bluuebunny/crossref_metadata_2025_split huggingface dataset:
Helical blade compression failure occurred during PFNA implantation
Authors: Wang Chaoqun , Wang Qingxian 
Published: July 2019

Abstract

Rationale:
Femoral intertrochanteric fracture happens easily in the elderly, especially those with osteoporosis. As a standard intramedullary fixation implant, Proximal Femoral Nail Anti-rotation (PFNA) is applied to various types of stable or unstable intertrochanteric fractures of femur. Due to blade-related factors, such as cutting-through into the hip joint, cutting out or back out, there are endless postoperative failure cases of internal fixation, but reports about perioperative failure that the helical blade cannot be tightened are lacking. In this case, we firstly report an intraoperative blade compression failure and an effective technique to help surgeons out of the dilemma by using cannulated hexagonal screwdriver which was already included in the orthopedic instrument box.

Patient concerns:
An 81-year-old lady suffered left hip pain, swelling and limitation of activity, after slipping and falling when she was in the toilet.

Diagnoses:
X-ray and computed tomography (CT)-scan showed comminuted left intratrochanteric fracture with a Jensen classification of IIa type.

Interventions:
The patient was treated by closed reduction and internal fixation with PFNA. We suffered an unprecedented problem that helical blade cannot be tightened by the blade impactor as usual. For fear of helical blade disintegration during removal and a significant decrease in pullout strength after reinsertions, we eliminated the dilemma by using a cannulated hexagonal screwdriver to tighten the “problem” helical blade.

Outcomes:
The “problem” helical blade was finally locked by using the SW4.0 mm cannulated hexagonal screwdriver which was already included in the instrument box. The operation ended successfully after completing subsequent steps.

Lessons:
The cannulated hexagonal screwdriver is an effective instrument that can help surgeons out of the dilemma when the blade impactor fails to tighten the helical blade in PFNA implantation.
The association between awareness and behavior concerning the need for protection when using pesticide sprays and neurologic symptoms
Authors: Li Jiangping , Yu Hu , He Shulan , Xue Min , Tian Danian , Zhou Jian , Xie Yongxin , Yang Huifang 
Published: July 2019

Abstract
Pesticide exposure is a major health risk factor among agricultural workers, and poor protective behavior and a lack of awareness concerning the risks of pesticide use in developing countries may increase the intensity of pesticide exposure. This cross-sectional study aimed to explore the relationship between neurologic symptoms and protective behavior and awareness in relation to pesticide use in China. Latent class cluster analysis was used to categorize participants into 3 latent cluster subgroups, namely, a poor protective behavior subgroup, an excellent protective awareness and behavior subgroup, and a poor protective awareness subgroup, using a person-centered approach. Multivariate regression models were used to detect the association between the latent class cluster subgroups and self-reported neurologic symptoms. The results showed that poor protective behavior in pesticide use was an important negative predicator of neurologic symptoms such as reduced sleep quality, frequency of nightmares, debility, hypopsia, and hypomnesis. These findings suggest that targeted interventions for agricultural workers, especially local greenhouse farmers, are urgently needed to improve pesticide protection behavior.
Postoperative intraperitoneal hyperthermic perfusion improve survival for advanced gastric cancer
Authors: Zhang Hong-Wei , Yang Jian-Jun , Zheng Ji-Yang , Sun Li , Yang Xue-Wen , Li Guo-Cai 
Published: July 2019

