bluuebunny/crossref_metadata_2025_split huggingface dataset:
Isolated Medial Patellofemoral Ligament Reconstruction for Patellar Instability Regardless of Tibial Tubercle–Trochlear Groove Distance and Patellar Height: Outcomes at 1 and 2 Years
Authors: Erickson Brandon J. , Nguyen Joseph , Gasik Katelyn , Gruber Simone , Brady Jacqueline , Shubin Stein Beth E. 
Published: April 2019

Background: It is unclear which patients with recurrent patellar instability require a bony procedure in addition to medial patellofemoral ligament (MPFL) reconstruction. Purpose: To report 1- and 2-year outcomes of patients after isolated MPFL reconstruction performed for patellar instability regardless of patellar height, tibial tubercle–trochlear groove (TT-TG) distance, or trochlear dysplasia. Study Design: Case series; Level of evidence, 4. Methods: All patients with recurrent patellar instability and without significant unloadable chondral defects (Outerbridge grade IV), cartilage defects (especially inferior/lateral patella), previous failed surgery, or pain >50% as their chief complaint were prospectively enrolled beginning March 2014. All patients underwent primary, unilateral, isolated MPFL reconstruction regardless of concomitant bony pathology for treatment of recurrent patellar instability. Information on recurrent subjective instability, dislocations, ability to return to sport (RTS), and outcome scores was recorded at 1 and 2 years. TT-TG distance, patellar height (with the Caton-Deschamps index), and trochlear depth were measured. Results: Ninety patients (77% female; mean ± SD age, 19.4 ± 5.6 years) underwent MPFL reconstruction between March 2014 and August 2017: 72 (80%) reached 1-year follow-up, and 47 (52.2%) reached 2-year follow-up (mean follow-up, 2.2 years). Mean TT-TG distance was 14.7 ± 5.4 mm (range, –2.2 to 26.8 mm); mean patellar height, 1.2 ± 0.11 mm (range, 0.89-1.45 mm); and mean trochlear depth, 1.8 ± 1.4 mm (range, 0.05-6.85 mm). Ninety-six percent of patients at 1 year and 100% at 2 years had no self-reported patellofemoral instability; 1 patient experienced a redislocation at 3.5 years. RTS rates at 1 and 2 years were 90% and 88%, respectively. Mean time to RTS was 8.8 months. All patients had clinically and statistically significant improvement in mean Knee injury and Osteoarthritis Outcome Score–Quality of Life (32.7 to 72.0, P < .001), mean International Knee Documentation Committee subjective form (51.4 to 82.6, P < .001), and mean Kujala score (62.2 to 89.5, P < .001). No difference existed between 1- and 2-year outcome scores (all P > .05). Conclusion: At early follow-up of 1 and 2 years, isolated MPFL reconstruction is an effective treatment for patellar instability and provides significant improvements in outcome scores with a low redislocation/instability rate regardless of bony pathologies, including TT-TG distance, Caton-Deschamps index, and trochlear dysplasia. Future data from this cohort will be used to assess long-term outcomes.
Effects and safety of separate low-dose hydrocortisone use in patients with septic shock: A meta-analysis
Authors: Wu Jing , Huang Man , Wang QianWen , Ma Yuefeng , Jiang Libing 
Published: April 2019

