bluuebunny/crossref_metadata_2025_split huggingface dataset:
Loss of Independence After Operative Management of Femoral Neck Fractures
Authors: Schemitsch Emil H. , Sprague Sheila , Heetveld Martin J. , Bzovsky Sofia , Heels-Ansdell Diane , Zhou Qi , Swiontkowski Marc , Bhandari Mohit ,   on behalf of the FAITH Investigators
Published: February 2019

Objectives:
The FAITH trial evaluated effects of sliding hip screws versus cancellous screws in femoral neck fracture patients. Using FAITH trial data, we quantified changes in living status, use of aids, and investigated factors associated with living and walking independently 12 months after fracture.

Methods:
We conducted a descriptive analysis to quantify patients' changes in living status, use of aids, and used multivariable Cox regression analyses to determine factors associated with living and walking independently after fracture.

Results:
Of patients who lived independently before hip fracture, 3.07% (50–80 years old) and 19.81% (>80 years old) were institutionalized 12 months after injury. Of patients who were walking independently before injury, 33.62% (50–80 years old) and 69.34% (>80 years old) required a walking aid 12 months after injury. Factors associated with higher chances of living independently included the following: being between 50 and 80 years, having a class I American Society of Anesthesiologists classification, not using a walking aid before fracture, being a nonsmoker or former smoker, and having an acceptable quality of implant placement. Factors associated with higher chances of walking without an aid included the following: being between 50 and 80 years, having a class I American Society of Anesthesiologists classification, living independently before fracture, being a nonsmoker or former smoker, having an undisplaced fracture, and not requiring revision surgery.

Conclusions:
Femoral neck fracture patients suffer great losses of independence. Identifying factors associated with living and walking independently after hip fracture may help surgeons better identify which patients are at risk and optimize care of patients with this injury.

Level of Evidence:
Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Confirming the Clinical Safety and Feasibility of a Bundled Methodology to Improve Cardiopulmonary Resuscitation Involving a Head-Up/Torso-Up Chest Compression Technique
Authors: Pepe Paul E. , Scheppke Kenneth A. , Antevy Peter M. , Crowe Remle P. , Millstone Daniel , Coyle Charles , Prusansky Craig , Garay Sebastian , Ellis Richard , Fowler Raymond L. , Moore Johanna C. 
Published: February 2019

Objectives:
Combined with devices that enhance venous return out of the brain and into the thorax, preclinical outcomes are improved significantly using a synergistic bundled approach involving mild elevation of the head and chest during cardiopulmonary resuscitation. The objective here was to confirm clinical safety/feasibility of this bundled approach including use of mechanical cardiopulmonary resuscitation provided at a head-up angle.

Design:
Quarterly tracking of the frequency of successful resuscitation before, during, and after the clinical introduction of a bundled head-up/torso-up cardiopulmonary resuscitation strategy.

Setting:
9-1-1 response system for a culturally diverse, geographically expansive, populous jurisdiction.

Patients:
All 2,322 consecutive out-of-hospital cardiac arrest cases (all presenting cardiac rhythms) were followed over 3.5 years (January 1, 2014, to June 30, 2017).

Interventions:
In 2014, 9-1-1 crews used LUCAS (Physio-Control Corporation, Redmond, WA) mechanical cardiopulmonary resuscitation and impedance threshold devices for out-of-hospital cardiac arrest. After April 2015, they also 1) applied oxygen but deferred positive pressure ventilation several minutes, 2) solidified a pit-crew approach for rapid LUCAS placement, and 3) subsequently placed the patient in a reverse Trendelenburg position (~20°).

Measurements and Main Results:
No problems were observed with head-up/torso-up positioning (n = 1,489), but resuscitation rates rose significantly during the transition period (April to June 2015) with an ensuing sustained doubling of those rates over the next 2 years (mean, 34.22%; range, 29.76–39.42%; n = 1,356 vs 17.87%; range, 14.81–20.13%, for 806 patients treated prior to the transition; p < 0.0001). Outcomes improved across all subgroups. Response intervals, clinical presentations and indications for attempting resuscitation remained unchanged. Resuscitation rates in 2015–2017 remained proportional to neurologically intact survival (~35–40%) wherever tracked.

