bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Foot to Last a Lifetime—Is Hindfoot Fusion Ever Appropriate for Pediatric Orthopaedic Conditions?
Authors: Kelly Derek M. 
Published: June 2021

Introduction:
Hindfoot deformities in the pediatric population can be painful and result in severe limitations. Although arthrodesis is known to relieve pain, there are concerns over its use because of the risk that adjacent joint degenerative disease could result, leading to a new source of pain, dysfunction, and additional surgical procedures later in life.

Methods:
A literature review of hindfoot fusions in children focused on articles with the highest levels of evidence and those of particular historical significance. Case examples were obtained by querying the billing records of the local clinic system for Current Procedural Terminology (CPT) codes of hindfoot arthrodeses. Surgery procedures were performed by both fellowship-trained pediatric orthopaedists and fellowship-trained foot and ankle orthopaedic surgeons.

Results:
The medical literature for this topic generally is divided into 2 main types of articles: those that describe hindfoot fusion procedures for a specific type of deformity or disease process and those that provide the indications and results of a single type of arthrodesis. Long-term follow-up studies are limited.

Discussion:
The long-term risk of degeneration to adjacent joints has been studied, with mixed results. Other problems, such as recurrent deformity, overcorrection, pseudarthrosis, osteonecrosis, and foot shortening also may be encountered over intermediate-term follow-up. Nevertheless, in properly chosen patients, hindfoot fusion can offer a great improvement over the damaging and destructive deformities of the feet caused by a variety of diseases and traumatic injuries. Hindfoot fusions have been used for the treatment of foot deformities secondary to severe trauma, hemophilia, tarsal coalition, clubfoot, and neurological disease such as polio, static encephalopathy, hereditary motor and sensory neuropathies, and myelodysplasia.

Conclusions:
Hindfoot fusion in a child or adolescent should be considered only for the most extreme cases when all other options, short of amputation, have been considered or exhausted. While these procedures can offer improvement in the challenging cases, the surgeon should be aware of their long-term implications, including adjacent joint degeneration.
What Happens to Our Neuromuscular Patients in Adulthood: Pathway to Independence and Maximal Function
Authors: Koop Steven E. , Shrader M. Wade 
Published: June 2021

Background:
Children with neuromuscular disorders regularly seek care from pediatric orthopaedic surgeons. These conditions can have a significant impact on the growth and development of children and their function and well-being as adults. Questions exist about the long-term outcomes of musculoskeletal interventions performed during childhood.

Methods:
A search of recent literature pertaining to the musculoskeletal and functional consequences of cerebral palsy, spina bifida, Duchenne muscular dystrophy, and spinal muscle atrophy was performed. Information from those articles was combined with the experience of the authors and their institutions.

Results:
Neuromuscular conditions can result in limb and spine deformities that lead to impaired physical function. Orthopaedic interventions during childhood can improve function and well-being and can be durable into adulthood. Unfortunately, many individuals with these conditions transition to adult health care that lacks the informed, collaborative multidisciplinary care they received as children. This can lead to unmet health care needs and a shortage of long-term natural history and outcome studies that would inform the care of children today.

Conclusions:
Adults with childhood-onset neuromuscular conditions need, and deserve, dedicated health care systems that include the best aspects of the care they received as children. Pediatric orthopaedic surgeons have a role in promoting the development of such systems and a responsibility to learn from their adult patients.

Level of Evidence:
Expert Opinion.
Treatment Options for End-Stage Hip Disease in Adolescents: To Replace, Fuse, or Reconstruct?
Authors: Novais Eduardo N. 
Published: June 2021

Introduction:
This paper aims to review the indications criteria for the surgical treatment of adolescents with hip osteoarthritis and summarize the contemporary techniques that orthopaedic surgeons can apply for hip reconstruction.

