bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intraoperative manipulation for flexion contracture during total knee arthroplasty
Authors: Matsui Yoshio , Matsuura Masanori , Minoda Yukihide , Nakagawa Sigeru , Okajima Yoshiaki , Kobayashi Akio , Inori Fumiaki 
Published: January 2019

Background: Joint gap unbalancing during total knee arthroplasty (TKA) induces flexion contracture. Flexion contracture is one of the most serious complications of TKA. When flexion contracture is found during surgery, intraoperative manipulation is often empirically performed. We evaluated the effects of intraoperative manipulation on joint gap and postoperative flexion contracture. Materials and methods: TKA was performed for 136 knees. Intraoperative manipulation was performed for flexion contracture in 61 knees. Joint gap changes before and after manipulation were measured at six positions from extension to 120° of flexion. Manipulation was not performed for 75 knees. The extension angle was measured radiographically immediately after surgery, at 3 months, and 6 months postoperatively. Extension angles with manipulation and without manipulation were compared. Results: Joint gap changes (mm) before and after manipulation were 0.1, 0.0, −0.2, −0.3, −0.1, and −0.3 at 0°, 30°, 45°, 60°, 90°, and 120° of flexion, respectively, indicating that manipulation could not change joint gaps significantly. Extension angles (°) with and without manipulation were −4.0 ± 4.6 and −3.8 ± 3.9 immediately after surgery, −5.3 ± 6.7 and −5.5 ± 6.2 at 3 months postoperatively, and −2.7 ± 6.0 and −3.8 ± 5.8 at 6 months postoperatively. No statistically significant difference existed between the values with or without manipulation during all periods. Conclusion: Intraoperative manipulation does not enlarge the gap or resolve postoperative flexion contracture. Developing the new surgical technique is required to achieve perfect balance at TKA.
Use of smartphone to improve acetabular component positioning in total hip athroplasty: A comparative clinical study
Authors: Pongkunakorn Anuwat , Chatmaitri Swist , Diewwattanawiwat Kittipong 
Published: January 2019

Background: The position of the acetabular cup is important to the outcome of total hip athroplasty (THA). We devised an instrument that uses the level indicator application of smartphone together with a mechanical alignment guide to improve the precision of cup placement. This study aims to determine the percentage of acetabular cups positioned in the Lewinnek safe zone comparing between the conventional technique (using a mechanical alignment guide alone) and the smartphone technique (using a mechanical alignment guide combined with the devised instrument and smartphone). Methods: A historical controlled trial was conducted among 82 patients who underwent primary THAs through a posterolateral approach. In the conventional group, 41 cups were placed during January 2013 and December 2014, whereas 41 cups in the smartphone group were placed during January 2015 and March 2016. Inclination and anteversion angles were measured in standardized pelvic radiographs. The cup orientation was compared between groups. Results: The inclination angle in the smartphone group was significantly lower than in the conventional group (40.9° (SD 3.8) vs. 46.3° (SD 6.7), p < 0.001), but the anteversion angle was higher (19.6° (SD 4.4) vs. 16.5° (SD 6.1), p = 0.010). The smartphone group had more cups positioned in the Lewinnek safe zone (90.2% vs. 56.1%, p = 0.001) and longer operative times (136 (SD 27) vs. 119 (SD 23) min, p = 0.011). No significant difference was found for blood loss ( p== 0.384) or dislocation rate ( p = 0.494). Conclusion: Using the computerized function of smartphone could improve the precision of cup positioning. Most cups were placed within a narrow margin inside the Lewinnek safe zone.
Prevalence and distribution of air in the leg on preoperative multidetector high-resolution computed tomography in closed and low-grade open tibial shaft fractures
Authors: Suzuki Takashi , Nakayama Yuhei , Matsui Kentaro , Ishii Keisuke , Kurozumi Taketo , Shindo Masateru 
Published: January 2019

