bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ideal Cardiovascular Health, Handgrip Strength, and Muscle Mass Among College Students: The FUPRECOL Adults Study
Authors: Garcia-Hermoso Antonio , Correa-Bautista Jorge Enrique , Izquierdo Mikel , Tordecilla-Sanders Alejandra , Prieto-Benavides Daniel , Sandoval-Cuellar Carolina , González-Ruíz Katherine , Ramírez-Vélez Robinson 
Published: January 2019

Abstract
Garcia-Hermoso, A, Correa-Bautista, JE, Izquierdo, M, Tordecilla-Sanders, A, Prieto-Benavides, D, Sandoval-Cuellar, C, González-Ruíz, K, and Ramírez-Vélez, R. Ideal cardiovascular health, handgrip strength, and muscle mass among college students: the FUPRECOL Adults study. J Strength Cond Res 33(3): 747–754, 2019—The American Heart Association established the 2020 Strategic Impact Goals to define the concept of ideal cardiovascular health (CVH) and the metrics needed to monitor it across populations. The purpose of this study was to investigate the relationship between handgrip strength, muscle mass, and ideal CVH among Colombian college students. Data from 1,835 college students were analyzed (1,128 female). Muscular strength was estimated using a hand-held dynamometer and normalized to body mass (normalized grip strength [NGS]). The percentage of body fat was determined for bioelectrical impedance analysis using tetrapolar whole-body impedance. Ideal CVH was defined as meeting the ideal levels of 4 behaviors (smoking, body mass index, physical activity, and diet adherence) and 3 factors (total cholesterol, fasting glucose, and blood pressure). Higher levels of NGS and muscle mass (relative to body mass) were associated with a higher number of ideal CVH metrics in both sexes (p for trend <0.001). For the total ideal CVH metrics scored on a continuous scale from 0 (all 7 poor) to 7 (all 7 ideal), a 1-metric increase was associated with reduced odds of weak NGS (33 and 36%) and low-medium muscle mass (28 and 34%) mass in men and women, respectively (all p < 0.001). This study indicates that in Colombian college students, both handgrip strength and muscle mass are positively associated with the ideal CVH metrics. To reduce the possible future public health burden of muscular weakness, health professionals need to encourage the public to optimize lifestyle-related risk factors during the young adult stage.
Dynamic Interactions Between the Genome and an Endogenous Retrovirus: Tirant in Drosophila simulans Wild-Type Strains
Authors: Fablet Marie , Jacquet Angelo , Rebollo Rita , Haudry Annabelle , Rey Carine , Salces-Ortiz Judit , Bajad Prajakta , Burlet Nelly , Jantsch Michael F , Guerreiro Maria Pilar García , Vieira Cristina 
Published: January 2019

Abstract
All genomes contain repeated sequences that are known as transposable elements (TEs). Among these are endogenous retroviruses (ERVs), which are sequences similar to retroviruses and are transmitted across generations from parent to progeny. These sequences are controlled in genomes through epigenetic mechanisms. At the center of the epigenetic control of TEs are small interfering RNAs of the piRNA class, which trigger heterochromatinization of TE sequences. The tirant ERV of Drosophila simulans displays intra-specific variability in copy numbers, insertion sites, and transcription levels, providing us with a well-suited model to study the dynamic relationship between a TE family and the host genome through epigenetic mechanisms. We show that tirant transcript amounts and piRNA amounts are positively correlated in ovaries in normal conditions, unlike what was previously described following divergent crosses. In addition, we describe tirant insertion polymorphism in the genomes of three D. simulans wild-type strains, which reveals a limited number of insertions that may be associated with gene transcript level changes through heterochromatin spreading and have phenotypic impacts. Taken together, our results participate in the understanding of the equilibrium between the host genome and its TEs.
Clinicopathological and immunohistochemical analysis of Sarcomatoid carcinoma of head and neck mucosal region: a retrospective analysis
Authors: Qayoom Sumaira , Akhtar Naseem , Kumar Madhu , Agarwal Preeti , Maurya Malti Kumari , Raghuvanshi Shivanjali , Agarwal Apoorva , Goel Madhu Mati 
Published: January 2019

