bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nerve Diameter in the Hand: A Cadaveric Study
Authors: Amador Ricardo O. , Westenberg Ritsaart F. , Langhammer Christopher G. , Knaus William J. , Chen Neal C. , Eberlin Kyle R. 
Published: March 2019

Background:
Nerve injuries in the hand are common and often pose a challenge for the upper extremity surgeon. A range of reconstructive options exist for nerve repair, but proper matching of nerve diameter is important for many of these techniques. The purposes of this study were to (1) describe the nerve diameters of the hand and their relative differences and (2) investigate whether there is a relationship between nerve diameter and external hand dimensions or body mass index.

Methods:
We utilized 18 freshly frozen cadaveric hands from adult donors aged 20–86 of both sexes for this study. Two independent observers measured each nerve diameter to the nearest 0.1 mm using a digital caliper.

Results:
Using the flexor zones as boundaries, a total of 33 nerve measurements were performed for each cadaveric hand. Nerve diameter increased from the distal to the proximal flexor zones. The internal common digital nerves in flexor zone 3 were larger than the external digital nerves. The median nerve was found to be nearly 2 times larger than the ulnar nerve at 2 locations within the wrist. There was a positive correlation between body mass index, hand span, hand width, and nerve diameter at several measured locations.

Conclusions:
This study provides reference values for nerve diameters of the hand and wrist and describes their relative differences. It is important for surgeons to be aware of these differences and to consider this information as we advance our efforts to reconstruct the hand and develop technologies for nerve repair.
Carpal Malalignment as a Predictor of Delayed Carpal Tunnel Syndrome after Colles’ Fracture
Authors: Watanabe Kentaro , Ota Hideyuki 
Published: March 2019

Background:
The present study aimed to clarify whether carpal malalignment associated with distal radius malunion after Colles’ fracture is involved in the onset of delayed carpal tunnel syndrome (DCTS) in elderly women.

Methods:
This retrospective case–control study was conducted in 40 female patients with Colles’ fracture treated with a cast, including 10 patients (mean age, 71.6 years) who developed DCTS from 6 weeks to 6 months after injury (DCTS group) and 30 patients (mean age, 73.4 years) without DCTS (control group). Radiological parameters, including the radiocapitate distance (RCD), volar prominence height (VPH), and volar tilt (VT) were measured. Relationships between the RCD and both the VPH and VT were examined, and the involvement of the RCD in the onset of DCTS was analyzed.

Results:
The RCD showed strong correlations with both the VPH and VT. The mean RCD was significantly lower in the DCTS group than in the control group (−12.8 mm versus −8.4 mm). Logistic regression analysis showed involvement of the RCD in the onset of DCTS, and the threshold value according to receiver operating characteristic curve analysis was −9.9 mm, with an odds ratio of 21.

Conclusions:
Dorsal displacement of the capitate due to Colles’ fracture malunion is involved in DCTS accompanied with anatomical alteration of the carpal tunnel. When the center of the head of the capitate is located more than 1 cm dorsally behind the volar cortical line of the radius, careful follow-up should be performed as DCTS may occur within 6 months after injury.
The Influence of Aerosol Density and Shape Factor on the Assessment of Internal Exposure to 239Pu
Authors: Zhang Bin , Sheng Wei , Xu Ming , Zhang Yang , Lei Jie-Ying , Ma Huai-Cheng 
Published: March 2019

Abstract
Internal exposure due to inhalation of aerosols depends on the ratio of aerodynamic shape factor (χ) to aerosol mass density (ρ). Inhaled aerosol parameters may differ from the default ρ and χ values provided by the International Commission on Radiological Protection, which are adopted for the assessment of internal exposures. This paper focuses on the influences of χ/ρ on the assessment of internal exposure to 239Pu for reference workers. Regional deposition fractions are found to decrease with increasing χ/ρ, and larger decreases are observed with smaller activity median aerodynamic diameter aerosols, while the slow clearance fractions (f
s) in the tracheobronchial region are more sensitive for larger activity median aerodynamic diameter aerosols. Results from biokinetics calculations reveal that both the time-dependent content (excretion) and cumulative activities are determined mainly for particles initially deposited in the alveolar-interstitial region, while f
s affects the local cumulative activities in the tracheobronchial region. χ/ρ is proven to have different influences for aerosols with different activity median aerodynamic diameters. The default χ/ρ values can be used when activity median aerodynamic diameters are greater than 1 μm, while one should pay attention to the value of χ/ρ when activity median aerodynamic diameters are less than 1 μm, where significant influence may be anticipated.
CAR‐T Cell Therapy in Diffuse Large B Cell Lymphoma: Hype and Hope
Authors: Hopfinger Georg , Jäger Ulrich , Worel Nina 
Published: March 2019

