bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of Medical Specialties in Medical Operations other than War: Lessons from Saudi Arabia
Authors: Newmark Jonathan , France Larry O. 
Published: March 2018

Abstract
From the experience of a U.S. Army Air Defense Artillery “battalion-plus” task force serving a 6-month rotation in the Kingdom of Saudi Arabia, we compiled the requirements for specialty consultations on deployed personnel in the predeployment screening phase, during deployment (including both inpatient hospitalizations and medical evacuations), and immediately upon return to home station. We required a wide variety of specialty expertise. In every phase of the operation, we consulted orthopedic surgery most often. Nonsurgical and surgical specialists were consulted in roughly equal numbers. Almost every field of adult medicine was represented in our sample. The distribution of consultations across specialties differs from what would be expected in combat but is similar to that seen in the few other studies of comparable populations. Excellent host nation support allowed us to use specialty expertise to an almost ideal extent. These data represent the most complete “snapshot” that has been taken of the requirements for specialty medical consultations in a military operation other than war (MOOTW). They demonstrate that under MOOTW conditions, even a healthy Army population requires the assistance of a full panel of medical specialties. They should serve as a benchmark for planners estimating the medical specialty needs that the Army must provide. Military medicine must provide access to essentially all medical specialties for personnel deployed under MOOTW conditions, whether through host nation support, telemedicine, or medical evacuation.
Venomous Snakebite in Thailand I: Medically Important Snakes
Authors: Chanhome Lawan , Cox Merel J. , Wilde Henry , Jintakoon Piboon , Chaiyabutr Narongsak , Sitprija Visith 
Published: March 2018

Abstract
Thailand has an abundance of venomous snakes. Among the neurotoxic family Elapidae, there are three species of the genus Naja (cobras), three of the genus Bungarus (kraits), and the king cobra of the genus Ophiophagus. Other Elapidae snakes in Thailand include sea snakes and Asian coral snakes of the genus Calliophis. They have potent venoms but rarely bite humans. Tissue and hemotoxic snakes are represented by family Viperidae, subfamilies Viperinae and Crotalinae. They remain an occupational hazard for farmers and rubber tappers, causing serious morbidity but only rare deaths, since competent treatment is now widely available throughout Thailand. Purified equine antivenin is manufactured locally for the monocled and Siamese spitting cobras (Naja kaouthia and N. siamensis), king cobra (Ophiophagus hannah), banded krait (Bungarus fasciatus), most green pit vipers (Trimeresurus sp.), Malayan pit viper (Calloselasma rhodostoma), and the Siamese Russell's viper (Daboia russelli siamensis).
SDSS-IV MaNGA: the spectroscopic discovery of strongly lensed galaxies
Authors: Talbot Michael S , Brownstein Joel R , Bolton Adam S , Bundy Kevin , Andrews Brett H , Cherinka Brian , Collett Thomas E , More Anupreeta , More Surhud , Sonnenfeld Alessandro , Vegetti Simona , Wake David A , Weijmans Anne-Marie , Westfall Kyle B 
Published: March 2018

Abstract
We present a catalogue of 38 spectroscopically detected strong galaxy–galaxy gravitational lens candidates identified in the Sloan Digital Sky Survey IV (SDSS-IV). We were able to simulate narrow-band images for eight of them demonstrating evidence of multiple images. Two of our systems are compound lens candidates, each with two background source-planes. One of these compound systems shows clear lensing features in the narrow-band image. Our sample is based on 2812 galaxies observed by the Mapping Nearby Galaxies at APO (MaNGA) integral field unit (IFU). This Spectroscopic Identification of Lensing Objects (SILO) survey extends the methodology of the Sloan Lens ACS Survey (SLACS) and BOSS Emission-Line Survey (BELLS) to lower redshift and multiple IFU spectra. We searched ∼1.5 million spectra, of which 3065 contained multiple high signal-to-noise ratio background emission-lines or a resolved [O ii] doublet, that are included in this catalogue. Upon manual inspection, we discovered regions with multiple spectra containing background emission-lines at the same redshift, providing evidence of a common source-plane geometry which was not possible in previous SLACS and BELLS discovery programs. We estimate more than half of our candidates have an Einstein radius ≳ 1.7 arcsec, which is significantly greater than seen in SLACS and BELLS. These larger Einstein radii produce more extended images of the background galaxy increasing the probability that a background emission-line will enter one of the IFU spectroscopic fibres, making detection more likely.
Behavioral Variant Frontotemporal Dementia as a Serious Complication of Spontaneous Intracranial Hypotension
Authors: Schievink Wouter I , Maya M Marcel , Barnard Zachary R , Moser Franklin G , Jean-Pierre Stacey , Waxman Alan D , Nuño Miriam 
Published: March 2018

