bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pediatric Gartland Type-IV Supracondylar Humeral Fractures Have Substantial Overlap with Flexion-Type Fractures
Authors: Mitchell Stuart L. , Sullivan Brian T. , Ho Christine A. , Abzug Joshua M. , Raad Micheal , Sponseller Paul D. 
Published: August 2019

Background:
Knowledge is limited about the diagnosis and treatment of modified Gartland type-IV supracondylar humeral fractures. We determined the prevalence of type-IV fractures, identified preoperative characteristics associated with these injuries, and assessed operative treatment characteristics.

Methods:
We retrospectively identified patients <16 years of age who underwent operative treatment of a supracondylar humeral fracture at 2 centers between 2008 and 2016. We compared patient, injury, and treatment characteristics between type-IV and type-III fracture groups (1:4, cases:controls). Preoperative radiographs were assessed by 4 pediatric orthopaedists blinded to fracture type. The odds of a fracture being type IV were assessed using univariate logistic regression for individual radiographic parameters. Significance was set at alpha = 0.05.

Results:
Type-IV fractures accounted for 39 (1.3%) of the supracondylar humeral fractures treated operatively during the study period. A type-IV fracture was associated with the following radiographic parameters: flexion angulation (odds ratio [OR] = 17; 95% confidence interval [CI] = 4.9 to 59), valgus angulation (OR = 5.6; 95% CI = 1.6 to 20), and lateral translation (OR = 4.1; 95% CI = 1.6 to 11) of the distal fragment; osseous apposition between the proximal and distal fragments (OR = 4.0; 95% CI = 1.8 to 9.0); and propagation of the fracture line toward the diaphysis of the proximal segment (OR = 9.2; 95% CI = 1.6 to 53). We found no significant differences in patient or injury characteristics between the groups. Compared with type-III fractures, type-IV fractures were treated more frequently with open reduction and percutaneous pinning (13% compared with 3.8%; p = 0.04) and were associated with longer mean operative time (82 ± 42 compared with 63 ± 28 minutes; p = 0.001).

Conclusions:
We identified 5 preoperative radiographic parameters associated with greater odds of a supracondylar humeral fracture being type IV rather than type III. No patient or injury characteristic differed significantly between the groups. Substantial overlap likely exists between type-IV and flexion-type fractures. Type-IV fractures were associated with longer operative time and were treated with open reduction more frequently than were type-III fractures.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
An Estimation of Lifetime Fatal Carcinogenesis Risk Attributable to Radiation Exposure in the First Year Following Polytrauma
Authors: Howard Anthony , West Robert , Iball Gareth , Panteli Michalis , Pandit Hemant , Giannoudis Peter V. 
Published: August 2019

Background:
The utilization of medical imaging continues to rise, including routine use in major trauma centers. The aims of this study were to estimate the amount of radiation exposure from radiographic imaging and the associated fatal carcinogenesis risk among patients treated for polytrauma at 1 institution.

Methods:
Included were patients who were admitted to our institution with an Injury Severity Score (ISS) of ≥16 during the period of January 2007 to December 2016. Records of patients were reviewed to assess exposures to radiation (excluding fluoroscopy) in the 12 months following injury. The risk of developing a fatal cancer of any type was modeled using patient age and sex, on the basis of the International Commission on Radiological Protection (ICRP) recommendations. Estimates of cancer risk were based on the exposure received and then imported into previously developed models.

Results:
Overall, 2,394 patients, with a mean ISS of 28.66 (range, 17 to 66), were included in our analysis. The mean total radiation dose received was 30.45 mSv and the median dose was 18.46 mSv. One hundred and fifteen patients (4.8% of the cohort) received ≥100 mSv of radiation. The total patient group had a 3.56% mean risk of fatal carcinogenesis of any type that related solely to medical exposure of radiation as a result of their injuries. In their lifetime, 85 patients would be expected to develop cancer as a result of medical imaging that they had undergone in the year following their accident. The ISS and the body region of injury contributing to the ISS were predictive of the level of radiation exposure.

