bluuebunny/crossref_metadata_2025_split huggingface dataset:
Taylor Spatial Frame or Reamed Intramedullary Nailing for Closed Fractures of the Tibial Shaft: A Randomized Controlled Trial
Authors: Frihagen Frede , Madsen Jan E. , Sundfeldt Mikael , Flugsrud Gunnar B. , Andreassen Joakim S. , Andersen Mette R. , Andreassen Geir S. 
Published: May 2020

Objectives:
To compare a modern ring fixator [Taylor Spatial Frame (TSF)] and reamed intramedullary nailing (IMN) for the treatment of closed tibial shaft fractures.

Design:
Randomized controlled trial.

Setting:
Two university hospitals.

Patients:
Patients between 18 and 70 years of age surgically treated for an acute tibial shaft fracture.

Intervention:
TSF (n = 31) versus a reamed intramedullary nail (n = 32). The patients were followed up for 2 years.

Main Outcome Measurements:
The physical component summary of Short Form 36 (SF-36) at 2 years was the primary outcome measure. Secondary outcomes included the other components of the SF-36, pain assessed by a visual analogue scale (VAS), complications, and resource consumption.

Results:
The mean age was 43 years (SD 14.0), and 42 (67%) were men. The physical component summary at 2 years was 52.4 (SD 6.3) in the TSF group and 53.3 (SD 8.0) in the IMN group (P = 0.35). There were modest differences in the other SF-36 scores during the follow-up period. Up to and including 12 months, the TSF group had less knee pain [at 12 months: VAS 0.5 (SD 1.2) vs. VAS 2.4 (SD 2.2; P < 0.001)], but this was not statistically significant at 24 months [VAS 0.7 (SD 1.4) vs. VAS 1.5 (SD 2.0; P = 0.11)]. Superficial skin infections were more frequent in the TSF group [22 (71%) vs. 4 (13%); P < 0.001]. The number of other complications was similar between the groups.

Conclusions:
Both TSF and IMN provided good clinical results. TSF had more pin-track infections but less knee pain the first year.

Level of Evidence:
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Distance Between Reproductive Structures and the Insertion Point of the Retrograde Pubic Ramus Screw
Authors: Luksameearunothai Kitchai , Amin Raj M. , Shafiq Babar , Hasenboehler Erik A. 
Published: May 2020

Objective:
To identify the distance between the guidewire for a retrograde pubic ramus screw and critical reproductive structures in men and women.

Methods:
Twenty hemipelves from 10 fresh-frozen cadavers (pelvis to distal femur) were studied. The mean (±SD) age was 77 ± 6 years for the 5 male cadavers and 71 ± 9 years for the 5 female cadavers. A 2.8-mm guidewire for a cannulated screw was inserted from the parasymphyseal bone using fluoroscopic guidance. The soft tissue was dissected and measurements performed by the first author. In men, we measured the closest distances from the guidewire entry point to the contralateral spermatic cord and corpus cavernosum. In women, we measured the closest distances from the guidewire entry point to the base of the clitoral body and clitoral glans.

Results:
In male cadavers, mean distances were 8.8 ± 4.2 mm to the spermatic cord and 13 ± 6.7 mm to the corpus cavernosum. The guidewire did not penetrate these structures in any specimen. In female cadavers, mean distances were 12 ± 5.7 mm to the base of the clitoral body and 40 ± 8.2 mm to the clitoral glans. The guidewire also did not penetrate these structures.

Conclusions:
The contralateral spermatic cord and corpus cavernosum in men and the base of the clitoral body in women are close to the pathway of the retrograde ramus screw guidewire. Careful identification of the entry point and avoidance of multiple attempts of guidewire insertion may reduce the risk of injury to these structures.
Guided Growth for Ankle Valgus Deformity: The Challenges of Hardware Removal
Authors: Westberry David E. , Carpenter Ashley M. , Thomas Jonathan T. , Graham George D. , Pichiotino Erin , Hyer Lauren C. 
Published: May 2020

Background:
Ankle valgus deformity is associated with conditions such as clubfoot, cerebral palsy, and myelodysplasia. Guided growth strategies using a transphyseal screw provide effective correction of ankle valgus deformity. When correction occurs before skeletal maturity, screw removal is required to prevent overcorrection in the coronal plane. In this study, we reviewed the outcomes of guided growth procedures for correction of ankle valgus and related difficulty with hardware extraction.

