bluuebunny/crossref_metadata_2025_split huggingface dataset:
Frequency of post-stroke pneumonia: Systematic review and meta-analysis of observational studies
Authors: Badve Monica S , Zhou Zien , van de Beek Diederik , Anderson Craig S , Hackett Maree L 
Published: March 2019

Background Post-stroke pneumonia and other infectious complications are serious conditions whose frequency varies widely across studies. Aims We conducted a systematic review to estimate the frequency of post-stroke pneumonia and other types of major infection. Summary of review MEDLINE, EMBASE, CINAHL, and PsycINFO databases were searched for prospective studies with consecutive recruitment of stroke patients. The primary outcome was post-stroke pneumonia. Secondary outcomes were any infection and urinary tract infection. Quality assessment was done using Newcastle Ottawa scale. Heterogeneity of estimates across study populations was calculated using Cochran's Q (heterogeneity χ2) and I2 statistics. A total of 47 studies (139,432 patients) with 48 sample populations were eligible for inclusion. Mean age of patients was 68.3 years and their mean National Institute of Health Stroke Scale score was 8.2. The pooled frequency of post-stroke pneumonia was 12.3% (95% confidence interval [CI] 11%–13.6%; I2 = 98%). The pooled frequency from 2011 to 2017 was 13.5% (95% CI 11.8%–15.3%; I2 = 98%) and comparable with earlier periods (P interaction = 0.31). The pooled frequency in studies in stroke units was 8% (95% CI 7.1%–9%; I2 = 78%) and significantly lower than other locations (P interaction = 0.001). The pooled frequency of post-stroke infection was 21% (95% CI 13%–29.3%; I2 = 99%) and of post-stroke urinary tract infection was 7.9% (95% CI 6.7%–9.3%; I2 = 96%). Conclusion Approximately 1 in 10 stroke patients experience pneumonia during the acute period of hospital care. The frequency of post-stroke pneumonia has remained stable in recent decades but is lower in patients receiving stroke unit care compared to management in other ward settings.
Clinical audit as a tool to optimize contracted private healthcare provision: Testing the waters in resource-deprived Greece
Authors: Souliotis Kyriakos , Golna Christina , Mantzana Vasiliki , Papaspyropoulos Sotirios , Koutsovasilis Anastasios , Sotiropoulos Alexios 
Published: March 2019

Background and Aims: Clinical audit is applied to optimize clinical practice and quality of healthcare services while controlling for money spent, critically in resource-deprived settings. This case study reports on the outcomes of a retrospective clinical audit on private hospitalizations, for which reimbursement had been pending by the Health Care Organization for Public Servants (OPAD) in Greece. This case study is the first effort by a social insurance organization in Greece to employ external clinical audit before settling contracted private healthcare charges. Methods: One thousand two hundred hospitalization records were reviewed retrospectively and a fully anonymized clinical audit summary report created for each one of them by a team of clinical audit experts, proposing evidence-based cuts in pending charges where medical services were deemed clinically unnecessary. These audit reports were then collated and analysed to test trends in overcharges among hospitalized insureds per reason for hospitalization. Results: The clinical audit report concluded that 17.4% of a total reimbursement claim of €12,387,702.18 should not be reimbursed, as it corresponded to unnecessary or not fully justifiable according to evidence-based, best practice, medical service provision. The majority of proposed cuts were related to charges for medical devices, which are borne directly by social insurance with no patient or private insurance co-payment. Conclusion: Clinical audit of hospital practice may be a key tool to optimize care provision, address supplier-induced demand and effectively manage costs for national health insurance, especially in circumstances of budgetary constraints, such as in austerity-stricken settings or developing national healthcare systems.
A modified tarsal sinus approach for intra-articular calcaneal fractures
Authors: Zhan Junfeng , Hu Chuanzhen , Zhu Nan , Fang Wang , Jing Juehua , Wang Gang 
Published: March 2019

