bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Relationship Between Gait Symmetry and Metabolic Demand in Individuals With Unilateral Transfemoral Amputation: A Preliminary Study
Authors: Mahon Caitlin E , Darter Benjamin J , Dearth Christopher L , Hendershot Brad D 
Published: January 2019

Abstract

Introduction
Temporal-spatial symmetry allows for optimal metabolic economy in unimpaired human gait. The gait of individuals with unilateral transfemoral amputation is characterized by temporal-spatial asymmetries and greater metabolic energy expenditure. The objective of this study was to determine whether temporal-spatial asymmetries account for greater metabolic energy expenditure in individuals with unilateral transfemoral amputation.

Materials and Methods
The relationship between temporal-spatial gait asymmetry and metabolic economy (metabolic power normalized by walking speed) was retrospectively examined in eighteen individuals with transfemoral amputation walking at a self-selected velocity overground. Pearson’s product-moment correlations were used to assess the relationship between: (1) step time symmetry and metabolic economy and (2) step length symmetry and metabolic economy. The retrospective analysis of this data was approved by the Walter Reed National Military Medical Center Institutional Review Board and all individuals provided written consent. Additional insights on this relationship are presented through a case series describing the temporal-spatial and metabolic responses of two individuals with transfemoral amputation who completed a split-belt treadmill walking test.

Results
For the cohort of individuals, there was no significant relationship between metabolic economy and either step time asymmetry or step length asymmetry. However, the case series showed a positive relationship between step length asymmetry and metabolic power as participants adapted to split-belt treadmill walking.

Conclusion
There is mixed evidence for the relationship between temporal-spatial asymmetries and metabolic energy expenditure. This preliminary study may suggest optimal metabolic energy expenditure in individuals with transfemoral amputation occurs at an individualized level of symmetry and resultant deviations incur a metabolic penalty. The results of this study support the idea that addressing only temporal-spatial gait asymmetries in individuals with transfemoral amputation through rehabilitation may not improve metabolic economy. Nevertheless, future prospective research is necessary to confirm these results and implications for clinical practice.
Risk Factors for Development of Carbapenem Resistance Among Gram-Negative Rods
Authors: Richter Stefan E , Miller Loren , Needleman Jack , Uslan Daniel Z , Bell Douglas , Watson Karol , Humphries Romney , McKinnell James A 
Published: January 2019

Abstract

Background
Infections due to carbapenem-resistant Gram-negative rods (CR-GNR) are increasing in frequency and result in high morbidity and mortality. Appropriate initial antibiotic therapy is necessary to reduce adverse consequences and shorten length of stay.

Methods
To determine risk factors for recovery on culture of CR-GNR, cases were retrospectively analyzed at a major academic hospital system from 2011 to 2016. Ertapenem resistance (ER-GNR) and antipseudomonal (nonertapenem) carbapenem resistance (ACR-GNR) patterns were analyzed separately. A total of 30951 GNR isolates from 12370 patients were analyzed, 563 of which were ER and 1307 of which were ACR.

Results
In multivariate analysis, risk factors for ER-GNR were renal disease, admission from another health care facility, ventilation at any point before culture during the index hospitalization, receipt of any carbapenem in the prior 30 days, and receipt of any anti-methicillin-resistant Staphylococcus aureus (anti-MRSA) agent in the prior 30 days (c-statistic, 0.74). Risk factors for ACR-GNR were male sex, admission from another health care facility, ventilation at any point before culture during the index hospitalization, receipt of any carbapenem in the prior 30 days, and receipt of any anti-MRSA agent in the prior 30 days (c-statistic, 0.76).

Conclusions
A straightforward scoring system derived from these models can be applied by providers to guide empiric antimicrobial therapy; it outperformed use of a standard hospital antibiogram in predicting infections with ER-GNR and ACR-GNR.
Bacteremic Community-Acquired Pneumonia in Ethiopian Children: Etiology, Antibiotic Resistance, Risk Factors, and Clinical Outcome
Authors: Negash Abel Abera , Asrat Daniel , Abebe Workeabeba , Hailemariam Tewodros , Hailu Tsegaye , Aseffa Abraham , Vaneechoutte Mario 
Published: January 2019

Abstract

Background
Community-acquired pneumonia (CAP) remains a leading cause of morbidity and mortality. We sought to determine the magnitude, etiology, and risk factors of CAP in children 5 years after introduction of pneumococcal conjugate vaccine (PCV) 10 in Ethiopia.

