bluuebunny/crossref_metadata_2025_split huggingface dataset:
First Rib Stress Fracture in Overhead Throwing Athletes
Authors: Itoh Yuya , Funakoshi Tadanao , Furushima Kozo , Kusano Hiroshi , Itoh Yoshiyasu 
Published: July 2019

Objectives: First-rib stress fractures as a potential cause for non-specific atraumatic chronic shoulder pain in adolescent athletes. However, etiology on throwing athletes with first rib fracture have not been still unknown. The purpose of this retrospective study was to investigate characteristic clinical features and radiographic findings of patients with the first rib fracture in overhead throwing athletes. Methods: Twenty-four cases of first rib stress fracture in 23 players were studied retrospectively. We reviewed clinical features, including age, initial symptom, sports, activity related to pain, method of diagnose, method of treatment, and final follow-up. Results: We found characteristic clinical features as follows; 16.8 years (13-25), 19 dominant side injury and 5 non-dominant injury, an acute increase in pain while swinging the bat (9 cases) or pitching the ball (6 cases). Sixteen cases presented with posterior shoulder, inferior or medial border of the scapula, upper thoracic back pain. The current study showed 17 healing on average 3.8 month after conservative treatment and 7 nonunion of throwing athlete with the first rib stress fracture, (69.6%, 30.4%, respectively). Analysis on radiographs and CT revealed that the first rib stress fractures were classified into 3 types depends on direction and portion of fracture lines: Groove type, fracture line along with the subclavian artery groove; Intrascalene type, fracture line inside the middle scalene muscle insertion; and Posterior type, fracture beside to the costovertebral articulation (Figure 1 a-c). A 3-dimensional CT angiography showed that fracture line in the Groove type was consistent with the subclavian artery and fracture line in the Intrascalene type was different to the subclavian artery (Figure 2 a-f).We found 2 symptomatic cases and they had the first rib resection cause of thoracic outlet syndrome. We calculated percent availability of the first rib based on the measurements of 2 different observers. Percent availability of the shoulder and cervical spine radiographs were 46% and 97%, respectively. The Cohen’s kappa coefficient and percent agreement of the shoulder and cervical spine were 0.87, 89.4% and 0.80, 99.0%, respectively. Conclusion: We should consider the first rib stress fracture when teenage overhead athletes have posterior shoulder pain and acute onset while swinging the bat or pitching the ball. An anteroposterior radiograph of the cervical spine was available for initial diagnose. Although 70% of the patients would heal in 3 months with conservative treatments, some patients may have a symptom like thoracic outlet syndrome.
Double-Row Repair Technique Provides Improved Dynamic Stabilization over Single-Row Repairs for Acute Bony Bankart Lesions
Authors: Greenstein Alexander , Brown Alexander M. , Roberts Aaron , Chen Raymond Edward , Knapp Emma , Voloshin Ilya 
Published: July 2019

Objectives: Previous studies of bony Bankart repair comparing single- and double-row reconstruction techniques have examined static forces required to displace the bony Bankart lesion. No studies, to date, have examined stability of bony Bankart repair with more physiologic concavity-compression model. We hypothesize the double-row fixation technique would provide superior stability and decreased displacement of a simulated bony Bankart lesion in a concavity-compression cadaveric model compared with single-row technique.Our aim was to examine the dynamic stability and ultimate displacement of single- vs double-row repair techniques for acute bony Bankart lesions Methods: Testing was performed on 13 matched pairs of glenoids with simulated bony Bankart fractures with a defect width of 25% of the glenoid diameter. Half of the fractures were repaired with a double-row technique, while the contralateral glenoids were repaired with a single-row technique. To determine dynamic biomechanical stability and ultimate step-off of the repairs a 150 N load and 2000 cycles of internal-external rotation at 1 Hz was applied to specimens to simulate standard rehabilitation protocols. Toggle was quantified throughout cycling with a coordinate measuring machine. After cyclic loading, the fracture displacement was measured. 3D spatial measurements were calculated using MATLAB. Results: The double-row technique resulted in significantly (p=0.005) less displacement (mean=342.48 µm SD=300.64 µm) than single-row technique (mean=981.84 µm, SD=640.38 µm). Ultimate fracture displacement of double-row repair was significantly less (mean=792.23 µm, SD=333.85 µm, p=0.046) after simulated rehabilitation by internal-external rotation cycling compared to single-row repair (mean=1,267.38 µm, SD=640.38 µm). Conclusion: The double-row fixation technique for arthroscopic bony Bankart repair results in superior stability throughout simulated rehabilitation and decreases ultimate displacement in a concavity-compression cadaveric model.
The Impact of Prior Musculoskeletal Injury and Orthopaedic Surgery on Draft Position, Availability, and Performance in Major League Baseball: A Summative Analysis of 1,890 Predraft Players
Authors: Ramkumar Prem N. , Navarro Sergio M. , Luu Bryan C. , Haeberle Heather S. , Soloff Lonnie , Frangiamore Salvatore Joseph , Schickendantz Mark S. 
Published: July 2019

