bluuebunny/crossref_metadata_2025_split huggingface dataset:
Genetic Analysis of Patients Who Experienced Awareness with Recall while under General Anesthesia
Authors: Sleigh Jamie W. , Leslie Kate , Davidson Andrew J. , Amor David J. , Diakumis Peter , Lukic Vesna , Lockhart Paul J. , Bahlo Melanie 
Published: July 2019

Abstract

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background
Intraoperative awareness with recall while under apparently adequate general anesthesia is a rare, unexplained, and often very distressing phenomenon. It is possible that a relatively small number of genetic variants might underlie the failure of general anesthetic drugs to adequately suppress explicit memory formation and recall in the presence of apparently adequate anesthesia concentrations.

Methods
The authors recruited 12 adult patients who had experienced an episode of intraoperative awareness with recall (compared with 12 controls), performed whole exome sequencing, and applied filtering to obtain a set of genetic variants that might be associated with intraoperative awareness with recall. The criteria were that the variant (1) had a minor allele frequency less than 0.1% in population databases, (2) was within exonic or splicing regions, (3) caused a nonsynonymous change, (4) was predicted to be functionally damaging, (5) was expressed in the top 50% of genes expressed in the brain, and (6) was within genes in Kyoto Encyclopedia of Genes and Genomes pathways associated with general anesthesia, drug metabolism, arousal, and memory.

Results
The authors identified 29 rare genetic variants in 27 genes that were absent in controls and could plausibly be associated with this disorder. One variant in CACNA1A was identified in two patients and two different variants were identified in both CACNA1A and CACNA1S. Of interest was the relative overrepresentation of variants in genes encoding calcium channels and purinergic receptors.

Conclusions
Within the constraints of the filtering process used, the authors did not find any single gene variant or gene that was strongly associated with intraoperative awareness with recall. The authors report 27 candidate genes and associated pathways identified in this pilot project as targets of interest for future larger biologic and epidemiologic studies.
Successful Reduction in Electrode-Related Pressure Ulcers During EEG Monitoring in Critically Ill Neonates
Authors: Mietzsch Ulrike , Cooper Kristin L. , Harris Mandy L. 
Published: July 2019

Background:
Neonates are at a high risk for pressure ulcers (PU) due to skin immaturity and exposure to various medical devices. The prevalence of PU in the neonatal intensive care unit is estimated to be 23%, with 80% of those being related to medical devices, including electroencephalographic (EEG) electrodes. Proposed mechanisms involve prolonged pressure to the electrodes and chemical reactions to conductive agents.

Purpose:
The object of this quality improvement project was to reduce PU in neonates during continuous EEG (cEEG) monitoring by 50% within 12 months and 75% within 18 months. A secondary objective was to eliminate electrode-related infections by 12 months. Balancing measures included gestational age at the time of monitoring, integrity of the EEG setup, and cost effectiveness. The process measure was adherence to the skin-monitoring tool kit.

Methods:
A multiple Plan-Do-Study-Act cycle method was used. All neonates monitored with cEEG were included. The monitoring tool kit was used to document the condition of scalp and EEG electrodes before, during, and after cEEG.

Results:
In the preproject period, 8.5% (9/106) of monitored patients developed PU, and 22.2% (2/9) of those developed infections. During the project period, 3.5% (7/198) of monitored patients developed PU and no infections were observed. During monitoring, 21 patients showed skin irritation, and timely intervention resulted in resolution in more than 90% of the cases and prevented progression into PU. Silver/silver chloride–plated electrodes, when exposed to external heat sources, can cause burns, resembling PU.

Implications for Practice:
Intervention at the electrode level together with skin inspection successfully reduces PU in neonates. Silver/silver chloride–plated electrodes should be avoided in neonates.