Conclusions:
Those involved in trauma care can use the ISS and body region to predict radiation exposure and the risk of fatal carcinogenesis of any type. We found that, for injuries to the limb and pelvis, the greater the severity of injury, the greater the radiation exposure and fatal carcinogenesis risk. However, this study does not provide an actuarial analysis. It is unknown how many patients in the study went on to develop cancer.

Level of Evidence:
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Role of Ligament Stabilizers of the Proximal Carpal Row in Preventing Dorsal Intercalated Segment Instability
Authors: Pérez Alfonso J. , Jethanandani Rishabh G. , Vutescu Emil S. , Meyers Kathleen N. , Lee Steve K. , Wolfe Scott W. 
Published: August 2019

Background:
Isolated injuries of the scapholunate interosseous ligament (SLIL) are insufficient to produce dorsal intercalated segment instability. There is no consensus about which additional ligamentous stabilizers are critical determinants of dorsal intercalated segment instability. The aim of this study was to evaluate the role of the long radiolunate (LRL), scaphotrapeziotrapezoid (STT), and dorsal intercarpal (DIC) ligaments in preventing dorsal intercalated segment instability.

Methods:
Thirty fresh-frozen forearms were randomized to 5 ligament section sequences to study the SLIL, LRL, STT, and DIC ligaments. The DIC-lunate insertion (DICL) and scaphoid insertion (DICS) were studied separately; the DIC insertions on the trapezium and triquetrum were left intact. Loaded posteroanterior and lateral fluoroscopic images were obtained at baseline and repeated after each ligament was sectioned. After each sequence, the wrists were loaded cyclically (71 N). The radiolunate angle was measured with load. Dorsal intercalated segment instability was defined as an increase of >15° in the radiolunate angle compared with baseline.

Results:
Division of the SLIL did not increase the radiolunate angle. Section of the SLIL+LRL or SLIL+DICL significantly increased the radiolunate angle but did not produce dorsal intercalated segment instability. Section of the SLIL+STT or SLIL+DICL+DICS produced dorsal intercalated segment instability.

Conclusions:
In order to produce dorsal intercalated segment instability, complete scapholunate injuries require the disruption of at least 1 critical ligament stabilizer of the scaphoid or lunate (the STT or DICL+DICS).

Clinical Relevance:
When treating SLIL tears with dorsal intercalated segment instability, techniques to evaluate the volar and dorsal critical stabilizers of the proximal carpal row should be considered.
Preferred Single-Vendor Program for Total Joint Arthroplasty Implants
Authors: Boylan Matthew R. , Chadda Anisha , Slover James D. , Zuckerman Joseph D. , Iorio Richard , Bosco Joseph A. 
Published: August 2019

Background:
In total joint arthroplasty, variation in implant use can be driven by vendor relationships, surgeon preference, and technological advancements. Our institution developed a preferred single-vendor program for primary hip and knee arthroplasty. We hypothesized that this initiative would decrease implant costs without compromising performance on quality metrics.

Methods:
The utilization of implants from the preferred vendor was evaluated for the first 12 months of the contract (September 1, 2017, to August 31, 2018; n = 4,246 cases) compared with the prior year (September 1, 2016, to August 31, 2017; n = 3,586 cases). Per-case implant costs were compared using means and independent-samples t tests. Performance on quality metrics, including 30-day readmission, 30-day surgical site infection (SSI), and length of stay (LOS), was compared using multivariable-adjusted regression models.

Results:
The utilization of implants from the preferred vendor increased from 50% to 69% (p < 0.001), with greater use of knee implants than hip implants from the preferred vendor, although significant growth was seen for both (from 62% to 81% for knee, p < 0.001; and from 38% to 58% for hip, p < 0.001). Adoption of the preferred-vendor initiative was greatest among low-volume surgeons (from 22% to 87%; p < 0.001) and lowest among very high-volume surgeons (from 61% to 62%; p = 0.573). For cases in which implants from the preferred vendor were utilized, the mean cost per case decreased by 23% in the program’s first year (p < 0.001), with an associated 11% decrease in the standard deviation. Among all cases, there were no significant changes with respect to 30-day readmission (p = 0.449) or SSI (p = 0.059), while mean LOS decreased in the program’s first year (p < 0.001).