Objectives: Despite the value to future coaches, franchise management, and medical personnel, little is known about the epidemiology of musculoskeletal injuries and surgeries and their future impact prior to the MLB draft. The purpose of this study was to determine the (1) epidemiology of all musculoskeletal injuries and surgeries for predraft MLB players; (2) risk of injury or surgery on draft position; (3) risk of injury or surgery on availability within the first two years; and (4) risk of injury or surgery on performance. Methods: A total of 1,890 medical records conducted by MLB team physicians prior to the draft were retrospectively reviewed from 2014 to 2018. Players were divided into three groups: non-injured (no musculoskeletal history), non-operative (previously injured but treated non-operatively), and operative (previous injury requiring surgery). Game statistics, including draft round, missed games, batting average (BA), and earned run average (ERA) for the first 2 seasons of MLB play were obtained for all available players, Players were matched for position, and confounders were analyzed for age, draft round using ANOVA analysis. Results: A total of 927 pitchers and 963 position players were evaluated, and 38.9% had no reported injury history, 48.6% reported injury but were treated non-operatively, and 12.4% were treated operatively. The most common pre-draft injuries were elbow tendonitis (n=312), UCL injury (n=212), and shoulder labral tear (n=76). The most common pre-draft treatments were physical therapy (922, 25.3%), UCL reconstruction (115, 3.2%), and fracture fixation (69, 1.9%). No difference was found between non-injured, non-operative, and operative groups in terms of draft position, games missed, and performance (BA for position players, p = 0.7246; ERA for pitchers, p=0.1956). After position matching, age and draft round were non-confounding. Conclusion: More than half of players entering the MLB report a musculoskeletal injury requiring treatment, with the most common pathology involves the shoulder and elbow. After position matching and analyzing for confounding factors like age and draft round, musculoskeletal history did not macroscopically impact draft position, short-term availability, or performance.
Effect of physical activity on severity of primary angle closure glaucoma
Authors: Chong Seong Niven Teh , Yaakub Azhany , Jalil Rohana Abdul , Tirmandas VN Karunakar , A/P Sandragasu Thayanithi , Noor Jelinar Binti Mohd , Husain Norhalwani Bt , Mustari Zuraidah Binti , Hamid Siti Azrin Ab , Mt Saad Ahmad B , AT Liza-Sharmini 
Published: July 2019

