bluuebunny/crossref_metadata_2025_split huggingface dataset:
Utility of Postreduction Radiographs After Fluoroscopy-Guided Reduction and Casting of Uncomplicated Pediatric Forearm Fractures
Authors: Chitnis Salil , Giordano Jon , Naraghi Leily , Bonadio William 
Published: January 2020

Objective
The aim of the study was to determine efficacy of performing postreduction radiographs in managing uncomplicated pediatric forearm fractures after reduction and casting under fluoroscopic guidance.

Design
This is retrospective analysis of consecutive cases.

Setting
The study was conducted in a large urban hospital pediatric emergency department (ED).

Participants
Pediatric patients presenting to the ED with a forearm fracture between the ages of 0 to 18 years. All received orthopedic manual reduction with fluoroscopic guidance and casting, then followed by performance of a dedicated 2-view radiographic series of postreduction forearm to document proper alignment and cast placement.

Main Outcome(s) and Measure(s)
Of 236 consecutive cases studied, there were only 5 cases (2%) in which the managing orthopedist determined that a further reduction attempt was warranted based on the postreduction radiograph results. All were mid-shaft fractures of both radius and ulna, which were angulated and/or displaced. The remaining 231 patients with an uncomplicated forearm fracture received no further ED clinical orthopedic intervention after performing postreduction radiographs. The mean ED time to ultimate discharge was prolonged an average of 89 minutes per patient after reduction and casting while awaiting performance/orthopedic review of postreduction radiographs. A calculation of postreduction radiograph cost amounted to a total of nearly US $50,000.

Conclusions
Performance of postreduction radiographs in children with uncomplicated pediatric forearm fractures that are reduced and casted under fluoroscopy has little clinical utility and contributes to increased radiation exposure, patient health care cost, and time spent in the ED. Patients with mid-shaft forearm fractures involving both radius and ulna (especially if angulated or displaced) are at risk for unacceptable reduction after casting and may be the target group in which performing post reduction radiographs has potential benefit.
HIV Seroconversion and Types of Relationships Among Men Who Have Sex With Men: A Cohort Study in China
Authors: Sun Xiaoming , Wang Chunyan , Zhao Kun , Zhang Lifen , Li Menglong , Sun Dianqin , Shu Wen , Ruan Yuhua , Zhang Jinyan , Vermund Sten H. , Li Dongliang , Hu Yifei 
Published: January 2020

Background:
The role of partner types in modifying HIV seroconversion risk among men who have sex with men (MSM) is complex. We sought to understand the role of regular sexual partners and risky sexual behavior in contributing to incident HIV infection among MSM.

Methods:
From July 2011 to August 2017, we recruited HIV-negative men who reported having anal or oral homosexual encounters in the past 6 months and they were followed up every 3 months for 2 visits. We collected sociodemographic and behavioral characteristics by a self-administrated questionnaire. HIV status was confirmed by a sequential rapid test and confirmatory test. We used multivariable Cox regression to identify risk factors and interaction models to evaluate the relative excess risk between relevant variables.

Results:
Among 1218 participants, the HIV seroconversion rate was 3.66/100 person-years. HIV seroconversion was associated with lower educational attainment [adjusted hazards ratio (aHR)] = 1.73, 95% CI: 1.06 to 2.81), having had penetrative sex with male before age of 18 years (aHR = 2.44, 95% CI: 1.20 to 4.99), not using condoms in the last sexual encounter (aHR = 2.19, 95% CI: 1.29 to 3.71), and having regular but not committed partners (aHR = 3.33, 95% CI: 1.77 to 6.93). Among 890 (73%) of men reported having regular partners, HIV seroconversion was more frequent in men whose stable partners were not committed as boyfriends (aHR = 3.31, 95% CI: 1.73 to 6.36) and in men having unprotected anal sex (aHR = 2.61, 95% CI: 1.42 to 4.80). Interaction between these 2 factors was observed (relative excess risk of interaction = 4.53).

