bluuebunny/crossref_metadata_2025_split huggingface dataset:
Posterior Approach for a Cemented Hemiarthroplasty
Authors: Petersen Kyle A. , Siesel Craig , Broering Chad , Miller Eric T. 
Published: July 2019

Purpose:
Femoral neck fractures are common injuries with over 1 million occurring yearly. This video demonstrates a case of a displaced femoral neck fracture treated with a cemented hemiarthroplasty through a posterior approach.

Methods:
Multiple approaches to the hip for arthroplasty have been described, each with advantages and disadvantages. Careful technique is critical to success.

Results:
This presents a case of a displaced femoral neck fracture treated with a cemented hemiarthroplasty through a posterior approach.

Conclusions:
Displaced femoral neck fractures are common fractures. The posterior approach for cemented hemiarthroplasty is a safe, reproducible technique.

Video available at:
http://links.lww.com/JOT/A796
Nerve Preservation and Allografting for Sensory Innervation Following Immediate Implant Breast Reconstruction
Authors: Peled Anne Warren , Peled Ziv M. 
Published: July 2019

Summary:
While newer breast reconstruction approaches utilizing nipple-sparing mastectomy (NSM) techniques and immediate reconstruction can provide excellent aesthetic outcomes, absent postoperative sensation remains a major limitation. Here, we present a novel technique for implant reconstruction combining the latest advances in breast oncologic, reconstructive, and peripheral nerve surgery to improve sensory outcomes. Sixteen women (31 breasts) underwent NSM and prepectoral, direct-to-implant reconstruction. During NSM, careful dissection was performed along the lateral aspect of the breast to preserve any visible intercostal nerves. When nerves could be preserved without compromising oncologic safety, they were left intact within the subcutaneous tissue of the lateral mastectomy skin flap. Nipple/areolar complex (NAC) neurotization was also performed utilizing allograft coapted from transected T4 or T5 lateral intercostal nerves to subareolar nerves identified at the completion of the mastectomy. Of the 12 women (23 breasts) with at least 3 months’ follow-up, NAC 2-point discrimination was preserved in 20 breasts (87%), was worse in 2 breasts (9%), and had actually improved in 1 breast (4%). All patients had intact sensation to light touch throughout the majority of, if not their entire, reconstructed breasts. None of the women developed dysesthesias or neuromas. Nerve grafting in conjunction with careful nerve preservation at the time of NSM and implant-based breast reconstruction is safe and effective with a 90% rate of preserved sensation. With longer follow-up, continued return of sensation or possibly improved sensation from baseline can be reasonably anticipated.
Vascularized Iliac Bone Graft for Complex Closure During Spinal Deformity Surgery
Authors: Reece Edward M. , Raghuram Anjali C. , Bartlett Erica L. , Lazaro Tyler T. , North Robert Y. , Bohl Michael A. , Ropper Alexander E. 
Published: July 2019

Summary:
Spinal pseudarthrosis is failure of bony union across a segment where arthrodesis has been attempted. A variety of treatment approaches have been proposed to promote bony union, including use of vascularized bone graft. We report a successful application of vascularized pedicled iliac crest bone graft (ICBG) to treat recurrent lumbar and sacral pseudarthrosis. The vascularized ICBG offers the advantages of biocompatibility, mechanical stability, and minimal antigenicity. Vascularized bone transfers to the spine undergo fusion without resorption, even in the presence of compressive and rotatory forces. With its ease of access within the operative field and limited donor site morbidity, vascularized ICBG is an ideal orthobiologic that expedites time to bony union.
Trends and Distribution Analysis of Occupational Exposure From Medical Practices in China (2010–2016)
Authors: Deng Jun , Fan Shengnan , Wang Tuo , Hao Shuxia , Liu Xiaohui , Guo Wen , Sun Quanfu 
Published: July 2019