Methods
We conducted a prospective observational study on the bacterial etiology and risk factors of CAP among children aged 0–15 years in 2 pediatric emergency departments in Addis Ababa, Ethiopia. Blood culture, antibiotic susceptibility testing, and amplification of pneumococcal lytA and cpsB genes were performed. Serotypes of Streptococcus pneumoniae were determined by Quellung reaction and sequencing the cpsB gene.

Results
Out of 643 eligible children, 549 were enrolled. The prevalence of bacteremic pneumonia was 5.6%. Staphylococcus aureus (26.5%) was the predominant pathogenic species, followed by Enterococcus faecium (11.8%), Escherichia coli (11.8%), and Klebsiella pneumoniae (11.8%). In univariate analysis, parental smoking and nonvaccination with PCV10 were associated with bacteremic CAP. In multivariable analysis, female sex (adjusted odds ratio [aOR], 2.3; 95% confidence interval [CI], 1.1–4.9), weight-for-age z-score (WAZ) &lt;–2 SDs (aOR, 2.2; 95% CI, 1.1–4.8), and lower chest indrawing (aOR, 0.44; 95% CI, 0.2–0.95) were independently associated with bacteremic CAP. The overall in-hospital case fatality rate was 2.37% (13/549), and WAZ &lt;–3 SDs (OR, 13.5; 95% CI, 3.95–46.12) was associated with mortality.

Conclusions
Five years after the introduction of PCV10 in Ethiopia, S. aureus was the main cause of bacteremic CAP in children, the contribution of S. pneumoniae was low, and there was a high level of antibiotic resistance among isolates.
Controlled Pedicle Subtraction Osteotomy Site Closure Using Flexible Hinge-Powered Operating Table
Authors: Jones Kristen E , Hunt Matthew A , Martin Christopher T , Polly David W 
Published: January 2019

Abstract

BACKGROUND AND IMPORTANCE
Pedicle subtraction osteotomy (PSO) is a 3-column osteotomy used to correct rigid, large magnitude sagittal spinal deformity. PSO is an inherently destabilizing procedure intraoperatively, with high risk of neurological deficits from vertebral body subluxation or translation during osteotomy closure. Traditionally, PSO closure has been performed utilizing compression or cantilevering forces across adjacent level instrumentation. Such forces can loosen the instrumentation or cause abrupt subluxation or translation due to the magnitude of force required for PSO closure, resulting in neurological injury. Here, we report using a flexible hinge-powered operating table for controlled closure of PSO in 1º increments via remote-control power of the table, without compression or cantilevering force required across implants.

CLINICAL PRESENTATION
The patient is a 68-yr-old man with a history of prior L2-S1 anterior-posterior fusion, healed sacral fracture, and left sacroiliac joint fusion presenting to our institution with severe back pain while standing. X-rays demonstrated significant sagittal malalignment with pelvic incidence (PI) of 79º and lumbar lordosis (LL) of 37º, while computed tomography scan confirms complete bone healing around prior interbody fusion sites, resulting in rigid sagittal deformity. Due to rigid PI-LL mismatch of 42º, we planned for L2-pelvis revision fusion with L4 PSO.

CONCLUSION
Here we demonstrate the utility of a flexible hinge-powered operating table for closure of PSO site. This technique eliminates force application to adjacent implants, minimizing vertebral body subluxation, or translation. We believe this allows for safer, more controllable osteotomy closure that minimizes risk of neurological injury.
Plantar Pressure During Gait in Pregnancy-Related Pelvic Girdle Pain and the Influence of Pelvic Belts
Authors: Bertuit Jeanne , Leyh Clara , Feipel Veronique 
Published: January 2019

ABSTRACT

Introduction
Many pregnant women experience pelvic girdle pain (PGP) during pregnancy. Etiologies are multifactorial and affect the joint stability of the sacroiliac joint. Pelvic belts could restore stability and help reduce pain during gait. The objectives were to analyze plantar pressure during gait in pregnant women with PGP, to evaluate the effect of pelvic belts, and to compare the effects of two types of belts on plantar pressure parameters.

Materials and Methods
Forty-six pregnant women with PGP, 58 healthy pregnant women, and 23 nonpregnant women were recruited. The motor task consisted of three-gait trials on a walkway. Plantar pressure was analyzed with four variables. Two types of pelvic belts for pregnant women were used.