Implications for Research:
Further research is needed to identify the optimal electrode for neonatal EEG.
A retrospective comparative study of patient satisfaction following ambulatory outpatient and inpatient total shoulder arthroplasty
Authors: Nelson Clay G. , Murphy William G. , Mulligan Ryan P. , Brolin Tyler J. , Azar Frederick M. , Throckmorton Thomas W. 
Published: July 2019

Background:
Little is known about patient perceptions of outpatient total shoulder arthroplasty (TSA). We evaluated patient-reported satisfaction with TSA in a freestanding ambulatory surgery center (ASC) and an inpatient (INPT) setting.

Methods:
Patients were mailed a survey regarding hospital admission, surgical site infections, and medical problems after surgery, as well as their satisfaction with the surgery and location. Patients were asked if, given the opportunity, they would change the location of their surgery.

Results:
Thirty-five patients with ASC surgery and 46 with INPT surgery completed the survey. Satisfaction regarding location and outcomes of surgery was similar, with no differences in readmission rates, need for medical care after surgery, or surgical site infections. A high percentage of patients in the INPT group would have changed their surgery location to an ASC setting.

Conclusions:
Patients were very satisfied with TSA, as well as the environment of their surgery (ASC or INPT). If given a choice, however, the ASC group preferred having their surgery in the ASC setting, while a high percentage of patients in the INPT group would have preferred to change to an ASC setting.

Level of Evidence:
Level III. Retrospective comparative study.
Hook Plate Fixation for Acute Unstable Distal Clavicle Fracture: A Systematic Review and Meta-analysis
Authors: Asadollahi Saeed , Bucknill Andrew 
Published: July 2019

Objectives:
To compare the outcome of hook plate fixation with other techniques in surgical fixation of acute unstable distal clavicle fractures.

Data Sources:
In July 2018, a systematic search of electronic databases (PubMed, Medline, Embase, and Cochrane databases for systematic reviews) was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Articles were limited to English language.

Study Selection:
Studies were included if they compared the results of hook plate fixation of acute unstable distal clavicle fracture in adults with other surgical techniques.

Data Extraction:
Data on the study setting, functional outcome, union, and complication rates were extracted. A quality assessment was performed using the Newcastle–Ottawa Scale.

Data Synthesis:
Eleven studies were found that met the inclusion criteria. Six hundred thirty-four patients were pooled using a random effects model. There were 397 male and 237 female patients. Primary outcome measure was functional result, and the secondary outcome measures were union and complication rates. There was no significant difference between the functional outcome and union rate between hook plate fixation, coracoclavicular (CC) stabilization, and locking plate fixation. Hook plate fixation resulted in a higher Constant–Murley score compared with tension band wiring (TBW) [odds ratio (OR), 3.52; 95% confidence interval (CI), 0.79–6.26]. It was also associated with a higher complication rate compared with CC stabilization (OR, 3.68; 95% CI, 1.19–11.33) and the locking plate (OR, 5.19; 95% CI, 1.58–17.06). Compared with TBW, hook plate fixation was associated with a lower complication rate (OR, 0.28; 95% CI, 0.10–0.77).

Conclusions:
Hook plate fixation achieves a similar functional outcome and union rate compared with CC stabilization and locking plate fixation. However, it has a superior functional result compared with TBW. The complication rate is higher compared with CC stabilization and locking plate fixation and is lower compared with TBW.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Evaluating the Utility of Follow-up Radiographs for Isolated Radial Head Fractures Undergoing Initial Nonoperative Treatment
Authors: Fenoglio Amy K. , Stephens Andrew R. , Zhang Chong , Presson Angela P. , Tyser Andrew R. , Kazmers Nikolas H. 
Published: July 2019

Objectives:
To evaluate the utility of follow-up radiographs in patients with isolated partial articular radial head fractures (OTA/AO 2R1B1 or 2R1B3).

Design:
Retrospective cohort study.

Setting:
Academic Level 1 Trauma Center.

Patients:
Adult patients (≥18 years) with isolated partial articular radial head fractures indicated for initial nonoperative treatment.

Intervention:
Analysis of elbow radiographs at initial presentation and at postinjury follow-up of 3–8 weeks.

Variables Measured:
Articular gap and step-off.