Objective: The aim of this study was to explore the effects and safety of low-dose hydrocortisone in patients with septic shock. Methods: The PubMed, EMBASE, and Cochrane Central Register of Controlled Trials were searched from database inception until 1 August 2018. Two reviewers performed literature selection, data extraction, and quality evaluation independently. Results: Twelve randomized controlled trials were included in this meta-analysis. The combined results showed that low-dose hydrocortisone use had no survival benefit in patients with septic shock (relative risk = 1.09; 95% confidence interval = 0.88–1.05; P = 0.37). But low-dose hydrocortisone use was useful for shock reverse (relative risk = 1.09; 95% confidence interval = 1.00–1.19; P = 0.04) and in shortening the time of vasopressor support (weighted mean difference = −1.79, 95% confidence interval = −2.05 to −1.52; P < 0.00001). In addition, use of low-dose hydrocortisone was associated with a higher risk of hyperglycemia (relative risk = 1.21; 95% confidence interval = 1.04–1.40; P = 0.01) and hypernatremia (relative risk = 6.34; 95% confidence interval = 1.19–33.81; P = 0.03). There was no significant improvement of intensive care unit mortality (relative risk = 1.11; 95% confidence interval = 0.93–1.33; P = 0.23) or hospital mortality (relative risk = 1.08; 95% confidence interval = 0.94–1.24; P = 0.29), length of intensive care unit (weighted mean difference = −1.84; 95% confidence interval = −5.80 to 2.11; P = 0.36) or length of hospital (weighted mean difference = 0.11; 95% confidence interval = −2.06 to 2.29; P = 0.98), and time of mechanical support (weighted mean difference = −0.69; 95% confidence interval = −1.76 to −0.38; P = 0.20) with the use of low-dose hydrocortisone. There was no significant difference in secondary infection (relative risk = 1.04; 95% confidence interval = 0.91–1.18; P = 0.57), recurrence of shock (relative risk = 1.47; 95% confidence interval = 0.64–3.39; P = 0.36), and gastrointestinal bleeding (relative risk = 1.41; 95% confidence interval = 0.89–2.22; P = 0.14) with the use of low-dose hydrocortisone. Conclusion: Although there was no effect of low-dose hydrocortisone on survival of patients with septic shock, it is associated with a higher rate of shock reversal and shortening duration of vasopressor support; thus, low-dose hydrocortisone may be an alternative drug in septic shock patients who are refractory to fluid resuscitation and vasopressors.
Optic nerve sheath diameter as a predictor of acute cerebellar infarction in acute vertigo patients without brain computed tomography abnormalities
Authors: You Myoung Sun , Lee Sun Hwa , Yun Seong Jong , Ryu Seokyong , Choi Seung Woon , Kim Hye Jin , Kang Tae Kyung , Oh Sung Chan , Cho Suk Jin 
Published: April 2019

Background and objectives: To date, no study has investigated the ability of optic nerve sheath diameter calculated from non-contrast brain computed tomography to predict acute cerebellar infarction in patients with acute vertigo. The aim of our study was to evaluate the predictive utility of optic nerve sheath diameter for diagnosing acute cerebellar infarction in patients with acute vertigo without computed tomography abnormalities. Methods: We retrospectively enrolled patients with acute vertigo without computed tomography abnormalities who underwent magnetic resonance imaging including diffusion-weighted imaging at our emergency department between January 2016 and December 2017. Two emergency physicians independently measured optic nerve sheath diameter at 3 mm (ONSD3) and 10 mm (ONSD10) behind the globe in each patient. Final magnetic resonance imaging reports with clinical progress notes were used as the reference standard. A multivariate logistic regression analysis, receiver operating characteristic curves, and intra-class correlation coefficients were calculated to estimate predictive value. Results: A total of 34 patients (16.1%) were diagnosed with acute infarction and 177 patients (83.9%) were diagnosed with peripheral vertigo. Mean ONSD3 ( p < 0.001) and ONSD10 ( p < 0.001) were independent predictive factors for distinguishing acute infarction and peripheral vertigo. ONSD3 (cut-off = 4.22 mm) had 100% (95% confidence interval = 89.7–100.0) sensitivity and 97.7% (95% confidence interval = 95.1–99.6) specificity with area under the receiver operating characteristic curve of 0.988 (95% confidence interval = 0.978–1.0), while ONSD10 (cut-off = 3.63 mm) had 100% (95% confidence interval = 89.7–100.0) sensitivity and 87.6% (95% confidence interval = 81.8–92.0) specificity with area under the receiver operating characteristic curve of 0.976 (95% confidence interval = 0.959–0.997). There were good inter- and intra-observer agreements for both sides of ONSD3 and ONSD10 (intra-class correlation coefficient range = 0.652–0.773). Conclusion: Optic nerve sheath diameter, in particular OSND3, is a feasible predictive marker for acute infarction in patients with acute vertigo without computed tomography abnormalities. This information can assist decision-making in ordering brain magnetic resonance imaging for the assessment of acute vertigo.
School Nurse Websites: What Do They Tell Us About School Nurses?
Authors: Moss Eileen , Bergren Martha Dewey , Maughan Erin D. 
Published: April 2019