Background: Sarcomatoid carcinoma is a biphasic tumour comprising both of malignant epithelial and mesenchymal elements derived monoclonally from same stem cells. These are unusual variants of squamous cell carcinoma and constitute less than 1% of the head and neck mucosal tumors. Only few studies have been published and needs more understanding to establish treatment guidelines. The aim of this study was to review the cases of carcinosarcoma arising from mucosal sites of head and neck and study their clinical, histological and Immunohistochemical features.Methods: Retrospective data and slides of histologically proven sarcomatoid carcinoma over a period of thirty -four months between January 2016 - October 2018 were retrieved and evaluated for various clinical and histopathological parameters.Results: Total of 22 cases were included in the study and the mean age of presentation was 58years with male: female ration 2:1. Most of the patients (81.8%) presented with a mass lesion of less than 6 months duration. The most common site was oral cavity (68.1%) followed by larynx (22.7%). Clinical stage was known in eleven cases. One case presented with pulmonary metastasis. Histopathologically, epithelial differentiation was identified in nine cases (41%) on morphology and in thirteen cases could be highlighted by cytokeratin positivity. The Mesenchymal component was arranged in sheets (63.7%) and fascicles (31.8%). Marked anaplasia and brisk mitosis wereseen in 54.5% and 19.3% respectively. On immunohistochemistry all 22 cases were positive for Vimentin, twenty cases were positive for cytokeratin/EMA and aberrant mesenchymal markers were expressed in 10% of cases. Follow up was available in eighteen cases out of which fourteen cases died within one year of diagnosis.Conclusions: Diagnosis of sarcomatoid carcinoma is challenging especially on small biopsy because of overlapping features with other spindle cell tumors. Understanding the clinicopathological features facilitates their diagnosis and effective clinical management.
Clinical profile of neonates admitted with hypernatremia in NICU at tertiary hospital in Vadodara, Gujarat, India
Authors: Pandya Nimisha , Mehta Kedar G. 
Published: January 2019

Background: Neonatal hypernatremia is less common but significant metabolic problem with acute morbidity as well as long term consequences. Many causative factors have been identified such as inadequate breastfeeding, hot weather with high evaporative losses , infections etc. It is important to identify, anticipate and correct the condition before it leads to damaging consequences. The objective of the present study was evaluation of clinical profile, renal parameters and causative factors associated with hypernatremia in exclusively breast-fed infants.Methods: A retrospective review of 30 new-borns less than 28 days of age admitted in GMERS General hospital for hypernatremia was conducted. The study group included inborn and out born admissions. Records were reviewed, feeding history, severity of hypernatremia and altered renal parameters were analysed. The study period was from April 2018to June2018i.e summer months.Results: Total NICU admissions were 303 during these months out of which 30 were diagnosed with hypernatremia completely and discharged. Mean age of presentation was 8.4 days. Sodium levels ranged from 146-179 mmol/l. Mild hypernatremia was most common (56.7%), followed by moderate hypernatremia in 40%. All neonates were on exclusive breast feeding. Majority of the affected neonates were term SGA followed by term AGA and preterm AGA. Renal parameters were altered in quarter of affected infants. Most common clinical feature noted was lethargy(70%), followed by fever(53.3%),significant weight loss ,jaundice and dehydration. 29 patients were successfully discharged on breast milk feeding.Conclusions: Hypernatremia though rare, is common in young infants in summer months. It is preventable and treatable condition. It is important to anticipate, identify and treat such patients at the earliest. Treating physicians and nursing staff should be more vigilant for establishment of breast feeding in low birth weight infants. Exclusive breast feeding for first six months of life should always be promoted.
A Systems-Based Practice Curriculum in Orthopaedics
Authors: Hacken Brittney , Jarvis-Selinger Sandra S. , Armstrong April D. , Black Sarah , Pratt Daniel , Black Kevin P. 
Published: January 2019