Main Outcome Measure:
Radiographic articular displacement between initial and follow-up radiographs.

Results:
For 72 included patients, initial radiographs were obtained on average 2.6 days after injury and follow-up radiographs 33.7 days thereafter. Equivalence tests evaluating gap and step-off thresholds of <1 mm were both significant, indicating that the cohort displaced <1 mm for both parameters between initial and follow-up radiographs. No patients proceeded to surgical treatment following the repeat radiographs.

Conclusions:
These fractures do not displace in the early postinjury period, as defined as a <1 mm of change in both intra-articular gap and step-off, as compared to initial radiographs. Routine follow-up radiographs for these injuries is a source of cost, but with limited utility in detecting interval displacement or leading to a change in management. Selective use of radiographs to evaluate specific clinical concerns may lead to cost savings.

Level of Evidence:
Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Ankle Fractures: An Expert Survey of Orthopaedic Trauma Association Members and Evidence-Based Treatment Recommendations
Authors: Coles Chad P. , Tornetta Paul , Obremskey William T. , Spitler Clay A. , Ahn Jaimo , Mirick Gudrun , Krause Peter , Nana Arvind , Rodriguez-Buitrago Andres ,   the Orthopaedic Trauma Association's Evidence-Based Quality Value and Safety Committee
Published: July 2019

Objectives:
To describe current practice patterns of orthopaedic trauma experts regarding the management of ankle fractures, to review the current literature, and to provide recommendations for care based on a standardized grading system.

Design:
Web-based survey.

Participants:
Orthopaedic Trauma Association (OTA) members.

Methods:
A 27-item web-based questionnaire was advertised to members of the OTA. Using a cross-sectional survey study design, we evaluated the preferences in diagnosis and treatment of ankle fractures.

Results:
One hundred sixty-six of 1967 OTA members (8.4%) completed the survey (16% of active members). There is considerable variability in the preferred method of diagnosis and treatment of ankle fractures among the members surveyed. Most responses are in keeping with best evidence available.

Conclusions:
Current controversy remains in the management of ankle fractures. This is reflected in the treatment preferences of the OTA members who responded to this survey.

Level of Evidence:
Therapeutic Level V. See Instructions for authors for a complete description of levels of evidence.
Are Two-Part Intertrochanteric Femur Fractures Stable and Does Stability Depend on Fixation Method?
Authors: Ricci Michael J. , McAndrew Christopher M. , Miller Anna N. , Kamath Ganesh , Ricci William M. 
Published: July 2019

Objectives:
To determine stability of 2-part intertrochanteric femur fractures and to determine whether secondary collapse is related to fixation method.

Design:
A retrospective cohort series.

Setting:
Single Level I Trauma Center.

Patients:
One hundred fourteen patients (82 female) older than 50 years (average age 75 years, range 50–100 years) with an acute low-energy standard obliquity 2-part intertrochanteric femur fracture (OTA/AO 31A) identified from an orthopaedic trauma database were studied.

Intervention:
Twenty-three patients were treated with a sliding hip screw (dynamic hip screw [DHS]), 53 with a dual screw trochanteric entry nail (INTERTAN), and 38 with a single-blade or screw trochanteric entry intramedullary nail (trochanteric fixation nail [TFN]) based on surgeon choice by 4 fellowship-trained orthopaedic trauma surgeons.

Main Outcome Measures:
Fracture collapse was measured by comparing immediate postoperative radiographs to those at final follow-up while controlling for magnification and rotation.

Results:
Collapse averaged 6.8 mm in the DHS group, 3.7 mm in the INTERTAN group, and 7.3 mm in the TFN group. When comparing groups, there was significantly more collapse in the DHS group compared with the INTERTAN group (P = 0.021), and significantly more collapse in the TFN group compared with the INTERTAN group (P < 0.001). Six patients (26%) in the DHS group had >10-mm collapse including 4 (17%) with greater than 20-mm collapse (max = 34.2 mm). Four patients (8%) in the INTERTAN group had >10-mm collapse and none had greater than 12.9 mm. Ten patients (26%) in the TFN group had >10-mm collapse and 3 (5%) had greater than 20-mm collapse (max = 30.7 mm).