Discussion:
Hip osteoarthritis remains a concerning burden to North American society. While the rate of total hip replacement (THR) in younger patients has increased in the last decades, younger patients may have a higher risk of revision hip replacement because of their increased level of activity and expected patient longevity compared with the elderly. Increased demand for multiple revision surgeries is a concern for the adolescent patient. Although in general THR has been increasingly recommended for the treatment of end-stage osteoarthritis secondary to pediatric hip disorders, hip arthrodesis remains a beneficial alternative for the treatment of severe hip disease secondary to infection and for patients who desire to engage in a very active lifestyle. Hip preservation procedures are ideally performed in the prearthritic stage or in hips with minimal degeneration to preserve the joint and achieve the most optimal outcomes. However, adolescents and young adults with moderate and rarely advanced arthritis may benefit from surgical treatment using hip preservation techniques.

Conclusions:
Treatment of adolescents with pain and dysfunction because of end-stage hip disease is challenging and controversial. THR and arthrodesis are the 2 principal alternatives. However, in particular circumstances, hip reconstruction may be recommended.
Prospective Study on Tension Band Plating: Most Patients are Not Returning to Normal Activities 1 Month Following Surgery
Authors: Grégoire Vanessa , Skaggs David L. , Jalloh Hulaimatu , Stevens Peter M. , Anesi Trevor , Holmes Stephanie , Heagy Victoria , Andras Lindsay M. 
Published: June 2021

Background:
Tension band plating for temporary hemiepiphysiodesis has been reported by several authors as simple and effective for treating angular deformities of the lower limb. Anecdotally, patients have reported higher pain levels than expected given the small size of incision and relatively minimal amount of dissection, and we sought to investigate this further.

Methods:
Patients 16 years old or less with lower extremity angular deformities or limb length inequality were prospectively enrolled before tension band plating from 2 pediatric institutions from July 2016 to December 2018. Participants completed postoperative questionnaires regarding their pain and activity level. Pain was assessed using the FACES Pain Scale. Patients were included if they completed the 1 month survey.

Results:
Of the 48 patients that met inclusion criteria (mean age at surgery: 13.1 y; range: 7 to 16 y), 39 patients completed the survey at 3 months postoperatively. There was a significant change in pain level between 1 week and 1 month postoperatively (P<0.001). Eighty-three percent (34/41) of patients were still taking pain medication at 1 week, which decreased to 38% (18/48) at 1 month. At 3 months, 21% (8/39) patients reported they were still using pain medication. At 1 month, 65% of patients (31/48) had not returned to their prior activity level. Of the 39 patients who played sports, 59% (23/39) still had not fully returned to sports at 1 month.

Conclusion:
At 1 month following tension band plating, 65% of patients had not returned to their preoperative activity level, and 38% were taking pain medications. Although the tension band plate and surgical incision is small in size, patients and parents should be counseled that there are significant activity limitations and pain levels for a month or longer in many patients.

Level of Evidence:
Level II.
Bacteriological features of implant-related infection after fracture operation and methods to identify pathogenic bacteria
Authors: Ma Xianzhi , Qi Wanle , Chao Shilan , Wang Zhendong 
Published: June 2021

Background:
This study summarizes the clinical features of bacterial cultures collected from infection after fracture fixation (IAFF), compares the results of bacterial culture from debridement versus sinus tract samples, and examines the relationship between the number of culture samples and success in identifying pathogenic bacteria.

Methods:
A retrospective analysis of 255 patients (202 males and 53 females) with IAFF from August 2017 to April 2020 was done. Common infection sites were femur, tibiofibular, hip joint, ankle, and humerus. Debridement was performed 438 times. Samples collected during debridement were sent for bacterial culture 295 times, with a variable number of culture samples taken. All samples were sent for general bacterial culture; results were summarized and success identifying pathogenic bacteria was compared for different culture sample sizes. Results from sinus tract samples (n=57) were also compared with pathogenic bacteria found in debridement samples.

