bluuebunny/crossref_metadata_2025_split huggingface dataset:
Return to Sports and Physical Activities After First Metatarsophalangeal Joint Arthrodesis in Young Patients
Authors: Da Cunha Rachael J. , MacMahon Aoife , Jones Mackenzie T. , Savenkov Aleksander , Deland Jonathan , Roberts Matthew , Levine David , Elliot Andrew , Kennedy John , Drakos Mark , Ellis Scott J. 
Published: April 2019

Background: Arthrodesis of the first metatarsophalangeal (MTP) joint has been shown to be effective in alleviating pain and correcting deformity in hallux rigidus. However, outcomes in specific sports and physical activities remain unclear. The aim of this study was to assess sports and physical activities in young patients following first MTP joint arthrodesis and to compare these results with clinical outcomes. Methods: Patients between ages 18 and 55 years who underwent MTP arthrodesis were identified by review of a prospective registry. Fifty of 73 eligible patients (68%) were reached for follow-up at a mean of 5.1 (range, 2.2-10.2) years with a mean age at surgery of 49.7 (range, 23-55) years. Physical activity was evaluated with a previously developed sports-specific, patient-administered questionnaire. Clinical outcomes were evaluated with the Foot and Ankle Outcome Score (FAOS). Results: Patients participated in 22 different sports and physical activities. The most common were walking, biking, weightlifting, swimming, running, and golf. Compared to preoperatively, patients rated 27.4% of activities as less difficult, 51.2% as the same, and 21.4% as more difficult. Patients returned to 44.6% of preoperative physical activities in less than 6 months and reached their maximal level of participation in 88.6% of physical activities. Ninety-six percent of patients (48/50) were satisfied with the procedure regarding return to sports and physical activities. Improvements in the FAOS Symptoms subscore were associated with increased postoperative running and walking duration, and improvements in FAOS Pain subscores were associated with greater patient satisfaction. Conclusion: Patients were able to participate in a wide variety of sports and physical activities postoperatively. Some patients reported increased difficulty, but were nonetheless satisfied with the procedure regarding physical activity participation. These findings suggest that first MTP joint arthrodesis is a reasonable option in young, active patients, and may be used to guide postoperative expectations. Level of Evidence: Level IV, retrospective case series.
Validation of PROMIS Global-10 compared with legacy instruments in patients with shoulder instability
Authors: Suriani Robert J , Kassam Hafiz F , Passarelli Natalie R , Esparza Rachel , Kovacevic David 
Published: April 2019

Background Outcomes instruments are used to measure patients’ subjective assessment of health status. The Patient-Reported Outcomes Measurement Information System (PROMIS) Global-10 was developed to be a concise yet comprehensive instrument that provides physical and mental health scores and an estimated EuroQol-5 Dimension (EQ-5D) score. Methods A total of 175 prospectively enrolled patients with shoulder instability completed the PROMIS Global-10, EQ-5D, American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and Western Ontario Shoulder Instability Index. Spearman correlations between PROMIS scores and the legacy instruments were calculated. Bland–Altman analysis assessed agreement between estimated and actual EQ-5D scores. Floor and ceiling effects were recorded. Results Correlation between actual and estimated EQ-5D was excellent-good (0.64/ p < 0.0005), but Bland–Altman agreement revealed high variability for estimated EQ-5D scores (95% CI: −0.30 to +0.34). Correlation of PROMIS physical scores was excellent-good with ASES (0.69/ p < 0.0005), good with SANE (0.43/ p<0.0005), and poor with WOSI (0.17/ p = 0.13). Correlation between PROMIS mental scores and all legacy instruments was poor. Conclusions PROMIS Global-10 physical function scores show high correlation with ASES but poor correlation with other legacy instruments, suggesting it is an unreliable outcomes instrument in populations with shoulder instability. The PROMIS Global-10 cannot replace actual EQ-5D scores for cost-effectiveness assessment in this population. Level of evidence Level II, study of diagnostic test.
Adjuvant chemotherapy improves prognosis of resectable stage IV colorectal cancer: a comparative study using inverse probability of treatment weighting
Authors: Nozawa Hiroaki , Takiyama Hirotoshi , Hasegawa Kiyoshi , Kawai Kazushige , Hata Keisuke , Tanaka Toshiaki , Nishikawa Takeshi , Sasaki Kazuhito , Kaneko Manabu , Murono Koji , Emoto Shigenobu , Sonoda Hirofumi , Nakajima Jun 
Published: April 2019

