bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictive factors associated with mortality in Korean elderly patients with hip fractures
Authors: Ko Youngji , Baek Seung-Hoon , Ha Yong-Chan 
Published: June 2019

Background: It is important to investigate the level of physical function impairment before fracture to predict mortality after hip fracture. This study aimed to examine the predictive factors associated with mortality depending on prefracture physical function impairment among Korean elderly patients. Methods: We included 1841 patients aged 65 years and older with hip fractures using osteoporosis-related hip fracture network data from 15 university hospitals in South Korea. The collected data included sociodemographic, nutritional, disease-related, and fracture- and surgery-related factors. For the degree of prefracture physical function impairment, ambulatory ability was classified into community, household, and nonfunctional ambulators. Binominal logistic regression was used to identify the predictive factors for mortality. Results: Analysis showed that mortality rate at the first follow-up after hip fracture was 4.9%, and most patients (77.7%) were community ambulators before fracture. Sociodemographic (older age, male sex), nutritional (low body mass index, low albumin level before surgery), and fracture- and surgery-related (nonsurgical management, complications after surgery) factors significantly predicted mortality, depending on the prefracture ambulatory status. Conclusions: This study emphasizes that nutritional assessment and management as interdisciplinary interventions from hospitalization to follow-ups should be performed to lower malnutrition and mortality risk. Therapeutic management for comorbidities negatively affecting surgery outcomes should be prioritized to reduce postoperative complications and mortality. Surgical treatment should be encouraged if it aligns with the therapeutic goals, even in poor health status.
Knowledge and Practices Toward Routine Medical Checkup Among Middle-Aged and Elderly People of Riyadh
Authors: AL-Kahil Abdullah Basel , Khawaja Rajab Ali , Kadri Ammar Yasser , Abbarh,MBBS Shahem Mohammad , Alakhras Jalal Tarif , Jaganathan Parameaswari Parthasarathy 
Published: June 2019

Introduction: Routine checkup is a form of preventive medicine, it’s a helpful practice to promote health in the community. Studying the prevalence of routine checkup, awareness, influencing, and preventing factors for it in our community will be a helpful tool for the health authorities to promote among individuals. Methodology: This cross-sectional study was conducted in different locations of Riyadh using a convenience sampling technique, with sample size of 414 Saudi participants of both genders aged 36 years old and above. The data were collected through self-administered structured questionnaire with demographic variables, frequency of routine medical checkup, knowledge questions, factors that enhance or prevent individual to do routine checkup and best way to spread the awareness. Results: Two hundred eighty-eight (69.57%) participants knew well about routine checkup and 142 (34.3%) of them do routine medical checkup. “Lack of time” and “Laziness” were reported as the 2 most common preventing factors (46% and 45.2%), respectively, and most common reason that influenced their practice was “health concern” (77.5%) followed by “worry about chronic or serious illness” (32.4%). Participants believed that social networks (eg, twitter, Facebook, etc) and media (eg, TV, radio) are most effective ways to spread awareness of it in the community (53.86% and 52.89%, respectively). Conclusion: There was high level of knowledge on routine health checkup, but a low prevalence was observed in practice. Hence, more health initiatives should be taken for routine medical screening in the Saudi community.
Cost Effectiveness of Chimeric Antigen Receptor T-Cell Therapy in Multiply Relapsed or Refractory Adult Large B-Cell Lymphoma
Authors: Lin John K. , Muffly Lori S. , Spinner Michael A. , Barnes James I. , Owens Douglas K. , Goldhaber-Fiebert Jeremy D. 
Published: June 2019

