bluuebunny/crossref_metadata_2025_split huggingface dataset:
Joint Contact Changes With Undersized Prosthetic Radial Heads
Authors: Bachman Daniel R. , Park Sangeun , Thaveepunsan Sutee , Fitzsimmons James S. , An Kai-Nan , O'Driscoll Shawn W. 
Published: August 2018

Objective:
To evaluate the effect of intentional undersizing of prosthetic radial head implant diameters on joint contact pressures.

Methods:
Eight fresh-frozen cadaveric elbows were aligned in neutral extension and loaded with 100 N using a custom testing apparatus. Radiocapitellar contact pressures were recorded using a Tekscan thin-film pressure sensor. Prosthetic radial head replacement was performed with 2 prostheses: the Anatomic Radial Head and the Evolve Proline Radial Head prostheses. Each design was sized according to the manufacturer's recommendations and then again using 2-mm smaller radial heads.

Results:
Average and peak pressures were significantly higher with the Evolve than the Anatomic prostheses (P < 0.03 and 0.02, respectively). Peak pressures decreased from 4.2 ± 0.5 MPa to 2.9 ± 0.3 MPa for the Anatomic Radial Heads and from 5.6 ± 0.5 MPa to 3.9 ± 0.6 MPa when the Evolve Radial Heads were undersized by 2 mm. The mean pressures of the Anatomic Radial Heads (1.4 ± 0.1 MPa) did not change significantly with undersizing (1.3 ± 0.1 MPa, P = 0.12), whereas the mean pressures of the Evolve Radial Heads (1.6 ± 0.1 MPa) were significantly reduced with undersizing (1.4 ± 0.1 MPa, P < 0.02).

Conclusion:
Both mean and peak pressures were initially high for the Evolve Radial Head sized based on the short axis diameter and were improved with further undersizing by 2 mm. Peak, but not mean, contact pressures were improved by undersizing the Anatomic prosthesis based on the long axis diameter.

Clinical Relevance:
These findings support the clinical recommendation of some surgeons to undersize the Evolve prosthesis by 2-mm smaller diameter than the current manufacturer's suggestion and give reason to consider doing the same for the Anatomic prosthesis.
Klhl14 Antisense RNA is a Target of Key Skeletogenic Transcription Factors in the Developing Intervertebral Disc
Authors: Kraus Petra , Sivakamasundari V. , Olsen Victoria , Villeneuve Victoria , Hinds Abbey , Lufkin Thomas 
Published: August 2018

Study Design.
RNA in situ hybridization (RISH) allows for validation and characterization of the long noncoding (lnc) natural antisense RNA (NAT) Klhl14as in the embryonic murine intervertebral disc (IVD) in the context of loss-of-function mutants for key transcription factors (TFs) in axial skeleton development.

Objective.
Validation of Klhl14as in the developing murine IVD.

Summary of Background Data.
The IVD is a focus of regenerative medicine; however, processes and signaling cascades resulting in the different cell types in a mature IVD still require clarification in most animals including humans. Technological advances increasingly point to implications of lnc NATs in transcription/translation regulation. Transcriptome data generation and analysis identified a protein encoding transcript and related noncoding antisense transcript as downregulated in embryos devoid of key TFs during axial skeleton development. Here, primarily, the antisense transcript is analyzed in this loss-of-function context.

Methods.

4930426D05Rik and 6330403N15Rik were identified as Klhl14as and sense, respectively, two transcripts downregulated in the vertebral column of midgestation Pax1 and Pax9 mutant mouse embryos. RISH on wildtype and mutant embryos for the TF encoding genes Pax1/Pax9, Sox5/Sox6/Sox9, and Bapx1 was used to further analyze Klhl14as in the developing IVD.

Results.

Klhl14as and Klhl14 were the top downregulated transcripts in Pax1

-/-

; Pax9

-/-
E12.5 embryos. Our data demonstrate expression of Klhl14as and sense transcripts in the annulus fibrosus (AF) and notochord of the developing IVD. Klhl14as expression in the inner annulus fibrosus (iAF) seems dependent on the TFs Pax1/Pax9, Sox6, Sox9, and Bapx1.

Conclusion.
We are the first to suggest a role for the lncRNA Klhl14as in the developing IVD. Our data link Klhl14as to a previously established gene regulatory network during axial skeleton development and contribute further evidence that lnc NATs are involved in crucial gene regulatory networks in eukaryotic cells.

