bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinically Isolated Syndrome and Early Relapsing Multiple Sclerosis
Authors: Metz Luanne M. 
Published: June 2019

ABSTRACT

PURPOSE OF REVIEW
This article reviews management of clinically isolated syndrome and early relapsing-remitting multiple sclerosis (MS). It provides a general approach to patient management and determination of prognosis, reviews first-line disease-modifying therapies, and provides an approach to treatment selection.

RECENT FINDINGS
Revision of the MS diagnostic criteria allows an earlier MS diagnosis, which reduces diagnostic uncertainty and often allows additional treatment options. Identification of factors that influence disease activity and progression highlights the importance of counseling patients about behavior modifications that, along with disease-modifying therapy, may improve long-term outcomes. Recommended lifestyle modifications include smoking cessation, vitamin D supplementation, a healthy diet, maintaining a healthy weight, remaining active, and management of cardiovascular risk factors. Identifying individuals at high risk for future disability allows them to make informed decisions about the use of highly effective, higher-risk disease-modifying therapies.

SUMMARY
Patients with clinically isolated syndrome, even those with only dissemination in space but not dissemination in time, and patients with relapsing-remitting MS and disease activity within the prior 2 years, are at high risk of disease activity within the next 2 years. Lifestyle modification suggestions and disease-modifying therapy should be considered. Treatment decisions should be made in collaboration with patients using the shared decision-making approach.
Pregnancy and Family Planning in Multiple Sclerosis
Authors: Langer-Gould Annette M. 
Published: June 2019

ABSTRACT

PURPOSE OF REVIEW
This article provides practical guidance on successful management of women with multiple sclerosis (MS) through pregnancy and the postpartum period.

RECENT FINDINGS
Recent studies indicate that most women diagnosed with MS today can have children, breast-feed, and resume beta interferons or glatiramer acetate per their preferences without incurring an increased risk of relapses during the postpartum period. More than 40% of women with mild MS do not require any treatment before conception or in the postpartum period. Women with highly active MS can now become well-controlled before, throughout, and after pregnancy via highly effective treatments. Unfortunately, pregnancy does not protect against relapses following the cessation of fingolimod or natalizumab, and some women experience severe rebound relapses during pregnancy. Accidental first-trimester exposure to teriflunomide or fingolimod increases the risk of fetal harm.

SUMMARY
Most women with MS can have normal pregnancies and breast-feed without incurring harm. Clinicians should avoid prescribing medications with known teratogenic potential (teriflunomide, fingolimod), known risk of severe rebound relapses (fingolimod, natalizumab), or unclear but plausible risks (dimethyl fumarate, alemtuzumab) to women of childbearing age who desire pregnancy or are not on reliable birth control. If a treatment needs to be resumed during breast-feeding, clinicians should opt for glatiramer acetate, interferon beta, natalizumab, or rituximab/ocrelizumab, as biologically plausible risks to the infant are exceedingly low.
Predatory behavior changes with satiety or increased insulin levels in the praying mantis (Tenodera sinensis)
Authors: Bertsch David J. , Martin Joshua P. , Svenson Gavin J. , Ritzmann Roy E. 
Published: June 2019

At any given moment behavior is controlled by a combination of external stimuli and an animal's internal state. As physiological conditions change, vastly different behaviors might result from the same stimuli. For example, the motivation to hunt and hunting strategy is influenced by satiety. Here, we describe how sensory responsiveness and motor activity of a praying mantis (Tenodera sinensis) are changed as the insect feeds, leading to an altered hunting strategy. We further show that these changes can be induced by injection of insulin, which likely functions as a metabotropic indicator.Praying mantises directed their attention toward real and simulated prey less often as they fed and became sated. The ranges of distance and azimuth at which prey was detected decreased as did pursuit of prey, while opportunistic close range attacks persisted. Together, these sensorimotor changes are indicative of a behavioral paradigm shift from “pursuit” to “ambush.” A similar effect was induced in starved praying mantises injected with 0.05 ml of 200 μg/ml bovine insulin. These experiments showed that insulin injection into the circulating hemolymph is sufficient to decrease prey orientation as well as in prey-directed locomotor behaviors (tracking and pursuit). The effects of both prey consumption and insulin injection were similarly dose-dependent. These results suggest that insulin is a signal of internal, physiological conditions that can modify responses to external stimuli. A change in hunting strategy thus results from coordinated effects of a neurohormone on a set of independent sensorimotor processes and the overall activity level of the animal.
New Chemical Family of [n-CxH(2x+1)NEt3][BEt3Me] Showing Ionic Plastic-Crystal (x = 4, 5), Rotator-Crystal (x = 6, 7) and Liquid-Crystal Phases (x = 8–16)
Authors: Yamada Yudai , Kashimoto Erina , Honda Hisashi 
Published: June 2019