Methods:
A retrospective review of patients with ankle valgus managed with transphyseal screw placement was performed. Clinical and radiographic data, including the lateral distal tibial angle (LDTA), type of screw placed, and time to correction was recorded. At hardware removal, we reviewed elements associated with difficult extraction defined as requiring the use of specialized screw removal/extraction sets or inability to remove the entirety of the screw.

Results:
One hundred nineteen patients (189 extremities) with a mean age of 11.7 years at time of screw placement met study inclusion criteria. Following correction of the valgus deformity, hardware removal occurred at an average of 18.4 months after placement of the screw. Preoperatively, the mean LDTA for the entire cohort was 81.3 degrees, and was corrected to a mean LDTA of 91.1 degrees. Complicated hardware removal occurred in 69 (37%) extremities. These 69 extremities had hardware in place an average of 1.8 years compared with an average of 1.4 years in extremities without difficult extraction (P<0.01). Six (9%) screws were unable to be removed in their entirety. Rebound valgus deformity occurred in 5 extremities (3%).

Conclusions:
Extraction of transphyseal screws in the correction of ankle valgus can be problematic. Specialized instrumentation was required in approximately one third of cases. Longevity of screw placement may be a factor that affects the ease of extraction. Additional exposure, access to specialized instrumentation, and additional operative time may be required for extraction.

Level of Evidence:
Level IV—case series.
Two-level Posterior Lumbar Interbody Fusion at the Lumbosacral Segment has a High Risk of Pseudarthrosis and Poor Clinical Outcomes
Authors: Fujimori Takahito , Sakaura Hironobu , Ikegami Daisuke , Sugiura Tsuyoshi , Mukai Yoshihiro , Hosono Noboru , Tateishi Kosuke , Fuji Takeshi 
Published: May 2020

Study Design:
This was a retrospective study.

Objectives:
The purposes of this study were to investigate the fusion rate and clinical outcomes of 2-level posterior lumbar interbody fusion (PLIF).

Summary of Background Data:
PLIF provides favorable clinical outcomes and a high fusion rate. However, most extant studies have been limited to the results of single-level PLIF. Clinical outcomes and fusion rate of 2-level PLIF are unknown.

Materials and Methods:
In total, 73 patients who underwent 2-level PLIF below L3 between 2008 and 2016 (follow-up period >2 y) were included. Patients were divided into the 2 groups on the basis of surgical level. The lumbar group included 48 patients who underwent L3/4/5 PLIF, and the lumbosacral group included 25 patients who underwent L4/5/S PLIF. Fusion rate and clinical outcomes were compared. The Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and a visual analog scale were used for evaluation.

Results:
Fusion rate was significantly lower in the lumbosacral group (lumbar 96% vs. lumbosacral 64%; P<0.001). Eight of 9 cases of pseudarthrosis occurred at the lumbosacral segment. Improvement in the mental health domain of the JOAPEQ was significantly lower in the lumbosacral group (lumbar 16 vs. lumbosacral 10; P=0.02). The VAS data showed that improvements in the following variables were significantly lower in the lumbosacral group than in the lumbar group: pain in low back (lumbar −38 vs. lumbosacral −23; P=0.004), pain in buttocks or lower leg (lumbar −48 vs. lumbosacral −29; P=0.04), and numbness in buttocks or lower leg (lumbar −44 vs. lumbosacral −33; P=0.04).

Conclusions:
Two-level PLIF at the lumbosacral segment demonstrated a significantly lower fusion rate and poorer clinical outcomes than that at the lumbar-only segments. Some reinforcement for the sacral anchor is recommended to improve fusion rate, even for short fusion like 2-level PLIF, if the lumbosacral segment is included.

Level of Evidence:
Level III.
Do Temporal Changes in Facial Expressions Help Identify Patients at Risk of Deterioration in Hospital Wards? A Post Hoc Analysis of the Visual Early Warning Score Study
Authors: Madrigal-Garcia Maria Isabel , Archer Dawn , Singer Mervyn , Rodrigues Marcos , Shenfield Alex , Moreno-Cuesta Jeronimo 
Published: May 2020

Objectives:
To determine whether time-series analysis and Shannon information entropy of facial expressions predict acute clinical deterioration in patients on general hospital wards.

Design:
Post hoc analysis of a prospective observational feasibility study (Visual Early Warning Score study).

Setting:
General ward patients in a community hospital.

Patients:
Thirty-four patients at risk of clinical deterioration.

Interventions:
A 3-minute video (153,000 frames) for each of the patients enrolled into the Visual Early Warning Score study database was analyzed by a trained psychologist for facial expressions measured as action units using the Facial Action Coding System.

