bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of diclofenac gel, ibuprofen gel, and ibuprofen gel with levomenthol for the topical treatment of pain associated with musculoskeletal injuries
Authors: Wade Alan G. , Crawford Gordon M. , Young David , Corson Stephen , Brown Colin 
Published: July 2019

Objective To determine whether 3% w/w levomenthol added to ibuprofen gel (5% w/w) improves its efficacy compared with ibuprofen gel alone or diclofenac gel (1.16%) for the treatment of soft-tissue injuries. Methods A total of 182 patients with acute soft-tissue injuries participated in a randomised, single-blind, single-dose study to assess the efficacy and safety of three topical analgesic gels. Efficacy was assessed as the score change in a numeric rating scale for pain. Results The median time to significant pain relief was 20 minutes for the ibuprofen/levomenthol and diclofenac gels but 25 minutes for ibuprofen gel. At 2 hours, significantly more patients treated with ibuprofen/levomenthol gel reported a cooling sensation (45.8%) compared with diclofenac (16.4%) or ibuprofen (14.7%) gels, and both ibuprofen/levomenthol and diclofenac gels provided significantly more effective global pain relief compared with ibuprofen gel. Few adverse events and no serious adverse events related to study medication were recorded. Conclusions Although all gels effectively relieved pain, both ibuprofen/levomenthol and diclofenac gels provided superior global pain relief compared with ibuprofen gel, with a shorter median time to significant pain relief. Only ibuprofen/levomenthol gel provided cooling for up to 2 hours. None of the gels were associated with serious safety concerns. EudraCT No 2015-005240-33 EU Clinical Trials Register URL: https://www.clinicaltrialsregister.eu/ctr-search/search
Patient-Reported Outcomes Measurement Information System (PROMIS) in Femoroacetabular Impingement (FAI)
Authors: Minkara Anas , O’Connor Michaela , Westermann Robert W. , Rosneck James T. , Lynch Thomas Sean 
Published: July 2019

Objectives: Patient-Reported Outcomes Measurement Information System (PROMIS) is an NIH-funded computerized adaptive test (CAT) developed to effectively assess patient outcomes in multiple domains, including physical function (PF), pain severity, and quality of life while minimizing patient burden. The purpose of this study is to validate PROMIS in patients undergoing hip arthroscopy for Femoroacetabular Impingement (FAI), including test-retest reliability and correlation with validated hip outcome measures. Methods: Patients undergoing elective hip arthroscopy for FAI were consecutively enrolled at a major academic center. Patients with chronic comorbidities, bilateral FAI with a staged approach, and lack of postoperative follow-up were excluded. Eligible patients completed the modified Hip Harris Score (mHHS), Hip Outcome Score Activities of Daily Living (HOS-ADL), International Hip Outcome Tool (iHOT-12), and PROMIS including PF, pain interference, and activity satisfaction. Questionnaires were completed preoperatively, two, and six weeks postoperatively. Ceiling effects were determined to be present if greater than 15% of patients scored the highest possible score on one of the patient reported outcome measurement tools in this study. The correlation of preoperative values with postoperative function were assessed utilizing the Pearson coefficient. Normality was evaluated using the Shapiro-Wilk test. Dependent sample t-tests were utilized to compare means in test-retest reliability. Results: There were 38 patients with a mean age of 29.3 ± 8.9 years (54% female) identified for the study. PROMIS demonstrated excellent correlation with HOS-ADL (Pearson coefficient of 0.81, Figure 1), as well as mHHS (0.80) and iHOT-12 (0.73). Patients with higher PROMIS-pain interference and pain intensity scores demonstrated a negative linear correlation with mHHS (r=-0.86, p<0.05), HOS-ADL (r=-0.71, p<0.05), and iHOT-12 (-0.71, p<0.01). PROMIS scores exhibited significant responsiveness to hip arthroscopy. Patients with higher activity satisfaction demonstrated excellent-good correlation with mHHS scores (r=0.66, p<0.05) and HOS-ADL (0.66, p<0.05). PROMIS also demonstrated excellent test-retest reliability with no variability in scores, including PF (55.5 ± 8.6 vs. 54.2 ± 10.5, p=0.74). No floor or ceiling effects were exhibited by PROMIS including the physical function, pain interference, pain intensity, social participation, and role satisfaction domain scores. Conclusion: PROMIS is a valid and efficient PRO in hip arthroscopy for FAI demonstrating excellent test-retest reliability and correlation with established hip outcome measures. No floor or ceiling effects were demonstrated by PROMIS. Subdomains also exhibit excellent prognostic ability in the clinical setting.
Predictors of Failure After Surgical Treatment of Femoroacetabular Impingement: Results of a Multicenter Prospective Cohort of 621 Hips
Authors: Nepple Jeffrey J. , Bedi Asheesh , Zaltz Ira , Larson Christopher M. , Sucato Daniel J. , Beaule Paul , Kim Young-Jo ,   ANCHOR Group, Clohisy John C. 
Published: July 2019