Abstract
New ionic liquid crystals of [n-CxH(2x+1)NEt3][BEt3Me] (abbreviated to [CxNEt3][BEt3Me]) were detected for species with even numbers of 8 ≤ x ≤ 16. In contrast, plastic- and rotator-crystal phases were obtained for [CxNEt3][BEt3Me] species with lower x values of x = 4, 5, and 6, 7, respectively. Because we previously documented plastic phases for the [CxNEt3][BEt3Me] (x = 1–3) species, [CxNEt3][BEt3Me] can be classified as a novel chemical family adopting the entire range of states (mesophases) between solid and isotropic liquid phases (plastic, rotator, and liquid crystals) as a function of the alkyl chain length. Polarized optical microscope (POM) and X-ray diffraction (XRD) measurements revealed that these liquid crystals (x = 8–16 with even numbers of x) form smectic B (x = 8) and A (x = 10), and nematic phases (x ≥ 12) in the liquid-crystal phases. In the case of x = 4, 5, XRD analysis showed that the salts form cubic crystal structures. Furthermore, the NMR line shapes revealed that both the cation and anion underwent isotropic reorientation. In contrast, the NMR spectra showed that the cations rotated about their long axis in the [C6NEt3][BEt3Me] and [C7NEt3][BEt3Me] crystals.
Photoreversible Interference Color Modulation to Multicolor in Photochromic Molecular Crystals
Authors: Morimoto Kohei , Tsujioka Hajime , Kitagawa Daichi , Kobatake Seiya 
Published: June 2019

Abstract
Functional molecular crystals responsive to external stimuli represent a new frontier for material chemistry and crystal engineering. Here, we report on the photoreversible interference color change in single crystals composed of a photochromic diarylethene derivative, 1,2-bis(2-ethyl-5-phenyl-3-thienyl)perfluorocyclopentene (1a). When crystal 1a was observed by rotating the sample stage at 45° from the extinction position under crossed Nicols, it showed an interference color. Upon irradiation with ultraviolet (UV) light, the interference color changed dramatically and instantaneously in response to photoirradiation due to the photocyclization reaction from the open-ring form to the closed-ring form. The change was quite sensitive to the photochromic reaction. It is attributable to the large decrease in retardation induced by the photocyclization reaction in crystals. These results might provide new opportunities for application of photochromic crystals.
Innominate Salter osteotomy using resorbable screws: A retrospective case series and presentation of a new concept for fixation
Authors: Hedelin H. , Larnert P. , Hebelka H. , Brisby H. , Lagerstrand K. , Laine T. 
Published: June 2019