AbstractPatients with non‐Hodgkin lymphomas (NHLs) resistant to standard therapies have a dismal prognosis. The outcome is even poorer in patients relapsing after autologous stem cell transplantation. Most of these patients do not qualify for an allogeneic hematopoietic cell transplantation (HCT) due to refractory disease, lack of a suitable allogeneic donor, higher age, or cumulative toxicity of previous chemotherapy. Despite patients undergoing allogeneic HCT normally profit from a graft‐versus‐lymphoma effect, overall survival in patients with NHL after HCT remains short. Therefore, novel treatment modalities are urgently needed. Chimeric antigen receptor (CAR)‐T cells, a new class of cellular immunotherapy involving ex vivo genetic modification of T cells to incorporate an engineered CAR have been used in clinical trials. In the majority of studies, B cell malignancies treated with CD19 targeting CAR‐T cells have been analyzed.Recently, results from 2 CD19 directed CAR‐T cell trials with an increased follow‐up of patients led to Food and Drug Administration and European Medicines Agency approval of tisagenlecleucel and axicabtagene ciloleucel. Common adverse events (AEs) include cytokine release syndrome and neurological toxicity, which may require admission to an intensive care unit, B cell aplasia and hemophagocytic lymphohistiocytosis. These AEs are manageable when treated by an appropriately trained team following established algorithm. In this review, we summarize the results of 3 large phase II CD19 CAR‐T cell trials and focus on AEs. We also provide a perspective of ongoing activity in this field with the intend to improve the potency of this emerging novel therapy.
Analysis of Spontaneous Eyelid Blink Dynamics Using a 240 Frames per Second Smartphone Camera
Authors: Godfrey Kyle J. , Wilsen Craig , Satterfield Kellie , Korn Bobby S. , Kikkawa Don O. 
Published: March 2019

Purpose:
To report initial results using a native 240 frames per second smartphone camera for 2-dimensional videographic analysis of eyelid dynamics during spontaneous blinking.

Methods:
Spontaneous blinking was prospectively recorded in volunteers using a smartphone camera recording at 240 frames per second in 720p. A standardized recording setup was used in which the smartphone was mounted on a tripod stand at 0.5 m in the Frankfort horizontal plane. Subjects viewed a nature documentary video in primary gaze while their spontaneous blinking was recorded for 3 minutes. Exclusion criteria included known eyelid malposition or ocular surface pathology, including dry eye syndrome, contact lens use, prior eyelid or intraocular surgery, prior periocular trauma, or craniofacial abnormality. Primary outcome measures were spontaneous interblink interval, blink rate in blinks per minute, percentage of incomplete blinks, and blink velocity.

Results:
The authors studied 10 subjects, 5 men and 5 women. Average age was 34 (range 19–58). Mean interblink interval was found to be 7.4 seconds (SD: 5.2, range: 1.9–17.6), corresponding to a mean blink rate of 13 blinks per minute (SD: 7.8, range: 3.4–32.0). Mean percentage of incomplete blinks was 49.8% (SD: 33.3, range: 0–100). Mean blink closure velocity was 93 mm/seconds (SD: 31, range: 40–160). These numbers are consistent with previously published results of spontaneous eyelid blink parameters.

Conclusions:
This study demonstrates that 240 frames per second videography native to modern smartphone cameras captures anatomic detail and blink dynamics with sufficient resolution and clarity to provide objective clinical information about spontaneous eyelid blink rate, dynamics, and function.
The Flip-Back Myocutaneous Advancement Flap for Periocular Reconstruction
Authors: Ko Marcus J. , Erickson Benjamin P. , Blessing Nathan W. , Tse David T. 
Published: March 2019

The flip-back myocutaneous flap offers a novel alternative to skin grafting or more extensive cheek rotational flaps for reconstruction of challenging anterior lamellar defects involving the eyelids and adjacent periocular tissues.

Purpose:
To present a novel myocutaneous flap for anterior lamellar reconstruction.

