bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of increasing copper from tri-basic copper chloride or a copper-methionine chelate on growth performance of nursery pigs1,2
Authors: Carpenter Corey B , Woodworth Jason C , DeRouchey Joel M , Tokach Mike D , Goodband Robert D , Dritz Steve S , Wu Fangzhou , Usry James L 
Published: December 2018

Abstract
A total of 2,117 pigs were used in two 35-d growth experiments to determine the effects of increasing added Cu from tri-basic copper chloride (TBCC) or a Cu-methionine chelate (Cu-chelate) on nursery pig growth performance. In experiment 1, 1,452 pigs (350 barrows [DNA 200 × 400; initially 5.9 ± 0.17 kg] in group 1 and 1,102 pigs [PIC 1050 × 280; initially 6.0 ± 0.26 kg] in group 2) were weaned at approximately 21 d of age. In experiment 2, 665 pigs (350 barrows, DNA 200 × 400; initially 6.4 ± 0.19 kg, in group 3 and 315 pigs, DNA 241 × 600; initially 5.2 ± 0.49 kg, in group 4) were weaned at approximately 21 d of age. Pigs in groups 1, 2, and 3 were fed a common starter diet for 7 d and pigs in group 4 were fed a common diet for 5 d after weaning before starting experiments. On d 0 of each experiment, pens of pigs were blocked by body weight (BW) and assigned to 1 of 7 dietary treatments. Treatments were arranged as a 2 × 3 factorial plus one control diet, with main effects of Cu source (TBCC vs. Cu-chelate) and level. Copper levels were 50, 100, or 150 mg/kg in experiment 1 and 75, 150, or 225 mg/kg in experiment 2. Diets were corn-soybean meal-based and fed in meal form in two phases (d 0 to 14 and 14 to 35). In experiment 1 from d 0 to 35, there was a Cu source × level interaction (linear, P &lt; 0.05) for average daily gain (ADG) and d 35 BW where the magnitude of improvement with increasing Cu was greater in pigs fed Cu-chelate compared to those fed TBCC. Increasing added Cu increased (linear, P &lt; 0.01) average daily feed intake (ADFI) and gain:feed (G:F). Although Cu source did not influence G:F, pigs fed Cu from Cu-chelate had greater (P ≤ 0.01) ADG and ADFI than those fed Cu from TBCC. In experiment 2, from d 0 to 35, there were no evidence for Cu source × level interactions. Increasing Cu increased (linear, P &lt; 0.05) ADG and final BW. The increase in ADG combined with unaffected ADFI resulted in marginally increased G:F (linear, P = 0.052). In summary, these results suggest that increasing dietary Cu from TBCC or a Cu-chelate improved overall ADG, and d 35 BW in nursery pigs and Cu source has potential to influence nursery pig performance.
Biomechanical Investigation of an Integrated 2-Screw Cephalomedullary Nail Versus a Sliding Hip Screw in Unstable Intertrochanteric Fractures
Authors: Santoni Brandon G. , Diaz Miguel A. , Stoops T. Kyle , Lannon Sean , Ali Ashley , Sanders Roy W. 
Published: December 2018

Objective:
To compare the efficacy of 2 intertrochanteric (IT) fracture fixation devices in conferring mechanical stability to unstable IT femur fractures.

Methods:
Nine pairs of cadaveric female femurs with a groupwise average bone quality indicative of osteopenia were used. An unstable IT fracture without calcar support (OTA/AO 31-A2) was created and stabilized with either a sliding hip screw and side plate (SHS) or a cephalomedullary nail using an integrated dual-screw fixation [InterTAN (ITN)]. Constructs were evaluated under stepwise and increasing cyclic loading up to 50,000 cycles (1500 N) or by failure in a test model that may best simulate hip joint contact forces at heel strike. Number of cycles to failure, failure load, and femoral head rotation about the screw axis were compared between groups.

Results:
The average number of cycles in the ITN group was greater compared with that in the SHS group (48,383 vs. 31,403 cycles, P = 0.046). Similarly, the average maximum load survived by the ITN group was greater than that of the SHS group (1456 vs. 1113 N, P = 0.046). The number of constructs that survived up to the maximum applied load of 1500 N was greater in the ITN group (8/9, 89%) when compared with that of the SHS constructs (3/9, 33%) (P = 0.049). Finally, the ITN group conferred greater rotational control of the femoral head compared with the SHS constructs (1.5 vs. 5.5 degrees, P = 0.018), and reduced the amount of varus collapse (11.1 vs. 31.1 degrees, P = 0.038).

