bluuebunny/crossref_metadata_2025_split huggingface dataset:
Shoulder Complex Mechanics in Adolescent Idiopathic Scoliosis and Their Relation to Patient-perceived Function
Authors: Rapp van Roden Elizabeth A. , Richardson Robert Tyler , Russo Stephanie A. , Rose William C. , Chafetz Ross S. , Gabos Peter G. , Shah Suken A. , Samdani Amer F. , Richards James G. 
Published: July 2018

Background:
Proper contribution of the scapulothoracic joint is necessary for adequate shoulder complex function. Associations between trunk shape and abnormal scapular kinematics and subsequent shoulder dysfunction have been established; however, the extent of shoulder dysfunction in adolescent idiopathic scoliosis (AIS) is still poorly understood. The purpose of this study was to perform a comprehensive analysis of scapular kinematics during multiplanar arm motion in patients with AIS and compare kinematics and patient-reported function with that of a typically developing cohort.

Methods:
Typically developing adolescents (n=33) and patients with AIS (n=26) with no history of spine or shoulder surgery were recruited for this study. A 3-dimensional optoelectronic motion capture system was used to analyze scapular kinematics in 4 positions: rest, full abduction, forward reach, and hand to spine. Subjects in each group also completed the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire as a measure of patient-reported function.

Results:
The convex shoulders of the patients with AIS exhibited deficits in scapular upward rotation and posterior tilt in all positions and reduced protraction range of motion during reaching. The AIS group also reported worse patient-perceived shoulder function than the typically developing group; however, this dysfunction was not related to specific scapular kinematic patterns.

Conclusions:
Patients with AIS show alterations in scapular kinematics that are associated with shoulder pathology. Despite displaying an unaffected ability to place the hand in space, the underlying joint mechanics place these adolescents at risk for future pathology. Accordingly, consideration of scapulothoracic and glenohumeral joint function is warranted in the treatment of AIS.

Level of Evidence:
Level III—cross-sectional comparison.
A Comparison of Transphyseal Neck-Head Tunneling and Multiple Epiphyseal Drilling on Femoral Head Healing Following Ischemic Osteonecrosis: An Experimental Investigation in Immature Pigs
Authors: Aruwajoye Olumide O. , Monte Felipe , Kim Audrey , Kim Harry K.W. 
Published: July 2018

Background:
Two operative procedures are currently advocated to stimulate the necrotic femoral head healing in children with Legg-Calve-Perthes disease: transphyseal neck-head tunneling (TNHT) and multiple epiphyseal drilling (MED). The purpose of this study was to compare the bone healing and physeal function after treatment with TNHT or MED in a piglet model of ischemic osteonecrosis.

Methods:
Eighteen piglets were induced with osteonecrosis by surgically placing a ligature tightly around the right femoral neck. One week later, the piglets were assigned to 1 of 3 treatment groups (n=6/group): (1) local nonweight bearing only (NWB), (2) TNHT plus NWB, or (3) MED plus NWB. The unoperated left femoral heads were used as normal controls. The animals were euthanized at 8 weeks after osteonecrosis induction. Histologic, histomorphometric, radiographic, microcomputed tomography (CT), and calcein-labeling assessments were performed. Statistical analysis included a 1-way ANOVA.

Results:
Micro-CT analyses showed higher femoral head bone volume in the MED group compared with the TNHT and the NWB groups (P<0.01). The MED group had a higher mean trabecular number (P<0.001) and new bone formation (P=0.001) based on calcein-labeling parameters compared with the TNHT and the NWB groups. In addition, the osteoclast number per bone surface was lower in the MED group compared with the NWB group (P=0.001). Histologic and micro-CT assessments of the proximal femoral physis revealed a larger physeal disruption at the site of physeal drilling in the TNHT group compared with the MED group. However, no significant differences in physeal elongation (P=0.61) and femoral neck length (P=0.31) were observed between the treatment groups.

Conclusions:
MED produced a higher bone volume and stimulated greater bone formation than the TNHT or the NWB alone. Both procedures did not produce a significant physeal growth disturbance during the study period.

Clinical Relevance:
This preclinical study provides evidence that MED produces more favorable bone healing than the TNHT in a large animal model of Legg-Calve-Perthes disease.
Trends in Pediatric ACL Reconstruction From the PHIS Database
Authors: Tepolt Frances A. , Feldman Lanna , Kocher Mininder S. 
Published: July 2018

Background:
Previous studies have suggested that anterior cruciate ligament (ACL) reconstruction surgeries are being performed with increased frequency in children and adolescents. The purpose of this study was to evaluate the trend in the frequency of ACL reconstructions normalized by total orthopaedic surgeries at pediatric hospitals nationwide.