Problem: Stakeholders often misunderstand the role of the school nurse resulting in underutilization or elimination of school nurse positions. Social media and school nurse websites are recommended to increase school nurse visibility and change the public narrative of school nursing. Objective: The objective of this needs assessment is to determine whether school nurses are using web presence to increase their visibility to affect the narrative of school nursing. Method: An evaluation was conducted to determine the presence and content of school nurse websites in 50 schools and their school districts across the nation. Results: Fewer than one third of school nurses have websites, three fourths of districts have a school district health websites, and there was no evidence of a nurse in 10% of the school websites assessed. Anticipated Contribution to Practice: The needs assessment determined that nurses are not maximizing school websites to communicate their role to stakeholders.
Baseline history of patients using selexipag for pulmonary arterial hypertension
Authors: Highland Kristin B. , Hull Michael , Pruett Janis , Elliott Caitlin , Tsang Yuen , Drake William 
Published: April 2019

Introduction: Since its introduction to the market in 2016, selexipag has been an alternative oral therapy among both treatment-naïve patients and those with mono or dual therapy failure; however, limited information is available regarding the presentation and management of patients with pulmonary arterial hypertension (PAH) prior to selexipag initiation. This study examined treatment patterns, healthcare utilization, and costs in the 12 months prior to and the 6 months following selexipag initiation. Methods: This was a retrospective study of adult commercial and Medicare Advantage with Part D (MAPD) health plan members with a medical or pharmacy claim for selexipag from 1 January 2016 through 31 May 2017, a diagnosis of pulmonary hypertension, and continuous health plan enrollment for 12 months prior to selexipag initiation (baseline period). Treatment patterns, healthcare utilization, and costs were measured over the baseline period and the 6 months following selexipag initiation (among patients with ⩾6 months of follow up). Results: After inclusion and exclusion criteria were applied, 95 patients were included in the analysis. At study start, 57.9% of patients were prescribed combination therapy, increasing to 69.5% immediately prior to selexipag initiation. Approximately 60% of patients had one baseline regimen. Emergency visits and inpatient admissions during the baseline period occurred in 63.2% and 48.4% of patients, respectively. Baseline medical costs rose steadily, increasing 266.8% in commercial and 26.7% in MAPD enrollees from the beginning to the end of the 12-month baseline period. PAH-related healthcare costs accounted for more than 80% of total costs. Mean medical costs in the 6 months following selexipag initiation were US$17,215 in commercial and US$23,976 in MAPD enrollees. Conclusions: The majority of patients with PAH remained on the same therapy in the 12 months prior to selexipag initiation despite high rates of healthcare utilization and increasing costs. Mean medical costs appeared to decrease after adding or switching to selexipag.
Comparison of toxicity and effectiveness between fixed-dose and body surface area-based dose capecitabine
Authors: de Man Femke M. , Veerman G.D. Marijn , Oomen-de Hoop Esther , Deenen Maarten J. , Meulendijks Didier , Mandigers Caroline M.P.W. , Soesan Marcel , Schellens Jan H.M. , van Meerten Esther , van Gelder Teun , Mathijssen Ron H.J. 
Published: April 2019

Background: Capecitabine is generally dosed based on body surface area (BSA). This dosing strategy has several limitations; however, evidence for alternative strategies is lacking. Therefore, we analyzed the toxicity and effectiveness of fixed-dose capecitabine and compared this strategy with a BSA-based dose of capecitabine in a large set of patients. Methods: Patients treated with fixed-dose capecitabine between 2003 and 2015 were studied. A comparable group of patients, dosed based on BSA, was chosen as a control cohort. A total of two combined scores were used: capecitabine-specific toxicity (diarrhea, National Cancer Institute Common Toxicity Criteria grade ⩾3, hand-foot syndrome ⩾2, or neutropenia ⩾2), and clinically relevant events due to toxicity, that is, hospital admission, dose reduction, or discontinuation. Per treatment regimen, patients were divided into three BSA groups based on BSA quartiles corrected for sex. Toxicity scores were compared by a Chi-square test between cohorts, and within cohorts using BSA groups. Progression-free survival (PFS) was estimated by the Kaplan–Meier method. Results: A total of 2319 patients were included (fixed dosed, n = 1126 and BSA-based dose, n = 1193). Overall, four regimens were evaluated: capecitabine-radiotherapy ( n = 1178), capecitabine-oxaliplatin ( n = 519), capecitabine triplet ( n = 181) and capecitabine monotherapy ( n = 441). The incidence of capecitabine-specific toxicity and clinically relevant events was comparable between fixed-dose and BSA-dosed patients, while a small difference (7.1%) in absolute dose was found. Both cohorts showed only a higher incidence of both toxicity scores in the lowest BSA group of the capecitabine-radiotherapy group ( p < 0.05). Subgroups of the fixed-dose cohort analyzed for PFS, showed no differences between BSA groups. Conclusions: Fixed-dose capecitabine is as comparably well tolerated and effective as BSA-based dosing and could be considered as a reasonable alternative for BSA-based dosing.
A Biomechanical Comparison of the Arciero and LaPrade Reconstruction for Posterolateral Corner Knee Injuries
Authors: Treme Gehron P. , Salas Christina , Ortiz Gabriel , Gill George Keith , Johnson Paul J. , Menzer Heather , Richter Dustin L. , Qeadan Fares , Wascher Daniel C. , Schenck Robert C. 
Published: April 2019