Background: Plate fixation using traditional lateral L-shape approach for intra-articular calcaneal fractures is complicated by 30% of wound complications, and the lateral small incision techniques with a tarsal sinus approach cannot sufficiently address all the fragments. A modified tarsal sinus approach with combined advantages of traditional lateral L-shape and tarsal sinus approaches for the treatment of intra-articular calcaneal fractures was developed. Method: This prospective study included 29 patients (13 Sanders type II and 16 type III) with calcaneal fractures were managed with this technique. Calcaneal height, width, length, Bohler’s angle, and Gissane angle were measured preoperatively, postoperatively, and at 1-year follow-up. Functional outcomes were assessed based on American Orthopedic Foot and Ankle Society (AOFAS) ankle/hindfoot score. Results: Twenty-nine patients with average follow-up time of 18 (range 13–29) months were included. The radiographs demonstrated significant corrections of the Bohler’s angle and Gissane angle, calcaneal width, length, and height from preoperation to postoperation and 1-year follow-up. Among all follow-up patients, one case had skin necrosis but healed after dressing. Another case had symptoms of numbness in the sural innervation area, which disappeared after 5 months of physical therapy and drug therapy. One case showed degenerative changes of subtalar joint at 1-year follow-up. No other wound complications like incision infection (superficial or deep) and wound dehiscence occurred. At 1-year follow-up, the mean AOFAS score was 90.2 ± 17.7 (range 70–98) and the good and excellent rate was 89.7%. Conclusion: The modified tarsal sinus approach in the treatment of Sander’s type II and III calcaneal fractures allowed adequate reduction and rigid fixation with low incidence of wound complications. Compared to sinus tarsi approach, this technique required shorter learning curve and was more easily mastered by young orthopedic surgeons. Thus, it was worthy of application clinically.
Clinical and radiological outcomes following isolated vertical medial meniscal tear repair in patients over 40 years old
Authors: Buyukkuscu Mehmet Ozbey , Misir Abdulhamit , Hamrayev Arif Jan , Ozcafer Rasit , Cetinkaya Engin 
Published: March 2019

Purpose: To evaluate the short-term clinical and radiological outcomes with degenerative changes in patients over 40 years old following isolated vertical medial meniscal tear repair. Methods: Between 2007 and 2015, 438 patients underwent arthroscopic meniscal repair. Thirty-three patients aged over 40 years with isolated vertical medial meniscal repair (23 males and 10 females, mean age 46.1 ± 7.0; range 40–67) were included in the study. Preoperative and postoperative physical examination findings, Lysholm knee score, the International Knee Documentation Committee score, magnetic resonance imaging findings, and Kellgren–Lawrence osteoarthritis stage were evaluated. Results: The mean follow-up period was 31.1 months ± 20.1 (range 12–100 months). There was statistically significant improvement in functional scores ( p < 0.05) and physical examination findings. In 22 patients (66.7%), improvement in the clinical and radiological results was detected ( p < 0.05). However, no correlation was found between clinical and radiological outcomes. There was also no significant change in osteoarthritis stages at the last follow-up visit. No significant difference was found between smokers and nonsmokers regarding clinical outcomes. Conclusion: Successful clinical and radiological outcomes can be obtained following isolated vertical medial meniscal tear repair in patients older than 40 years. Age is not the sole criterion for the success of meniscal repair; rather, the functional capacity of the patient, the location of the tear, the grade of knee joint arthritis, and the quality of the meniscal tissue should be taken into consideration.
Outcomes After Fresh Osteochondral Allograft Transplantation for Medium to Large Chondral Defects of the Knee
Authors: Thomas Dimitri , Shaw K. Aaron , Waterman Brian R. 
Published: March 2019