Purpose: The prevalence and distribution of air present in the leg in closed and low-grade open tibial shaft fractures are unknown on multidetector high-resolution computed tomography (CT). The purpose of this study was to determine the rate of surgical site infection (SSI) in cases where debridement was not performed in the area of air infiltration. Methods: Eighty-one closed and low-grade open tibial shaft fractures that underwent multidetector high-resolution CT on admission and were treated with an intramedullary nail were examined retrospectively. Results: Of the 36 Gustilo type I or II open fractures, all had local air around the fracture site (within 5 cm proximal and distal from the fracture center). Of these, 25 showed remote air (more than 5 cm away from the fracture center). The most frequent site of remote air was in the subcutaneous tissue, followed by the anterior compartment and deep posterior compartment. All open fractures were treated with local irrigation and debridement, regardless of the presence of remote air, followed by a reamed intramedullary nail. No SSI developed until bone union. Of the 45 closed fractures, 3 patients showed air in the leg on the CT. No debridement was performed for closed fractures. One patient who did not have air in the leg developed SSI. All fractures united eventually. Conclusions: In low-grade open tibial shaft fractures, air can spread far from the fracture site. Even in closed tibial shaft fractures, air can be identified in the leg. The debridement of the area of air infiltration, however, is not necessary for prevention of SSI.
Magnetic Resonance Imaging Findings of the Asymptomatic Elbow Predict Injuries and Surgery in Major League Baseball Pitchers
Authors: Garcia Grant H. , Gowd Anirudh K. , Cabarcas Brandon C. , Liu Joseph N. , Meyer John R. , White Gregory M. , Romeo Anthony A. , Verma Nikhil N. 
Published: January 2019

Background: Repetitive pitching produces significant stress on the elbow that may result in structural abnormalities discernable on magnetic resonance imaging (MRI) without causing symptoms. Purpose: To determine whether there exists an association between subclinical MRI findings in asymptomatic elbows of Major League Baseball (MLB) players and future placement on the disabled list (DL) or future operative procedure. Study Design: Cohort study; Level of evidence, 3. Methods: MRI scans of the elbows of professional-level baseball pitchers, taken during routine presigning imaging at a single organization from 2005 to 2017, were retrospectively reviewed. Publicly available databases were queried to exclude pitchers with an injury before the earliest session of elbow MRI. Three blinded reviewers reviewed all MRI scans independently to evaluate for the presence of chondral damage to the joint, loose bodies, ulnar collateral ligament (UCL) heterogeneity or tears, flexor pronator mass defects, and signs of posteromedial (PM) impingement. Binary imaging findings were related to future placement on the DL for elbow complaints and future elbow surgery. Results: A total of 41 pitchers had asymptomatic MRI findings with no prior DL placement. For players who eventually went on the DL, there were a statistically greater number of players with UCL heterogeneity ( P = .021), humeral-sided partial UCL tears ( P = .031), and PM impingement ( P = .004) on preinjury MRI compared with players who remained healthy. PM impingement was related to future elbow-related surgery ( P = .003). Pitchers with UCL heterogeneity were associated with reduced career strike zone percentage, innings pitched, and fastball percentage ( P < .05 for all). Conclusion: UCL heterogeneity, PM impingement, and humeral-sided partial tears were correlated with future DL placement for elbow-related reasons in MLB pitchers. Asymptomatic PM impingement may be a precursor to future surgery.
Effect of Cigarette Smoking on Patient-Reported Outcomes in Hip Arthroscopic Surgery: A Matched-Pair Controlled Study With a Minimum 2-Year Follow-up
Authors: Lall Ajay C. , Hammarstedt Jon E. , Gupta Asheesh G. , Laseter Joseph R. , Mohr Mitchell R. , Perets Itay , Domb Benjamin G. 
Published: January 2019