Conclusions:
The integrated dual-screw construct appeared to confer significantly greater fracture stability compared with a sliding hip screw and side plate using a worst-case model that simulates heel strike during gait. Study data provide biomechanical evidence that the ITN device may provide more stability and rotational resistance than a sliding hip screw in the elderly female patient population with an unstable IT fracture and compromised bone quality.
Symmetry Matching of the Medial Acetabular Surface—A Quantitative Analysis in View of Patient-Specific Implants
Authors: Osterhoff Georg , Petersik Andreas , Sprengel Kai , Pape Hans-Christoph 
Published: December 2018

Objective:
To quantify intrapelvic surface symmetry in reference to a preshaped suprapectineal acetabular implant.

Methods:
In this cross-sectional study, an anatomically preshaped acetabular fracture implant was fitted on 3D surface models of 516 pelvises from a preexisting bone database using a software tool for automated implant fitting (SOMA, Stryker Orthopaedic Modeling and Analytics) of a CAD model of the implant. The distances between bone and the reference implant were measured at 2310 reference points for each hemipelvis.

Results:
The average distance between the left hemipelvis and the plate was 1.98 mm (median, 10% percentile: 1.45, 90% percentile: 2.78) and 2.0 mm (median, 10% percentile: 1.45, 90% percentile: 2.92) between the right hemipelvis and the plate. There was no significant difference between the 2 hemipelvises (median absolute pairwise delta: 0.25 mm; 10% percentile: 0.04, 90% percentile: 0.82; Wilcoxon, P = 0.064).

Conclusions:
With regard to the periacetabular surface of the inner pelvis, the pelvis can be considered sufficiently symmetric for using the mirrored contralateral hemipelvis as a template for patient-specific implants in acetabular fracture fixation.
The Financial Impact of the Affordable Care Act on a Level-1 Orthopedic Trauma Service
Authors: Beck Chad J. , Shelton Trevor J. , Wisner David H. , Wolinsky Philip R. 
Published: December 2018

Objectives:
To determine the impact of the Affordable Care Act (ACA) on professional fees and proportion of payer type for an orthopedic trauma service at a level-1 trauma center.

Methods:
We analyzed professional fee data and payer mix for the 18 months before and after implementation of the ACA. Data were collected for inpatients (IP) and outpatients (OP). We corrected for changes in patient volume between the 2-time periods by calculating average values per patient.

Results:
Post ACA, we treated a higher percentage of patients with Medicaid and had a reduction in the percentage of uninsured/county payers. Collections for IPs decreased $75.49/patient and OPs decreased $0.10/patient. Our collection rate decreased 6% for IPs and 5% for OPs. In particular, Medicaid collections decreased by $180/IP, and $4/OP, and Medicare decreased by $61/IP and increased $5/OP post ACA, whereas contract collections increased by $140/IP and $20/OP. The changes in our own institution's insurance were mixed with decreases of $514/IP for partial risk and $735/IP for full-risk insurance and increases of $1/OP for partial risk, and $35/OP for full-risk insurance.

Conclusions:
Post ACA, we saw less patients, primarily in the OP setting. This shift was accompanied by a significant decrease in our collection rate; specifically, a decrease in the amount we collected per Medicaid patient—the category of payer that increased post ACA. The ACA did allow more uninsured patients access to medical care but was associated with lower IP and OP reimbursements.
Percutaneous Vertebral Augmentation for Vertebral Compression Fractures
Authors: Rabei Rana , Patel Ketan , Ginsburg Michael , Patel Mikin V. , Turba Ulku C. , Arslan Bulent , Ahmed Osman 
Published: December 2018

Study Design.
Retrospective analysis of Medicare data

Objective.
To analyze trends of vertebral augmentation in the elderly Medicare population in the context of evolving evidence and varied medical society opinions.

Summary of Background Data.
Percutaneous vertebral augmentation offers a minimally invasive therapy for vertebral compression fractures. Numerous trials have been published on this topic with mixed results. The impact of these studies and societal recommendations on physician practice patterns is not well understood.

Methods.
The Centers for Medicare and Medicaid Services annual Medicare Physician Supplier Procedure Summary database was examined for kyphoplasty and vertebroplasty procedures from 2005 through 2015. Top provider specialties were determined based on annual procedural volume, and grouped into the three broad categories of radiology, surgery, and anesthesia/pain medicine. Data entries were independently analyzed by provider type, site of service, submitted charges, and reimbursement rates for interventions during the study period.