Conclusions:
The creation of a preferred single-vendor model for hip and knee arthroplasty implants led to significant cost savings and decreased cost variability within the program’s first year. Higher-volume surgeons were less likely to modify their implant choice than were lower-volume surgeons. Despite the potential learning curve associated with changes in surgical implants, there was no difference in short-term quality metrics.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Spatio-temporal characterization of S- and M/L-cone degeneration in the Rd1 mouse model of retinitis pigmentosa
Authors: Narayan Daniel S. , Ao Jack , Wood John P. M. , Casson Robert J. , Chidlow Glyn 
Published: August 2019

Abstract
Background
The Pde6brd1 (Rd1) mouse is widely used as a murine model for human retinitis pigmentosa. Understanding the spatio-temporal patterns of cone degeneration is important for evaluating potential treatments. In the present study we performed a systematic characterization of the spatio-temporal patterns of S- and M/L-opsin + cone outer segment and cell body degeneration in Rd1 mice, described the distribution and proportion of dual cones in Rd1 retinas, and examined the kinetics of microglial activation during the period of cone degeneration.

Results
Outer segments of S- and M/L-cones degenerated far more rapidly than their somas. Loss of both S- and M/L-opsin + outer segments was fundamentally complete by P21 in the central retina, and 90% complete by P45 in the peripheral retina. In comparison, degeneration of S- and M/L-opsin + cell bodies proceeded at a slower rate. There was a marked hemispheric asymmetry in the rate of S-opsin + and M/L-opsin + cell body degeneration. M/L-opsin + cones were more resilient to degeneration in the superior retina, whilst S-opsin + cones were relatively preserved in the inferior retina. In addition, cone outer segment and cell body degeneration occurred far more rapidly in the central than the peripheral retina. At P14, the superior retina comprised a minority of genuine S-cones with a much greater complement of genuine M/L-opsin cones and dual cones, whilst the other three retinal quadrants had broadly similar numbers of genuine S-cones, genuine M/L-cones and dual cones. At P60, approximately 50% of surviving cones in the superior, nasal and temporal quadrants were dual cones. In contrast, the inferior peripheral retina at P60 contained almost exclusively genuine S-cones with a tiny minority of dual cones. Microglial number and activity were stimulated during rod breakdown, remained relatively high during cone outer segment degeneration and loss of cone somas in the central retina, and decreased thereafter in the period coincident with slow degeneration of cone cell bodies in the peripheral retina.

Conclusion
The results of the present study provide valuable insights into cone degeneration in the Rd1 mouse, substantiating and extending conclusions drawn from earlier studies.
Accuracy of the lower third molar radiographic imaging to estimate age among Ugandan young people
Authors: Mwesigwa Catherine Lutalo , Kutesa Annet Mutebi , Munabi Ian Guyton , Kabenge Catherine Ann , Buwembo William 
Published: August 2019

Abstract
Objective: Dental development is a useful method for age estimation. Although third molar eruption is commonly used to estimate age in Uganda, it is reported to be unreliable because of external influences. The more reliable radiographic techniques have inter-ethnic differences but data from sub-Saharan Africa are limited regarding estimating age in young adults. This study, therefore, aimed at determining the accuracy of Demirjian’s classification of the lower third molar, a common dental age estimation method, in estimating key ages in a Ugandan population using Ugandan references. Dental records of 1021 Ugandans aged 10-22 years were assigned to two groups; reference and test. The reference data was retrieved from a database of a previous bigger research project.
Results: The overall sample population comprised of 514/1021 (50.3%) males. The mean age was 15.8 (3.6) years. No significant sex differences in dental age were established in the reference sample (520 records). Accuracy values (area under the curve) at the 12-, 14-, 16- and 18-year-cut-offs were between 0.83 and 0.90 using the test sample (501 records). The results suggest that Demirjian’s classification of the lower third molars is a useful method for age estimation in the young urban Ugandan population in the 10-22-year age-group.
An assessment for Diagnostic and Therapeutic Modalities for Management of Pediatric Iron Defficiency Anemia in Saudi Arabia: a Crossectional Study
Authors: Sulayyim Hadi J Al , Omari Ali Al , Badri Motasim 
Published: August 2019