Conclusions:
The head-up/torso-up cardiopulmonary resuscitation bundle was feasible and associated with an immediate, steady rise in resuscitation rates during implementation followed by a sustained doubling of the number of out-of-hospital cardiac arrest patients being resuscitated. These findings make a compelling case that this bundled technique will improve out-of-hospital cardiac arrest outcomes significantly in other clinical evaluations.
Applying Clinical Decision Rules in a Patient With Venous Thromboembolism After an Elective Total Knee Arthroplasty: A Case Report
Authors: Heick John D. 
Published: February 2019

Introduction:
Venous thromboembolism (VTE) includes both deep vein thrombosis (DVT) and pulmonary embolism (PE), is the third most common cardiovascular disease behind myocardial infarction and stroke, and is responsible for 10% of hospital deaths as a result of PE. The purposes of this case report are to (1) describe such an incident in a 63-year-old man status-post right total knee arthroplasty who is referred to physical therapy and (2) highlight the role of using clinical decision rules (CDRs) and the recently published VTE clinical practice guidelines.

Case presentation:
A 63-year-old man presented to an orthopedic surgeon for elective total knee arthroplasty of the right knee. The patient reported for his initial physical therapy session 3 weeks after surgery, and while warming up on a recumbent bicycle, he started having difficulty catching his breath. The patient was ultimately diagnosed with bilateral PE and a right lower extremity proximal DVT.

Conclusion:
This case illustrates the importance of using an evidence-based approach for determining the clinical probability of VTE by following clinical guidelines. This case also highlights the importance of using CDRs and communicating in a timely manner to ensure patient safety.
Anxiety and Fear of Exercise in Cardiopulmonary Rehabilitation
Authors: Farris Samantha G. , Abrantes Ana M. , Bond Dale S. , Stabile Loren M. , Wu Wen-Chih 
Published: February 2019

Purpose:
One unexplored mechanism for poor outcomes in cardiovascular and pulmonary rehabilitation (CVPR) is fear about aerobic exercise. Patients in CVPR may tend to avoid aerobic exercise because of the fear of physical sensations associated with exertion. This study examined fear about exercise in patients enrolled in outpatient CVPR and practitioner beliefs and behaviors related to fear associated with exercise.

Methods:
Survey data were collected from patients (n = 117) enrolled in cardiac rehabilitation (n = 69) and pulmonary rehabilitation (n = 48) and practitioners (n = 16) who were exercise physiologists and nurses working in CVPR.

Results:
Fears about exercise and avoidance behaviors were common among patients. In pulmonary rehabilitation, fears and avoidance of exercise were correlated with higher levels of anxiety and depression (r values = 0.27-0.54), lower forced expiratory volume in the first second of expiration/forced vital capacity (r values = −0.13 to −0.39), lower health-related quality of life (r values = −0.13 to −0.62), and stronger beliefs about utility of anxiety treatment (r values = 0.21-0.36). In cardiac rehabilitation, fears about exercise were correlated with higher levels of anxiety (r values = 0.19-0.38), lower mental health quality of life (r values = −0.25 to −0.27), and stronger beliefs about utility of anxiety treatment (r values = 0.30-0.40), and avoidance of exercise was correlated with lower exercise tolerance and poorer physical health quality of life (r values = −0.22 to −0.24). Practitioners estimated that an average of 47 ± 20% of patients experience fear associated with exercise and reported low feelings of preparedness to address patient anxiety and fear.

Conclusions:
It may be beneficial to provide practitioners with skills to recognize and address anxiety and fear in their patients as it relates to exercise.
Recent Surgical Trends in Pediatric Corneal Transplantation: A 13-Year Review
Authors: Zhu Angela Y. , Prescott Christina R. 
Published: February 2019

Purpose:
Corneal transplantation is the standard of care for pediatric corneal opacities, but little consensus exists on optimal surgical management. Our goal was to evaluate cross-sectional data of donor and recipient characteristics collected from eye banks providing tissue for pediatric corneal transplant cases to assess surgical trends in pediatric keratoplasty over the past 13 years.