Results:
In patients with IAFF, debridement samples had more gram-positive than gram-negative bacteria; the top 5 bacteria presented were: Staphylococcus aureus, Staphylococcus epidermis, Pseudomonas aeruginosa, Enterobacter cloacae, and Escherichia coli. Bacteria were found in 75.6% of culture samples from debridement. Five samples showed the highest rate of detection (90.6%) and 82.8% were identified with pathogenic bacteria. The cultural results from the sinus tract matched with those from the debridement samples 67.30% of the time, while 42.10% matched the pathogenic bacteria.

Conclusions:
For bacterial culture, 5 or more samples can improve the pathogen detection rate. Bacterial culture of sinus tract samples is not recommended as the basis for choosing appropriate antibiotics.
Testing for Implicit Gender Bias among Plastic Surgeons
Authors: Bucknor Alexandra , Ngaage Ledibabari M. , Taylor Kirsten J. , Kamali Parisa , Rakhorst Hinne A. , Mathijssen Irene M. J. , Furnas Heather 
Published: June 2021

Background:
The aim of this study was to examine for the presence of implicit bias within the field of plastic surgery using a gender-specific Implicit Association Test (IAT), specifically looking at gender and career stereotypes.

Methods:
A Gender-Career/Family Implicit Association Test was developed and distributed to the international plastic surgery community. Mean scores were calculated. Respondents were provided with an automated summary interpretation of their results, categorizing association for a particular grouping of gender and career/family as a little or no, slight, moderate, or strong. Respondents were also asked a series of demographic and post-IAT questions.

Results:
Ninety-five responses were available for analysis. Overall, respondents showed a moderate-to-strong association of male + career / female + family compared with the reverse, which was statistically significant. Nearly half of the respondents thought they might have an implicit gender-related bias; however, 50% post-test would not change their behavior based on results, while 9.5% would.

Conclusions:
Plastics surgeons may have an unconscious tendency to associate men with a career and women with a family. Further steps must be taken to increase awareness and mitigate the impact of implicit gender bias.
A Case of Giant Congenital Melanocytic Nevus Treated with Combination Therapy of Autologous Mesh-skin Grafts and Cultured Epithelial Autografts
Authors: Im Seongwang , Yamanaka Hiroki , Tsuge Itaru , Katsube Motoki , Sakamoto Michiharu , Morimoto Naoki 
Published: June 2021

Summary:
Surgical excision of a giant congenital melanocytic nevus (GCMN) results in a full-thickness skin defect that is usually difficult to reconstruct even with tissue expansion or skin grafting. Here, we report the first case of GCMN treated with a combination of cultured epithelial autografts (CEAs) and mesh-skin grafts to reconstruct a large skin defect after surgical excision. A 14-month-old girl had a GCMN occupying 20% of the total body surface area of her neck and back. A 5-stage, full-thickness excision was performed between the age of 14 and 25 months. In each intervention, the wound after excision was covered with 1:6 mesh-skin grafts and CEAs, except for the neck, where patch skin grafts and CEAs were used. The skin grafts and CEAs were engrafted without shedding and epithelialization was completed within 3-4 weeks. Eighteen months after the last surgery, a mesh-like scar remained, with no recurrence or severe contracture observed. The cosmetic appearances of the donor sites (the scalp and lower abdomen) were acceptable. The application of CEAs with mesh-skin grafts has been established for the treatment of severe burns. This combined method also provides a possible option for the treatment of GCMNs.
A Review and Measurement Study of the Central Mound Pedicle for Breast Reduction
Authors: Swanson Eric 
Published: June 2021

Background:
The central mound approach to breast reduction has been the subject of recent interest in the literature. However, quantitative evaluation using measurements is lacking. This review was undertaken to objectively evaluate changes in breast dimensions, and to compare the results to a popular alternative method, vertical mammaplasty.

Methods:
An electronic search was performed using PubMed to identify all publications endorsing the central mound technique. Published lateral photographs were matched for size and orientation, with computer assistance. Measurements included breast projection, upper pole projection, lower pole level, breast mound elevation, nipple level, and breast parenchymal ratio. Results were compared with published measurement data for the vertical technique.