Abstract
Background: Iron deficiency anemia (IDA) is a global public health issue that affect more than 2 billion individuals worldwide. However evidence for optimal management of IDA is lacking. Objectives: To assess the diagnostic criteria and therapeutic modalities for pediatric IDA employed by physicians in a major public healthcare facility in Riyadh. Methodology: A validated questionnaire including demographic data and patient case-scenarios related to diagnosis and treatment of IDA was employed. Robust regression analysis was used to identify factors associated with overall score of participants. Results: Of the 166 physicians surveyed 147(88.6%) were included in the study. Wide variability was observed in IDA diagnosis and therapy practises. For nutritional IDA, only 15.6% recommended no other laboratory tests in addition to CBC. The majority preferred treatment with ferrous sulfate (77.6%) divided into two doses (57.1%), but the total daily elemental iron doses varied widely from 2 to 6 mg/kg. For intravenous iron, 42.9% recommended iron dextran, 32.7% iron sucrose, and 13.4% would continue oral iron. Of all assessed factors, median score was significantly highest in pediatric hematologists compared with pediatricians, family medicine specialists and GPs; p=0.007, and those work in tertiary care compared with those in primary care; p=0.043. However, in multivariate robust regression analysis, overall score was only significantly associated with professional qualification pediatric hematologist β=13.71,95%CI 2.48-24.95, p=0.017; pediatrician β=1.77,95%C (-6.05-9.59, p=0.66; family medicine β=2.66,95%CI-4.30-9.58, p=0.45 compared with general practitioner. Conclusion: Wide variations exist among physicians in diagnosis and treatment of pediatric IDA. Intervention programs and national guidelines are urgently needed.
Continuing evolution of H6N2 influenza A virus in South African chickens and the implications for diagnosis and control
Authors: Abolnik Celia , Strydom Christine , Rauff Dionne Linda , Wandrag Daniel Barend Rudolph , Petty Deryn 
Published: August 2019

Abstract
Background: The threat of poultry-origin H6 avian influenza viruses to human health emphasizes the importance of monitoring their evolution. South Africa’s H6N2 epidemic in chickens began in 2001 and two co-circulating antigenic sub-lineages of H6N2 could be distinguished from the outset. The true incidence and prevalence of H6N2 in the country has been difficult to determine, partly due to the continued use of an inactivated whole virus H6N2 vaccine and the inability to distinguish vaccinated from non-vaccinated birds on serology tests. In the present study, the complete genomes of twelve H6N2 viruses isolated from various farming systems between September 2015 and February 2019 in three major chicken-producing regions were analysed and a serological experiment was used to demonstrate the effects of antigenic mismatch in diagnostic tests.
Results: Genetic drift in H6N2 continued and antigenic diversity in sub-lineage I is increasing; no sub-lineage II viruses were detected. Reassortment patterns indicated epidemiological connections between provinces as well as different farming systems, but there was no reassortment with wild bird or ostrich influenza viruses. The sequence mismatch between the official antigens used for hemagglutination inhibition (HI) testing and circulating field strains has increased steadily, and we demonstrated that these antigens are likely to miss H6N2 field infections. More concerning, sub-lineage I H6N2 viruses have acquired three of the nine HA mutations associated with human receptor-binding preference (A13S, V187D and A193N) since 2002. Most sub-lineage I viruses isolated since 2015 have acquired the K702R mutation in PB2 associated with the ability to infect humans, whereas prior to 2015 most viruses in sub-lineages I and II contained the avian lysine marker. All strains had an unusual HA0 motif of PQVETRGIF or PQVGTRGIF.
Conclusions: The H6N2 viruses in South African chickens are mutating and reassorting amongst themselves but have remained a genetically pure lineage since they emerged more than 18 years ago. Greater efforts must be made by government and industry in the continuous isolation and characterization of field strains for use as HI antigens, new vaccine seed strains and to monitor the zoonotic threat of H6N2 viruses.
Prevalence of modern contraceptive utilization and associated factors among women of reproductive age from 36-49 years in Ethiopia, 2018: Community based cross-sectional survey
Authors: Zena Dereje , Asrat Anemaw , Fentahun Agumas 
Published: August 2019

