bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes After Severe Distal Tibia, Ankle, and/or Foot Trauma: Comparison of Limb Salvage Versus Transtibial Amputation (OUTLET)
Authors: Bosse Michael J. , Teague David , Reider Lisa , Gary Joshua L. , Morshed Saam , Seymour Rachel B. , Toledano James , Cannada Lisa K. , Steverson Barbara , Scharfstein Daniel O. , Luly Jason , MacKenzie Ellen J. ,   METRC
Published: March 2017

Summary:
Severe foot and ankle injuries are complex and challenging to treat, often requiring multiple operations to salvage the limb contributing to a prolonged healing period. There is some evidence to suggest that early amputation for some patients may result in better long-term outcomes than limb salvage. The challenge is to identify the regional injury burden for an individual that would suggest a better outcome with an amputation. The OUTLET study is a prospective, multicenter observational study comparing 18-month outcomes after limb salvage versus early amputation among patients aged 18–60 years with severe distal tibia, ankle, and foot injuries. This study aims to build upon the previous work of the Lower Extremity Assessment Project by identifying the injury and patient characteristics that help define a subgroup of salvage patients who will have better outcomes had they undergone a transtibial amputation.
A Prospective Randomized Trial to Assess Oral Versus Intravenous Antibiotics for the Treatment of Postoperative Wound Infection After Extremity Fractures (POvIV Study)
Authors: Obremskey William T. , Schmidt Andrew H. , O'Toole Robert V. , DeSanto Jennifer , Morshed Saam , Tornetta Paul , Murray Clinton K. , Jones Clifford B. , Scharfstein Daniel O. , Taylor Tara J. , Carlini Anthony R. , Castillo Renan C. ,   METRC
Published: March 2017

Summary:
Patients surgically treated for infection after extremity fractures are typically discharged with a 6- to 12-week antibiotic regimen. Intravenous (IV) antibiotics are associated with significant cost and potential complications of deep vein thrombosis, line clotting, and sepsis. Many of the pathogens that cause musculoskeletal infection have both oral (PO) and IV antibiotic options with adequate bioavailability and antibacterial effect, yet IV antibiotics remain the standard of care absent evidence that PO options are clinically as efficacious. The POvIV study is a prospective, multicenter, randomized trial to compare PO with IV antibiotic therapy in patients with postoperative wound infections after extremity fractures. Patients between the ages of 18 and 84 who have a culture-positive surgical site infection after internal fixation for fracture repair or arthrodesis are approached for this study, and if they provide consent, are randomly assigned to receive either PO or IV antibiotics. Antibiotic selection is based on culture and sensitivity results. Randomization determines the route of administration. Patients are followed for 1 year after study enrollment. This study will be the largest prospective randomized trial to evaluate the safety and effectiveness of PO antibiotic use for treatment of postoperative wound infections. Results will inform clinician decisions on antibiotic delivery in patients with postoperative wound infections.
Supplemental Perioperative Oxygen to Reduce Surgical Site Infection After High-Energy Fracture Surgery (OXYGEN Study)
Authors: O'Toole Robert V. , Joshi Manjari , Carlini Anthony R. , Sikorski Robert A. , Dagal Armagan , Murray Clinton K. , Weaver Michael J. , Paryavi Ebrahim , Stall Alec C. , Scharfstein Daniel O. , Agel Julie , Zadnik Mary , Bosse Michael J. , Castillo Renan C. ,   METRC
Published: March 2017

Summary:
Supplemental perioperative oxygen (SPO) therapy has been proposed as one approach for reducing the risk of surgical site infection (SSI). Current data are mixed regarding efficacy in decreasing SSI rates and hospital inpatient stays in general and few data exist for orthopaedic trauma patients. This study is a phase III, double-blind, prospective randomized clinical trial with a primary goal of assessing the efficacy of 2 different concentrations of perioperative oxygen in the prevention of SSIs in adults with tibial plateau, pilon (tibial plafond), or calcaneus fractures at higher risk of infection and definitively treated with plate and screw fixation. Patients are block randomized (within center) in a 1:1 ratio to either treatment group (FiO2 80%) or control group (FiO2 30%) and stratified by each study injury location. Secondary objectives of the study are to compare species and antibacterial sensitivities of the bacteria in patients who develop SSIs, to validate a previously developed risk prediction model for the development of SSI after fracture surgery, and to measure and compare resource utilization and cost associated with SSI in the 2 study groups. SPO is a low cost and readily available resource that could be easily disseminated to trauma centers across the country and the world if proved to be effective.
Surgical Treatment of Congenital and Obligatory Dislocation of the Patella in Children
Authors: Sever Ronen , Fishkin Michael , Hemo Yoram , Wientroub Shlomo , Yaniv Moshe 
Published: March 2017