Measurements and Main Results:
Three-thousand six-hundred eighty-eight action unit were analyzed over the 34 3-minute study periods. The action unit time variables considered were onset, apex, offset, and total time duration. A generalized linear regression model and time-series analyses were performed. Shannon information entropy (Hn) and diversity (Dn) were calculated from the frequency and repertoire of facial expressions. Patients subsequently admitted to critical care displayed a reduced frequency rate (95% CI moving average of the mean: 9.5–10.9 vs 26.1–28.9 in those not admitted), a higher Shannon information entropy (0.30 ± 0.06 vs 0.26 ± 0.05; p = 0.019) and diversity index (1.36 ± 0.08 vs 1.30 ± 0.07; p = 0.020) and a prolonged action unit reaction time (23.5 vs 9.4 s) compared with patients not admitted to ICU. The number of action unit identified per window within the time-series analysis predicted admission to critical care with an area under the curve of 0.88. The area under the curve for National Early Warning Score alone, Hn alone, National Early Warning Score plus Hn, and National Early Warning Score plus Hn plus Dn were 0.53, 0.75, 0.76, and 0.81, respectively.

Conclusions:
Patients who will be admitted to intensive care have a decrease in the number of facial expressions per unit of time and an increase in their diversity.
Personalized Ventilation to Multiple Patients Using a Single Ventilator: Description and Proof of Concept
Authors: Han Jay S. , Mashari Azad , Singh Devin , Dianti Jose , Goligher Ewan , Long Michael , Ng William , Wasowicz Marcin , Preiss David , Vesely Alex , Kacmarek Robert , Keshavjee Shaf , Brochard Laurent , Fisher Joseph A. , Slutsky Arthur S. 
Published: May 2020

Objectives:
To design and test a ventilator circuit that can be used for ventilation of two or more patients with a single ventilator, while allowing individualization of tidal volume, fractional concentration of oxygen, and positive end-expiratory pressure to each patient, irrespective of the other patient’s respiratory system mechanics.

Design:
Description and proof of concept studies.

Settings:
Respiratory therapy laboratory.

Subjects:
Ventilation of mechanical test lungs.

Interventions:
Following a previously advocated design, we used components readily available in our hospital to assemble two “bag-in-a-box” breathing circuits. Each patient circuit consisted of a flexible bag in a rigid container connected via one-way valve to a test lung, along with an inline positive end-expiratory pressure valve, connected to the ventilator’s expiratory limb. Compressed gas fills the bags during “patient” exhalation. During inspiration, gas from the ventilator, in pressure control mode, enters the containers and displaces gas from the bags to the test lungs. We varied tidal volume, “respiratory system” compliance, and positive end-expiratory pressure in one lung and observed the effect on the tidal volume of the other.

Measurements and Main Results:
We were able to obtain different tidal volume, dynamic driving pressure, and positive end-expiratory pressure in the two lungs under widely different compliances in both lungs. Complete obstruction, or disconnection at the circuit connection to one test lung, had minimal effect (< 5% on average) on the ventilation to the co-ventilated lung.

Conclusions:
A secondary circuit “bag-in-the-box” system enables individualized ventilation of two lungs overcoming many of the concerns of ventilating more than one patient with a single ventilator.
The effects of a new, improved Chinese medicine, Gengnianchun formula granules, on hot flushes, depression, anxiety, and sleep in Chinese peri- and postmenopausal women: a randomized placebo-controlled trial
Authors: Zhang Yang , Cao Yuankui , Wang Li 
Published: May 2020

Abstract

Objective:
The aim of the study was to investigate the effectiveness and safety of a new, improved herbal formula of a traditional Chinese medicine, improved Gengnianchun (I-GNC), on hot flushes, depression, anxiety, and sleep in peri- and postmenopausal women in China.

Methods:
A randomized, single-blind, placebo-controlled trial of peri- and postmenopausal women with Kupperman Index (KMI) scores of 15 or higher was conducted for 12 weeks. Hot flush frequencies, KMI scores, Hamilton depression scale scores, Hamilton anxiety scale scores, and Pittsburgh Sleep Quality Index scores were evaluated. Each outcome was evaluated every 4 weeks.

Results:
Ninety-eight participants completed the study. The I-GNC formula significantly reduced the mean (SD) frequency of hot flushes from 7 (4.554) to 1.2 (1.675) in the I-GNC group and from 6.74 (3.43) to 3.66 (2.635) in the placebo group (P < 0.01). The KMI (P < 0.01), Hamilton depression scale (P < 0.01), and Hamilton anxiety scale (P < 0.01) scores decreased in both groups after treatment, and significant differences were observed between the two groups (P < 0.01); however, no significant difference in the Pittsburgh Sleep Quality Index score was observed. I-GNC had no effect on serum follicle-stimulating hormone or E2 levels. There were no obvious adverse effects.