Background: Adjuvant chemotherapy (AC) is known to be beneficial for stage III colorectal cancer (CRC). In contrast, only a few studies have reported the survival benefits of AC for stage IV CRC after curative surgery. Methods: We identified 155 CRC patients with various organ metastases who underwent curative surgery in our hospital between 2003 and 2017. Clinicopathological parameters and postoperative AC were reviewed. Multivariate analyses were performed to identify prognostic factors. Moreover, the effects of AC on recurrence-free survival (RFS) and overall survival (OS) were analyzed using inverse probability of treatment weighting. Results: The cohort comprised 94 males and 61 females, with a mean age of 63 years. AC was administered to 57% of patients who underwent surgery between 2003 and 2010 and 76% between 2011 and 2017 ( p = 0.015). AC was more likely administered to patients with a good performance status, high preoperative albumin level, regional node and peritoneal metastases, and no intraoperative blood transfusion. Multivariate analyses identified AC as a significant prognostic factors for RFS and OS [hazard ratio (HR): 1.86, p = 0.003, and 2.66, p = 0.002, respectively]. After adjusting for different backgrounds, 5-year RFS and OS rates were higher in patients receiving AC (27% and 67%) than in those without AC (14% and 46%, p < 0.0001 and p = 0.0005). Subgroup analyses showed that AC significantly improved RFS in node-negative patients (HR: 2.16, p = 0.029), and RFS and OS in node-positive patients (HR: 2.03, p < 0.0001, and 2.02, p = 0.001, respectively). Conclusion: AC can be discussed with resectable stage IV CRC patients because of its significant survival-improving effects.
Efficacy of Dexamethasone Versus Fluticasone Nasal Sprays in Postoperative Patients With Chronic Rhinosinusitis With Nasal Polyps
Authors: Seiberling Kristin A. , Kidd Stephanie C. , Kim Grace H. , Church Christopher A. 
Published: April 2019

Background Topical nasal steroids are commonly prescribed to patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) following endoscopic sinus surgery (ESS). They are found to be effective in improving symptoms and quality of life as well as reducing the incidence of nasal polyps recurrence. Objective We sought to determine whether a higher concentration of topical nasal steroid spray is more effective than the standard nasal steroid spray in controlling symptoms and preventing recurrence of polyps in patients with CRSwNP who underwent ESS. Method A double-blind randomized controlled trial was performed on patients with CRSwNP after ESS. Patients were randomized into 2 treatment groups: one received topical nasal dexamethasone 0.032% and the other, fluticasone proprionate. The 22-item Sino-Nasal Outcome Test (SNOT-22) and Lund-Kennedy nasal endoscopy scores were measured at the initiation of topical nasal steroid treatment and then at approximately 4-, 8-, and 12-week intervals. Results Thirty-nine patients were enrolled in the study. Eighteen patients continued using the medications prescribed to them for the duration of the study. There were 8 patients in the dexamethasone group and 10 patients in the fluticasone group. Both groups saw significant improvements in postoperative SNOT-22 and Lund-Kenney scores over time. There was no significant difference in improvement between the groups. Conclusion There is no significant increased benefit in using a higher dose nasal steroid spray compared to the standard dose nasal steroid spray after ESS.
Influence of pharmacist intervention on drug safety of geriatric inpatients: a prospective, controlled trial
Authors: Nachtigall Angela , Heppner Hans J. , Thürmann Petra A. 
Published: April 2019

