bluuebunny/crossref_metadata_2025_split huggingface dataset:
Narcotic use and total hip arthroplasty
Authors: Bolarinwa Surajudeen A , Casp Aaron A , Cancienne Jourdan M , Werner Brian C , Browne James A 
Published: June 2018

Background: The purpose of this study is to: (1) characterise risk factors for prolonged narcotic use following total hip arthroplasty (THA); (2) examine preoperative and prolonged postoperative narcotic use as independent risk factors for complications following THA. Methods: A national database identified primary THA patients from 2007–2015. Preoperative (POU) and prolonged postoperative narcotics users (PPU) were identified. A multivariable logistic regression analysis was utilised to identify any patient-related risk factors for prolonged use, and examined POU and PPU as risk factors for complications following THA. Results: 55,354 THA patients were included, 18,740 (33.8%) POU and 14,996 (27.1%) PPU. Preoperative narcotics use was the most significant factor associated with prolonged postoperative narcotic use. Preoperative and prolonged postoperative use were associated with significantly higher complications postoperatively. Conclusions: Preoperative narcotic use is the most significant patient specific risk factor for prolonged postoperative narcotic use. POUs and PPUs are at a significantly higher risk of postoperative infection and revision surgery.
Efficacy of urokinase lock to treat thrombotic dysfunction of tunneled hemodialysis catheters: A retrospective cohort study
Authors: Van Hulle Freya , Bonkain Florence , De Clerck Dieter , Aerden Dimitri , Vanwijn Isabelle , Tielemans Christian , Wissing Karl Martin 
Published: June 2018

Background: There are few data to inform decisions about the optimal management of occluded tunneled cuffed hemodialysis catheters with thrombolytic locking solutions. The effect of dose, dwell-time, and number of administrations remains controversial. Methods: In this retrospective single-center review of tunneled cuffed catheters used between 2010 and 2014, restoration of blood flow as well as pre- and post-pump pressures after either short (30 min) or prolonged (48–72 h) administration of 100,000 IU of urokinase locking solution was evaluated in all thrombotic dysfunctions. We also assessed if multiple urokinase locks for the same thrombotic dysfunction event were more efficient to restore catheter performance than single administration. Results: Data on 773 thrombotic events in 148 patients (236 catheters) were collected during observation period. After urokinase treatment, blood flow and pre-pump pressure improved (median of 50 mL/min and 20 mmHg) whereas post-pump pressure decreased (median of 15 mmHg) (all P < 0.0001). The short thrombolytic procedure, used in more severely dysfunctional catheters, resulted in significantly larger improvements in catheter function than the long procedure. Multiple administrations for the same thrombotic event further improved access function in case of persisting dysfunction after first lock but had no added beneficial effect if blood flow and/or pump pressures were normalized after first urokinase lock. Conclusion: Both short and prolonged administration of urokinase locks were efficient in restoring blood flow and pre- and post-pump pressures in dialysis catheters with thrombotic dysfunction. Multiple urokinase locks provide added benefit on these outcomes only in case of persisting dysfunction after the first lock.
Is our current method of cervical spine control doing more harm than good?
Authors: Phaily Ary , Khan Mansoor 
Published: June 2018

