bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intramedullary nails with cannulated screw fixation for the treatment of unstable femoral neck fractures
Authors: Guo Jialiang , Dong Weichong , Yin Bing , Jin Lin , Lin Zhe , Hou Zhiyong , Zhang Yingze 
Published: December 2018

Objective Unstable femoral neck fractures are typically high-angled shear fractures caused by high-energy trauma. Internal fixation of femoral neck fractures with placement of parallel cannulated screws in an inverted triangle configuration is commonly performed in the clinical setting. This study was performed to investigate the primary results of intramedullary nailing with cannulated screws for the treatment of unstable femoral neck fractures in young and middle-aged patients. Methods In total, 96 consecutive patients with no history of hip surgery using inverted triangular cannulated compression screws or construction nails with cannulated screws were reviewed. Their demographic and radiological data were retrospectively collected from our institutional database. Results Inverted cannulated screws had an excellent effect on decreasing the blood loss volume and incision size, but intramedullary nails exhibited superior advantages in decreasing screw exit and shortening the hospital stays. The Harris hip scores were comparable between the two groups. Conclusions Intramedullary fixation with cannulated screws has advantages in treating complicated femoral neck fractures. Besides cannulated screws, intramedullary fixation with cannulated screws might be another method to treat unstable femoral neck fractures in young and middle-aged patients. The study was registered in ClinicalTrials.gov. Unique Protocol ID: 11156458. The ClinicalTrial number is NCT03550079.
Cortical abnormalities in episodic migraine: A multi-center 3T MRI study
Authors: Magon Stefano , May Arne , Stankewitz Anne , Goadsby Peter J , Schankin Christoph , Ashina Messoud , Amin Faisal M , Seifert Christian L , Mallar Chakravarty M , Müller Jannis , Sprenger Till 
Published: December 2018

Background Several previous studies have investigated cortical abnormalities, specifically cortical thickness, in patients with migraine, with variable results. The relatively small sample sizes of most previous studies may partially explain these inconsistencies. Objective To investigate differences of cortical thickness between control subjects and migraineurs in a large cohort. Methods Three Tesla MRI data of 131 patients (38 with and 93 without aura) and 115 control subjects were analysed. A vertex-wise linear model was applied controlling for age, gender and MRI scanner to investigate differences between groups and determine the impact of clinical factors on cortical thickness measures. Results Migraineurs showed areas of thinned cortex compared with controls bilaterally in the central sulcus, in the left middle-frontal gyrus, in left visual cortices and the right occipito-temporal gyrus. Frequency of migraine attacks and the duration of the disorder had a significant impact on cortical thickness in the sensorimotor cortex and middle-frontal gyrus. Patients without aura showed thinner cortex than controls bilaterally in the central sulcus and in the middle frontal gyrus, in the left primary visual cortices, in the left supramarginal gyrus and in the right cuneus. Patients with aura showed clusters of thinner cortex bilaterally in the subparietal sulcus (between the precuneus and posterior cingulate cortex), in the left intraparietal sulcus and in the right anterior cingulate. Conclusion These results indicate cortical abnormalities in specific brain regions in migraineurs. Some of the observed abnormalities may reflect a genetic susceptibility towards developing migraine attacks, while others are probably a consequence of repeated head pain attacks.
The Role of Inflammatory Cytokines in Cardiac Arrest
Authors: Jou Christopher , Shah Rian , Figueroa Andrew , Patel Jignesh K. 
Published: December 2018