Level of Evidence: N/A.
Correlation Between Postoperative Distribution of Lordosis and Reciprocal Progression of Thoracic Kyphosis and Occurrence of Proximal Junctional Kyphosis Following Surgery for Adult Spinal Deformity
Authors: Ohba Tetsuro , Ebata Shigeto , Oba Hiroki , Koyama Kensuke , Haro Hirotaka 
Published: August 2018

Study Design:
This was a retrospective cohort study using consecutive patients.

Objectives:
The objectives of this study were to evaluate the effect of lumbar lordosis (LL) construction on postoperative reciprocal progression of thoracic kyphosis (TK) and occurrence of proximal junctional kyphosis (PJK) following surgery for adult spinal deformity (ASD).

Summary of Background Data:
A large postoperative TK has been reported as an iatrogenic risk factor for PJK following surgery for ASD. Therefore, knowing how to anticipate and regulate postoperative reciprocal progression in TK with LL restorative surgery is important to prevent PJK. The LL proportion including distribution of the lordosis (lordosis distribution index: LDI) in the lower (L4–S1) and upper (L1–L3) arcs has been known as important because it alters the distribution of load. However, the influence of postoperative LL construction on postoperative reciprocal change in TK resulting in PJK is largely unknown.

Methods:
Sixty-six consecutive patients with ASD treated with LL restorative surgery with a fusion level consistently selected from T8–T10 to the pelvis and followed-up for a minimum of 1 year. Abnormal PJK was evaluated according to the Boachie-Adjei classification. Roland-Morris Disability Questionnaire and Oswestry Disability Index were measured at 1 year after surgery.

Results:
The prevalence of PJK in the present study was 33.3%. Outcomes of patients with PJK were significantly worse than in patients without PJK, regardless of PJK grade. Postoperative reciprocal progression in TK with LL restorative surgery was found. Preoperative risk factors of PJK were older age and smaller sacral slope angle. Postoperative risk factors for PJK included increased TK and decreased LDI. We found a strong correlation between postoperative LDI and reciprocal progression of TK resulting in PJK.

Conclusions:
Postoperative LDI is crucial to prevent excess reciprocal progression of TK resulting in PJK.
Multiple-Level Lumbar Total Disk Replacement
Authors: Rasouli Alexandre , Cuellar Jason M. , Kanim Lea , Delamarter Rick 
Published: August 2018

Background:
Recent studies demonstrate the efficacy of lumbar arthroplasty using the ProDisc-L. Patients frequently present with multilevel pathology and may be candidates for multilevel disk replacement.

Purpose:
To evaluate clinical outcomes and sagittal range of motion of operated levels and adjacent lumbar motion segments in multiple-level ProDisc-L constructs after 2–6 years follow-up.

Patient Sample:
A total of 159 patients underwent adjacent 2-level (n=114), 3-level (n=41), or 4-level (n=4) lumbar total disk replacement (TDR).

Study-Design:
This is a prospective cohort.

Outcome Measures:
Clinical measures: Oswestry Disability Index and Visual Analog Score of patient satisfaction (VAS-S) and pain (VAS-P) data were collected. Radiographic measures: sagittal motion on preoperative and postoperative lumbar radiographs at each operative segment and adjacent segment.

Methods:
Patients were evaluated with radiographic and clinical outcomes measures preoperatively, at 6 weeks, 3 months, 6 months, and annually for 24–72 months postoperatively.

Results:
Radiographic: at the motion segment adjacent to the TDR, mean preoperative range of motion (ROM) was 8.20±2.88 degrees, compared with 8.40±2.4 degrees postoperatively at last follow-up (P>0.05). Between the 3 TDR groups, there were no significant differences in ROM at any time point except at L5–S1. Across both groups for TDR motion segments, the mean preoperative ROM was 10.15±2.71 versus 12.30±2.25 degrees postoperatively (P=0.011) at last follow-up. At L5–S1 mean preoperative motion was 7.60±3.90 versus 5.81±3.1 degrees postoperatively (P=0.60). Clinical: at 24–72 months postoperatively, all patients had significant reductions in Oswestry Disability Index, VAS-P, and VAS-S scores (P<0.05). At up to 72 months of follow-up, no patient underwent adjacent-level surgery but there were 3 cases of index-level revision surgery.

Conclusions:
Multilevel TDR preserves ROM at the individual TDR levels. Most significantly, the nonoperative adjacent level maintains its preoperative ROM at 2–6 years postoperatively. At up to 6 years of follow-up, there has been no need for revision or adjacent-segment surgery. Patients also demonstrate significant improvement in pain and disability at latest follow-up.
Intersphincteric Resection Has Similar Long-term Oncologic Outcomes Compared With Abdominoperineal Resection for Low Rectal Cancer Without Preoperative Therapy: Results of Propensity Score Analyses
Authors: Tsukamoto Shunsuke , Miyake Mototaka , Shida Dai , Ochiai Hiroki , Yamada Kazunosuke , Kanemitsu Yukihide 
Published: August 2018

BACKGROUND:
Intersphincteric resection has been performed for very low rectal cancer in place of abdominoperineal resection to avoid permanent colostomy.