PURPOSE Two anti-CD19 chimeric antigen receptor T-cell (CAR-T) therapies are approved for diffuse large B-cell lymphoma, axicabtagene ciloleucel (axi-cel) and tisagenlecleucel; each costs $373,000. We evaluated their cost effectiveness. METHODS We used a decision analytic Markov model informed by recent multicenter, single-arm trials to evaluate axi-cel and tisagenlecleucel in multiply relapsed/refractory, adult, diffuse large B-cell lymphoma from a US health payer perspective over a lifetime horizon. Under a range of plausible long-term effectiveness assumptions, each therapy was compared with salvage chemoimmunotherapy regimens and stem-cell transplantation. Main outcomes were undiscounted life years, discounted lifetime costs, discounted quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (3% annual discount rate). Sensitivity analyses explored uncertainty. RESULTS In an optimistic scenario, assuming a 40% 5-year progression-free survival (PFS), axi-cel increased life expectancy by 8.2 years at $129,000/QALY gained (95% uncertainty interval, $90,000 to $219,000). At a 30% 5-year PFS, improvements in life expectancy were more modest (6.4 years) and expensive ($159,000/QALY gained [95% uncertainty interval, $105,000 to $284,000]). In an optimistic scenario, assuming a 35% 5-year PFS, tisagenlecleucel increased life expectancy by 4.6 years at $168,000/QALY gained (95% uncertainty interval, $105,000 to $414,000/QALY). At a 25% 5-year PFS, improvements in life expectancy were smaller (3.4 years) and more expensive ($223,000/QALY gained [95% uncertainty interval, $123,000 to $1,170,000/QALY]). Administering CAR-T to all indicated patients would increase US health care costs by approximately $10 billion over 5 years. Price reductions to $250,000 and $200,000, respectively, or payment only for initial complete response (at current prices) would allow axi-cel and tisagenlecleucel to cost less than $150,000/QALY, even at 25% PFS. CONCLUSION At 2018 prices, it is possible that both CAR-T therapies meet a less than $150,000/QALY threshold. This depends on long-term outcomes compared with chemoimmunotherapy and stem-cell transplantation, which are uncertain. Widespread adoption would substantially increase non-Hodgkin lymphoma health care costs. Price reductions or payment for initial response would improve cost effectiveness, even with modest long-term outcomes.
Phases and Phenotypes of Multiple Sclerosis
Authors: Kantarci Orhun H. 
Published: June 2019

ABSTRACT

PURPOSE OF REVIEW
This article describes the dynamic evolution of multiple sclerosis (MS) through its phases and the impact of this understanding on treatment decisions.

RECENT FINDINGS
MS consists of three phases: (1) the high-risk phase, (2) the relapsing-remitting phase, and (3) the progressive phase. Increasingly, subclinical disease activity is becoming an integral part of our definition of disease course in MS. In many patients, the relapsing-remitting phase starts as subclinical activity, likely long before they present with a clinically isolated syndrome. Differentiating progressive MS subgroups is also becoming less relevant. This is illustrated by comparing progressive MS that evolves from an asymptomatic state in individuals with radiologically isolated syndrome (primary progressive MS) and symptomatic individuals with relapsing-remitting MS (secondary progressive MS). In each case, the background disease activity and pathology can be indistinguishable. These phases evolve on a continuum and largely follow the aging process with little influence by the preceding clinical activity level. Recently, it also became evident that one or a few poorly recovered relapses at the beginning of clinical manifestations of MS predict much earlier progressive MS onset.

SUMMARY
These findings suggest that interventions to prevent progressive MS, when they become available for clinical practice, may need to be considered as early as when the asymptomatic radiologically isolated syndrome is detected. This early treatment approach is being evaluated with ongoing trials with available disease-modifying therapies. In contrast, continuing the use of disease-modifying therapy beyond a certain age may have little benefit. However, being in the progressive phase of MS is not, in itself, an argument against disease-modifying therapy use in active disease in younger patients.
Monitoring, Switching, and Stopping Multiple Sclerosis Disease-Modifying Therapies
Authors: Gross Robert H. , Corboy John R. 
Published: June 2019

ABSTRACTPURPOSE OF REVIEWThis article reviews appropriate monitoring of the various multiple sclerosis (MS) disease-modifying therapies, summarizes the reasons patients switch or stop treatment, and provides a framework for making these management decisions.RECENT FINDINGSWith the increasing number of highly effective immunotherapies available for MS, the possibility of better control of the disease has increased, but with it, the potential for side effects has rendered treatment decisions more complicated. Starting treatment early with more effective and better-tolerated disease-modifying therapies reduces the likelihood of switching because of breakthrough disease or lack of compliance. Clinical and radiographic surveillance, and often blood and other paraclinical tests, should be performed periodically, depending on the disease-modifying therapy. Helping patients navigate the uncertainty around switching or stopping treatment, either temporarily or permanently, is one of the most important things we do as providers of MS care.SUMMARYOngoing monitoring of drug therapy is a crucial component of long-term MS care. Switching treatments may be necessary for a variety of reasons. Permanent discontinuation of treatment may be appropriate for some patients with MS, although more study is needed in this area.
A transcriptomic roadmap to α- and β-cell differentiation in the embryonic pancreas
Authors: van Gurp Léon , Muraro Mauro J. , Dielen Tim , Seneby Lina , Dharmadhikari Gitanjali , Gradwohl Gerard , van Oudenaarden Alexander , de Koning Eelco J. P. 
Published: June 2019