Methods:
Retrospective interventional case series of consecutive patients who underwent Mohs reconstruction using the flip-back flap. Operations were performed by a single surgeon (DTT) between January 2012 and May 2016. For lower eyelid defects, an extended subciliary incision was made and a skin-muscle flap developed and suspended in the manner of lower eyelid blepharoplasty. A back-cut was used to develop a pedicle from the overlapping tissue, which was then rotated 180 degrees into the defect. A similar method was employed in an inverted manner for upper eyelid defects. Postoperative eyelid function, cosmesis, complications, and need for further interventions were assessed.

Results:
Ten patients—8 with lower and 2 with upper eyelid defects—were reconstructed using this method. Mean follow up was 18.3 ± 15.5 months with a minimum interval of 4 months. Despite the 180-degree rotation of a relatively narrow pedicle, none of the patients experienced flap necrosis. Postoperative function and cosmesis was satisfactory, with no tissue puckering, notching, or symptomatic retraction. No antimetabolite/steroid injection or surgical revision was required.

Conclusions:
The flip-back flap expands the armamentarium of the periocular reconstructive surgeon. Its particular forte is in addressing broad and relatively shallow anterior lamellar defects where sufficient tissues are not available for transposition via a uni- or bipedicle flap. By leveraging the robust periocular vascular plexus and defying traditional guidelines governing pedicle formation and rotation, it permits creation of a local flap in cases where skin grafts or extensive Mustarde-style flaps might otherwise be required.
Pediatric Prehospital Intraosseous Access During Combat Operations in Iraq and Afghanistan
Authors: Schauer Steven G. , Ng Patrick C. , April Michael D. , Hill Guyon J. , Arana Allyson A. , Bebarta Vikhyat S. 
Published: March 2019

Background
Vascular access in critically ill pediatric patients can be challenging with delays potentially leading to worse outcomes. Intraosseous (IO) access has a low rate of complications and can be utilized to administer lifesaving medications. Combat medics are trained to treat adults but may also be required to treat children in the deployed setting. Vascular access in children can be challenging, especially in a hypovolemic state. There are limited data on prehospital lifesaving interventions in children in the combat setting. We sought to characterize the use of IO access in pediatric patients who sustained trauma in the combat setting.

Methods
We queried the Department of Defense Trauma Registry for all pediatric patients admitted to fixed-facilities and forward surgical teams in Iraq and Afghanistan from January 2007 to January 2016. Within that population, we searched for all subjects with a documented prehospital IO or intravenous (IV) access obtained. Subjects with both an IO and IV documented were placed into the IO category. We separated subjects by age groupings: younger than 1, 1 to 4, 5 to 9, 10 to 14, and 15 to 17 years.

Results
During the study period, there were 3439 subjects 17 years or younger. There were 177 in the IO cohort and 803 in the IV cohort. Most subjects in the IO cohort were in the 10- to 14-year-old age group (35.6%), male (79.1%), located in Afghanistan (95.5%), and injured by explosive (52.0%), with lower survival rates than the IV cohort (68.9% vs 90.7%, P < 0.001). Hemostatic dressing application, tourniquet application, intubation, cardiopulmonary resuscitation, sedative administration, ketamine administration, and paralytic administration were all higher in the IO cohort.

Conclusions
Pediatric IO placement in the prehospital setting occurred infrequently. Pediatric subjects receiving an IO had higher injury severity scores and higher mortality rates compared with those who received an IV only. Intraosseous use appears to be used more often in critically ill pediatric subjects.
Early Intervention and Postural Adjustments During Reaching in Infants at Risk of Cerebral Palsy
Authors: van Balen Lieke C. , Dijkstra Linze-Jaap , Dirks Tineke , Bos Arend F. , Hadders-Algra Mijna 
Published: March 2019

Purpose:
To investigate postural effects of the family-centered program, COPing with and CAring for infants with special needs (COPCA), applied at 3 to 6 months' corrected age in infants at high risk of cerebral palsy. Previously, we reported postural differences between the infants at risk of CP in the control group of the current study and a group of infants developing typically. Now we focus on differences between 2 intervention groups.

Methods:
We explored postural adjustments during reaching in seated infants at 4, 6, and 18 months using surface electromyography of arm, neck, and trunk muscles. Infants randomly received the family-centered program or another infant physical therapy. Using videotaped intervention sessions, we investigated correlations between time spent on specific physical therapeutic actions and direction specificity, recruitment order, and anticipatory activation at 18 months.

Results:
Postural adjustments in both groups were similar, but development of direction specificity and anticipatory activation in COPCA infants better mimicked typical development. These 2 parameters were associated with COPCA-type physical therapeutic actions.