Methods:
We performed a retrospective review of recipient data, collected from 4 major eye banks, for pediatric patients (<18 years) who underwent corneal transplantation between January 2005 and December 2017. We analyzed trends in surgical indications, types of keratoplasty, and donor/recipient characteristics.

Results:
Our database included 2620 total pediatric cases. Penetrating keratoplasty (PKP) remains the most common surgery performed (79.8%), but more partial-thickness transplant cases [eg, endothelial keratoplasty (EK)] have been performed since 2008. The most commonly reported transplant indication was ectasias/thinnings (34.1%) overall and congenital opacities (17.0%) in children less than 5 years. Average donor age was significantly lower for the youngest recipient age group of less than 5 years (P < 0.001); endothelial cell count was also higher, and death-to-surgery time was lower for PKP and EK cases versus other keratoplasties.

Conclusions:
Indications for transplant vary across age groups but are consistent with previous reports. Popularity of partial-thickness transplants has increased since 2008. Surgeons prefer younger donor tissue for younger patients and have higher thresholds for endothelial cell count for PKP and EK cases. Centralized tracking of pediatric keratoplasty cases is necessary for further investigation of long-term outcomes.
Evaluation of Dry Eye Disease in Children With Systemic Lupus Erythematosus and Healthy Controls
Authors: Ong Tone Stephan , Elbaz Uri , Silverman Earl , Levy Deborah , Williams Sara , Mireskandari Kamiar , Ali Asim 
Published: February 2019

Purpose:
To compare the symptoms and signs of dry eye disease (DED) in children with systemic lupus erythematosus (SLE) with those in healthy children using common diagnostic tools.

Methods:
Prospective, observational, single-center cohort study. Thirty-four subjects with SLE and 15 healthy subjects were recruited from the Hospital for Sick Children in Toronto, Canada. Subjects underwent subjective and objective dry eye assessments using the Canadian Dry Eye Assessment (CDEA) questionnaire, tear film osmolarity, slit lamp examination, tear film break-up time, corneal fluorescein staining, Schirmer test 1, and conjunctival lissamine green staining.

Results:
No difference in symptoms was found between children with SLE and healthy children (CDEA score 6.4 ± 5.4 vs. 3.8 ± 3.2; P = 0.09). Corneal staining was more prevalent in children with SLE than in healthy children (58.8% vs. 20.0%; P = 0.01), and children with SLE had higher mean corneal fluorescein staining scores (1.7 ± 1.7 vs. 0.2 ± 0.4; P = 0.002). No statistically significant differences in tear osmolarity, inter-eye differences in tear osmolarity, tear film break-up time, Schirmer test 1, or lissamine green staining scores were observed between the 2 groups. In healthy children, CDEA scores weakly correlated with corneal fluorescein staining score (r = 0.53, P = 0.04). In children with SLE, no correlation between CDEA score and any of the diagnostic test outcomes was found.

Conclusions:
There is discordance between symptoms and signs of DED in children with SLE. Corneal fluorescein staining is essential for the diagnosis of DED in these children.
Planning for Active Learning in the Didactic Classroom
Authors: DeWitt Rachel D. 
Published: February 2019

Abstract
Driven by the convergence of the exponential growth of medical knowledge and the dated medical education delivery system, educators in physician assistant (PA) programs are striving to create teaching practices that actively engage students, improve knowledge retention, and prepare students for a career that requires lifelong learning and reflection. The emphasis on professor-directed teaching and learning activities is shifting toward a more learner-centered approach. To incorporate appropriate active learning exercises into the PA classroom, instructors must plan, design, and execute pedagogically sound practices. In addition, instructors must find a concrete way in which to reflect on and refine their classroom exercises so that they can expand their teaching skills even while educating their students.
Inadvertent epidural anesthesia associated with catheterization following continuous psoas compartment block in a patient with scoliosis
Authors: Kim Byung-Gun , Yang Chunwoo , Soh Sunghyun , Lee Kyungjoo 
Published: February 2019

Abstract

Rationale:
Psoas compartment block (PCB) is typically performed using surface anatomical landmarks and neurostimulation for guidance. However, anatomical anomalies, such as scoliosis, make this technique unreliable, posing a challenge for the anesthesiologist when inducing regional anesthesia.

