bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effect of BMI and surgical approach on acetabular component malpositioning in a cohort of military patients with hip arthroplasty
Authors: Formby Peter M. , Nappo Kyle E. , Purcell Richard L. , Pickett Adam , Newman Michael T. , Mack Andrew W. 
Published: March 2018

Background:
Previous studies have looked at body mass index (BMI) and its effects on acetabular cup malpositioning with differing results. In the present study, we sought to add to the literature by examining for a correlation between obesity and cup malposition in a military population.

Methods:
We reviewed the radiographs and clinical notes of 200 patients undergoing primary total hip arthroplasty (THA) from November 2011 to April 2014. Acetabular component position was determined on standing postoperative anteroposterior pelvic radiographs. We then determined correlations between cup anteversion and inclination with BMI and surgical approach. Further, we determined differences in the rate of acetabular component malpositioning outside of an “ideal” position between nonobese (BMI <30) and obese (BMI >30) patient groups.

Results:
We found no correlation between cup anteversion or inclination and BMI when examined independently (r=0.02, P=0.79 and r=0.08, P=0.29, respectively). However, there was a difference in the proportion of cups outside of the “ideal” position between nonobese and obese groups (53% vs. 69%; P=0.029). Without regard for BMI, the lateral approach had lower anteversion (15.4 vs. 26.6, P<0.001) and higher cup inclination angles (48.4 vs. 45.3, P=0.002) compared to the posterior approach.

Conclusions:
Although obesity may not correlate in a linear relationship with anteversion or inclination, it is a risk factor for acetabular component malposition outside of an “ideal” zone. This study shows that increased BMI may be a risk factor for cup malpositioning in a younger, military THA population.
Reliability of a Condensed Computer-Based Patient Outcomes Scoring Tool in Orthopaedic Trauma Patients
Authors: Crist Brett D. , Pashuck Troy D. 
Published: March 2018

Objectives:
To determine the reliability of a condensed computer-based patient-centered outcome score system versus multiple standard uncondensed validated outcome scores used in orthopaedic trauma.

Design:
Prospective.

Setting:
Level I Trauma Center.

Patients/Participants:
One hundred patients older than 18 years with various orthopaedic injuries were evaluated at a Level I Trauma Clinic.

Intervention:
Study participants were randomly assigned to complete the paper-based and computer-based versions of the EQ-5D and musculoskeletal functional assessment at different times during the same visit.

Main Outcome Measurements:
Score variability between the computer-based and paper-based versions.

Results:
The average score difference between the computer-based and paper-based musculoskeletal functional assessment was 0.50, with an SD of 6.03 and a 95% confidence interval of −0.71 to 1.71. For the EQ-5D, the average score difference was 0.12 with an SD of 0.20 and a 95% confidence interval of −0.05 to 0.05.

Conclusions:
Because patient-centered outcomes drive the direction of orthopaedic care, it is critical to collect patient data efficiently while minimizing responder burden. This condensed web-based adaptive outcome tool reliably produced similar scores when compared with individual paper scores, and it decreased responder burden and error.
Molding Spica Casts to Maintain Alignment of Femur Fractures
Authors: Nielsen Ena , Skaggs David L. , Ryan Deirdre , Andras Lindsay M. 
Published: March 2018

Background:
Femur fractures in young children are frequently treated with spica casting. Texts recommend molding spica casts into valgus and recurvatum to counter deforming muscular forces, but how much overcorrection to aim for has not been evaluated. Our goal was to determine how much valgus and recurvatum is optimal at the time of casting to end up with anatomic alignment.

Methods:
Patients 1 to 6 years old with femur fractures treated with spica casts between January 1, 2008 and January 31, 2014 who were followed until radiographic union were included in the study. Patients with underlying medical comorbidities affecting bone quality, refractures, or preexisting femur deformities or that did not have intraoperative imaging were excluded.