Objective: To determine the association between physical activity and severity of primary angle closure glaucoma in Malay patients. Methods: A cross-sectional study was conducted involving 150 primary angle closure glaucoma patients between April 2014 and August 2016. Using the International Physical Activity Questionnaire, the physical activity status was assessed and divided into three categories: mild, moderate and heavy physical activity. The duration of physical activity and corresponding minimum energy requirements were calculated. Ocular examination was performed including Humphrey visual field 24-2 analysis assessment. Based on two consecutive reliable Humphrey visual fields, the severity of glaucoma was scored according to modified Advanced Glaucoma Intervention Study and classified as mild (0–5), moderate (6–11) and severe (12–20). Association between physical activity and Advanced Glaucoma Intervention Study score was determined with multiple linear regression analysis. Results: A total of 150 Malay patients with primary angle closure glaucoma were included (50 patients with mild, 50 with moderate and 50 with severe glaucoma). Physical activity showed inverse association with the severity of primary angle closure glaucoma. After calculating adjustments for age, sex, duration of glaucoma, body mass index, systemic co-morbidities, family history of glaucoma, myopia and educational status [adjusted b –3.41, 95% confidence interval (–5.23, –1.59), p < 0.001], there was also an inverse relationship with Advanced Glaucoma Intervention Study score. Every increase in physical activity level reduces the Advanced Glaucoma Intervention Study score by 3.4 point. Conclusion: Physical activity is the potential modifiable risk factor in reducing the severity of glaucoma among primary angle closure glaucoma patients. However, there is possibility of the severity of glaucoma restricted the physical activity of primary angle closure glaucoma patients.
Going Forward with #MeToo Movement: Towards a Safer Work Environment
Authors: Gupta Rajiv , Gupta Arunima , Nehra Dharmender 
Published: July 2019

Introduction: The volcanic eruption of the #MeToo movement shows that the problem was there for long and was simmering on. The movement was initiated with the aim of knowing the magnitude of the problem and has now spread worldwide. The cases of the Me Too sexual wave are recent and have not yet attracted much scientific attention, though literature on sexual harassment is widely available and the psychological mechanisms implicated in this movement can be understood and examined through it. Objectives: This article aims to attract attention of the medical fraternity to update themselves of this issue which is essential for better understanding of the movement which has potentially good, bad, and ugly undercurrents. We will call attention to these aspects perusing the literature both at national and international levels. This would also be subjected to an analysis of the established concepts and principles of human psychology and behavior. Conclusion: It is amply clear that the time for sweeping things under the carpet is over and the catharsis that flooded the social media, print media, and TV just show how important it is to make the future workplace fair to both genders.
Epidermal stem cells in wound healing and their clinical applications
Authors: Yang Ronghua , Liu Fengxia , Wang Jingru , Chen Xiaodong , Xie Julin , Xiong Kun 
Published: July 2019

Abstract
The skin has important barrier, sensory, and immune functions, contributing to the health and integrity of the organism. Extensive skin injuries that threaten the entire organism require immediate and effective treatment. Wound healing is a natural response, but in severe conditions, such as burns and diabetes, this process is insufficient to achieve effective treatment. Epidermal stem cells (EPSCs) are a multipotent cell type and are committed to the formation and differentiation of the functional epidermis. As the contributions of EPSCs in wound healing and tissue regeneration have been increasingly attracting the attention of researchers, a rising number of therapies based on EPSCs are currently under development. In this paper, we review the characteristics of EPSCs and the mechanisms underlying their functions during wound healing. Applications of EPSCs are also discussed to determine the potential and feasibility of using EPSCs clinically in wound healing.
Delivering a complex mental health intervention in low-resource settings: lessons from the implementation of the PRIME mental healthcare plan in primary care in Sehore district, Madhya Pradesh, India
Authors: Shidhaye Rahul , Murhar Vaibhav , Muke Shital , Shrivastava Ritu , Khan Azaz , Singh Abhishek , Breuer Erica 
Published: July 2019