Introduction: Post-cardiac arrest syndrome (PCAS) is characterized by systemic ischemia/reperfusion injury, anoxic brain injury, and post-arrest myocardial dysfunction superimposed on a precipitating pathology. The role of inflammatory cytokines in cardiac arrest remains unclear. Aims: We aimed to describe, with an emphasis on clinical applications, what is known about the role of inflammatory cytokines in cardiac arrest. Data Sources: A PubMed literature review was performed for relevant articles. Only articles in English that studied cytokines in patients with cardiac arrest were included. Results: Cytokines play a crucial role in the pathogenesis of PCAS. Following cardiac arrest, the large release of circulating cytokines mediates the ischemia/reperfusion injury, brain dysfunction, and myocardial dysfunction seen. Interleukins, tumor necrosis factor, and matrix metalloproteinases all play a unique prognostic role in PCAS. High levels of inflammatory cytokines have been associated with mortality and/or poor neurologic outcomes. Interventions to modify the systemic inflammation seen in PCAS continue to be heavily studied. Currently, the only approved medical intervention for comatose patients following cardiac arrest is targeted temperature management. Medical agents, including minocycline and sodium sulfide, have demonstrated promise in animal models. Conclusions: The role of inflammatory cytokines for both short- and long-term outcomes is an important area for future investigation.
Age matters when comparing hemiarthroplasty and total hip arthroplasty for femoral neck fractures in Medicare patients
Authors: Eskildsen Scott M , Kamath Ganesh V , Del Gaizo Daniel J 
Published: December 2018

Introduction: The optimal treatment of patients with a displaced intracapsular femoral neck fracture remains controversial. We utilised a national database of Medicare patients to determine if there was any difference in complications and reoperation rate of patients undergoing total hip arthroplasty (THA) or hemiarthroplasty (HA) for femoral neck fractures. Methods: This study utilised the PearlDiver Patient Records Database, a national for-fee database of Medicare patient procedure and diagnosis records from 2005 to 2012. Outcome procedures and diagnoses including revision, dislocation, infection, and cardiovascular events that occurred during the study time period were also identified over the entire study period as well as 90 days and 2 years. Results: We identified 275,439 patients with femoral neck fractures who underwent HA and 26,017 patients who underwent THA, respectively. Patients undergoing HA had significantly lower rates ( p < 0.0001) of revision 2.48% versus 3.85% (OR = 0.633; 95% CI, 0.592–0.678), dislocation 1.76% versus 3.39% (0.512; 0.476–0.551), infection 3.44% versus 4.87% (0.694; 0.657–0.737). There was no statistical significant difference in 2-year cardiac morbidity ( p = 0.252). However, when controlling for age, patients 65–69 years showed no significant difference in infection or revision over the study period or at 2 years. Conclusions: In this study, patients who underwent THA for femoral neck fractures had a higher rate of dislocations, infections and increased rates of repeat surgery than those who underwent HA but this difference was not significant in patients 65–69 years. Hemiarthroplasty may result in fewer complications in older Medicare patients although this difference may not be present in younger Medicare patients.
The transtelephonic electrocardiogram-based triage is an independent predictor of decreased hospital mortality in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention
Authors: Papai Gyorgy , Csato Gabor , Racz Ildiko , Szabo Gabor , Barany Tamas , Racz Agnes , Szokol Miklos , Sarman Balazs , Edes Istvan F , Czuriga Daniel , Kolozsvari Rudolf , Edes Istvan 
Published: December 2018

Introduction The transtelephonic electrocardiogram has been shown to have a great value in the management of out-of-hospital chest pain emergencies. In our previous study it not only improved the pre-hospital medical therapy and time to intervention, but also the in-hospital mortality in ST-segment elevation myocardial infarction. It was hypothesised that the higher in-hospital survival rate could be due to improved transtelephonic electrocardiogram-based pre-hospital management (electrocardiogram interpretation and teleconsultation) and consequently, better coronary perfusion of patients at the time of hospital admission. To test this hypothesis, our database of ST-segment elevation myocardial infarction patients was evaluated retrospectively for predictors (including transtelephonic electrocardiogram) that may influence in-hospital survival. Methods and results The ST-segment elevation myocardial infarction patients were divided into two groups, namely (a) hospital death patients ( n = 49) and (b) hospital survivors (control, n = 726). Regarding pre-hospital medical management, the transtelephonic electrocardiogram-based triage (odds ratio 0.48, confidence interval 0.25–0.92, p = 0.0261) and the administration of optimal pre-hospital medical therapy (acetylsalicylic acid and/or clopidogrel and glycoprotein IIb/IIIa inhibitor) were the most important independent predictors for a decreased risk in our model. At the same time, age, acute heart failure (Killip class >2), successful pre-hospital resuscitation and total occlusion of the infarct-related coronary artery before percutaneous coronary intervention were the most important independent predictors for an increased risk of in-hospital mortality. Discussion In ST-segment elevation myocardial infarction patients, (a) an early transtelephonic electrocardiogram-based teleconsultation and triage, (b) optimal pre-hospital antithrombotic medical therapy and (c) the patency and better perfusion of the infarct-related coronary artery on hospital admission are important predictors of a lower in-hospital mortality rate.
Health literacy practices in social virtual worlds and the influence on health behaviour
Authors: McElhinney Evelyn , Kidd Lisa , Cheater Francine M. 
Published: December 2018