Results:
A total of 52 patients met the inclusion criteria. Average intraoperative angulation was 2.6 degrees of valgus (range: 9 degrees varus to 13 degrees valgus, SD: 4.5) and 1.1 degrees of recurvatum (range: 10 degrees recurvatum to 17 degrees procurvatum, SD: 4.8). At the initial postoperative visit, the average angulation was 2.7 degrees of varus (range: 21 degrees varus to 11degrees valgus, SD: 6.4) and 7.2 degrees of procurvatum (range: 6 degrees recurvatum to 25 degrees procurvatum, SD: 6.6). At the time of radiographic union/wedging average angulation was 2.0 degrees of varus (range: 15 degrees varus to 10 degrees valgus, SD: 5.8) and 8.5 degrees of procurvatum (range: 5 degrees recurvatum to 29 degrees procurvatum, SD: 7.5). Between the intraoperative period to time of union or wedging, fracture alignment gained an average of 4.6 degrees of varus (range: 17 degrees varus to 13 degrees valgus, SD: 6.6) and 9.8 degrees of procurvatum (range: 8 degrees recurvatum to 30 degrees procurvatum, SD: 9.1). Seven patients underwent cast wedging due to loss of reduction before radiographic union, 2 patients underwent reoperation due to excessive angulation in the early postoperative period, and 5 patients developed malunions.

Conclusion:
Femur fractures treated with spica casts gain 5 degrees of varus and 10 degrees of procurvatum between cast application and fracture union.

Level of Evidence:
Level IV.
Literature Review of Spinal Cord Glioblastoma
Authors: Timmons Joshua J. , Zhang Kisa , Fong Johnson , Lok Edwin , Swanson Kenneth D. , Gautam Shiva , Wong Eric T. 
Published: March 2018

Objectives:
This systematic review aims to investigate spinal cord glioblastoma (scGBM) and correlations between patient traits and survival outcome, as well as differences in cohorts administered temozolomide or total resections, through an analysis of published cases reported up to October 2016.

Methods:
We obtained patient data by querying PubMed and Google Scholar with predetermined search terms and inclusion criteria that enabled the identification of relevant case reports. Survival was compared using Kaplan-Meier curves and log-rank analyses.

Results:
Of 153 patients with scGBM identified through a literature search, 135 met the predetermined search and inclusion criteria. Median overall survival (OS) for the resulting cohort was 12 (95% CI, 10-14) months. The female sex was found to significantly predict worse outcomes, and a sizable number of patients with long-term disease were found to have afflictions of the thoracic spinal cord. Neither the pediatric, temozolomide nor total resection subgroups had significantly improved survival characteristics, by log-rank analysis, relative to counterparts.

Conclusions:
These data elucidate the characteristics of patients with scGBM. For more sophisticated and in-depth analyses in the future, it is imperative that time-of-treatment information is recorded in future case reports. In addition, all case reports should be made available to prevent publication bias.
Are You There? The Growing Need to Get the Right Diagnosis in Disorder of Consciousness
Authors: Torrisi Michele , Piccolo Adriana , De Luca Rosaria , Berenati Matteo , Olivo Antonella , Maresca Giuseppa , Naro Antonino , Calabrò Rocco Salvatore 
Published: March 2018

ABSTRACT
Disorder of consciousness (DOC) can be either an acute and reversible condition or a chronic condition, including vegetative state or minimally conscious state. Herein, we describe a patient who has unexpectedly recovered consciousness after being in a misdiagnosed vegetative state for a long period. A 63-year-old woman was admitted to our rehabilitation center in vegetative state (Coma Recovery Scale-Revised score, 6) and treated with a standard rehabilitation program, including physical therapy and multisensory stimulation, besides psychoactive drugs. After 26 months of such training, she progressively presented with unexpected signs of awareness. Thus, she was submitted to an intensive cognitive rehabilitation with a significant improvement of her performance (Coma Recovery Scale-Revised score, 19). With this report, we want to underline that the early use of paraclinical methods, including neuroimaging and neurophysiological paradigms, is mandatory in DOC to reach a more accurate diagnosis and perform the most appropriate neurorehabilitation. Moreover, diagnosis of functional locked-in syndrome should be considered because some patients with DOC may have covert awareness with the impossibility to display consistent and reproducible behaviors due to a “motor-cognitive dissociation.”
Recovery in the Severely Impaired Arm Post-Stroke After Mirror Therapy
Authors: Chan Wing Chiu , Au-Yeung Stephanie S.Y. 
Published: March 2018

Objective
This study aimed to examine the effectiveness of mirror therapy on recovery in the severely impaired arm after stroke.

Design
Using single-blind randomized controlled design, patients with severely impaired arm within 1-month post-stroke were assigned to receive mirror therapy (n = 20) or control therapy (n = 21), 30 mins twice daily for 4 wks in addition to conventional rehabilitation. During mirror therapy and control therapy, subjects practiced similar structured exercises in both arms, except that mirror reflection of the unaffected arm was the visual feedback for mirror therapy, but mirror was absent for control therapy so that subjects could watch both arms in exercise. Fugl-Meyer Assessment and Wolf Motor Function Test were the outcome measurements.