Background: Articular cartilage defects of the knee can significantly impair function among young, high-demand patients. There are several techniques for chondral restoration, including osteochondral allograft transplantation (OCA), that may alleviate pain and re-create the native anatomy. However, clinical outcomes among athletic cohorts are limited. Purpose: To evaluate the efficacy and functional outcomes of OCA for medium to large osteochondral defects of the knee in physically active United States military servicemembers. Study Design: Case series; Level of evidence, 4. Methods: A military health care database was queried to identify all OCA procedures performed between January 2009 and March 2013. Inclusion criteria were army personnel with a minimum of 2 years’ follow-up. Exclusion criteria included incomplete follow-up, inaccurate coding, and nonmilitary status. Variables of interest included sex, age, lesion location, grade and size of the lesion, body mass index, tobacco use, preoperative and postoperative visual analog scale (VAS) scores for pain, and presence of perioperative complications. Overall failure was defined as the inability to return to preoperative functional activities because of persistent knee complaints (clinical failure) or a revision cartilage procedure or arthroplasty (surgical failure). Results: A total of 61 patients (52 male; mean age, 31.7 years) were identified, with a mean 46.2-month follow-up. The mean VAS pain score improved from 4.10 ± 2.17 preoperatively to 2.68 ± 2.73 postoperatively ( P < .0009), and only 6 (9.8%) required a subsequent revision chondral procedure. Overall, 39 patients (63.9%) were able to return to a level of activity that allowed for the completion of military duties. Risk factors for clinical failure were preoperative body mass index, preoperative pain as measured on the VAS, and moderate to severe postoperative pain on the VAS. The risk factor for surgical failure was the presence of a complication. Risk factors for overall failure were the presence of a complication and moderate to severe postoperative pain on the VAS. Conclusion: OCA provided moderate success in retaining active-duty army servicemembers. Approximately two-thirds of patients undergoing OCA were able to return to their preinjury occupational activity, while approximately 57% of patients returned to prior levels without a subsequent revision chondral procedure or arthroplasty.
The Incidence of Retinal Breaks Induced by Posterior Hyaloid Separation During 27-Gauge Pars Plana Vitrectomy
Authors: Rahman Rubina , Patil Ajay , Stephenson John 
Published: March 2019

Purpose: As advances are made in smaller-gauge vitrectomy, it is important to characterize the associated risks. This allows the surgeon to anticipate complications and appropriately counsel patients. The incidence of iatrogenic retinal breaks in 25- and 23-gauge (G) vitrectomy is known, but no studies exist looking at the incidence in 27G vitrectomy with an attached posterior hyaloid face (PHF). This study set out to characterize the incidence. Methods: A retrospective, consecutive, observational study of patients undergoing 27G transconjunctival sutureless vitrectomy for macular pathology or floaters was conducted. This was a single-surgeon series conducted between 2015 and 2017 at Calderdale Royal Hospital, United Kingdom. Inclusion criteria included only those with an attached PHF at the disc, identified intraoperatively. Results: Data were collected and analyzed in 94 patients. Preoperative diagnosis frequency was as follows: epiretinal membrane 24 (25.5%), macular hole 47 (50.0%), vitreomacular traction 11 (11.7%), and floaters 12 (12.8%). In 82 out of 94 patients (89.1%), 27G vitrectomy was combined with 2.2 mm microincisional phacoemulsification with lens implantation. The incidence of iatrogenic retinal breaks associated with PHF separation during 27G PPV was 17% (16 cases). Conclusions: This is the first study to report the incidence of peripheral retinal breaks induced by PHF separation during 27G vitrectomy. Our single-surgeon case series of 27G PPV for all elective vitreoretinal indications, in eyes with attached vitreous, yielded an iatrogenic break rate of 17%. However, no postoperative retinal detachments followed. Statistical analysis revealed no specific risk factors to be significantly associated with outcome (incidence of retinal tear).
Plerixafor alone for the mobilization and transplantation of HLA-matched sibling donor hematopoietic stem cells
Authors: Chen Yi-Bin , Le-Rademacher Jennifer , Brazauskas Ruta , Kiefer Deidre M. , Hamadani Mehdi , DiPersio John F. , Litzow Mark R. , Craig Michael , Horwitz Mitchell E. , Artz Andrew S. , McClune Brian L. , Fernandez Hugo F. , Duong Hien Kim , Kobusingye Hati , Proue Mandi , Drexler Rebecca J. , Horowitz Mary M. , Shaw Bronwen E. , Miller John P. , Hosoba Sakura , Waller Edmund K. , Devine Steven M. 
Published: March 2019