Patient concerns:
A 69-year-old woman with lumbar scoliosis scheduled for total hip arthroplasty underwent PCB with catheterization.

Diagnoses:
Inadvertent epidural anesthesia with catheterization following PCB was diagnosed using a lumbar radiograph.

Interventions:
Due to hypotension induced by local anesthetic (LA) epidural diffusion, the patient received intravenous hydration and vasopressor. Since bilateral sensory block was noted at the T3 level, with an incomplete motor blockade in both legs, the surgery was performed under epidural anesthesia.

Outcomes:
The patient remained hemodynamically stable throughout the duration of the surgical procedure. The surgery was uneventful and without further complications.

Lessons:
Patients with lumbar scoliosis are highly at risk of LA epidural diffusion, following PCB using traditional landmark-based approach. Other nerve-localizing technique can minimize the risk of this complication.
A comparative analysis of clinicopathological factors between esophageal small cell and basaloid squamous cell carcinoma
Authors: Ishida Hirotaka , Kasajima Atsuko , Onodera Yu , Konno Takuro , Maruyama Shota , Okamoto Hiroshi , Sato Chiaki , Heishi Takahiro , Sakurai Tadashi , Taniyama Yusuke , Takahashi Masanobu , Fujishima Fumiyoshi , Jingu Keiichi , Ishioka Chikashi , Sasano Hironobu , Kamei Takashi 
Published: February 2019

Abstract
Esophageal small cell carcinoma (E-SmCC) and basaloid squamous cell carcinomas (BSCCs) are both highly aggressive malignancies, but their detailed differences in clinical behaviors have remained virtually unknown. In addition, treatment strategies of the patients with E-SmCC have not been established. 29 cases of E-SmCC and 39 with BSCC were examined in this study to clarify the clinical features and outcome of the patients with E-SmCC and to compare the findings with those of BSCC. E-SmCCs presented a more advanced status than BSCC (TNM Stage: P = .002). Esophagectomy was performed in 15 small cell carcinoma patients and 14 were treated with non-surgical/systemic therapy. The clinical outcome of the small cell carcinoma cases was significantly worse than those with BSCC (P = .001), but results of a stage-stratified analysis revealed that the Stage I small cell carcinoma patients presented favorable prognosis (3-year survival rate 100%, n = 4). In contrast, among those with Stage II–IV, clinical outcome tended to be better in the systemic therapy group (3-year survival rate 49%, n = 13) than the surgically treated group (3-year survival rate 0%, n = 12). E-SmCC was a more aggressive neoplasm than BSCC. However, early detection could possibly improve the clinical outcome of patients with E-SmCC. Systemic therapy could also benefit the patients with advanced disease (Stage II–IV).
Uterine size and volume are associated with a higher clinical pregnancy rate in patients undergoing assisted reproduction technology
Authors: Gao Hong , Liu Dong-e , Li Yumei , Tang Jing , Hu Shimin , Wu Xinrui , Tian Zhengwen , Tan Hongzhuan 
Published: February 2019

Abstract
The aim of this study was to investigate the relationships between uterine size and volume and clinical pregnancy rate.
This longitudinal study was conducted among patients undergoing assisted reproduction technology (ART) treatment at the Reproductive Medicine Center from January 2010 to May 2017, all of whom provided informed consent to participate in the study. The uterine size, for all patients, was measured by transvaginal ultrasonography before ovarian stimulation. Clinical pregnancy was diagnosed by ultrasound confirmation of at least an intrauterine gestational sac and fetal cardiac activity 4 weeks after embryo transfer.
A total of 11,924 patients were enrolled in this study. Compared to patients with uterine lengths of 50 to 59 mm (referent), patients with uterine lengths ≥60 mm had a lower clinical pregnancy rate. Compared to patients with uterine widths of 30 to 39 mm (referent), patients with uterine widths of 40 to 49 mm and those with uterine widths of ≥50 mm had a lower clinical pregnancy rate. Compared with those with a uterine anteroposterior diameter of <30 mm (referent), patients with uterine anteroposterior diameters of ≥50 mm had a lower clinical pregnancy rate. Compared with those with a uterine volume of 30 to 49 mL (referent), patients with a uterine volume ≥70 mL had a lower clinical pregnancy rate.
The patients with an optimal uterine length, width, anteroposterior diameter, and volume had a higher clinical pregnancy rate than those with suboptimal uterine measurements. Uterine sizes and volumes that were too large reduced the clinical pregnancy rate.
Comparison of dual-time point 18F-FDG PET/CT tumor-to-background ratio, intraoperative 5-aminolevulinic acid fluorescence scale, and Ki-67 index in high-grade glioma
Authors: Kim Yong-il , Cho Kyung Gi , Jang Su Jin 
Published: February 2019