Results
After the intervention, both mirror therapy and control therapy groups had significant arm recovery similarly in Fugl-Meyer Assessment (P = 0.867), Wolf Motor Function Test-Time (P = 0.947) and Wolf Motor Function Test-Functional Ability Scale (P = 0.676).

Conclusion
Mirror therapy or control therapy, which involved exercises concurrently for the paretic and unaffected arms during subacute stroke, promoted similar motor recovery in the severely impaired arm.
Neutralization Sensitivity of a Novel HIV-1 CRF01_AE Panel of Infectious Molecular Clones
Authors: Chenine Agnes-Laurence , Merbah Melanie , Wieczorek Lindsay , Molnar Sebastian , Mann Brendan , Lee Jenica , O'Sullivan Anne-Marie , Bose Meera , Sanders-Buell Eric , Kijak Gustavo H. , Herrera Carolina , McLinden Robert , O'Connell Robert J. , Michael Nelson L. , Robb Merlin L. , Kim Jerome H. , Polonis Victoria R. , Tovanabutra Sodsai 
Published: March 2018

Background:
HIV-1 CRF01_AE is dominant in Thailand where RV144 vaccine trial was conducted. To study immune correlates of protection in ongoing trials, CRF01_AE-derived reagents are essential. Here, we present a panel of 14 HIV-1 infectious molecular clones (IMCs) identified from different stages of infection and characterization of their neutralization sensitivity using 2 standard assays.

Methods:
One full-length IMC was constructed using a transmitted-founder virus to express Renilla luciferase (LucR) reporter gene and full-length envelopes (envs) of exogenous HIV-1. A panel of IMCs was generated, expressing envs of viruses from acute (Fiebig stages I/II and I-IV) and chronic (>Fiebig VI) infection. Neutralization assays were performed using TZM-bl or A3R5 cell lines, and sera or monoclonal antibodies (mAbs). Wilcoxon matched-paired test was used to assess neutralization differences between assays and reagents; correlation coefficients were evaluated by linear regression.

Results:
Neutralization potency observed was significantly higher in the A3R5 assay when testing mAbs and serum pools (P < 0.0001); the stage of infection from which env was derived did not associate with IMC neutralization sensitivity. Neutralization values from A3R5 and TZM-bl assays were strongly correlated when mAbs were tested (R2 = 0.7, P < 0.0001), but a weaker association was seen with serum pools (R2 = 0.17, P = 0.03).

Conclusions:
This novel panel of CRF01_AE reporter IMC is useful for assessing vaccine-induced neutralizing antibodies in multiple assays, including those using primary cell targets. The significant differences in TZM-bl and A3R5 neutralization sensitivity, as well as the poor association when using polyclonal sera indicates the need for caution in choosing one specific platform.
Conservative Treatment for Delayed Infection After Cranioplasty With Titanium Alloy
Authors: Hu Yuanwei , Li Xiang , Zhao Ruirui , Zhang Kang 
Published: March 2018

Abstract
Cranioplasty (CP) is considered a low-risk operation in the field of neurosurgery following decompression craniectomy. Nevertheless, CP is still burdened by surgical complications, among which early or late infections are the most common outcome-threatening ones. Most of infection cases occur within a week after CP. Except that, implant-associated scalp infection is the most common complication, and leads to implant removal in many patients with refractory and recurrent infection. The authors reported a patient presenting with epidural infection about 3 months after titanium implant and cured by anti-infective treatment for 2 weeks.
Use of Irradiated Homologous Costal Cartilage in Rhinoplasty: Complications in Relation to Graft Location
Authors: Suh Man Koon , Lee Seung Jong , Kim Yeon-Jun 
Published: March 2018

Background:
Nasal septal cartilage and conchal cartilages are preferred sources of grafts in augmentation rhinoplasty. Rib cartilage can also be used, but it may evoke a patient's concerns about a scar and an extensive surgery. In such cases, irradiated homologous costal cartilage (IHCC) can be a useful alternative. However, controversy still exists in many literatures regarding complications with use of IHCC. Therefore, the authors reviewed our experiences with IHCC in rhinoplasty and analyzed the complications in relation to graft location.