Results.
Between 2005 and 2015 total annual claims for vertebral augmentation procedures in the Medicare population increased from 108.11% (37,133–77,276) peaking in 2008 and declining by 15.56% in 2009. Radiology is the largest provider of vertebral augmentation by specialty with declining market shares from 71% in 2005 to 43% in 2015. The frequency of vertebroplasty declined by 61.7% (35,409–13,478) from 2005 to 2015 with reduction in Medicare reimbursement. Annual volume of kyphoplasty grew by 18.3% (48,725–57,646) with significant increase in reimbursement for office-based procedures ($728.50/yr, P < 0.001, R
2 = 0.69).

Conclusion.
The annual volume of vertebral augmentation declined in 2009 following two negative trials on vertebroplasty. Although these publications had a persistent negative impact on practice of vertebroplasty, the overall frequency of vertebral augmentation in the Medicare population has not changed significantly between 2005 and 2015. Instead, there has been a significant shift in provider practice patterns in favor of kyphoplasty in increasingly outpatient and office-based settings.

Level of Evidence: 3
Vaginal estrogen use and chronic disease risk in the Nurses’ Health Study
Authors: Bhupathiraju Shilpa N. , Grodstein Francine , Stampfer Meir J. , Willett Walter C. , Crandall Carolyn J. , Shifren Jan L. , Manson JoAnn E. 
Published: December 2018

Abstract

Objective:
To examine the associations between vaginal estrogen use and multiple health outcomes including cardiovascular disease (total myocardial infarction, stroke, and pulmonary embolism/deep vein thrombosis), cancer (total invasive, breast, endometrial, ovarian, and colorectal cancer), and hip fracture.

Methods:
We included postmenopausal women from the Nurses’ Health Study (1982-2012) who were not current users of systemic hormone therapy at the start of the study or during follow-up. Vaginal estrogen use was self-reported on the biennial questionnaires. Information on incident health outcomes were self-reported and confirmed by medical records. We used Cox proportional hazards regression to model the multivariable adjusted hazard ratios and the 95% confidence intervals for vaginal estrogen use and multiple health outcomes.

Results:
Over 18 years of follow-up, after adjusting for covariates, risks for cardiovascular disease, cancer, and hip fracture were not different between users and nonusers of vaginal estrogen. No statistically significant increase in risk of any health outcome was observed with vaginal estrogen use. In sensitivity analyses, when we examined associations by hysterectomy status, the stratified results were generally similar to those for the total cohort.

Conclusions:
Vaginal estrogen use was not associated with a higher risk of cardiovascular disease or cancer. Our findings lend support to the safety of vaginal estrogen use, a highly effective treatment for genitourinary syndrome of menopause.
Surgical Therapy of Temporal Triggered Migraine Headache
Authors: Bertozzi Nicolò , Simonacci Francesco , Lago GianLuigi , Bordin Chiara , Raposio Edoardo 
Published: December 2018

Background:
The auriculotemporal and zygomaticotemporal nerves are the 2 primary trigger points in the temporal area of migraine headache. Different surgical approaches are described in literature, either open or endoscopic ones.

Methods:
We described and delineated the currently adopted strategies to treat temporal trigger points in migraine headache. Furthermore, we reported our personal experience in the field.

Results:
Regardless of the type of approach, outcomes observed were similar and ranged from 89% to 67% elimination / >50% reduction rates. All procedures are minimally invasive and only minor complications are reported, with an incidence ranging from 1% to 5%.

Conclusions:
Just like upper limb compressive neuropathies, migraine headache is believed to be caused by chronic compression of peripheral nerves (ie, the terminal branches of trigeminal nerve) caused by surrounding structures (eg, muscles, vessels, and fascial bands) the removal of which eventually results in improvement or elimination of migraine attacks. Particular attention should be paid to the close nerve/artery relationship often described in anatomical studies and clinical reports.
CUTICULAR DRUSEN
Authors: Sakurada Yoichi , Parikh Ravi , Gal-Or Orly , Balaratnasingam Chandrakumar , Leong Belinda C.S. , Tanaka Koji , Cherepanoff Svetlana , Spaide Richard F. , Freund K. Bailey , Yannuzzi Lawrence A. 
Published: December 2018

Purpose:
Cuticular drusen (CD) have been associated with manifestations of age-related macular degeneration such as atrophy and neovascularization in the macula. In this study, eyes with CD were followed and investigated for the estimated 5-year risk of progression to sequelae of age-related macular degeneration such as geographic atrophy (GA) and macular neovascularization (MNV).