Abstract
IIntroduction: Modern Contraceptive use allows people to attain their desired number of children and determine the spacing of pregnancies. Objective: The main objective of this study is to assess the Prevalence of modern contraceptive utilization and associated factors among women of reproductive age from 36-49 years in Ethiopia. Methodology: A community based, cross-sectional study was employed from January 1 to June 30, 2016, among women of reproductive age from 36-49 years in all regions of Ethiopia. A bivariate, multivariable logistic regression model was fit and statistical significance was determined with odds ratios and 95 % confidence level. Result: The overall modern contraceptive prevalence rate was found to be 17%. Being wealthy (Adjusted Odds Ratio=4.120 95%CI (2.853, 5.949), higher educated (Adjusted Odds Ratio =3.329, 95%CI (2.065, 5.368) and having more numbers of living children (Adjusted Odds Ratio =1.714, 95% (1.328, 2.212) was significantly associated with use of modern contraceptive methods. Conclusion: The utilization of modern contraceptive method was low. Contraceptive utilization was associated with some socio-economic and socio-demographic factors like age, educational status, women wealth index and number of children. Keywords: modern Contraceptives use, Associated Factors and Women
Identification of quantitative trait loci and the exploration of candidate genes for the tolerance to Zn deficiency in maize
Authors: Xu Jianqin , Zhu Xiaoyang , Fu Xiuyi , Yu Futong 
Published: August 2019

Abstract
Background

Zn is essential for plants and Zn deficiency leads to great reduction in quality and quantity of crops. Maize, as one of the most important main staple crops worldwide, is more susceptible to Zn deficiency than any other cereal crops. Therefore, understanding the functional mechanisms in tolerance to Zn deficiency in maize is urgent but is still lacking. In this study, quantitative trait loci (QTL) analysis in K22 and By815 RIL population with high-density bin map was conducted to investigate genetic basis of the mechanisms in maize to tolerate Zn deficiency, subsequently some candidate genes were identified and considered as being associated with Zn metabolisms in plants.

Results

21 QTLs were detected and accounted for 5.9% - 16.6% of phenotypic variations. Based on the co-localization in this study and the comparisons with previous studies in different RIL and GWAS populations, 223 candidate genes were identified inside the reduced QTL peak intervals on chromosome 1, 2, 6, 7 and 9. Furthermore, 9 genes detected within the peak bins of valuable genomic regions are suggested to be associated with ions transportation and some redox processes affected by Zn deficiency. Additionally, 5 genes, including ZmIRT1, ZmNRAMP6, ZmEIN2 and ZmHMAs, whose homologous gene have been studied and considered to be responsible for metal cations transportation and ethylene-signaling pathway requiring a transition metal were discovered in 5 loci we mapped.

Conclusions

14 target genes identified in 9 loci we mapped in this work were explored to elucidate the potential functions in Zn homeostasis and the direct or indirect effects on mechanisms in Zn deficiency tolerance in maize. It is the first time that ZmIRT1, ZmNRAMP6, ZmHMAs were identified using linkage analysis under Zn deficiency in maize, providing genetic evidence and foundation for further gene functional characterization. Our findings have assisted us untangling the genetic basis of possible mechanisms in response to Zn deficiency in maize.