Methods:
A retrospective chart review was made of all patients who underwent rhinoplasty with IHCC between 2007 and 2015. A total of 323 patients were included. The authors considered the cases that required revision surgery for external aesthetic changes as complications. The authors defined major complications, including resorption, infection, fracture, or warping.

Results:
The total complication rate was 8%. Two fractures (0.6%), 4 fragmentation (1.2%), 4 resorptions (1.2%), 4 infections (1.2%), and 2 warpings (0.6%) were noted. Most of these complications occurred for the septal extension graft. Other complications, including 1 nasal obstruction, 2 visible contours, 3 caudal septal deviations, and 4 cases of unfavorable results (patient unsatisfactions), were noted.

Conclusions:
Based on the outcomes of this study, the authors concluded that IHCC is a useful and reliable source of cartilage graft and can serve as an alternative graft material for rhinoplasty. However, care must be taken in use of IHCC graft in areas under tension such as septal extension graft, though its complication rate is low.
Upper First Premolar Positioning Evaluation for the Stability of the Dental Occlusion: Anatomical Considerations
Authors: Sambataro Sergio , Cervino Gabriele , Fiorillo Luca , Cicciù Marco 
Published: March 2018

Abstract
The present study aimed to find the proper distorotation of the upper first premolar to achieve the therapeutic ideal advocated for the stability of the human occlusion. Normal teeth were analyzed and occlusal photocopies of upper arch were made to perform the 2 measurements. The first parameter was the angle formed by the perpendicular to the wire through the buccal cusp and a line connecting the buccal and the lingual cusps of the upper first premolar. The second one was the angle from the buccal line and the sagittal plane of the model. The amount of distorotation was calculated and a method to bond the bracket was suggested.
Orbital Subcutaneous Emphysema in a Child
Authors: Aubin-Lemay Camille , Acar Philippe , Alnaif Nayif , Alamri Abdulrahman , Azzi Alain Joe , Cugno Sabrina 
Published: March 2018

Abstract
The authors present a rare case of nontraumatic medial orbital wall fracture in an 11-year-old girl. Fractures of the orbital wall secondary to nose blowing have not been previously described in the pediatric population. The patient reported a history of chronic forceful nose blowing, followed by periorbital swelling after an episode of vigorous nose blowing. Erroneous diagnoses of sinusitis and periorbital cellulitis lead to unnecessary antibiotic treatment. The authors hypothesize that repeated and aggressive nose blowing is analogous to stress fractures, leading to weakening and eventual fracture of the medial orbital wall.
Antiviral Therapy Reduces Hepatocellular Carcinoma Recurrence in Patients With Low HBV-DNA Levels
Authors: Huang Gang , Li Peng-peng , Lau Wan Yee , Pan Ze-ya , Zhao Ling-hao , Wang Zhen-guang , Wang Meng-chao , Zhou Wei-ping 
Published: March 2018

Background:
Despite antiviral treatment has been shown to reduce hepatocellular carcinoma (HCC) recurrence after curative treatment for hepatitis B virus (HBV)-related HCC in patients with high preoperative HBV-DNA levels, it is still unclear whether antiviral therapy is useful in reducing recurrence in patients with low preoperative HBV-DNA levels.

Methods:
In this randomized controlled trial, 200 patients who underwent curative resection for HCC with low baseline HBV-DNA levels were randomly assigned to receive preemptive antiviral therapy or not. The primary endpoints were recurrence-free survival. This study was censored on March 31, 2015 when all surviving patients had a minimum follow-up of 60 months. The analysis was done on an intention-to-treat basis.

Results:
The baseline clinical, laboratory, and tumor characteristics of the 2 groups were comparable. The 1-, 3-, and 5-year recurrence-free survival rates for the antiviral group and the control group were 85.9%, 55.2%, and 52.0% and 80.6%, 40.9%, and 32.3%, respectively. The corresponding overall survival rates for the 2 groups were 94.0%, 75.7%, and 64.1% and 90.0%, 62.4%, and 43.7%, respectively. The recurrence-free survival and overall survival for the antiviral group were significantly better than the control group (P = 0.016, P = 0.004, respectively). After adjusting for confounding prognostic factors in a Cox model, the relative risks of recurrence and death for antiviral treatment were 0.601 [95% confidence interval (CI), 0.409–0.884; P = 0.010] and 0.509 (95% CI, 0.333–0.778; P = 0.002), respectively. Antiviral therapy was an independent protective factor of late tumor recurrence (hazard ratio [HR] = 0.316, 95% CI 0.157–0.637; P = 0.001) but not of early tumor recurrence (HR = 0.782, 95% CI, 0.493–1.240; P = 0.296).