Background:
Congenital (fixed) dislocations and obligatory (habitual) patellar dislocations represent a complex clinical and surgical challenge. Numerous treatment options, offering different perspectives, and surgical solutions are reported in the literature.
We implemented the surgical technique principles, originally described by Stanisavljevic, for congenital (fixed) and obligatory (habitual) patellar dislocations, with slight modifications.

Methods:
We retrospectively evaluated the results of group of 12 patients (15 knees), operated between the years 2002 and 2013. The procedure includes extensive subperiosteal quadriceps realignment and soft tissue medial plication, followed by distal realignment through patellar tendon splitting. The outcome measures were patellar stability, knee range of motion, Pedi-IKDC knee function score, and the PODCI global function score.

Results:
The study group included 12 patients, 9 females and 3 males (15 knees) whose mean age was 5 years 2 months at diagnosis and 7 years 5 months at surgery. Nine patients had an underlying diagnosed genetic background [Down syndrome (n=6), Larsen syndrome (n=2), nail-patella syndrome (n=1)]. The mean follow-up was 46.2 months. Eleven patients, gained stable patella with no recurrence of dislocation. Postoperative knee active extension was improved significantly (P<0.0001) for all patients. The average postoperative Pedi-IKDC and PODCI scores were significantly higher (P<0.001) among the idiopathic group.

Conclusions:
These results suggest that the Stanisavljevic procedure principles with modifications, provides an efficient method for treatment of fixed and obligatory patellar dislocation. In our opinion, young age at surgery played an important role in the surgical outcome.

Level of Evidence:
Level IV—therapeutic.
Control of Walking Speed in Children With Cerebral Palsy
Authors: Davids Jon R. , Cung Nina Q. , Chen Suzy , Sison-Williamson Mitell , Bagley Anita M. 
Published: March 2017

Background:
Children’s ability to control the speed of gait is important for a wide range of activities. It is thought that the ability to increase the speed of gait for children with cerebral palsy (CP) is common. This study considered 3 hypotheses: (1) most ambulatory children with CP can increase gait speed, (2) the characteristics of free (self-selected) and fast walking are related to motor impairment level, and (3) the strategies used to increase gait speed are distinct among these levels.

Methods:
A retrospective review of time-distance parameters (TDPs) for 212 subjects with CP and 34 typically developing subjects walking at free and fast speeds was performed. Only children who could increase their gait speed above the minimal clinically important difference were defined as having a fast walk. Analysis of variance was used to compare TDPs of children with CP, among Gross Motor Function Classification System (GMFCS) levels, and children in typically developing group.

Results:
Eight-five percent of the CP group (GMFCS I, II, III; 96%, 99%, and 34%, respectively) could increase gait speed on demand. At free speed, children at GMFCS I and II were significantly faster than children at GMFCS level III. At free speed, children at GMFCS I and II had significantly greater stride length than those at GMFCS levels III. At free speed, children at GMFCS level III had significantly lower cadence than those at GMFCS I and II. There were no significant differences in cadence among GMFCS levels at fast speeds. There were no significant differences among GMFCS levels for percent change in any TDP between free and fast walking.

Discussion:
Almost all children with CP at GMFCS levels I and II can control the speed of gait, however, only one-third at GMFCS III level have this ability. This study suggests that children at GMFCS III level can be divided into 2 groups based on their ability to control gait speed; however, the prognostic significance of such categorization remains to be determined.

Level of Evidence:
Diagnostic level II.
Impact of Targeted Interventions on Trends in Central Line-Associated Bloodstream Infection: A Single-Center Experience From the Republic of Korea
Authors: Cho Sun Young , Chung Doo Ryeon , Ryu Jae Geum , Choi Jong Rim , Ahn Nayeon , Kim Seonwoo , Kim Min-Ji , Ha Young Eun , Kang Cheol-In , Peck Kyong Ran , Song Jae-Hoon 
Published: March 2017

Objective:
To assess the impact of targeted interventions on trends in central line-associated bloodstream infection.

Design:
A before-and-after study between January 2013 and September 2014.

Setting:
Tertiary hospital in the Republic of Korea.