Results
Plantar pressure in women with PGP compared with controls showed differences in all parameters: they displayed lower gait velocity and lower values for most pressure variables at the rear and forefoot (medial side). Conversely, these values were higher for the midfoot (lateral side). These alterations were also found in healthy pregnant women. There was no difference in plantar pressure between groups, those who had or had not used belts, and between the types of belt.

Conclusions
Pregnant women, with or without PGP, showed nearly the same changes in plantar pressure during gait. PGP did not change plantar pressure parameters. Wearing any of the belts during pregnancy did not have an effect on plantar pressure parameters during gait in pregnant women with PGP.
Three-dimensional printing of facial contour based on preoperative computer simulation and its clinical application
Authors: Zeng Hui , Yuan-Liang Shih , Xie Gan , Lu Feng , Fu Rong 
Published: January 2019

Abstract
Facial contouring is a complex procedure performed to alter tissue contents and restore facial appearance. However, it is difficult to measure the amount of the tissue volume that is needed. This study demonstrated the use of preoperative computer simulation (PCS) and 3-dimensional (3D) printing in contouring procedure to maximize outcomes.
Three-dimensional surface imaging (3DSI) or computed tomography imaging (CTI) data were reconstructed into a 3D model by Mimics software. PCS was performed by simulating the changes in bone and soft tissue. The stimulating volume change was calculated by Boolean operations. Finally, the virtual model was exported into 3D printer to produce physical templates to guide surgical plan. PCS and actual postoperative results were compared using objective rating scales and by cephalometrical measurements.
With the direct guidance of PCS and 3D templates, contouring procedure was performed accurately. Satisfactory facial contouring was achieved with less operative time. As the plastic surgery panel rated, 45.8% of the 3DSI results and 41.7% of the CTI results were identical with the actual outcome, and 0% of them was poor. There were no significant differences in patient satisfaction between the PCS of 3DSI and CTI.
Preoperative computer simulation is an accurate method for designing contour adjustment plans, and can be an efficient and reliable predictor of outcomes with customized templates.
A case report of successful treatment of necrotizing fasciitis using negative pressure wound therapy
Authors: de Paula Fabiana Martins , Pinheiro Edivania Anacleto , Oliveira Vanessa Marcon de , Ferreira Cristiane Munaretto , Monreal Maria Tereza Ferreira Duenhas , Rolan Marisa Dias , Matos Vanessa Terezinha Gubert de 
Published: January 2019

Abstract

Rationale:
Necrotizing fasciitis is a destructive tissue infection with rapid progression and high mortality. Thus, it is necessary that high-performance dressings be introduced as possibilities of treatment.

Patient concerns:
Female patient, 44 years of age, admitted to hospital unit complaining of lesion in the gluteal region and drainage of purulent secretion in large quantity followed by necrosis.

Diagnoses:
The diagnosis of necrotizing fasciitis was carried out with the computerized tomography examination result and its association with the patient's clinical condition.

Interventions:
Initially, successive debridements were carried out in lower limbs as well as primary dressing with enzymatic debriding action until indication of negative pressure wound therapy, for the period of 2 weeks in the right lower limb and for 5 weeks in the left lower limb, with changes every 72 h. Dressing with saline gauze was used at the end of this therapy until hospital discharge.

Outcomes:
After the use of negative pressure wound therapy, we observed the presence of granulation tissue, superficialization and reduction of lesion extension. The patient presented good tolerance and absence of complications.

Lessons:
Negative pressure wound therapy constituted a good option for the treatment of necrotizing fasciitis, despite the scarcity of protocols published on the subject.
Clinicopathologic and prognostic significance of tumor-infiltrating CD8+ T cells in patients with hepatocellular carcinoma
Authors: Xu Xuezhong , Tan Yulin , Qian Yan , Xue Wenbo , Wang Yibo , Du Jianguo , Jin Lei , Ding Wei 
Published: January 2019

Abstract

Background:
In patients with hepatocellular carcinoma (HCC), the clinicopathologic and prognostic roles of tumor-infiltrating CD8+ T cells for survival are still controversial. A meta-analysis was performed to resolve this issue.