Abstract
Occupational exposure to ionizing radiation from medical practices in China has been collected for a 7 y period between 2010 and 2016 from roughly 220 individual monitoring service providers through the Chinese Registry of Radiation Workers. Statistical dose distributions and characteristic tendencies are presented based on the evaluation in terms of six occupational categories. A reduction can be seen in average annual effective dose for interventional radiology, nuclear medicine, diagnostic radiology, radiotherapy, dental radiology, and others by 52%, 47%, 46%, 34%, 69%, and 31%, respectively, for the 7 y period. More than 94.5% of radiation workers received annual doses less than the public dose limit (1 mSv) in 2016. Workers engaged in nuclear medicine and interventional radiology activities were found to receive relatively more dose than the other fields of practice. Diagnostic radiology makes the dominant contribution of 68% to the collective effective dose of 73,641.3 person mSv received by 211,613 radiation workers in medical practices in 2016. The observation of workers in medical practices receiving well below the recommended occupational dose limit (20 mSv) could be a result of an improvement in radiation protection practices in the medical field in China. However, it is still necessary to control and manage the workplace and radiation workers to avoid unnecessary exposures, in particular for the workers engaged in nuclear medicine and interventional radiology activities.
Comparison of Clinical Outcomes: Bivalirudin With Transfemoral Access Versus Heparin With Transradial Access in Patients With ST segment Elevation Myocardial Infarction
Authors: Mallidi Jaya , Ulahannan John , Chaubey Vinod K. , Atreya Auras R. , Shakoor Muhammad T. , Fisher Daniel , Garb Jane , Lotfi Amir 
Published: July 2019

Introduction:
The best combination of access site and anticoagulant used during primary percutaneous coronary intervention (PCI) in patients presenting with ST segment elevation myocardial infarction is not known.

Methods:
We conducted a retrospective cohort study of all patients >18 years of age who underwent primary PCI in 2 large regional ST segment elevation myocardial infarction centers in Massachusetts between 2012 and 2014. The cohort was divided into 3 groups: bival/fem, hep/rad, or off-protocol, based on anticoagulation and access used. We used multiple logistic regression model to compare major cardiovascular events—major adverse cardiovascular events (MACE) and bleeding complications between the 2 on-protocol groups (bival/fem and hep/rad).

Results:
Of the 1074 patients in this study, there were 443 (41%), 501 (47%), and 130 (12%) patients in bival/fem, hep/rad, and off-protocol groups, respectively. There were significantly higher number of cardiogenic shock patients in the bival/fem compared to the hep/rad group (6.5% vs. 3.0%, P < 0.001). There was a trend toward reduced MACE in the hep/rad group compared to bival/fem (2.8 % vs. 5.1%, P = 0.068). When cardiogenic shock patients are excluded, there is no significant difference in mortality rates (bival/fem: 2.7% vs. hep/rad: 1.0%, P = 0.07) or bleeding complications between the groups (hep/rad: 4.5% vs. bival/fem: 2.1%, P = 0.06).

Conclusions:
In patients undergoing primary PCI, there was a trend toward reduced inpatient MACE with the use of heparin and radial access compared with bivalirudin with femoral access. In patients without cardiogenic shock, there is no significant difference in mortality or bleeding rates between the 2 groups.
Further Investigations on the Crosslinking of Tarsal Collagen as a Treatment for Eyelid Laxity: Optimizing the Procedure in Animal Tissue
Authors: Smith Tai M. , Suzuki Shuko , Sabat Nestor , Rayner Cassie L. , Harkin Damien G. , Chirila Traian V. 
Published: July 2019

Safe irradiation conditions are established for the exposure of ex vivo ovine tarsus to ultraviolet-A radiation as a potentially effective treatment for eyelid laxity in human patients.

Purpose:
A follow-up experimental study on the exposure of animal tarsal plate to ultraviolet-A radiation aimed at establishing an optimum range for safe irradiation conditions.

Methods:
Sheep tarsus specimens were excised postmortem and then subjected to irradiation with ultraviolet-A rays (wavelength 365 nm) at higher irradiances than those reported in an initial study, using a laboratory radiation source. The mechanical properties (tensile strength and Young’s modulus) of irradiated and nonirradiated samples were evaluated in a mechanical tester. The test and control specimens were examined histologically with an aim to assess the effects of radiation upon the meibomian glands and tarsal collagen networks, and to establish a safe range for the exposure irradiance level.