Abstract
Plerixafor, a direct antagonist of CXCR4/stromal-derived factor 1, can safely and rapidly mobilize allografts without the use of granulocyte colony-stimulating factor (G-CSF). We conducted a phase 2, multicenter, prospective study of plerixafor-mobilized HLA-identical sibling allografts for allogeneic hematopoietic cell transplantation in recipients with hematological malignancies. Donors (n = 64) were treated with subcutaneous plerixafor (240 µg/kg) and started leukapheresis (LP) 4 hours later. The primary objective was to determine the proportion of donors who were successfully mobilized: defined as collection of ≥2.0 × 106 CD34+ cells per kilogram recipient weight in ≤2 LP sessions. Recipients subsequently received reduced intensity (RIC; n = 33) or myeloablative (MAC; n = 30) conditioning. Sixty-three of 64 (98%) donors achieved the primary objective. The median CD34+ cell dose per kilogram recipient weight collected within 2 days was 4.7 (0.9-9.6). Plerixafor was well tolerated with only grade 1 or 2 drug-related adverse events noted. Bone pain was not observed. Plerixafor-mobilized grafts engrafted promptly. One-year progression-free and overall survivals were 53% (95% confidence interval [CI], 36% to 71%) and 63% (95% CI, 46% to 79%) for MAC and 64% (95% CI, 47% to 79%) and 70% (95% CI, 53% to 84%) for RIC recipients, respectively. Donor toxicity was reduced relative to G-CSF mobilized related donors. This is the first multicenter trial to demonstrate that, as an alternative to G-CSF, plerixafor rapidly and safely mobilizes sufficient numbers of CD34+ cells from matched sibling donors for HCT. Engraftment was prompt, and outcomes in recipients were encouraging. This trial was registered at clinicaltrials.gov as #NCT01696461.
Effect of Sevoflurane Versus Isoflurane on Emergence Time and Postanesthesia Care Unit Length of Stay: An Alternating Intervention Trial
Authors: Maheshwari Kamal , Ahuja Sanchit , Mascha Edward J. , Cummings Kenneth C. , Chahar Praveen , Elsharkawy Hesham , Kurz Andrea , Turan Alparslan , Sessler Daniel I. 
Published: March 2019

BACKGROUND:We previously reported that the duration of hospitalization was not different between isoflurane and sevoflurane. But more plausible consequences of using soluble volatile anesthetics are delayed emergence from anesthesia and prolonged stays in the postanesthesia care unit (PACU). We therefore compared isoflurane and sevoflurane on emergence time and PACU duration.METHODS:We reanalyzed data from 1498 adults who participated in a previous alternating intervention trial comparing isoflurane and sevoflurane. Patients, mostly having colorectal surgery, were assigned to either volatile anesthetic in 2-week blocks that alternated for half a year. Emergence time was defined as the time from minimum alveolar concentration fraction reaching 0.3 at the end of the procedure until patients left the operating room. PACU duration was defined from admission to the end of phase 1 recovery. Treatment effect was assessed using Cox proportional hazards regression, adjusted for imbalanced baseline variables.RESULTS:A total of 674 patients were given isoflurane, and 824 sevoflurane. Emergence time was slightly longer for isoflurane with a median (quartiles) of 16 minutes (12–22 minutes) vs 14 minutes (11–19 minutes) for sevoflurane, with an adjusted hazard ratio of 0.81 (97.5% CI, 0.71–0.92;P< .001). Duration in the PACU did not differ, with a median (quartiles) of 2.6 hours (2.0–3.6 hours) for isoflurane and 2.6 hours (2.0–3.7 hours) hours for sevoflurane. The adjusted hazard ratio for PACU discharge time was 1.04 (97.5% CI, 0.91–1.18;P= .56).CONCLUSIONS:Isoflurane prolonged emergence by only 2 minutes, which is not a clinically important amount, and did not prolong length of stay in the PACU. The more soluble and much less-expensive anesthetic isoflurane thus seems to be a reasonable alternative to sevoflurane.
Prolonged Duration Local Anesthesia by Combined Delivery of Capsaicin- and Tetrodotoxin-Loaded Liposomes
Authors: Shomorony Andre , Santamaria Claudia M. , Zhao Chao , Rwei Alina Y. , Mehta Manisha , Zurakowski David , Kohane Daniel S. 
Published: March 2019

BACKGROUND:
Capsaicin, the active component of chili peppers, can produce sensory-selective peripheral nerve blockade. Coadministration of capsaicin and tetrodotoxin, a site-1 sodium channel blocker, can achieve a synergistic effect on duration of nerve blocks. However, capsaicin can be neurotoxic, and tetrodotoxin can cause systemic toxicity. We evaluated whether codelivery of capsaicin and tetrodotoxin liposomes can achieve prolonged local anesthesia without local or systemic toxicity.