Methods:
A consecutive series of patients with CD were followed for the development of GA and MNV. Whenever possible, they were also studied retrospectively. The patients with CD were categorized into three phenotypic groups. Phenotype 1: eyes had concentrated, densely populated CD in the macular and paramacular area, Phenotype 2: eyes showed scattered CD in the posterior fundus, and Phenotype 3: involved eyes with CD mixed with large drusen (>200 µm). The 5-year incidence of progression was then estimated using a Kaplan–Meier estimator.

Results:
A total of 63 eyes from 38 patients (35 women with a mean age at presentation of 58.9 ± 14.2 years) were studied and followed for a mean of 40 ± 18 months. Thirteen patients had single eyes with GA (84.5%; 11/13) or MNV (15.5%; 2/13) in one eye at presentation and were subsequently excluded. Geographic atrophy developed in 19.0% (12/63) of eyes and MNV in 4.8% (3/63) of eyes. The cumulative estimated 5-year risk of GA and MNV was 28.4% and 8.7%, respectively. The estimated 5-year incidence of MNV or GA was 12.6%, 50.0%, and 51.6% in Phenotype 1, Phenotype 2, and Phenotype 3, respectively (P = 0.0015, log-rank test). No difference in risk was found in the development of GA or MNV (P = 0.11) between the subgroup of patients presenting with GA or MNV in their fellow eye and those with both eyes included.

Conclusion:
When patients with CD are followed longitudinally, there was a significant risk of progression to GA or MNV for Phenotype 2 and Phenotype 3. Patients with CD are commonly first diagnosed in the fifth decade of life, and there is a female predominance. Clinicians should use multimodal imaging to detect and be aware of the risk of progression to manifestations of GA and MNV. These risks of GA and MNV suggest that patients with CD may be part of the overall spectrum of age-related macular degeneration.
A Randomized Trial to Evaluate the Effect of Toric Versus Spherical Contact Lenses on Vision and Eyestrain
Authors: Berntsen David A. , Cox Stephanie M. , Bickle Katherine M. , Mathew Jessica H. , Powell Daniel R. , Seidman Scott H. , Little Borm Kim , Lorenz Kathrine Osborn , Nichols Jason J. 
Published: December 2018

Objectives:
To compare the effect of toric versus spherical soft contact lenses on objective measures of visual performance using visual acuity and electromyography of the orbicularis oculi muscle.

Methods:
Current soft contact lens wearers with −0.75 to −1.75 D astigmatism in each eye were binocularly fitted with toric (1-Day ACUVUE MOIST for astigmatism) and spherical (1-Day ACUVUE MOIST) contact lenses in random order. After each fitting and at 1-week follow-up, high- and low-contrast visual acuities were measured. Electromyography was used to objectively evaluate eyestrain. Linear mixed models were used to assess differences between toric and spherical contact lenses.

Results:
The mean age (±SD) of the 60 participants was 27.5±5.0 years, spherical refractive error was −3.68±2.01 D, and cylinder was −1.28±0.36 D. High- and low-contrast visual acuities with toric lenses were better than with spherical lenses at both fitting (toric high-contrast: −0.065±0.078 and low-contrast: 0.133±0.103 vs. spherical high-contrast: 0.001±0.104 and low-contrast: 0.224±0.107) and follow-up (toric high-contrast: −0.083±0.087 and low-contrast: 0.108±0.107 vs. spherical high-contrast: −0.015±0.095 and low-contrast: 0.211±0.104) (all P<0.0001). Electromyography-measured eyestrain was less with toric versus spherical contact lenses at fitting (least-square ratio of toric over spherical=0.72; P=0.0019) but not at follow-up (ratio=0.86; P=0.11).

Conclusion:
These results suggest that toric contact lenses provided improved objective measures of vision in a low-to-moderate astigmatic population.
Renal transplantation and predisposition to opportunistic infections
Authors: Dandamudi Raja , Smith Jodi , Dharnidharka Vikas R. 
Published: December 2018

Purpose of review
Infections represent a significant source of morbidity and mortality after kidney transplantation in children. We review recent advances in epidemiology, assessment, prevention and treatment for several different infections.

Recent findings
Infections, such as bacterial urinary tract infection or opportunistic viral infection remain common, may be increasing and represent a large proportion of hospitalization. Extended antiviral agent use reduces the incidence of cytomegalovirus disease but its efficacy to reduce Epstein–Barr virus disease remains controversial. Human herpesvirus-6 and hepatitis E virus represent new infections to keep in mind. Ureteral stenting increases the rate of early UTI. Several new vaccines are now available, but rates of complete vaccination pretransplant are low.