Objectives: Surgical treatment of femoroacetabular impingement attempts to improve patients’ symptoms through treatment of intra-articular labrochondral pathology and correction of underlying bony deformity. The purpose of the current study was to determine independent predictors of failure after surgical treatment of femoroacetabular impingement in a large prospective multicenter cohort study. Methods: A prospective cohort study of the surgical treatment of FAI was performed. A total of 760 hips undergoing primary surgical treatment of FAI were enrolled across seven surgeons. Patient characteristics, baseline patient reported outcomes (PROs), imaging findings, intraoperative pathology, and surgical treatments were prospectively recorded. A total of 621 hips (81.6%) with minimum one year follow-up were included in the current study (mean 4.3 years). The mHHS was assessed relative to the minimally clinically important difference (MCID, 8 points) and patient acceptable symptom state (PASS, 74 points). Univariate analyses were performed to identify factors significantly associated with failure. Multivariate logistic regression was performed to identify independent predictors of failure. Results: A total of 621 hips undergoing surgical treatment of FAI were assessed at a mean 4.2 years postoperatively. This cohort had a mean age of 29.8 and included 56.8% females. Multivariate logistic regression identified independent predictors of each failure definition. Failure A (THA) was independently associated with increasing age, acetabular microfracture (both p<0.001), and femoral head chondroplasty (p=0.02). Failure B (THA or revision surgery) was independently associated only with lower preoperative mHHS (p<0.001) (p=0.01). A lower failure C (clinical failure) was independently associated with participation in competitive athletics (p=0.01), BMI (p<0.001), and male gender (p<0.001). Conclusion: This large multicenter cohort demonstrates the outcomes of FAI treatment at a mean of 4.3 years postoperative. Rates of THA and revision surgery were 4.0% and 6.9%. An additional 14.8% of patients demonstrates clinical failure based on patient-reported outcomes.
Variations in Blood Supply from Proximal to Distal in the Ulnar Collateral Ligament of the Elbow: A Qualitative Descriptive Cadaveric Study
Authors: Buckley Patrick S. , Morris Elizabeth R. , Robbins Colin , Kemler Bryson , Frangiamore Salvatore Joseph , Ciccotti Michael G. , Huard Johnny , LaPrade Robert F. , Hackett Thomas R. 
Published: July 2019

Objectives: The vascular supply of the ulnar collateral ligament (UCL) is unknown. Previous studies have reported varying success in return to play rates after non-operative management of partial UCL tears and suggest a varying healing capacity as possibly related to UCL injury location. The purpose of this study was to analyze the macroscopic vascular anatomy of the ulnar collateral ligament of the elbow. Methods: Eighteen, fresh-frozen, male cadaveric elbows from nine donors were sharply dissected 15 cm proximal to the medial epicondyle. Sixty mL of India Ink was injected through the brachial artery of each elbow. Arms were then frozen at -10°C, radial side down in 15-20° of elbow flexion. A bandsaw was used to section the frozen elbows into 5 mm coronal or sagittal sections. Sections were cleared for visualization using the modified Spalteholz technique. Images of specimens were taken and the qualitative description of the UCL vascularity was undertaken. Results: We consistently found a dense blood supply to the proximal UCL, while the distal UCL was hypovascular. We observed a possible osseous contribution to the proximal UCL from the medial epicondyle in addition to an artery from the flexor/pronator musculature that consistently appeared to provide vascularity to the proximal UCL. The degree of vascular penetration moving from proximal to distal in the UCL ranged from 39-68% of the overall UCL length, with a 49% average length of vascular penetration of the UCL. Conclusion: Our study found a difference in the vascular supply of the ulnar collateral ligament. The proximal UCL was well vascularized, while the distal UCL was hypovascular. This difference in vascular supply may be a factor in the differential healing capacities of the UCL based on the location of injury. An improved understanding of the macroscopic vascular supply of the UCL may aid in the clinical management of partial UCL tears and suggest an indication for treatments with respect to location of UCL injuries.
Time Required to Achieve Clinically Significant Outcomes After Arthroscopic Rotator Cuff Repair
Authors: Manderle Brandon J. , Gowd Anirudh K. , Liu Joseph , Beletsky Alexander , Bush-Joseph Charles A. , Cole Brian J. , Forsythe Brian , Nicholson Gregory P. , Verma Nikhil N. 
Published: July 2019