Methods:
The Pediatric Health Information System (PHIS) database was queried for patients age 18 years or younger who underwent orthopaedic surgery at any of the PHIS-participating hospitals 2004-2014. The subset of patients who had been treated with ACL reconstruction were identified using Current Procedural Terminology (CPT) and International Classification of Diseases, Ninth Revision (ICD-9) procedure codes. The yearly rate was expressed as the number of ACL reconstructions per 1000 orthopaedic surgeries, and a linear model was used to fit the data to illustrate the relative trend.

Results:
In total, 470,126 orthopaedic surgeries, including 15,231 ACL reconstructions, were performed for patients 18 years or younger at 27 pediatric hospitals. ACL reconstructions were performed at a yearly rate of 32.4 per 1000 orthopaedic surgeries. Between 2004 and 2014, the number of ACL reconstructions increased 5.7-fold, whereas orthopaedic surgeries increased 1.7-fold; there was a 2.8-fold increase in ACL reconstructions relative to total pediatric orthopaedic surgeries. The 10-year relative fold increase was nearly equivalent across sexes, and the increasing trend in ACL reconstructions relative to orthopaedic surgeries was also seen across age groups.

Conclusions:
The number of ACL reconstructions performed for children and adolescents in pediatric hospitals nationwide markedly increased by nearly 3 times relative to orthopaedic surgeries over a recent 10-year period.

Level of Evidence:
Level IV.
Post Dengue Fever Epidural Abscess With or Without Spondylodiscitis: A Case Series of Eight Patients in a Single Season in a Single Center
Authors: Pillai Suresh S. , Shameer Moidu , Hassan Asif , Parambil Abdurehiman K. , Reddy Sivasankar , Vishnu R Bala , Mohammad Shameem G. 
Published: July 2018

Study Design.
A retrospective case series.

Objective.
The aim of this study was to report the immunosuppression and secondary bacterial infection after dengue viral infection and the predilection of these infections in the spine. This can trigger further research in to this fact. The possibility of change in the serotype of dengue virus, which are neurotropic, may be looked into.

Summary of Background Data.
This is the largest case series of epidural abscess with or without spondylodiscitis within 6 weeks following dengue virus infection.

Methods.
We performed a retrospective review of all the eight cases treated for epidural abscess with or without spondylodiscitis within 6 weeks following dengue virus infection in our center during the period of 3 months from June 2017 to August 2017.

Results.
Of the eight cases, three of them were infected with Methicillin Resistant Saphylococcus Aureus and all of them grew the bug in the blood culture. Three of them had Methicillin Sensitive Staphylococcus Aureus (MSSA), one with MSSA septicemia, and one had associated Elizabeth Kingia meningoseptica infection and one patient had positive Acid Fast Bacilli stained in smears. Two patients were infected with pseudomonas. Some patients had multiple site abscess and epidural abscess without spondylodiscitis. Five of them had neurological deficit, which recovered with abscess drainage and antibiotic treatment. The Erythrocyte Sedimentation rate, C-Reactive Protein, and serum ferritin were elevated in these patients.

Conclusion.
This is a large case series of epidural abscess with or without spondylodiscitis within 6 weeks following dengue virus infection. The predilection of dengue virus for the neural tissue should be further investigated. Post dengue immunosuppression also needs further study.

Level of Evidence: 4
Blood Loss Trends and Financial Implications in Adolescent Idiopathic Scoliosis
Authors: Alamanda Vignesh K. , Massengill Danae L. , Rozario Nigel , Moore Charity G. , Scannell Brian , Brighton Brian , Vanderhave Kelly L. 
Published: July 2018

Study Design:
This was a retrospective cohort study.

Objective:
The primary goal was to evaluate risk factors related to increased blood loss in adolescent idiopathic surgery (AIS) surgery with the secondary goal being to evaluate the financial implications around the use of intraoperative cell salvage (ICS) and the routine preallocation of autogenous blood products.

Summary of Background Data:
Deformity correction for AIS is a complex procedure and can be associated with significant blood loss.

Methods:
A retrospective cohort study was conducted on consecutive patients between the ages of 10 and 18 years who underwent posterior spinal fusion of 7–12 levels over a 3-year period between January 2013 and December 2015. Demographic information and surgical characteristics were recorded. All patients had a preoperative type and cross of 2 units and ICS was used in all cases. Charges for preoperative type and cross and ICS were also measured. Univariate and multivariable analyses were performed to identify pertinent variables affecting blood loss.