Background: Demographic shift leads to an increasing number of geriatric patients suffering from multimorbidity and resulting polypharmacy. Polypharmacy is shown to be associated with drug-related problems (DRPs) and increased morbidity. For Germany, a hospital-based intervention may be successful optimizing of polypharmacy. The aim of this study was to reduce DRPs in geriatric inpatients by a structured pharmacist’s intervention and to measure the acceptance rate of pharmaceutical recommendations. Methods: This study followed an open, prospective, quasi-randomized, controlled design and was conducted in a geriatric department in a teaching hospital in Germany. Patients of all sexes were included, with a minimum age of 70 years, a written informed consent and a regular intake of at least five drugs daily. Primary outcome was the percentage of patients having a DRP at admission and discharge. A DRP was defined as a prescription without indication or a relevant drug–drug interaction or prescription of a potentially inappropriate medication or presence of an adverse drug reaction. Recommendations were classified and discussed face to face. Statistical analyses were performed using a full-set analysis and a matched-pairs design. Results: Within 12 months, 411 patients were recruited with median age of 82 years (intervention: n = 209; control: n = 202). Median number of drugs at admission was 10 (range 5–24), at discharge 9 (range 3–21). In the intervention group, the percentage of patients with a DRP was reduced from 86.6% to 56.0%; in the control group, from 76.7% to 76.2% ( p value < 0.001). Medication appropriateness index score was reduced by 56% in the intervention group and by 0.2% in the control group ( p value < 0.001). Implementation rate of the pharmaceutical recommendation was 80%. Conclusion: This prospective controlled trial showed that a pharmacist’s intervention was successful in optimizing polypharmacy in geriatric inpatients.
Socio-demographic and economic factors are associated with nutritional status of adolescent school girls in Lay Guyint Woreda, Northwest Ethiopia
Authors: Arage Getachew , Assefa Mekonnen , Worku Teshager 
Published: April 2019

Objective: This study was aimed at assessing socio-demographic and economic factors associated with nutritional status of adolescent school girls in Lay Guyint Woreda, Northwest Ethiopia. Methods: The school-based cross-sectional study comprising 362 adolescent girls aged 10–19 years was included in the study. Simple random sampling technique with proportional allocation to size was used to select the participants. An interviewer-administered questionnaire and anthropometric measurement were used to collect the data. An anthropometric measurement was converted to the indices of nutritional status using World Health Organization Anthro Plus software. Result: The overall prevalence of stunting and thinness among adolescent girls were 16.3% and 29%, respectively. Adolescents aged 14–15 years (AOR = 3.65; 95% confidence interval: 1.87, 7.11), adolescents living in rural areas (AOR = 1.34; 95% confidence interval: 1.24, 2.33), and adolescents who did not have snack (AOR = 11.39; 95% confidence interval: 1.47, 17.8) were positively associated with stunting. Whereas mother’s occupation was negatively associated with stunting (AOR = 0.12; 95% confidence interval: 0.17, 0.87). Similarly, being a rural resident (AOR = 2.40; 95% confidence interval: 1.13, 5.08) and adolescents aged 14–15 years (AOR = 6.05; 95% confidence interval: 2.15, 17.04) were positively associated with thinness. Educational status of adolescent girls was negatively associated with thinness (AOR = 0.13; 95% confidence interval: 0.05, 0.35). Conclusion: Stunting and thinness are prevalent among adolescent girls. The age of adolescents, place of residence, having a snack, and mother’s occupation was significantly associated with stunting and thinness. Having at least a one-time snack in addition to the usual diet is strongly recommended.
Motion of the distal tibiofibular syndesmosis under different loading patterns: A biomechanical study
Authors: Hu Wan-kun , Chen Da-wei , Li Bing , Yang Yun-feng , Yu Guang-rong 
Published: April 2019

