bluuebunny/crossref_metadata_2025_split huggingface dataset:
Estimating Gestational Age From Ultrasound Fetal Biometrics
Authors: Skupski Daniel W. , Owen John , Kim Sungduk , Fuchs Karin M. , Albert Paul S. , Grantz Katherine L. ,   for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Fetal Growth Studies
Published: July 2017

OBJECTIVE:
To compare the accuracy of a new formula with one developed in 1984 (and still in common use) and to develop and compare racial and ethnic-specific and racial and ethnic-neutral formulas.

METHODS:
The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Fetal Growth Studies-Singletons was a prospective cohort study that recruited women in four self-reported racial–ethnic groups—non-Hispanic black, Hispanic, non-Hispanic white, and Asian—with singleton gestations from 12 U.S. centers (2009–2013). Women with a certain last menstrual period confirmed by first-trimester ultrasonogram had longitudinal fetal measurements by credentialed study ultrasonographers blinded to the gestational age at their five follow-up visits. Regression analyses were performed with linear mixed models to develop gestational age estimating formulas. Repeated cross-validation was used for validation. The estimation error was defined as the mean squared difference between the estimated and observed gestational age and was used to compare the formulas' accuracy.

RESULTS:
The new formula estimated the gestational age (±2 SD) within ±7 days from 14 to 20 weeks of gestation, ±10 days from 21 to 27 weeks of gestation, and ±17 days from 28 to 40 weeks of gestation. The new formula performed significantly better than a formula developed in 1984 with an estimation error of 10.4 compared with 11.2 days from 21 to 27 weeks of gestation and 17.0 compared with 19.8 days at 28–40 weeks of gestation, respectively. Racial and ethnic-specific formulas did not outperform the racial and ethnic-neutral formula.

CONCLUSION:
The NICHD gestational age estimation formula is associated with smaller errors than a well-established historical formula. Racial and ethnic-specific formulas are not superior to a racial–ethnic-neutral one.
Posterior Fracture Dislocation of the Shoulder: A Modified McLaughlin Procedure
Authors: Konda Sanjit R. , Fisher Nina , Gage Mark , Egol Kenneth A. 
Published: July 2017

Purpose:
Bilateral posterior fracture dislocation is a rare injury commonly associated with seizures. When the humeral head defect (reverse Hill–Sachs lesion) is between 20% and 45%, operative fixation using a modified McLaughlin procedure is recommended. This video demonstrates a case of bilateral posterior fracture dislocation after a drug-induced seizure treated with a modified McLaughlin procedure.

Methods:
The original McLaughlin procedure involved transfer of the subscapularis tendon from the lesser tuberosity to the reverse Hill–Sachs defect. However, the modified McLaughlin procedure is more commonly described in the literature as of late and involved the transfer of the lesser tuberosity along with the subscapularis.

Results:
This video demonstrates the modified McLaughlin technique for a posterior fracture dislocation. Computerized tomography confirms the articular impression fractures of the proximal humerus. Through a deltopectoral approach, the lesser tuberosity along with the subscapularis tendon was transferred into the defect.

Conclusions:
The modified McLaughlin procedure demonstrates excellent clinical and radiographic results after posterior fracture dislocation of the shoulder with a reverse Hill–Sachs lesion between 25% and 45%.
Suture Repair of a Pole Patella Fracture
Authors: Swensen Stephanie , Fisher Nina , Atanda Abiola , Egol Kenneth A. 
Published: July 2017

Purpose:
Operative fixation of displaced patella fractures is considered to be standard of care. However, patients with inferior pole patella fractures have limited options in terms of fixation. This video demonstrates the repair of an inferior pole patella fracture using nonabsorbable suture fixation.

Methods:
Suture repair of patella fractures is a clinically acceptable technique, yielding similar functional results to patella fractures treated with K-wires or cannulated screws while reducing the rates of removal of hardware after fixation.

Results:
This video features the repair of a displaced, comminuted inferior pole patella fracture using 5 Ethibond and Fiberwire. Postoperative radiographs confirm bony union.