Abstract

BACKGROUND
Behavioral variant frontotemporal dementia (bvFTD) is a devastating early onset dementia. Symptoms of bvFTD may be caused by spontaneous intracranial hypotension (SIH), a treatable disorder, but no comprehensive study of such patients has been reported.

OBJECTIVE
To describe detailed characteristics of a large cohort of patients with SIH and symptoms of bvFTD.

METHODS
We identified patients with SIH who met clinical criteria for bvFTD. Patients were compared to a cohort of SIH patients without bvFTD.

RESULTS
The mean age for the 21 men and 8 women was 52.9 yr (range, 37–65 yr). All 29 patients with bvFTD symptoms had hypersomnolence. Magnetic resonance imaging showed brain sagging in all patients, cerebrospinal fluid (CSF) opening pressure low in about half of patients, but a spinal CSF leak could not be detected in any patient. All patients underwent epidural blood patching, but 26 patients eventually underwent 1 or more surgical procedures. Overall, a good outcome was obtained in 21 patients (72%); 20 (91%) of 22 patients who had not undergone prior Chiari surgery compared to 1 (14%) of 7 patients who did undergo Chiari surgery (P < .003). Compared to SIH patients without symptoms of bvFTD (n = 547), those with bvFTD symptoms were older, more often male, less often demonstrated CSF leak on spinal imaging, and more often underwent surgery (P < .02).

CONCLUSION
bvFTD in SIH is rare and associated with brain sagging and hypersomnolence. Spinal CSF leaks are rarely detected. bvFTD symptoms are often refractory to the usual percutaneous procedures but most patients can be cured.
Systemic Exercise-Induced Hypoalgesia Following Isometric Exercise Reduces Conditioned Pain Modulation
Authors: Alsouhibani Ali , Vaegter Henrik Bjarke , Hoeger Bement Marie 
Published: March 2018

Abstract

Objective
Physically active individuals show greater conditioned pain modulation (CPM) compared with less active individuals. Understanding the effects of acute exercise on CPM may allow for a more targeted use of exercise in the management of pain. This study investigated the effects of acute isometric exercise on CPM. In addition, the between-session and within-session reliability of CPM was investigated.

Design
Experimental, randomized crossover study.

Setting
Laboratory at Marquette University.

Subjects
Thirty healthy adults (19.3±1.5 years, 15 males).

Methods
Subjects underwent CPM testing before and after isometric exercise (knee extension, 30% maximum voluntary contraction for three minutes) and quiet rest in two separate experimental sessions. Pressure pain thresholds (PPTs) at the quadriceps and upper trapezius muscles were assessed before, during, and after ice water immersions.

Results
PPTs increased during ice water immersion (i.e., CPM), and quadriceps PPT increased after exercise (P &lt; 0.05). CPM decreased similarly following exercise and quiet rest (P &gt; 0.05). CPM within-session reliability was fair to good (intraclass correlation coefficient [ICC] = 0.43–0.70), and the between-session reliability was poor (ICC = 0.20–0.35). Due to the variability in the systemic exercise-induced hypoalgesia (EIH) response, participants were divided into systemic EIH responders (N = 9) and nonresponders (N = 21). EIH responders experienced attenuated CPM following exercise (P = 0.03), whereas the nonresponders showed no significant change (P &gt; 0.05).