METHODS:
Capsaicin- and tetrodotoxin-loaded liposomes were developed. Male Sprague-Dawley rats were injected at the sciatic nerve with free capsaicin, capsaicin liposomes, free tetrodotoxin, tetrodotoxin liposomes, and blank liposomes, singly or in combination. Sensory and motor nerve blocks were assessed by a modified hotplate test and a weight-bearing test, respectively. Local toxicity was assessed by histologic scoring of tissues at the injection sites and transmission electron microscopic examination of the sciatic nerves. Systemic toxicity was assessed by rates of contralateral nerve deficits and/or mortality.

RESULTS:
The combination of capsaicin liposomes and tetrodotoxin liposomes achieved a mean duration of sensory block of 18.2 hours (3.8 hours) [mean (SD)], far longer than that from capsaicin liposomes [0.4 hours (0.5 hours)] (P < .001) or tetrodotoxin liposomes [0.4 hours (0.7 hours)] (P < .001) given separately with or without the second drug in free solution. This combination caused minimal myotoxicity and muscle inflammation, and there were no changes in the percentage or diameter of unmyelinated axons. There was no systemic toxicity.

CONCLUSIONS:
The combination of encapsulated tetrodotoxin and capsaicin achieved marked prolongation of nerve block. This combination did not cause detectable local or systemic toxicity. Capsaicin may be useful for its synergistic effects on other formulations even when used in very small, safe quantities.
A high-content imaging approach to profile C. elegans embryonic development
Authors: Wang Shaohe , Ochoa Stacy D. , Khaliullin Renat N. , Gerson-Gurwitz Adina , Hendel Jeffrey M. , Zhao Zhiling , Biggs Ronald , Chisholm Andrew D. , Desai Arshad , Oegema Karen , Green Rebecca A. 
Published: March 2019

ABSTRACT
The Caenorhabditis elegans embryo is an important model for analyzing mechanisms of cell fate specification and tissue morphogenesis. Sophisticated lineage-tracing approaches for analyzing embryogenesis have been developed but are labor intensive and do not naturally integrate morphogenetic readouts. To enable the rapid classification of developmental phenotypes, we developed a high-content method that employs two custom strains: a Germ Layer strain that expresses nuclear markers in the ectoderm, mesoderm and endoderm/pharynx; and a Morphogenesis strain that expresses markers labeling epidermal cell junctions and the neuronal cell surface. We describe a procedure that allows simultaneous live imaging of development in 80-100 embryos and provide a custom program that generates cropped, oriented image stacks of individual embryos to facilitate analysis. We demonstrate the utility of our method by perturbing 40 previously characterized developmental genes in variants of the two strains containing RNAi-sensitizing mutations. The resulting datasets yielded distinct, reproducible signature phenotypes for a broad spectrum of genes that are involved in cell fate specification and morphogenesis. In addition, our analysis provides new in vivo evidence for MBK-2 function in mesoderm fate specification and LET-381 function in elongation.
Single cell analysis of adult mouse skeletal muscle stem cells in homeostatic and regenerative conditions
Authors: Dell'Orso Stefania , Juan Aster H. , Ko Kyung-Dae , Naz Faiza , Perovanovic Jelena , Gutierrez-Cruz Gustavo , Feng Xuesong , Sartorelli Vittorio 
Published: March 2019

ABSTRACT
Dedicated stem cells ensure postnatal growth, repair and homeostasis of skeletal muscle. Following injury, muscle stem cells (MuSCs) exit from quiescence and divide to reconstitute the stem cell pool and give rise to muscle progenitors. The transcriptomes of pooled MuSCs have provided a rich source of information for describing the genetic programs of distinct static cell states; however, bulk microarray and RNA sequencing provide only averaged gene expression profiles, blurring the heterogeneity and developmental dynamics of asynchronous MuSC populations. Instead, the granularity required to identify distinct cell types, states, and their dynamics can be afforded by single cell analysis. We were able to compare the transcriptomes of thousands of MuSCs and primary myoblasts isolated from homeostatic or regenerating muscles by single cell RNA sequencing. Using computational approaches, we could reconstruct dynamic trajectories and place, in a pseudotemporal manner, the transcriptomes of individual MuSC within these trajectories. This approach allowed for the identification of distinct clusters of MuSCs and primary myoblasts with partially overlapping but distinct transcriptional signatures, as well as the description of metabolic pathways associated with defined MuSC states.