Results:
In total, 134 patients met inclusion criteria. ICS was used in all cases. In total, 51 patients were transfused cell saver blood intraoperatively/postoperatively at the discretion of the surgeon. On average 133 mL were returned to the patient. No complications related to ICS were observed. Multivariable analysis identified male sex, lower body mass index and higher surgical time to be associated with increased blood loss (P<0.05). All 134 patients had a preoperative type and cross, with an average charge to patient of $311. Patients were charged $1037 for intraoperative use of ICS and $242 for centrifugation. Patients who had allogeneic transfusion were charged $1047.

Conclusions:
Several blood conservation strategies, including use of ICS, exist to minimize the consequences of blood loss. Routine use of preoperative type and cross may be avoided except in cases where significant blood loss is anticipated—that is adolescent male individuals, those with a lower body mass index and in whom a longer surgical time is anticipated.
Distinctive Roles and Mechanisms of Human Neutrophil Peptides in Experimental Sepsis and Acute Respiratory Distress Syndrome
Authors: Wu Jianfeng , Han Bing , Fanelli Vito , Wen Xiaoyan , Huang Yongbo , Luo Alice , Ghazarian Mirna , Wang Dingyan , Khang Julie , Morriello Florence , Liaw Patricia C. , Marshall John , Zhong Nanshan , Guan Xiangdong , Slutsky Arthur S. , Li Yimin , Zhang Haibo 
Published: July 2018

Objectives:
To examine the effects and mechanisms of human neutrophil peptides in systemic infection and noninfectious inflammatory lung injury.

Design:
Prospective experimental study.

Setting:
University hospital-based research laboratory.

Subjects:
In vitro human cells and in vivo mouse models.

Interventions:
Wild-type (Friend virus B-type) and conditional leukocyte human neutrophil peptides transgenic mice were subjected to either sepsis induced by cecal ligation and puncture or acute lung injury by intratracheal instillation of hydrochloric acid followed by mechanical ventilation. Using human neutrophil peptides as bait, the basal cell adhesion molecule (CD239) and the purinergic P2Y purinoceptor 6 receptor were identified as the putative human neutrophil peptides receptor complex in human lung epithelial cells.

Measurements and Main Results:
In the cecal ligation and puncture sepsis model, Friend virus B-type mice exhibited higher systemic bacterial load, cytokine production, and lung injury than human neutrophil peptides transgenic mice. Conversely, an increased lung cytokine production was seen in Friend virus B-type mice, which was further enhanced in human neutrophil peptides transgenic mice in response to two-hit lung injury induced by hydrochloric acid and mechanical ventilation. The human neutrophil peptides–mediated inflammatory response was mediated through the basal cell adhesion molecule-P2Y purinoceptor 6 receptor signal pathway in human lung epithelial cells.

Conclusions:
Human neutrophil peptides are critical in host defense against infectious sepsis by their cationic antimicrobial properties but may exacerbate tissue injury when neutrophil-mediated inflammatory responses are excessive in noninfectious lung injury. Targeting the basal cell adhesion molecule/P2Y purinoceptor 6 signaling pathway may serve as a novel approach to attenuate the neutrophil-mediated inflammatory responses and injury while maintaining the antimicrobial function of human neutrophil peptides in critical illness.
Molecular Regulation of Acute Tie2 Suppression in Sepsis
Authors: Thamm Kristina , Schrimpf Claudia , Retzlaff Jennifer , Idowu Temitayo O. , van Meurs Matijs , Zijlstra Jan G. , Ghosh Chandra C. , Zeitvogel Jana , Werfel Thomas A. , Haller Hermann , Parikh Samir M. , David Sascha 
Published: July 2018

Objectives:
Tie2 is a tyrosine kinase receptor expressed by endothelial cells that maintains vascular barrier function. We recently reported that diverse critical illnesses acutely decrease Tie2 expression and that experimental Tie2 reduction suffices to recapitulate cardinal features of the septic vasculature. Here we investigated molecular mechanisms driving Tie2 suppression in settings of critical illness.

Design:
Laboratory and animal research, postmortem kidney biopsies from acute kidney injury patients and serum from septic shock patients.

Setting:
Research laboratories and ICU of Hannover Medical School, Harvard Medical School, and University of Groningen.

Patients:
Deceased septic acute kidney injury patients (n = 16) and controls (n = 12) and septic shock patients (n = 57) and controls (n = 22).