Conclusion:
Stability of 2-part intertrochanteric femur fractures is dependent on the fixation device. These fractures are not necessarily stable when treated with a sliding hip screw as 26% treated with this method collapsed greater than 10 mm and 17% more than 20 mm. Dual screw intramedullary nail fixation seems to be most effective to maintain stability for patients with this fracture pattern.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
The Longitudinal Short-, Medium-, and Long-Term Functional Recovery After Unstable Pelvic Ring Injuries
Authors: Neufeld Michael E. , Broekhuyse Henry M. , O'Brien Peter J. , Guy Pierre , Lefaivre Kelly A. 
Published: July 2019

Objectives:
Describe the trajectory of functional recovery for patients with surgically treated unstable pelvic ring injuries from baseline to 5 years.

Design:
Prospective cohort study.

Setting:
Level I Trauma Center.

Patients/Participants:
One hundred eight adult patients with surgically treated pelvic fractures (72% OTA/AO 61 B1-B3 and 28% OTA/AO 61 C1-C3) were enrolled into the institutions orthopaedic trauma database between 2004 and 2015. The cohort was 78% men with a mean age of 44.9 years and injury severity score of 16.9.

Intervention:
Surgical pelvic stabilization.

Main Outcome Measurements:
Function was measured at baseline and prospectively at 6 months, 1, and 5 years postoperatively using the Short Form–36 Physical Component Score (SF-36 PCS). The trajectory was mapped, and the proportion of patients achieving a minimal clinically important difference (MCID) between time points was determined.

Results:
The mean SF-36 PCS improved for the entire group between 6 and 12 months (P = 0.001) and between 1 and 5 years (P = 0.02), but did not return to baseline at 5 years (P < 0.0001). The proportion of patients achieving a MCID between 6 and 12 months and 1 and 5 years was 75% and 60%, respectively. The functional level was similar between type B and C groups at baseline (P = 0.5) and 6 months (P = 0.2); however, the type B cohort reported higher scores at 1 year (P = 0.01) and 5 years (P = 0.01). Neither group regained their baseline function (P < 0.0001).

Conclusions:
Functional recovery for patients with surgically treated pelvic fractures is characterized by an initial decline in function, followed by sharp improvement between 6 and 12 months, and continued steady improvement between 1 and 5 years. Type B injuries show better early recovery than type C and reach a higher level of function at the final follow-up. Despite the proportion of patients achieving MCID, patients do not regain the preinjury level of function.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Supplementation of Lateral Locked Plating for Distal Femur Fractures: A Biomechanical Study
Authors: Fontenot Philip B. , Diaz Miguel , Stoops Kyle , Barrick Brett , Santoni Brandon , Mir Hassan 
Published: July 2019

Objectives:
To investigate the biomechanical properties of a lateral locked plate alone or in combination with a supplemental medial plate or an intramedullary nail (IMN).

Methods:
Intra-articular distal femur fractures with metaphyseal comminution (OTA/AO 33-C) were simulated with a standardized model in 28 synthetic femora and divided into 4 groups. Group I was instrumented with a 4.5-mm lateral locked distal femoral plate alone, group II with a lateral locked plate plus a low-profile precontoured 3.5-mm medial distal tibial plate, group III with a lateral locked plate plus a medial 3.5-mm reconstruction plate, and group IV with a lateral locked plate plus a retrograde IMN. Specimens were then axially loaded and cycled to failure or runout. Outcomes of interest were baseline stiffness, survivability, and cycles to failure.

Results:
Groups III and IV have a significantly higher baseline stiffness (P < 0.001) when compared with groups I and II. Furthermore, groups III and IV had a higher max load to failure (P < 0.01) when compared with groups I and II. The survivability in groups III and IV was 71% and 100%, respectively, while no specimens in group I or II survived maximum loading. There was no significant difference between group III and IV regarding stiffness, survivability, and cycles to failure.

