bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fingertip defect reconstruction with a modified pivot flap
Authors: Petrella Giovanna , Tosi Daniele , Sapino Gianluca , Adani Roberto 
Published: September 2020

The pivot flap can treat volar oblique defects of the fingers distal to the distal interphalangeal joint. We present our experience in 11 fingers (11 patients) using this flap, including some modifications that optimize flap harvesting, mobilization, inset, and vascular supply and outcomes. The flaps harvested had an average size of 2.4 × 2.0 cm. The patients were followed for an average of 21 months (range 12 to 36) after surgery. Sensitivity of the flap was evaluated with the Semmes–Weinstein monofilaments test and static two-point discrimination test. Cold intolerance was also evaluated. The pivot flap with the modifications demonstrates a reliable technique for fingertip defect reconstruction. The results, in terms of sensitivity and functional recovery, seem promising. Level of evidence: IV
Efficacy of iron supplementation in patients with inflammatory bowel disease treated with anti-tumor necrosis factor-alpha agents
Authors: Kim Su Young , An Sejin , Park Dong Kyun , Kwon Kwang An , Kim Kyoung Oh , Chung Jun-Won , Kim Jung Ho , Kim Yoon Jae 
Published: September 2020

Background: Anemia is a common extraintestinal manifestation of inflammatory bowel disease (IBD). However, data on the influence of anti-tumor necrosis factor-alpha (anti-TNF-α) agents and iron supplementation on anemia in patients with IBD are sparse. We assessed the effect of iron supplementation in patients with IBD initially treated with an anti-TNF-α agent. Methods: Data from 79 IBD patients who started anti-TNF-α treatment at a tertiary hospital were analyzed. The patients were divided into the anti-TNF-α ( n = 52) and anti-TNF-α with iron supplementation ( n = 27) groups. Effects on laboratory parameters, the prevalence of anemia, and disease activity were evaluated at baseline (year 0) and 1 year later. Results: The hemoglobin (Hb) level significantly increased between years 0 and 1 in both groups [12.0 ± 1.8–13.3 ± 2.0 g/dL in the anti-TNF-α group ( p < 0.001) and 9.8 ± 2.4–11.7 ± 2.3 g/dL in the anti-TNF-α and iron supplementation group ( p = 0.004)]. In a subgroup analysis of severely anemic patients with IBD, iron supplementation increased the magnitude of the improvement in Hb level (8.5 ± 1.5–11.4 ± 2.1 g/dL; p = 0.001) compared with the anti-TNF-α group (9.3 ± 0.8–11.4 ± 2.7 g/dL; p = 0.081). Disease activity was significantly improved in both groups at year 1 compared with year 0. Persistent anemia was significantly correlated with severe anemia at baseline ( p = 0.017). Conclusion: In anemic patients with IBD, anti-TNF-α agents led to clinically meaningful improvements in anemia independent of iron supplementation. Also, iron supplementation could be helpful in severely anemic patients with IBD.
A User-Centered Approach to Evaluating Wayfinding Systems in Healthcare
Authors: Bubric Katherine , Harvey Gillian , Pitamber Tiffany 
Published: September 2020

Objective: The purpose of this methodology is to provide the designers of wayfinding systems in healthcare facilities a process for evaluating and optimizing a design prior to implementation. The use of this methodology can improve patient experience in hospitals by preventing the installation of confusing, incomplete, and/or frustrating wayfinding systems. Background: Despite known wayfinding and information design principles, wayfinding continues to be a challenge in healthcare environments. One reason is that the design of wayfinding systems is rarely evaluated with end users prior to implementation. The methodology outlined in this article is an application of usability testing that involves end users navigating a space using prototyped signage and other elements of a wayfinding system to determine the effectiveness of the system and identify improvement opportunities. This methodology was developed for use in an emergency department that had outdated signage and required a new wayfinding system. Conclusion: This methodology provides a structured process for testing and improving the design of a hospital wayfinding system prior to implementation.
Development of a Novel Computational Model for Evaluating Fall Risk in Patient Room Design
Authors: Novin Roya Sabbagh , Taylor Ellen , Hermans Tucker , Merryweather Andrew 
Published: September 2020