Results:
As expected, irradiation induced both stiffening and strengthening of the tarsal plate specimens. At an irradiance of 50 mW/cm2 for 3-minute exposure, these effects were at their maximum level, after which a decline in mechanical characteristics were observed. No destruction of the tarsal connective tissue or the meibomian glands were noticed up to an irradiance of 125 mW/cm2 for 3-minute exposure, corresponding to a fluence of 22.5 J/cm2. Histology revealed that the collagen network surrounding the glands were packed more compactly following irradiation. At a fluence of 45 J/cm2, massive destruction of periglandular collagen-rich network and meibocytes were demonstrated histologically.

Conclusions:
The study indicates that irradiation of tarsal collagen leading to tissue stiffening shall be carried out at levels of fluence between 10 and 15 J/cm2, a region that is deemed safe. The exposure time can be adjusted according to the surgeon’s decision.
Orbital Glial Heterotopia: A Report of 2 Cases and Review of the Literature
Authors: Mehta Neesurg S. , Tenzel Phillip A. , Sharfi Duaa , Colley Patrick , Iacob Codrin , Reddy Harsha S. 
Published: July 2019

Orbital glial heterotopia, commonly considered a rare congenital lesion generally presenting in children, may first become symptomatic in adulthood. Biopsy is required for diagnosis, with symptoms and prognosis dependent on location and growth of the lesion.

Purpose:
To review the clinical radiographic and histopathologic findings associated with orbital glial heterotopia.

Methods:
A literature search in PubMed and Scopus was performed to include all articles published in English between 1980 and January 1, 2019. A case series including 29 case reports of 29 patients, as well as the authors’ 2 cases, were considered in the literature review.

Results:
The majority of the cases had onset of symptoms (86%) and age at presentation (71%) before 5 years of age. The most common presenting symptoms and signs were swelling (45%), strabismus (32%), and proptosis (26%). The most common lesion locations described were inferolateral (19%) or primarily posterior orbital or apical (19%). The most common findings associated with orbital glial heterotopia were microphthalmia (10%) and anophthalmia (6%); however, the majority did not have systemic abnormalities (71%). The most common imaging modality was CT scan (71%). Diagnosis was made with histologic analysis in all cases, and confirmed after subtotal resection (35%), total resection (39%), or incisional biopsy (26%). The majority of the cases report no growth on repeat imaging, with only 3 reports of recurrence.

Conclusions:
Glial heterotopia in the orbit is a rare clinical entity most commonly presenting in children. We present 2 cases of orbital glial heterotopia in adults, with a literature on these lesions in both the pediatric and adult populations. Surgeons and pathologists should be aware of this atypical presentation in adulthood. Biopsy is required for diagnosis but is not without risk. Prognosis is generally favorable.
From education to practice: What we can learn about the workforce from a survey of new nurse practitioners
Authors: Faraz Asefeh , Salsberg Edward 
Published: July 2019

ABSTRACT

Background and purpose:
To understand the posttraining plans and job market for new nurse practitioners (NPs), a survey was conducted of new family NPs (FNPs) in 2017. The survey was also designed to test the logistics and feasibility of conducting such a survey on a national scale and the usefulness of data gathered.

Methods:
A descriptive, cross-sectional study was conducted through an online survey administered to a national sample of 159 FNPs who graduated from an accredited NP program.

Conclusions:
Many new NPs are not willing or interested in moving out of their local community even if there are limited opportunities locally. There are high numbers of NPs going into private practice compared with community health or federally qualified health centers. Many new NPs have extensive previous work experience as registered nurses in hospitals; the career progression to NP shifts their work setting from inpatient to outpatient settings.

Implications for practice:
Although the job market for new NPs is generally good, with the rapid increase in NP graduates combined with the unwillingness or inability of many new NPs to move, some areas may have surpluses of NPs and limited job opportunities for new NPs, whereas other areas may have shortages upcoming. The survey of new NP graduates is a useful tool to monitor the experience of new NPs and provides valuable information to NP programs and prospective students. Future research should ensure a representative sample of new graduate NPs to accurately reflect the experience of new NPs.
Treatment of Auricular Hematomas by OK-432: How and Why It Works
Authors: Ohta Nobuo , Fukase Shigeru , Kusano Yusuke , Saito Yutaro , Tateda Yutaka , Ishida Yusuke , Ikeda Ryoukichi , Yamazaki Muneharu , Ono Junya , Izuhara Kenji 
Published: July 2019

Objectives:
The aim of this article was to investigate the effectiveness and underlying mechanisms of OK-432 therapy in patients with auricular hematomas.