Objectives: To define the time-dependent nature of the minimally clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) after arthroscopic rotator cuff repair (RCR). Methods: A prospectively maintained institutional registry was queried for all patients undergoing arthroscopic RCR from 2014-2017 with completed pre-operative, 6 month, 1 and 2 year patient-reported outcome measure (PROM) surveys. MCID, SCB and PASS were calculated for the American Shoulder and Elbow Surgeons Score (ASES) using anchor-based methodology with receiver operating curve/area under curve analysis. Time to MCID, SCB and PASS was calculated using Kaplan-Meier analysis. A Cox multivariate regression model was used to calculate hazard ratios with respect to preoperative factors and intraoperative pathology. Results: 95 patients were included. Average age was 56.9 ± 9.5 years, average BMI was 30.8 ± 7.0 kg/m2. Mean symptom duration was 8.5 ± 7.8 months. Established MCID, SCB, PASS for the ASES were 11.1, 17.5, and 86.7 respectively. A total of 94.8% achieved MCID, 84.4% achieved SCB, and 54.6% achieved thresholds for PASS. Median achievement of MCID, SCB, and PASS occurred at 161, 166, and 347 days, respectively. Older patients had an increased likelihood of achieving MCID and SCB (HR: 1.036, 95% CI: 1.009, 1.064, p=0.009 and HR: 1.026, 95% CI: 1.000, 1.051, p=0.045, respectively). Lower preoperative score increased the likelihood of achieving SCB (HR: 0.976, 95% CI: 0.964, 0.989, p<0.001). Sustaining a dominant sided injury reduced the likelihood of achieving PASS (HR: 0.692, 95% CI: 0.513, 0.932, p=0.015). Conclusion: This study established the timeline to reach MCID, SCB and PASS in patients undergoing primary arthroscopic RCR. 80% of patients can expect to achieve MCID and SCB within one year, while 50% achieve PASS at this time point. Future studies should account for this trend in improvement when determining appropriate follow-up. [Figure: see text][Table: see text]
Progressive Supranuclear Palsy, Corticobasal Degeneration, and Multiple System Atrophy
Authors: Greene Paul 
Published: July 2019

ABSTRACT

PURPOSE OF REVIEW
Patients who have parkinsonian features, especially without tremor, that are not responsive to levodopa, usually have one of these three major neurodegenerative disorders rather than Parkinson disease: progressive supranuclear palsy (PSP), multiple system atrophy (MSA), or corticobasal degeneration (CBD). Each of these disorders eventually develops signs and symptoms that distinguish it from idiopathic Parkinson disease, but these may not be present at disease onset. Although these conditions are not generally treatable, it is still important to correctly diagnose the condition as soon as possible.

RECENT FINDINGS
In recent years, it has been increasingly recognized that the symptoms of these diseases do not accurately predict the pathology, and the pathology does not accurately predict the clinical syndrome. Despite this, interest has grown in treating these diseases by targeting misfolded tau (in the case of PSP and CBD) and misfolded α-synuclein (in the case of MSA).

SUMMARY
Knowledge of the characteristic signs and symptoms of PSP, MSA, and CBD are essential in diagnosing and managing patients who have atypical parkinsonian syndromes.
Ataxia
Authors: Kuo Sheng-Han 
Published: July 2019

ABSTRACT

PURPOSE OF REVIEW
This article reviews the symptoms, laboratory and neuroimaging diagnostic tests, genetics, and management of cerebellar ataxia.