OBJECTIVE:
This study aimed to evaluate long-term oncologic outcomes of intersphincteric resection compared with abdominoperineal resection.

DESIGN:
In this retrospective study, propensity score matching and stratification analyses were performed to reduce the effects of confounding factors between groups, including age, sex, BMI, CEA value, tumor height, tumor depth, lymph node enlargement, and circumferential resection margin measured by MRI.

SETTING:
A database maintained at our institute was used to identify patients during the period between 2000 and 2014.

PATIENTS:
A total of 285 patients who underwent curative intersphincteric resection (n = 112) or abdominoperineal resection (n = 173) for stage I to III low rectal cancer without preoperative chemoradiotherapy were enrolled in this study.

MAIN OUTCOME MEASURE:
The main outcome was recurrence-free survival.

RESULTS:
Patients in the abdominoperineal resection group were more likely to have a preoperative diagnosis of advanced cancer before case matching. After case matching, clinical outcomes were similar between intersphincteric resection and abdominoperineal resection groups. Five-year relapse-free survival rates were 69.9% for the intersphincteric resection group and 67.9% for abdominoperineal resection group (p = 0.64), and were similar in the propensity score-matched cohorts (89 matched pairs). Three-year cumulative local recurrence rates were 7.3% for intersphincteric resection and 3.9% for abdominoperineal resection (p = 0.13). In the propensity score-matched model, the hazard ratio for recurrence after intersphincteric resection in comparison with abdominoperineal resection was 0.90. Stratification analysis revealed similar recurrence rates (HR, 0.75–1.68) for intersphincteric resection in comparison with abdominoperineal resection.

LIMITATION:
Eight covariates were incorporated into the model, but other covariates were not included.

CONCLUSIONS:
Our findings suggest similar oncologic outcomes for intersphincteric resection and abdominoperineal resection without preoperative chemoradiotherapy in patients with low rectal cancer adjusted for background variables. See Video Abstract at http://links.lww.com/DCR/A661.
Perioperative Transcutaneous Tibial Nerve Stimulation to Reduce Postoperative Ileus After Colorectal Resection: A Pilot Study
Authors: Venara Aurélien , Bougard Marie , Mucci Stéphanie , Lemoult Annabelle , Le Naoures Paul , Darsonval Astrid , Barbieux Julien , Neunlist Michel , Hamy Antoine P. 
Published: August 2018

BACKGROUND:
Postoperative ileus involves an inflammatory pathway characterized by an increase of inflammation mediators in the colon wall; this could probably be prevented by sacral nerve neuromodulation. The posterior tibial nerve can be stimulated electrically to mimic neuromodulation.

OBJECTIVE:
The aims of this study were to assess the efficacy of transcutaneous posterior tibial nerve stimulation in reducing the delay in GI motility recovery, to assess the safety of posterior tibial nerve stimulation in a perioperative setting, and to assess the efficacy of posterior tibial nerve stimulation in reducing the occurrence of postoperative ileus.

DESIGN:
This was a preliminary randomized controlled study.

SETTINGS:
This study was conducted in 1 academic hospital in France.

PATIENTS:
Forty patients undergoing an elective colectomy were included and randomly assigned into 2 groups, posterior tibial nerve stimulation or placebo, according to the side of colectomy and the surgical access size.

INTERVENTION:
Perioperative posterior tibial nerve stimulation or placebo was performed 3 times per day according to the randomly assigned group.

MAIN OUTCOME MEASURES:
Delay in GI motility recovery (passage of stool and tolerance of solid food) was measured.

RESULTS:
Of the 40 patients included, 34 were included in the final analysis, in which 2 patients in the placebo group were allocated the incorrect device. The 6 other patients were secondarily excluded because of protocol deviation. In the intention-to-treat analysis, the mean delay in GI motility recovery was 3.6 and 3.11 days (in the placebo and tibial nerve stimulation groups; p = 0.60). Occurrence of postoperative ileus was not significantly higher in the placebo group (35.3% vs 17.6%; p = 0.42). In the per-protocol analysis, we observed the same trends except for the occurrence of postoperative ileus, which was significantly higher in the placebo group (p = 0.045). Tolerance to posterior tibial nerve stimulation was good, and all of the patients completed the protocol.