Conclusions:
Suture fixation for pole patella fractures provides reliable fixation and reduces the risk of postoperative complications secondary to hardware irritation. This case highlights the success of this technique.
Vasomotor hot flashes and cardiac repolarization: a randomized placebo-controlled trial of postmenopausal hormone therapy
Authors: Lantto Hanna , Haapalahti Petri , Viitasalo Matti , Väänänen Heikki , Sovijärvi Anssi R.A. , Ylikorkala Olavi , Mikkola Tomi S. 
Published: July 2017

Abstract

Objective:
The aim of the study was to compare the effects of different hormone therapies on cardiac repolarization in recently postmenopausal women with and without hot flashes.

Methods:
We recruited 150 healthy women: 72 with and 78 without hot flashes. They were randomized and treated for 6 months with transdermal estradiol (1 mg/day), oral estradiol (OE) alone (2 mg/day) or combined with medroxyprogesterone acetate (MPA; 5 mg/day), or placebo. Cardiac repolarization was assessed by measuring QT intervals, rate-dependence of QT-end interval, and T waves from 24-hour electrocardiographic recording before and during hormone therapy, comprising a total of over 20 million QT-interval measurements.

Results:
Hot flashes were accompanied with shortened median T-peak – T-end interval (at RR interval of 700, 800, and 900 ms; P = 0.040, 0.020, and 0.032; η2 = 0.35, 0.39, and 0.37; respectively) during the use of OE but not transdermal estradiol. In contrast, the addition of MPA to OE lengthened the maximal QT-end (at RR interval of 500 ms, P = 0.016, η2 = 0.27) and the maximal T-peak – T-end interval (at RR interval of 500 and 600 ms; P = 0.016 and 0.032; η2 = 0.25 and 0.22, respectively). These effects were not seen in women without hot flashes.

Conclusions:
Hot flashes predict beneficial shortening in cardiac repolarization during OE, but not if MPA is combined with OE. These data may provide one explanation for MPA-related cardiac hazards in epidemiological studies.
Impact of age at first childbirth on primary open-angle glaucoma
Authors: Park Sangshin , Choi Nam-Kyong 
Published: July 2017

Abstract

Objective:
No studies have addressed the relationship between the timing of first childbirth and primary open-angle glaucoma (POAG). The aim of the study was to identify the relationship between age at first childbirth and POAG and to examine the contribution of parity to the age at first childbirth–POAG relationship in postmenopausal women.

Methods:
The study population comprised postmenopausal women aged 50 or above in the cross-sectional Korea National Health and Nutrition Examination Survey from 2010 to 2012. Participants were grouped into quintiles by age at first childbirth for analysis. This study used logistic regression and mediation analyses with accommodations for the complex sampling structure of the survey.

Results:
Of the 4,057 women in the study population, the mean age at first childbirth was 23.7 years, and POAG prevalence was 3.4%. Prevalence of POAG was lowest in women whose first childbirth was between the ages of 27 and 44 (1.8%). Their risk for POAG (odds ratio [OR], 0.25; 95% CI, 0.10-0.65) was significantly lower than in those whose first childbirth was between the ages of 13 and 20, after adjustments for covariates. Late first delivery (≥27 y) was directly (OR, 0.57) and totally (OR, 0.85) associated with the decreased risk of POAG; decreased parity in women who delivered their first child at an older age attenuated the age at first childbirth–POAG relationship (OR of indirect effect, 1.50).

Conclusions:
First childbirth at the age of 27 years or above decreases the risk of POAG in postmenopausal women. Decreased parity, caused by late first childbirth, attenuated the magnitude of the total effects of age at first childbirth on POAG.
Propranolol treatment prevents chronic central sensitization induced by repeated dural stimulation
Authors: Boyer Nelly , Signoret-Genest Jérémy , Artola Alain , Dallel Radhouane , Monconduit Lénaïc 
Published: July 2017