Methods:
We identified studies from PubMed, Embase, and the Cochrane Library to evaluate the clinicopathologic and prognostic value of tumor-infiltrating CD8+ T cells in patients with HCC. A meta-analysis was conducted to estimate clinicopathologic characteristics, overall survival (OS), and disease-free survival. The hazard ratio (HR) and 95% confidence interval (CI) were calculated employing fixed-effect or random-effect models depending on the heterogeneity of the included trials.

Results:
A total of 3509 patients from 21 observational studies were enrolled. The meta-analysis revealed that high levels of intratumoral CD8+ tumor-infiltrating lymphocytes (TILs) were associated with better OS (OS; HR = 0.676, P = .001) and disease-free survival (disease-free survival [DFS]; HR = 0.712, P = .002). The pooled analysis also demonstrated high density of infiltration of CD8+ TILs in margin of tumor (MT) was statistically significant associated with better OS (HR = 0.577; P <.001). Moreover, the patients with low CD8+ TILs infiltration had negative HBSAg (OR = 1.67, P = .02), large tumor size (OR = 1.74, P <.01), and later TNM stage (OR = 1.70, P <.01).

Conclusions:
Our findings suggested that low levels of CD8+ TILs predict large tumor size, later TNM stage and might be a promising prognostic factor of HCC especially for Asian patients. High-quality randomized controlled trials are needed to determine if CD8+ TILs could serve as targets for immunotherapy in hepatocellular carcinoma.
Statin therapy and erythropoiesis-stimulating agent hyporesponsiveness in patients with nondialysis chronic kidney disease
Authors: Sui Zhun , Wang Mi , Zuo Li 
Published: January 2019

Abstract
Erythropoiesis-stimulating agents (ESAs) are frequently used among patients with renal anemia, while a significant proportion of patients exhibit ESA hyporesponsiveness despite adequate dosing. Previous studies have suggested an inverse association between ESA hyporesponsiveness and statin use among patients receiving dialysis therapy. However, studies based on predialysis patients are extremely limited.
Based on electronic medical records of a tertiary hospital in Beijing, China between April 2010 and April 2015, we investigated the association between statin use and ESA hyporesponsiveness among patients with predialysis-chronic kidney disease (CKD).
Altogether 232 patients with CKD initiating ESA therapy and with hemoglobin levels monitored for at least 6 months were included in our analyses. Among them, 77 (38.5%) were long-term statin users (regular statin treatment for more than 3 months) before ESA initiation. Overall, 6.5% of the statin users and 17.1% of nonusers were considered to have ESA hyporesponsiveness. Long-term statin therapy was significantly associated with a lower proportion of ESA hyporesponsiveness in fully adjusted model (odds ratio 0.15, 95% confidence interval: 0.03–0.64).
We found that long-term statin therapy was inversely associated with ESA hyporesponsiveness among predialysis patients with CKD. Further studies are needed to validate our observations, and to explore the potential mechanisms between ESA resistance and statin therapy.
Tenascin-C expression is significantly associated with the progression and prognosis in gastric GISTs
Authors: Shen Chaoyong , Wang Chengshi , Yin Yuan , Chen Huijiao , Yin Xiaonan , Cai Zhaolun , Chen Zhixin , Zhang Bo , Zhou Zongguang 
Published: January 2019

Abstract
Tenascin-C (TNC), an extracellular matrix glycoprotein, has been implicated in progression of various types of cancer. However, few reports exist on TNC expression in gastrointestinal stromal tumors (GISTs). We here attempted to investigate the expression pattern and prognostic significance of TNC in gastric GISTs. We studied TNC expression in 122 gastric GISTs tissue samples by immunohistochemistry, and examined the correlations of TNC expression with clinicopathological parameters and survival of gastric GISTs. The TNC-high expression was observed in 30 (24.6%) of 122 of gastric GISTs. The high levels of TNC expression in gastric GISTs was significantly associated with tumor size (P < .001), multivisceral resection (P = .006), metastasis at initial diagnosis (P = .006), mitotic count (P = .002) and NIH risk classification (P = .015). The TNC mRNA and protein levels were found to significantly downregulated in tumors without progression compared to those tumors which occurred tumor progression during the follow-up period (P < .05). As for the prognostic analysis, it revealed that tumor size, mitotic count, surgical margins, multivisceral resection, and TNC expression were independent predictors of PFS for gastric GISTs (P < .05). The overexpression of TNC may be as a possible marker for the metastatic potential of gastric GISTs patients.
The effectiveness of problem-based learning in pediatric medical education in China
Authors: Ma Yimei , Lu Xiaoxi 
Published: January 2019

Abstract

Background:
The aim of this meta-analysis is to assess the effectiveness of problem-based learning (PBL) in pediatric medical education in China.