Background: The rate of hip arthroscopic surgery has recently increased; however, there is limited literature examining patient-reported outcomes (PROs) in cigarette smokers. Purpose/Hypothesis: The purpose of this study was to evaluate whether smoking status for patients undergoing hip arthroscopic surgery affects clinical findings and PRO scores. We hypothesized that patients who smoke and undergo primary hip arthroscopic surgery will have similar clinical examination findings and preoperative and postoperative PRO scores compared with nonsmoking patients. Study Design: Cohort study; Level of evidence, 3. Methods: Data were collected on all patients who underwent primary hip arthroscopic surgery from February 2008 to July 2015. A retrospective analysis of the data was then conducted to identify patients who reported cigarette use at the time of the index procedure. Patients were matched 1:2 (smoking:nonsmoking) based on sex, age within 5 years, labral treatment (repair vs reconstruction vs debridement), workers’ compensation status, and body mass index within 5 kg/m2. All patients were assessed preoperatively and postoperatively using 4 PRO measures: the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score–Sport-Specific Subscale (HOS-SSS), and International Hip Outcome Tool–12 (iHOT-12). Pain was estimated using a visual analog scale. Satisfaction was measured on a scale from 0 to 10. Significance was set at P < .05. Results: A total of 75 hips were included in the smoking group, and 150 hips were included in the control group. Preoperatively, the smoking group had significantly lower PRO scores compared with the control group for the mHHS, NAHS, and HOS-SSS. Both groups demonstrated significant improvement from preoperative levels. A minimum 2-year follow-up was achieved, with a mean of 42.5 months for the smoking group and 47.6 months for the control group ( P = .07). At the latest follow-up, the smoking group reported inferior results for all outcome measures compared with controls. The improvement in PRO scores and rates of treatment failure, revision arthroscopic surgery, and complications was not statistically different between the groups. Conclusion: Patients who smoke had lower PRO scores preoperatively and at the latest follow-up compared with nonsmokers. Both groups demonstrated significant improvement in all PRO scores. These results show that while hip arthroscopic surgery may still yield clinical benefit in smokers, these patients may ultimately achieve an inferior functional status. To optimize results, physicians should advise patients to cease smoking before undergoing hip arthroscopic surgery.
Ocular Venous Air Embolism: A Report of 5 Cases
Authors: Morris Robert E. , Boyd Gwendolyn L. , Sapp Mathew R. , Oltmanns Matthew H. , Kuhn Ferenc , Albin Maurice S. 
Published: January 2019

Purpose: The purpose of this case series is to report 5 new cases of ocular venous air embolism (OVAE). We define OVAE as a precipitous drop in end-tidal carbon dioxide, a choroidal detachment, or a choroidal wound, followed by signs of impending or actual cardiovascular collapse, during vitrectomy air infusion. Methods: A case report series was retrospectively reviewed. Results: Four of the 5 OVAE cases (80%) were fatal, occurring in conjunction with repair of rhegmatogenous retinal detachment (2 cases); a large surgical wound of the choroid (1 case); and vitrectomy repair of an injured eye (1 case). One patient survived OVAE during choroidal melanoma endoresection after prompt discontinuance of air infusion by anesthesia personnel previously alerted to the OVAE risk. Conclusions: OVAE is a rare but usually fatal complication of air infusion into the eye during vitrectomy. Because the effective response time to avoid a fatal OVAE outcome can be less than 1 minute, use of preventive measures is critical.
Bridging the gaps of headache care for underserved populations: A medication overuse headache survey among international headache society members from Latin America
Authors: Lisicki Marco , Flores Juan Antonio Castro , Bordini Carlos Alberto , Goicochea María Teresa , Peres Mario Fernando Prieto 
Published: January 2019

Introduction: Headache epidemiological studies in Latin America are scarce, and available data suggest that medication overuse headache is an existing health concern in the region. Materials and Methods: A survey empirically constructed to assess the management of medication overuse headache was sent to all the International Headache Society (IHS) members from Latin American countries. Results: We found no IHS members in 13 countries of Latin America. In countries with active members, the median number of IHS members per million inhabitants was significantly less when compared to Western Europe. Although the International Classification of Headache Disorders-3-beta (ICHD-3-beta) criterion was the most frequently used tool for medication overuse headache diagnosis, 41% of responders considered the diagnostic criterion ‘ambiguous’ and only 67% found them ‘very useful’. With respect to preferred treatment patterns, an important lack of uniformity, and a very limited usage of therapeutic approaches widely employed in other regions, characterized the responses. Conclusion: There is an urgent need to reach a consensus and establish region-specific strategies for the management of medication overuse headache as well as other headache disorders in this region. Development of headache specialized educational programmes, and participation of Latin American health providers in the IHS, should be incentivized.
Disparities in place of death for patients with hematological malignancies, 1999 to 2015
Authors: Chino Fumiko , Kamal Arif H. , Chino Junzo , LeBlanc Thomas W. 
Published: February 2019