This study explored how health information accessed via a 3D social virtual world and the representation of ‘self’ through the use of an avatar impact physical world health behaviour. In-depth interviews were conducted in a sample of 25 people, across 10 countries, who accessed health information in a virtual world (VW): 12 females and 13 males. Interviews were audio-recorded via private in-world voice chat or via private instant message. Thematic analysis was used to analyse the data. The social skills and practices evidenced demonstrate how the collective knowledge and skills of communities in VWs can influence improvements in individual and community health literacy through a distributed model. The findings offer support for moving away from the idea of health literacy as a set of skills which reside within an individual to a sociocultural model of health literacy. Social VWs can offer a place where people can access health information in multiple formats through the use of an avatar, which can influence changes in behaviour in the physical world and the VW. This can lead to an improvement in social skills and health literacy practices and represents a social model of health literacy.
Cost-effectiveness of low-dose rivaroxaban and aspirin versus aspirin alone in people with peripheral or carotid artery disease: An Australian healthcare perspective
Authors: Zomer Ella , Si Si , Hird Thomas R , Liew Danny , Owen Alice J , Tonkin Andrew , Reid Christopher M , Ademi Zanfina 
Published: December 2018

AimsPeripheral artery disease affects 1.2% of the population globally and is associated with an increased risk of atherothrombotic cardiovascular events, major adverse limb events and mortality. The Cardiovascular Outcomes for People Using Anti-coagulation Strategies (COMPASS) trial demonstrated positive results of rivaroxaban plus aspirin therapy compared to aspirin therapy alone in those with peripheral artery disease or carotid artery disease. We sought to estimate the cost-effectiveness from the Australian healthcare system perspective.Methods and resultsA Markov model was developed to simulate the experiences of a hypothetical population of 1000 individuals with peripheral artery disease or carotid artery disease, profiled on the COMPASS trial, treated with rivaroxaban plus aspirin therapy versus aspirin therapy alone. With each annual cycle, individuals were at risk of having non-fatal cardiovascular disease events, major adverse limb events, or dying. Individuals were also at risk of non-fatal major bleeding. The model had a lifetime time horizon. Costs and utilities were sourced from the literature and discounted at 5.0% annually. Rivaroxaban plus aspirin therapy prevented 143 non-fatal cardiovascular disease events, 118 major adverse limb events and 10 deaths compared to aspirin therapy alone. Conversely, 156 additional major non-fatal bleeds were accrued. With an additional 256 quality-adjusted life years gained, at an additional cost of AUD$6,858,103, the incremental cost-effectiveness ratio was AUD$26,769 (discounted) per quality-adjusted life year gained, which is below Australia’s arbitrary willingness to pay threshold of AUD$50,000.ConclusionIn those with peripheral artery disease or carotid artery disease, rivaroxaban plus aspirin therapy is effective and cost-effective in the prevention of recurrent cardiovascular disease compared to aspirin therapy alone.
Injury Risk and Injury Burden Are Related to Age Group and Peak Height Velocity Among Talented Male Youth Soccer Players
Authors: Bult Hans Jan , Barendrecht Maarten , Tak Igor Joeri Ramon 
Published: December 2018