Methods:
We searched Chinese electronic databases, including the China National Knowledge Infrastructure, WanFang Data, the China Science Periodical Database, and the Chinese BioMedical Literature Database. We also searched English electronic databases, including PubMed, Embase, and the Cochrane Central Register of Controlled Trials. We searched for published studies that compared the effects of PBL and traditional lecture-based learning (LBL) on students’ theoretical knowledge, skill, and case analysis scores during pediatric medical education in China. All randomized controlled trials (RCTs) were included.

Results:
A total of 12 RCTs were included, with a total sample size of 1003 medical students. The PBL teaching model significantly increased theoretical knowledge scores (95% confidence interval [CI], 0.79–1.52; P < .00001), skill scores (95% CI, 0.87–2.25; P < .00001), and case analysis scores (P < .00001, I
2 = 88%) compared with those using the LBL teaching model alone.

Conclusion:
The current meta-analysis shows that PBL in pediatric medical education in China appears to be more effective than the traditional teaching method in improving theoretical knowledge, skill, and case analysis scores. However, a more controlled design of RCT is needed to confirm the above conclusions in future work.
Clinical characteristics and follow-up of benign convulsions with mild gastroenteritis among children
Authors: Ma Xiaohong , Luan Shaoyong , Zhao Yiming , Lv Xiumin , Zhang Ruiyun 
Published: January 2019

Abstract
Benign convulsions with mild gastroenteritis have a high incidence in the North China, previous reports it has been caused by rotavirus infection, which is a non-febrile convulsion. In recent years, we observed that norovirus infection gradually increased all the years round and most of them are febrile convulsion.
Retrospective analysis was performed on 55 pediatric patients with benign convulsions with mild gastroenteritis (CWG) who were admitted between January 2010 and January 2015.
The median age of the norovirus infection group was greater than that of the rotavirus infection group. Norovirus infection has no obvious seasonality. The peak age of benign CWG onset was less than 3 years (74.5%). In 69.1% of all cases, the temperature was less than 38 °C. In 70.9% of cases, children had experienced more than 2 episodes. In 96.4% of all cases, convulsive episodes were shorter than 5 min. Convulsions mostly occurred within the first 2 days (78.2%) after gastroenteritis tract symptoms. Most episodes featured generalized tonic-clonic seizure (87.3%). Serum Na+ levels were lower while other biochemical test results were normal. Follow-up 2 years attack again (16.8%), intelligence quotient was not reduced.
CWG febrile or afebrile occurs most frequently among young children. In addition to the rotavirus, the norovirus might also cause this syndrome. The prognosis is favorable and long-term anti-seizure treatment is considered to be unnecessary.
The safety and efficacy of acupuncture for erectile dysfunction
Authors: Wang Jisheng , Zhou Yu , Dai Hengheng , Bao Binghao , Dang Jin , Li Xiao , Wang Bin , Li Haisong 
Published: January 2019

Abstract

Background:
Erectile dysfunction is a common male disease, the constant pace of life, increasing pressure on life, and changes in diet, living environment, lifestyle, etc., lead to an increase in the number of patients with erectile dysfunction (ED). Acupuncture has been widely used in clinical trials of ED in recent years. There are many clinical trials that confirm that acupuncture can improve male erectile function. This study used a network meta-analysis (NMA) to compare the effectiveness and safety of different forms of acupuncture on ED.

Methods:
We will search for PubMed, Cochrane Library, AMED, EMBASE, WorldSciNet; Nature, Science online and China Journal Full-text Database (China National Knowledge Infrastructure), China Biomedical Literature CD-ROM Database (CBM), and related randomized controlled trials (RCTs) included in the China Resources Database. The time is limited from the construction of the library to December 2018. The quality of the included RCTs will be evaluated with the risk of bias tool and evidence will be evaluated by Grading of Recommendations Assessment, Development and Evaluation. STATA 13.0 and WinBUGS 1.4.3 through the GeMTC package will be used to perform an NMA to synthesize direct and indirect evidence.