Conclusions:
Incidence among MSM in China was high; unprotected sex with steady but not committed partners was associated with increased seroconversion risk. It is imperative to expand safer sex education and training for MSM to reduce unsafe sexual behaviors, including awareness that casual partners are not the only source of infection.
Prolonged Amenorrhea and Low Hip Bone Mineral Density in Women Living With HIV—A Controlled Cross-sectional Study
Authors: King Elizabeth M. , Nesbitt Ariel , Albert Arianne Y.K. , Pick Neora , Cote Helene C.F. , Maan Evelyn J. , Prior Jerilynn C. , Murray Melanie C.M. ,   the CIHR team on Cellular Aging and HIV Comorbidities in Women and Children (CARMA)
Published: January 2020

Background:
Women living with HIV (WLWH) have higher rates of prolonged secondary amenorrhea (no flow for ≥1 year) than HIV-negative women. Both having amenorrhea and being HIV positive are associated with lower areal bone mineral density (BMD). However, their combined BMD effects remain unclear. Therefore, we investigated prolonged amenorrhea and BMD in WLWH and controls.

Methods:
This cross-sectional study enrolled WLWH and HIV-negative control women aged 19–68 years of similar backgrounds. We assessed BMD (Hologic; as age- and ethnicity-matched Z-scores) in the Children and women: AntiRetrovirals and Markers of Aging cohort. Participants were stratified by amenorrhea history defined as past/present lack of menses for ≥1 year at age 45 and younger and not because of surgery, breastfeeding, pregnancy, or hormonal contraception. Hip and spine Z-scores by amenorrhea/no amenorrhea used linear models with multivariable analysis for relationships within WLWH.

Results:
WLWH (N = 129) were similar to controls (N = 129) in age, body mass index, ethnicity, and substance use. Among WLWH, 21% experienced prolonged amenorrhea vs. 9% in controls. WLWH had significantly lower total hip (mean ± SD: −0.4 ± 0.9 vs. 0.3 ± 1.1; P < 0.001) and spine (−0.5 ± 1.3 vs. 0.2 ± 1.3; P = 0.001) Z-scores than controls. Amenorrhea was independently associated with hip (P = 0.01) but not spine (P = 0.94) BMD by multivariable linear regression. WLWH with amenorrhea had lower hip Z-scores (−0.8 ± 0.9) than those without (−0.3 ± 0.8; P = 0.01). They also had higher rates of substance use, smoking, opioid therapy, hepatitis C coinfection, and lower CD4 nadir.

Conclusions:
WLWH had higher rates of prolonged amenorrhea and lower BMD than controls. WLWH with amenorrhea experienced lower hip BMD Z-scores than those without. Prolonged amenorrhea is an added osteoporosis risk in WLWH.
An Exploratory Study of Correlates of Allostatic Load in Older People Living With HIV
Authors: Fazeli Pariya L. , Waldrop-Valverde Drenna , Yigit Ibrahim , Turan Bulent , Edberg Jeff , Kempf Mirjam , Vance David 
Published: January 2020

Background:
Older people living with HIV (PLWH) experience poorer outcomes than seronegative counterparts. Allostatic load (AL) markers have shown utility as indicators of cumulative wear-and-tear of stress on biological systems. However, little is known about correlates of AL in PLWH.

Methods:
Ninety-six PLWH aged 50+ completed a comprehensive neurobehavioral assessment and blood draw. Select AL markers (ie, 10 blood markers) were available for a subset (n = 75) of seronegative controls. AL was operationalized as a sum of markers in the highest risk quartile for: cortisol, DHEA, IL-6, TNF-alpha, C-reactive protein, glucose, total cholesterol, high-density lipoprotein cholesterol, triglycerides, albumin, systolic and diastolic blood pressure, and body mass index.

Results:
PLWH had higher risk levels than seronegatives with small–medium effect sizes for several biomarkers. Among HIV+ African Americans (84% of PLWH), higher AL was associated with lower psychological resilience (rho = −0.27, P = 0.02), less physical activity (rho = −0.29, P < 0.01), poorer neurocognitive functioning (rho = −0.26, P = 0.02), greater basic activity of daily living complaints (P < 0.01), and diabetes (P < 0.01). Multivariable regressions within African American PLWH for significant AL-outcome associations (ie, neurocognitive function, basic activity of daily living complaints, diabetes) showed that associations with AL remained significant when adjusting for relevant covariates. Mediation analysis suggested that the association between socioeconomic status and neurocognitive function was mediated by AL.