LIMITATIONS:
The amplitude of stimulation is set according to patient sensation, so some patients could have been aware of their group. In addition there were some inherent limitations because of the preliminary nature of the study and several deviations from the protocol.

CONCLUSIONS:
Posterior tibial nerve stimulation was safe in a perioperative setting and had a potential effect on GI motility recovery. The results of this study will be useful for sample size calculations in a larger prospective randomized trial. See Video Abstract at http://links.lww.com/DCR/A708.
Stress Distribution Patterns within Viscero- and Neurocranium during Nasoalveolar Molding: a Finite Element Analysis
Authors: Ritschl Lucas M. , Heinrich Veronika , Grill Florian D. , Roth Maximilian , Hedderich Dennis M. , Rau Andrea , Wolff Klaus-Dietrich , Bauer Franz X. , Loeffelbein Denys J. 
Published: August 2018

Background:
The purpose of this study was to evaluate the stress distribution patterns within the viscero- and neurocranium of neonates during nasoalveolar molding.

Methods:
Finite element models of 3 different healthy neonates at different times of life (date of birth, 4 weeks, and 3.5 months) were generated on the basis of computed tomography scans. A validated workflow, including segmentation, meshing, setting of boundary conditions, and implementation of a bone density–dependent material model, was carried out for each model. A small and a large unilateral alveolar and hard palatal cleft were virtually cut in each model. The stress distribution pattern in each model was then analyzed by using Ansys APDL.

Results:
Convergence analysis validated the results. The virtual experiments at the date of birth showed a stress pattern above a previously defined threshold value of 30,000 Pa in the ipsilateral naso-orbital-complex, frontal sinus, and the anterior fossa of the base of the skull, with von Mises values > 35,000 Pa. Stress patterns at the age of 4 weeks and 3.5 months showed reduced von Mises values at < 15,000 Pa.

Conclusions:
Nasoalveolar molding therapy is a safe presurgical treatment modality without significant influence on the viscero- and neurocranium of neonates. Treatment, considering the stress distribution at the naso-orbital-complex and anterior fossa of the base of the skull, should begin in the second week of life, and treatment initiation of preterm infants should be adapted respectively.
Shaping a Flap Using a Bioabsorbable Mold—A Preliminary Report
Authors: Nishibayashi Akimitsu , Tomita Koichi , Taminato Mifue , Yano Kenji , Hosokawa Ko 
Published: August 2018

Background:
We previously reported that good surgical outcomes can be obtained with breast mold made by 3-dimensional printing. However, detailed breast shape is often difficult to create. Accordingly, we aimed to determine whether transplanting a flap and bioabsorbable mold in vivo would yield better results by retaining the flap shape inside the mold during the scar formation period.

Methods:
Vascularized adipose flaps were elevated in the bilateral inguinal region of male Sprague-Dawley rats (n = 7). A cone-shaped, bioabsorbable mold (LactoSorb mesh) was created using a template. On the experimental side, the flap was inserted into the mold and fixed. On the control side, a conical flap was created using absorbable sutures, based on a template.

Results:
The flaps were harvested 3 months postoperatively, and flap volume, base area, and projection were measured with 3-dimensional imaging. Volume and base area on the mold side tended to be smaller than those on the control side (P = 0.18 and 0.13, respectively) and close to the values of the template. In addition, the ratio of projection and base area value was significantly greater on the mold side than on the control side (P = 0.04). Histology revealed little inflammatory cell invasion, and scar tissue thickness around the flap showed no significant difference between the 2 groups (P = 0.76).

Conclusions:
This study demonstrated that soft-tissue morphology can be controlled to some extent with a bioabsorbable mold. Its clinical application in breast reconstruction requires further investigation.
MACULAR VORTEX VEIN IN A HIGHLY MYOPIC EYE IMAGED BY OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY
Authors: Kaplan Richard I. , Walsh Joseph B. , Rosen Richard B. , Gupta Meenakashi 
Published: August 2018

Purpose:
To report a case of macular vortex vein imaged with indocyanine green angiography, spectral domain optical coherence tomography, and optical coherence tomography angiography.

Methods:
Observational case report.