Conclusion:
When considering fixation for intra-articular distal femur fractures with metaphyseal comminution (OTA/AO 33-C), we found that supplementation of a lateral locked plate with a medial plate or an IMN to be biomechanically superior to lateral locked plating alone regarding stiffness, survivability, and cycles to failure. A low-profile precontoured plate did not add significantly to the construct stiffness in this study.
Temporal Variation of Scores Along the Course of the Ponseti Treatment in Older Children: A Ready Guide to Progress of Treatment
Authors: Agarwal Anil , Shanker Mukesh 
Published: July 2019

Purpose:
We aimed to graphically study the correction trend along the course of Ponseti treatment in older children with idiopathic clubfeet.

Methods:
The temporal variation of total Pirani and Dimeglio scores and their individual components at each casting session was represented graphically. Tenotomy correction was accounted for separately. We classified 0 to 4 as early, 4 to 8 as midlevel, and beyond 8 as late casts to describe the sequence of treatment.

Results:
A total of 27 patients (39 feet; bilateral in 12) were studied. The average patient age was 4.78±2.36 years. Rigid equinus was the more severe pretreatment deformity in Pirani system and also the most difficult to treat component. Posterior crease and medial crease were least severe and were treated in early casts. Reducibility of lateral head of talus, curved lateral border of foot, and empty heel were moderately severe and showed a gradual improvement pattern over subsequent casting sessions. For Dimeglio components, equinus was the most resistant deformity, and it persisted until late casts. Adduction, rotation, and varus were moderately severe, and they followed a gradual improvement slope. Several components/scores did not turn 0 after correction for older clubfoot children.

Conclusions:
The treatment graphs for older clubfoot children adequately illustrated the initial severity, number of Ponseti casts used, correction of total scores and their individual components over sequential casting sessions, tenotomy influence, and the residual deformities.
Scoliosis and Cardiopulmonary Outcomes in Osteogenesis Imperfecta Patients
Authors: Bronheim Rachel , Khan Sobiah , Carter Erin , Sandhaus Robert A. , Raggio Cathleen 
Published: July 2019

Study Design.
Retrospective clinical study of individuals with osteogenesis imperfecta (OI).

Objective.
To assess the relationship between severity of scoliosis and pulmonary function, and to assess the relationship between restrictive lung disease and self-reported quality of life in individuals with OI.

Summary of Background Data.
OI is a heritable connective tissue disorder characterized by osteopenia and a predisposition to fracture. Respiratory insufficiency is a leading cause of mortality. Literature on pulmonary function in this population has shown a negative correlation between percent-predicted vital capacity and severity of scoliosis. However, it has been suggested that decreased pulmonary function in OI may be due to intrinsic pulmonary disease, in addition to the impact of vertebral compression fractures and scoliosis.

Methods.
Anterior-posterior spine radiographs and pulmonary function tests from 30 individuals with OI were reviewed. Radiographs were evaluated for scoliosis, defined as a curve ≥ 10°. If more than one curve was present, the largest curve was used. Pulmonary function was defined as the forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) ratio. Restrictive pulmonary disease was defined as FEV1/FVC > 80%, while obstructive disease was defined as FEV1/FVC < 70%. Bivariate correlation analysis was performed, using Spearman rho correlation coefficient (P < 0.05). Quality of life was assessed by SF-36.

Results.
The mean age was 27.6 years (range: 12–42 yrs). 57.6% were female. OI type IV was the most common (46.7%), followed by OI type III (33.3%), OI type I (10%), OI type IX (6.67% each), and OI type VIII (3.33%). Pulmonary comorbidity was present in 40% of individuals, while 6.67% had a cardiac comorbidity. The correlation between scoliosis and pulmonary function was weak and not significant (R = −0.059, P = 0.747).

Conclusion.
Pulmonary function is not significantly correlated with scoliosis, supporting the hypothesis that decreased pulmonary function is intrinsic to OI and/or chest wall deformities, rather than secondary to scoliosis.

Level of Evidence: 4