Conclusions:
These exploratory findings are consistent with the larger aging literature, suggesting that lower AL may serve as a pathway to better health and functional outcomes, particularly in African American PLWH. Furthermore, resilience and physical activity may reduce AL in this population.
Secondary Lymphedema Following Radical Prostatectomy
Authors: Cellina Michaela , Martinenghi Carlo , Gibelli Daniele , Menozzi Andrea , Soresina Massimo , Boccanera Dario , Giardini Denisa , Oliva Giancarlo 
Published: January 2020

Abstract
Lymphedema (LE) is a progressive chronic disorder, frequently related to malignancies and their treatment in Western countries. It markedly affected patients' quality of life, and its management is challenging, mainly based on conservative therapy, as bandages and manual lymphatic drainage, with limited results.
Recent advances in imaging technology and microsurgical techniques have changed the approach to this disorder, particularly the recent application of magnetic resonance for the study of LE and the increasingly widespread use of surgical interventions, such as vascularized lymph node transfer. As secondary LE due to radical prostatectomy and/or radiation treatment is a frequent cause of chronic disability in the male population, and few data are available in literature about which imaging technique can be applied to diagnose it and about the surgical modalities to treat this condition, we want to propose an overview on the lymphatic vessels anatomy and function, on the applications of noncontrast magnetic resonance lymphangiography and about the pieces of information this examination can provide, and on the technique of vascularized lymph node transfer and the rationale of this surgical procedure in secondary LE related to prostatic malignancy treatment.
Prepectoral Versus Subpectoral Implant-Based Breast Reconstruction
Authors: Li Yunzhu , Xu Gang , Yu Nanze , Huang Jiuzuo , Long Xiao 
Published: January 2020

Background
There is currently no consensus on the ideal plane for implant placement in breast reconstruction. The study compares the clinical efficacy and safety between prepectoral and subpectoral implant-based breast reconstruction.

Methods
PubMed, Web of Sciences, EMBASE, and Cochrane databases were systematically searched following the PRISMA guidelines. Inclusion criteria were articles describing implant-based breast reconstructions with implant placed either prepectorally or subpectorally. Primary outcomes were postoperative complications, pain score, and patients' quality of life.

Results
There were 15 studies including a total of 1868 patients. Overall complication rates were comparable between the prepectoral and subpectoral groups (odds ratio [OR], 0.79; confidence interval [CI], 0.57–1.10). The capsular contracture rate was reduced in the prepectoral group (OR, 0.45; CI, 0.27–0.73), whereas no significant difference was observed in terms of skin necrosis (OR, 0.72; CI, 0.45–1.17), implant loss (OR, 0.85; CI, 0.56–1.30), and patients' quality of life (standardised mean difference, 0.25; CI, −0.51 to 1.00).

Conclusion
The prepectoral implant-based breast reconstruction is a good alternative to subpectoral implant-based breast reconstruction for a certain group of patients, eliminating animation deformity without increasing complications.
Techniques for Patient Positioning During Burn Surgery
Authors: Vrouwe Sebastian Q. , Pham Christopher H. , Gillenwater T. Justin , Yenikomshian Haig A. 
Published: January 2020

Introduction
Patient positioning in the operating room remains a challenge for burn surgeons; burn surgery involves critically ill patients who require close monitoring, difficult exposures, and careful handling of grafted areas. Various techniques to optimize intraoperative positioning during burn surgery have been described in the literature. The aim of this review was to outline these positioning techniques and report on their complications.

Methods
A systematic review was performed by 2 independent reviewers using PubMed, Scopus, and OvidSP MEDLINE databases. Articles were included if they described intraoperative techniques to position patients undergoing burn surgery. The primary variable of interest was complications related to positioning during surgery.

Results
The search identified 1855 nonduplicate citations, of which 29 underwent full-text review, and 10 met inclusion criteria. Three studies described overhead suspension techniques, including a hook-and-pulley system, ceiling chains, weighted IV poles, and mounted crossbars; no complications were reported. Six studies described limb fixation techniques, including Steinmann pins, finger traps, wrist/ankle wraps, towel clips through eschar or distal phalanges, and external fixators. Complications included one case of hardware failure of external fixation and several pin site infections. Four studies described table modification techniques, including a modified Stryker frame, a fracture table, the Mayfield headrest, and the recliner position; no complications were reported.