Summary
Infections remain a critical posttransplant issue associated with significant medical burdens. Emerging data on associated risk factors, assessment of and treatment for infections provide clinicians with new knowledge.
Symptoms of Feeding Problems in Preterm‐born Children at 6 Months to 7 Years Old
Authors: Park Jinhee , Thoyre Suzanne M. , Pados Britt F. , Gregas Matt 
Published: December 2018

ABSTRACTObjectives:Describe symptoms of feeding problems in children born very preterm (<32 weeks gestation) and moderate to late preterm (32–37 weeks gestation) compared to children born full‐term; explore the contribution of medical risk factors to problematic feeding symptoms.Methods:The sample included 57 very preterm, 199 moderate to late preterm, and 979 full‐term born children ages 6 months to 7 years. Symptoms of feeding problems were assessed using the Pediatric Eating Assessment Tool and compared between groups after accounting for the child's age and/or sex. With the sample of preterm children, we further analyzed 11 medical factors as potential risk factors affecting a child's feeding symptoms: feeding problems in early infancy and conditions of oxygen requirement past 40 weeks of postmenstrual age, congenital heart disease, structural anomaly, genetic disorder, cerebral palsy, developmental delay, speech‐language delay, sensory processing disorder, vision impairment, or symptoms of gastroesophageal reflux.Results:Compared to children born full‐term, both very preterm and moderate to late preterm born children had significantly higher scores on the Pediatric Eating Assessment Tool total scale and all 4 subscales. More severe symptoms were noted in very preterm children, particularly in the areas of Physiologic Symptoms and Selective/Restrictive Eating. Among preterm children, all 11 medical factors were found to be associated significantly with increased symptoms of feeding problems.Conclusion:Compared to children born full‐term, preterm born children demonstrated greater symptoms of feeding problems regardless of their current age, suggesting children born preterm may require more careful monitoring of feeding throughout childhood.
Quantifying Burn Injury–Related Disability and Quality of Life in the Developing World
Authors: McMahon Heather A. , Ndem Idorenyin , Gampper Lauren , Gampper Thomas J. , DeGeorge Brent R. 
Published: December 2018

Background
Untreated or undertreated burns are commonly encountered by plastic surgeons on medical trips in India and represent a major cause of disability. We sought to utilize validated patient-reported outcomes instruments to identify the patient population with the greatest burn-related disability in order to appropriately allocate plastic surgery resources to those in greatest need.

Methods
The Quick Disability of the Arm, Shoulder, and Hand, RAND 36-Item Short Form Health Survey, and Burn-Specific Health Scale–Revised, Brief, and Adapted questionnaires were administered via an interpreter during a plastic surgery trip to Jharkhand, India, in January 2018. Demographics, comorbidities, and burn-specific history were recorded.

Results
Twenty-eight postburn patients were surveyed (mean age, 17.0 ± 9.2 years; male:female ratio, 1:2.5). Mean time from injury was 4.74 years. No patient had received formal, primary burn care. Mechanism of injury: flame (39%), oil (32%), scalding water (14%), and other (14%). Fifty-four percent were extremity burns; 25%, facial; and 18%, neck burns. The Burn-Specific Health Scale–Revised, Brief, and Adapted demonstrated that the most significantly impacted domains for all patients were body image and skin sensitivity, with more than 80% of patients complaining of issues with skin sensitivity. In addition, children (aged <18 years) had diminished body image domain scores. RAND SF-36 scores were lowest in the energy (73.1 ± 25.0) and general health (76.5 ± 13.8) domains, and females with extremity burns demonstrated statistically significant decreases in their physical limitation domain scores (85.9 ± 17.3, P < 0.05). Females with extremity burns also had statistically significant lower scores in the energy domain (64.09 ± 25.75) as compared with their male counterparts with extremity burns (100 ± 0, P = 0.045). In general, females scored lower than did males in multiple domains, and those results reached statistical significance in the energy (65.9 ± 24.6 vs 93.6 ± 10.9), emotional (77.2 ± 21.5 vs 95.4 ± 11.2), and general health domains (71.1 ± 11.9 vs 90.0 ± 7.5) with P < 0.05. Children demonstrated significantly diminished scores in the emotional (75.5 ± 24.6) and general health (79.1 ± 11.8) domains.

Conclusion
These data demonstrate the significant impact on quality of life that untreated burns have in this population. Male and female children with extremity burns and adult women with extremity burns were most significantly affected in multiple domains. Consequently, children and adult women with extremity burns appear to be the patient cohort with the greatest opportunity to impact their quality of life. These data may be utilized to improve patient triage and resource allocation for future surgical trips but could also be of significant benefit to internal health agencies and ministries for the same purpose.