Abstract
Patients with hematologic malignancies (HMs) often receive aggressive end-of-life care and less frequently use hospice. Comprehensive longitudinal reporting on place of death, a key quality indicator, is lacking. Deidentified death certificate data were obtained via the National Center for Health Statistics for all HM deaths from 1999 to 2015. Multivariate regression analysis (MVA) was used to test for disparities in place of death associated with sociodemographic variables. During the study period, there were 951 435 HM deaths. Hospital deaths decreased from 54.6% in 1999 to 38.2% in 2015, whereas home (25.9% to 32.7%) and hospice facility deaths (0% to 12.1%) increased (all P &lt; .001). On MVA of all cancers, HM patients had the lowest odds of home or hospice facility death (odds ratio [OR], 0.55; 95% confidence interval, 0.54-0.55). Older age (40-64 years: OR, 1.34; ≥65 years: OR, 1.89), being married (OR, 1.62), and having myeloma (OR, 1.34) were associated with home or hospice facility death, whereas being black or African American (OR, 0.68), Asian (OR, 0.58), or Hispanic (OR, 0.84) or having chronic leukemia (OR, 0.83) had decreased odds of dying at home or hospice (all P &lt; .001). In conclusion, despite hospital deaths decreasing over time, patients with HMs remained more likely to die in the hospital than at home.
RETRACTED ARTICLE: Research on English translation distortion detection based on image evolution
Authors: Cui Lianhe 
Published: January 2019

AbstractAt present, there are serious distortions in the translation of image English characters. In order to alleviate this problem, this study improves the traditional algorithm, uses the Canny edge detection method as the edge detection method through experimental comparison and analysis, and combines the image evolution to analyze the English character translation of multiple complex images. Simultaneously, in this study, the closed space is used to fill the small holes in the target area, and some intrinsic characteristics of the text area are used to form the heuristic knowledge to limit the connected area, and the English candidate area is constructed for the image recognition algorithm of the image. Then, this study uses the English candidate area as the recognition area for translation recognition. The research shows that the algorithm has certain practical effects and can provide a theoretical reference for subsequent related research.
Changing nurses’ views of the therapeutic environment: randomised controlled trial
Authors: Csipke Emese , Wykes Til , Nash Stephen , Williams Paul , Koeser Leo , McCrone Paul , Rose Diana , Craig Tom 
Published: January 2019

BackgroundAlthough patients value evidence-based therapeutic activities, little is known about nurses' perceptions.AimsTo investigate whether implementing an activities training programme would positively alter staff perceptions of the ward or be detrimental through the increased workload (trial registration: ISRCTN 06545047).MethodWe conducted a stepped wedge cluster randomised trial involving 16 wards with psychology-led nurse training as the intervention. The main outcome was a staff self-report measure of perceptions of the ward (VOTE) and secondary outcomes measuring potential deterioration were the Index of Work Satisfaction (IWS) and the Maslach Burnout Inventory (MBI). Data were analysed using mixed-effects regression models, with repeated assessments from staff over time.ResultsThere were 1075 valid outcome measurements from 539 nursing staff. VOTE scores did not change over time (standardised effect size 0.04, 95% CI –0.09 to 0.18, P = 0.54), neither did IWS or MBI scores (IWS, standardised effect size 0.02, 95% CI –0.11 to 0.16, P = 0.74; MBI standardised effect size –0.09, 95% CI –0.24 to 0.06, P = 0.24). There was a mean increase of 1.5 activities per ward (95% CI –0.4 to 3.4, P = 0.12) and on average 6.3 more patients attended groups (95% CI –4.1 to 16.6, P = 0.23) following training. Staff feedback on training was positive.ConclusionsOur training programme did not change nurses' perceptions of the ward, job satisfaction or burnout. During the study period many service changes occurred, most having a negative impact through increased pressure on staffing, patient mix and management so it is perhaps unsurprising that we found no benefits or reduction in staff skill.Declaration of interestNone.
Predictors of psychotic symptoms among young people with special educational needs
Authors: Stanfield Andrew C. , McKechanie Andrew G. , Lawrie Stephen M. , Johnstone Eve C. , Owens David G.C. 
Published: January 2019