Introduction Early cervical spine immobilisation has long been considered the standard of care in the management of trauma patients with suspected spinal cord injury. There has been conflicting evidence regarding its benefits and risks. This article reviews the current literature and whether the continued use of routine cervical spine immobilisation is still appropriate in modern trauma care. Method A literature search was conducted using the Medline PubMed, Google Scholar and Cochrane Library online databases. The searches were limited to full text, English language studies conducted on adults in the last 20 years (July 1997 to July 2017). Results The entrenchment of cervical spine immobilisation in trauma management is multifactorial. In the pre-hospital setting, immobilisation is recommended whilst awaiting full assessment. Fear of missed diagnoses of spinal injuries encourages defensive medicine and over-immobilisation. Effective cervical spine immobilisation is appropriate in certain cases and reduces the risk of further spinal cord injury. However, research has shown that we are over-immobilising, and in penetrating trauma, cervical spine immobilisation increases the risk of mortality. Conclusions The practice of routine cervical spine immobilisation for trauma patients is outdated, ineffective and results in iatrogenic injury. Routine cervical spine immobilisation is not backed up by robust evidence. It has been clearly shown that in cases of penetrating spinal injuries, cervical spine immobilisation is not only ineffective but is also linked to an increased risk of mortality. Special considerations must also be taken in patients who have pre-existing spinal conditions, impending airway compromise, or at risk of aspiration and those with head injuries or suspected traumatic brain injuries. A selective approach to cervical spine immobilisation is recommended and should be reserved for cases deemed high risk rather than a standard rule for all trauma patients.
The Image Today: Field-Notes on the Interdisciplinary Use of the Visioning Workshop
Authors: Bodinet Jelena Cingel 
Published: June 2018

Fred Polak wrote in his classic text, The Image of The Future: The rise and fall of images of the future precedes or accompanies the rise and fall of cultures. As long as the society’s image is positive and flourishing, the flower of culture is in full bloom. Once the image begins to decay and lose its vitality, however, the culture does not long survive. This is, arguably, one of the most important tenets of Futures Studies as an academic discipline. This essay explores the importance and practice of imbuing our communities (especially our youth) with the ability to create positive future images; assisting them in the recognition of their own agency in the creation of preferred futures; and encouraging them to become active participants in the creation of positive personal and communal futures today.
Intraosseous schwannomas involving the sacrum: Characteristic imaging findings and review of the literature
Authors: Summers Spencer , Jose Jean , Barrera Carlos M , Pretell-Mazzini Juan , Subhawong Ty , Nguyen Nguyen V , Kerr Darcy , Nielsen G Petur , Rosenberg Andrew E 
Published: June 2018

Background and purpose Sacral intraosseous schwannomas represent a rare subset of schwannomas. The existing literature detailing the radiographic appearance of intraosseous schwannomas is limited. The aim of this study is to formally characterize the radiological appearance of sacral intraosseous schwannomas to differentiate them from other lytic lesions. Materials and methods Imaging studies of 13 pathologically proven intraosseous schwannomas were reviewed from multiple institutions by fellowship-trained radiologists. A PubMed search was performed and identified four papers pertaining to the imaging characteristics of sacral intraosseous schwannomas. The results of these papers were compared to findings from our cases. Results All tumors had heterogeneous signals and were predominately solid but cystic components with fluid-fluid levels were present. The tumors caused a mass effect but none infiltrated the surrounding soft tissues. Post-contrast T1-weighted images revealed heterogeneous enhancement in all 13 tumors and four possessed non-enhancing cysts. A literature review identified 16 other cases of sacral intraosseous schwannomas forming a total of 29 cases examined. Conclusions Sacral intraosseous schwannomas should be considered in the differential diagnosis for both radiologists and pathologists when dealing with large expansile, lytic lesions, with well-defined sclerotic margins involving the sacrum. This is particularly important in middle-aged adults presenting with pathology centered around S2-3.
Arterial spin labeling perfusion: Prospective MR imaging in differentiating neoplastic from non-neoplastic intra-axial brain lesions
Authors: Soni Neetu , Srindharan Karthika , Kumar Sunil , Mishra Prabhakar , Bathla Girish , Kalita Jyantee , Behari Sanjay 
Published: June 2018