ABSTRACT
During pancreatic development, endocrine cells appear from the pancreatic epithelium when Neurog3-positive cells delaminate and differentiate into α-, β-, γ- and δ-cells. The mechanisms involved in this process are still incompletely understood. We characterized the temporal, lineage-specific developmental programs during pancreatic development by sequencing the transcriptome of thousands of individual pancreatic cells from E12.5 to E18.5 in mice, and identified all known cell types that are present in the embryonic pancreas, but focused specifically on α- and β-cell differentiation by enrichment of a MIP-GFP reporter. We characterized transcriptomic heterogeneity in the tip domain based on proliferation, and characterized two endocrine precursor clusters marked by expression of Neurog3 and Fev. Pseudotime analysis revealed specific branches for developing α- and β-cells, which allowed identification of specific gene regulation patterns. These include some known and many previously unreported genes that appear to define pancreatic cell fate transitions. This resource allows dynamic profiling of embryonic pancreas development at single cell resolution and reveals novel gene signatures during pancreatic differentiation into α- and β-cells.
Formation of Five-Membered Carbocycles from d-Glucose: A Concise Synthesis of 4-Hydroxy-2-(hydroxymethyl)cyclopentenone
Authors: Koseki Yoshitaka , Watanabe Toshihiro , Kamishima Takaaki , Kwon Eunsang , Kasai Hitoshi 
Published: June 2019

Abstract
A concise synthesis of 4-hydroxy-2-(hydroxymethyl)cyclopentenone (1) has been accomplished from d-glucose by a three-step sequence that features a catalyst-free hydrothermal reaction of d-glucal, which is readily obtained from d-glucose. Optimization of the reaction conditions for synthesizing 1 was performed by changing the temperature and reaction time. The treatment of d-glucal under the optimal conditions, i.e., at 120 °C for 24 h, provided 1 in the highest isolated yield of 61%. 1 would become a versatile intermediate for the synthesis of various fine chemicals having a cyclopentenone structure from cellulosic biomass.
The proximal interphalangeal joint: arthritis and deformity
Authors: Herren Daniel 
Published: June 2019

Finger joints are of the most common site of osteoarthritis and include the DIP, PIP and the thumb saddle joint. Joint arthroplasty provides the best functional outcome for painful destroyed PIP joints, including the index finger. Adequate bone stock and functional tendons are required for a successful PIP joint replacement Fixed swan-neck and boutonnière deformity are better served with PIP arthrodesis rather than arthroplasty. Silicone implants are the gold standard in terms of implant choice. Newer two-component joints may have potential to correct lateral deformities and improve lateral stability. Different surgical approaches are used for PIP joint implant arthroplasty according to the needs and the experience of the surgeon. Post-operative rehabilitation is as critical as the surgical procedure. Early protected motion is a treatment goal. Revision and exchange PIP arthroplasty may successfully be used to treat chronic pain, but will not correct deformity. Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180042
Use of three-dimensional technology for complications of upper limb fracture treatment
Authors: Michielsen Maartje , Van Haver Annemieke , Vanhees Matthias , van Riet Roger , Verstreken Frederik 
Published: June 2019

In malunion cases, restoration of anatomy is a key factor in obtaining a good functional outcome, but this can be technically very challenging. Three-dimensional printed bone models can further improve understanding of the malunion pattern. The use of three-dimensional (3D) computer planning, and the assembly of patient-specific instruments and implants, especially in complex deformities of the upper limb, allow accurate correction while reducing operation time, blood loss volume and radiation exposure during surgery. One of the major disadvantages of the 3D technique is the additional cost because it requires specific computer software, a dedicated clinical engineer, and a 3D printer. Further technical developments and clinical investigations are necessary to better define the added value and cost/benefit relationship of 3D in the treatment of complex fractures, non-unions, and malunions. Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180074
Orthopaedic registries with patient-reported outcome measures
Authors: Wilson Ian , Bohm Eric , Lübbeke Anne , Lyman Stephen , Overgaard Søren , Rolfson Ola , W-Dahl Annette , Wilkinson Mark , Dunbar Michael 
Published: June 2019