BackgroundPsychotic symptoms and psychotic disorders occur at increased rates in adults with intellectual disability, including borderline intellectual functioning, compared with the general population. Little is known about the development of such symptoms in this population.AimsTo examine whether clinical factors predictive of psychotic disorder in a familial study of schizophrenia also apply to those with intellectual disability.MethodAdolescents with special educational needs (SEN) were assessed with the Structured Interview for Schizotypy (SIS) and Childhood Behavioural Checklist (CBCL). These scores were used to prospectively divide participants based on their anticipated risk for psychotic disorder. A subsample were reassessed three times over 6 years, using the Positive and Negative Syndrome Scale (PANSS).ResultsThe SEN group were more symptomatic than controls throughout (Cohen's d range for PANSS subscale scores: 0.54–1.4, all P &lt; 0.007). Over 6 years of follow-up, those above the SIS and CBCL cut-off values at baseline were more likely than those below to display morbid positive psychotic symptoms (odds ratio, 3.5; 95% CI 1.3–9.0) and develop psychotic disorder (odds ratio, 11.4; 95% CI 2.6–50.1). Baseline SIS and CBCL cut-off values predicted psychotic disorder with sensitivity of 0.67, specificity of 0.85, positive predictive value of 0.26 and negative predictive value of 0.97.ConclusionsAdolescents with SEN have increased psychotic and non-psychotic symptoms. The personality and behavioural features associated with later psychotic disorder in this group are similar to those in people with familial loading. Relatively simple screening measures may help identify those in this vulnerable group who do and do not require monitoring for psychotic symptoms.Declaration of interestNone.
The potential drug cost impact of nivolumab (N) in patients with advanced/metastatic gastric cancer (GC) or gastroesophageal junction cancer (GEJC) in Canada.
Authors: Virik Kiran , Wilson Robert B 
Published: January 2019

101 Background: Advanced/metastatic GC and GEJC is associated with poor survival outcomes. Systemic treatment options are limited in patients having had at least two lines of chemotherapy. Immune checkpoint inhibitors (ICIs) appear to be a promising therapeutic option in these patients. The role of predictive biomarkers to response to ICIs remains to be fully elucidated. This may ultimately inform the utility and thus potentially the drug cost incurred by ICIs. The ATTRACTION-2 phase III study using N in heavily pretreated advanced GC and GEJC patients improved outcomes. The use of ICIs has an anticipated budgetary impact on health care systems within the context of this potentially funded utilization of N. Methods: An estimation of the N drug cost alone for advanced de novo and relapsed cases diagnosed in 2017 and subsequently treated in the third line in Canada was undertaken. A cost estimate for N treatment in earlier lines was also evaluated. N cost per patient was calculated based on treatment indication, duration of treatment, standard dose/schedule. The analysis was performed in Canadian dollars ($) and assumed complete drug delivery and uncomplicated cycles. The cost of N was obtained from the pan Canadian Oncology Drug Review (PCODR) cost for N in lung cancer. The number of target patients and N utilization was derived from constructed schema to give a budget impact estimate. Results: Estimated N cost per treated patient is $15,770. The N drug cost in the third line setting is estimated at $5.9 million (M) for GC and $2.4M for GEJC, total $8.4M (IQR $3.9M-$18.7M). For first line and second line N in eligible pts respectively: potential drug cost is $23.7M, $11.8M for GC and $9.7M, $4.9M for GEJC. A sensitivity analysis was performed. Conclusions: ICIs potentially add a drug cost burden to the publically funded Canadian healthcare system. As biomarkers predictive of response evolve and patients are treated accordingly, the drug cost burden may lessen. Potential earlier line use and a longer duration of therapy will add to the estimated budgetary impact.