Objectives: This study proposes a computational model to evaluate patient room design layout and features that contribute to patient stability and mitigate the risk of fall. Background: While common fall risk assessment tools in nursing have an acceptable level of sensitivity and specificity, they focus on intrinsic factors and medications, making risk assessment limited in terms of how the physical environment contributes to fall risk. Methods: We use literature to inform a computational model (algorithm) to define the relationship between these factors and the risk of fall. We use a trajectory optimization approach for patient motion prediction. Results: Based on available data, the algorithm includes static factors of lighting, flooring, supportive objects, and bathroom doors and dynamic factors of patient movement. This preliminary model was tested using four room designs as examples of typical room configurations. Results show the capabilities of the proposed model to identify the risk associated with different room layouts and features. Conclusions: This innovative approach to room design evaluation and resulting estimation of patient fall risk show promise as a proactive evidence-based tool to evaluate the relationship of potential fall risk and room design. The development of the model highlights the challenge of heterogeneity in factors and reporting found in the studies of patient falls, which hinder our understanding of the role of the built environment in mitigating risk. A more comprehensive investigation comparing the model with actual patient falls data is needed to further refine model development.
Platelet-Rich Plasma Does Not Inhibit Inflammation or Promote Regeneration in Human Osteoarthritic Chondrocytes In Vitro Despite Increased Proliferation
Authors: Rikkers Margot , Dijkstra Koen , Terhaard Bastiaan F. , Admiraal Jon , Levato Riccardo , Malda Jos , Vonk Lucienne A. 
Published: September 2020

Objective The aims of the study were to assess the anti-inflammatory properties of platelet-rich plasma (PRP) and investigate its regenerative potential in osteoarthritic (OA) human chondrocytes. We hypothesized that PRP can modulate the inflammatory response and stimulate cartilage regeneration. Design Primary human chondrocytes from OA knees were treated with manually prepared PRP, after which cell migration and proliferation were assessed. Next, tumor necrosis factor-α–stimulated chondrocytes were treated with a range of concentrations of PRP. Expression of genes involved in inflammation and chondrogenesis was determined by real-time polymerase chain reaction. In addition, chondrocytes were cultured in PRP gels and fibrin gels consisting of increasing concentrations of PRP. The production of cartilage extracellular matrix (ECM) was assessed. Deposition and release of glycosaminoglycans (GAG) and collagen was quantitatively determined and visualized by (immuno)histochemistry. Proliferation was assessed by quantitative measurement of DNA. Results Both migration and the inflammatory response were altered by PRP, while proliferation was stimulated. Expression of chondrogenic markers COL2A1 and ACAN was downregulated by PRP, independent of PRP concentration. Chondrocytes cultured in PRP gel for 28 days proliferated significantly more when compared with chondrocytes cultured in fibrin gels. This effect was dose dependent. Significantly less GAGs and collagen were produced by chondrocytes cultured in PRP gels when compared with fibrin gels. This was qualitatively confirmed by histology. Conclusions PRP stimulated chondrocyte proliferation, but not migration. Also, production of cartilage ECM was strongly downregulated by PRP. Furthermore, PRP did not act anti-inflammatory on chondrocytes in an in vitro inflammation model.
lncRNA DLEU2 accelerates gastric cancer growth by downregulating miR-30a-5p
Authors: Zhu Hua-Li , Zou Jing 
Published: September 2020

Introduction: lncRNA DLEU2 has been indicated to act a crucial role in the bioprocess of cancer. But, the role and molecular mechanisms of lncRNA DLEU2 in gastric cancer (GC) remain unknown. Methods: The correlation of DLEU2 or miR-30a-5p with the clinical parameters and outcomes of GC patents was implemented by TCGA cohort. Cell viability and invasion were estimated by MTT and Transwell assays. The interplay between DLEU2 and miR-30a-5p was confirmed by a luciferase report assay. The effects of DLEU2 on miR-30a-5p or MMP2/9 were detected by qRT-PCR and Western blot. Results: We found that the enhanced expression of DLEU2 was linked to the pathological stage and poor survival in GC patients. Overexpressing DLEU2 prompted the cell proliferation and invasion of AGS cells, but silencing DLEU2 weakened these effects in MKN-28 cells. In addition, DLEU2 could negatively modulate and be bound with miR-30a-5p, which could counteract DLEU2-caused cell proliferation. High expression of miR-30a-5p was linked to a favorable survival in patients with GC. Conclusion: Our findings suggested that lncRNA DLEU2 could favor the growth of GC by downregulating miR-30a-5p.
Intravenous administration of tranexamic acid in total hip arthroplasty does not change the blood coagulopathy: a prospective thrombelastography analysis
Authors: Zhang Xing-chen , Sun Ma-ji , Pan Sheng , Rui Min , Zhao Feng-chao , Zha Guo-chun , Pang Yong , Zheng Xin , Guo Kai-jin 
Published: September 2020

