bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Retrospective Comparative Cohort Study Comparing Temporary Internal Fixation to External Fixation at the First Stage Debridement in the Treatment of Type IIIB Open Diaphyseal Tibial Fractures
Authors: Fowler Timothy , Whitehouse Michael , Riddick Andrew , Khan Umraz , Kelly Michael 
Published: January 2019

Objectives:
To compare the rates of deep infection, flap failure, and nonunion after temporary internal fixation (TIF) with temporary external fixation (ex-fix) in the management of Gustilo–Anderson type IIIB open tibia fractures.

Design:
Retrospective comparative cohort study.

Setting:
Level 1 trauma center.

Patients/Participants:
Sixty-four consecutive patients with a Gustilo–Anderson type IIIB open diaphyseal tibia fracture (OTA/AO 42) were treated between May 2014 and May 2016. Forty-seven patients (TIF = 24; ex-fix = 23) met the inclusion criteria and underwent 2-stage reconstruction. Definitive fixation was with an intramedullary nail.

Intervention:
Temporary fracture stabilization at the first-stage debridement was achieved with either TIF with a plate or ex-fix.

Main Outcome Measurement:
The main outcome measure was deep infection.

Results:
There were 4 complications in the ex-fix group (3 infection and 1 nonunion) and 2 complications in the TIF group (1 infection and 1 flap failure). Multiple regression modeling revealed that infection (P = 0.610), nonunion (P = 0.918), and flap failure (P = 0.112) were not significantly associated with the mode of temporary fixation or other demographic and treatment variables. The odds ratio of patients treated with TIF developing an infection compared with those treated with an ex-fix was 0.29 (95% confidence interval, 0.03–3.01).

Conclusions:
TIF of type IIIB open diaphyseal tibial fractures seems to be a safe alternative to conventional external fixation.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Using Historical Variation in Opioid Prescribing Immediately After Fracture Surgery to Guide Maximum Initial Prescriptions
Authors: Bhashyam Abhiram R. , Basilico Matthew , Weaver Michael J. , Harris Mitchel B. , Heng Marilyn 
Published: January 2019

Objectives:
Recent studies have advocated for prescription opioid maximums (based on percentage reductions from historical amounts) to reduce excess prescribing. Implementing this in orthopaedic trauma has been difficult, given the injury variety and limited historical data on postoperative prescribing. We report on the initial opioid prescriptions for a large cohort of postoperative, opiate-naive fracture patients and hypothesize that prescribing was associated with fracture location and morphology.

Design:
Retrospective cohort analysis.

Setting:
Two American College of Surgeons Level I trauma centers.

Patients:
Six thousand eight hundred seventy-nine orthopaedic trauma patients treated between 2002 and 2015. Only patients who had a single operatively treated injury and were opiate naive (had not received an opioid prescription in the 6 months before presentation) were included.

Intervention:
Postoperative opioid discharge prescription.

Outcomes:
We analyzed the quantity of initial opioids prescribed in morphine milligram equivalents (MMEs, a standardized unit of opioid dosage used for comparison across opioid types). Fracture location and morphology were classified using the OTA/AO classification.

Results:
Fracture location was an independent predictor of the MME prescribed (P < 0.001). All other fracture locations were prescribed significantly higher MME than distal radius fractures (control group, 150 MME, P < 0.01). There was no difference in MMEs prescribed by articular involvement or degree of comminution.

Conclusions:
We demonstrate significant variation in initial postoperative opioid prescribing to opiate-naive orthopaedic trauma patients by fracture location, but not by fracture morphology. We use these data to propose a guideline based on the OTA/AO fracture classification for the maximum initial prescription of opioids.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
The Role of Computed Tomography and Magnetic Resonance Imaging in the Diagnosis of Pediatric Thoracolumbar Compression Fractures
Authors: Franklin Don B. , Hardaway Austin T. , Sheffer Benjamin W. , Spence David D. , Kelly Derek M. , Muhlbauer Michael S. , Warner William C. , Sawyer Jeffrey R. 
Published: January 2019

Background:
Because of concerns about radiation exposure, some centers consider magnetic resonance imaging (MRIs) the preferred imaging modality for pediatric thoracic and/or lumbar compression fractures. The purpose of this study was to evaluate the sensitivity of computed tomography (CT) and MRI in diagnosing thoracolumbar compression fractures and the utility of MRI in their management.