Purpose The Salter innominate osteotomy (SIO) in children is traditionally stabilized by Kirschner-wires, which have issues regarding stability, infection and the need to be extracted. To counter these disadvantages, we present a surgical method to stabilize SIO with modern resorbable poly lactic-co-glycolic acid screws. Using a case series of 21 patients treated with SIO for developmental dysplasia of the hip or Legg-Calvé-Perthes disease we evaluate the feasibility of the method. Methods The integrity of the osteotomy was interpreted by radiological measurements of acetabular index, centre-edge angle and Reimer's index. Perioperative and postoperative complications were evaluated. Results Radiographic evaluation revealed a stable osteotomy and favourable development in all measured parameters with the exception of one patient who fell out of bed the first day postoperatively. No other perioperative surgical complications were observed and there were no local reactions to the resorbable screws. Conclusion Modern resorbable screws carry multiple benefits both for the patient and the surgeon. In our case series the implants provided sufficient stability and the implants caused no local reactions. The use of resorbable implants gave the surgeon a wider range of possible screw placements and avoided the need for implant removal. Level of evidence Level IV – Case series
Emergency room closed reduction versus in situ splinting in the treatment of paediatric supracondylar humerus fractures
Authors: Sylvia S. M. , Maguire K. J. , Molho D. A. , Levens B. J. , Stone M. E. , Hanstein R. , Schulz J. F. , Fornari E. D. 
Published: June 2019

Purpose Displaced supracondylar humerus fractures are treated with open or closed reduction and percutaneous pinning. In 2012, our management of patients with a displaced fracture changed from closed reduction in the emergency department (ED) to in situ splinting prior to closed reduction and pinning in the operating room (OR). The purpose of this study was to investigate if outcomes or complications differ between these two management methods. Methods Patients less than ten years old with a Gartland type II or III supracondylar humerus fracture between 2008 and 2016 were included. Cases of polytrauma were excluded. Radiographic outcomes were assessed at follow-up. The Fisher's exact test was used for categorical variables and the Wilcoxon rank sums tests for continuous variables. Results In all, 157 patients were included, 89 with reduction in the ED and 68 without. There was no significant difference between the groups related to demographic factors or fracture characteristics. Patients managed without reduction in the ED had a lower average delay from ED to OR compared with those treated with reduction (16 hours versus 22 hours, p < 0.005) and a shorter hospital length of stay (34 hours versus 40 hours, p < 0.005). Conclusion No difference in complications or outcomes was found between patients with Type II or III supracondylar fractures treated initially with or without closed reduction in the ED. Patients treated without ED reduction were taken to the OR sooner and remained in the hospital for a shorter period of time. Splinting in situ reduces anaesthesia exposure without increasing postoperative complications or suboptimal outcomes. Level of Evidence Level III, retrospective comparative study
Exposing the glenoid in shoulder arthroplasty
Authors: Nové-Josserand Laurent 
Published: June 2019

Glenoid exposure should offer frontal access to the glenoid to allow the ancillary tools to be used freely and thus facilitate the good positioning of the glenoid implant. The two classically recognized approaches for shoulder arthroplasty are the deltopectoral and the transdeltoid approach. The axillary nerve is the most important anatomical structure in the glenoid, passing down the anterior part of the subscapularis, the inferior pole of the joint and the deep face of the deltoid muscle. Inferior glenohumeral release is the key step that allows the humerus to be retracted back or downwards thereby exposing the glenoid face on. In difficult and stiff cases, once pectoralis major release, osteophyte resection and posterior capsulectomy have been performed, a compression fracture, produced by using a retractor to push against the upper extremity of the humerus, can provide the extra few millimetres of space required to use the ancillary tools without hindrance. Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180057
The benefits of collaboration: the Nordic Arthroplasty Register Association
Authors: Mäkelä Keijo T. , Furnes Ove , Hallan Geir , Fenstad Anne Marie , Rolfson Ola , Kärrholm Johan , Rogmark Cecilia , Pedersen Alma Becic , Robertsson Otto , W-Dahl Annette , Eskelinen Antti , Schrøder Henrik M. , Äärimaa Ville , Rasmussen Jeppe V. , Salomonsson Björn , Hole Randi , Overgaard Søren 
Published: June 2019