Results:
Twenty-three manuscripts were identified. Ten included photographs suitable for analysis. On average, breast projection decreased 1.1 cm after central mound breast reduction (P < 0.05). Upper pole projection dropped 0.4 cm (not significant). The lower pole level was raised 2.6 cm (P < 0.05). The nipple level was over-elevated 0.6 cm, on average. The breast parenchymal ratio increased by 0.54. A central mound dissection decreased breast projection. In contrast, publications using a vertical breast reduction demonstrated maintenance of upper pole and breast projection and a modest (<1 cm) increase.

Conclusions:
For each measurement comparison, the vertical method outperforms the central mound. Because of its anatomy and geometry, measurements show that the vertical method for breast reduction is more favorable than a central mound dissection. This method can also be used safely for secondary breast reductions.
Invasive Group A Streptococcus Infection in Children in Central Israel in 2012–2019
Authors: Canetti Michal , Carmi Amit , Paret Gideon , Goldberg Lior , Adler Amos , Amit Sharon , Rokney Assaf , Ron Merav , Grisaru-Soen Galia 
Published: June 2021

Background:
Group A Streptococcus can cause serious and sometimes life-threatening disease in children. The past few years have witnessed a rise in invasive group A Streptococcus infection (iGASi) for unclear reasons. This study attempted to describe the epidemiology, the clinical and demographic characteristics and the outcomes associated with iGASi in hospitalized children in central Israel

Methods:
We retrospectively analyzed the medical records of children <18 years old discharged with a diagnosis of iGASi between January 2012 and December 2019. Clinical, laboratory and microbiologic data, and immunization status were retrieved. The patients were divided into severe and nonsevere groups based on their clinical presentation. The emm type was determined at the national reference center.

Results:
A total of 167 patients with 206 positive cultures for group A Streptococcus were identified. Hospitalizations for iGASi increased from 701 to 958 per 100,000 admissions between 2012–2015 and 2016–2019, respectively, representing an increase of 37%. The majority of the isolates were from the otolaryngologic system followed by blood, deep soft tissue and respiratory sites. Uncomplicated mastoiditis was the most common diagnosis, followed by bacteremia. Pneumonia was the main diagnosis in the severe group (39.4%).

Conclusions:
The admissions because of iGASi in children <18 years old increased during the last 8 years. Surveillance systems and prospective studies should be conducted to expend our understanding of the epidemiology of iGASi in children, better assess the pathogenesis and specific risk factors and monitor changes in emm-type distribution.
Stable Incidence of Invasive Pneumococcal Disease in Children in Northern France From 2014 Through 2018
Authors: Coronas Emilie , Martinot Alain , Varon Emmanuelle , Wallet Frédéric , Dubos François 
Published: June 2021

Background:
The 13-valent pneumococcal conjugate vaccine (PCV13) has been recommended in France since June 2010. The aim of this study was to evaluate the trends in the incidence of invasive pneumococcal disease (IPD) resulting in hospitalization of children younger than 18 years of age, to identify the vaccination status of these patients and to analyze the serotypic evolution of the pneumococci involved in the various types of IPD.

Methods:
This multicenter retrospective study reviewed all admissions of children younger than 18 years of age for IPD from 2014 through 2018 in all hospitals with a pediatric or neonatal unit in northern France. Data completeness was obtained by matching 3 independent databases. The incidence of IPD resulting in hospitalization was calculated per age group. The clinical course and the vaccine and nonvaccine types were described overall and by the IPD type.