Methods:
Retrospective review identified 52 patients aged 0 to 18 years with 191 thoracic and/or lumbar compression fractures who had both CT and MRI during the initial trauma evaluation. The decision to perform CT and/or MRI was made by the attending pediatric spine surgeon. In all cases the CT scan was performed before the MRI. All imaging studies were reviewed by a board-certified pediatric radiologist and attending pediatric spine surgeon.

Results:
Only 10 patients (19%) had a single-level injury. Of 42 with multiple compression fractures, 34 (81%) had fractures in contiguous levels, and 8 had noncontiguous injuries. Comparing CT and MRI, there was complete agreement in the number and distribution of fractures in 23 patients (44%). MRI identified additional levels of fracture in 15 patients (29%); 14 (27%) had fewer levels fractured on MRI than CT. Only one patient (2%) had fractures seen on MRI after a normal CT scan. Complete correlation between CT and MRI was seen in 59% (17/29) of patients aged 11 to 18 years, compared with 26% (6/23) of patients younger than 11.

Conclusions:
In pediatric patients with mild thoracic or lumbar compression fracture(s), CT scan demonstrates a high sensitivity in determining the presence or absence of a fracture compared with MRI. Although some variability exists between the 2 modalities in the exact number of spinal levels involved, the definitive treatment and outcome were not changed by the addition of MRI. The information that may be obtained from an MRI must be weighed against the increased time and expense of the study, as well as the risks associated with sedation when necessary.

Level of Evidence:
Level II—diagnostic study.
Reliability of Radiographic Assessments of the Hip in Cerebral Palsy
Authors: Shore Benjamin J. , Martinkevich Polina , Riazi Mahdis , Baird Emily , Encisa Clarissa , Willoughby Kate , Narayanan Unni G. 
Published: January 2019

Introduction:
Children with cerebral palsy are at risk for progressive hip displacement. Since surveillance for hip displacement uses specific radiographic measurements to guide decision making, it is important to establish the reliability of these measurements, which include Reimer’s migration percentage (MP), acetabular index or acetabular angle (AI or AA), and pelvic obliquity (PO). The purpose of this study was to determine the intraobserver and interobserver reliability of these radiographic measures among an international group of pediatric orthopaedic surgeons participating in the prospective international multicenter Cerebral Palsy Hip Outcomes Project (CHOP) currently underway to evaluate the outcomes of hip interventions in cerebral palsy.

Methods:
Two compact discs (CDs) containing the same 25 anteroposterior pelvis radiographs in Digital Imaging and Communications in Medicine (DICOM) format were provided to participating surgeons at least 2 weeks apart. To reduce the likelihood of recall or any effects of learning or fatigue, the order of the radiographs varied on the 2 CD versions, and participating surgeons received the 2 CDs in random order. The intraclass correlation coefficients (ICCs) were calculated to assess interobserver and intraobserver reliability. Mean absolute differences of hip measurements obtained at 2 time points were also calculated.

Results:
The MP had the highest reliability followed by PO, AI, and AA with a mean intrarater ICC (SD; range) of 0.95 (0.04; 0.84 to 0.98); 0.92 (0.03; 0.85 to 0.97); 0.84 (0.05; 0.75 to 0.92); and 0.82 (0.14; 0.51 to 0.98); respectively. The mean interrater ICC (SD; range) for MP, PO, AI, and AA were 0.94 (0.05; 0.78 to 0.99); 0.90 (0.04; 0.76 to 0.99); 0.79 (0.08; 0.52 to 0.93); and 0.69 (0.23; 0.42 to 0.98) for MP, PO, AI, and AA, respectively. The mean (SD; 95% confidence interval) for the absolute difference between the 2 measurements for the raters was 4.9% (2.9%; 3.4%-6.4%); 3. 8 degrees (1.2 degrees; 3.1-4.5 degrees); 2.6 degrees (1.5 degrees; 1.7-3.5 degrees); and 1.3 degrees (0.3 degrees; 1.29-1.31 degrees) for MP, AI, AA, and PO, respectively.