Purpose The purpose of this article is to assess the diagnostic performance of arterial spin-labeling (ASL) magnetic resonance perfusion imaging to differentiate neoplastic from non-neoplastic brain lesions. Material and methods This prospective study included 60 consecutive, newly diagnosed, untreated patients with intra-axial lesions with perilesional edema (PE) who underwent clinical magnetic resonance imaging including ASL sequences at 3T. Region of interest analysis was performed to obtain mean cerebral blood flow (CBF) values from lesion (L), PE and normal contralateral white matter (CWM). Normalized (n) CBF ratio was obtained by dividing the mean CBF value of L and PE by mean CBF value of CWM. Discriminant analyses were performed to determine the best cutoff value of nCBFL and nCBFPE in differentiating neoplastic from non-neoplastic lesions. Results Thirty patients were in the neoplastic group (15 high-grade gliomas (HGGs), 15 metastases) and 30 in the non-neoplastic group (12 tuberculomas, 10 neurocysticercosis, four abscesses, two fungal granulomas and two tumefactive demyelination) based on final histopathology and clincoradiological diagnosis. We found higher nCBFL (6.65 ± 4.07 vs 1.68 ± 0.80, p < 0.001) and nCBFPE (1.86 ± 1.43 vs 0.74 ± 0.21, p < 0.001) values in the neoplastic group than non-neoplastic. For predicting neoplastic lesions, we found an nCBFL cutoff value of 1.89 (AUC 0.917; 95% CI 0.854 to 0.980; sensitivity 90%; specificity 73%) and nCBFPE value of 0.76 (AUC 0.783; 95% CI 0.675 to 0.891; sensitivity 80%; specificity 58%). Mean nCBFL was higher in HGGs (8.70 ± 4.16) compared to tuberculomas (1.98 ± 0.87); and nCBFPE was higher in HGGs (3.06 ± 1.53) compared to metastases (0.86 ± 0.34) and tuberculomas (0.73 ± 0.22) ( p < 0.001). Conclusion ASL perfusion may help in distinguishing neoplastic from non-neoplastic brain lesions.
Identifying and assessing potential harm of medication errors and potentially unsafe medication practices in paediatric hospital settings: a field study
Authors: Rishoej Rikke Mie , Almarsdóttir Anna Birna , Thybo Christesen Henrik , Hallas Jesper , Juel Kjeldsen Lene 
Published: June 2018

Background: Hospitalized children are prone to experience harm from medication errors (MEs). Strategies to prevent MEs can be developed from identified malfunctioning practices and conditions in the medication use process. In this study, we aimed to identify MEs and potentially unsafe medication practices (PUMPs) in hospitalized children, and to assess the potential harm of these, using raters of different professions. Methods: A 1-week observation using an undisguised technique was conducted on four paediatric hospital wards. One observer followed ward staff during medication prescribing, preparation and administration. MEs and PUMPs were documented using field notes. Three raters including a physician, a nurse and a clinical pharmacist assessed the potential harm of each ME and PUMP using a six-point Likert scale. Agreement was analysed using Fleiss’ Kappa. Results: A total of 16 MEs and 809 PUMPs were identified involving a preparation and administration error rate of 8%. No actual harm to patients was observed during the study. Raters assessed the potential harm of 318 unique MEs and PUMPs. Only slight agreement was found (Kappa = 0.26–0.33). A 4-hour delay in the administration of intravenous cefuroxime received the highest harm score. Observations involving no information during prescribing and variations in medication preparation were considered potentially fatal for medications such as digoxin, morphine, enoxaparin and insulin. Conclusions: MEs and potentially unsafe practices and conditions may affect medication safety of hospitalized children. However, observed MEs did not result in any harm. The agreement among raters assessing the potential harm of observations was low. Alternative methods to determine the clinical relevance of errors are needed.
Which one is more affected by navigation-assisted cup positioning in total hip arthroplasty: Anteversion or inclination? A retrospective matched-pair cohort study in Asian physique
Authors: Oh Kwang Jun , Kim Byung Kag , Jo Myung Il , Ahn Byung Mun 
Published: June 2018