Abstract
To evaluate the value of intraperitoneal hyperthermic perfusion (IPHP) in the treatment of gastric cancer.
Gastric cancer (GC) is a malignancy with poor prognosis, recent years have demonstrated advances in the use of IPHP for the treatment of advanced gastric cancer (AGC), but the outcome is controversial.
Between January 2015 and January 2017, 134 patients with GC were treated with IPHP in our surgery department, 130 of them were advanced GC patients, and other 1439 cases were treated without IPHP for comparison. In this retrospective cohort study, demographic, perioperative data, and follow-up data were analyzed by univariant analysis, Kaplan–Meier and Cox regression survival analysis.
We found the 1-year survival in IPHP group was significantly longer than it in non-IPHP group (85.5% vs 73.8%, P = .027). and IPHP decreased mortality 1.8 times in 2-year course (OR = 0.556, P = .004). The incidence rate of total complications in IPHP group was similar to that in the Non-IPHP group (6.67% vs 7.46%, respectively; P = .718). We classified all patients into four groups, operation alone, operation + chemotherapy, operation + IPHP, and operation + IPHP + chemotherapy. The 1-year survival in the groups was 70.2%, 77.5%, 83.1%, and 93.5%, respectively (P = .001), compared with the group of operation alone, the 2-year mortality risk was decreased 1.76 times (OR = 0.569, P = .030) and 2.59 times (OR = 0.385, P = .022) in operation + IPHP group and operation + IPHP + chemotherapy group.
Our results suggest that IPHP could contribute to improve survival of patients with gastric cancer. And the modality of operation + IPHP + chemotherapy is the optimal treatment modality for gastric cancer.
Fertility and pregnancy outcomes following hysteroscopic metroplasty of different sized uterine septa
Authors: Wang Xi , Hou Haiyan , Yu Qi 
Published: July 2019

Abstract
Different sizes of uterine septum between infertile women and patients with abortions may have a clinical relevance in reproductive performance after surgery. This study aimed to assess if the fecundity of women after surgical correction of the uterine septum is associated with septum size.
A retrospective, single-center, cohort study was conducted in Peking Union Medical College Hospital using patients aged between 21 and 37 years. Hysteroscopic metroplasty was performed on 121 patients with a uterine septum. The septum size was assessed by ultrasonography and hysteroscopy. The subjects were divided into 3 groups: Group A consisted of 35 women with complete uterine septum (mean ± standard deviation (SD) age 28.29 ± 3.53; group B consisted of 48 women with uterine septum >2.5 cm (mean ± SD age 28.85 ± 3.63); and group C consisted of 48 women with uterine septum ≤2.5 cm (mean ± SD age 28.79 ± 3.74). Age and body mass index (BMI) were not significantly different among the 3 groups.
No serious hysteroscopic complications occurred. However, uterine septa were observed in 4 cases after surgery and 6 cases of intrauterine adhesions were observed after long-term follow-up. The abortion rate decreased, and term delivery rate increased significantly in the 3 groups after hysteroscopic metroplasty. The infertility rate was significantly lower in group C after surgery. However, no significant difference was observed in the infertility rate between groups A and B. The recurrent abortion rate was significantly lower in group A than in groups B and C before surgery. After surgery, the infertility rate was significantly higher in group A than in group B (28.57% and 10.53%, respectively; P = .048). After at least 12-months of follow-up, the pregnancy rate in group A was significantly lower than that in group C (71.43% and 89.47%, respectively; P = .048).
Uterine septum resection improves obstetrical outcomes. After surgery, the infertility rate was significantly higher in patients with complete uterine septum than in those with a large partial uterine septum, and the pregnancy rate in patients with complete uterine septum was lower than that in the patients with a small partial uterine septum.
Study protocol of the cost-effectiveness comparison of two preventive methods in the incidence of caries
Authors: Fernández-Barrera Miguel Ángel , Lara-Carrillo Edith , Scougall-Vilchis Rogelio José , Pontigo-Loyola América Patricia , Ávila-Burgos Leticia , Casanova-Rosado Juan Fernando , Casanova-Rosado Alejandro José , Minaya-Sánchez Mirna , Medina-Solís Carlo Eduardo 
Published: July 2019

Abstract

Introduction:
Dental caries is the most frequent oral disease worldwide and the main cause of tooth loss in children and young adults. One of the most frequently affected areas is the occlusal surfaces of the first permanent molars (FPM) due to their morphological complexity. At present, several preventive treatments can reduce the incidence of this disease in school populations. In Mexico, the most commonly used technologies are those derived from some presentation of fluoride; on the other hand, research on this topic has been limited.

Objective:
To determine the cost-effectiveness of two different methods for preventing the incidence of caries on the FPM of schoolchildren (6–8 years of age) from public primary schools.