Conclusions:
Postural control was similar after both interventions. Positive outcomes were associated with fewer intervening actions of the therapist and greater allowance of spontaneous movements.
Physical Therapy Outcome Measures for Assessment of Lower Extremity Chronic Pain-Related Function in Pediatrics
Authors: Mirek Elizabeth , Logan Deirdre , Boullard Kimberly , Hall Amber M. , Staffa Steven J. , Sethna Navil 
Published: March 2019

Purpose:
To assess the clinical utility of 5 physical therapy (PT) outcome measures in quantifying functional changes in pediatric lower extremity chronic pain treated at a hospital-based interdisciplinary rehabilitation center.

Design:
This was a cross-sectional study with retrospective review of 173 individuals, 8 to 18 years old, treated from June 2008 to 2013.

Methods:
The measures used were the Timed Up and Go, Timed Up and Down Stairs, Bruininks-Oseretsky Test of Motor Proficiency, Second Edition, 6-minute walk test, and Lower Extremity Functional Scale. Participant performance was correlated with demographic characteristics, the Functional Disability Index, Multidimensional Anxiety Scale for Children, Child Depression Inventory, and Canadian Occupational Performance Measure.

Results:
Scores from all 5 PT measures showed significant improvement following treatment. Functional Disability Index correlated to every PT measure except the 6-minute walk test.

Conclusions:
This study supports the clinical use of these PT measures to track functional progress after rehabilitative treatment of lower extremity chronic pain-related disability.
Daily and Weekly Rehabilitation Delivery for Young Children With Gross Motor Delay: A Randomized Clinical Trial Protocol (the DRIVE Study)
Authors: Ferrante Rachel , Hendershot Sarah , Baranet Kathy , Barbosa Gardenia , Carey Helen , Maitre Nathalie , Lo Warren , Pan Jeff , Heathcock Jill 
Published: March 2019

Purpose:
The proposed project tests the principle that frequency of rehabilitation is an important regulator of therapeutic response in infants.

Methods:
We will randomize 75 infants with cerebral palsy, 6 to 24 months of age and/or Gross Motor Function Classification System levels III to V (higher severity), to determine the short-term and long-term effects of 3 dosing protocols consisting of an identical number of 2-hour sessions of the same motor learning-based therapy applied over a different total number of calendar weeks.

Results and Conclusions:
The results will inform clinicians, families, and scientists about dosing and will provide needed recommendations for frequency of rehabilitation to optimize motor function and development of young children with cerebral palsy.
Examination and Management of a 4-Year-Old Following a Femoral Aneurysmal Bone Cyst: A Case Report
Authors: Kirker Kaitlin , Masaracchio Michael , Freeland Megan 
Published: March 2019

Purpose:
The literature lacks recommendations for postoperative rehabilitation following removal of aneurysmal bone cysts (ABCs). This case report describes the rehabilitation with return to age-appropriate functional activities for a 4-year-old following surgical fixation of a femoral ABC, with emphasis on clinical decision-making in the absence of definitive treatment algorithms.

Summary of Key Points:
The child improved in range of motion, strength, balance, transfers, gait, stair negotiation, and percentile rank on the Test of Gross Motor Development 2.

Conclusion:
This case is successful outcomes of a 4-year-old girl (GP) following surgical fixation for an ABC.

Recommendations for Clinical Practice:
This case fills a current void in the literature emphasizing clinical decision-making and attainment of GP-specific functional goals. A goal-driven approach incorporating key elements of the International Classification of Function model resulted in successful return to age-appropriate activity following surgical fixation of a femoral fracture due to an ABC.
Hospital Surveys by the Centers for Medicare and Medicaid Services: An Analysis of More Than 34,000 Deficiencies
Authors: Antognini Joseph F. 
Published: March 2019

Objectives
The aims of the study were to analyze hospital deficiencies reported by the Centers for Medicare and Medicaid Services (CMS) for a 10-year period (2007–2017) and thereby determine the specific conditions of participation (CoP) cited in each deficiency.

Methods
Deficiency data from the CMS Web site was downloaded and analyzed. A determination was made regarding the CoP assigned to each deficiency. In addition, deficiencies were analyzed according to the presence or absence of an immediate jeopardy (the most serious potential risk) and whether there was state-to-state variation.