Patients:
All patients with central-line catheters in the hospital.

Interventions:
In September 2013, interventions that targeted central line insertion practices were implemented in 10 ICUs, including compliance monitoring with a central line insertion practices bundle and use of an all-inclusive catheter kit. The impact of targeted interventions on trends in central line-associated bloodstream infection was evaluated by segmented autoregression analysis of an interrupted time series.

Measurements and Main Results:
The average hospital-wide central line-associated bloodstream infection rates in the baseline and intervention periods were 1.84 and 1.56 per 1,000 catheter-days, respectively. During the baseline period, there was an increase of central line-associated bloodstream infection rate of 0.12 per 1,000 catheter-days per month. In the intervention period, there was a decrease of central line-associated bloodstream infection rate of 0.16 per 1,000 catheter-days per month (change in slope, –0.28; 95% CI, –0.37 to –0.19; p < 0.0001). In ICUs, the average central line-associated bloodstream infection rates in the baseline and intervention periods were 1.92 and 1.64 per 1,000 catheter-days, respectively. During the baseline period, there was an increase of central line-associated bloodstream infection rate of 0.18 per 1,000 catheter-days per month in ICUs. After sequential-targeted interventions, there was a decrease of central line-associated bloodstream infection rate of 0.16 per 1,000 catheter-days per month (change in slope, –0.34; 95% CI, –0.50 to –0.18; p = 0.0007).

Conclusions:
Targeted interventions were associated with significant changes in trends in the occurrence rate of central line-associated bloodstream infection in ICUs and the entire hospital.
The Absence of Fever Is Associated With Higher Mortality and Decreased Antibiotic and IV Fluid Administration in Emergency Department Patients With Suspected Septic Shock
Authors: Henning Daniel J. , Carey Jeremy R. , Oedorf Kimie , Day Danielle E. , Redfield Colby S. , Huguenel Colin J. , Roberts Jonathan C. , Sanchez Leon D. , Wolfe Richard E. , Shapiro Nathan I. 
Published: March 2017

Objective:
This study evaluates whether emergency department septic shock patients without a fever (reported or measured) receive less IV fluids, have decreased antibiotic administration, and suffer increased in-hospital mortality.

Design:
This was a secondary analysis of a prospective, observational study of patients with shock.

Setting:
The study was conducted in an urban, academic emergency department.

Patients:
The original study enrolled consecutive adult (aged 18 yr or older) emergency department patients from November 11, 2012, to September 23, 2013, who met one of the following shock criteria: 1) systolic blood pressure less than 90 mm Hg after at least 1L IV fluids, 2) new vasopressor requirement, or 3) systolic blood pressure less than 90 mm Hg and IV fluids held for concern of fluid overload. The current study is limited to patients with septic shock. Patients were grouped as febrile if they had a subjective fever or a measured temperature >100.4°F documented in the emergency department; afebrile patients lacked both.

Measurements and Main Results:
Among 378 patients with septic shock, 207 of 378 (55%; 50–60%) were febrile by history or measurement. Afebrile patients had lower rates of antibiotic administration in the emergency department (81% vs 94%; p < 0.01), lower mean volumes of IV fluids (2,607 vs 3,013 mL; p < 0.01), and higher in-hospital mortality rates (33% vs 11%; p < 0.01). After adjusting for bicarbonate less than 20 mEq/L, lactate concentration, respiratory rate greater than or equal to 24 breaths/min, emergency department antibiotics, and emergency department IV fluids volume, being afebrile remained a significant predictor of in-hospital mortality (odds ratio, 4.3; 95% CI, 2.2–8.2; area under the curve = 0.83).

Conclusions:
In emergency department patients with septic shock, afebrile patients received lower rates of emergency department antibiotic administration, lower mean IV fluids volume, and suffered higher in-hospital mortality.
Novel Approach to Treating Androgenetic Alopecia in Females With Photobiomodulation (Low-Level Laser Therapy)
Authors: Friedman Shelly , Schnoor Patricia 
Published: March 2017

BACKGROUND
Photobiomodulation, also referred to as low-level laser therapy (LLLT), has been studied and used for (among other diseases) the promotion of hair regrowth.