Objective: Despite the wide use of tranexamic acid (TXA) in the perioperative period of total hip arthroplasty (THA), whether the hemostatic state changes after the application of intravenous (IV)-TXA are still unknown. The aim of this study was to investigate whether IV administration of TXA changes the blood coagulation following primary THA via thrombelastography (TEG) analysis and conventional laboratory tests. Methods: A total of 174 patients who underwent primary THA from September 2016 to July 2018 were selected. They were randomly divided into two groups, 86 patients with IV administration of 15 mg/kg TXA and 88 controls without TXA usage. Demographic data, TEG paremeters, d-dimer levels, fibrin degradation products, hemoglobin, hematocrit concentration, platelet, transfusion rates, perioperative blood loss, and the occurrence of deep vein thrombosis were collected. TEG and conventional laboratory tests were performed the day before operation, the first day after operation, and seventh day after operation. Results: There were no differences with regard to TEG or conventional laboratory tests between the two groups ( p > 0.05). The total blood loss and drain blood loss in the TXA group were significantly lower than those in the control group ( p < 0.05). The transfusion rates and the volume of blood transfusion of the control group were higher than those of the TXA group ( p < 0.05). Conclusion: The administration of IV-TXA resulted in a significant reduction in total blood loss, transfusion volumes, and transfusion rates without the increase of thromboembolic complications. Moreover, it was confirmed that TXA would not change the coagulation via the TEG analysis.
Do Modern Designs of Metal-Backed Glenoid Components Show Improved Clinical Results in Total Shoulder Arthroplasty? A Systematic Review of the Literature
Authors: Kim Dong Min , Alabdullatif Fahad , Aldeghaither Mohammed , Shin Myung Jin , Kim Hyojune , Park Dongjun , Kholinne Erica , Jeon In-Ho , Koh Kyoung Hwan 
Published: September 2020

Background: Despite the increased popularity of reverse total shoulder arthroplasty, total shoulder arthroplasty is the standard treatment for advanced shoulder arthritis in young adult patients. Conventional metal-backed glenoid (MBG) designs result in more loosening and revision surgery compared with cemented polyethylene glenoid components. However, modern MBG designs have been recently devised to overcome such drawbacks. Purpose: To compare the radiolucency, loosening, and failure rates of modern MBG designs with those of conventional designs. Study Design: Systematic review; Level of evidence, 4. Methods: A search for relevant articles was carried out using the PubMed, Cochrane Library, and Embase databases using MeSH (Medical Subject Headings) terms and natural keywords. A total of 362 articles were screened. We descriptively analyzed numerical data between the groups and statistically analyzed categorical data, such as the presence of loosening, failure, and revision surgery. The main outcome was the rate of revision surgery or failure. Subgroup analysis according to follow-up duration was performed to reduce heterogeneity. Results: A total of 25 articles (2036 shoulders) were included; 15 articles (1579 shoulders) involved a conventional MBG design, and 10 (457 shoulders) involved a modern design. The mean age of the patients was 64.2 and 66.5 years in the conventional and modern design groups, respectively, with a mean follow-up duration of 102.0 and 56.1 months, a mean gain of forward elevation of 35.1° and 61.7°, and a mean gain of external rotation of 24.2° and 39.2°. The rate of radiolucency was 48.0% and 16.7%, the rate of loosening was 11.2% and 4.9%, and the rate of revision was 15.9% and 2.4%, for the conventional and modern design groups, respectively. Subgroup analysis according to follow-up duration showed that the rates of loosening and revision were significantly lower in the modern design group ( P < .001). Conclusion: Our findings suggest that modern MBG designs showed significantly lower loosening and failure rates than conventional designs. The overall results of the comparison, including loosening, failure, change in range of motion, and clinical scores, indicate that modern MBG designs are promising. More long-term follow-up studies on modern MBGs should be conducted.
Postoperative Deep Gluteal Syndrome After Hip Arthroscopic Surgery
Authors: Uchida Soshi , Kizaki Kazuha , Hirano Fumitaka , Martin Hal David , Sakai Akinori 
Published: September 2020