Results
A total of 30,808 of 34,522 deficiencies were assigned specific “tags” related to a COP, with 77% of the A tags assigned to the following six CoP: patient rights, nursing services, quality improvement, medical records, governing body, and emergency services. Immediate jeopardy was assigned in 730 tags, and a patient death was more likely to be associated with the determination of immediate jeopardy; actual patient deaths were associated with 21% of surveys that resulted in immediate jeopardy. Survey rates varied state-to-state; 14.3 surveys per 1 million population at the 80th percentile and 6.0 surveys per million at the 20th percentile, respectively. Utah and Vermont had the least (1.7) and greatest (70.3) rates, respectively, a 41-fold difference.

Conclusions
These data indicate that (a) hospital surveys result in most deficiencies being assigned to a subset of CoP; (b) a patient death is more likely to be associated with a finding of immediate jeopardy, and (c) there is significant state-to-state variation in survey rates.
Care Coordination for Patients on Chronic Opioid Therapy Following Surgery
Authors: Lagisetty Pooja , Bohnert Amy , Goesling Jenna , Hu Hsou Mei , Travis Breanna , Lagisetty Kiran , Brummett Chad M. , Englesbe Michael J. , Waljee Jennifer 
Published: March 2019

Objective:
To describe if patients with chronic opioid use with a consistent usual prescriber (UP) prior to surgery and if early return to that UP (<30 d) would be associated with fewer high risk prescribing events in the postoperative period.

Summary Background Data:
Over 10 million people each year are prescribed opioids for chronic pain. There is little evidence regarding coordination of opioid management and best practices for patients on long-term opioid therapy patients following surgery.

Methods:
The study design is a retrospective cohort study. We identified 5749 commercially insured patients aged 18 to 64 with chronic opioid use who underwent elective surgery between January 2008 and March 2015. The predictors were presence of a UP and early return (<30 d from surgery) to a UP. The primary outcome was new high-risk opioid prescribing in the 90-day postoperative period (multiple prescribers, overlapping opioid and/or benzodiazepine prescriptions, new long acting opioid prescriptions, or new dose escalations to > 100 mg OME).

Results:
In this cohort, 73.8% of patients were exposed to high risk prescribing postoperatively. Overall, 10% of patients did not have a UP preoperatively, and were more likely to have prescriptions from multiple prescribers (OR 2.23 95% CI 1.75–2.83) and new long acting opioid prescriptions (OR 1.69, 95% CI 1.05–2.71). Among patients with a UP, earlier return was associated with decreased odds of receiving prescriptions from multiple prescribers (OR 0.80, 95% CI 0.68–0.95).

Conclusion:
Patients without a UP prior to surgery are more likely to be exposed to high-risk opioid prescribing following surgery. Among patients who have a UP, early return visits may enhance care coordination with fewer prescribers.
Prior Resection of the Primary Tumor Prolongs Survival After Peptide Receptor Radionuclide Therapy of Advanced Neuroendocrine Neoplasms
Authors: Kaemmerer Daniel , Twrznik Matthias , Kulkarni Harshad R. , Hörsch Dieter , Sehner Susanne , Baum Richard P. , Hommann Merten 
Published: March 2019

Objective:
The aim of the study was to compare impact on survival after resection of primary tumors (PTs) after peptide receptor radionuclide therapy (PRRT).

Background:
PRRT is a highly effective therapeutic option to treat locally advanced or metastatic neuroendocrine neoplasms (NENs).

Methods:
We retrospectively analyzed the data of 889 patients with advanced NEN (G1-G3, stage IV) treated with at least 1 cycle of PRRT. In 486 of 889 patients (55%, group 1), PT had been removed before PRRT. Group 2 constituted 403 patients (45%) with no prior PT resection. Progression-free survival (PFS) and overall survival (OS) was determined by 68Ga SSTR-PET/CT in all patients applying RECIST and EORTC.

Results:
Most patients had their PT in pancreas (n = 335; 38%) and small intestine (n = 284; 32%). Both groups received a mean of 4 cycles of PRRT (P = 0.835) with a mean cumulative administered radioactivity of 21.6 ± 11.7 versus 22.2 ± 11.2 GBq (P = 0.407). Median OS in group 1 was 134.0 months [confidence interval (CI): 118–147], whereas OS in group 2 was 67.0 months (CI: 60–80; hazard ratio 2.79); P < 0.001. Likewise, the median progression-free survival after first PRRT was longer in group 1 with 18.0 (CI: 15–20) months as compared to group 2 with 14.0 (CI: 15–18; hazard ratio 1.21) months; P = 0.012.

Conclusions:
A previous resection of the PT before PRRT provides a significant survival benefit in patients with NENs stage IV.