RECENT FINDINGS
Recent advances in genetics have led to the identification of novel genetic causes for ataxia and a more comprehensive understanding of the biological pathways critical for normal cerebellar function. When these molecular pathways become dysfunctional, patients develop cerebellar ataxia. In addition, several ongoing clinical trials for Friedreich ataxia and spinocerebellar ataxia will likely result in novel symptomatic and disease-modifying therapies for ataxia. Antisense oligonucleotides for spinocerebellar ataxias associated with CAG repeat expansions might be a promising therapeutic strategy.

SUMMARY
Cerebellar ataxias include heterogeneous disorders affecting cerebellar function, leading to ataxic symptoms. Step-by-step diagnostic workups with genetic investigations are likely to reveal the underlying causes of ataxia. Some disease-specific therapies for ataxia exist, such as vitamin E for ataxia with vitamin E deficiency and thiamine for Wernicke encephalopathy, highlighting the importance of recognizing these forms of ataxia. Finally, genetic diagnosis for patients with ataxia will accelerate clinical trials for disease-modifying therapy and will have prognostic value and implications for family planning for these patients.
Psychogenic (Functional) Movement Disorders
Authors: Thenganatt Mary Ann , Jankovic Joseph 
Published: July 2019

ABSTRACTPURPOSE OF REVIEWThis article reviews a practical approach to psychogenic movement disorders to help neurologists identify and manage this complex group of disorders.RECENT FINDINGSPsychogenic movement disorders, also referred to as functional movement disorders, describe a group of disorders that includes tremor, dystonia, myoclonus, parkinsonism, speech and gait disturbances, and other movement disorders that are incongruent with patterns of pathophysiologic (organic) disease. The diagnosis is based on positive clinical features that include variability, inconsistency, suggestibility, distractibility, suppressibility, and other supporting information. While psychogenic movement disorders are often associated with psychological and physical stressors, the underlying pathophysiology is not fully understood. Although insight-oriented behavioral and pharmacologic therapies are helpful, a multidisciplinary approach led by a neurologist, but also including psychiatrists and physical, occupational, and speech therapists, is needed for optimal outcomes.SUMMARYThe diagnosis of psychogenic movement disorders is based on clinical features identified on neurologic examination, and neurophysiologic and imaging studies can provide supporting information.
The Rise of Portobelo and the Transformation of the Spanish American Slave Trade, 1640s–1730s: Transimperial Connections and Intra-American Shipping
Authors: García-Montón Alejandro 
Published: July 2019

AbstractThis article analyzes the rise of Portobelo as the most important center of the Spanish American slave trade from the 1660s to the 1730s. Portobelo's emergence was one of the most striking results of the structural transformation that the slave trade to Spanish America underwent between the 1640s and the 1650s. In these years, intra-American transimperial shipping displaced direct slave voyages from Africa to the Spanish Caribbean. By focusing on the elements that underpinned Portobelo's emergence, this essay shows how shifting transimperial connections affected the making and unmaking of the intraimperial circuits that supplied slaves to Spanish America. This approach reveals the inner workings, evolving links, and disputed hierarchies that interlocked port towns with inland cities and also structured the African diaspora in Spanish America and the emergence of a black Pacific.
The Climate of Conflict: Politico-environmental Press Coverage and the Eruption of the Mexican Revolution, 1907–1911
Authors: Wolfe Mikael D. 
Published: July 2019

AbstractThis article combines the insights of historical climatology and analysis of press coverage to reexamine the agrarian origins of the Mexican Revolution from 1907 to 1911. Using a collection of hundreds of articles from dozens of newspapers, contemporary meteorological and agricultural bulletins, government correspondence, secondary works, and recent historical climatological data, I argue that environmental dynamics and political processes were intertwined in the four years preceding the revolution. Specifically, I contend that politico-environmental press coverage of drought and frost based on incomplete or misleading regional climatic information strongly influenced the government's relief measures and thereby exacerbated the acute economic and political crises that led to the ouster of the dictator Porfirio Díaz. By analyzing these understudied climate-society dynamics surrounding the Mexican Revolution, the article's aim is to expand understanding of the significance of these dynamics as well as to incorporate the Mexican case into the global historiography on climate and rebellion.
Ports of Transnational Labor Organizing: Anarchism along the Peruvian-Chilean Littoral, 1916–1928
Authors: Savala Joshua 
Published: July 2019