Conclusions
Isometric exercise decreased CPM in individuals who reported systemic EIH, suggesting activation of shared mechanisms between CPM and systemic EIH responses. These results may improve the understanding of increased pain after exercise in patients with chronic pain and potentially attenuated CPM.
Understanding health policy to improve primary care management of obesity
Authors: Bowen Pamela G. , Lee Loretta T. , McCaskill Gina M. , Bryant Pamela H. , Hess Mary Annette , Ivey Jean B. 
Published: March 2018

Abstract:
NPs are ideal candidates for implementing positive health changes for obese patients. Providers have medical expertise and can promote obesity reduction strategies to their patients. Increased awareness of the influence of health policy and clinical implications for obesity management are needed.
Intraoperative Sedation With Dexmedetomidine is Superior to Propofol for Elderly Patients Undergoing Hip Arthroplasty
Authors: Mei Bin , Meng Gaige , Xu Guanghong , Cheng Xinqi , Chen Shishou , Zhang Ye , Zhang Ming , Liu Xuesheng , Gu Erwei 
Published: March 2018

Background:
Peripheral nerve block is a preferable method for elderly patients receiving hip arthroplasty. Sedation with dexmedetomidine may reduce postoperative delirium (POD). The aim of this study was to investigate whether intraoperative sedation with dexmedetomidine, as a supplementary to peripheral nerve block for elderly patients receiving total hip arthroplasty, can decrease the prevalence of POD.

Methods:
A prospective, randomized controlled study was conducted with patients 65 years of age or older who underwent total hip arthroplasty between June 2016 and June 2017. The patients were randomly assigned to receive a lumbosacral plexus plus T12 paravertebral block supplemented with propofol or dexmedetomidine for sedation. Incidence of POD was the primary endpoint and was determined with the confusion assessment method, and incidence of postoperative cognitive dysfunction (POCD) was assessed with the mini-mental state examination. The time of ambulation, discharge time, and complications over a 30-day postsurgery period were also recorded.

Results:
A total of 296 patients were randomly assigned to 2 groups. The patients sedated with dexmedetomidine had lower incidences of POD and POCD and were out of bed and discharged sooner than the patients sedated with propofol. There was no difference in complications between the 2 groups.

Conclusions:
As a supplementary to peripheral nerve block, intraoperative sedation with dexmedetomidine could be associated with a lower incidence of POD, which may have benefits on reducing the incidence of early POCD and offering a better short-term recovery for elderly patients receiving hip arthroplasty.
Effects of Prone Positioning on Transpulmonary Pressures and End-expiratory Volumes in Patients without Lung Disease
Authors: Kumaresan Abirami , Gerber Robert , Mueller Ariel , Loring Stephen H. , Talmor Daniel 
Published: March 2018

Abstract

Background
The effects of prone positioning on esophageal pressures have not been investigated in mechanically ventilated patients. Our objective was to characterize effects of prone positioning on esophageal pressures, transpulmonary pressure, and lung volume, thereby assessing the potential utility of esophageal pressure measurements in setting positive end-expiratory pressure (PEEP) in prone patients.

Methods
We studied 16 patients undergoing spine surgery during general anesthesia and neuromuscular blockade. We measured airway pressure, esophageal pressures, airflow, and volume, and calculated the expiratory reserve volume and the elastances of the lung and chest wall in supine and prone positions.

Results
Esophageal pressures at end expiration with 0 cm H2O PEEP decreased from supine to prone by 5.64 cm H2O (95% CI, 3.37 to 7.90; P < 0.0001). Expiratory reserve volume measured at relaxation volume increased from supine to prone by 0.15 l (interquartile range, 0.25, 0.10; P = 0.003). Chest wall elastance increased from supine to prone by 7.32 (95% CI, 4.77 to 9.87) cm H2O/l at PEEP 0 (P < 0.0001) and 6.66 cm H2O/l (95% CI, 3.91 to 9.41) at PEEP 7 (P = 0.0002). Median driving pressure, the change in airway pressure from end expiration to end-inspiratory plateau, increased in the prone position at PEEP 0 (3.70 cm H2O; 95% CI, 1.74 to 5.66; P = 0.001) and PEEP 7 (3.90 cm H2O; 95% CI, 2.72 to 5.09; P < 0.0001).