Material and methods:
This is a randomized experimental design. Participants will be assigned to two treatment groups of 114 each. In the first group, pit and fissure sealants will be applied, whereas the second group will receive a fluoride varnish. The work will be carried out in schoolchildren that attend public elementary schools in the state of Hidalgo, Mexico. The result variable will be the incidence of caries and the total cost of each of the interventions will be calculated in order to calculate the intervention's cost-effectiveness.

Conclusion:
This work will allow us to compare the cost-effectiveness of the pit and fissure sealants and the fluoride varnish in order to determine which offers the best results.
Triglycerides and endothelial function: molecular biology to clinical perspective
Authors: Kajikawa Masato , Higashi Yukihito 
Published: July 2019

Purpose of review
Recently, a high level of triglycerides has attracted much attention as an important residual risk factor of cardiovascular events. We will review and show the mechanisms underlying the association of endothelial dysfunction with hypertriglyceridemia and present clinical evidence for a relationship between endothelial function and triglycerides.

Recent findings
Clinical studies have shown that hypertriglyceridemia is associated with endothelial dysfunction. It is likely that hypertriglyceridemia impairs endothelial function through direct and indirect mechanisms. Therefore, hypertriglyceridemia is recognized as a therapeutic target in the treatment of endothelial dysfunction. Although experimental and clinical studies have shown that fibrates and omega-3 fatty acids not only decrease triglycerides but also improve endothelial function, the effects of these therapies on cardiovascular events are controversial.

Summary
Accumulating evidence suggests that hypertriglyceridemia is an independent risk factor for endothelial dysfunction. Triglycerides should be considered more seriously as a future target to reduce cardiovascular events. Results of ongoing studies may show the benefit of lowering triglycerides and provide new standards of care for patients with hypertriglyceridemia possibly through improvement in endothelial function.
Facial Nerve Hematoma After Penetrating Middle Ear Trauma
Authors: Han Kyujin , Roh Hong Gee , Shin Jung Eun , Kim Chang-Hee 
Published: July 2019

Abstract
Penetrating middle ear injury may cause hearing loss, vertigo, or facial nerve injury, although facial nerve paralysis followed by head trauma is a rare condition. In this study, we report a case of a 3-year-old patient with delayed facial palsy on the left side that developed 4 days after an accidental tympanic membrane perforation caused by a cotton-tipped swab. Otoendoscopic examination revealed a perforation in the posterosuperior quadrant of the tympanic membrane. Audiometry revealed no hearing loss on the injured side, and eye movement examination did not reveal spontaneous or positional nystagmus. Pre- and postcontrast T1-weighted magnetic resonance imaging demonstrated high signal intensity along the tympanic portion of the fallopian canal, which suggested that hemorrhage within the facial canal may be a cause of delayed facial palsy. It can be assumed that traumatic injury at the dehiscent facial nerve in the tympanic portion caused hematoma within the fallopian canal, resulting in delayed facial nerve palsy.
Reevaluation of FAST Sensitivity in Pediatric Blunt Abdominal Trauma Patients
Authors: Riera Antonio , Hayward Harrison , Torres Silva Cicero , Chen Lei 
Published: July 2019

Background
The utility of the focused assessment with sonography in trauma (FAST) examination in hemodynamically stable pediatric blunt abdominal trauma (BAT) patients is controversial.We report our 3-year experience with FAST performance to detect greater than physiologic amounts of intraperitoneal fluid after BAT.

Methods
We performed a retrospective chart review of all FAST examinations performed from July 2015 to June 2018 at a level I pediatric trauma center. The main outcome of interest was the performance of a concerning FAST (cFAST) compared with a computed tomography scan diagnosis for greater than physiologic levels of free fluid (FF) and clinical follow-up. A cFAST was defined by the presence of any FF in the upper abdomen or by a moderate to large amount of FF present in the pelvis. The interobserver reliability of cFASTwas assessed with Cohen κ coefficient. Locations of FF were assessed.