Background: Injury to the posterolateral corner (PLC) of the knee requires reconstruction to restore coronal and rotary stability. Two commonly used procedures are the Arciero reconstruction technique (ART) and the LaPrade reconstruction technique (LRT). To the authors’ knowledge, these techniques have not been biomechanically compared against one another. Purpose: To identify if one of these reconstruction techniques better restores stability to a PLC-deficient knee and if concomitant injury to the proximal tibiofibular joint or anterior cruciate ligament affects these results. Study Design: Controlled laboratory study. Methods: Eight matched-paired cadaveric specimens from the midfemur to toes were used. Each specimen was tested in 4 phases: intact PLC (phase 1), PLC sectioned (phase 2), PLC reconstructed (ART or LRT) (phase 3), and tibiofibular (phase 4A) or anterior cruciate ligament (phase 4B) sectioning with PLC reconstructed. Varus angulation and external rotation at 0º, 20º, 30º, 60º, and 90º of knee flexion were quantified at each phase. Results: In phase 3, both reconstructions were effective at restoring laxity back to the intact state. However, in phase 4A, both reconstructions were ineffective at stabilizing the joint owing to tibiofibular instability. In phase 4B, both reconstructions had the potential to restrict varus angulation motion. There were no statistically significant differences found between reconstruction techniques for varus angulation or external rotation at any degree of flexion in phase 3 or 4. Conclusion: The LRT and ART are equally effective at restoring stability to knees with PLC injuries. Neither reconstruction technique fully restores stability to knees with combined PLC and proximal tibiofibular joint injuries. Clinical Relevance: Given these findings, surgeons may select their reconstruction technique based on their experience and training and the specific needs of their patients.
Resistance Exercise Counteracts Tumor Growth in Two Carcinoma Rodent Models
Authors: PADILHA CAMILA S. , TESTA MAYRA T. , MARINELLO POLIANA C. , CELLA PAOLA S. , VOLTARELLI FABRÍCIO A. , FRAJACOMO FERNANDO T. , CECHINI RUBENS , DUARTE JOSÉ ALBERTO R. , GUARNIER FLAVIA A. , DEMINICE RAFAEL 
Published: April 2019

ABSTRACT

Purpose
Although resistance exercise (RE) is now recognized as an adjuvant in cancer treatment because of its capacity to prevent muscle wasting, weakness, and cachexia, it is unknown whether RE can mitigate tumor development. Two solid adenocarcinoma models (Walker-256 and Ehrlich) were used to investigate the effects of RE on tumor cell proliferation, growth, and aggressiveness parameters in tumor-bearing animals’ life span.

Methods
Walker-256 tumor-bearing rats and Ehrlich tumor-bearing mice were subjected to RE, which consisted of climbing a ladder apparatus with loads tied to their tails. After 4 wk, animals were euthanized, and tumors were excised and assessed for tumor microenvironment evaluation such as cell proliferation and apoptosis determination, collagen deposit, and presence of malignant tumor morphology.