The Nordic Arthroplasty Register Association (NARA) was established in 2007 by arthroplasty register representatives from Sweden, Norway and Denmark with the overall aim to improve the quality of research and thereby enhance the possibility for quality improvement with arthroplasty surgery. Finland joined the NARA collaboration in 2010. NARA minimal hip, knee and shoulder datasets were created with variables that all countries can deliver. They are dynamic datasets, currently with 25 variables for hip arthroplasty, 20 for knee arthroplasty and 20 for shoulder arthroplasty. NARA has published statistical guidelines for the analysis of arthroplasty register data. The association is continuously working on the improvement of statistical methods and the application of new ones. There are 31 published peer-reviewed papers based on the NARA databases and 20 ongoing projects in different phases. Several NARA publications have significantly affected clinical practice. For example, metal-on-metal total hip arthroplasty and resurfacing arthroplasty have been abandoned due to increased revision risk based on i.a. NARA reports. Further, the use of uncemented total hip arthroplasty in elderly patients has decreased significantly, especially in Finland, based on the NARA data. The NARA collaboration has been successful because the countries were able to agree on a common dataset and variable definitions. The collaboration was also successful because the group was able to initiate a number of research projects and provide answers to clinically relevant questions. A number of specific goals, set up in 2007, have been achieved and new one has emerged in the process. Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180058
Inadvertent excision of malignant soft tissue tumours
Authors: Grimer Robert , Parry Michael , James Steven 
Published: June 2019

Inadvertent excision of lumps which turn out to be sarcomas is not uncommon. Imaging has a limited role in detecting microscopic residual disease but can show the extent of the previous surgical field. Standard treatment is wide re-excision, usually combined with radiotherapy. Residual tumour is found in an average of 50% of reported cases. The presence of residual disease is an adverse prognostic factor. All lumps bigger than a golf ball should have a diagnosis prior to excision. Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180060
Musculoskeletal treatment in haemophilia
Authors: Atilla Bülent , Güney-Deniz Hande 
Published: June 2019

Haemophilia is a group of coagulation disorders inherited in an X-linked recessive pattern. Nearly three-quarters of all haemorrhages in haemophilia occur in the musculoskeletal system, usually in the large muscles and joints of the lower extremity. While prevention of bleeding with active prophylaxis is the recommended optimal therapy for severe haemophilia, there are many patients suffering from musculoskeletal system complications subsequent to uncontrolled bleeding. Recombinant clotting factor concentrates led to home treatment of acute bleeding episodes as well as allowing for minor and major surgical interventions. Avoiding of further complications by radiosynoviorthesis is the first-line recommendation, and arthroplasty is regarded as the effective salvage procedure for patients presenting with severe disability. Physiotherapy and rehabilitation in haemophilia patients are important to return the normal status of joint motion, to regain the muscle strength, to obtain the optimal functional levels and to improve patients’ quality of life. Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180068
The geriatric patient: special aspects of peri-operative management
Authors: Wirtz Dieter , Kohlhof Hendrik 
Published: June 2019

This article offers a German perspective on orthopaedic management of geriatric populations in higher-income countries. Specific orthopaedic procedures necessitate a more intensive level of care in older adult patients, especially with co-morbidities, than in younger patients. During the pre-, peri- and post-operative periods, several aspects such as patient blood management principles improve the outcomes of geriatric patients. New interdisciplinary geriatric models of care including geriatric and orthopaedic specialties have to be established to take care of the special needs of geriatric patients. Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180087
Does the source of referral affect outcomes for paediatric testicular torsion?
Authors: Peeraully R , Jancauskaite M , Dawes S , Green S , Fraser N 
Published: June 2019