Results:
One hundred thirty cases of IPD were identified: 51 with bacteremia, 45 meningitis, 28 pneumonia or pleuropneumonia and 6 arthritis. The IPD incidence ranged from 2.4 to 3.0/100,000 in children under 18 years of age (95% confidence intervals, 1.4–3.3 and 1.9–4.1, respectively), and from 9.5 to 15.9/100,000 in children under 2 years of age, with no significant differences over time. Nonvaccine types were predominant (81%), mainly 24F, 23B and 10A. Vaccine serotype 3 was involved in 10 cases of IPD, 2 of which were in correctly vaccinated children. Two cases of IPD could have been prevented by vaccination. Neurologic sequelae affected 26% of these children (62% of those with meningitis). Six children died from IPD (5%).

Conclusion:
The incidence of IPD resulting in hospitalization remained stable in northern France during the study period, with no significant increase in nonvaccine types. Further surveillance is needed to adjust the vaccination strategy if necessary.
Special MRI Techniques to Suss out Spontaneous Cerebrospinal Fluid Leaks
Authors: Yushvayev Ernest , Delman Bradley N. , Kirsch Claudia F.E. 
Published: June 2021

Abstract
Anterior skull base cerebrospinal fluid (CSF) fistulas result from skull base osteodural defects, allowing subarachnoid space CSF to escape into pneumatized cavities such as the paranasal sinuses and nasal fossa. Precise localization, characterization, and effective treatment of CSF leaks is essential to prevent meningitis, treatment failure, or recurrence. Advances in magnetic resonance imaging have improved radiologists’ ability to localize and characterize anterior skull base CSF fistulas. This article reviews new imaging techniques enabling diagnostic location of CSF fistulas, with an emphasis on magnetic resonance imaging–based techniques.
A rare-event study of frequency regulation and contingency services from grid-scale batteries
Authors: Patrice Goodridge Maldon , Moriarty John , Pizzoferrato Andrea 
Published: June 2021

We perform a rare-event study on a simulated power system in which grid-scale batteries provide both regulation and emergency frequency control ancillary services. Using a model of random power disturbances at each bus, we employ the skipping sampler, a Markov Chain Monte Carlo algorithm for rare-event sampling, to build conditional distributions of the power disturbances leading to two kinds of instability: frequency excursions outside the normal operating band, and load shedding. Potential saturation in the benefits, and competition between the two services, are explored as the battery maximum power output increases.
This article is part of the theme issue ‘The mathematics of energy systems’.
Characterisation of Staphylococcus argenteus carried by healthy Royal Marines: a molecular epidemiology case-study
Authors: Jauneikaite Elita , Pichon Bruno , Mosavie Mia , Fallowfield Joanne L. , Davey Trish , Thorpe Neil , Nelstrop Andrew , Sriskandan Shiranee , Lamb Lucy E 
Published: June 2021

AbstractObjectivesDuring a prospective study of S. aureus carriage in Royal Marines (RM) recruits, six S. argenteus strains were identified in four recruits undertaking military training together. As S. argenteus sepsis leads to mortality similar to S. aureus, we determined the potential for person-to-person transmission, to evaluate future outbreak risk.MethodsWe used whole-genome sequencing to characterise S. argenteus and investigate phylogenetic relationships between isolates. Participant colonisation with S. aureus and skin and soft tissue infection acquisition were recorded.ResultsAll six S. argenteus strains were spa-type t5078, ST2250. Strains were detected in 4/40 recruits in the same troop (training cohort) in weeks 1, 6 or 15 of training. No mec, tsst or LukPV genes were detected. We identified differences of 10-35 core SNPs between S. argenteus from different recruits. In two recruits, two S. argenteus strains were isolated; these could be distinguished by 3 and 15 core SNPs in each case. S. argenteus was not identified in any one of the other 21 participating troops (1,012 recruits).ConclusionsThe identification of S. argenteus within a single troop from the total recruit population supports a common source for transmission, supported by SNP analysis. The high number of SNPs between some isolates may indicate a common source of diverse isolates or a high level of S. argenteus mutation in carriage. S. argenteus ST2250 is a newly recognised lineage; a better understanding of the frequency of genetic changes during transmission and transition from asymptomatic carriage to disease is required.