Total joint arthroplasty is performed to decreased pain, restore function and productivity and improve quality of life. One-year implant survivorship following surgery is nearly 100%; however, self-reported satisfaction is 80% after total knee arthroplasty and 90% after total hip arthroplasty. Patient-reported outcomes (PROs) are produced by patients reporting on their own health status directly without interpretation from a surgeon or other medical professional; a PRO measure (PROM) is a tool, often a questionnaire, that measures different aspects of patient-related outcomes. Generic PROs are related to a patient’s general health and quality of life, whereas a specific PRO is focused on a particular disease, symptom or anatomical region. While revision surgery is the traditional endpoint of registries, it is blunt and likely insufficient as a measure of success; PROMs address this shortcoming by expanding beyond survival and measuring outcomes that are relevant to patients – relief of pain, restoration of function and improvement in quality of life. PROMs are increasing in use in many national and regional orthopaedic arthroplasty registries. PROMs data can provide important information on value-based care, support quality assurance and improvement initiatives, help refine surgical indications and may improve shared decision-making and surgical timing. There are several practical considerations that need to be considered when implementing PROMs collection, as the undertaking itself may be expensive, a burden to the patient, as well as being time and labour intensive. Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180080
Patient-reported functional outcomes and health-related quality of life following fractures of the talus
Authors: Stirling P , MacKenzie SP , Maempel JF , McCann C , Ray R , Clement ND , White TO , Keating JF 
Published: June 2019

IntroductionThe primary aim of this study was to investigate patient-reported outcomes following talar fractures. Secondary aims were to investigate health-related quality of life and to determine whether it is influenced by functional outcome.Materials and methodsThis retrospective study identified 56 talar fractures over eight years. Patients were contacted by post and the Olerud and Molander score (OMS), Manchester–Oxford Foot and Ankle scores (MOXFQ) and Euroqol-5D-3L collected.ResultsThe mean age was 35.2 years (range 13–78 years). There were four cases (7.1%) of avascular necrosis and one (1.8%) non-union occurred. Data from patient-reported outcome measures were available for 42 patients (75.0%) with a median follow-up of 67.1 months (range 23.2–111.8 months). Mean OMS was 60.0 (standard deviation ± 29.51) and median MOXFQ was 30.33 (interquartile range 47.13). Median Euroqol-5D-3L index was 0.74 (interquartile range 0.213) and median Euroqol-5D-3L visual analogue score was 80 (interquartile range 21). Older age, open fractures, multiple injuries and subsequent avascular necrosis were associated with worse patient-reported outcomes (P < 0.05), with older age, avascular necrosis and open fractures found to be independent predictors of poor OMS, and avascular necrosis and open fractures independently predicting MOXFQ score on regression analysis (P < 0.05). Poor self-reported function, measured by OMS and MOXFQ, correlated with worse health-related quality of life as measured by the Euroqol-5D-3L index (OMS: r = 0.764, P < 0.001; MOXFQ: r = 0.824, P < 0.001) and visual analogue score (OMS: r = 0.450, P = 0.003; MOXFQ: r=0.559, P < 0.001).ConclusionsOlder age, avascular necrosis and open fractures predict poorer functional outcomes following talar fractures. Patients with worse limb-specific functional outcomes are more likely to have a worse perception of health-related quality of life.
Appendicovesical fistula presenting as hypokalaemic hyperchloraemic metabolic acidosis: a case report
Authors: Keane S , Tebala GD 
Published: June 2019