Background:Teaching and assessment of the systems-based practice competency have been a challenge for many educators in graduate medical education. Previous research done at our institution demonstrated a marked inconsistency across institutions in educational content, methods of delivery, and performance assessment. As a result, we developed a 2-week health systems curriculum for orthopaedic surgery residents.Methods:A 2-week health systems rotation was developed during which postgraduate year (PGY)-1 residents were excused from their normal clinical duties. Residents followed patients as observers of the health-care system, challenged to view health care through the eyes of the patient and to identify what could be done individually and collectively to provide a better and safer experience. Additional learning experiences were designed on the basis of our literature review. At the end of the rotation, residents discussed and provided a written summary of their experiences and completed an anonymous evaluation. Using a Likert scale (1 to 10), residents were asked if the experience was educational and whether it was it additive to their undergraduate medical education for each of the 9 educational areas.Results:The mean responses for all 9 educational areas were 8.2 for whether the experience was educational and 8.3 for whether it was it additive to participants’ undergraduate medical education. Feedback from residents indicated that they found the course very helpful and that it inspired them to consider how they could “create overdue and necessary changes in our health-care system.”Conclusions:Our health systems rotation in PGY-1 has been a valuable learning experience for the residents and has created a foundation on which to build in subsequent years of residency.
Cost-Effectiveness of Operative Versus Nonoperative Treatment of Displaced Midshaft Clavicle Fractures
Authors: Liu Jane , Srivastava Karan , Washington Travis , Hoegler Joseph , Guthrie S. Trent , Hakeos William , Moutzouros Vasilios 
Published: January 2019

Background:
While previous studies have shown higher union rates and a quicker return to work with operative treatment of substantially displaced clavicle fractures, there is disagreement whether operative treatment results in improved clinical outcomes. Patients who undergo operative treatment sometimes require additional surgery for implant removal. Nonoperative treatment may fail so that delayed surgical intervention is ultimately required. The duration for which the clinical benefits of operative treatment remain superior to those of nonoperative treatment has not been well established in the literature. Considering these uncertainties, surgeons are faced with a difficult decision regarding whether operative treatment of a midshaft clavicle fracture will be cost-effective. The purpose of this study was to identify the most cost-effective strategy by considering these uncertain parameters with use of decision-analysis techniques.

Methods:
An expected-value decision tree was built to estimate the quality-adjusted life years (QALYs) and costs for operative and nonoperative treatment of substantially displaced midshaft clavicle fractures. Values for parameters in the decision model were derived from the literature. Medical costs were obtained from the Medicare database. A Markov model was used to calculate the QALYs for the duration of life expectancy. The decision model was used to analyze the duration for which the clinical results of operative treatment were superior to those of nonoperative treatment during the first 5 years after the operation and during a lifetime. Sensitivity analysis was performed to determine which parameters have the most influence on cost-effectiveness.

Results:
Operative treatment was more cost-effective than nonoperative treatment in 54% and 68% of the Monte Carlo trials in the 5-year and lifetime analyses, respectively. The cost per QALY with operative management was <$38,000 and <$8,000 in the 5-year and lifetime analyses, respectively. This is below the willingness-to-pay threshold of $50,000 per QALY. For operative treatment to remain cost-effective, its clinical benefits must persist for at least 3 years.

Conclusions:
Operative treatment is more cost-effective than nonoperative treatment for substantially displaced midshaft clavicle fractures. The clinical benefits derived with operative treatment must persist for at least 3 years for operative treatment to remain cost-effective. This research should not be used to conclude that all clavicle fractures should be treated surgically. It is best that such a decision is made through a patient-surgeon shared decision-making process.

Level of Evidence:
Economic and Decision Analysis Level II. See Instructions for Authors for a complete description of levels of evidence.
Long-Term Results of a 2-Stage Exchange Protocol for Periprosthetic Joint Infection Following Total Hip Arthroplasty in 164 Hips
Authors: Petis Stephen M. , Abdel Matthew P. , Perry Kevin I. , Mabry Tad M. , Hanssen Arlen D. , Berry Daniel J. 
Published: January 2019

Background:
Limited data exist that show the long-term risks of reinfection and mechanical failure with a contemporary 2-stage exchange protocol for periprosthetic joint infection following total hip arthroplasty. The purpose of this study was to determine the long-term reinfection and mechanical failure rates of 2-stage exchange for periprosthetic joint infection after total hip arthroplasty.