Study Design and Setting:
Case series with planned data collection.

Subjects and Methods:
We tried this therapy in 47 patients with auricular hematoma between April 2008 and August 2018. We aspirated as much of the fluid content of each lesion as possible with a 21-gage needle. We injected OK-432 solution into the lesion with the same needle that we used for aspiration. We performed this treatment at an outpatient basis without hospitalization.

Results:
Disappearance and marked reduction of the lesion were observed in all patients who had this therapy, and local scarring and deformity of the auricle did not occur in any patients. As adverse effects, local pain at the injection site and fever (37–38.5°C) were observed in some cases of the patients who had this therapy. The concentrations of various cytokines in each aspirate before and after OK-432 therapy were investigated. The production of tumor necrosis factor-α, interleukin-6, interleukin-8, interferon gamma, vascular endothelial growth factor, and periostin was significantly elevated in the aspirate fluid after OK-432 therapy.

Conclusion:
OK-432 therapy is simple, easy, safe, effective, and can be used as a substitute for surgery in the treatment of auricular hematoma.
Mycotic Pseudoaneurysm of Internal Carotid Artery Induced by Skull Base Osteomyelitis
Authors: Budhiraja Shilpi , Sagar Prem , Kumar Rajeev , Sharma Suresh C. 
Published: July 2019

Background:
Skull base osteomyelitis (SBO) is predominantly seen in immunocompromised patients, with diabetes mellitus being the most common underlying comorbidity. Microbial aetiology is commonly bacterial, although fungal SBO is encountered in a small fraction of patients. Treatment consists of prolonged antimicrobial therapy, control of underlying comorbidity, and surgical debridement in selected cases. Involvement of cranial nerves is a common complication and is considered a poor prognostic factor. Pseudoaneurysm of internal carotid artery caused by skull base osteomyelitis is a very rare complication, limited to few case reports only.

Case:
We report the case of a 55-year-old diabetic patient with bacterial SBO who developed pseudoaneurysm of cervical–petrous part of internal carotid artery during the course of treatment.

Conclusion:
New onset symptoms or persistent symptoms in SBO suggest progressive disease and necessitate re-evaluation of the microbial aetiology and antimicrobial treatment. Skull base osteomyelitis induced aneurysm is rare but can be life threatening, if not identified and managed immediately.
A case report of cholangiocarcinoma combined with moderately differentiated gastric adenocarcinoma
Authors: Yang Yan-Hui , Deng Qing , Yang Tian-Bao , Gui Yang , Zhang Yu-xiang , Liu Jiang-Bo , Deng Qian , Liu Wei-Feng , Sun Jun-Jun 
Published: July 2019

Abstract

Rationale:
Multiple primary carcinoma (MPM) refers to simultaneous or successive occurrence of ≥2 types of primary malignant tumors in a single organ or in different organs of the same individual. It is rarely seen in clinical practice. Among the various types of MPM, hilar cholangiocarcinoma combined with gastric cancer is extremely rare.

Patient concerns:
The patient was a 61-year-old man who was admitted to our hospital due to upper abdominal discomfort and yellow-stained skin mucosa for 9 days.

Diagnoses:
Preoperative diagnosis: Considering the typical preoperative painless jaundice as well as his clinical imaging report, the patient received the following preoperative diagnosis: obstructive jaundice, type IV hilar cholangiocarcinoma based on Bismuth-Corlette classification, and no intrahepatic distant metastasis. Intraoperative diagnosis: The results of intraoperative snap freezing and laboratory examination indicated gastric adenocarcinoma. Therefore, the patient received an intraoperative diagnosis of obstructive jaundice, hilar cholangiocarcinoma, and gastric cancer. Postoperative pathological diagnosis: Postoperative pathological examination of the gastric lesion revealed the following results: ulcerative, moderately differentiated gastric adenocarcinoma and intestinal type in the Lauren classification of stomach cancer; moderately differentiated adenocarcinoma of the bile duct.