Background: The relationship between injury risk (IR) in age groups and periods around peak height velocity (PHV) remains unclear. PHV is defined as the moment of the largest increase in body height. Purpose: To investigate injury risk and injury burden as functions of growth velocity (periods around PHV) and chronological age groupings (under 12 years [U12] to U19) in talented youth male soccer players. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 170 players from the youth academy of a Dutch soccer club (highest professional league: Eredivisie) were observed for 1 to 3 seasons. Injuries, exposure, PHV age, and chronological age were registered. The injury incidence density (IID) and injury burden per 1000 hours of soccer participation, with 95% CIs, were calculated for 5 PHV periods and 7 age groups. These were compared with the overall cohort results using incidence ratios (IRs) and burden ratios (BRs) with 95% CIs. Results: The mean age at PHV was 14.4 ± 0.65 years (range, 12.8-16.5 years). The mean IID for the total cohort was 8.34 injuries per 1000 hours (95% CI, 7.71-9.02). Compared with the overall mean, a significantly higher IID was found for PHV period 4+5 (IR, 1.31 [95% CI, 1.00-1.71]; P = .049) and for the U15 group (IR, 1.49 [95% CI, 1.24-1.79]; P < .001). The overall injury burden was 58.37 injury days per 1000 hours (95% CI, 56.66-60.13). In PHV period 4+5, the injury burden was significantly higher (BR, 1.53 [95% CI, 1.39-1.68]; P < .001) when compared with the overall mean. Also, compared with the overall mean, the injury burden was higher in the U16 (BR, 1.48 [95% CI, 1.39-1.58]; P < .001), U15 (BR, 1.28 [95% CI, 1.19-1.38]; P < .001), and U17 groups (BR, 1.21 [95% CI, 1.13-1.31]; P < .001). Conclusion: Talented young soccer players were more prone to injuries during the 6 months after PHV (31% above overall mean) as well as in the U15 group (49% above overall mean). Based on the higher injury burden in the U16 (48%), U15 (28%), and U17 (21%) groups, we suggest that research on injury risk factors and preventive measures should primarily target these age groups. Additional interventions based on PHV may be of limited value from a screening perspective. Further research is needed on the interaction between age groups and PHV periods.
A novel RAG1 mutation reveals a critical in vivo role for HMGB1/2 during V(D)J recombination
Authors: Thwaites Daniel T. , Carter Clive , Lawless Dylan , Savic Sinisa , Boyes Joan M. 
Published: December 2018

Abstract
The Recombination Activating Genes, RAG1 and RAG2, are essential for V(D)J recombination and adaptive immunity. Mutations in these genes often cause immunodeficiency, the severity of which reflects the importance of the altered residue or residues during recombination. Here, we describe a novel RAG1 mutation that causes immunodeficiency in an unexpected way: The mutated protein severely disrupts binding of the accessory protein, HMGB1. Although HMGB1 enhances RAG cutting in vitro, its role in vivo was controversial. We show here that reduced HMGB1 binding by the mutant protein dramatically reduces RAG cutting in vitro and almost completely eliminates recombination in vivo. The RAG1 mutation, R401W, places a bulky tryptophan opposite the binding site for HMG Box A at both 12- and 23-spacer recombination signal sequences, disrupting stable binding of HMGB1. Replacement of R401W with leucine and then lysine progressively restores HMGB1 binding, correlating with increased RAG cutting and recombination in vivo. We show further that knockdown of HMGB1 significantly reduces recombination by wild-type RAG1, whereas its re-addition restores recombination with wild-type, but not the mutant, RAG1 protein. Together, these data provide compelling evidence that HMGB1 plays a critical role during V(D)J recombination in vivo.
Outcomes of Peer Review for Radiotherapy Treatment Plans With Palliative Intent
Authors: Thompson Dina , Cox Kimberly , Loudon James , Yeung Ivan , Wells Woodrow 
Published: December 2018