BackgroundThe PRogramme for Improving Mental health care (PRIME) designed, implemented and evaluated a comprehensive mental healthcare plan (MHCP) for Sehore district, Madhya Pradesh, India.AimsTo provide quantitative measures of outputs related to implementation processes, describe the role of contextual factors that facilitated and impeded implementation processes, and discuss what has been learned from the MHCP implementation.MethodA convergent parallel mixed-methods design was used. The quantitative strand consisted of process data on mental health indicators whereas the qualitative strand consisted of in-depth interviews and focus group discussions with key stakeholders involved in PRIME implementation.ResultsThe implementation of the MHCP in Sehore district in Madhya Pradesh, India, demonstrated that it is feasible to establish structures (for example Mann-Kaksha) and operationalise processes to integrate mental health services in a ‘real-world’ low-resource primary care setting. The key lessons can be summarised as: (a) clear ‘process maps’ of clinical interventions and implementation steps are helpful in monitoring/tracking the progress; (b) implementation support from an external team, in addition to training of service providers, is essential to provide clinical supervision and address the implementation barriers; (c) the enabling packages of the MHCP play a crucial role in strengthening the health system and improving the context/settings for implementation; and (d) engagement with key community stakeholders and incentives for community health workers are necessary to deliver services at the community-platform level.ConclusionsThe PRIME implementation model could be used to scale-up mental health services across India and similar low-resource settings.Declaration of interestNone.
Pivotal Trial of Enfortumab Vedotin in Urothelial Carcinoma After Platinum and Anti-Programmed Death 1/Programmed Death Ligand 1 Therapy
Authors: Rosenberg Jonathan E. , O’Donnell Peter H. , Balar Arjun V. , McGregor Bradley A. , Heath Elisabeth I. , Yu Evan Y. , Galsky Matthew D. , Hahn Noah M. , Gartner Elaina M. , Pinelli Juan M. , Liang Shang-Ying , Melhem-Bertrandt Amal , Petrylak Daniel P. 
Published: July 2019

PURPOSE Locally advanced or metastatic urothelial carcinoma is an incurable disease with limited treatment options, especially for patients who were previously treated with platinum and anti–programmed death 1 or anti–programmed death ligand 1 (PD-1/L1) therapy. Enfortumab vedotin is an antibody–drug conjugate that targets Nectin-4, which is highly expressed in urothelial carcinoma. METHODS EV-201 is a global, phase II, single-arm study of enfortumab vedotin 1.25 mg/kg (intravenously on days 1, 8, and 15 of every 28-day cycle) in patients with locally advanced or metastatic urothelial carcinoma who were previously treated with platinum chemotherapy and anti–PD-1/L1 therapy. The primary end point was objective response rate per Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 by blinded independent central review. Key secondary end points were duration of response, progression-free survival, overall survival, safety, and tolerability. RESULTS Enfortumab vedotin was administered to 125 patients with metastatic urothelial carcinoma. Median follow-up was 10.2 months (range, 0.5 to 16.5 months). Confirmed objective response rate was 44% (95% CI, 35.1% to 53.2%), including 12% complete responses. Similar responses were observed in prespecified subgroups, such as those patients with liver metastases and those with no response to prior anti–PD-1/L1 therapy. Median duration of response was 7.6 months (range, 0.95 to 11.30+ months). The most common treatment-related adverse events were fatigue (50%), any peripheral neuropathy (50%), alopecia (49%), any rash (48%), decreased appetite (44%), and dysgeusia (40%). No single treatment-related adverse events grade 3 or greater occurred in 10% or more of patients. CONCLUSION Enfortumab vedotin demonstrated a clinically meaningful response rate with a manageable and tolerable safety profile in patients with locally advanced or metastatic urothelial carcinoma who were previously treated with platinum and anti–PD-1/L1 therapies.
Financial Costs and Burden Related to Decisions for Breast Cancer Surgery
Authors: Greenup Rachel A. , Rushing Christel , Fish Laura , Campbell Brittany M. , Tolnitch Lisa , Hyslop Terry , Peppercorn Jeffrey , Wheeler Stephanie B. , Zafar S. Yousuf , Myers Evan R. , Hwang E. Shelley 
Published: July 2019