Conclusions:
The traditional Chinese medicine herbal formula I-GNC can alleviate the symptoms of menopausal syndrome and improve quality of life among peri- and postmenopausal women. I-GNC is safe and has no notable adverse effects.
Difference in the Cesium Body Contents of Affected Area Residents Depending on the Evacuation Timepoint Following the 2011 Fukushima Nuclear Disaster
Authors: Igarashi Yu , Kim Eunjoo , Hashimoto Shozo , Tani Kotaro , Yajima Kazuaki , Iimoto Takeshi , Ishikawa Tetsuo , Akashi Makoto , Kurihara Osamu 
Published: May 2020

Abstract
Estimating the internal thyroid dose received by residents involved in the 2011 Fukushima Daiichi Nuclear Power Plant (FDNPP) accident has been a challenging task because of the shortage of direct human measurements related to the largest contributing radioisotope to the dose, 131I. In a previous dose estimation, we used the results of whole-body counter (WBC) measurements targeting 134Cs and 137Cs, based on the assumption that these radioisotopes were incorporated at the same time as 131I in the early phase of the accident. The main purpose of this study was to clarify whether the trace of the early intake remained in the WBC measurements that were started several months after the accident. In the present work, WBC data of 1,639 persons from Namie town, one of the heavily contaminated municipalities, were analyzed together with their evacuation behavior data. The results demonstrated that the cesium detection rate in the WBC results was several times higher in the late evacuees [who evacuated outside the 20-km radius of the FDNPP at 3:00 p.m. (Japanese Local Time) on 12 March or later] compared to the prompt evacuees (who evacuated before 3:00 p.m. on 12 March). Among the adults, the cesium detection rates (and the 90th percentile values of the 137Cs intake) of the prompt and late evacuees were about 20% (5.4 × 103 Bq) and 60% (1.6 × 104 Bq), respectively. Approximately 20% of the individuals analyzed were categorized as late evacuees. These differences in cesium would be caused by exposure to the radioactive plume in the afternoon on 12 March, which was likely to influence the late evacuees. On the other hand, the intake on 15 March, when the largest release event occurred, was expected to be relatively small for Namie town's residents. In conclusion, the trace of the early intake remained in the WBC measurements, although this would not necessarily be true for all subjects. The results obtained from this study would provide useful information for the reconstruction of the early internal thyroid doses from radioiodine in the future.
MSC-Derived Extracellular Vesicles: New Emergency Treatment to Limit the Development of Radiation-Induced Hematopoietic Syndrome?
Authors: Cavallero Sophie , Riccobono Diane , Drouet Michel , François Sabine 
Published: May 2020

Abstract
Nuclear accidents or acts of terrorism involving radioactive sources might lead to mass casualties irradiation. The hematopoietic system is one of the most critical and radiation-sensitive tissues because the limited life span of blood cells requires the continuous division of hematopoietic stem cells (HSCs) into the bone marrow. The radiation-induced hematopoietic syndrome, RI-HS, is an impairment of the hematopoiesis that will result in pancytopenia of various degrees. In fact, treatment with granulocyte-colony stimulating factor (G-CSF) is considered as a valuable adjunct to treatment controls in some irradiated patients. Nevertheless, these overexposed patients with bone marrow suppression have minimal medullary territories that do not allow complete recovery of hematopoiesis but lead to significant immunoreactivity following allogeneic hematopoietic stem cell transplantation (HSCT). The high morbidity and mortality of these overexposed patients is a reminder of the lack of effective treatment for hematopoietic syndrome. During the last 20 y, a therapeutic approach for mesenchymal stem cells (MSC) has been proposed for the management of accidentally irradiated victims. Many preclinical animal studies have shown that MSC, mainly by their secretory activity, in particular extracellular vesicles (EVs), contribute to the control of inflammation and promote regeneration of tissues by accelerating angiogenesis and re-epithelialization processes. Therefore, we investigated the potential effect of EVs on the reduction of early bone marrow ionization toxicity, early anti-apoptotic therapy, and vascular protection in the RI-HS model. The main purpose is to propose an innovative treatment of non-patient-specific RI-HS emergency treatment in order to limit allogeneic HSC.
RETAINED, NONDISSOLVING, TUBULAR FOREIGN BODIES IN THE VITREOUS CAVITY AFTER INTRAVITREAL DEXAMETHASONE (OZURDEX) IMPLANTATION
Authors: Han Ian C. , Critser D. Brice , Amram Alec L. , Folk James C. 
Published: May 2020

Purpose:
To describe the retention of large, tubular, nondissolving foreign bodies because of a complication of the intravitreal dexamethasone implant (Ozurdex).