Discussion
Numerous techniques have been described to improve patient positioning during burn surgery. No major complications were identified in this systematic review. Most techniques use standard operating room equipment and can aid in safe and easier operations.
The History of Alloplastic Ear Reconstruction for Microtia
Authors: Kozusko Steven D. , Konofaos Petros , Wallace Robert Doyle 
Published: January 2020

Abstract
Microtia reconstruction is a unique and challenging field in reconstructive surgery. In the early 20th century, many different alloplastic materials have been used in an attempt to recreate the fibrocartilaginous framework of the native ear. These materials include celluloid, tantalum wire cage, nylon mesh, polyethylene, and acrylic. The first standard for alloplastic microtia reconstruction, silicone, is one fraught with complications and failures. This alloplastic material is walled off by the host and prone to scar tissue formation and extrusion. Alloplastic microtia reconstruction largely shifts to porous polyethylene, where the results are markedly superior. This is attributed to the porous structure of porous polyethylene, which allows tissue ingrowth. Moreover, the use of the temporoparietal fascia flap for total coverage of the implant has impressively lowered the risk of implant extrusion. However, there is paucity in the literature regarding the evolution of alloplastic microtia reconstruction, especially characterizing historical mistakes, significant technique evolutions, and drawbacks/advantages of materials. This review serves as a guide both to avoid repeating mistakes and to improve outcomes.
Modulation of the HGF/c-Met Axis Impacts Prolonged Hematopoietic Progenitor Mobilization Following Trauma and Chronic Stress
Authors: Loftus Tyler J. , Kannan Kolenkode B. , Mira Juan C. , Brakenridge Scott C. , Efron Philip A. , Mohr Alicia M. 
Published: January 2020

ABSTRACT

Background:
Trauma and hemorrhagic shock trigger mobilization of hematopoietic progenitor cells (HPC) from bone marrow to peripheral blood. Hepatocyte growth factor (HGF), tyrosine-protein kinase Met (c-Met), matrix metallopeptidase 9 (MMP-9), and corticosterone regulate this mobilization process. We hypothesized that beta-blockade with propranolol and sympathetic outflow inhibition with clonidine following trauma and chronic stress would decrease hematopoietic progenitor cell mobilization.

Methods:
Sprague-Dawley rats were randomized to undergo three models of injury and stress: lung contusion, LC plus hemorrhagic shock (LCHS), or LCHS plus chronic restraint stress for 2 h daily (LCHS/CS). Propranolol and clonidine were administered by daily intraperitoneal injection until sacrifice on day seven. Bone marrow HGF, c-Met, and MMP-9 were measured by real-time PCR. Plasma corticosterone was measured by ELISA. Percentage HPC in peripheral blood was measured by flow cytometry.

Results:
Propranolol and clonidine significantly decreased bone marrow MMP-9 expression, plasma corticosterone levels, and HPC mobilization, and significantly increased hemoglobin levels. HPC mobilization was greatest following LCHS/CS (5.4 ± 1.8) and was significantly decreased by propranolol (2.2 ± 0.9, P < 0.001) and clonidine (1.7 ± 0.5, P < 0.001). Hemoglobin (g/dL) was lowest following LCHS/CS (12.3 ± 1.2) and was significantly increased by propranolol (13.7 ± 0.4, P = 0.022) and clonidine (14.1 ± 1.1, P < 0.001).

Conclusions:
Severe injury was associated with increased bone marrow HGF, c-Met, and MMP-9, circulating corticosterone, HPC mobilization, and persistent anemia. Attenuating the neuroendocrine response to injury and stress with propranolol and clonidine reduced MMP-9 expression, corticosterone levels, HPC mobilization, and the degree of anemia.
Robotic-assisted Pancreaticoduodenectomy: Technique Description and Performance Evaluation After 60 Cases
Authors: Marino Marco V. , Podda Mauro , Pisanu Adolfo , di Saverio Salomone , Fleitas Manuel G. 
Published: January 2020

Purpose:
Robotic pancreaticoduodenectomy (RPD) remains one of the most challenging abdominal operations. During the implementation of new surgical technologies, safety and efficacy outcomes must be rigorously monitored and the learning curve clearly identified.

Materials and Methods:
The authors investigated their experience during the adoption of RPD, analyzing the outcomes of our first 60 consecutive cases, divided into group A (1 to 30) and group B (31 to 60). The cumulative sum (CUSUM) analysis was used to define the learning curve.