Purpose: The distal tibiofibular syndesmosis is an important structure for ankle stability. The objective of this study was to evaluate the motion of the syndesmosis under different loading patterns and determine the characteristics of the syndesmotic motion. Methods: Six fresh cadaveric lower extremity specimens with the knee reserved were tested in this study. The skin and muscles were removed with all ligaments around the syndesmosis and knee and ankle joint intact. An axial load of 600 N was applied to the specimens with the ankle joint in 10° dorsiflexion, neutral position, and 15° plantar flexion using a universal material testing machine. Then, with the ankle joint positioned neutrally, a combination of 600-N axial and 5-Nm torsional external rotation loading was applied to the specimens. The medial–lateral and anterior–posterior displacement and rotation of the distal fibula relative to the distal tibia were measured. Results: Under the axial loading, the distal fibula tended to move medially and anteriorly and rotate internally with the ankle positioned from the neutral position to 15° plantar flexion. Meanwhile, when the ankle was positioned from the neutral position to 10° dorsiflexion, the distal fibula tended to move laterally and posteriorly and rotate externally. Under the combined loading, with respect to the isolated axial loading, the distal fibula tended to move medially and posteriorly, and rotate externally relative to the distal tibia. Conclusion: Micro motion existed in the syndesmosis. The relative motion of the syndesmosis was correlated to the ankle position and loading patterns.
Effects of Perioperative Nonsteroidal Anti-inflammatory Drug Administration on Soft Tissue Healing: A Systematic Review of Clinical Outcomes After Sports Medicine Orthopaedic Surgery Procedures
Authors: Constantinescu David S. , Campbell Michael P. , Moatshe Gilbert , Vap Alexander R. 
Published: April 2019

Background: The effects of perioperative nonsteroidal anti-inflammatory drugs (NSAIDs) on soft tissue healing in humans have yet to be established. Purpose: To systematically review the literature addressing the effects of perioperative NSAID administration on soft tissue healing and clinical patient outcomes. Study Design: Systematic review; Level of evidence, 3. Methods: This review study was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. A review of the literature regarding the existing evidence for clinical effects of NSAID use on soft tissue healing was performed through use of the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed (1980 to present), and MEDLINE. Inclusion criteria for articles were as follows: outcome studies after soft tissue (ligament, meniscus, tendon, muscle) healing after surgical procedure with perioperative NSAID administration, at least 1 year of follow-up, English language, and human participants. Results: A total of 466 studies were initially retrieved, with 4 studies satisfying all inclusion criteria. Among the surgical procedures reported, 93% of the patients (4144/4451) underwent anterior cruciate ligament (ACL) reconstruction, 3% (120/4451) underwent rotator cuff repair, 3% (155/4451) underwent Bankart shoulder repair, and 1% (32/4451) underwent meniscal repair. The reported surgical failure rate among patients administered NSAIDs was 3.6% (157/4360). The reported surgical failure rate among control participants not given NSAIDs was 3.7% (147/3996). NSAID use showed no statistically significant effect on need for reoperation in meniscal repair ( P = .99), ACL reconstruction ( P = .8), and Bankart repair ( P = .8) compared with no NSAID administration. Celecoxib administration had a significantly higher rate of retear (37%) after rotator cuff repair compared with ibuprofen (7%) ( P = .009). Conclusion: Insufficient data are available to definitively state the effects of perioperative NSAIDs on soft tissue healing. Use of NSAIDs should be considered on a case-by-case basis and may not affect healing rates following either meniscal, ACL, rotator cuff, or Bankart repair. However, celecoxib (a selective COX-2 inhibitor) may inhibit tendon-to-bone healing in rotator cuff repair. Further research through clinical trials is required to fully determine whether NSAIDs have an adverse effect on soft tissue healing.
The Role of Heritage Impact Assessment in Safeguarding World Heritage Sites: Application Study on Historic Areas of Istanbul and Giza Pyramids
Authors: Yilmaz Yildirim , Gamil Rehab El 
Published: April 2019

This article aims to explore the role of heritage impact assessment (HIA) as a tool to safeguard world heritage sites from the adverse impacts of proposed projects as well as to recommend effective mitigation measures to create the balance between preservation and development. These mitigations will help the decision makers to take the right decision concerning the potential development. The methodology adopts a qualitative approach which is based on semi-structured interviews with site managers of two world heritage sites: historic areas of Istanbul in Turkey and the Giza pyramids in Egypt. Other interviews were conducted with some archaeologists and some governmental bodies in both countries to evaluate the level of awareness of HIA and assess the current and potential threats resulting from development proposals. Consequently, the article applies the HIA methodology to evaluate the potential impacts of proposed projects in both heritage sites. HIA can be an effective solution in order to eliminate the contradictions between the stakeholders investing in world heritage sites. The findings revealed that both world heritage sites are threatened by infrastructure and development projects. There is a lack of professionals who are able to conduct HIA methodology, thus Turkey and Egypt depend mainly on foreign experts to conduct it.
Cardiovascular care of patients with chronic myeloid leukemia (CML) on tyrosine kinase inhibitor (TKI) therapy
Authors: Barber Mary C. , Mauro Michael J. , Moslehi Javid 
Published: April 2019