Background: Deep gluteal syndrome (DGS) is an uncommon source of buttock and groin pain, resulting from entrapment of the sciatic nerve in the deep gluteal space. The incidence and risk factors of postoperative DGS after primary hip arthroscopic surgery are currently unknown. Purpose: To investigate the incidence and risk factors of postoperative DGS after primary hip arthroscopic surgery. Study Design: Case-control study; Level of evidence, 3. Methods: This study reviewed 1167 patients who underwent arthroscopic surgery between 2010 and 2018 by a single surgeon at a single center in Japan. DGS was defined using the seated piriformis stretch test, active hamstring test, and evidence of a hypertrophic sciatic nerve on magnetic resonance imaging. Overall, 11 of 1167 patients were diagnosed with DGS postoperatively. The DGS group (n = 11) was compared with the non-DGS group (n = 1156). Patient age, sex, body mass index (BMI), generalized joint laxity (GJL; Beighton score >6), number of hip arthroscopic procedures, and radiographic parameters including lateral center-edge angle, Sharp angle, vertical center anterior angle, Tönnis angle, alpha angle, ischiofemoral distance, ischiofemoral space, and quadratus femoris space were compared. The prevalence of developmental dysplasia of the hip (DDH) and borderline DDH (BDDH) was also compared. Logistic regression analysis was conducted to identify potential predictors for a postoperative DGS diagnosis. Results: The incidence of postoperative DGS in our study was 0.9%. Female sex (male:female ratio: 0:11 in DGS group vs 568:588 in non-DGS group; P < .01), mean number of hip surgical procedures (1.8 ± 0.9 in DGS group vs 1.1 ± 0.4 in non-DGS group; P < .01), and GJL ( P < .01) were significantly higher in the DGS group, while the mean BMI was significantly lower in the DGS group (19.8 ± 1.8 vs 22.7 ± 3.6 kg/m2, respectively; P < .01). Radiographic parameters were not significantly different between groups. Logistic regression analysis revealed that female sex (odds ratio [OR], 22.0 [95% CI, 1.29-374.56]), multiple surgical procedures (OR, 7.8 [95% CI, 2.36-25.95]), GJL (OR, 40.9 [95% CI, 8.74-191.70]), lower BMI (OR, 0.77 [95% CI, 0.644-0.914]), and DDH/BDDH (OR, 18.1 [95% CI, 2.30-142.10]) were potential predictors of postoperative DGS. Conclusion: The incidence of postoperative DGS in our study was 0.9%. The predictors for postoperative DGS after hip arthroscopic surgery were female sex, GJL, multiple hip surgical procedures, and DDH/BDDH. Although hip arthroscopic surgery can provide favorable clinical outcomes, surgeons should be aware of the risk factors for DGS as a complication of hip arthroscopic surgery.
Real-Time Strategic Change: Flashback to Whole Systems Change and Relating to Organisation Development Sponsors in India
Authors: Sachdev Anil , Chakravarty Arjya 
Published: September 2020

This article intends to introduce and explore the process and execution of change in complex dynamic organisation systems. Transformations are purposeful system-wide journey of organisational change. The emphasis is on the interaction between system elements more than on the analysis of each component. ‘Whole System transformation’ is involved in creating renewed organisations from within itself by enabling or allowing the system to transform itself. Real-time strategic change is presented as a framework in this context of evolutionary open systems. This article explores organisational change in a richer and more insightful way. The large-scale interaction process (LSIP) is illustrated and explained and its relationship to transformation and change in organisations is explored in a procedural view of this change paradigm. The authors outline the theoretical aspects of organisational change processes in Kathie Dannemiller’s whole systems thinking intellectual heritage. The article draws from experiences in many organisations that have benefited from this approach over the last 25 years with capability built among hundreds of facilitators to carry this approach forward.
Mechanisms of orthopnoea in patients with advanced COPD
Authors: Elbehairy Amany F. , Faisal Azmy , McIsaac Hannah , Domnik Nicolle J. , Milne Kathryn M. , James Matthew D. , Neder J. Alberto , O'Donnell Denis E. 
Published: September 2020