Abstract
Migraine is currently conceptualized as a chronic disease with episodic manifestations. In some patients, migraine attack frequency increases, leading to chronic migraine. Daily preventive therapy is initiated to decrease attack frequency. Propranolol, a first-line medication for migraine prophylaxis, reduces attack frequency in nearly 50% of patients receiving it. However, the mechanisms of its antimigraine action are unclear. We examined the effect of daily propranolol treatment (10 mg·kg−1 per os, 8 days) in a rat model of recurrent activation of dural nociceptors (repeated infusion of an inflammatory soup (IS) on the dura through a cannula every 2-3 days). Propranolol does not abort IS-induced acute cephalic mechanical allodynia but blocks the development of a chronic cutaneous hypersensitivity upon repeated IS injections. Furthermore, propranolol prevents (1) the elevated touch-evoked Fos expression within the trigeminocervical complex, (2) enhanced both spontaneous activity, and evoked responses of second-order trigeminovascular neurons, (3) elevated touch-evoked rostral ventromedial medulla and locus coeruleus Fos expression and (4) diffuse noxious inhibitory controls impairment, induced by repeated IS injections. Our results suggest that propranolol exerts its prophylactic action, at least in part, by blocking the chronic sensitization of descending controls of pain, arising from the rostral ventromedial medulla and locus coeruleus, and in turn preventing the maintenance of a state of facilitated trigeminovascular transmission within the trigeminocervical complex. Assessing changes in these brain areas has the potential to elucidate the mechanisms for migraine transformation and to reveal novel biological and molecular targets for specific migraine-preventive therapies.
Rock Climbing–Related Bone Marrow Edema of the Hand: A Follow-up Study
Authors: Lutter Christoph , Hochholzer Thomas , Bayer Thomas , Schöffl Volker 
Published: July 2017

Objective:
Sport climbers strain passive and active anatomical structures of their hands and fingers to the maximum during training or competition. This study was designed to investigate bone marrow edema (BME) in rock climbing athletes.

Design:
Systematic detection, treatment, and follow-up investigation of rock climbing athletes with BME of the hand.

Setting:
Primary-level orthopedic surgery and sports medicine division of a large academic medical center.

Patients:
Thirty-one high-level climbers with diffuse pain in the hand and wrist joint caused by rock climbing were included in this study.

Interventions:
The therapy consisted of consequent stress reduction and a break from sports.

Main Outcome Measures:
Reduction of BME shown through magnetic resonance imaging (MRI) and regaining of preinjury climbing levels (Union Internationale des Associations d' Alpinisme metric scale).

Results:
In 28 patients, MRI revealed osseous edema because of overload at the respective area of interest, mainly in the distal radius, the distal ulna, or the carpal bones, which could not be otherwise diagnosed as inflammations, tumors, or injuries. We classified these edemas and fractures of the hamate because of overload. The edema was a stress reaction to highly intensive training and climbing with presumably high traction to the wrist area. The control MRIs demonstrated that even with a consequent stress reduction, the edemas required 3 to 4 months to disappear completely.

Conclusions:
Climbers with nonspecific, diffuse pain in the wrist and/or the fingers should be examined with MRI to detect or exclude the diagnosis of a BME.
The Role of Preoperative Steroids in Atraumatic Cochlear Implantation Surgery
Authors: Lo Jonathon , Campbell Luke , Sale Phillip , Chambers Scott , Hampson Amy , Eastwood Hayden , O’Leary Stephen 
Published: July 2017

Hypothesis:
Depth of insertion is related to the extent of tissue response and low frequency hearing loss. Intravenous steroids have greatest effect in reducing postimplantation fibrosis and hearing loss in the presence of significant electrode insertion trauma, when compared with saline treatment.

Background:
Experiments exploring the enhancement of cochlear implantation (CI) outcomes with glucocorticosteroids have produced mixed results, possibly due to lack of standardization of the CI model.

Methods:
Forty-eight normal-hearing guinea pigs were randomly implanted with a highly flexible electrode to a depth of 1.5, 3.0, or 5.0 mm. For each insertion depth, sub-cohorts received either intravenous saline (“saline”) or dexamethasone (“steroid”) 60 minutes before implantation. Shifts in electrocochleography thresholds at 2 to 32 kHz were determined before and 4 weeks after implantation. Cochleae were harvested and imaged.

Results:
Low-frequency hearing loss was greatest with 5.0 mm insertions. Fracture of the osseous spiral lamina and/or fibrotic involvement of the round window membrane exacerbated hearing loss. The extent of intracochlear fibrosis was directly related to the depth of insertion. Steroids reduced the intracochlear tissue response for deepest insertions and in apical regions of the cochlea where basilar membrane contact was prevalent. Steroids preserved no more hearing than saline at all insertion depths.