Abstract
The aim of this study was to compare preoperative dual-time point 18F-fluorodeoxyglucose (FDG) uptake pattern with intraoperative 5-aminolevulinic acid (5-ALA) fluorescence in high-grade gliomas. In addition, we assessed for possible associations with a pathologic parameter (Ki-67 index).
Thirty-one patients with high-grade glioma (M:F = 19:12, mean age = 60.6 ± 11.2 years) who underwent dual-time point 18F-FDG positron emission tomography (PET)/computed tomography (CT) scan before surgery were retrospectively enrolled; 5-ALA was applied to the surgical field of all these patients and its fluorescence intensity was evaluated during surgery. Measured 18F-FDG PET/CT parameters were maximum and peak tumor-to-background ratio (maxTBR and peakTBR) at base (-base) and delayed (-delay) scan. The intensity of 5-ALA fluorescence was graded on a scale of three (grade I as no or mild intensity, grade II as moderate intensity, and grade III as strong intensity).
Seven of the patients had WHO grade III brain tumors and 24 had WHO grade IV tumors (mean tumor size = 4.8 ± 1.8 cm). MaxTBR-delay and peakTBR-delay showed significantly higher values than maxTBR-base and peakTBR-base, respectively (all P < .001). Among the 18F-FDG PET/CT parameters, only maxTBR-delay demonstrated significance according to grade of 5-ALA (P = .030), and maxTBR-delay gradually decreased as the fluorescence intensity increased. Also, maxTBR-delay and peakTBR-delay showed significant positive correlation with Ki-67 index (P = .011 and .009, respectively).
Delayed 18F-FDG uptake on PET/CT images could reflect proliferation in high-grade glioma, and it has a complementary role with 5-ALA fluorescence.
Imatinib-induced irreversible interstitial lung disease
Authors: Zhang Ping , Huang Jingfeng , Jin Fangfang , Pan Jiaohai , Ouyang Guifang 
Published: February 2019

Abstract

Rationale:
Imatinib mesylate (imatinib) is a classic tyrosine kinase inhibitor used to treat chronic myeloid leukemia. Although it is well tolerated by most patients and helps in the achievement of complete remission, a few rare imatinib-associated adverse effects such as pulmonary interstitial fibrosis have been reported. Because of its rareity, the clinical features of imatinib-induced interstitial lung disease (ILD) remain unclear.

Patient concerns:
A 49-year-old Chinese man with chronic myeloid leukemia received oral treatment with imatinib and initially exhibited a good response. However, he presented with cough and fever 9 months after treatment initiation.

Diagnoses:
Pulmonary computed tomography indicated diffuse interstitial fibrosis in both lungs. All tests for possible infectious pathologies provided negative results.

Interventions:
The patient was diagnosed with interstitial pneumonia and treated with antibiotics; however, there was no improvement. On the basis of a suspicion of imatinib-induced ILD, imatinib was discontinued and prednisone treatment was initiated.

Outcomes:
The patient's symptoms ameliorated with treatment, and imatinib was reintroduced. However, he developed cough and dyspnea again, and his treatment was switched to nilotinib as a second-line regimen. He was regularly monitored, and although his clinical symptoms ameliorated, computed tomography performed 29 months after he was diagnosed with ILD showed irreversible pulmonary interstitial fibrosis without progression.

Lessons:
Clinicians should consider the possibility of severe irreversible ILD and carefully monitor patients receiving imatinib treatment.