Many patients with severe chronic obstructive pulmonary disease (COPD) report an unpleasant respiratory sensation at rest, which is further amplified by adoption of a supine position (orthopnoea). The mechanisms of this acute symptomatic deterioration are poorly understood.Sixteen patients with advanced COPD and a history of orthopnoea and 16 age- and sex-matched healthy controls underwent pulmonary function tests (PFTs) and detailed sensory–mechanical measurements including inspiratory neural drive (IND) assessed by diaphragm electromyography (EMGdi), oesophageal pressure (Pes) and gastric pressure (Pga), in both sitting and supine positions.Patients had severe airflow obstruction (forced expiratory volume in 1 s (FEV1): 40±18% pred) and lung hyperinflation. Regardless of the position, patients had lower inspiratory capacity (IC) and higher IND for a given tidal volume (VT) (i.e.greater neuromechanical dissociation (NMD)), higher intensity of breathing discomfort, higher minute ventilation (V′E) and higher breathing frequency (fB) compared with controls (all p<0.05). For controls in a supine position, IC increased by 0.48 Lversussitting erect, with a small drop inV′E, mainly due to reducedfB(all p<0.05). By contrast, IC remained unaltered in patients with COPD, but dynamic lung compliance (CLdyn) decreased (p<0.05) in the supine position. Breathing discomfort, inspiratory work of breathing (WOB), inspiratory effort, IND, NMD and neuroventilatory uncoupling all increased in COPD patients in the supine position (p<0.05), but not in the healthy controls. Orthopnoea was associated with acute changes in IND (r=0.65, p=0.01), neuroventilatory uncoupling (r=0.76, p=0.001) and NMD (r=0.73, p=0.002).In COPD, onset of orthopnoea coincided with an abrupt increase in elastic loading of the inspiratory muscles in recumbency, in association with increased IND and greater NMD of the respiratory system.
Accelerated FEV1decline and risk of cardiovascular disease and mortality in a primary care population of COPD patients
Authors: Whittaker Hannah R. , Bloom Chloe , Morgan Ann , Jarvis Deborah , Kiddle Steven J. , Quint Jennifer K. 
Published: September 2020

Accelerated lung function decline has been associated with increased risk of cardiovascular disease (CVD) in a general population, but little is known about this association in chronic obstructive pulmonary disease (COPD). We investigated the association between accelerated lung function decline and CVD outcomes and mortality in a primary care COPD population.COPD patients without a history of CVD were identified in the Clinical Practice Research Datalink (CPRD)-GOLD primary care dataset (n=36 382). Accelerated decline in forced expiratory volume in 1 s (FEV1) was defined using the fastest quartile of the COPD population's decline. A Cox regression was used to assess the association between baseline accelerated FEV1decline and a composite CVD outcome over follow-up (myocardial infarction, ischaemic stroke, heart failure, atrial fibrillation, coronary artery disease and CVD mortality). The model was adjusted for age, sex, smoking status, body mass index, history of asthma, hypertension, diabetes, statin use, Modified Medical Research Council (mMRC) dyspnoea score, exacerbation frequency and baseline FEV1% predicted.6110 COPD patients (16.8%) had a CVD event during follow-up; median length of follow-up was 3.6 years (interquartile range (IQR) 1.7–6.1 years). Median rate of FEV1decline was –19.4 mL·year−1(IQR –40.5–1.9); 9095 patients (25%) had accelerated FEV1decline (> –40.5 mL·year−1), 27 287 (75%) did not (≤ –40.5 mL·year−1). Risk of CVD and mortality was similar between patients with and without accelerated FEV1decline (HRadj0.98, 95% CI 0.90–1.06). Corresponding risk estimates were 0.99 (95% CI 0.83–1.20) for heart failure, 0.89 (95% CI 0.70–1.12) for myocardial infarction, 1.01 (95% CI 0.82–1.23) for stroke, 0.97 (95% CI 0.81–1.15) for atrial fibrillation, 1.02 (95% CI 0.87–1.19) for coronary artery disease and 0.94 (95% CI 0.71–1.25) for CVD mortality. Rather, risk of CVD was associated with a mMRC score ≤2 and two or more exacerbations in the year prior.CVD outcomes and mortality were associated with exacerbation frequency and severity and increased mMRC dyspnoea score but not with accelerated FEV1decline.