Conclusions:
MP is a reproducible measure with excellent intrarater and interrater reliability. However, differences in MP of <7% should be treated with caution as these might be a consequence of measurement error. Although we found a high level of intrarater and interrater reliability of the AI, AA, and PO, these measurements are more variable and not ideal for use as discrete outcome measures. Instead, these parameters might be useful for prognostication and decision making when consistent trends are observed longitudinally over time which might be better indications of true change.
Data Omission by Physician Trainees on ICU Rounds*
Authors: Artis Kathryn A. , Bordley James , Mohan Vishnu , Gold Jeffrey A. 
Published: January 2019

Objectives:
Incomplete patient data, either due to difficulty gathering and synthesizing or inappropriate data filtering, can lead clinicians to misdiagnosis and medical error. How completely ICU interprofessional rounding teams appraise the patient data set that informs clinical decision-making is unknown. This study measures how frequently physician trainees omit data from prerounding notes (“artifacts”) and verbal presentations during daily rounds.

Design:
Observational study.

Setting:
Tertiary academic medical ICU with an established electronic health record and where physician trainees are the primary presenters during daily rounds.

Subjects:
Presenters (medical student or resident physician), interprofessional rounding team.

Interventions:
None.

Measurements and Main Results:
We quantified the amount and types of patient data omitted from photocopies of physician trainees’ artifacts and audio recordings of oral ICU rounds presentations when compared with source electronic health record data. An audit of 157 patient presentations including 6,055 data elements across nine domains revealed 100% of presentations contained omissions. Overall, 22.9% of data were missing from artifacts and 42.4% from presentations. The interprofessional team supplemented only 4.1% of additional available data. Frequency of trainee data omission varied by data type and sociotechnical factors. The strongest predictor of trainee verbal omissions was a preceding failure to include the data on the artifact. Passive data gathering via electronic health record macros resulted in extremely complete artifacts but paradoxically predicted greater likelihood of verbal omission when compared with manual notation. Interns verbally omitted the most data, whereas medical students omitted the least.

Conclusions:
In an academic rounding model reliant on trainees to preview and select data for presentation during ICU rounds, verbal appraisal of patient data was highly incomplete. Additional trainee oversight and education, improved electronic health record tools, and novel academic rounding paradigms are needed to address this potential source of medical error.
Treatment With Acetylsalicylic Acid Reverses Endotoxin Tolerance in Humans In Vivo: A Randomized Placebo-Controlled Study
Authors: Leijte Guus P. , Kiers Dorien , van der Heijden Wouter , Jansen Aron , Gerretsen Jelle , Boerrigter Verin , Netea Mihai G. , Kox Matthijs , Pickkers Peter 
Published: January 2019

Objective:
To investigate immunostimulatory effects of acetylsalicylic acid during experimental human endotoxemia and in sepsis patients.

Design:
Double-blind, randomized, placebo-controlled study in healthy volunteers and ex vivo stimulation experiments using monocytes of septic patients.

Setting:
Intensive care research unit of an university hospital.

Subjects:
Thirty healthy male volunteers and four sepsis patients.

Interventions:
Healthy volunteers were challenged IV with endotoxin twice, at a 1-week interval, with each challenge consisting of a bolus of 1 ng/kg followed by continuous administration of 1 ng/kg/hr during 3 hours. Volunteers were randomized to acetylsalicylic acid prophylaxis (80 mg acetylsalicylic acid daily for a 14-d period, starting 7 d before the first endotoxin challenge), acetylsalicylic acid treatment (80 mg acetylsalicylic acid daily for the 7-d period in-between both endotoxin challenges), or the control group (receiving placebo). Furthermore, monocytes of sepsis patients were incubated with acetylsalicylic acid preexposed platelets and were subsequently stimulated with endotoxin.

Measurements and Main Results:
Acetylsalicylic acid prophylaxis enhanced plasma tumor necrosis factor-α concentrations upon the first endotoxin challenge by 50% compared with the control group (p = 0.02) but did not modulate cytokine responses during the second endotoxin challenge. In contrast, acetylsalicylic acid treatment resulted in enhanced plasma levels of tumor necrosis factor-α (+53%; p = 0.02), interleukin-6 (+91%; p = 0.03), and interleukin-8 (+42%; p = 0.02) upon the second challenge, whereas plasma levels of the key antiinflammatory cytokine interleukin-10 were attenuated (–40%; p = 0.003). This proinflammatory phenotype in the acetylsalicylic acid treatment group was accompanied by a decrease in urinary prostaglandin E metabolite levels (–27% ± 7%; p = 0.01). Ex vivo exposure of platelets to acetylsalicylic acid increased production of tumor necrosis factor-α (+66%) and decreased production of interleukin-10 (–23%) by monocytes of sepsis patients.