Results
A total of 448 FAST cases were eligible for review. The median age was 11 years with 64% male. Thirty-one FAST examinations (6.9%) were positive for some amount of FF; 18 (4.0%) were cFASTs. In the cFAST group, 11 patients (61%) were hemodynamically stable. The cFAST had a sensitivity of 89% (95% confidence interval [CI], 65%–99%), specificity of 99% (95% CI, 98%–100%), positive predictive value of 89% (95% CI, 67%–97%), and negative predictive value of 99% (95% CI, 98%–100%). The positive and negative likelihood ratios were 191 (95% CI, 47–769) and 0.11 (95% CI, 0.03–0.41). The κ coefficient for cFASTwas 0.72 with 86% agreement. Free fluid on cFAST cases was observed in the pelvis (78%), right upper quadrant (44%), and left upper quadrant (44%).

Conclusions
In pediatric BAT patients, a cFAST has acceptable sensitivity and remains a highly specific test to rule in greater than physiologic quantities of FF with confidence.
What Do Saudi Children Ingest?
Authors: Ibrahim Ahmed H. , Andijani Abdurahman , Abdulshakour Muhammed , Algain Sulwan , Thamrah Asma Abu , Ali Mariam M. , Marwah Haifa , Aldaher Anwaar , Bashir Salman , Alsaleem Badr , Asery Ali , Al-Hussaini Abdulrahman 
Published: July 2019

Objectives
Few studies investigated the correlation between foreign body (FB) ingestion and occurrence of complications. The local literature is limited to case reports and small case series on esophageal FBs. We conducted this study to identify the high-risk factors predisposing to complications among Saudi children ingesting FBs.

Methods
The medical records of 436 children (boys, 59.6%; mean age, 4.4 ± 2.7 years) presenting to the emergency department (ED) between 2007 and 2016 were retrospectively reviewed. Relative risk analysis of clinical variables was performed between 2 groups: The first group constituted children without FB-related complications (n = 389), and the second group included those with major complications (n = 14). Major complication was defined as any event associated with significant morbidity such as esophageal stricture, esophageal perforation, esophageal fistula, and intestinal perforation or fistula formation.

Results
Most of the 436 cases presented between ages 2 and 4 years (35.1%). Coin was the most commonly ingested FB (22.9%) followed by button battery (19.5%). Most of the ingested FBs passed spontaneously without intervention (69%). Upper endoscopy was performed in 121 cases (27.7%). By multivariate analysis, the variables that were significantly associated with major complications included the following: very young age group (0–2 years; odds ratio [OR], 11.5), button battery (OR, 4), FB impacted at upper esophagus (OR, 8.7), and longer time duration to visit the ED (OR, 14.7).

Conclusion
Button battery impaction at upper esophagus in very young children and delayed presentation to the ED were the most significant risk factors of FB-related complications.
Effect Modification of the Association Between Race and Stage at Colorectal Cancer Diagnosis by Socioeconomic Status
Authors: McGrew Kaitlin M. , Peck Jennifer D. , Vesely Sara K. , Janitz Amanda E. , Snider Cuyler A. , Dougherty Tyler M. , Campbell Janis E. 
Published: July 2019

Objectives:
To compare risks of distant-stage colorectal cancer (CRC) diagnosis between whites and American Indian/Alaska Natives (AI/ANs) and to explore effect modification by area-based socioeconomic status (SES).

Design:
Retrospective cohort study using data from the Oklahoma Central Cancer Registry.

Setting:
Oklahoma.

Participants:
White and AI/AN cases of CRC diagnosed in Oklahoma between 2001 and 2008 (N = 8 438). A subanalysis was performed on the cohort of those aged 50 years and older (N = 7 728).

Main Outcome Measure:
Risk of distant-stage CRC diagnosis stratified by SES score.

Results:
Race and SES were independently associated with distant-stage diagnosis. In SES-stratified analyses, AI/ANs in the 2 lowest SES groups experienced increased risks in the overall cohort and among those aged 50 years and older. In multivariable models, risks remained significant among those aged 50 years and older in the lowest SES groups (Adjusted risk ratio SES score of 2: 1.31, 95% confidence interval: 1.06-1.63 and adjusted risk ratio SES score of 1: 1.21, 95% confidence interval: 1.01-1.44).