Methods:
This is a single-center, retrospective chart review of patients who were found to have retained, nondissolvable tubular foreign bodies in the vitreous cavity for more than 6 months (the expected dissolution time of the implants) after Ozurdex injections. Ocular symptomatology and multimodal imaging were reviewed.

Results:
Five patients had retained, nondissolvable tubular foreign bodies in the vitreous that persisted for months (mean 28.2 months, range 9–67 months) after intravitreal injection of Ozurdex. Two patients were symptomatic due to the foreign bodies and chose alternate local therapy, but none of the patients opted for surgical explantation.

Conclusion:
Persistent, nondissolving, tubular foreign bodies can be seen in the vitreous cavity for years after injection of the Ozurdex implant. Clinicians should be aware of this complication that has the potential to cause visual symptoms and ocular morbidity.
Usefulness of Optical Coherence Tomography Angiography in the Differential Diagnosis Between Superior Segmental Optic Hypoplasia and Normal-tension Glaucoma
Authors: Lee So Yeon , In Jung Hee , Kim Chang Hwan , Hong Young Jae 
Published: May 2020

Purpose:
The differential diagnosis of superior segmental optic hypoplasia (SSOH) and normal-tension glaucoma (NTG) is an issue in the ophthalmologic field. To date, several modalities have been developed to solve this issue; however, no standard methods have been established. Recently, optical coherence tomography angiography (OCTA) has been introduced to better evaluate the volumetric angiography images. Therefore, in this study, we investigated the usefulness of OCTA in differentiating between SSOH and NTG.

Materials and Methods:
In this retrospective study, we included 26 patients with SSOH who had definite visual field defects and 40 patients with NTG who had only inferior visual field defects. Age, sex, intraocular pressure, refractive error, retinal nerve fiber layer thickness, and visual field defects were compared between the groups. In addition, we analyzed and compared the peripapillary vessel density (VD) measured on OCTA between the groups. The area under the receiver operating characteristic curves were obtained for each parameter.

Results:
On Cirrus HD-OCT, the retinal nerve fiber layer in patients with SSOH was thinner in the superonasal segment and thicker in the superotemporal segment compared with patients with NTG. In the analysis of OCTA, the peripapillary VD of the superonasal segment was significantly lower in the SSOH group than in the NTG group, while it was significantly higher in the superotemporal segment in the SSOH group than in the NTG group. The optimal superonasal-to-superotemporal ratio cutoff was 0.8828, with a sensitivity of 95% and specificity of 92.3%, for the diagnosis of SSOH (area under the receiver operating characteristic curve=0.962).

Conclusions:
Our findings suggest that the superonasal-to-superotemporal VD ratio measured on OCTA may be used to distinguish between SSOH and NTG. However, further large-scale studies are required to verify our findings.
Transient Myopia Secondary to Supraciliary Effusion: Unusual Complication After an Uneventful Prolene Gonioscopy-assisted Transluminal Trabeculotomy
Authors: Aktas Zeynep , Ucgul Ahmet Y. , Segawa Asadu 
Published: May 2020

Purpose:
The purpose of this study was to report 2 cases experiencing a transient decrease in their vision due to the development of acute myopia after an uneventful prolene gonioscopy-assisted transluminal trabeculotomy (GATT) surgery.

Methods:
A 52-year-old woman with primary open-angle glaucoma and an 8-year-old boy with juvenile glaucoma underwent uneventful GATT surgery.

Results:
On the postoperative first day, both patients had mild shallow anterior chamber and intraocular pressures measured as 19 and 16 mm Hg, respectively. Both patients had myopia measured as −4.5 and −6.0 D, respectively. Fundus examination was unremarkable in the first patient, whereas it showed bilateral optic disc cupping and retinal nerve fiber layer atrophy in the second patient. In the first patient, supraciliary effusion was detected by using ultrasound biomicroscopy. Ultrasound biomicroscopy could not be performed in the second patient, but ocular ultrasonography revealed a thin layer of suprachoroidal fluid. Myopia was completely regressed, and visual acuity increased within 1 week of the follow-up in both patients. At the sixth month of the follow-up, intraocular pressures in both patients were under control without any antiglaucoma medications.

Conclusion:
Transient decrease in vision after the GATT surgery might occur secondary to supraciliary effusion leading to acute, transient myopia.