Conclusions:
Treatment, but not prophylaxis, with low-dose acetylsalicylic acid, partially reverses endotoxin tolerance in humans in vivo by shifting response toward a proinflammatory phenotype. This acetylsalicylic acid–induced proinflammatory shift was also observed in septic monocytes, signifying that patients suffering from sepsis-induced immunoparalysis might benefit from initiating acetylsalicylic acid treatment.
Extracorporeal Membrane Oxygenation Use in Cardiogenic Shock: Impact of Age on In-Hospital Mortality, Length of Stay, and Costs
Authors: Chung Mabel , Zhao Yuansong , Strom Jordan B. , Shen Changyu , Yeh Robert W. 
Published: January 2019

Objectives:
Increasing age is a well-recognized risk factor for in-hospital mortality in patients receiving extracorporeal membrane oxygenation for cardiogenic shock, but the shape of this relationship is unknown. In addition, the impact of age on hospital length of stay, patterns of patient disposition, and costs has been incompletely characterized.

Design:
Retrospective analysis of the National Inpatient Sample.

Setting:
U.S. nonfederal hospitals, years 2004–2016.

Patients:
Adults with cardiogenic shock treated with extracorporeal membrane oxygenation (3,094; weighted national estimate: 15,415).

Interventions:
None.

Measurements and Main Results:
The mean age of extracorporeal membrane oxygenation recipients was 54.8 ± 15.4 years (range, 18–90 yr). Crude in-hospital mortality was 57.7%. Median time-to-death was 8 days (interquartile range, 3–17 d). A linear relationship between age and in-hospital mortality was observed with a 14% increase in the adjusted odds of in-hospital mortality for every 10-year increase in age (adjusted odds ratio, 1.14; 95% CI, 1.08–1.21; p < 0.0001). Thirty-four percent of patients were discharged alive at a median time of 30 days (interquartile range, 19–48 d). The median length of stay and total hospitalization costs were 14 days (interquartile range, [5–29 d]) and $134,573 ($71,782–$239,439), respectively, both of which differed significantly by age group (length of stay range from 17 d [18–49 yr] to 9 d [80–90 yr]; p < 0.0001 and cost range $147,548 [18–49 yr] to $105,350 [80–90 yr]; p < 0.0001).

Conclusions:
Age is linearly associated with increasing in-hospital mortality in individuals receiving extracorporeal membrane oxygenation for cardiogenic shock without evidence of a threshold effect. Median time-to-death is approximately 1 week. One third of patients are discharged from the hospital alive, but the median time-to-discharge is 1 month. Median length of stay ranges from 9 to 17 days depending on age. Hospitalization costs exceed $100,000 in all age groups.
Outcomes in Patients With Metastatic Pancreatic Adenocarcinoma With the Introduction of New Chemotherapeutic Drugs
Authors: Zhang Kevin J. , Dyson Greg , Gatz Joshua L. , Silverman Michael E. , Tesfaye Anteneh A. , Shields Anthony F. , Philip Philip A. 
Published: January 2019

Objectives:
Adenocarcinoma of the pancreas represents the third leading cause of cancer-related death in the United States. Drug combinations, FOLFIRINOX (5-FU, leucovorin, irinotecan, and oxaliplatin) and gemcitabine/nab-paclitaxel, showed a clinically meaningful benefit when compared with single-agent gemcitabine in phase III trials. The goal of this study was to investigate whether there was an increase in overall survival (OS) for patients treated for metastatic pancreatic cancer after the introduction of the above regimens.

Materials and Methods:
Patients were grouped into 2 treatment eras that were before and after the introduction of these newer chemotherapeutic regimens; 2006-2010 and 2011-2015, respectively. Baseline demographics and disease-related variables were collected from metastatic pancreatic cancer treated at the Barbara Ann Karmanos Cancer Institute in Detroit, MI.

Results:
When stratified by treatment era, the later era had an improvement in survival (hazard ratio for death of 0.61; P=0.005). Median OS was 8.97 and 9.95 months for the earlier (n=59) versus latter era (n=99), respectively. There was an increase from 28.3% to 38.9% at 12 months between the earlier and later era, an improvement of 37.4%. African Americans had a worse outcome with a hazard ratio of 1.63 (P=0.02) for death. When comparing the eras, Caucasians had a longer median OS in each era in addition to having a greater improvement in median OS between eras.