Results
Our data demonstrate that RE mitigated tumor growth and favored tumor end points such as lower Scarff–Bloom–Richardson histological grade tumor, denoting slow cell aberrant form and division, decreased tumor cell proliferation (evaluated by nucleus marked with antigen ki-67), and lower viable tumor area in both types of tumors studied. In addition, RE stimulated tumor microvessel density in Walker-256 tumor-bearing rats, but there was no change in their life span.

Conclusion
RE may mitigate tumor growth and tumor malignancy parameters such as lower histopathological grade, assuming less nuclear pleomorphism and mitotic cells, smaller viable tumor area, and decreased tumor cell proliferation in both adenocarcinomas. In addition, RE induced tumor vascularization.
RUY DUARTE DE CARVALHO E O PARADOXO DO MODERNO ESTADO-NAÇÃO ANGOLANO
Authors: Rodrigues Fischgold Christian 
Published: April 2019

O presente artigo analisa dois textos publicados pelo autor angolano Ruy Duarte de Carvalho nos últimos anos de sua vida: “Tempo de ouvir o ‘outro’ enquanto o “outro” ainda existe, antes que haja só o outro... (2008), e Da Angola Diversa (2009). Esses textos apresentam uma visão da problemática da representação da diversidade e propõem uma cartografia das alteridades contemporâneas inseridas nas estruturas do Estado angolano.
Training a new non-medical endoscopist within 7 months: lessons learned
Authors: Ware Dale 
Published: April 2019

Background: The demands on endoscopy services are ever growing, due to the Bowel Cancer Screening Programme and advancements in endoscopic technologies. In order to meet these needs, service providers have looked to non-medical staff as potential endoscopists in a bid to expand workforces and deliver timely endoscopic procedures to patients, as appropriate, within referral guidelines. Method: A training plan was developed to train four nurses to become endoscopists. Two nurses would be trained at a time over a period of 7 months. This article outlines the challenges that were faced and overcome in order to successfully train four non-medical endoscopists within the time frame. Results: The target of 200 procedures within the 7 months were met for all trainees. Conclusion: Organisation and communication with all disciplines involved were key to a successful training programme. Forward planning and advanced booking of lists were vital to ensure regular training lists and good patient attendance.
Noninvasive Detection of Bladder Cancer by Shallow-Depth Genome-Wide Bisulfite Sequencing of Urinary Cell-Free DNA for Methylation and Copy Number Profiling
Authors: Cheng Timothy H T , Jiang Peiyong , Teoh Jeremy Y C , Heung Macy M S , Tam Jacqueline C W , Sun Xiao , Lee Wing-Shan , Ni Meng , Chan Ronald C K , Ng Chi-Fai , Chan K C Allen , Chiu Rossa W K , Lo Y M Dennis 
Published: April 2019

Abstract

BACKGROUND
The current diagnosis and monitoring of bladder cancer are heavily reliant on cystoscopy, an invasive and costly procedure. Previous efforts in urine-based detection of bladder cancer focused on targeted approaches that are predicated on the tumor expressing specific aberrations. We aimed to noninvasively detect bladder cancer by the genome-wide assessment of methylomic and copy number aberrations (CNAs). We also investigated the size of tumor cell-free (cf)DNA fragments.

METHODS
Shallow-depth paired-end genome-wide bisulfite sequencing of urinary cfDNA was done for 46 bladder cancer patients and 39 cancer-free controls with hematuria. We assessed (a) proportional contribution from different tissues by methylation deconvolution, (b) global hypomethylation, (c) CNA, and (d) cfDNA size profile.

RESULTS
Methylomic and copy number approaches were synergistically combined to detect bladder cancer with a sensitivity of 93.5% (84.2% for low-grade nonmuscle-invasive disease) and a specificity of 95.8%. The prevalence of methylomic and CNAs reflected disease stage and tumor size. Sampling over multiple time points could assess residual disease and changes in tumor load. Muscle-invasive bladder cancer was associated with a higher proportion of long cfDNA, as well as longer cfDNA fragments originating from genomic regions enriched for tumor DNA.

CONCLUSIONS
Bladder cancer can be detected noninvasively in urinary cfDNA by methylomic and copy number analysis without previous knowledge or assumptions of specific aberrations. Such analysis could be used as a liquid biopsy to aid diagnosis and for potential longitudinal monitoring of tumor load. Further understanding of the differential size and fragmentation of cfDNA could improve the detection of bladder cancer.