Interventions:
Molecular biology assays (Western blot, quantitative polymerase chain reaction) + in vitro models of flow and transendothelial electrical resistance experiments in human umbilical vein endothelial cells; murine cecal ligation and puncture and lipopolysaccharide administration.

Measurements and Main Results:
We observed rapid reduction of both Tie2 messenger RNA and protein in mice following cecal ligation and puncture. In cultured endothelial cells exposed to tumor necrosis factor-α, suppression of Tie2 protein was more severe than Tie2 messenger RNA, suggesting distinct regulatory mechanisms. Evidence of protein-level regulation was found in tumor necrosis factor-α–treated endothelial cells, septic mice, and septic humans, all three of which displayed elevation of the soluble N-terminal fragment of Tie2. The matrix metalloprotease 14 was both necessary and sufficient for N-terminal Tie2 shedding. Since clinical settings of Tie2 suppression are often characterized by shock, we next investigated the effects of laminar flow on Tie2 expression. Compared with absence of flow, laminar flow induced both Tie2 messenger RNA and the expression of GATA binding protein 3. Conversely, septic lungs exhibited reduced GATA binding protein 3, and knockdown of GATA binding protein 3 in flow-exposed endothelial cells reduced Tie2 messenger RNA. Postmortem tissue from septic patients showed a trend toward reduced GATA binding protein 3 expression that was associated with Tie2 messenger RNA levels (p < 0.005).

Conclusions:
Tie2 suppression is a pivotal event in sepsis that may be regulated both by matrix metalloprotease 14–driven Tie2 protein cleavage and GATA binding protein 3–driven flow regulation of Tie2 transcript.
Half-Dose Versus Full-Dose Alteplase for Treatment of Pulmonary Embolism*
Authors: Kiser Tyree H. , Burnham Ellen L. , Clark Brendan , Ho P. Michael , Allen Richard R. , Moss Marc , Vandivier R. William 
Published: July 2018

Objectives:
Recent evidence suggests that half-dose thrombolysis for pulmonary embolism may provide similar efficacy with reduced bleeding risk compared with full-dose therapy, but comparative studies are lacking. We aimed to evaluate the effectiveness and safety of half-dose versus full-dose alteplase for treatment of pulmonary embolism.

Design:
A retrospective cohort study comparing outcomes in patients receiving half-dose (50 mg) versus full-dose (100 mg) alteplase for pulmonary embolism. We used propensity score matching and sensitivity analyses to address confounding and hospital-level clustering.

Setting:
Data from 420 hospitals obtained from the Premier Healthcare Database between January 2010 and December 2014.

Subjects:
Adult critically ill patients with acute pulmonary embolism treated with IV alteplase therapy.

Interventions:
None.

Measurements and Main Results:
This study included 3,768 patients: 699 (18.6%) in the half-dose and 3,069 (81.4%) in the full-dose group. At baseline, patients receiving half-dose alteplase required vasopressor therapy (23.3% vs 39.4%; p < 0.01) and invasive ventilation (14.3% vs 28.5%; p < 0.01) less often, compared with full dose. After propensity matching (n = 548 per group), half-dose alteplase was associated with increased treatment escalation (53.8% vs 41.4%; p < 0.01), driven mostly by secondary thrombolysis (25.9% vs 7.3%; p < 0.01) and catheter thrombus fragmentation (14.2% vs 3.8%; p < 0.01). Hospital mortality was similar (13% vs 15%; p = 0.3). There was no difference in cerebral hemorrhage (0.5% vs 0.4%; p = 0.67), gastrointestinal bleeding (1.6% vs 1.6%; p = 0.99), acute blood loss anemia (6.9% vs 4.6%; p = 0.11), use of blood products (p > 0.05 for all), or documented fibrinolytic adverse events (2.6% vs 2.8%; p = 0.82).