Methods:
We identified 164 hips (162 patients) with infection after total hip arthroplasty between 1991 and 2006 treated with a 2-stage exchange protocol with no prior treatment for periprosthetic joint infection. With regard to Musculoskeletal Infection Society diagnostic criteria, at least 1 major criterion or 4 of 6 minor criteria were fulfilled in 129 hips (79%). The cumulative incidence with a competing risk of death was calculated for reinfection, aseptic revisions, and all-cause revisions. The risk factors for reinfection were evaluated using Cox proportional hazards regression. Harris hip scores were calculated. The mean age at the time of spacer insertion was 68 years, and 35% of the patients were female. Excluding the patients with <2 years of follow-up, the mean follow-up was 12 years (range, 2 to 21 years).

Results:
The cumulative incidence of recurrence of infection was 10% at 1 year, 14% at 5 years, and 15% at 10 and 15 years. Seventeen patients (11%) used chronic antibiotic suppression (>6 months), with 7 (41%) of these having recurrent infection at the time of the latest follow-up. Use of chronic antibiotic suppression was the only predictive factor for reinfection (hazard ratio, 4.5 [95% confidence interval (CI), 1.9 to 10.9]; p = 0.001). The cumulative incidence of aseptic femoral and acetabular revisions was 2.6% at 5 years and 3.3% at 10 and 15 years. The cumulative incidence of all-cause revisions was 15% at 5 years and 16% at 10 and 15 years. Dislocation was the most common complication, with 28 dislocations occurring in 20 patients (12%). The mean Harris hip score improved from 52 points prior to spacer insertion to 70 points at 15 years after reimplantation (p < 0.01).

Conclusions:
The rate of recurrence of infection of 15% for up to 15 years after total hip arthroplasty was similar to previous shorter-term reports of 2-stage exchange for periprosthetic joint infection. Surgeons should anticipate mitigating instability after reimplantation. Implant survivorship free of aseptic loosening and clinical outcomes were preserved for the long term. The role of chronic antibiotic suppression in the long-term treatment of periprosthetic joint infection requires further investigation.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Development of an Institutional Opioid Prescriber Education Program and Opioid-Prescribing Guidelines
Authors: Stepan Jeffrey G. , Lovecchio Francis C. , Premkumar Ajay , Kahlenberg Cynthia A. , Albert Todd J. , Baurley James W. , Nwachukwu Benedict U. 
Published: January 2019

Background:
Our institution developed a 1-hour mandatory narcotics-prescribing education program as well as postoperative opioid-prescribing guidelines in response to the opioid epidemic. The purpose of this study was to evaluate the effect of this hospital-wide opioid education and subsequent institution of postoperative opioid guidelines on opioid-prescribing practices after ambulatory surgery.

Methods:
This retrospective study was performed at 1 academic orthopaedic hospital. In November 2016, a 1-hour mandatory opioid education program was completed by all hospital prescribers. Postoperative opioid guidelines were then developed and were disseminated in February 2017. All postoperative narcotic prescriptions after ambulatory procedures performed by 3 separate services (hand, sports, and foot and ankle services) were evaluated over 4 months prior to and after the mandatory opioid education and subsequent release of service-specific guidelines.

Results:
Overall, there was a significant decrease in pills and total oral morphine equivalents prescribed after dissemination of guidelines compared with the pre-intervention cohort procedures (p < 0.001) performed by the sports and hand services. With regard to the sports medicine service, the mean difference in pills prescribed was 6.47 pills (95% confidence interval [CI], 5.4 to 7.5 pills) for knee arthroscopy, 5.6 pills (95% CI, 2.5 to 8.7 pills) for shoulder arthroscopy, and 16.3 pills (95% CI, 13.6 to 19.1 pills) for hip arthroscopy. With regard to the hand service, the mean difference in pills prescribed was 13.0 pills (95% CI, 10.2 to 15.8 pills) for level-1 procedures, 12.4 pills (95% CI, 9.9 to 15.0 pills) for carpal tunnel release, and 21.7 pills (95% CI, 18.0 to 25.3 pills) for distal radial fractures. The decrease in pills prescribed in the post-intervention cohort amounts to almost 30,000 fewer opioid pills prescribed per year after these 6 procedures alone. There was no significant change (p > 0.05) in either the number of pills or the oral morphine equivalents prescribed after any of the 3 procedures performed by the foot and ankle service (ankle arthroscopy, bunion surgery, and Achilles tendon repair).