Conclusions:
In patients with low preoperative HBV-DNA levels, antiviral therapy significantly reduced HCC recurrence after R0 hepatic resection.
Prevention of firearm injuries with gun safety devices and safe storage: An Eastern Association for the Surgery of Trauma Systematic Review
Authors: Violano Pina , Bonne Stephanie , Duncan Thomas , Pappas Peter , Christmas A. Britton , Dennis Andrew , Goldberg Stephanie , Greene Wendy , Hirsh Michael , Shillinglaw William , Robinson Bryce , Crandall Marie 
Published: March 2018

BACKGROUND
Over 50,000 homicides and suicides occur each year. An estimated half of all US households are believed to have a firearm present, making them one of the most ubiquitous consumer products. Our goal was to determine if the manner of storage of a firearm in a home could potentially make a difference in the outcomes of intentional and unintentional injuries involving a firearm; specifically addressing the use of gun safes and devices that block/disable firearm function (trigger locks, cable locks, etc.).

METHODS
A comprehensive review of the literature was performed. We used Grading of Recommendations Assessment, Development, and Evaluation methodology to assess the breadth and quality of the data specific to our Population, Intervention, Comparator, Outcomes (PICO) questions.

RESULTS
A total of 176 studies were initially identified, then, 120 more added after a subsequent literature review, with 97 removed as duplicates. One hundred ninety-one case reports, case series, and reviews were removed because they did not focus on prevention or did not address our comparators of interest. This left a total of two studies which merited inclusion for PICO 1, should gun locks be used to prevent firearm injuries and six studies which merited inclusion for PICO 2, should safe storage for guns be used to prevent firearm injuries.

CONCLUSION
PICO 1: We conditionally recommend that gun locks be used to prevent unintentional firearm injury. PICO 2: Because of the large effect size and the reasonable quality of available evidence with safe storage of firearms, we recommend safe storage prevent firearm-related injuries.

LEVEL OF EVIDENCE
Systematic review, level III.
The Alvarado score should be used to reduce emergency department length of stay and radiation exposure in select patients with abdominal pain
Authors: Coleman Jamie J. , Carr Bryan W. , Rogers Tyrone , Field Matthew S. , Zarzaur Ben L. , Savage Stephanie A. , Hammer Peter M. , Brewer Brian L. , Feliciano David V. , Rozycki Grace S. 
Published: March 2018

BACKGROUND
Abdominal pain is the common reason patients seek treatment in emergency departments (ED), and computed tomography (CT) is frequently used for diagnosis; however, length of stay (LOS) in the ED and risks of radiation remain a concern. The hypothesis of this study was the Alvarado score (AS) could be used to reduce CT scans and decrease ED LOS for patients with suspected acute appendicitis (AA).

METHODS
A retrospective review of patients who underwent CT to rule out AA from January 1, 2015, to December 31, 2015, was performed. Patient demographics, medical history, ED documentation, operative interventions, complications, and LOS were all collected. Alvarado score was calculated from the medical record. Time to CT completion was calculated from times the patient was seen by ED staff, CT order, and CT report.

RESULTS
Four hundred ninety-two patients (68.1% female; median age, 33 years) met the inclusion criteria. Most CT scans (70%) did not have findings consistent with AA. Median AS for AA on CT scan was 7, compared with 3 for negative CT (p < 0.001). One hundred percent of female patients with AS of 10 and males with AS of 9 or greater had AA confirmed by surgical pathology. Conversely, 5% or less of female patients with AS of 2 or less and 0% of male patients with AS of 1 or less were diagnosed with AA. One hundred six (21.5%) patients had an AS within these ranges and collectively spent 10,239 minutes in the ED from the time of the CT order until the radiologist's report.

CONCLUSION
Males with an AS of 9 or greater and females with AS of 10 should be considered for treatment of AA without imaging. Males with AS of 1 or less and females with AS of 2 or less can be safely discharged with follow-up. Using AS, a significant proportion of patients can avoid the radiation risk, the increased cost, and increased ED LOS associated with CT.

LEVEL OF EVIDENCE
Diagnostic IV, therapeutic IV.