Conclusions:
Compared with full-dose alteplase, half-dose was associated with similar mortality and rates of major bleeding. Treatment escalation occurred more often in half-dose–treated patients. These results question whether half-dose alteplase provides similar efficacy with improved safety, and highlights the need for further study before use of half-dose alteplase therapy can be routinely recommended in patients with pulmonary embolism.
Squamoid Eccrine Ductal Carcinoma: An Aggressive Mimicker of Squamous Cell Carcinoma
Authors: Mckissack Sterling S. , Wohltmann Wendi , Dalton Scott R. , Miletta Nathanial R. 
Published: July 2018

Abstract:
Squamoid eccrine ductal carcinoma (SEDC) is an uncommon cutaneous adnexal malignancy that has the potential for an aggressive clinical course. The authors present a case of SEDC that resulted in widespread metastases and death. The clinical, histological, and immunohistochemical features of SEDC and several entities on the differential diagnosis are reviewed.
PERIPHERAL RETINAL DRUSEN–LIKE DEPOSITS IN GUCY2C CONGENITAL SECRETORY DIARRHEA SYNDROME
Authors: Cugley Dean , Brislane Nicholas , Guymer Robyn , Carden Susan 
Published: July 2018

Purpose:
To report the presence of drusen in infancy, in a patient with Type 1 retinopathy of prematurity and a rare congenital sodium diarrhea secondary to a sporadic GUCY2C mutation.

Methods:
A case report generated by review of clinical course, with imaging of 1 patient and literature review.

Results:
A 1.075-kg infant born at gestation age 27 weeks was admitted to our institution with respiratory distress and secretory diarrhea. During screening for retinopathy of prematurity, peripheral drusen–like subretinal deposits were identified. There were no similar findings in either parent or family history of ocular pathologies. Their distribution is atypical for that seen in other causes of early onset drusen such as autosomal dominant drusen or Sorsby fundus dystrophy. Retinopathy of prematurity was identified, which progressed to Type 1, and was treated with bilateral indirect peripheral retinal photocoagulation at gestational age of 40 weeks. Fluorescein angiography was performed and was consistent with peripheral drusen. Optical coherence tomography of the central macula and an awake electroretinogram at 6 months were normal. Serial examinations confirmed no progression in the drusen-like deposits or in retinopathy of prematurity, with clinically appropriate visual development observed during close follow-up.

Conclusion:
We identify a unique ocular phenotype of retinal drusen–like deposits in an infant with a rare, sporadic GUCY2C mutation.
TREATMENT OF REFRACTORY TUBERCULAR SERPIGINOUS–LIKE CHOROIDITIS WITH INTRAVITREAL METHOTREXATE
Authors: Tsui Edmund , Fern Craig M. , Goldberg Naomi R. 
Published: July 2018

Purpose:
To describe a case of tubercular serpiginous–like choroiditis that progressed, despite antitubercular medication, corticosteroids, and immunomodulatory treatment, which ultimately quieted after two intravitreal methotrexate injections.

Methods:
Case report.

Results:
A 35-year-old woman reported a shadow in the left eye for 2 weeks. She presented with tubercular serpiginous–like choroiditis in the right eye 2 years prior. At that time, she was started on antituberculosis therapy but was noncompliant and lost to follow-up. On re-presentation, there was a new active left-eye serpiginous lesion, with repeat positive QuantiFERON gold testing. Four antituberculosis drugs were started, followed by corticosteroids and azathioprine, with continued progression despite aggressive treatment. She was finally given 2 intravitreal methotrexate injections (400 μg/0.1 cc) 1 month apart, with final arrest of lesion extension. The uveitis remained quiet for over 24 months, and the patient was able to discontinue all systemic therapy.

Conclusion:
Intravitreal methotrexate injections halted progression of treatment-refractory tubercular serpiginous–like choroiditis.
Cypass Supraciliary Stent in Eye With Chronic Angle Closure and Postvitrectomy With Silicone Oil
Authors: Hopen Michael L. , Patel Shamil , Gallardo Mark J. 
Published: July 2018

Purpose:
To report a case of successful intraocular pressure (IOP) reduction following Cypass supraciliary stent implantation in a postvitrectomized eye filled with silicone oil and chronic angle-closure glaucoma.

Materials and Methods:
This is a case report.

Results:
A 19-year-old female with chronic angle-closure glaucoma underwent combined cataract extraction, goniosynechiolysis and Cypass supraciliary shunt implantation. Patient had a history of proliferative diabetic retinopathy and a tractional retinal detachment, which required pars plana vitretomy and silicone oil implantation, and was subsequently complicated by neovascular glaucoma requiring implantation of an inferior glaucoma drainage device. Approximately 6 months later, the patient’s IOP increased to 36 mm Hg on maximum tolerable medical therapy. The patient underwent combined cataract extraction and Cypass implantation and is now controlled with an IOP of 16 mm Hg on 3 classes of medications 6 months postoperatively.

Conclusions:
Implantation of a Cypass supraciliary shunt can be an effective means for controlling IOP in patients with chronic angle-closure glaucoma in a postvitrectomized eye with silicone oil implantation and failed glaucoma drainage device.