Conclusion:
Cochlear trauma influenced postimplantation hearing loss and steroid effect on fibrosis. Fibrosis, and to a lesser extent, postimplantation hearing loss increased proportionally to the depth of insertion. Steroids did not influence fibrosis relating to the cochleostomy, but could reduce scarring as the electrode negotiated the hook region or near the electrode tip.
Transcutaneous Endoscopic Necrosectomy for Walled-off Pancreatic Necrosis in the Paracolic Gutter
Authors: Saumoy Monica , Kumta Nikhil A. , Tyberg Amy , Brown Elizabeth , Lieberman Micheal D. , Eachempati Soumitra R. , Winokur Ronald S. , Gaidhane Monica , Sharaiha Reem Z. , Kahaleh Michel 
Published: July 2017

Background:
Walled-off pancreatic necrosis (WON) is a sequelae of acute pancreatitis that requires debridement, once infected. Recently, endoscopic necrosectomy has become the mainstay for management. However, peripancreatic collections that extend to the paracolic gutter or lesser sac, are more challenging to treat endoscopically. We report an endoscopic method for management of necrotic collections that extend into the paracolic gutter.

Methods:
Consecutive patients, with symptomatic WON extending into the retroperitoneum, were included in a prospective registry. Each patient underwent transcutaneous endoscopic necrosectomy (TEN) through a fully covered self-expanding esophageal metal stent. After resolution of the collection, the external stent was removed, and the cutaneous fistula was allowed to close by secondary intention. Clinical success was defined as resolution of the WON, and successful removal of all percutaneous drains. Patient demographics, procedural/periprocedural adverse events, and follow-up data, were collected.

Results:
Nine patients underwent direct TEN. Patients initially underwent CT-guided percutaneous drainage, with an average of 31 days between initial drainage and endoscopic necrosectomy. All patients had a technically successful placement of a fully covered esophageal metal stent through the cutaneous fistula. After a median of 3 endoscopic debridement sessions, 8 of 9 (89%) patients had successful removal of all percutaneous drains, and resolution of necrotic collections. One patient died of multisystem organ failure from severe acute pancreatitis.

Conclusions:
TEN for infected WON is a safe and efficacious technique for patients with endoscopically inaccessible collections.
Pediatric Orbeez Ingestions Reported to Texas Poison Centers
Authors: Forrester Mathias B. 
Published: July 2017

Objectives
There is concern that ingestion of superabsorbent polymer toys, which can absorb large amounts of fluid and increase greatly in volume, may pose a risk if swallowed by children.
The intent of this study was to characterize pediatric Orbeez ingestions reported to a statewide poison center system.

Methods
Cases were Orbeez ingestions among patients 19 years or younger reported to Texas poison centers during January 2011 to June 2016. The distribution by various demographic and clinical factors was determined.

Results
Of 110 total cases, 56% were female and 55% were 5 years or younger. Eighty-six percent of the ingestions were unintentional. Sixty-nine percent occurred at the patient's home and 28% at school. Seventy-eight percent of the patients were managed on site. The reported adverse effects were vomiting (4%), abdominal pain (3%), constipation (1%), diarrhea (1%), and fever (1%). The reported treatments were dilution (42%), food or snack (16%), other emetics (1%), whole bowel irrigation (1%), antihistamines (1%), and intravenous fluids (1%).

Conclusions
Pediatric Orbeez ingestions tended to involve younger children, were unintentional, and occurred at the child's home or school. Most ingestions were managed outside of a healthcare facility. This study provides further evidence that ingestion of Orbeez by children is not likely to result in serious problems, such as intestinal obstruction. The information in this investigation may assist in prevention and education activities.
Smartphone-based mobile thermal imaging technology to assess limb perfusion and tourniquet effectiveness under normal and blackout conditions
Authors: Barron Morgan R. , Kuckelman John P. , McClellan John M. , Derickson Michael J. , Phillips Cody J. , Marko Shannon T. , Smith Joshua P. , Eckert Matthew J. , Martin Matthew J. 
Published: July 2017

BACKGROUND
Over the past decade, there has been a resurgence of tourniquet use in civilian and military settings. Several key challenges include assessment of limb perfusion and adequacy of tourniquet placement, particularly in the austere or prehospital environments. We investigated the utility of thermal imaging to assess adequacy of tourniquet placement.