Purpose: Peer review of a proposed treatment plan is increasingly recognized as an important quality activity in radiation medicine. Although peer review has been emphasized in the curative setting, applying peer review for treatment plans that have palliative intent is receiving increased attention. This study reports peer review outcomes for a regional cancer center that applied routine interprofessional peer review as a standard practice for palliative radiotherapy. Methods and Materials: Peer review outcomes for palliative radiotherapy plans were recorded prospectively for patients who began radiotherapy between October 1, 2015, and September 30, 2017. Recommended and implemented changes were recorded. The content of detailed discussions was recorded to gain insight into the complexities of palliative treatment plans considered during peer review. Results: Peer review outcomes were reviewed for 1,413 treatment plans with palliative intent. The proportions of detailed discussions and changes recommended were found to be 139 (9.8%) and 29 (2.1%), respectively. The content of detailed discussions and changes recommended was categorized. Major changes represented 75.9% of recommended changes, of which 84.2% were implemented clinically. Conclusion: Many complexities exist that are specific to palliative radiotherapy. Interprofessional peer review provides a forum for these complexities to be openly discussed and is an important activity to optimize the quality of care for patients with treatment plans that have palliative intent.
Comparison of Quality Oncology Practice Initiative Metrics in Solid Tumor Oncology Clinic With or Without Concomitant Supportive Oncology Consultation
Authors: Rosenblum Rachel , Huo Ran , Scarborough Bethann , Goldstein Nathan , Smith Cardinale B. 
Published: December 2018

Purpose: The Quality Oncology Practice Initiative (QOPI) is a quality measurement and improvement program designed to assess practice performance for various consensus-based and evidence-based measures. In this study, we evaluated differences in QOPI metrics met among patients with advanced solid cancer receiving routine oncologic care alone (routine care) compared with patients receiving integrated oncology and specialty-level palliative care (supportive care). Methods: We conducted a retrospective chart review of 100 randomly selected patients treated between June 2013 and June 2015 from our supportive care group and matched these patients to 100 routine care group patients on the basis of tumor type and initial oncology visit date. We used the electronic medical record to collect data regarding patient demographics, palliative care–specific QOPI metrics, intensive care unit admissions, and hospice enrollment. We performed multivariate analysis comparing differences between the two groups. Results: A total of 200 patients were included. Both groups had similar baseline characteristics. Supportive care consultation improved the absolute number of QOPI metrics met ( P = .01). The QOPI metrics more likely to be met included the following: pain appropriately addressed ( P < .01), advance care directives documented by third office visit ( P < .01), and longer hospice enrollment ( P < .01). Conclusion: Integrating palliative care consultation with routine oncologic care improved pain management and end-of-life planning and care. Properly addressing pain and guiding advance care discussions require specialized skills. These data support the need for increased primary palliative care education for oncologists and further development of supportive oncology practices.
Evaluation of the Measuring and Improving Quality in Palliative Care Survey
Authors: Dy Sydney M. , Sharma Ritu , Kuchinad Kamini , Liew Zi-Rou , Abu Al Hamayel Nebras , Hannum Susan M. , Zhu Junya , Kamal Arif H. , Walling Anne M. , Lorenz Karl A. , Isenberg Sarina R. 
Published: December 2018

Purpose: To evaluate the reliability, content validity, and variation among sites of a survey to assess facilitators and barriers to quality measurement and improvement in palliative care programs. Methods: We surveyed a sample of diverse US and Canadian palliative care programs and conducted postcompletion discussion groups. The survey included constructs addressing educational support and training, communication, teamwork, leadership, and prioritization for quality measurement and improvement. We tested internal consistency reliability, described variation among sites, and reported descriptive feedback on content validity. Results: Of 103 respondents in 11 sites, the most common roles were attending physician (38.9%) and nurse practitioner, clinical nurse specialist, or physician assistant (16.5%). Internal consistency reliability was acceptable (Cronbach’s α = .70 to .99) for all but one construct. Results varied across sites by more than 1 point on the 1 to 5 scales between the 10th and 90th percentiles of sites for two constructs in recognition and focus on quality measurement (score range by site, 1.7 to 4.8), one construct in teamwork (score range, 3.1 to 4.6), and five constructs in quality improvement (score range, 1.8 to 4.6). In descriptive content validity evaluation, respondents described the survey as an opportunity for assessing quality initiatives and discussing potential improvements, particularly improvements in communication, training, and engagement of team members regarding program quality efforts. Conclusion: This survey to assess palliative care team perspectives on barriers and facilitators for quality measurement and improvement demonstrated reliability, content validity, and initial evidence of variation among sites. Our findings highlight how palliative care team members’ perspectives may be valuable to plan, evaluate, and monitor quality-of-care initiatives.