Introduction This single centre study retrospectively analysed the intraoperative findings relative to source of referral for emergency scrotal explorations performed in a tertiary level paediatric surgery department. Methods All patients who underwent emergency scrotal exploration under the care of paediatric surgeons in our unit between April 2008 and April 2016 were identified. Clinical data were obtained from contemporaneous records. Results Over the 8-year study period, 662 boys underwent emergency scrotal exploration: 6 (1%) were internal referrals, 294 (44%) attended our emergency department (ED) directly, 271 (41%) were referred from primary care and 91 (14%) were transferred from other hospitals. Excluding procedures in neonates, testicular torsion was present in 100 cases (15%). Testicular detorsion with bilateral 3-point testicular fixation was performed in 66 (66%) and orchidectomy with contralateral fixation in 34 (34%) where the torted testis was non-viable intraoperatively. The orchidectomy rate in the presence of torsion was 23% in ED referrals (12/52), 43% in primary care referrals (12/28) and 50% for transfers (10/20). The difference in rates between ED referrals and patients transferred from other hospitals was significant (p=0.026). There was no significant difference in median age between any of the groups (p=0.10). Conclusions Boys undergoing emergency scrotal exploration had a higher orchidectomy rate when transferred from other hospitals to our unit. This difference was statistically significant when compared with boys presenting directly to our ED. This supports advice from The Royal College of Surgeons of England for undertaking paediatric scrotal explorations in the presenting hospital when safe to do so rather than delaying the care of these patients by transferring them to a tertiary paediatric surgical unit.
Revascularisation through the obturator foramen of lower limbs with a compromised ipsilateral groin due to infection
Authors: Zenunaj G , Traina L , Acciarri P , Spataro C , Gasbarro V 
Published: June 2019

Introduction Infra-inguinal vascular reconstruction with active groin infection is a concerning issue. Using resistant grafts to infection is the most adopted approach. However, in absence of these materials in acute situations, the trans-obturator approach allows for limb revascularisation avoiding the infected site. We evaluated the effectiveness of this approach in patients who needed lower limb revascularisation with an ipsilateral groin infection. Materials and methods A retrospective study was conducted over a four-year period. Results Over this period, 13 patients underwent trans-obturator reconstructions (13 external iliac–popliteal above-knee and one aortobipopliteal above-knee bypass). Seven patients had been previously revascularised and were admitted for graft infection (six infra-inguinal bypasses, one axillo-bifemoral bypass). Four presented with acute limb ischaemia, three with groin haematoma and one with a groin abscess. The remaining cases consisted of drug-addicted patients with injury of femoral vessels due to self-injection of drugs. The patients underwent reconstructions with autologous grafts which complicated early with groin haematoma. After transobturator revascularisation, the groin underwent debridement with applying vacuum-assisted wound closure device. Conclusion The transobturator approach could be considered as a chance for lower limb revascularisation in case of ipsilateral groin infection. Moreover, avoiding the infected site allowed us to focus separately and safely on the treatment of the inguinal wound.
Perforated diverticulitis in the North of England: trends in patient outcomes, management approach and the influence of subspecialisation
Authors: Baldock TE , Brown LR , McLean RC 
Published: June 2019

Introduction In recent years, several management options have been used in the management of perforated diverticulitis, ranging from conservative treatment to laparotomy. General surgery has also become increasingly specialised over time. This retrospective cohort study investigated changes in patient outcomes following perforated diverticulitis, management approach and the influence of consultant subspecialisation over time. Materials and methods Data was collected on patients admitted with perforated diverticulitis in the North of England between 2002 and 2016. Subspecialisation was categorised as colorectal or other general subspecialties. The primary outcome of interest was overall 30-day mortality; secondary outcomes included surgical approach, stoma and anastomosis rate. Results A total of 3394 cases of perforated diverticulitis were analysed (colorectal, n = 1290 and other subspecialists, n = 2104) with a 30-day mortality of 11.6%. There was a significant reduction in mortality over time (2002–2006: 18.6% to 2012–2016: 6.8, P < 0.001). There was a significant reduction in open surgery (60% to 25.3%, P < 0.001) with increased conservative management (37.4% to 63.5%, P < 0.001), laparoscopic resection (0.1% to 4.9%, P < 0.001) and laparoscopic washout (0.1% to 5.7%, P < 0.001). Patients admitted under colorectal surgeons had lower mortality than other subspecialists (9.9% vs 12.4%, P = 0.027), which remained significant following multivariate adjustment (hazard ratio 1.44, P = 0.039). These patients had fewer stomas (13.9% vs. 21.0%, P = 0.001) and higher anastomosis rates (22.1% vs 15.8%, P = 0.004). Conclusion This study demonstrated considerable improvements in the management of perforated diverticulitis alongside the positive impact of subspecialisation on patient outcomes.