A 52-year-old man was admitted with diarrhoea and faecaluria and referred recurrent urinary tract infections for over 20 years. He also reported a two-week hospital admission more than 20 years ago for right iliac fossa pain, which was managed conservatively. Computed tomography showed a fistulous tract extending from the bladder with an unclear connection to the bowel. Cystoscopy confirmed the presence of a vesical fistula and biopsy of the tract confirmed colonic mucosa. Flexible sigmoidoscopy was negative. A cystogram was requested as an outpatient procedure and the patient was discharged after antibiotic treatment. A few days after discharge the patient was readmitted as an emergency to critical care for severe hyperchloraemic hypokalaemic acidosis and a Glasgow Coma Score of 6/15. He was intubated and ventilated and his metabolic derangement was treated. As soon as his conditions improved, he underwent emergency laparotomy, which revealed the presence of a fistula between the caecal fundus and the bladder. The fistula was repaired and the patient recovered swiftly and completely and was discharged on postoperative day 5. At 12-month follow up the patient was completely symptoms-free, his bowel habits were normal and he has not had any urinary infection. Appendicovesical fistula is a rare and potentially lethal condition due to its metabolic consequences. Past history of right iliac fossa pain treated conservatively, diarrhoea and recurrent urinary tract infection must raise suspicion.
Fistulotomy with or without marsupialisation of wound edges in treatment of simple anal fistula: a randomised controlled trial
Authors: Anan M , Emile SH , Elgendy H , Shalaby M , Elshobaky A , Abdel-Razik MA , Elbaz SA , Farid M 
Published: June 2019

Background Promotion of healing of the anal wound after fistulotomy may help accelerate recovery and return to work. The present study aimed to assess the effect of marsupialisation of the edges of the laid open fistula track on wound healing after anal fistulotomy for simple anal fistula. Methods This was a prospective randomised trial on patients with simple anal fistula. Patients were randomly assigned to one of two groups; group I underwent anal fistulotomy and group II underwent anal fistulotomy and marsupialisation of the edges of the laid open track. Outcomes of the study were time to achieve complete wound healing, operation time, postoperative pain and complications. Results Sixty patients of mean age of 40.8 years with simple anal fistula were randomly divided into two equal groups. No significant differences between the two groups regarding operation time (16.8 vs 18.4 minutes; P = 0.054), postoperative pain score (1.6 vs 1.2; P = 0.22), and complication rates were recorded. Group II achieved complete healing in a significantly shorter duration than group I (5.1 vs 6.7 weeks; P < 0.0001). Conclusion Marsupialisation of the edges of the laid open fistula track after fistulotomy resulted in quicker wound healing with similar complication and recurrence rates to lay open fistulotomy alone.
Use of an automated knot fastener shortens operative times in minimally invasive mitral valve repair
Authors: Perin G , Shaw M , Pingle V , Palmer K , Al-Rawi O , Ridgway T , Pousios D , Modi P 
Published: June 2019

Introduction Longer durations of cardiopulmonary bypass and aortic cross clamp are associated with increased morbidity and mortality. Little is known about the effect of automated knot fasteners (Cor-Knot®) in minimally invasive mitral valve repair on operative times and outcomes. The aim of this study was to evaluate whether these devices shortened cardiopulmonary bypass and aortic cross clamp times and whether this impacted on postoperative outcomes. Materials and methods All patients undergoing isolated minimally invasive mitral valve repair by a single surgeon between March 2011 and March 2016 were included (n = 108). Two cohorts were created based on the use (n = 52) or non-use (n = 56) of an automated knot fastener. Data concerning intraoperative variables and postoperative outcomes were collected and compared. Results Preoperative demographics were well matched between groups with no significant difference in logistic Euroscore (manual vs automated: median 3.1, interquartile range, IQR, 2.1–5.5, vs 5.4, IQR 2.2–8.3; P = 0.07, respectively). Comparing manually tied knots to an automated fastener, cardiopulmonary bypass and aortic cross clamp times were significantly shorter in the automated group (cardiopulmonary bypass: median 200 minutes, IQR 180–227, vs 165 minutes (IQR 145–189 minutes), P < 0.001; aortic cross clamp 134 minutes (IQR 121–150 minutes) vs 111 minutes (IQR 91–137 minutes), P < 0.001, respectively). There was no mortality and no strokes, nor were there any differences in postoperative outcomes including reoperation for bleeding, renal failure, intensive care or hospital stay. Conclusions The use of an automated knot fastener significantly reduces cardiopulmonary bypass and aortic cross clamp times in minimally invasive mitral valve repair but this does not translate into an improved clinical outcome.