OBJECTIVE/MATERIALS AND METHODS/RESULTS
A clinical study was developed to define the physiologic effects that occur when the human hair follicle and surrounding tissue structures are exposed to laser light using a novel device that is fitted with an array of laser diode sources operating at 650 nm and placed inside a sports cap to promote discretion while in use. The study demonstrates that low-level laser treatment of the scalp every other day for 17 weeks using the HANDI-DOME LASER device is a safe and effective treatment for androgenetic alopecia in healthy females between the ages of 18 to 60 with Fitzpatrick skin Types I to IV and Ludwig–Savin Baldness Scale I-2 to II-2 baldness patterns. Subjects receiving LLLT at 650 nm achieved a 51% increase in hair counts as compared with sham-treated control patients in this multicenter randomized controlled trial.

CONCLUSION
These results suggest that the emerging technology of low-level laser therapy may play a potentially significant role in health care providers' armamentarium for the disease androgenic alopecia.
Acetylcholine–Atropine Interactions: Paradoxical Effects on Atrial Fibrillation Inducibility
Authors: Liu Yu , Scherlag Benjamin J. , Fan Youqi , Xia Wenfang , Huang He , Po Sunny S. 
Published: March 2017

Abstract:
Atropine (ATr) is well known as a cholinergic antagonist, however, at low concentrations ATr could paradoxically accentuate the parasympathetic actions of acetylcholine (ACh). In 22 pentobarbital anesthetized dogs, via a left and right thoracotomy, a leak-proof barrier was attached to isolate the atrial appendages (AAs) from the rest of the atria. In group 1 (Ach+ATr+Ach), ACh, 100 mM, was placed on the AA followed by the application of ATr, 2 mg/mL. The average atrial fibrillation (AF) duration was 17 ± 7 minutes. After ATr was applied to the AA and ACh again tested, the AF duration was markedly attenuated (2 ± 2 minutes, P < 0.05). In group 2 (ATr+Ach), ATr was initially applied to the AA followed by the application of ACh, 100 mM. There was no significant difference in AF duration (16 ± 4 minutes vs. 18 ± 2 minutes, P = NS). The inhibitory effect of ATr on induced HR reduction (electrical stimulation of the anterior right ganglionated plexi and vagal nerves) was similar between groups 1 and 2. These observations suggest that when ATr is initially administered it attaches to the allosteric site of the muscarinic ACh receptor (M2) leaving the orthosteric site free to be occupied by ACh. The M3 receptor that controls HR slowing does not show the same allosteric properties.
Induration at Injection or Infusion Site May Reduce Bioavailability of Parenteral Phenobarbital Administration
Authors: Nakayama Hirokazu , Echizen Hirotoshi , Ogawa Ryuichi , Akabane Atsuya , Kato Toshiaki , Orii Takao 
Published: March 2017

Background:Phenobarbital is well tolerated and effective for controlling agitation or preventing convulsion at the end of life. No information is available concerning parenteral bioavailability of phenobarbital when induration develops at the injection or infusion site. We investigated whether induration at injection or infusion site is related to phenobarbital bioavailability via parenteral routes of continuous subcutaneous infusion and intermittent subcutaneous or intramuscular injection.Methods:A retrospective analysis was conducted on the medical data obtained from 18 patients who received chronic subcutaneous or intramuscular injections of phenobarbital for the prevention of convulsions and underwent plasma concentration monitoring of the drug. Patients whose concomitant medications were altered during the observation periods were excluded from the analysis. Comparisons were performed for concentration/dose (C/D) ratios obtained from patients with induration at injection or infusion sites (induration group, n = 6) and those without induration (noninduration group, n = 12).P< 0.05 was considered statistically significant.Results:The induration group showed significantly reduced C/D ratio compared with the noninduration group [median (range): 0.131 (0.114–0.334) versus 0.219 (0.180–0.322) d/L,P< 0.05). Assuming that systemic clearance was constant in our patients, changes in the C/D ratio would have contributed to 40% (median) reduction in bioavailability of the drug from the injection or infusion site.Conclusions:Our data suggest that absolute bioavailability of phenobarbital may be reduced when induration develops at the injection or infusion site in patients treated parenterally by continuous subcutaneous infusion or intramuscular injection.
ONE-YEAR RESULTS OF HALF- VERSUS STANDARD-DOSE PHOTODYNAMIC THERAPY COMBINED WITH RANIBIZUMAB FOR POLYPOIDAL CHOROIDAL VASCULOPATHY
Authors: Wong Ian Y. , Shi Xuan , Gangwani Rita , Iu Lawrence P. , Fung Nicholas , Li Qing , Ng Alex L. K. , Li Xiaoxin 
Published: March 2017

Purpose:
To explore the efficacy of half-dose verteporfin photodynamic therapy (hd-PDT) and standard-dose photodynamic therapy (sd-PDT), when combined with ranibizumab in the treatment of polypoidal choroidal vasculopathy.