Conclusion:
Socioeconomic status is an effect modifier in the association between race/ethnicity and stage at CRC diagnosis. Disparities in stage at CRC diagnosis exist between AI/ANs and whites with lower estimated SES. Efforts are needed to increase CRC screening among lower SES AI/ANs.
Racial Misclassification in Mortality Records Among American Indians/Alaska Natives in Oklahoma From 1991 to 2015
Authors: Dougherty Tyler M. , Janitz Amanda E. , Williams Mary B. , Martinez Sydney A. , Peercy Michael T. , Wharton David F. , Erb-Alvarez Julie , Campbell Janis E. 
Published: July 2019

Objective:
The primary purpose of this study was to compare age-adjusted mortality rates before and after linkage with Indian Health Service records, adjusting for racial misclassification. We focused on differences in racial misclassification by gender, age, geographic differences, substate planning districts, and cause of death. Our secondary purpose was to evaluate time trends in misclassification from 1991 to 2015.

Design:
Retrospective, descriptive study.

Setting:
Oklahoma.

Participants:
Persons contained in the Oklahoma State Health Department Vital Records.

Main Outcome Measures:
To evaluate the age-adjusted mortality ratio pre– and post–Indian Health Service record linkage (misclassification rate ratio) and to evaluate the overall trend of racial misclassification on mortality records measured through annual percent change (APC) and average annual percent change (AAPC).

Results:
We identified 2 stable trends of racial misclassification upon death for American Indians/Alaska Natives (AI/ANs) from 1991 to 2001 (APC: −0.2%; 95% confidence interval: −1.4% to 1.0%) and from 2001 to 2005 (APC: −6.9%; 95% confidence interval: −13.7% to 0.4%). However, the trend identified from 2005 to 2015 decreased significantly (APC: −1.4%; 95% confidence interval: −2.5% to −0.2%). For the last 5 years available (2011-2015), the racial misclassification adjustment resulted in higher mortality rates for AI/ANs reflecting an increase from 1008 per 100 000 to 1305 per 100 000 with the linkage process. There were an estimated 3939 AI/ANs in Oklahoma who were misclassified as another race upon death in those 5 years, resulting in an underestimation of actual AI/AN deaths by nearly 29%.

Conclusions:
An important result of this study is that misclassification is improving; however, this effort needs to be maintained and further improved. Continued linkage efforts and public access to linked data are essential throughout the United States to better understand the burden of disease in the AI/AN population.
Assessing Retrobulbar Hyaluronidase as a Treatment for Filler-Induced Blindness in a Cadaver Model
Authors: Paap Michael K. , Milman Tatyana , Ugradar Shoaib , Silkiss Rona Z. 
Published: July 2019

Background:
Retrobulbar injection of hyaluronidase is a proposed but unproven treatment for blindness induced by hyaluronic acid gel fillers. This study examines the viability of this treatment by determining whether hyaluronidase can diffuse through the dural sheath of the optic nerve to clear a filler-mediated occlusion of the central retinal artery.

Methods:
Six human cadaveric optic nerves were studied in vitro. One optic nerve was selected as a control and maintained at physiologic temperature, without any exposure to hyaluronic acid gel or hyaluronidase. Another optic nerve was randomly selected to simulate the filler-induced central retinal artery occlusion with subsequent retrobulbar hyaluronidase injection. To simulate a central retinal artery occlusion, this experimental nerve and additional controls were injected with hyaluronic acid gel. These hyaluronic acid gel–injected nerves were then either injected directly with hyaluronidase to establish a control for intraneural hyaluronidase exposure, or immersed in undiluted hyaluronidase to simulate retrobulbar hyaluronidase injection. To control for passive diffusion of hyaluronic acid gel from neural parenchyma, one nerve was immersed in saline. Following fixation, the nerves were grossly and microscopically assessed for the quantity and distribution of hyaluronic acid.

Results:
Intact hyaluronic acid gel was observed grossly and microscopically in the control optic nerves injected directly with filler and not with hyaluronidase. The control optic nerve injected with intraneural hyaluronidase exhibited partial digestion of the filler. Immersion in undiluted hyaluronidase led to no apparent gross or microscopic digestion of injected intraneural hyaluronic acid gel.

Conclusion:
Hyaluronidase does not demonstrate the ability to cross the dural sheath of the optic nerve, suggesting that retrobulbar hyaluronidase injection is unlikely to alleviate hyaluronic acid gel–mediated central retinal artery occlusion and blindness.