Interventions:
Surgical resection operation was carried out and the patient received chemotherapy after operation. But we could not strictly follow the relevant clinical guidelines to perform standardized operations and provide comprehensive treatment because of his economic situation, psychological factors, and the current medical environment in China.

Outcomes:
The patient did not receive standardized postoperative therapy. Although he lived and worked normally for 8 months after the operation, he died 10 months after surgery.

Lessons:
This report reminds us to pay close attention to the likelihood of MPM and other low-incidence diseases. The physicians and imaging clinicians should explore all clinical possibilities to avoid misdiagnosis of this rare disease and formulate effective treatment plans to maximize the therapeutic benefits for the patient.
Risk factors for drug-resistant epilepsy
Authors: Xue-Ping Wang , Hai-Jiao Wang , Li-Na Zhu , Xu Da , Ling Liu 
Published: July 2019

Abstract

Background:
Drug resistant epilepsy (DRE) is very common among children and adults and studies had found some related risk factors for DRE, while the results were not consistent. The aim of this study was to identify risk factors for drug-resistant epilepsy.

Methods:
Three electronic databases (Medline, Embase and Cochrane library) were searched to identify studies with a cohort design reporting on epidemiologic evidence regarding risk factors for DRE.

Results:
The pooled prevalence of DRE in newly diagnosed epilepsy patients was 25% (95% CI 17–32%). Abnormal electroencephalography (EEG) (both slow wave and epileptiform discharges) (RR 2.80; 95% CI 1.95–4.0), status epilepticus (SE) (RR 11.60; 95% CI 7.39–18.22), symptomatic etiology (RR 3.36; 95% CI 2.53–4.46), multiple seizure types (RR 3.66; 95% CI 2.37–5.64) and febrile seizures (RR 3.43; 95% CI 1.95–6.02) were identified as strong risk factors for DRE. In addition, firm conclusions cannot be drawn for poor short-term outcomes of therapy, neurodevelopment delay and high initial seizure frequency for the heterogeneity of study results. The predictive effect of focus onset seizure was not stable after removing one study and switching the effect model. Age of onset was not risk factors for DRE.

Conclusions:
The current meta-analysis identified potential risk factors for DRE. The results may contribute to better prevention strategies and treatments for DRE.
Pharmacological and non-pharmacological treatments for irritable bowel syndrome
Authors: Zhou Shenghui , Liu Xiaoli , Wang Xiaoxia , Xi Fenglin , Luo Xiaoke , Yao Liang , Tang Hao 
Published: July 2019

Abstract

Background:
The global prevalence of Irritable bowel syndrome (IBS) is estimated to be as high as 15% and a number of different non-pharmacological and pharmacological treatments have been used to manage IBS in clinical practice, which poses great challenges for clinicians to make appropriate decisions. Hence, a systematic review and network meta-analysis on all available pharmacological and non-pharmacological treatments for IBS is needed to provide reliable evidence.

Methods:
We will search the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane IBD Group Specialized Trials Register, MEDLINE, EMBASE, and Chinese Biomedical medicine (CBM) from inception to 31, May 2019. Randomized controlled trials of pharmacological and nonpharmacological interventions for IBS will be included. Study quality will be assessed on the basis of the methodology and categories described in the Cochrane Collaboration Handbook. Primary outcomes are global or clinical improvement and quality of life. A Bayesian network meta-analysis would be performed, and relative ranking of agents would be assessed. A node splitting method will be used to examine the inconsistency between direct and indirect comparisons when a loop connecting 3 arms exists.

Results:
Researchers will rank the effectiveness and safety of the potentials interventions for IBS according the characteristics of patients by conducting an advanced network meta-analysis based on Bayesian statistical model, and interpret the results by using GRADE approach.

Conclusion:
The conclusion of our study will provide updated evidence to rank the effectiveness and safety of pharmacological and non-pharmacological interventions for IBS.

Ethics and dissemination:
Ethical approval is not applicable since this study is a network meta-analysis based on published trials.

Protocol registration number:
CRD42018083844.