author and others that the incidence of allergic and/or contact dermatitis is much higher than commonly considered. The authors prospectively studied 102 consecutive patients who underwent breast surgery performed by the senior author with 2-octyl cyanoacrylate placed over incisions as an occlusive dressing. Two patients with a known glue allergy did not receive cyanoacrylate at surgery but were scratch tested to confirm the diagnosis. All patients were followed postoperatively. Twelve patients went on to develop significant dermatitis postoperatively after glue placement. Cyanoacrylate was confirmed as the cause of all rashes by allergy scratch testing for a total incidence of 14 percent (14 patients). Given the popularity of cyanoacrylate products across emergency rooms, clinics, and operating rooms, awareness of the true incidence of these reactions may caution against their use in the future.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.