AbstractThis article centers cross-border solidarity in the post–War of the Pacific (1879–83) context in Peru and Chile. I examine the ways in which some maritime and port workers in these countries in the early twentieth century created bonds of solidarity despite the reigning nationalism of the day. The article analyzes labor struggles and the move toward industrial organizing in Mollendo, Peru; Chilean Industrial Workers of the World efforts at creating links with Peruvian workers; and police repression after a 1925 strike in Mollendo. I combine an in-depth view of local organizing with the transnational political moves and connections forged by maritime and port workers. They lived and organized in their own ports while also forming bonds with other working-class people in the shared space of the Pacific littoral. Their organizing locally and transnationally challenged the chauvinistic nationalism of the era.
Physical Activity Is Higher in Patients with Left Ventricular Assist Device Compared with Chronic Heart Failure
Authors: MORENO-SUAREZ IGNACIO , LIEW SYLVIA , DEMBO LAWRENCE G. , LARBALESTIER ROBERT , MAIORANA ANDREW 
Published: July 2019

ABSTRACT

Purpose
Left ventricular assist devices (LVAD) are associated with an increased aerobic capacity in patients with chronic heart failure (CHF). However, studies evaluating the impact of LVAD implantation on physical activity (PA) are lacking. The aim of this study was to compare daily PA levels in participants with LVAD with well-matched CHF participants.

Methods
Sixteen participants with an LVAD (age, 59.1 ± 10.8 yr) were case-matched to 16 participants with advanced CHF (age, 58.3 ± 8.7 yr), who were listed or being considered for cardiac transplantation. Participants underwent a cardiopulmonary exercise test to determine peak oxygen consumption (V˙O2 peak). Physical activity was monitored continuously for seven consecutive days with an Actiheart monitor.

Results
V˙O2 peak in the CHF group (12.3 ± 3.5 mL·kg−1·min−1) was not significantly different to the LVAD group before LVAD implantation (10.4 ± 2.1 mL·kg−1·min−1), but was lower than in the LVAD group after implantation (15.8 ± 4.3 mL·kg−1·min−1; P < 0.05). Physical activity was higher in the LVAD (19.7 ± 6.4 kJ·kg−1·d−1) compared with the CHF group (11.6 ± 6.9 kJ·kg−1·d−1; P = 0.001). The LVAD participants spent more time performing moderate-intensity PA than their CHF counterparts (median, 26 min·d−1; interquartile range, 24–40 min·d−1 vs median, 12 min·d−1; interquartile range, 9–16 min·d−1; P < 0.001). Physical activity was correlated with V˙O2 peak (r = 0.582; P = 0.001) across participants in the CHF and LVAD groups.

Conclusions
Higher levels of PA were observed in participants with LVAD compared with patients with advanced CHF. This may be due to a higher V˙O2 peak, resulting in an improved capacity to perform activities of daily living with less symptoms.
A Dual-Accelerometer System for Detecting Human Movement in a Free-living Environment
Authors: NARAYANAN ANANTHA , STEWART TOM , MACKAY LISA 
Published: July 2019

ABSTRACT

Purpose
Accurate measurement of various human movement behaviors is essential in developing 24-h movement profiles. A dual-accelerometer system recently showed promising results for accurately classifying a broad range of behaviors in a controlled laboratory environment. As a progressive step, the aim of this study is to validate the same dual-accelerometer system in semi free-living conditions in children and adults. The efficacy of several placement sites (e.g., wrist, thigh, back) was evaluated for comparison.

Methods
Thirty participants (15 children) wore three Axivity AX3 accelerometers alongside an automated clip camera (clipped to the lapel) that recorded video of their free-living environment (ground truth criterion measure of physical activity). Participants were encouraged to complete a range of daily-living activities within a 2-h timeframe. A random forest machine-learning classifier was trained using features generated from the raw accelerometer data. Three different placement combinations were examined (thigh–back, thigh–wrist, back–wrist), and their performance was evaluated using leave-one-out cross-validation for the child and adult samples separately.

Results
Machine learning models developed using the thigh–back accelerometer combination performed the best in distinguishing seven distinct activity classes with an overall accuracy of 95.6% in the adult sample, and eight activity classes with an overall accuracy of 92.0% in the child sample. There was a drop in accuracy (at least 11.0%) when other placement combinations were evaluated.

Conclusions
This validation study demonstrated that a dual-accelerometer system previously validated in a laboratory setting also performs well in semi free-living conditions. Although these results are promising and progressive, further work is needed to expand the scope of this measurement system to detect other components of behavior (e.g., activity intensity and sleep) that are related to health.