Abstract
Cardiovascular (CV) health has emerged as an important consideration in patients with chronic myeloid leukemia (CML) because of improved prognosis. Indeed, the success of BCR-ABL1 tyrosine kinase inhibitors (TKIs) has increased the focus on survivorship and late toxicity in oncological care. Survivorship issues in this population include CV disease prevention, given its prevalence in the general population. The introduction of BCR-ABL1 TKIs represented a unique concept of indefinite cancer therapy, only recently evolving to include “treatment-free remission.” Importantly, later-generation BCR-ABL1 TKIs have been associated with CV complications. Dasatinib has been associated with pleural/pericardial effusions and pulmonary hypertension, whereas nilotinib and ponatinib have been linked to the development of vascular occlusive events. There is currently a dearth of data with respect to the mechanisms of drug toxicities, the subsets of patients at risk, and prevention and treatment strategies to mitigate CV complications in patients with CML. Nevertheless, optimal patient CV risk assessment needs to become a more central tenet of patient care in CML. We propose several practical considerations for the practicing oncologist relative to the CV health of patients with CML, especially those on chronic TKI therapy.
Iron deficiency in gynecology and obstetrics: clinical implications and management
Authors: Breymann Christian , Auerbach Michael 
Published: April 2019

Abstract
Iron deficiency is the commonest cause of anemia during pregnancy; however, its prevalence is highly determined by nutritional and socioeconomic status. Oral iron is the frontline therapy, but is often poorly tolerated. Awareness of the available intravenous formulations is essential for management. Before delivery, risk factors such as multiparity and heavy uterine bleeding increase the prevalence of iron deficiency and should be motivation for early diagnosis and treatment. Neonates born with iron deficiency have a statistically significant increment in both cognitive and behavioral abnormalities that persist after repletion, highlighting the need for heightened awareness of the diagnosis. A smartphone application providing information on nutrition and treatment is provided. New formulations of intravenous iron with carbohydrate cores, which bind elemental iron more tightly, minimize the release of labile free iron to allow complete replacement doses of intravenous iron in 15 to 60 minutes, facilitating and simplifying care.
Preventing venous thromboembolism during pregnancy and postpartum: crossing the threshold
Authors: Skeith Leslie 
Published: April 2019

Abstract
When should a patient with a known thrombophilia or prior venous thromboembolism (VTE) receive low-molecular-weight heparin (LMWH) prophylaxis during pregnancy and/or the postpartum period? Accurately predicting thrombotic and bleeding risks and knowing what to do with this information is at the heart of decision-making in these challenging scenarios. This article will explore the concept of a risk threshold from clinician and patient perspectives and provide guidance for the use of antepartum and postpartum LMWH prophylaxis in women with a known thrombophilia or prior VTE. Advice for the management of LMWH prophylaxis use around labor and delivery is also reviewed.
Diagnosis and management of postpartum ovarian vein thrombosis
Authors: Bannow Bethany T. Samuelson , Skeith Leslie 
Published: April 2019

Abstract
Case presentation: A 26-year-old woman experienced persistent fever (39.5°C), chills, and right-lower-quadrant tenderness 3 days after caesarean delivery. A computed tomography (CT) scan of the abdomen and pelvis with contrast revealed enlargement of her right ovarian vein with an associated intraluminal filling defect. What is the best treatment of this patient?
Chronic neutropenia in LGL leukemia and rheumatoid arthritis
Authors: Gazitt Tal , Loughran Thomas P. 
Published: April 2019

AbstractThis section reviews the diagnostic criteria and pathogenesis of large granular lymphocyte (LGL) leukemia. There is a particular focus on the overlap of LGL leukemia and rheumatoid arthritis (Felty's syndrome). Current understanding of the mechanisms of neutropenia in these disorders is discussed. Finally, treatment indications and therapeutic recommendations are outlined.