Methods:
Subjects were allocated to either the hd-PDT arm or the sd-PDT arm. All subjects received an injection of ranibizumab and PDT treatment (dosage according to allocation) at baseline. Subjects were followed up monthly for 12 months, and re-treatment were given at each visit if criteria were met.

Results:
There were 26 subjects in the hd-PDT arm and 32 in the sd-PDT arm. Overall mean age was 69.3 ± 9.4 years. Baseline demographics and ocular features did not differ significantly between the two arms. Improvement in vision and reduction in central retinal thickness were similar between the two arms. When presenting, visual acuity was better than 20/50 (logarithm of the minimum angle of resolution 0.4), or when there were three or less polyps angiogram, those treated with hd-PDT tended to perform better than those treated with sd-PDT.

Conclusion:
In general, hd-PDT was able to produce similar results as sd-PDT. Subgroup analysis revealed superior results with hd-PDT when baseline vision was 20/50 or better, or when there were three or less polyps on indocyanine green angiography.
Strategies for Deep Anterior Lamellar Keratoplasty After Hydrops in Keratoconus
Authors: Fuest Matthias , Mehta Jodhbir S. 
Published: March 2017

Abstract:
Corneal hydrops affects approximately 2.5% of keratoconus (KC) cases, predominantly young males approximately 25 years of age with steep cones. Often, patients are left with a vision-reducing corneal scar frequently necessitating surgical treatment. Penetrating keratoplasty (PK) has worse survival outcomes in hydrops than in general KC cases. Deep anterior lamellar keratoplasty (DALK) is a nonpenetrating technique believed to achieve equal or better outcomes in visual acuity, graft survival, endothelial rejection rates, and endothelial cell survival in comparison with PK, while maintaining globe integrity and the patients' Descemet membrane (DM) and endothelium. Outcomes for patients with KC are promising. After hydrops, a corneal scar involving DM complicates the ability to perform DALK using standard techniques. So far few case series described successful treatment of hydrops scars with DALK. In this review, we summarize, evaluate, and discuss the current known approaches to DALK in patients after hydrops.
Biomarker of extracellular matrix remodelling C1M and proinflammatory cytokine interleukin 6 are related to synovitis and pain in end-stage knee osteoarthritis patients
Authors: Radojčić Maja R. , Thudium Christian S. , Henriksen Kim , Tan Keith , Karlsten Rolf , Dudley Amanda , Chessell Iain , Karsdal Morten A. , Bay-Jensen Anne-Christine , Crema Michel D. , Guermazi Ali 
Published: March 2017

Abstract
Little is known about local and systemic biomarkers in relation to synovitis and pain in end-stage osteoarthritis (OA) patients. We investigated the associations between the novel extracellular matrix biomarker, C1M, and local and systemic interleukin 6 (IL-6) with synovitis and pain. Serum C1M, plasma, and synovial fluid IL-6 (p-IL-6, sf-IL-6) were measured in 104 end-stage knee OA patients. Contrast-enhanced magnetic resonance imaging was used to semiquantitatively assess an 11-point synovitis score; pain was assessed by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Neuropathic Pain Questionnaire (NPQ). Linear regression was used to investigate associations between biomarkers and synovitis, and biomarkers and pain while controlling for age, sex, and body mass index. We also tested whether associations between biomarkers and pain were confounded by synovitis. We found sf-IL-6 was associated with synovitis in the parapatellar subregion (B = 0.006; 95% confidence interval [CI] 0.003-0.010), and no association between p-IL-6 and synovitis. We also observed an association between C1M and synovitis in the periligamentous subregion (B = 0.013; 95% CI 0.003-0.023). Furthermore, sf-IL-6, but not p-IL-6, was significantly associated with pain, WOMAC (B = 0.022; 95% CI 0.004-0.040), and NPQ (B = 0.043; 95% CI 0.005-0.082). There was no association between C1M and WOMAC pain, but we did find an association between C1M and NPQ (B = 0.229; 95% CI 0.036-0.422). Lastly, synovitis explained both biomarker-NPQ associations, but not the biomarker-WOMAC association. These results suggest that C1M and IL-6 are associated with synovitis and pain, and synovitis is an important confounding variable when studying biomarkers and neuropathic features in OA patients.