METHODS
The FLIR ONE smartphone-based thermal imager was utilized. Ten swine underwent tourniquet placement with no associated hemorrhage (n = 5) or with 40% hemorrhage (n = 5). Experiment 1 simulated proper tourniquet application, experiment 2 had one of two tourniquets inadequately tightened, and experiment 3 had one of two tourniquets inadequately tightened while simulating blackout-combat conditions. Static images were taken at multiple time points up to 30 minutes. Thermal images were then presented to blinded evaluators who assessed adequacy of tourniquet placement.

RESULTS
The mean core temperature was 38.3 °C in non-hemorrhaged animals versus 38.2 °C in hemorrhaged animals. Hemorrhaged animals were more hypotensive (p = 0.001), anemic (p < 0.001), vasodilated (p = 0.008), and had a lower cardiac output (p = 0.007) compared to non-hemorrhaged animals. The thermal imaging temperature reading decreased significantly after proper tourniquet placement in all animals, with no difference between hemorrhaged and non-hemorrhaged groups at 30 minutes (p = 0.23). Qualitative thermal image analysis showed clearly visible perfusion differences in all animals between baseline, adequate tourniquet, and inadequate tourniquet in both hemorrhaged and non-hemorrhaged groups. Ninety-eight percent of blinded evaluators (n = 62) correctly identified adequate and inadequate tourniquet placement at 5 minutes. Images in blackout conditions showed no adverse impact on thermal measurements or in the ability to accurately characterize perfusion and tourniquet adequacy.

CONCLUSIONS
A simple handheld smartphone-based forward looking infrared radiometry device demonstrated a high degree of accuracy, reliability, and ease of use for assessing limb perfusion. Forward looking infrared radiometry also allowed for rapid and reliable identification of adequate tourniquet placement that was not affected by major hemorrhage or blackout conditions.
Impact of venous thromboembolism chemoprophylaxis on postoperative hemorrhage following operative stabilization of spine fractures
Authors: Sharpe John P. , Gobbell Wade C. , Carter Andrea M. , Pahlkotter Maranda K. , Muhlbauer Michael S. , Camillo Francis X. , Fabian Timothy C. , Croce Martin A. , Magnotti Louis J. 
Published: July 2017

BACKGROUND
Prophylactic anticoagulation may decrease the risk of venous thromboembolism (VTE) in patients with spine fractures following blunt trauma but comes with the threat of postoperative bleeding in patients requiring stabilization of these fractures. The purpose of this study was to evaluate the impact of preoperative anticoagulation on VTE and bleeding complications in patients with blunt spine fractures requiring operative stabilization.

METHODS
All patients with blunt spine fractures requiring operative stabilization over a 6-year period were identified. Patients with a hospital stay of less than 48 hours or missing data were excluded. Patients were stratified by age; severity of shock, spinal cord injury, fracture location, injury severity; and timing and duration of anticoagulation. Outcomes included bleeding complications (wound hematoma/infection and development of epidural hematoma) and VTE (pulmonary embolism and deep venous thrombosis). Outcomes were evaluated to determine risk factors for bleeding complications and VTE in the management of operative spine fractures.

RESULTS
Seven hundred five patients were identified: 355 patients received one dose or more of preoperative anticoagulation, and 350 did not receive preoperative anticoagulation. Seventy-two percent were male, with a mean injury severity score and Glasgow Coma Scale score of 21 and 14, respectively. Bleeding complications occurred in 18 patients (2.6%), and 20 patients (2.8%) had VTE. Patients with VTE were more severely injured (Glasgow Coma Scale score of 13 vs 15, p ≤ 0.001 and injury severity score of 27 vs 18, p = 0.008). Despite longer time to mobilization (4 vs 2 days, p < 0.001), patients who received 50% or more of their scheduled preoperative doses had fewer episodes of pulmonary embolism (0.4% vs 2.2%, p < 0.05), with no difference in bleeding complications (2.1% vs 2.9%, p = 0.63) compared to patients who received either no preoperative anticoagulation or less than 50% of their scheduled preoperative doses.

CONCLUSIONS
Preoperative anticoagulation in patients with operative spine fractures reduced the risk of pulmonary embolism without increasing bleeding complications. Preoperative anticoagulation is both safe and beneficial in patients with operative spine fractures.

LEVEL OF EVIDENCE
Therapeutic study, level IV.