Conclusions:
There was a modest improvement in median OS between 2006-2010 and 2011-2015 with the introduction of newer chemotherapeutic regimens. However, there has been no significant improvement in outcomes for African Americans or in short-term survival.
Vision Performance and Accommodative/Binocular Function in Children Wearing Prototype Extended Depth-of-Focus Contact Lenses
Authors: Tilia Daniel , Sha Jennifer , Thomas Varghese , Bakaraju Ravi C. 
Published: January 2019

Objective:
To assess two prototype contact lenses (CLs) that extend depth of focus through deliberate manipulation of multiple spherical aberration terms (extended depth-of-focus [EDOF]) for visual performance, accommodative and binocular function, and objective static near refraction against a single-vision (SV) CL.

Method:
This was a prospective, randomized, cross-over, single-masked (participant) clinical trial in which 16 myopic children wore 2 prototype CLs (EDOF
L
/EDOF
H
) designed for presbyopes and a SV CL, each for one week. Measurements comprised monocular and binocular high-contrast visual acuity (HCVA: 6 m, 40 cm), binocular low-contrast visual acuity (LCVA: 6 m), contrast sensitivity (CS: 6 m), phorias (3 m, 33 cm), monocular-accommodative facility (33 cm), and objective static refraction (spherical equivalent M) at zero, −3, and −5 D vergences. Measurements were taken 10 min after lens insertion. Subjective response was assessed using take-home questionnaires comprising vision clarity (distance/intermediate/near), vision quality (haloes at night/ghosting), vision stability when moving (playing sport/using stairs), and comfort.

Results:
Single vision was significantly better than both EDOF CLs for monocular HCVA, LCVA, and CS (6 m); vision clarity (distance), ghosting (P≤0.040), and EDOF
L
for binocular HCVA (6 m, P=0.047). M was significantly closer to the ideal objective static refraction at −3 and −5 D vergences (P≤0.004) with both EDOF compared with SV CLs. There were no differences between CLs for any other variable (P≥0.169).

Conclusion:
Extended depth-of-focus CLs caused minimal disruption to the accommodative and binocular system compared with SV CLs when worn by myopic children. Future EDOF designs for children should reduce the difference between SV for distance vision and vision quality while maintaining the same performance for intermediate and near.
Differentiation between hepatic cystic echinococcosis types 1 and simple hepatic cysts
Authors: Ran Bo , Aji Tuerganaili , Jiang Tieming , Zhang Ruiqing , Guo Qiang , Abulizi Abuduaini , Yimiti Yusfu , Wen Hao , Shao Yingmei 
Published: January 2019

Abstract
This study aims to evaluate the clinic value of ultrasound, computed tomography (CT) and serological testing in the differentiation between hepatic Cystic Echinococcosis (CE) types 1 and simple hepatic cysts.
Totally 50 patients with CE Types 1 and 50 patients with simple hepatic cysts were included. All patients examined by ultrasound, CT and serological testing respectively. The receiver operating characteristic (ROC) curve of diagnosis methods was drawn and their sensitivity, specificity, Youden index, positive likelihood ratio, negative likelihood ratio, positive predictive value and negative predictive value were compared. Pathology result was used as golden standard.
The area under ROC curve of ultrasound was 0.97 and of CT and serological testing was 0.79 and 0.71 respectively. The sensitivity of ultrasound in the diagnosis of CE Types 1 was 96.00%, specificity was 98.00%, the positive likelihood ratio was 48.00, and negative likelihood ratio was 0.04. Disease prevalence was 50%, positive predictive value was 97.96%, and negative predictive value was 96.08%. The sensitivity of CT was 80.00%, specificity was 62.00%, positive likelihood ratio was 2.11, and negative likelihood ratio was 0.32. Disease prevalence was 50%, positive predictive value was 67.80%, and negative predictive value was 75.61%. The sensitivity of immunological test was 86.00%, specificity was 72.00%, positive likelihood ratio was 3.07, and negative likelihood ratio was 0.19. Disease prevalence was 50%, positive predictive value was 75.44%, and negative predictive value was 83.72%. Combined ultrasound and immunological test, the sensitivity and the specificity was 82% and 100% respectively. Combined CT and immunological test, the sensitivity the specificity was 70% and 82% respectively.
In the differentiate diagnosis of CE Types 1 and simple hepatic cyst, ultrasound is better than CT with high sensitivity and specificity, therefore recommended. Immunological examination is an important complement to the imaging examination.