PURPOSE: Financial toxicity is a well-recognized adverse effect of cancer care, yet little is known about how women consider treatment costs when facing preference-sensitive decisions for breast cancer surgery or how surgical treatment choice affects financial harm. We sought to determine how financial costs and burden relate to decisions for breast cancer surgery. METHODS: Women (≥ 18 years old) with a history of breast cancer were recruited from the Army of Women and Sisters Network to complete an 88-item electronic survey. Descriptive statistics and regression analysis were used to evaluate the impact of costs on surgical decisions and financial harm after breast cancer surgery. RESULTS: A total of 607 women with stage 0 to III breast cancer were included. Most were white (90%), were insured privately (70%) or by Medicare (25%), were college educated (78%), and reported household incomes of more than $74,000 (56%). Forty-three percent underwent breast-conserving surgery, 25% underwent mastectomy, 32% underwent bilateral mastectomy, and 36% underwent breast reconstruction. Twenty-eight percent reported that costs of treatment influenced their surgical decisions, and at incomes of $45,000 per year, costs were prioritized over breast preservation or appearance. Overall, 35% reported financial burden as a result of their cancer treatment, and 78% never discussed costs with their cancer team. When compared with breast-conserving surgery, bilateral mastectomy with or without reconstruction was significantly associated with higher incurred debt, significant to catastrophic financial burden, treatment-related financial hardship, and altered employment. Among the highest incomes, 65% of women were fiscally unprepared, reporting higher-than-expected (26%) treatment costs. CONCLUSION: Cancer treatment costs influenced decisions for breast cancer surgery, and comparably effective surgical treatments differed significantly in their risk of patient-reported financial burden, debt, and impact on employment. Cost transparency may inform preference-sensitive surgical decisions and improve patient-centered care.
Myoclonus
Authors: Caviness John N. 
Published: July 2019

ABSTRACTPURPOSE OF REVIEWThis article offers clinicians a strategic approach for making sense of a symptom complex that contains myoclonus. The article presents an evaluation strategy that highly leverages the two major classification schemes of myoclonus. The goal of this article is to link evaluation strategy with diagnosis and treatment of myoclonus.RECENT FINDINGSThe growth of medical literature has helped better define myoclonus etiologies. Physiologic study of myoclonus types and etiologies with electrophysiologic testing has provided greater clarity to the pathophysiology of the myoclonus in various diseases. Although studies have been limited, the role of newer treatment agents and methods has made progress.SUMMARYMyoclonus has hundreds of different etiologies. Classification is necessary to evaluate myoclonus efficiently and pragmatically. The classification of myoclonus etiology, which is grouped by different clinical presentations, helps determine the etiology and treatment of the myoclonus. The classification of myoclonus physiology using electrophysiologic test results helps determine the pathophysiology of the myoclonus and can be used to strategize symptomatic treatment approaches. Both basic ancillary testing (including EEG and imaging) and more comprehensive testing may be necessary. Treatment of the underlying etiology is the ideal approach. However, if such treatment is not possible or is delayed, symptomatic treatment guided by the myoclonus physiology should be considered. More controlled study of myoclonus treatment is needed. Further research on myoclonus generation mechanisms should shed light on future treatment possibilities.
Gender Division of Farm Work and Occupational Injuries
Authors: Karttunen Janne P. , Rautiainen Risto H. , Quendler Elisabeth 
Published: July 2019

Abstract. Several studies have shown that males are at greater risk of agricultural injuries than females. We investigated if gender division of farm work helps explain this risk difference in the self-employed Finnish farming population. We used insurance claims data and postal survey data charting the relative division of farm work between male and female farmers. Over the five-year study period (2009 to 2013), the average number of farmers was 75,893 (67% males and 33% females). A total of 22,648 occupational injuries (77% males and 23% females) were compensated during that time. Males had significantly higher rates of any, minor, serious, and recurrent injuries compared to females. Altogether, 319 usable responses were received in the postal survey (13% response rate). Both farm work time and occupational injuries differed by gender. Crop production, construction, forestry, and machinery contracting work were male-dominated, whereas females took the main responsibility for domestic and caretaking work. On livestock farms, animal husbandry was divided quite evenly between males and females (56% and 44% contributions, respectively). Animal husbandry-related injuries were distributed similarly (58% males and 42% females), but all other types of injuries occurred mostly to males. These results suggest that the risk of injuries is also nearly equal, given equal work time. Therefore, gender is an indicator of different work exposures in farming, rather than a risk factor for injury. Better understanding of the division of work and the corresponding risk of injuries can help in the design of interventions for males and females in agriculture. Keywords: Agriculture, Claim, Exposure, Farmer, Gender, Insurance, Occupational injury, Work.