Conclusions
End-expiratory esophageal pressure decreases, and end-expiratory transpulmonary pressure and expiratory reserve volume increase, when patients are moved from supine to prone position. Mean respiratory system driving pressure increases in the prone position due to increased chest wall elastance. The increase in end-expiratory transpulmonary pressure and expiratory reserve volume may be one mechanism for the observed clinical benefit with prone positioning.
Acute correction of proximal tibial varus deformity in adolescent Blount disease with a low-profile Ilizarov frame
Authors: EL Ghafar Khaled Abd , Samir Shadi , Diab Ramy Ahmed 
Published: March 2018

Background:
Adolescent tibia vara usually presents with genu varum deformity and is commonly associated with internal tibial torsion. The Ilizarov technique is one of the accepted techniques for correction of this deformity. Acute correction has the advantage of a shorter duration in the fixator and less patient discomfort. Using the Ilizarov construct with two rings decreases bulkiness of the frame and improves compliance.

Methods:
Thirteen male patients with adolescent Blount disease, seven of whom had bilateral deformities (total 20 knees), were managed by extra-focal tibial valgus lateral translation osteotomy with a low- profile Ilizarov frame fixation. The frame was removed after full union, and patients were followed-up for 18 mo. Patients were assessed clinically using intercondylar distance and radiographically by measuring the distal lateral femoral angle and proximal medial tibial angle on CT scanogram.

Results:
All patients achieved correction of the tibial varus deformity. The intercondylar distance improved from 12.1 cm on average preoperatively to 5 cm on average postoperatively. The mean preoperative deviation of the medial proximal tibial angle was 22 degrees while the mean postoperative deviation was 2.4 degrees (ranging from 0-8.5 degrees). The mean duration to union of the osteotomy was 9 wk (range, 7-10 wk). Pin track infection occurred in 8 limbs.

Conclusions:
Extra-focal percutaneous valgus lateral translation osteotomy and fixation with a low-profile Ilizarov frame allows accurate deformity correction, shorter duration in the fixator, and better patient comfort and satisfaction.
The utility and limitations of using trabecular bone score with FRAX
Authors: Martineau Patrick , Leslie William D. 
Published: March 2018

Purpose of review
Trabecular bone score (TBS) is a texture index derived from the lumbar spine dual-energy X-ray absorptiometry which can assess skeletal quality and provide information about fracture risk independent of bone mineral density (BMD). TBS is useful in assessing osteoporotic fracture risk, with lower TBS values associated with increased fracture risk. In this article, we review the current state of TBS, including its utility and limitations in the assessment and management of osteoporosis, with particular emphasis on the recent literature.

Recent findings
Ten-year fracture risk assessment using the FRAX tool can be improved through the use of a TBS adjustment. The use of TBS-adjusted FRAX can change management in a modest but significant number of patients, particularly in those close to an intervention threshold. Change in lumbar spine TBS for patients undergoing antiresorptive treatment is not a useful indicator of antifracture effect.

Summary
Lumbar spine TBS provides information complementary to conventional BMD, and has been shown to be clinically useful for enhancing fracture risk prediction.
Cost-Effectiveness Analysis of Syndesmotic Screw Versus Suture Button Fixation in Tibiofibular Syndesmotic Injuries
Authors: Ramsey Duncan C. , Friess Darin M. 
Published: March 2018

Objectives:
To evaluate the cost effectiveness of suture buttons compared with syndesmotic screws for repair of tibiofibular syndesmotic injuries.

Methods:
A decision tree model was constructed to describe outcomes after syndesmosis repair using suture buttons and syndesmotic screws from the perspective of a capitated health care system. Outcomes were uneventful healing, removal of symptomatic implants, deep infection, and persistent diastasis requiring revision. Weighted literature averages were used to estimate variables for a baseline model. Outcomes were measured in quality adjusted life years. Procedure and implant costs were derived from Medicare reimbursement rates and the University Health System Consortium. An incremental cost-effectiveness ratio threshold of $50,000 per quality-adjusted life years was used to evaluate cost effectiveness.

Results:
The baseline model did not identify suture buttons to be cost effective. Sensitivity analysis demonstrates the model to be exquisitely sensitive to small changes in reoperation rates and implant price. At median University Health System Consortium implant prices, if the removal rate for symptomatic screws is below 13.7%, then screws are cost effective. If the screw removal rate is greater than 17.5%, then a suture button is cost effective. Within this interval, detailed analysis of the model suggests that screws may be the cost-effective strategy, but that determination should be taken with caution.