Results:
A 51-year-old myopic man presented with the complaint of a floater in his left eye for the previous 2 weeks. His visual acuity was 20/25 in the right eye and 20/40 in the left eye. Biomicroscopy was normal. Retinoscopy revealed lattice degeneration and posterior vitreous detachment of both eyes with dilated submacular vasculature in the right eye and submacular hemorrhage in the left eye. Spectral domain optical coherence tomography demonstrated dilated vessels in the choroid of the right eye and a choroidal neovascular membrane in the left eye. Fluorescein angiography and indocyanine green angiography showed a macular vortex vein in the right eye. Optical coherence tomography angiography demonstrated normal vessel densities in the superficial and deep capillary plexuses. No abnormalities were detected in the outer retina or choriocapillaris. Optical coherence tomography angiography delineated the macular vortex vein with a relative flow void in the right eye. His vision remained stable in the right eye.

Conclusion:
Macular vortex veins may be a prominent, albeit rare, incidental finding in highly myopic eyes. Further studies with application of newer optical coherence tomography angiography modalities, such as swept-source optical coherence tomography angiography, are recommended to improve our understanding and monitoring of these structures.
Using Charlson Comorbidity Index to Predict Short-Term Clinical Outcomes in Hospitalized Older Adults
Authors: Sinvani Liron , Kuriakose Roshini , Tariq Sara , Kozikowski Andrzej , Patel Vidhi , Smilios Christopher , Akerman Meredith , Qiu Guang , Makhnevich Alex , Cohen Jessica , Wolf-Klein Gisele , Pekmezaris Renee 
Published: August 2018

ABSTRACT
This study examined the prognostic value of the Charlson Comorbidity Index (CCI) in predicting short-term clinical outcomes in hospitalized older adults. We conducted a retrospective cohort study of patients, older than 75 years, admitted to the medicine service at a large tertiary hospital (New York). We used the Enhanced International Classification of Disease, 9th Revision, Clinical Modification adaptation to abstract the CCI from electronic medical records. The CCI scores were compared, using the standard Deyo version and the Schneeweiss version. Outcome measures included in-hospital mortality, length of stay (LOS), and 30-day readmissions. When comparing Charlson/Deyo and Charlson/Deyo/Schneeweiss with and without age, we found similar significant association with regard to in-hospital mortality, with a moderate predictive ability (area under the curve [AUC]: 0.5906–0.6433). However, for 30-day readmissions and LOS, the predictive ability was poor (AUC: 0.5598–0.6106 and ρ: 0.11–0.12, respectively). The CCI is, at most, a moderate predictor of in-hospital mortality and a poor predictor of other important healthcare outcomes relevant to administrative healthcare practices.
An Educational Intervention Using Steno Balance Cards to Improve Glycemic Control in Patients With Poorly Controlled Type 2 Diabetes Mellitus
Authors: WU Yueh-Chu , KORNELIUS Edy , YANG Yi-Sun , CHEN Yih-Fen , HUANG Chien-Ning 
Published: August 2018

ABSTRACT

Background:
Type 2 diabetes mellitus (T2DM) is largely attributableto lifestyle factors. Although physiological and medical care needs must be met, psychosocial factors should not be neglected.

Purpose:
The aim of this study was to determine whether a 6-month intervention consisting of educational sessions using Steno Balance Cards, which involves guided group dialogue, resulted in better glycemic outcomes than conventional diabeteseducation.

Methods:
Patients with T2DM whose glycolated hemoglobin A1c levels were higher than 8% were recruited from September to October 2015. Ninety-two patients were assigned to either the psychosocial balance dialogue (PBD) group (n = 46) or the standard care (SC) group (n = 46). The PBD group received instructions about diabetes using the Steno “Balance Card” method, which involves the use of themed picture cards to elicit group dialogue. The Balance Cards were developed by the Danish Steno Diabetes Center. In the SC group, patients received general diabetes education using a conventional teachingmode.

Results:
In the PBD group, glycolated hemoglobin A1c decreased 1.3% from 8.1% ± 0.7% to 6.8% ± 0.8%, whereas it decreased 0.6% in the SC group from 8.0% ± 0.6% to 7.4% ± 0.7%, with p < .05. At the end of the 6-month study period, the PBD group and the SC group completed a health-related quality of life questionnaire(12-item Short-Form Health Survey) and a well-being index (WHO-5) questionnaire. In the PBD group, the difference before and after the intervention showed that the well-being (WHO-5) score increased by 45.4 points, whereas the physiological score increased by 28.0, and the mental component score increased by 29.0. In the SC group, the well-being (WHO-5) score increased by 6.4, whereas the physiological score increased by 4.7, and the mental component score increased by 9.6. There were statistically significant differences in questionnairescores between the two groups (p < .05).

Conclusions/Implications for Practice:
The results of this study indicate that the dialogue sessions using Steno Balance Cards are beneficial for patients with T2DM in terms of improved glycemic control and quality of life.