Conclusions:
We developed a prescriber education program and followed up with consensus-based guidelines for postoperative opioid prescriptions. These interventions caused a significant decrease in excessive opioid-prescribing practices after ambulatory orthopaedic surgery at our hospital. We urge initiatives by national orthopaedic organizations to develop and promote education programs and procedure and disease-specific opioid-prescribing guidelines.
Techniques and Considerations for the Operative Treatment of Ankle Fractures in the Elderly
Authors: Konopitski Andrew , Boniello Anthony J. , Shah Mitesh , Katsman Anya , Cavanaugh Garrett , Harding Susan 
Published: January 2019

* In managing fragility fractures about the ankle, nonoperative treatment should be considered with the caveat that soft-tissue integrity is of the utmost importance.* Consultation with medical and nutritional services for the comanagement of elderly patients with a fragility ankle fracture improves outcomes.* Soft-tissue preservation in the elderly is optimized with the judicious use of a tourniquet.* In elderly patients, a congruent ankle joint with axial alignment and stability should be emphasized over achieving anatomic articular reduction.* Less invasive surgical techniques, such as percutaneously placed anterior-to-posterior screws for posterior malleolar fractures and intramedullary fibular fixation, should be considered in the elderly.* Construct stability in elderly patients is maximized with the use of lateral locking plates, tibia-pro-fibula screws, and bicortical medial malleolar screws.* The use of external fixation with hydroxyapatite-coated pins should be considered in the treatment algorithm for fragility ankle fractures in elderly patients.
Duloxetine Reduces Pain and Improves Quality of Recovery Following Total Knee Arthroplasty in Centrally Sensitized Patients
Authors: Koh In Jun , Kim Man Soo , Sohn Sueen , Song Kwang Yun , Choi Nam Yong , In Yong 
Published: January 2019

Background:
Unexplained postoperative pain is one of the most feared complications of total knee arthroplasty (TKA). A persistent noxious peripheral stimulus, such as the pain of chronic knee osteoarthritis, can cause central sensitization in which the central nervous system becomes hyperexcitable, resulting in hypersensitivity to both noxious and non-noxious stimuli. Patients with central sensitization may be more susceptible to unexplained pain after TKA. Duloxetine, a selective serotonin norepinephrine reuptake inhibitor (SNRI), can ameliorate the pain associated with central sensitization, and we aimed to determine whether it could reduce postoperative pain and improve quality of recovery after TKA in patients with central sensitization.

Methods:
Patients undergoing TKA were screened for central sensitization preoperatively with use of the Central Sensitization Inventory (CSI). Among 464 patients with primary osteoarthritis who were scheduled for primary unilateral TKA, 80 were identified as being centrally sensitized and were included in the study. Forty patients were randomly assigned to the duloxetine group (30 mg 1 day before surgery and for 6 weeks after surgery), and 40 were randomized to the control group (no duloxetine). Pain and quality of recovery were assessed with use of the Brief Pain Inventory (BPI), the Short Form-36 (SF-36), the Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP), and the Hamilton Depression Scale. The prevalence of adverse medication effects was also noted.

Results:
The patients in the duloxetine group had better performance across pain metrics during the initial 2 to 12-week postoperative period (p < 0.05). The duloxetine group also had a superior quality of recovery 2 weeks after TKA, as indicated by emotional and physical functioning (all p < 0.05). There was no difference between groups in the prevalence of adverse events.

Conclusions:
A substantial number of patients are centrally sensitized before TKA. Surgeons should consider selective incorporation of duloxetine into the multimodal postoperative analgesic protocol, according to the severity of central sensitization, to minimize the possibility of persistent pain following TKA.

Level of Evidence:
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.