Conclusions:
Moving away from the practice of routinely removing all syndesmotic screws has changed the financial landscape of syndesmosis repair. At their median cost, suture buttons are likely to be cost effective over screws for symptomatic screw removal rates greater than 17.5%. Cost effectiveness is sensitive to changes in implant removal rates and the number of devices used per patient.

Level of Evidence:
Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Do Immediate Postoperative Radiographs Change Patient Management After Fracture Fixation? A Systematic Review
Authors: Teo Tammie , Schaeffer Emily , Cooper Anthony , Mulpuri Kishore 
Published: March 2018

Objectives:
To evaluate whether immediate (0–3 days) postoperative radiography leads to alterations in the management of patients postfracture fixation.

Data Sources:
Systematic review of English-language articles in the MEDLINE (1946–2016), EMBASE (1974–2016), CDSR (2005–2016), CENTRAL (1948–2016), and Google Scholar databases using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Study Selection:
Randomized or non–randomized controlled trials and prospective or retrospective cohort studies that addressed surgical management of the upper extremity, lower extremity or hip fractures were eligible for review. All included studies needed to have performed radiography within 0–3 days of surgery and reported any directly resulting management changes.

Data Extraction:
Data were independently extracted by 2 reviewers using a standardized data collection form with predefined data fields for demographics, interventions, study methods, complications, and management outcomes.

Data Synthesis:
A random-effects model was applied, and pooled effects for absolute benefit increase (ABI) and number needed to treat (NNT) were calculated.

Conclusions:
Combining the 11/12 articles that reported by patient numbers, the ABI of immediate postoperative radiography for management change was 0.13% [95% confidence interval (CI), 0.00078%–0.60%; NNT = 753]. The ABI for identification of complications was 0.22% (95% CI, 0.0015%–1.24%; NNT = 453). Current literature suggests that immediate postoperative radiography does not lead to management change in most patients after fracture fixation. More comprehensive reporting, along with further prospective comparative research, is encouraged.

Level of Evidence:
Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Quantifying the Location of the Radial Nerve in Children for Intraoperative Use
Authors: Nielsen Ena , Andras Lindsay M. , Skaggs David L. 
Published: March 2018

Background:
In adults, a relative “safe zone” for lateral approaches to the elbow has been well described in efforts to reduce iatrogenic injury, typically a minimum of 6 cm proximal to the lateral epicondyle. To avoid iatrogenic injury to the radial nerve intraoperatively, we investigated the distance of the nerve from the distal humeral physis in children.

Methods:
All patients who had axial and coronal T1-weighted magnetic resonance imagings of the humerus and elbow between 2005 and 2015 were eligible. Patients were excluded if there was any pathology causing significant alteration to the normal anatomy of the distal humerus or surrounding soft tissue. The axial cut in which the radial nerve was positioned along a line passing through the center of the humerus in the transverse plane was identified, and the location of the nerve was marked. This axial cut was cross-referenced with the corresponding coronal view. The distance along the lateral edge of the humerus in a straight line from the marked location of the radial nerve to the distal humeral physis was measured.

Results:
In total, 21 magnetic resonance imagings of 20 patients met the inclusion criteria. The mean distance of the radial nerve proximally from the distal humeral physis was as follows by age group: below 1-year old=1.7 cm (range, 1.2 to 2.5 cm); 1 to 2-years old=2.8 cm (range, 1.8 to 3.2 cm); 4 to 5-years old=5.3 cm (range, 5.1 to 5.5 cm); 6-years old and above=7.3 cm (range, 6.0 to 9.2 cm). For below 6-years old, when age was multiplied by 1 cm to define a predicted safe zone all radial nerves were found proximal to this. All patients 6 years and above had measurements that fell into the adult range of >6 cm, whereas no patients below 6-years old had measurements in this range.

Conclusions:
The distance of the radial nerve proximally from the distal humeral physis can be safely approximated for children below 6 years of age by multiplying patient age in years by 1 cm. By the age of 6 the distance of the radial nerve falls within the adult range (>6 cm).

Level of Evidence:
Level III.