Introduction: The purpose of this study was to compare acetabular cup positioning using an imageless navigation-assisted total hip arthroplasty (THA) to a case-matched control group using the conventional technique in Asian physique. Methods: Case matching controlled study using retrospectively collected data for THAs was done. Matching criteria were gender, age ± 5 years, and body mass index ± 5 kg/m2. Thirty patients who had navigation THAs were manually matched to a conventional group of 30 patients. After measuring anteversion and inclination on 3-D CT, final cup anteversion was calculated using the mathematical formula (anteversion = arctan [tan (anatomic anteversion) × sin (inclination)]). Results: No significant difference was observed between mean inclination ( p = 0.420), anteversion ( p = 0.697), and the mean deviation from 15° for anteversion ( p = 0.649). However, there was a statistical significant difference for mean deviation from 40° for inclination ( p = 0.027). There was a significant difference in the percentage of correctly placed acetabular cup in safe zones with inclination ( p = 0.039). Conclusions: Although soft tissue overlying the pubic tubercle interfered with registration of the bony landmark and thereby induced inaccuracy of anteversion angles in the navigation group, the use of imageless navigation-assisted technique increases the placement within the safe zone for inclination and enhances the accuracy and the precision of inclination of the acetabular cup relative to the conventional THA rather than anteversion. This finding may be due to the effect of the patient’s physique on the anterior pelvic plane (APP)-based reference system of imageless navigation.
Correlation Between Quality of Evidence and Number of Citations in Top 50 Cited Articles in Rotator Cuff Repair Surgery
Authors: Sochacki Kyle R. , Jack Robert A. , Nauert Richard , Harris Joshua D. 
Published: June 2018

Background: The number of article citations has been used as a measure for the impact of an article in the medical literature, with little emphasis on quality. Purpose: To (1) identify the top 50 most cited articles related to rotator cuff repair surgery, (2) determine whether there was a correlation between the top cited articles and level of evidence, and (3) determine whether there was a correlation between the top cited articles and study quality. Study Design: Cross-sectional study. Methods: The Web of Science and Scopus online databases were searched to identify the top 50 cited articles in rotator cuff repair surgery. Methodological quality was analyzed for each article using the Modified Coleman Methodology Score (MCMS), Jadad scale, and Methodological Index for Non-Randomized Studies (MINORS). Correlation coefficients were calculated to determine the degree of correlation between the top cited articles and level of evidence and study quality using each quality score. Results: The mean number of citations for each article in each of the 2 databases was 319 ± 187 (range, 177.5-1033.5). Twenty-nine articles (58%) were from the United States. The most common level of evidence was level 4 (54%), with 3 (6%) articles being level 1. There was no significant correlation between the mean number of citations and level of evidence ( rs = –0.28), the MCMS ( rs = –0.29), and the MINORS score ( rs = –0.25). There was a weak negative correlation between the mean number of citations and the Jadad score ( rs = –0.36). Conclusion: The top 50 cited articles in rotator cuff repair surgery comprise a variety of years, journals, countries of origin, and study types. Despite being the 50 most cited articles, the most common type of article was the level 4 case series with a poor mean quality assessment score. There was no significant correlation between the mean number of citations and level of evidence or methodological quality using a variety of scores.
Anti-VEGF for Management of Neovascularization of Iris and Neovascular Glaucoma
Authors: Xia Tian , Zarbin Marco A. , Bhagat Neelakshi 
Published: June 2018

Purpose: To study the treatment effect of antivascular endothelial growth factor (anti-VEGF) injections on eyes with iris neovascularization (NVI). Methods: Retrospective study of patients who underwent intravitreal anti-VEGF for the treatment of NVI at the Rutgers-Institute of Ophthalmology and Visual Sciences between January 1, 2007 and March 30, 2017. Results: Twenty-eight eyes (mean age, 63 ± 13 years old, 12 [43%] males) were identified. All patients had NVI, and 23 patients had concurrent neovascular glaucoma. The etiology of anterior segment ischemia was proliferative diabetic retinopathy in 20 eyes (71%), central retinal vein occlusion in 7 eyes (25%), and branch retinal vein occlusion in 1 eye (4%). Corneal edema in 25 eyes (89%), hyphema in 11 (39%), visually significant cataract in 25 (86%), and vitreous hemorrhage in 15 (54%) precluded an adequate view to the fundus to perform panretinal photocoagulation (PRP). All patients initially received anti-VEGF therapy; PRP was provided in some eyes ( n = 7) with persistent NVI if the view to the fundus improved. On average, 1.66 (median, 1; standard deviation [SD], 1.64) anti-VEGF injections were performed before complete NVI regression was achieved. Complete regression of rubeosis iridis took an average of 42 (median, 40; SD, 48) days from the first injection. Ten eyes (36%) had recurrence of rubeosis at 198 (median, 126; SD, 165) days after complete regression of NVI. Conclusions: NVI regression was noted in all eyes. Anti-VEGF may be a good supplement for initial NVI management in eyes when PRP cannot be initiated.
Treatment strategies for adolescent and young adult patients with acute myeloid leukemia
Authors: O’Dwyer Kristen , Freyer David R. , Horan John T. 
Published: June 2018