Results:
The authors observed a reduction in operative time (125 min) and estimated blood loss (185 mL) between the firsts 1 to 30 and the latest 30 cases. The overall rate of complications showed the tendency to decrease during the experience (46.7% vs. 23.3%, P=0.02), conversely, severe complications and the rate of clinically relevant postoperative pancreatic fistula did not show a significant reduction in the incidence (P=0.37 and P=0.67, respectively). The mean number of lymph nodes harvested improved significantly after 30 cases (P=0.004).

Conclusion:
Surgical performance improved significantly after the first 30 cases.
Pull back the curtain: External data validation is an essential element of quality improvement benchmark reporting
Authors: Jakubus Jill Lynn , Di Pasquo Shauna L. , Mikhail Judy N. , Cain-Nielsen Anne H. , Jenkins Peter C. , Hemmila Mark R. 
Published: January 2020

BACKGROUND
Accurate and reliable data are pivotal to credible risk-adjusted modeling and hospital benchmarking. Evidence assessing the reliability and accuracy of data elements considered as variables in risk-adjustment modeling and measurement of outcomes is lacking. This deficiency holds the potential to compromise benchmarking integrity. We detail the findings of a longitudinal program to evaluate the impact of external data validation on data validity and reliability for variables utilized in benchmarking of trauma centers.

METHODS
A collaborative quality initiative-based study was conducted of 29 trauma centers from March 2010 through December 2018. Case selection criteria were applied to identify high-yield cases that were likely to challenge data abstractors. There were 127,238 total variables validated (i.e., reabstracted, compared, and reported to trauma centers). Study endpoints included data accuracy (agreement between registry data and contemporaneous documentation) and reliability (consistency of accuracy within and between hospitals). Data accuracy was assessed by mean error rate and type (under capture, inaccurate capture, or over capture). Cohen's kappa estimates were calculated to evaluate reliability.

RESULTS
There were 185,120 patients that met the collaborative inclusion criteria. There were 1,243 submissions reabstracted. The initial validation visit demonstrated the highest mean error rate at 6.2% ± 4.7%, and subsequent validation visits demonstrated a statistically significant decrease in error rate compared with the first visit (p < 0.05). The mean hospital error rate within the collaborative steadily improved over time (2010, 8.0%; 2018, 3.2%) compared with the first year (p < 0.05). Reliability of substantial or higher (kappa ≥0.61) was demonstrated in 90% of the 20 comorbid conditions considered in the benchmark risk-adjustment modeling, 39% of these variables exhibited a statistically significant (p < 0.05) interval decrease in error rate from the initial visit.

CONCLUSION
Implementation of an external data validation program is correlated with increased data accuracy and reliability. Improved data reliability both within and between trauma centers improved risk-adjustment model validity and quality improvement program feedback.
Prevalence of Mild Cognitive Impairment in the Elderly Population in Greece: Results From the HELIAD Study
Authors: Vlachos George S. , Kosmidis Mary H. , Yannakoulia Mary , Dardiotis Efthimios , Hadjigeorgiou Georgios , Sakka Paraskevi , Ntanasi Eva , Stefanis Leonidas , Scarmeas Nikolaos 
Published: January 2020

Introduction:
Timely recognition of mild cognitive impairment (MCI) is essential in optimizing prevention and treatment for Alzheimer disease. Because of the paucity of data on MCI epidemiology in Greece and the variability of worldwide published results, we investigated the prevalence and determinants of MCI in the elderly population in Greece.

Methods:
As part of the Hellenic Epidemiological Longitudinal Investigation of Aging and Diet (HELIAD), we randomly selected 1960 individuals 65 years and older to undergo full neurological and neuropsychological assessment by a multidisciplinary team. MCI was diagnosed according to the Petersen criteria.

Results:
The age-standardized and gender-standardized prevalence of MCI in people aged 65 years and older in Greece is 13.11%. The amnestic and multidomain MCI subtypes are more common than their nonamnestic and single-domain counterparts, respectively. Almost two thirds of cases are because of suspected Alzheimer disease. Every additional year of age increases the odds of prevalent MCI by 7.4%, every additional year of education decreases the odds of MCI by 6.3%, and apolipoprotein E (APOE-ε4) carriage increases the odds of MCI by 57.9%.

Conclusions:
MCI prevalence in the elderly population in Greece is on par with previously reported rates. Prospective studies with robust methodology will enhance our understanding of the dementia continuum.