Abstract
Adolescents and young adults (AYAs) form a unique group of patients with newly diagnosed acute myeloid leukemia (AML). They differ in terms of disease biology, psychosocial challenges, survival, and in other important respects from children as well as from middle-aged and older adults. AYAs may be treated using pediatric protocols developed in trials composed primarily of younger patients, or using adult protocols developed in trials composed primarily of older patients. After reviewing the distinguishing characteristics of AYAs with AML, we compare and contrast the chemotherapy approaches and argue that neither the pediatric nor adult approaches may be ideally suited for AYAs and the development of AYA-specific approaches merits further consideration. We finish by putting forth ideas for future research to optimize chemotherapy treatment of AYAs with AML.
The management of Hodgkin lymphoma in adolescents and young adults: burden of disease or burden of choice?
Authors: Flerlage Jamie E. , Metzger Monika L. , Bhakta Nickhill 
Published: June 2018

Abstract
Adolescents and young adults (AYAs) comprise the largest age group affected by Hodgkin lymphoma (HL). Despite excellent overall survival of AYA patients with HL due to advances in treatment regimens, therapy-associated late effects continue to be a concern in HL survivors, especially for younger patients who have decades of life remaining. Since the first clinical trial for HL with chemotherapy in 1964, subsequent protocols have attempted to reduce chemotherapy-induced toxicities and yet maintain high overall survival rates. Today, new analytic methods applied to data from survivorship cohorts, such as the recently described cumulative burden of disease metric, can be used to inform changes for future protocols. Although pediatric and adult trial consortia have followed this process, the AYA population, an age cohort split between pediatric and adult health care services, faces many barriers to care and is the least likely to be enrolled in clinical trials. AYA patients with HL theoretically have a choice to be treated in pediatric or adult protocols when presented with these options. Recent efforts by the National Clinical Trials Network, the Children’s Oncology Group, and others have been made to ensure that the burden of choice for the AYA population is not greater than the burden of disease.
Acute lymphoblastic leukemia in adolescent and young adults: treat as adults or as children?
Authors: Boissel Nicolas , Baruchel André 
Published: June 2018

Abstract
Adolescent and young adult (AYA) patients with acute lymphoblastic leukemia (ALL) are recognized as a unique population with specific characteristics and needs. In adolescents age 15 to 20 years, the use of fully pediatric protocols is supported by many comparative studies of pediatric and adult cooperative groups. In young adults, growing evidence suggests that pediatric-inspired or even fully pediatric approaches may also dramatically improve outcomes, leading to long-term survival rates of almost 70%, despite diminishing indications of hematopoietic stem-cell transplantation. In the last decade, better knowledge of the ALL oncogenic landscape according to age distribution and minimal residual disease assessments has improved risk stratification. New targets have emerged, mostly in the heterogeneous B-other group, particularly in the Philadelphia-like ALL subgroup, which requires both in-depth molecular investigations and specific evaluations of targeted treatments. The remaining gap in the excellent results reported in children has many other contributing factors that should not be underestimated, including late or difficult access to care and/or trials, increased acute toxicities, and poor adherence to treatment. Specific programs should be designed to take into account those factors and finally ameliorate survival and quality of life for AYAs with ALL.